Papers by Giovanni de Simone
International journal of cardiology, May 1, 2018
In general, women have lower risk for cardiovascular disease. We tested whether this sex-specific... more In general, women have lower risk for cardiovascular disease. We tested whether this sex-specific protection persists also in the presence of hypertensive left ventricular hypertrophy (LVH). 12,329 women and men with hypertension and free from prevalent cardiovascular disease enrolled in the prospective Campania Salute Network registry were followed over a median of 4.1years. Subjects were grouped according to the absence or the presence of LVH identified by echocardiography using validated sex-specific cut-off values of LV mass index (>47g/min women and >50g/min men). Main outcome was major cardiovascular events (MACE; combined acute coronary syndromes, stroke, hospitalization for heart failure and incident atrial fibrillation). The cardiovascular risk profile accompanying LVH did not differ between sexes, but presence of obesity and diabetes carried higher probability for LVH in women, and LVH was more prevalent in women than men (43.4 vs. 32.1%, p<0.001). Among patients ...
European journal of preventive cardiology, 2017
Background Increased pulse pressure is associated with structural target organ damage, especially... more Background Increased pulse pressure is associated with structural target organ damage, especially in elderly patients, increasing cardiovascular risk. Design In this analysis, we investigated whether high pulse pressure retains a prognostic effect also when common markers of target organ damage are taken into account. Methods We analysed an unselected cohort of treated hypertensive patients from the Campania Salute Network registry ( n = 7336). Participants with available cardiac and carotid ultrasound were required to be free of prevalent cardiovascular disease, with ejection fraction ≥50%, and no more than stage III Chronic Kidney Disease. The median follow-up was 41 months and end-point was occurrence of major cardiovascular events (i.e. fatal and non-fatal stroke or myocardial infarction and sudden death). Based on current guidelines, pulse pressure ≥60 mm Hg was classified as high pulse pressure ( n = 2356), at the time of the initial visit, whereas pulse pressure <60 mm Hg ...
American journal of cardiac imaging, 1994
In validation studies, M-mode echocardiography has been shown to measure left ventricular (LV) ma... more In validation studies, M-mode echocardiography has been shown to measure left ventricular (LV) mass with reasonable accuracy (r > or = .90 v necropsy measurements) in species ranging in body size from humans to rats. The sensitivity of antemortem echocardiography for the detection of necropsy LV hypertrophy as a qualitative abnormality has also been high (85% to 100%). Increased LV mass is strongly related to both increased blood pressure and to being overweight or to other causes of increased cardiac volume work. LV mass is also increased in the presence of exaggerated blood pressure responses to everyday activity, high sodium intake and blood viscosity, and genetic factors predisposing to hypertension. Indexation of LV mass by body surface area or height has advantages for the detection of hypertrophy related to hypertension or obesity. Indexation of LV mass for the power of its relation to height (2.7) revealed by analysis of growth (allometric) relations may accomplish both t...
European Journal of Echocardiography, 2006
... 1195 Differentiation between pathological and physiological left ventricular hypertrophy by t... more ... 1195 Differentiation between pathological and physiological left ventricular hypertrophy by tissue Doppler assessment of right ventricular function D. Vinereanu1 ; C. Gherghinescu1 ; AC Tweddel2 ; M. Cinteza1 ; AG Fraser2 1University of Medicine Carol Davila, Bucharest ...
Nutr.Metab Cardiovasc.Dis., 2005
Background and aim: To assess efficacy of sibutramine in obese subjects, and influence on hemodyn... more Background and aim: To assess efficacy of sibutramine in obese subjects, and influence on hemodynamics, valve function and left ventricular (LV) geometry and performance. Methods and results: Three-month double-blind, parallel groups, randomized, placebo-controlled of 15 mg o.i.d. sibutramine administration combined with diet. Twenty-five to 65 year-old males or postmenopausal females, were enrolled if their BMI was between 30 and 40 kg/m 2 , without evidence of concomitant diseases. Body weight, BMI, blood pressure (BP), echocardiographic LV mass, cardiac output, and diastolic function were measured. Body weight and BMI were better reduced with sibutramine (weight loss of 5% or more in 9 of 11 patients) than placebo group (weight loss of 5% or more in 5 of 9 patients; all p ! 0.05). Systolic and diastolic BP decreased similarly in both arms. No difference in mean heart rate was detected between treatments. The two groups had slightly different LV geometry at baseline. LV mass decreased with weight loss, more in the sibutramine group (p ! 0.05), due to reduction in LV chamber size. Stroke volume tended to be reduced in the sibutramine group, influencing diastolic pattern. E/A ratio tended to decrease in the sibutramine group without changes in isovolumic relaxation time and deceleration time of E velocity. No onset or increased severity of valve regurgitation was detected. Conclusions: Combined to hypocaloric diet, sibutramine increases weight loss in obese individuals. Weight changes have positive effect on reduction of BP and
Echocardiography, 2014
Background: Patients with rheumatoid arthritis have an increased risk for cardiovascular disease.... more Background: Patients with rheumatoid arthritis have an increased risk for cardiovascular disease. Because of accelerated atherosclerosis and changes in left ventricular (LV) geometry, circumferential and longitudinal (C&L) LV systolic dysfunction (LVSD) may be impaired in these patients despite preserved LV ejection fraction. The aim of this study was to determine the prevalence of and factors associated with combined C&L LVSD in patients with rheumatoid arthritis. Methods: One hundred ninety-eight outpatients with rheumatoid arthritis without overt cardiac disease were prospectively analyzed from January through June 2014 and compared with 198 matched control subjects. C&L systolic function was evaluated by stress-corrected midwall shortening (sc-MS) and tissue Doppler mitral annular peak systolic velocity (S 0). Combined C&L LVSD was defined if sc-MS was <86.5% and S 0 was <9.0 cm/sec (the 10th percentiles of sc-MS and S 0 derived in 132 healthy subjects). Results: Combined C&L LVSD was detected in 56 patients (28%) and was associated with LV mass (odds ratio, 1.03; 95% CI, 1.01-1.06; P = .04) and concentric LV geometry (odds ratio, 2.76; 95% CI, 1.07-7.15; P = .03). By multiple logistic regression analysis, rheumatoid arthritis emerged as an independent predictor of combined C&L LVSD (odds ratio, 2.57; 95% CI, 1.06-6.25). The relationship between sc-MS and S 0 was statistically significant in the subgroup of 142 patients without combined C&L LVSD (r = 0.40, F < 0.001), having the best fitting by a linear function (sc-MS = 58.1 + 3.34 Â peak S 0 ; r 2 = 0.19, P < .0001), absent in patients with combined C&L LVSD. Conclusions: Combined C&L LVSD is detectable in about one fourth of patients with asymptomatic rheumatoid arthritis and is associated with LV concentric remodeling and hypertrophy. Rheumatoid arthritis predicts this worrisome condition, which may explain the increased risk for cardiovascular events in these patients.
High Blood Pressure & Cardiovascular Prevention, 2008
worldwide, and the WHO states that high blood pressure levels are responsible for 62% of cerebrov... more worldwide, and the WHO states that high blood pressure levels are responsible for 62% of cerebrovascular events and 49% of ischaemic heart diseases globally. Effective antihypertensive treatment significantly reduces individual total cardiovascular risk. Both cardiac and vascular consequences of arterial hypertension derive from structural and functional abnormalities of peripheral arteries, and these clinical conditions strongly predispose to developing major hypertension-related cardiovascular events. Due to the asymptomatic or oligo-symptomatic course, before being clinically evident, of hypertensive cardiopathy (e.g. hypertensive disease), the appropriate and periodic evaluation of structural and functional cardiac damage represents an important diagnostic and prognostic outcome for driving therapeutic strategy in the clinical management of hypertension. The present guidelines, endorsed by the Joint Committee of the Italian Society of Hypertension, the Italian Society of Cardiology, and the Associazione Nazionale Medici Cardiologi Ospedalieri, are aimed to help physicians to choose the best diagnostic and therapeutic approach in the clinical management of any individual hypertensive patient.
Journal of the American College of Cardiology, 1992
The spectrum of left ventricular geometric adaptation to hypertension was Investigated in 165 pat... more The spectrum of left ventricular geometric adaptation to hypertension was Investigated in 165 patients with untreated essential hypertension and 125 age-and gender-matched normal adults studied by two-dimensional and M-mode oehoeardlography. Among hypertensive patients, left ventricular mass index and relative wall thickness were normal in 52%, whereas 13% had increased relative wall thickness with normal ventricular mass ("concentric remodeling"), 27% had increased mass with normal relative wall thickness (eccentric hypertrophy) and only 8% had "typical" hyperensive concentric hypertrophy (increase in both variables). Systemic hemodydamics paralleled ventricular geometry, with the highest peripheral resistance in the groups with concentric remodeling and hypertrophy, whereas cardiac index was supernormal in those with eccentric hypertrophy and low normal in The left ventricle is generally thought to adapt to sustained arterial hypertension by developing concentric hypertrophy (1,2). AccorAisg to the paradigm of cowpcasatory ventricular response to a chronic pressure overload, ventricular wall thickness should increase proportionally to blood pressure level to maintain normal wall stress (I) ; left ventricular dilation is considered to represent a late transition toward myocardial failure (2). However, left ventricular adaptation to human hypertension has been shown to be more complex than expected. In fact, many patients with mild to moderate hypertension
Journal of the American College of Cardiology, 1995
Conclusions: Significant differences in baseline LV function were observed between groups. Graded... more Conclusions: Significant differences in baseline LV function were observed between groups. Graded increases in SW occurred with dobutamine inotropic modulation in both groups, although the responses were significantly attenuated in CHF pts (p < 0.05). This noninvasive method may be useful to assess LV contractile reserve in chronic CHF pts.
Journal of the American College of Cardiology, 1995
Objectives. We sought to determine whether growth influences the relation between left ventricula... more Objectives. We sought to determine whether growth influences the relation between left ventricular mass and body size and whether use of different body size indexes affects the ability of ventricular mass to predict complications of hypertension. Background. Allometric (or growth) signals between left ventricular mass and height have recently been reported to improve previous approaches for normalization of ventricular mass for body size. Methods. Residuals of left ventricular mass-height 2'7 relations were analyzed in a learning series of 611 normotensive, normalweight subjects 4 months to 70 years old and, separately, in 383 children (< 17 years old) and 228 adults. Ten-year cardiovascular morbidity in a test series of 253 hypertensive adults was compared with groups with normal or high baseline left ventricular mass normalized for body weight, height, body surface area and allometric powers of height. Results. The dispersion of residuals of ventricular mass versus height 2"7 increased with increasing height or age in children but not in adults, suggesting that the effect of other variables on ventricular growth increases during body growth and stabilizes in adulthood. Therefore, we derived separate allometric signals for adults (predicted ventricular mass = 45.4 x height 2"13, r = 0.48) and children (32.3 × height 2"3, r = 0.85) (both p < 0.0001). Patients with left ventricular hypertrophy had 3.3 times higher cardiac risk with elevated left ventricular mass/height 2"7 (p < 0.001), 2.6 to 2.7 times higher risk with left ventricular mass indexed for height, height 2a3 and body surface area (all p < 0.01) and 1.7 times the risk with ventricular mass/weight (p > 0.1). Conclusions. These results show the following: 1) Variability of left ventricular mass in relation to height increases during human growth; 2) allometric signals of left ventricular mass versus height are lower in adults and children than those obtained across the entire age spectrum; 3) height-based indexes of left ventricular mass at least maintain and may enhance prediction of cardiac risk by hypertensive left ventricular hypertrophy; and 4) the allometric signal derived across the entire spectrum of age appears to be more useful for prediction of cardiovascular risk than that computed in adults.
Journal of Hypertension, 2007
Background Blood pressure control is disappointingly suboptimal in populations. Whether metabolic... more Background Blood pressure control is disappointingly suboptimal in populations. Whether metabolic abnormalities influence blood pressure control is unclear. We evaluated the relationship between metabolic risk factors and blood pressure control in a large population of patients with hypertension. Methods From our Hypertension Centre, 4551 subjects (43.4% women; age 51 W 12 years) were selected with available data for metabolic and cardiovascular evaluation (no prevalent cardiovascular disease), at the last control visit. A modified Adult Treatment Panel III definition of metabolic syndrome was adopted changing waist girth for body mass index (>-30 kg/m 2). Blood pressure was considered controlled when supine office blood pressure was below 140/90 mmHg, or uncontrolled if this target was not achieved. Blood pressure control has been evaluated in relation to metabolic risk factors, adjusting for age, sex, and the number of antihypertensive medications. Results The metabolic syndrome phenotype was found in 1444 individuals (31.72%). The probability of uncontrolled blood pressure was 43% higher in patients with the metabolic syndrome than in those without, independently of covariates. This probability was also confirmed in 728 untreated patients. The probability of uncontrolled blood pressure significantly and independently increased with the increasing number of metabolic risk factors. Uncontrolled blood pressure was also independently associated with the prescription of more medications. Conclusion Insufficient control of blood pressure is independently associated with the presence of the metabolic syndrome. Blood pressure control worsens with the increasing number of metabolic risk factors associated with hypertension, despite the use of a greater number of medications.
Journal of Hypertension, 2006
The appropriateness of left ventricular (LV) mass to cardiac workload may be calculated by the ra... more The appropriateness of left ventricular (LV) mass to cardiac workload may be calculated by the ratio of observed LV mass to the value predicted for an individual&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s sex, height, and stroke work at rest. To investigate test-retest reproducibility of observed/predicted LV mass in a single patient. We measured intraclass correlation and interval of agreement between two M-mode tracings, recorded both at the same session and 3-10 days apart in 200 participants (45 +/- 13 years, body mass index 25 +/- 4 kg/m; 99 hypertensive and 101 normotensive; 50% of each group were women) in 16 centres in Italy. Tracings were read by two observers in each centre. The values of observed/predicted LV mass value ranged from 40.78 to 215.50%. On the same day, the within-observer 90% interval of agreement between tracings 1 and 2 was -23 to +20%. For day-to-day test-retest within-observer variability (average three cycles), the 90% interval of agreement of the observed/predicted LV mass was -30 to +32%. The 90% interval of agreement of test-retest between-observer variability was -25 to +25%. The categorical consistency of retest in the identification of subjects with appropriate LV mass, classified in the first study (i.e. &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt; 73% and &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 128%), was 90% (k = 0.87). Measurement of the appropriateness of LV mass in single patients allows acceptable risk stratification, with a coefficient of consistency similar to that reported for LV mass. The probability of a true change (90% chance) in observed/predicted LV mass over time is maximized for a single-reader difference greater than 22%, although lesser differences might also have clinical relevance.
Journal of Hypertension, 1998
Background M-mode echocardiographic left ventricular mass calculated using a thick-wall prolate e... more Background M-mode echocardiographic left ventricular mass calculated using a thick-wall prolate ellipsoidal model is widely used in clinical and epidemiologic studies. Doubts regarding the ability of this approach to obtain a precise estimate of left ventricular weight across a wide range of values have recently been raised and an alternate thin-wall ellipsoidal model has been proposed to gain greater precision. Objective To compare thin-wall and thick-wall (American Society of Echocardiography and Penn convention) models for calculation of left ventricular mass. Design Validation, cross-sectional, and longitudinal studies. Participants Necropsy data and living cohorts from Naples, New York City, and Umbria region of Italy (PIUMA registry). Results The average thin-wall left ventricular mass was slightly greater than the necropsy left ventricular weight (mean 225 versus 220 g), whereas no difference was detected using regression-adjusted thick-wall methods. Use of the thin-walled model slightly overestimated left ventricular mass relative to both thick-wall models at the lowest left ventricular mass while slightly underestimating the highest values. Comparison of Cox proportional hazard models in two longitudinal studies demonstrated that there was a substantial equivalence among methods, with a marginally better performance of thick-wall models for cardiovascular risk stratification (P < 0.05 in one study). Conclusions Although it is imperfect, because it is based on simplifying geometric assumptions, computation of left ventricular mass on the basis of M-mode echocardiographic left ventricular dimensions using thick-wall prolate-ellipsoidal models is valuable for identification of left ventricular hypertrophy and for cardiovascular risk stratification of patients with essential hypertension. Calculation of left ventricular mass by use of a thin-wall prolate-ellipsoidal geometry does not yield appreciably different results than those which are obtained by use of thick-wall models.
Journal of Hypertension, 2001
To evaluate whether assessment of appropriateness of left ventricular mass (LVM) adds to the trad... more To evaluate whether assessment of appropriateness of left ventricular mass (LVM) adds to the traditional definition of left ventricular hypertrophy (LVH). Cross-sectional, relational. Echocardiographic LVH and appropriateness of LVM were studied in 562 subjects (231 normotensive controls, aged 35+/-11 years, 142 women; 331 hypertensive patients, aged 47+/-11 years, 135 women) classified on the basis of either the presence or the absence of both LVH (LVM index &amp;amp;gt; or = 51 g/m2.7) and inappropriate LVM (LVM &amp;amp;gt; 128% of the value predicted by an equation including age, sex and stroke work). Body mass index was comparable in hypertensive patients and controls. Hypertensive patients without LVH but with inappropriate LVM (n = 21) had higher relative wall thickness and total peripheral resistance than all other groups, whereas cardiac output was lower (all P &amp;amp;lt; 0.001). Midwall mechanics was normal with appropriate LVM, independently of presence of LVH, whereas it was depressed in inappropriate LVM, either with or without LVH (both P &amp;amp;lt; 0.0001). There was no substantial difference in ejection fraction among controls and hypertensive groups. Stress-corrected midwall shortening was more closely related to deviation of LVM from the value appropriate for stroke work, body size and gender (r = -0.56, P &amp;amp;lt; 0.0001) than to LVM index (r = -0.26). Inappropriate LVM is associated with concentric geometry, high peripheral resistance and depressed wall mechanics. The deviation of LVM from the value appropriate for stroke work, body size and sex correlates with measures of myocardial function better than LVM.
Hypertension, 1996
The evaluation of the effect of obesity on left ventricular systolic performance may differ in re... more The evaluation of the effect of obesity on left ventricular systolic performance may differ in relation to the method used to measure left ventricular function and to the type of study population. Whether obesity worsens left ventricular midwall mechanics in arterial hypertension has never been investigated. Accordingly, we assessed echocardiographic left ventricular midwall shortening–circumferential end-systolic stress relations in 156 normotensive and normal-weight (reference) adults, 94 normotensive and overweight (1985 National Institutes of Health partition values) to obese (body mass index >30 kg/m 2 ) adults, 263 hypertensive and normal-weight adults, and 224 hypertensive and overweight-to-obese adults. There was an inverse relation of midwall shortening to circumferential end-systolic stress in all groups (all P <.005). Left ventricular performance as a ratio of observed to predicted midwall shortening fell below the fifth percentile in 4 of 94 (4%) of overweight-to-o...
The American Journal of Cardiology, 1996
Echocardiographic meridional wall stress-endocardial shortening relations provide estimates of le... more Echocardiographic meridional wall stress-endocardial shortening relations provide estimates of left ventricular (LV) contractility that do not uniformly detect myocardial dysfunction despite severe symptoms in dilated cardiomyopathy. To improve detection of myocardial dysfunction in patients with congestive heart failure (CHF) due to dilated cardiomyopathy, echocardiographic meridional and circumferential end-systolic stress were related to endocardial and midwall shortening in 42 patients (95% dead within a mean of 22 months) with dilated cardiomyopathy and 140 normal subjects. A method to estimate LV long-axis dimension from M-mode minor-axis epicardial measurements was developed in a separate series of 115 subjects. Endocardial shortening to meridional wall stress relation identified 31 of 42 CHF patients falling below the 95% normal confidence interval of the reference population; use of midwall shortening decreased this number to 26 (p = NS). The use of circumferential wall stress identified 39 of 42 patients with subnormal endocardial LV shortening and 41 of 42 patients with depressed midwall performance (p &amp;amp;lt; 0.01 vs use of meridional stress). The circumferential/meridional wall stress ratio was 2.6 +/- 0.5 in normal subjects and 1.3 +/- 0.2 in CHF patients (p &amp;amp;lt; 0.0001). Thus, use of circumferential end-systolic stress as the measure of afterload improves the detection of myocardial dysfunction by stress/shortening relations in patients with CHF. The ratio between the 2 stresses decreases with more spherical LV shape. Midwall and endocardial shortening measurements are equivalent in the setting of thin LV walls as occurs in dilated cardiomyopathy.
American Heart Journal, 2003
It is unclear whether fibrinogen predicts cardiovascular events independently of echocardiographi... more It is unclear whether fibrinogen predicts cardiovascular events independently of echocardiographic cardiovascular abnormalities and traditional risk factors. We studied 2671 American Indians who participated in the second Strong Heart Study examination (1993-1995) and were observed for an average of 50 +/- 6 months. Participants with baseline overt coronary artery disease or a plasma creatinine level &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt; or =3 mg/dL were excluded. Left ventricular hypertrophy, elevated arterial stiffness, and subnormal myocardial contractility were assessed by echocardiography. Prevalences of echocardiographic abnormalities and cardiovascular event rates were higher with higher fibrinogen levels. Incident cardiovascular events (n = 158) and deaths (n = 64) were more frequent in participants with elevated fibrinogen levels (&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt;400 mg/dL) than in participants with lower fibrinogen levels, as was the prevalence of echocardiographic abnormalities (both P…
Hypertension, 1994
Clinical evaluation of the hypertensive patient has traditionally relied on physician measurement... more Clinical evaluation of the hypertensive patient has traditionally relied on physician measurement of blood pressure and assessment of target-organ involvement by simple laboratory tests. However, this approach is limited in its ability to identify individual patients at high or low risk of complications. In recent years, noninvasive methods have been developed to identify pathological transformations of the heart and arteries that collectively comprise "preclinical hypertensive disease." Measurements by echocardiogram or other methods of left ventricular mass and relative wall thickness identify a spectrum of cardiac adaptations to hypertension, including concentric and eccentric hypertrophy, the recently described pattern of "concentric left ventricular remodeling" (normal mass but increased relative wall thickness), and normal ventricular geometry. In clinical studies, each anatomic pattern is associated with a distinct profile of resting hemodynamics, ambulato...
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Papers by Giovanni de Simone