MedCalc 7.4.2.0 serial key or number

Systemic inflammation plays an important role in the development of atherosclerosis (AS). The aim of this study was to evaluate the presence of early AS in patients with familial Mediterranean fever (FMF) that is characterized by recurrent inflammatory attacks of serositis. Sixty-one FMF patients (30 Male/31 Female; 31.5 [18–54] years) and 31 healthy controls (16 Male/15 Female; 31 [22–58] years) were studied. All FMF patients were on regular daily colchicine treatment and during attack-free periods. Both the FMF patients and controls with a history of diabetes mellitus (DM), hypertension, and hyperlipidemia were excluded. Body mass index (BMI) was calculated. Serum lipids, C-reactive protein (CRP), and erythrocyte sedimentation rate (ESR) were assessed. Two-hour oral glucose tolerance test was performed to rule out DM and glucose intolerance. To investigate early AS “endothelium-dependent flow-mediated dilatation (FMD%),” “nitroglycerin-induced endothelium-independent peripheral vasodilatation (NTG%),” and intima-media thickness (IMT) of common carotid arteries (CCA) were measured by ultrasonograpy. The median disease duration for FMF patients was 16 (1–45) years. Age, sex, BMI, smoking status, and serum lipids were comparable in patients and controls (p > 0.05). However, ESR and standard CRP were significantly higher in the patients group (p < 0.05). There were no differences in the measurements of right, left, and averaged IMT of CCA between patients and controls ([0.49 vs 0.5], [0.51 vs 0.52] and [0.5 vs 0.51]; p > 0.05, respectively). None of the subjects had carotid artery plaques. FMD% and NTG% were also similar in patients and controls group ([18.2 vs 20.6] and [24.2 vs 22.5]; p > 0.05, respectively). This study suggests that the markers of early AS are not impaired in FMF patients on regular daily colchicine treatment.

atherosclerosis

brachial artery diameter

body mass index

common carotid artery

C-reactive protein

cardiovascular

diabetes mellitus

erythrocyte sedimentation rate

flow-mediated dilatation

familial Mediterranean fever

high density lipoprotein

hypertension

intima-media thickness

low density lipoprotein

nitroglycerin

rheumatoid arthritis

systemic lupus erythematosus

Statistical Package of Social Science

total cholesterol

triglycerides

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Affiliations

1. Department of Internal Medicine, Division of Rheumatology, School of Medicine, Dokuz Eylul University, 35340, Inciralti, Izmir, Turkey

   Ismail Sari, Gercek Can, Servet Akar, Merih Birlik, Nurullah Akkoc & Fatos Onen

2. Department of Radiology, School of Medicine, Dokuz Eylul University, 35340, Inciralti, Izmir, Turkey

   Oguzhan Karaoglu, Aytac Gulcu & Yigit Goktay

3. Department of Internal Medicine, School of Medicine, Dokuz Eylul University, 35340, Inciralti, Izmir, Turkey

   Mehmet Tunca

4. Tip Fakultesi, Ic hastaliklari ABD, Immunoloji-Romatoloji BD, Dokuz Eylul Universitesi, 35340, Inciralti, Izmir, Turkey

   Fatos Onen

Clinical and Experimental Biomedicine

Mieczyslaw Pokorski Editor

Advances in
Medicine and
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Advances in Experimental Medicine
and Biology
Clinical and Experimental Biomedicine

Volume 1133

Subseries Editor
Mieczyslaw Pokorski
More information about this subseries at http://www.springer.com/series/16003
Mieczyslaw Pokorski
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Advances in Medicine
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Editor
Mieczyslaw Pokorski
Opole Medical School
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ISSN 0065-2598 ISSN 2214-8019 (electronic)

Library of Congress Control Number: 2019933306

# Springer Nature Switzerland AG 2019

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The registered company address is: Gewerbestrasse 11, 6330 Cham, Switzerland
Contents

Left Ventricular Strain and Relaxation Are Independently

v
vi Contents

Factors Affecting Health-Related Quality of Life in Liver

Left Ventricular Strain and Relaxation Are

Arkadiusz Lubas, Robert Ryczek, Artur Maliborski,

Abstract echocardiography with speckle tracking imaging

1
2 A. Lubas et al.

1 Introduction The objective of the present study was to

(10–13 MHz). To calculate cIMT, three manual mode, as previously described (Lubas et al. 2013,
measurements of intima-media complex on the 2015). Short sequences of video clips recorded in
far wall of the left carotid artery, at least 10 mm the DICOM format presenting the color-coded
from the carotid sinus, were averaged. flow velocity in the renal cortex were then
evaluated (PixelFlux medical device;
Cardiac Sonography Echocardiography was Chameleon-Software, Leipzig, Germany)
performed at the day when the blood pressure according to the ultrasound dynamic tissue perfu-
monitor was disconnected, using the Vivid S6 sion measurement method (Scholbach et al.
system with the M4S-RS sector transducer of 2004). The size of averaged total (arterial and
1.5–3.6 MHz (GE Healthcare, Chicago, IL). venous) renal cortical perfusion (RCP) in cm/s
Measurements of the tricuspid annular plane sys- was evaluated as a surrogate of right and left
tolic excursion (TAPSE), diameter of vena cava heart function on kidney perfusion.
inferior (VCI), and wall thickness and diameter of Estimated glomerular filtration rate (eGFR)
the left ventricular cavity were performed in the was assessed using the chronic kidney disease
M-mode imaging in accordance with the epidemiology formula based on the measurement
recommendations of the American Society of of cystatin C in the serum (Levey et al. 2009).
Echocardiography (Sahn et al. 1978). Left ven-
tricular mass was calculated from the Devereux
et al. (1986) formula and then normalized for 2.2 Statistical Analysis
body surface area, calculated according to
Mosteller (1987), to obtain the LVMI index. Data were presented as means
SD. Correlations
The LVEF in the Simpson’s biplane method, CI, between variables were examined using the
and the indices of diastolic LV function such as Pearson or Spearman method depending on the
the peak values of early (E wave) and late fulfillment of the normal distribution condition.
(A wave) mitral inflow velocities and tissue The presence of intragroup differences was tested
Doppler early diastolic mitral annular velocity using the Kruskal-Wallis analysis of variance
(E0 ) at the septal corner of mitral annulus were (ANOVA). Stepwise multivariable regression
measured. Then, E/A and E/E0 ratios were calcu- analysis was used to identify the factors indepen-
lated as previously described (Lubas et al. 2017; dently associated with RCP. Receiver operating
Lang et al. 2006). The LV longitudinal strain characteristic (ROC) analysis was performed to
calculations were based upon the speckle tracking identify the nadir value of LVEF corresponding
technique, using the dedicated automated func- to the threshold value of RCP. For statistical
tional imaging protocol. The measurements were evaluation, a commercial Statistica 12 package
done at post-processing, using was used (StatSoft Inc., Tulsa, Oklahoma, USA).
electrocardiography-gained loop images acquired
in typical apical views. The tracked area was
detected automatically and then manually 3 Results
corrected. The GLS was the arithmetic mean of
longitudinal strain in four-, two-, and three- Baseline patient characteristics and the results of
chamber views. echocardiography and RCP measurements are
presented in Table 1.
Kidney Ultrasound After having the biochemis- In the study group, hypertension was treated
try tests done, patients underwent kidney ultra- with angiotensin-converting enzyme inhibitors or
sound examination using the 4 L 2–5 MHz angiotensin receptor blockers in 36 patients.
convex transducer (Logiq P6; GE Healthcare, Thirty-six patients received β-blockers,
Seoul, Korea). Renal perfusion was assessed 23 calcium channel blockers, and 38 diuretics,
using the same transducer in the color Doppler and 12 received α-blockers. RCP associated
4 A. Lubas et al.

Table 1 Baseline patient characteristics and results

Table 2 Comparison of left ventricular ejection fraction (LVEF) and left ventricular global longitudinal strain (GLS) on
renal cortical perfusion (RCP) in groups stratified by quartiles of RCP
Quartile I Quartile II Quartile III Quartile IV p-value quartile
(n ¼ 16) (n ¼ 16) (n ¼ 16) (n ¼ 15) I:II:III:IV
RCP (cm/s) 0.06
0.04* 0.16
0.30* 0.29
0.05* 0.52
0.13* <0.001
eGFR (mL/min/1.73 m2) 34.6
14.1* 48.8
23.6** 74.8
26.7* 81.7
33.2** <0.001
GLS (%) 14.6
3.9*** 17.6
3.6 17.6
3.4 19.2
3.3*** 0.011
E/E0 11.6
3.0 11.2
3.3 9.1
2.0 9.0
1.9 0.015
LVEF (%) 57.1
11.5 62.2
8.2 61.6
8.4 65.9
7.2 0.094
eGFR estimated glomerular filtration rate, E/E0 early mitral inflow velocity and mitral annular early diastolic velocity
ratio
*
p < 0.001; **p ¼ 0.033; ***p ¼ 0.007

significantly with age, renal function, LVMI, and Although the initial LVEF significantly
with the functional indices of the left ventricle associated with RCP, after dividing patients into
(Table 1). However, the TAPSE and TRPG four groups by quartiles of RCP, the Kruskal-
indices of right ventricular function assessed in Wallis ANOVA showed significant differences
the standard echocardiographic examination and only in the E/E0 , GLS, and renal function, but
the diameter of VCI failed to associate with RCP. not in LVEF (Table 2; Fig. 1; Panel I and II). In
Left Ventricular Strain and Relaxation Are Independently Associated with. . . 5

Fig. 1 Imaging examples

the multivariable regression analysis performed threshold value of RCP ¼ 0.284 (95%CI 0.231;
in relation to age and taking into account the 0.337). In order to obtain an approximate LVEF
indices that associated with RCP, i.e., LVMI, result corresponding to the threshold value of
LVEF, GLS, E/E0 , IMT, PP, and eGFR, only the RCP, ROC analysis was performed in which the
eGFR (r ¼ 0.418; p < 0.001), E/E0 (r ¼ 0.259, highest sensitivity (70%) and specificity (52%)
p ¼ 0.022), and GLS (r ¼ 0.238, p ¼ 0.035) were found for LVEF of 64.8%. However, this
were found to independently affect the value of result was insignificant (AUC ¼ 0.611, p ¼ 0.121).
RCP (r2 ¼ 0.440, p < 0.001; power of the test
0.999 for probability of type I error α ¼ 0.05).
The examples of predicted RCP values with 4 Discussion
known LV GLS, E/E0 , and eGFR values are
shown in Table 3. The present study demonstrates that indices of
The use of the known threshold values for the renal function and left ventricular systolic and
results of normal and abnormal indices that sig- diastolic function are independent factors enable
nificantly related to RCP enabled to predict the to explain approximately 44% of the variability in
6 A. Lubas et al.

Table 3 Prediction of renal cortical perfusion (RCP) values based on multivariate regression analysis
eGFR
(mL/min/1.73 m2) GLS (%) E/E0 Predicted RCP (95%CI) (cm/s)
90 16 8 0.36 (0.30; 0.42)
60 16 8 0.28 (0.23; 0.34)
60 20 8 0.33 (0.27; 0.39)
60 16 10 0.25 (0.21; 0.29)
eGFR estimated glomerular filtration rate, GLS left ventricular global longitudinal strain, E/E0 early mitral inflow velocity
and mitral annular early diastolic velocity ratio, 95%CI 95% confidence intervals

RCP. GLS assessed by speckle tracking echocar- the RCP value. This means that the higher the
diography is a measure of the averaged strain of E/E0 ratio (normal <8 cm/s, abnormal >13 cm/s),
the longitudinal myocardium fibers in all the lower the renal perfusion. Thus, both systolic
segments of the left ventricle, examined during (GLS) and diastolic (E/E0 ) left ventricular func-
contraction. The shortening of longitudinal fibers tion affect renal perfusion. The evaluation of the
is expressed in negative percentage values, where left ventricular function is therefore essential for
the higher is the absolute value the greater the the diagnosis of disorders of the cardiorenal axis.
shortening of the fibers in question (normal On the other hand, it may be expected that
GLS < 16%) (Yingchoncharoen et al. 2013). patients with heart failure with preserved ejection
GLS is considered an equivalent to the left ven- fraction (HFpEF), i.e., so-called isolated diastolic
tricular systolic function, and it appears an earlier insufficiency, would also be characterized by
and more sensitive marker of left ventricular mus- lower RCP indices compared to those without
cle damage than LVEF (Smiseth et al. 2016). heart failure with the same LVEF value. In this
Moreover, GLS has been found of predictive sense, the evaluation of RCP can be useful in the
value for LVEF decrease in patients with heart early diagnosis of cardiorenal syndrome.
failure (Adamo et al. 2017; Romano et al. 2017). The study by Gnanaraj et al. (2013) has shown
GLS is a quantitative, objective method, mostly a significant role of venous congestion in reduc-
dependent on the software, and is characterized ing renal perfusion in patients with acute
by a greater repeatability (intra-observer 3.3%; decompensated heart failure, while the observed
inter-observer 4.0%), while the variability of markers of decreased cardiac output are not of
LVEF results, largely conditioned by the experi- such significance. However, that study has used
ence of the experimenter, is nearly twice as high LVEF, without the GLS assessment. Further, in
(intra-observer 6.3%, inter-observer 10.3%) patients with decompensated heart failure, venous
(King et al. 2016). In the present study, GLS congestion is the main symptomatic problem
had a greater impact on the RCP value than the forcing the patients to seek hospital help. It is
calculated LVEF. Although the attempt to estimate thus difficult to expect that the impaired renal
the LVEF value corresponding to the borderline venous outflow will not cause a decrease in
RCP was estimated at approximately 65%, this renal blood flow, particularly in the presence of
result was not significant and due to the Ray et reduced arterial perfusion. In the present study,
al. (2010) criteria, had a poor diagnostic value. patients were in the optimal condition, with a
The E/E0 ratio is a quotient of the maximal well-controlled arterial pressure and without
velocity of early mitral valve inflow (E) and symptoms of heart failure. The functional indices
early diastolic velocity of the mitral annulus (E0 ) of the right heart (TAPSE, TRPG) and VCI diam-
and it correlates with the left ventricular filling eter measured directly before the right atrium
pressure that is higher in case of left ventricular were not significantly related to renal perfusion.
diastolic dysfunction. In this study, E/E0 was sig- The majority of antihypertensive drugs used in
nificantly inversely associated with renal perfu- the treatment of high blood pressure impair renal
sion, and it was an independent factor modifying autoregulation and significantly modify renal
Left Ventricular Strain and Relaxation Are Independently Associated with. . . 7

perfusion (Digne-Malcolm et al. 2016). Hence, The study protocol was approved by the Bioethics Com-
there is a greater dependence of renal perfusion mittee of the Military Institute of Medicine (No. 35/WIM/
2011 of June 15, 2016).
on functional indices of the heart in the patients.
On the other hand, in the studies performed so far,
Informed Consent Written informed consent was
a significant impact of antihypertensive drugs on obtained from all individual participants included in the
RCP has been found, which explains approxi- study.
mately 29% of RCP variability (Lubas et al.
2018). Such a relation of renal hemodynamics
may be reduced in patients who are not on hypo-
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https://doi.org/10.1007/5584_2018_283
# Springer Nature Switzerland AG 2018
Published online: 16 October 2018

Coupling of Blood Pressure

Marcin Gruszecki, Yurii Tkachenko, Jacek Kot,

Abstract transforms during handgrip and cold tests.

M. Gruszecki and A. Gruszecka

9
10 M. Gruszecki et al.

was first handgrip and then cold test. The ered an indirect marker of cerebrospinal fluid
handgrip challenge consisted of a 2-min strain, volume (CSF) (Gruszecki et al. 2018b).
indicated by oral communication from the Both stress and pain are associated with white
investigator, at 30% of maximum strength. matter dysfunction and changes in neural plastic-
The cold test consisted of 2 min of hand ity and overall neural architecture (Coppieters
immersion to approximately wrist level in et al. 2018; Bishop et al. 2017; Nugent et al.
cold water of 4  C, verified by a digital ther- 2015; Sheikh et al. 2014; Upadhyay et al. 2012).
mometer. Each test was preceded by 10 min at One of the possible mechanisms that might be
baseline and was followed by 10-min recovery involved in white matter alterations is abnormal
recordings. BP and SAS were recorded simul- CSF pulsatility (Beggs et al. 2016a, b; Bateman
taneously. Three 2-min stages of the proce- et al. 2008). CSF pulsatile flow is driven by heart-
dure, baseline, test, and recovery, were and lung-generated blood inflows and outflows to
analyzed. We found that BP–SAS coupling and from the brain (Gruszecki et al. 2018a, b; Shi
was present only at cardiac frequency, while et al. 2018).
at respiratory frequency both oscillators were Periodic oscillations in CSF volume can be
uncoupled. Handgrip and cold test failed to indirectly assessed using SAS width as a surrogate.
affect BP–SAS cardiac–respiratory coupling. In short, the main assumption for near-infrared
We showed similar handgrip and cold test transillumination/backscattering sounding
cardiac bispectral coupling for individual (NIR-T/BSS), the technique we use, is that trans-
subjects. Further studies are required to estab- lucent CSF in SAS acts as a propagation duct for
lish whether the observed intersubject infrared radiation, a technique resembling optical
variability concerning the BP–SAS coupling fiber engineering. This allows for measurement of
at cardiac frequency has any potential clinical SAS width to estimate changes in CSF volume
predictive value. (Frydrychowski and Pluciński 2007; Pluciński
and Frydrychowski 2007; Pluciński et al. 2000).
Keywords NIR-T/BSS has been validated against magnetic
Bispectral analysis · Blood pressure · Cardiac resonance imaging, showing comparable SAS
frequency · Cold test · Handgrip test · width alterations induced by shifts in the body
Subarachnoid space width position (Frydrychowski et al. 2012).
The handgrip test results in increased blood
pressure (BP) (Macey et al. 2012; Wszedybyl–
Winklewska et al. 2012). Therefore, it seemed
1 Introduction
logical that relatively quick BP elevation may
result in substantial alterations in the BP–SAS
The handgrip test and the cold test are widely
relationship. Quite surprisingly, analysis of
used to assess the stress response and activation
amplitude coherences between these two signals
of the sympathetic nervous system in humans.
has not revealed any substantial changes. On the
Nevertheless, the neural circuits involved in
contrary, sympathetic nervous system activation
information processing differ between these
seems to stabilize the BP–SAS relationship
tests. Particularly, neural processing of handgrip
(Winklewski et al. 2015a, b). Nevertheless, a
involves motor components, while cold test
lack of change in the amplitude coherence does
involves pain components (Vaegter et al. 2014;
not preclude alterations in the BP–SAS coupling
Macey et al. 2012). We and others also observed
detected with other mathematical methods.
significant differences in cerebral blood volume
The aim of the study was to assess the BP–
and subarachnoid space (SAS) width responses to
SAS coupling properties using time–frequency
handgrip and cold tests (Winklewski et al. 2015a,
bispectral analysis based on wavelet transforms
b; Wilson et al. 2005). SAS width can be consid-
(Clemson et al. 2016; Jamšek et al. 2004, 2007).
Coupling of Blood Pressure and Subarachnoid Space Oscillations at Cardiac. . . 11

Consequently, our goal was to track time 2.2 Measurements

 
where f 3 ¼ 1= 1
f1 þ f1 is the wavelet coefficient
b122 ðf 1 ; f 2 Þ
2

and “*” denotes complex conjugation.