Browsing by Autor "Rimoldi, Stefano F"

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Response to letters regarding article, "Pulmonary and systemic vascular dysfunction in young offspring of mothers with preeclampsia"
(Facultad de Medicina, Enfermería, Nutrición y Tecnología Médica, 2011) Rimoldi, Stefano F
We thank Lazdam et al and Yuan et al for their interesting comments on our study.1 Lazdam et al point out that in our study, birth weight in offspring of mothers with preeclampsia was significantly lower than in controls, and suggest that the vascular impairment in offspring was caused by a combination of the independent effects of preeclampsia and intrauterine growth restriction rather than by preeclampsia per se. To test this hypothesis, we performed a subgroup analysis of 15 offspring of mothers with preeclampsia and 15 controls matched for birth weight (3080 291 versus 3077 398 g; P 0.98). We found that the difference in flow-mediated dilation between birth-weight-matched offspring of preeclampsia and controls (6.4% 1.3% versus 8.9% 1.2%; P 0.0001) tended to be even larger than the one we reported in the entire groups (6.3% 1.2% versus 8.3% 1.6%; P 0.0001). This additional analysis, together with the already reported lack of any significant relationship between birth weight and flow-mediated dilation, indicates that vascular dysfunction in these young offspring is related to preeclampsia alone, and that low birth weight does not contribute to this problem. We therefore do not overestimate the impact of preeclampsia on vascular function in these term offspring.
Systemic vascular dysfunction in patients with chronic mountain sickness
(Facultad de Medicina, Enfermería, Nutrición y Tecnología Médica, 2012) Rimoldi, Stefano F
Background: Chronic mountain sickness (CMS) is a major public health problem characterized by exaggerated hypoxemia and erythrocytosis. In more advanced stages, patients with CMS often present with functional and structural changes of the pulmonary circulation, but there is little information on the systemic circulation. In patients with diseases associated with chronic hypoxemia at low altitude, systemic vascular function is altered. We hypothesized that patients with CMS have systemic vascular dysfunction that may predispose them to increased systemic cardiovascular morbidity. Methods: To test this hypothesis, we assessed systemic endothelial function (by flow-mediated dilation [FMD]), arterial stiffness, and carotid intima-media thickness and arterial oxygen saturation (SaO2) in 23 patients with CMS without additional classic cardiovascular risk factors and 27 age-matched healthy mountain dwellers born and permanently living at 3,600 m. For some analyses, subjects were classified according to baseline SaO2 quartiles; FMD of the highest quartile subgroup (SaO2 90%) was used as a reference value for post hoc comparisons. Results: Patients with CMS had marked systemic vascular dysfunction as evidenced by impaired FMD (CMS, 4.6% 1.2%; control subjects, 7.6% 1.9%; P,.0001), greater pulse wave velocity (10.6 2.1 m/s vs 8.4 1.0 m/s, P,.001), and greater carotid intima-media thickness (690 120 mm vs 570 110 mm, P5.001). A positive relationship existed between SaO2 and FMD (r50.62, P,.0001). Oxygen inhalation improved (P,.001) but did not normalize FMD in patients with CMS, although it normalized FMD in hypoxemic control subjects (SaO2,90%) and had no detectable effect in normoxemic control subjects (SaO2 90%). Conclusions: Patients with CMS show marked systemic vascular dysfunction. Structural and functional alterations contribute to this problem that may predispose these patients to premature cardiovascular disease.