pyrophosphate and Hypertension

Medial arterial calcification is accelerated in patients with CKD and strongly associated with increased arterial rigidity and cardiovascular mortality. Recently, a novel in vitro blood test that provides an overall measure of calcification propensity by monitoring the maturation time (T50) of calciprotein particles in serum was described. We used this test to measure serum T50 in a prospective cohort of 184 patients with stages 3 and 4 CKD, with a median of 5.3 years of follow-up. At baseline, the major determinants of serum calcification propensity included higher serum phosphate, ionized calcium, increased bone osteoclastic activity, and lower free fetuin-A, plasma pyrophosphate, and albumin concentrations, which accounted for 49% of the variation in this parameter. Increased serum calcification propensity at baseline independently associated with aortic pulse wave velocity in the complete cohort and progressive aortic stiffening over 30 months in a subgroup of 93 patients. After adjustment for demographic, renal, cardiovascular, and biochemical covariates, including serum phosphate, risk of death among patients in the lowest T50 tertile was more than two times the risk among patients in the highest T50 tertile (adjusted hazard ratio, 2.2; 95% confidence interval, 1.1 to 5.4; P=0.04). This effect was lost, however, after additional adjustment for aortic stiffness, suggesting a shared causal pathway. Longitudinally, serum calcification propensity measurements remained temporally stable (intraclass correlation=0.81). These results suggest that serum T50 may be helpful as a biomarker in designing methods to improve defenses against vascular calcification.

Topics: Aged; Aged, 80 and over; alpha-2-HS-Glycoprotein; Arteriosclerosis; Biomarkers; Calcinosis; Calcium Phosphates; Cardiovascular Diseases; Causality; Comorbidity; Diabetes Mellitus; Diphosphates; Disease Susceptibility; Female; Follow-Up Studies; Humans; Hypertension; Male; Middle Aged; Mortality; Osteoclasts; Phosphates; Prospective Studies; Pulse Wave Analysis; Renal Dialysis; Renal Insufficiency, Chronic; Risk; Serum Albumin; Smoking; Vascular Resistance

Seventy eight patients with arterial hypertension were examined by echo-, radiocardiography and scintigraphy of the myocardium, using 99mTc pyrophosphate and 201Tl. A relationship was found between the development of hypertrophy of the left ventricle and the impairment of it perfusion and function. At the same time there was a correlation between the decrease in cardiac output and the deterioration of myocardial blood supply. It was demonstrated that 99mTc pyrophosphate or 201Tl myocardial scintigraphy yielded the coincident results when relative heart failure was evaluated in patients with arterial hypertension and left ventricular hypertrophy.

Topics: Adult; Cardiomegaly; Coronary Circulation; Diphosphates; Female; Heart; Hemodynamics; Humans; Hypertension; Male; Middle Aged; Radionuclide Imaging; Technetium; Technetium Tc 99m Pyrophosphate; Thallium Radioisotopes

The clinical value of myocardial scintigraphy with 99mTc-pyrophosphate in conjunction with bicycle ergometry was assessed through the correlation of the latter's results with the clinical course of coronary heart disease over 1 year in 21 patients with first myocardial infarction during its early healing stage and 17 anginal patients without a history of myocardial infarction. The disease ran a stable course at the time of the testing in all the patients; later on, 11 of those developed various complications associated with coronary heart disease, or died. Three scintigraphic recordings were made: prior to, at the peak of, and after the exercise. Thirteen scintigraphic patterns were identified. They are interpreted on the basis of presumed variation in the degree of myocardial damage and blood supply to affected areas under the effect of exercise; a relation is also noted with predicted risk of complications. The method has proved reliable in identifying patients at low risk for complications. Providing indirect evidence of the quality of blood supply to damaged myocardial areas during rationed exercise, it furnishes additional criteria for the assessment of the patients' working capacity.

Topics: Adult; Aged; Angina Pectoris; Coronary Circulation; Diphosphates; Exercise Test; Female; Heart; Humans; Hypertension; Male; Middle Aged; Myocardial Infarction; Radionuclide Imaging; Risk; Technetium; Technetium Tc 99m Pyrophosphate; Time Factors

The authors examined 166 patients with ischemic heart disease and attacks of angina pectoris and 21 healthy individuals. Scintigraphy, electrocardiography and tests for the activity of creatine phosphokinase and its MB fraction were carried out at rest, during physical exercise and 1--3 days after it. It was found that pyrophosphate-99mTc may accumulate in the myocardium both during the attack of angina pectoris and after its cessation. Angina pectoris may occur both with diffuse and with focal pyrophosphate-99mTc accumulation in the myocardium. Positive results of scintigraphy were encountered considerably more often in patients examined during physical exercise than in those examined at rest. Scintigraphic signs of angina pectoris which occurs under the effect of physical exertion develop less frequently, but persisted for a longer time than its electrocardiographic signs.

Topics: Adult; Angina Pectoris; Diphosphates; Exercise Test; Female; Heart; Humans; Hypertension; Male; Middle Aged; Radionuclide Imaging; Technetium

Myocardial scinitgrams, using 99mTc-stannous pyrophosphate, showed an acute posterior infarction and an abnormally placed left kidney in a 24-year-old hypertensive man; Further study revealed that the kidney was displaced by a mass later proven to be a pheochromocytoma. The latter was the cause of his hypertension and probably instigated the acute myocardial infarction.

Topics: Adult; Diphosphates; Humans; Hypertension; Kidney Diseases; Male; Myocardial Infarction; Pheochromocytoma; Radionuclide Imaging; Technetium