Search Results (62)

Background/Objectives: Cardiac amyloidosis (CA) and cardiac sarcoidosis (CS) are two distinct infiltrative cardiomyopathies that can present with overlapping clinical features, including heart failure and arrhythmias. However, they arise from fundamentally different pathophysiological mechanisms: amyloid protein deposition in CA versus granulomatous inflammation in CS. These differing pathophysiologies result in divergent imaging patterns, clinical trajectories, and treatment strategies. This study aims to compare the clinical presentations, imaging characteristics, and outcomes of patients with CA and CS to identify key differentiating factors that can improve diagnostic precision and guide therapy. Methods: This single-center, retrospective, cross-sectional study analyzed electronic medical records of patients diagnosed with CA (limited to transthyretin CA) or CS at Mount Sinai Morningside system from January 2017 until October 2023. Patients were identified using diagnostic codes and confirmed by histology or disease-specific imaging criteria. Clinical data, transthoracic echocardiography (TTE), cardiac magnetic resonance (CMR) imaging, pyrophosphate scintigraphy (PYP), and fluorodeoxyglucose positron emission tomography (FDG-PET) findings were collected. Statistical comparisons between groups were performed using chi-square tests and independent t-tests, with p < 0.05 considered statistically significant. Results: A total of 16,834 patients were screened and 216 patients were included in the analysis (125 CA, 92 CS). CA patients were older (78.2 vs. 62.0 years, p = 0.01), had greater interventricular septal thickness (1.57 vs. 1.10 cm, p = 0.01), and exhibited diffuse late gadolinium enhancement (LGE) and elevated extracellular volume (ECV) on CMR. CS patients had higher rates of ventricular tachycardia (53.3% vs. 10.7%, p = 0.01), increased myocardial fluorodeoxyglucose (FDG) uptake on positron emission tomography (PET) (90%), and more frequent implantable cardioverter-defibrillator (ICD) placement (66.3% vs. 13.0%, p = 0.01). Conclusions: CA and CS demonstrate distinct imaging profiles, arrhythmic risks, and treatment patterns. Early differentiation using advanced imaging is crucial for implementing disease-modifying therapies in CA and for immunosuppression and ICD implantation in CS, thereby improving patient outcomes. Full article

Late gadolinium enhancements (LGEs) appear in asymptomatic individuals as septal stripes, which mimic abnormal LGEs in patients with dilated cardiomyopathy (DCM). We aimed to evaluate the frequency and extent of LGE variation in asymptomatic individuals and to compare it with those of DCM group. This retrospective study included asymptomatic and DCM groups who underwent CMR imaging. LGE was defined as a myocardial signal intensity higher than five standard-deviations of normal myocardium. LGE was evaluated in right ventricular insertion points (RVIPs) and mid-interventricular septum. A total of 273 asymptomatic individuals (age, 54.3 ± 5.8 years, 209 males) and 100 patients with DCM (age, 55.3 ± 4.9 years, 73 males) were included. LGE was observed in 99.3% of asymptomatic and 100% of DCM groups. The average number of myocardial segments with LGE was distinguishable between asymptomatic and DCM groups (5.5 ± 1.7 vs. 7.6 ± 2.2; p < 0.001). The thickness of LGE differed between two groups in mid-septum (4.5 ± 1.3 mm vs. 5.7 ± 1.8 mm; p < 0.001), upper RVIP (6.1 ± 1.9 mm vs. 8.7 ± 2.7 mm; p < 0.001), and lower RVIP (6.4 ± 2.3 mm vs. 8.6 ± 2.8 mm; p < 0.001). Considerable overlap was observed in LGE between asymptomatic and DCM groups despite different LGE characteristics between them. LGEs within normal range should not be interpreted as abnormal findings in the evaluation of myocardial diseases including DCM. Full article

Background/Objectives: Systemic arterial hypertension is a prevalent condition associated with adverse cardiac remodeling. Echocardiography plays a crucial role in assessing cardiac structure and function in hypertensive patients. This study aimed to evaluate the changes in echocardiographic parameters in hypertensive patients over a 3-year follow-up period and assess the impact of blood pressure control and antihypertensive medication use on these changes. Methods: This observational cohort study included 131 adult patients with systemic arterial hypertension who underwent annual echocardiographic assessments. Statistical analyses included paired and unpaired comparisons, regression modeling, and subgroup analyses by BP control and lifestyle behavior. Results: Over the 3-year follow-up, mean left ventricular mass (LVM) increased significantly from 173.99 ± 59.33 g to 183.26 ± 64.19 g (p = 0.018), and the prevalence of LV hypertrophy rose from 29.0% to 40.5% (p = 0.021). Patients with uncontrolled blood pressure at the final visit had significantly greater interventricular septum and posterior wall thicknesses (p = 0.009 and p = 0.012, respectively), but no statistically significant difference in ΔLVM. Those who adopted more healthy lifestyle behaviors showed a dose-dependent reduction in LVM progression, with each additional lifestyle improvement associated with a −3.25 g change in ΔLVM (p = 0.01). Multivariable linear regression identified baseline LVM, sex, and lifestyle score as independent predictors of 3-year LVM change (model R² = 0.318). Conclusions: Our findings indicate that long-term cardiac remodeling may continue in hypertensive patients despite treatment, particularly in the presence of suboptimal BP control. Sustained lifestyle improvements were independently associated with attenuation of LVM progression. These results underscore the importance of integrating behavioral interventions alongside pharmacologic therapy in routine hypertension management. Full article

Objective: To investigate the association between prenatal ultrasonographic markers of macrossomia and C-peptide, a neonatal hyperinsulinemia marker, in pregnancies complicated by gestational diabetes mellitus (GDM), with a focus on fetal adipose tissue thickness, liver length, and interventricular septal thickness. Methods: This prospective cohort study included 223 pregnant women followed from 28 to 36 weeks of gestation in two referral centers in Brazil. The GDM group and matched controls underwent serial ultrasound assessments of fetal biometry, including thigh, abdominal, and subscapular skinfolds, fetal liver length, and interventricular septum thickness. Neonatal hyperinsulinemia was assessed using umbilical cord C-peptide levels. Statistical analyses included t-tests, chi-square tests, correlation analyses, and multivariate logistic regression. Results: Fetuses of mothers with GDM exhibited significantly greater abdominal [t(221) = −3.999, p < 0.01] and subscapular [t(221) = −2.502, p = 0.02] skinfolds, liver length [t(221) = −3.785, p < 0.01], and interventricular septum [t(221) = −4.781, p < 0.01] thickness. However, umbilical cord C-peptide levels did not differ significantly between groups [t(189) = −1.724, p = 0.09]. Only weak correlations were found between fetal ultrasound markers and C-peptide levels. Among all parameters, subcutaneous tissue thickness showed the highest (ρ = 0.30), though still limited, predictive value. Conclusions: Fetuses of mothers with GDM demonstrated increased measures of liver length, subscapular adiposity, and interventricular septal thickness compared to controls. However, these prenatal biometric markers showed weak correlations with neonatal C-peptide levels. Full article

Background/Objectives: The development of normal fetal cardiac function, a dynamic process that has not yet been precisely documented throughout the literature, is difficult to quantify by classic echocardiography. Our aim was to analyze the function of the fetal myocardium through speckle tracking and establish reference values for global and segmental longitudinal strain for both ventricles in fetuses with a gestational age (GA) between 22 and 39 weeks. Methods: We conducted a prospective study in which 170 fetuses underwent echocardiographic evaluation and those 150 that were eligible for the study underwent offline speckle tracking analysis. Results: A mixed-design ANOVA model with Greenhouse–Geisser correction showed no significant differences in regional strain measurements among GA groups (F [2, 147] = 1.25, p = 0.289) but showed significant differences in regional strain measurements among the right ventricle (RV), left ventricle (LV), and interventricular free wall (Greenhouse–Geisser F [1.3, 195.2] = 45.70, p < 0.001, GG ε = 0.66, original df = 2, 294). The wall-by-segment interaction term of the model was statistically significant for regional strain (Greenhouse–Geisser F [2.7, 394.2] = 27.00, p < 0.001, GG ε = 0.67, original df = 4, 588), while the segment-by-gestational age group term had a tendency toward statistical significance (Greenhouse–Geisser F [3.0, 221.4] = 2.21, p = 0.088, GG ε = 0.75, original df = 4, 294). The results of Welch’s ANOVA model showed no significant difference in right-ventricle peak global longitudinal strain (pGLS) between GA groups (F [2.0, 92.2] = 0.52, p = 0.5972) and global longitudinal strain measurements (F [2.0, 89.6] = 27.00, p = 0.3733). Conclusions: The reference values for longitudinal strain, represented by the pGLS for LV, ranged from −20.79 to −8.05 for fetuses with a GA between 22 and 27 weeks, from −20.14 to −8.99 for fetuses with a GA between 28 and 33 weeks, and from −20.19 to −8.88 for fetuses with a GA between 34 and 39 weeks. For RV pGLS, the reference values were between −18.99 and −6.35, also depending on GA. Reference ranges for the large gestational groups studied can help us to recognize subtle changes in fetal cardiac function. Full article

Background: The Da Silva Cone procedure for Ebstein anomaly has dramatically improved tricuspid valve competence and clinical outcomes. However, preoperative left ventricular (LV) dysfunction and immediate postoperative right ventricular (RV) systolic dysfunction are frequently observed. While excellent valve outcomes are well established, recovery of biventricular function following the Cone remains less defined. This study aimed to evaluate longitudinal changes in RV and LV function postoperatively and over a minimum of six months post-Cone operation. Methods: A single center retrospective review of 134 patients who underwent Cone repair for Ebstein’s anomaly from 2016 to 2024 was performed. Echocardiograms were analyzed at three time points: preoperative (Time 1), hospital discharge (Time 2), and ≥6 months postoperative (Time 3). RV parameters included fractional area change (FAC), tricuspid annular plane systolic excursion (TAPSE), and tricuspid S′. LV parameters included left ventricular ejection fraction (LVEF), end-diastolic volume indexed to body surface area (LVEDVi), left ventricular stroke volume (LVSVi), and mitral E/E′. Subgroup analyses examined outcomes by prior Glenn, Starnes procedure, and degree of RV dilation. Paired two sample t-tests were used to compare serial measures. Results: Median age at surgery was 7.8 years (IQR: 2.3–17.7). All patients had discharge echocardiograms; 70 had follow-up studies at ≥6 months. RV function declined postoperatively with reductions in FAC (35% to 21%), TAPSE (2.0 to 0.8 cm), and S′ (13 to 5 cm/s), all p < 0.001. By Time 3, these measures improved (FAC to 29%, TAPSE to 1.3 cm, S′ to 7 cm/s) but did not fully return to baseline. LVEDVi and LVSVi increased significantly by Time 3 (LVEDVi: 47 to 54 mL/m²; LVSVi: 30 to 34 mL/m²; p < 0.001), while LVEF remained unchanged. Patients with prior Glenn or Starnes had greater Time 1 LV volumes and lower RV function, but by Time 3, most differences resolved. Moderate–severe preoperative RV dilation was associated with worse RV function at Time 2 and normalized by Time 3. Conclusions: The Da Silva Cone procedure leads to early postoperative RV dysfunction with partial recovery over the mid-term follow-up. Concurrently, LV filling and stroke volume improve, reflecting favorable interventricular interaction. These findings support echocardiographic surveillance to guide functional recovery post-Cone and inform patient counseling. Full article

Hypertrophic cardiomyopathy (HCM) is the most common monogenic heart disease, with an estimated prevalence of 1:600 in the general population, and is associated with significant morbidity. HCM is characterized by left ventricular hypertrophy and interventricular septal thickening due to sarcomere protein gene mutations. The recent emergence of cardiac myosin inhibitors (CMIs), specifically mavacamten and aficamten, has introduced a paradigm shift in HCM management by directly targeting the hypercontractile state of the disease. This review comprehensively discusses the molecular mechanisms of mavacamten and aficamten, highlighting their biochemical similarities and differences from available data. It evaluates their reported efficacy in completed clinical trials, such as reducing left ventricular outflow tract (LVOT) obstruction, improving functional capacity, and enhancing quality of life in HCM. It further provides insight and updates to ongoing trials of both CMIs. Finally, it compares and elaborates on the safety profiles of mavacamten and aficamten, discussing their favorable safety profiles shown in completed studies. In current clinical practice, only mavacamten is approved for use, and clinical insights concerning both CMIs are limited, but encouraging. In summary, cardiac myosin inhibitors are a promising class of disease-modifying drugs for HCM with proven short-term safety and efficacy, but limited data are available to fully determine their long-term effects and efficacy in diverse patient populations. Ongoing research is necessary to further explore and define their role in HCM management. Full article

Background/Objectives: COVID-19 is associated with multiple systemic effects, including cardiovascular complications. However, its interplay with cardiac conduction abnormalities remains underexplored. We compared the clinical profile of COVID-19 patients with pre-existing left bundle branch block (LBBB) or right bundle branch block (RBBB) at hospital admission. Methods: This study included 100 COVID-19 patients with antecedent BBB (50 LBBB, 50 RBBB). Critical cardiometabolic, renal, hematological, and inflammatory markers were measured. Logistic regression was used to identify key predictors differentiating COVID-19 patients with LBBB and RBBB. Spearman’s correlations were applied to assess intra-strata associations for these variables. Results: COVID-19 patients with LBBB patients were significantly more likely to display lower systolic blood pressure (p = 0.012) but greater left atrial size (p = 0.008), left ventricular diameter (p = 0.001), and interventricular septal thickness (p = 0.023). Hematological and inflammatory markers differed, with LBBB patients being prone to exhibit higher red cell distribution width (p = 0.005), lymphocyte count (p < 0.001), neutrophil count (p = 0.045), and C-reactive protein (p < 0.001). This group also tended to show lower erythrocyte sedimentation rate (p = 0.013) and glycated hemoglobin (p = 0.045) but higher random glucose (p = 0.014). Absolute lymphocyte count, C-reactive protein, and left ventricular diameter were the most robust predictors distinguishing LBBB from RBBB. Significant associations were found exclusively for LBBB, all of them being weak. These predominantly negative relationships indicated an inflammatory origin, and most of them occurred for lymphocyte count. Conclusions: COVID-19 patients with LBBB and RBBB present distinct clinical profiles at hospital admission. The former group demonstrates a more adverse baseline clinical profile, particularly in terms of cardiac and inflammatory markers. These findings suggest that pre-existing BBB type may influence disease progression, potentially helping in risk stratification for COVID-19 patients. Full article

Background: Cardiac involvement in sarcoidosis is often subclinical, with late manifestations associated with poorer prognosis. Speckle-tracking echocardiography (STE) is gaining attention due to its ability to detect subclinical alterations in myocardial contraction patterns and quantification of abnormal parameters. Methods: Databases, including PubMed, Cochrane Central, Embase, Scopus, and Web of Science, were searched to identify studies comparing echocardiographic parameters in sarcoidosis patients with healthy controls. Mean difference (MD) with 95% confidence intervals (CI) were pooled using the inverse-variance random-effects model in Review Manager Version 5.4.1. Statistical significance was considered at p-value <0.05. Results: Thirteen studies with 1416 participants (854—sarcoidosis; 562—healthy controls) were included. In a pooled analysis, patients with sarcoidosis demonstrated a significantly lower left ventricular global longitudinal strain (LV GLS) (Mean Difference [MD]: −3.60; 95% Confidence Interval [CI]: −4.76, −2.43; p < 0.0001) and left ventricular global circumferential strain (LV GCS) (MD: −2.52; 95% CI: −4.61, −0.43; p = 0.02), along with a significantly higher pulmonary artery systolic pressure (PASP) (MD: 4.19; 95% CI: 0.08, 8.29; p = 0.05), left ventricular end-systolic diameter (LVESD) (MD: 0.90; 95% CI: 0.10, 1.71; p = 0.03), A-wave velocity (MD: 3.36; 95% CI: 0.33, 6.39; p = 0.03), and E/E’ ratio (MD: 1.33; 95% CI: 0.42, 2.23; p = 0.004) compared to healthy controls. No significant differences were noted in left ventricular ejection fraction (LVEF), left ventricular global radial strain (LV GRS), interventricular septal thickness (IVST), tricuspid annular plane systolic excursion (TAPSE), left ventricular end-diastolic diameter (LVEDD), E-wave velocity, and E/A ratio. Conclusions: STE serves as a promising imaging modality in detecting subclinical cardiac involvement in sarcoidosis patients with no overt cardiac manifestations. A widespread cardiovascular evaluation of sarcoidosis patients with STE is recommended to detect these altered myocardial contractile patterns. The early detection of cardiac sarcoidosis is essential to prevent adverse clinical outcomes and improve mortality. Full article

Background and Objectives: Regular exercise is known to induce cardiovascular adaptations collectively referred to as “athlete’s heart”. While previous research has explored the morphological and functional cardiac adaptations in athletes, the relationship between vitamin D (25-hydroxyvitamin D [25(OH)D]) levels and echocardiographic parameters remains underexplored. This study aims to assess the association between 25(OH)D levels and structural and functional cardiac parameters using electrocardiographic (ECG) and echocardiographic evaluations in athletes. Materials and Methods: This case–control study included 93 male athletes, categorized into professional (n = 68) and recreational (n = 25) groups. Professional athletes were further divided into football (n = 19), weightlifting (n = 22), and running (n = 27) subgroups. Serum 25(OH)D levels were measured using high-performance liquid chromatography–tandem mass spectrometry (LC-MS/MS). Standard 12-lead ECG and transthoracic echocardiography were performed to assess cardiac structure and function. Data were analyzed using statistical tests that were appropriate for normal and non-normal distributions, with a significance level set at p < 0.05. Results: Athletes exhibited higher left ventricular interventricular septum (IVS) thickness and left ventricular posterior wall thickness (LVPWd) compared to the control group. Significant differences in diastolic function parameters, including early (E) and late (A) diastolic filling velocities and the E/A ratio, were observed among athlete subgroups. The weightlifting group showed lower end-systolic diameter (ESD) values than the football group. However, no statistically significant relationship was found between 25(OH)D levels and echocardiographic diastolic parameters. While more than half of the athletes had insufficient 25(OH)D levels (<30 ng/mL), their average values were higher than those reported in previous studies. Conclusions: This study demonstrates that 25(OH)D levels do not significantly influence echocardiographic diastolic parameters in athletes. However, notable differences in structural and functional cardiac findings were observed among different sports disciplines. These findings contribute to the understanding of cardiac adaptations in athletes and suggest that 25(OH)D may not play a crucial role in diastolic function. Further research is needed to explore the long-term effects of vitamin D on athletic cardiac performance. Full article

Background: Sarcoidosis is a multisystem disorder characterized by non-caseating granulomas in various organs. While cardiac sarcoidosis (CS) is clinically rare, it has significant implications, including heart failure, ventricular arrhythmias, and sudden cardiac death. Speckle-tracking echocardiography has emerged as a promising tool for detecting subclinical myocardial dysfunction, which is cost-efficient and readily available. This meta-analysis aims to evaluate differences in functional echocardiographic parameters between patients with CS and extracardiac sarcoidosis (ECS) to improve early recognition and management. Methods: A comprehensive search of major bibliographic databases was conducted to identify studies up to December 2024. Mean differences (MDs) with 95% CIs were pooled using the inverse-variance random-effect model. Results: Seven studies with 478 patients with sarcoidosis (CS: 159 and ECS: 319) were included. Patients with CS had a significant reduction in left ventricular global longitudinal strain (MD: −2.73; 95% CI: −4.09, −1.38; p < 0.0001) and tricuspid annular plane systolic excursion (MD: −0.59; 95% CI: −1.12, −0.05; p = 0.03) compared to patients with ECS. No significant differences in the LV global circumferential strain, interventricular septum thickness, left ventricular ejection fraction, E/A ratio, E/E’ ratio, LV end-diastolic diameter, and LV end-systolic diameter were noted. Conclusions: LV GLS and TAPSE are promising parameters for the early detection of cardiac involvement in sarcoidosis, with significant prognostic implications. Although STE provides a cost-effective and accessible alternative to CMR and FDG-PET, further research is needed to standardize its use and validate diagnostic cut-offs. Full article

Objective: This study aims to investigate the possible effects of gestational diabetes mellitus (GDM) on fetal heart structure and the relationship of this effect with maternal blood sugar control. Materials and Methods: In this cross-sectional study, 19 women with GDM at 24–36 weeks of gestation (case group) and 21 healthy pregnant women at the same weeks of gestation (control group) were examined. Fetal heart structure was evaluated by ultrasonography; interventricular septum (IVS) thickness, right and left ventricular sphericity indices, global sphericity index (GSI) and cardio-thoracic ratio were also measured. In addition, mothers’ HbA1c values (an indicator of blood sugar control) were recorded. Result: An increase in IVS thickness was observed in the fetuses of mothers with GDM. A more rounded trend was observed in the right ventricular structure, but this did not create a significant difference. No significant relationship was found between maternal blood sugar control and fetal heart structure. Conclusions: This study examined the effects of gestational diabetes on fetal cardiac morphology and the relationship of this effect with maternal glycemic control. Babies of mothers with GDM had a significantly thicker interventricular septum. A more rounded trend was detected in the right ventricular structure. However, this change was not found to be statistically significant. In addition, no significant correlation was found between maternal glycemic control and fetal cardiac morphology. Full article

Background and Objectives: Resistance exercises (REs) are a type of physical activity that individuals from many age groups have been doing recreationally, both as amateurs and professionally, in their daily lives in recent years. It is crucial to understand the effects of such sports on cardiac morphology in order to maximize the benefit of training and to tailor the training content accordingly. The aim of this study was to investigate the relationship between training experience (TE) and left ventricular (LV) systolic and diastolic parameters and left atrial (LA) mechanical function in healthy subjects who regularly performed RE for different durations. Materials and Methods: Forty-five healthy adults [age = 28.91 ± 10.30 years, height = 178.37 ± 5.49 cm, weight = 83.15 ± 13.91 kg, body mass index = 26.03 ± 3.42 kg/m², TE = 7.28 ± 6.49 years] who performed RE between 1 year and 20 years were included in our study. The transthoracic echocardiograms (ECHOs) of the participants were evaluated by the cross-sectional research method, which is often used to understand the current situation in a given time period. Correlations between TE and LV systolic and diastolic parameters and LA mechanical function were analyzed. Results: As a result, interventricular septal thickness (IVS; r = 0.33, p = 0.028), the aortic diameter systole (ADs; r = 0.56, p < 0.001), and aortic diameter diastole (ADd; r = 0.58, p < 0.001) were positively correlated with TE, indicating associations with increased left ventricular (LV) hypertrophy and reduced ventricular compliance, while the aortic strain (AS; r = −0.44, p = 0.002), aortic distensibility (AD; r = −0.62, p < 0.001), and diastolic flow parameters including E (r = −0.41, p = 0.005), E/A (r = −0.38, p = 0.011), and E/Em (r = −0.31, p = 0.041) were negatively correlated with TE, reflecting impairments in diastolic function. Conclusions: This study showed that diastolic parameters were adversely affected in chronic RE. Therefore, we think that these individuals may have decreased relaxation and filling functions of the heart, which may also reduce adequate oxygen and nutrient delivery to the tissues. In this context, cohort studies are needed to analyze in detail the reasons for the decrease in diastolic parameters in these individuals. Full article

Background/Objectives: Smoking and hypertension are major contributors to cardiovascular diseases, with smoker hypertensives typically presenting with exacerbated health risks. These factors are associated with COVID-19 aggravation, but their cumulative impact in the context of this disease remains understudied. Our hypothesis was that hypertensive smokers display a more vulnerable health profile (versus non-smokers) upon hospital admission for COVID-19. Methods: This exploratory observational study compared the clinical profiles of hypertensive COVID-19 patients depending on their smoking status. Focusing on key cardiometabolic, blood, renal, hepatic, and inflammatory markers, this investigation included 100 hypertensive COVID-19 patients (50 smokers and 50 non-smokers) aged 50 and above. Logistic regression and Spearman’s correlations were used to identify significant predictors and relationships among variables. Results: Hypertensive smokers with COVID-19 were significantly more likely to exhibit higher heart rate (p = 0.047), left atrial size (p = 0.013) and diameter (p = 0.040), left ventricular end-systolic volume (p = 0.036), and interventricular septal thickness (p ≤ 0.001). These patients were also much more prone to display elevated CRP (p = 0.035) and hemoglobin (p = 0.011). The renal profiles of the smokers and non-smokers differed, with the smokers showing a significantly greater likelihood to have high serum urea (p = 0.036), but normal-to-low serum potassium (p = 0.011) and sodium (p ≤ 0.001). Their lipid profile was less favorable, with higher triglycerides (p ≤ 0.001), but lower HDL (p = 0.008). The strongest predictors of smoking status were interventricular septal thickness, triglycerides, and serum sodium. Conclusions: Hypertensive smokers admitted to the hospital with COVID-19 tend to exhibit a more adverse clinical profile, particularly in terms of cardiovascular remodeling, lipid imbalances, renal profile, and inflammation. These findings suggest that smoking exacerbates the effects of hypertension in the context of COVID-19, highlighting the need for more aggressive monitoring and management in this patient group. Full article

Background: Accumulating evidence from clinical trials, large registries, and meta-analyses of population studies shows that increased Blood Pressure Variability (BPV) is predictive of Cardiovascular (CV) outcomes, independently of the average Blood Pressure (BP) values. One of the mechanisms explaining the relationship between BPV and target organ damage is the inflammatory response. The Systemic Immune Inflammation Index (SII), which relies on peripheral blood cell counts, including platelets, neutrophils, and lymphocytes, has emerged as a predictor of prognosis and outcomes in various diseases. The aim of this study was to investigate the association of the SII with Ambulatory Blood Pressure Variability (ABPV) in newly diagnosed hypertensive patients. Methods: This study was designed as a cross-sectional observational study. A total of 1606 consecutive newly diagnosed Hypertension (HT) patients were included in the study. The population was evaluated across 3 different categories according to HT grades (5 groups), eligibility for antihypertensive therapy (2 groups) and ABPV levels (2 groups). Results: Significant differences were observed between ABPV groups in terms of Neutrophil to Lymphocyte ratio, Platelet to Lymphocyte ratio, glucose, SII, high-sensitive CRP, HT grade, Inter-Ventricular Septum, Posterior Wall thickness, and Left Ventricular Mass (p < 0.005). There was a significant relationship between SII and ABPV (r: 0.619, p < 0.05). At the cutoff value of 580.49, SII had 77% sensitivity and 71% specificity for ABPV > 14 (AUC: 0.788). Conclusions: SII may assist in developing an early treatment approach to minimize complications in patients with high ABPV who are at a higher risk of CV events. Full article