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Castro-Diehl C, Song RJ, Mitchell GF, McManus D, Cheng S, Vasan RS, Xanthakis V. Association of subclinical atherosclerosis with echocardiographic indices of cardiac remodeling: The Framingham Study. PLoS One 2020; 15:e0233321. [PMID: 32413074 PMCID: PMC7228064 DOI: 10.1371/journal.pone.0233321] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Accepted: 05/02/2020] [Indexed: 12/02/2022] Open
Abstract
Background It is well established that coronary artery disease progresses along with myocardial disease. However, data on the association between coronary artery calcium (CAC) and echocardiographic variables are lacking. Methods and results Among 2,650 Framingham Study participants (mean age 51 yrs, 48% women; 40% with CAC>0), we related CT-based CAC score to left ventricular (LV) mass index (LVMi), LV ejection fraction (LVEF), E/e’, global longitudinal strain (GLS), left atrial emptying fraction (LAEF), and aortic root diameter (AoR), using multivariable-adjusted generalized linear models. CAC score (independent variable) was used as log-transformed continuous [ln(CAC+1)] and as a categorical (0, 1–100, and ≥101) variable. Adjusting for standard risk factors, higher CAC score was associated with higher LVMi and AoR (βLVMI per 1-SD increase 0.012, βAoR 0.008; P<0.05, for both). Participants with 1≤CAC≤100 and those with CAC≥101 had higher AoR (βAoR 0.013 and 0.020, respectively, P = 0.01) than those with CAC = 0. CAC score was not significantly associated with LVEF, E/e’, GLS or LAEF. Age modified the association of CAC score with AoR; higher CAC scores were associated with larger AoR more strongly in older (>58 years; βAoR0.0042;P<0.007) than in younger (≤58 years) participants (βAoR0.0027;P<0.03). Conclusions We observed that subclinical atherosclerosis was associated with ventricular and aortic remodeling. The prognostic significance of these associations warrants evaluation in additional mechanistic studies.
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Affiliation(s)
- Cecilia Castro-Diehl
- Department of Medicine, Section of Preventive Medicine and Epidemiology, Boston University School of Medicine, Boston, Massachusetts, United States of America
| | - Rebecca J. Song
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, United States of America
| | - Gary F. Mitchell
- Cardiovascular Engineering, Inc, Norwood, MA, United States of America
| | - David McManus
- Department of Medicine, University of Massachusetts Medical School, Worcester, MA, United States of America
| | - Susan Cheng
- Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, United States of America
| | - Ramachandran S. Vasan
- Department of Medicine, Section of Preventive Medicine and Epidemiology, Boston University School of Medicine, Boston, Massachusetts, United States of America
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, United States of America
- Boston University’s and National Heart, Lung and Blood Institute’s Framingham Heart Study, Framingham, MA, United States of America
- Department of Medicine, Section of Cardiology, Boston University School of Medicine, Boston, Massachusetts, United States of America
| | - Vanessa Xanthakis
- Department of Medicine, Section of Preventive Medicine and Epidemiology, Boston University School of Medicine, Boston, Massachusetts, United States of America
- Boston University’s and National Heart, Lung and Blood Institute’s Framingham Heart Study, Framingham, MA, United States of America
- Department of Biostatistics, Boston University School of Public Health, Boston, MA, United States of America
- * E-mail:
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52
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Proximal aortic diameter evolution in hypertensive patients with mild-to-moderate aortic dilatation: a 5-year follow-up experience. J Hypertens 2020; 38:716-722. [DOI: 10.1097/hjh.0000000000002315] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
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53
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Nwabuo CC, Vasan RS. Pathophysiology of Hypertensive Heart Disease: Beyond Left Ventricular Hypertrophy. Curr Hypertens Rep 2020; 22:11. [PMID: 32016791 DOI: 10.1007/s11906-020-1017-9] [Citation(s) in RCA: 74] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
PURPOSE OF REVIEW Given that the life expectancy and the burden of hypertension are projected to increase over the next decade, hypertensive heart disease (HHD) may be expected to play an even more central role in the pathophysiology of cardiovascular disease (CVD). A broader understanding of the features and underlying mechanisms that constitute HHD therefore is of paramount importance. RECENT FINDINGS HHD is a condition that arises as a result of elevated blood pressure and constitutes a key underlying mechanism for cardiovascular morbidity and mortality. Historically, studies investigating HHD have primarily focused on left ventricular (LV) hypertrophy (LVH), but it is increasingly apparent that HHD encompasses a range of target-organ damage beyond LVH, including other cardiovascular structural and functional adaptations that may occur separately or concomitantly. HHD is characterized by micro- and macroscopic myocardial alterations, structural phenotypic adaptations, and functional changes that include cardiac fibrosis, and the remodeling of the atria and ventricles and the arterial system. In this review, we summarize the structural and functional alterations in the cardiac and vascular system that constitute HHD and underscore their underlying pathophysiology.
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Affiliation(s)
| | - Ramachandran S Vasan
- Framingham Heart Study, 73 Mt. Wayte Avenue, Suite 2, Framingham, MA, 01702, USA. .,Departments of Epidemiology and Biostatistics, Boston University School of Public Health, Boston, MA, USA. .,Department of Medicine, Sections of Preventive Medicine and Epidemiology, and Cardiovascular Medicine, Boston University Schools of Medicine, Boston, MA, USA.
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Amend G, Palvolgyi R, Rodriguez VM, Bold RJ, Evans CP. A Case Series of Preoperative Endovascular Stenting in Patients Undergoing Postchemotherapy Resection of Complex Oncologic Masses. Eur Urol Oncol 2020; 3:1-6. [PMID: 31892469 DOI: 10.1016/j.euo.2019.11.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Accepted: 11/20/2019] [Indexed: 10/25/2022]
Abstract
The incidence of complications for postchemotherapy (PC) resections is high. Severe intraoperative hemorrhage during retroperitoneal lymph node dissection is of significant concern. The safety and efficacy of endovascular technology in vascular surgery have been demonstrated, but no studies have incorporated endovascular stenting in preoperative planning. We present a case series of four patients with nonseminomatous germ cell tumors who underwent preoperative endovascular stenting to identify and protect major vascular structures encased by complex PC tumors. We measured operative time, estimated blood loss, intraoperative transfusion requirement, length of stay, and postoperative complications. In all cases, surgery progressed without full continuous identification of the major vascular structures and their branches because of the assurance that hemorrhage would be controlled should they be breached. PATIENT SUMMARY: Preoperative endovascular stenting may be an effective approach for minimizing intraoperative hemorrhage and operative time in patients undergoing bulky postchemotherapy dissection. Additional studies are needed to better clarify patient selection criteria and quantify the efficacy and adverse consequences.
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Affiliation(s)
- Gregory Amend
- Department of Urologic Surgery, University of California at Davis, Sacramento, CA, USA
| | - Roland Palvolgyi
- Department of Urologic Surgery, University of California at Davis, Sacramento, CA, USA
| | - Victor M Rodriguez
- Department of Vascular Surgery, University of California at Davis, Sacramento, CA, USA
| | - Richard J Bold
- Department of Surgical Oncology, University of California at Davis, Sacramento, CA, USA
| | - Christopher P Evans
- Department of Urologic Surgery, University of California at Davis, Sacramento, CA, USA.
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55
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Growth of the thoracic aorta in the smoking population: The Danish Lung Cancer Screening Trial. Int J Cardiol 2020; 299:276-281. [DOI: 10.1016/j.ijcard.2019.06.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Revised: 06/03/2019] [Accepted: 06/05/2019] [Indexed: 12/15/2022]
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56
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Climie RE, Gallo A, Picone DS, Di Lascio N, van Sloten TT, Guala A, Mayer CC, Hametner B, Bruno RM. Measuring the Interaction Between the Macro- and Micro-Vasculature. Front Cardiovasc Med 2019; 6:169. [PMID: 31824963 PMCID: PMC6882776 DOI: 10.3389/fcvm.2019.00169] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Accepted: 11/07/2019] [Indexed: 01/09/2023] Open
Abstract
Structural and functional dysfunction in both the macro- and microvasculature are a feature of essential hypertension. In a healthy cardiovascular system, the elastic properties of the large arteries ensure that pulsations in pressure and flow generated by cyclic left ventricular contraction are dampened, so that less pulsatile pressure and flow are delivered at the microvascular level. However, in response to aging, hypertension, and other disease states, arterial stiffening limits the buffering capacity of the elastic arteries, thus exposing the microvasculature to increased pulsatile stress. This is thought to be particularly pertinent to high flow/low resistance organs such as the brain and kidney, which may be sensitive to excess pressure and flow pulsatility, damaging capillary networks, and resulting in target organ damage. In this review, we describe the clinical relevance of the pulsatile interaction between the macro- and microvasculature and summarize current methods for measuring the transmission of pulsatility between the two sites.
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Affiliation(s)
- Rachel E Climie
- INSERM, U970, Paris Cardiovascular Research Center (PARCC), Paris Descartes University, Paris, France.,Baker Heart and Diabetes Institute, Melbourne, VIC, Australia.,Menzies Institute for Medical Research, University of Tasmanian, Hobart, TAS, Australia
| | - Antonio Gallo
- Cardiovascular Prevention Unit, Department of Endocrinology and Metabolism, Pitié-Salpêtrière Hospital, Paris, France.,Laboratoire d'imagerie Biomédicale, INSERM 1146 - CNRS 7371, Sorbonne University, Paris, France
| | - Dean S Picone
- Menzies Institute for Medical Research, University of Tasmanian, Hobart, TAS, Australia
| | - Nicole Di Lascio
- Institute of Clinical Physiology, National Research Council, Pisa, Italy
| | - Thomas T van Sloten
- INSERM, U970, Paris Cardiovascular Research Center (PARCC), Paris Descartes University, Paris, France.,Cardiovascular Research Institute Maastricht and Department of Internal Medicine, Maastricht University Medical Centre, Maastricht, Netherlands
| | - Andrea Guala
- Department of Cardiology, Hospital Universitari Vall d'Hebron, Vall d'Hebron Institute of Research, Barcelona, Spain
| | - Christopher C Mayer
- AIT Austrian Institute of Technology GmbH, Center for Health & Bioresources, Biomedical Systems, Vienna, Austria
| | - Bernhard Hametner
- AIT Austrian Institute of Technology GmbH, Center for Health & Bioresources, Biomedical Systems, Vienna, Austria
| | - Rosa Maria Bruno
- INSERM, U970, Paris Cardiovascular Research Center (PARCC), Paris Descartes University, Paris, France
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57
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Agnese V, Pasta S, Michelena HI, Minà C, Romano GM, Carerj S, Zito C, Maalouf JF, Foley TA, Raffa G, Clemenza F, Pilato M, Bellavia D. Patterns of ascending aortic dilatation and predictors of surgical replacement of the aorta: A comparison of bicuspid and tricuspid aortic valve patients over eight years of follow-up. J Mol Cell Cardiol 2019; 135:31-39. [DOI: 10.1016/j.yjmcc.2019.07.010] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Revised: 07/17/2019] [Accepted: 07/21/2019] [Indexed: 12/20/2022]
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Beale AL, Meyer P, Marwick TH, Lam CSP, Kaye DM. Sex Differences in Cardiovascular Pathophysiology: Why Women Are Overrepresented in Heart Failure With Preserved Ejection Fraction. Circulation 2019; 138:198-205. [PMID: 29986961 DOI: 10.1161/circulationaha.118.034271] [Citation(s) in RCA: 300] [Impact Index Per Article: 60.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Consistent epidemiological data demonstrate that patients with heart failure with preserved ejection fraction (HFpEF) are more likely to be women than men. Exploring mechanisms behind this sex difference in heart failure epidemiology may enrich the understanding of underlying HFpEF pathophysiology and phenotypes, with the ultimate goal of identifying therapeutic approaches for the broader HFpEF population. In this review we evaluate the influence of sex on the key domains of cardiac structure and function, the systemic and pulmonary circulation, as well as extracardiac factors and comorbidities that may explain the predisposition of women to HFpEF. We highlight the potential role of factors exclusive to or more prevalent in women such as pregnancy, preeclampsia, and iron deficiency. Finally, we discuss existing controversies and gaps in knowledge, as well as the clinical importance of known sex differences in the context of the potential need for sex-specific diagnostic criteria, improved risk stratification models, and targeted therapies.
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Affiliation(s)
- Anna L Beale
- Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia (A.L.B., T.H.M., D.M.K.).,Department of Cardiology, Alfred Hospital, Melbourne, Victoria, Australia (A.L.B., T.H.M., D.M.K.).,Faculty of Medicine, Monash University, Melbourne, Victoria, Australia (A.L.B., D.M.K.)
| | - Philippe Meyer
- Faculty of Medicine, Monash University, Melbourne, Victoria, Australia (A.L.B., D.M.K.)
| | - Thomas H Marwick
- Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia (A.L.B., T.H.M., D.M.K.).,Department of Cardiology, Alfred Hospital, Melbourne, Victoria, Australia (A.L.B., T.H.M., D.M.K.)
| | - Carolyn S P Lam
- National Heart Centre Singapore (C.S.P.L.).,Duke-National University of Singapore (C.S.P.L.).,University Medical Centre Groningen, The Netherlands (C.S.P.L.)
| | - David M Kaye
- Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia (A.L.B., T.H.M., D.M.K.). .,Department of Cardiology, Alfred Hospital, Melbourne, Victoria, Australia (A.L.B., T.H.M., D.M.K.)
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59
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Lee YJ, Kim SM, Lee YA, Kim GB, Shin CH, Yang SW. Relationship between systolic hypertension assessed by 24-hour ambulatory blood pressure monitoring and aortic diameters in young women with Turner syndrome. Clin Endocrinol (Oxf) 2019; 91:156-162. [PMID: 31001842 DOI: 10.1111/cen.13995] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2019] [Revised: 04/15/2019] [Accepted: 04/15/2019] [Indexed: 01/02/2023]
Abstract
OBJECTIVE Patients with Turner syndrome (TS) are at high risk for cardiovascular morbidity and mortality due to aortic dilation. We evaluated the prevalence of hypertension and its risk factors and investigated the relationship between systolic hypertension and aortic diameter in young patients with TS. DESIGN Observational, cross-sectional study. PATIENTS AND MEASUREMENTS Forty-two patients with TS (15-35 years) who had achieved final adult heights underwent 24-h ambulatory blood pressure monitoring (ABPM). Fasting glucose, insulin and lipid profiles were measured. The homeostasis model assessment of insulin resistance (HOMA-IR) was calculated. Echocardiography was performed to evaluate aortic diameters (aortic annulus, aortic root at the sinuses of Valsalva, sinotubular junction and ascending aorta), which were converted into Turner-specific z-scores. RESULTS Systolic and/or diastolic hypertension was identified in 71.4% (n = 30) of patients, as assessed by 24-hour ABPM. Twenty-eight patients (66.7%) were nondippers. Patients with systolic hypertension (n = 8, 19.0%) had a higher weight, waist circumference and HOMA-IR levels than those without hypertension (P < 0.05 for all). After adjusting for covariates, HOMA-IR was independently associated with systolic hypertension (odds ratio 10.1, P = 0.043). After adjusting for age and bicuspid aortic valve, systolic hypertension was independently related to increased aortic diameter at the aortic annulus (β = 1.064, P = 0.009) and sinotubular junction (β = 1.124, P = 0.016). CONCLUSIONS Hypertension is highly prevalent and independently associated with IR in young patients with TS. The significant relationship between systolic hypertension and aortic diameters underscores the importance of BP and IR control.
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Affiliation(s)
- Yun Jeong Lee
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea
| | - Shin Mi Kim
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea
| | - Young Ah Lee
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea
| | - Gi Beom Kim
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea
| | - Choong Ho Shin
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea
| | - Sei Won Yang
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea
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60
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Mitchell GF. Aortic stiffness, pressure and flow pulsatility, and target organ damage. J Appl Physiol (1985) 2018; 125:1871-1880. [PMID: 30359540 PMCID: PMC6842890 DOI: 10.1152/japplphysiol.00108.2018] [Citation(s) in RCA: 79] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Revised: 09/17/2018] [Accepted: 10/24/2018] [Indexed: 01/19/2023] Open
Abstract
Measures of aortic stiffness and pressure and flow pulsatility have emerged as correlates of and potential contributors to cardiovascular disease, dementia, and kidney disease. Higher aortic stiffness and greater pressure and flow pulsatility are associated with excessive pulsatile load on the heart, which increases mass and reduces global longitudinal strain of the left ventricle. Excessive stiffness and pulsatility are also associated with microvascular lesions in high-flow organs, such as the brain and kidney, suggesting that small vessels in these organs are damaged by pulsatility. This brief review will summarize evidence relating aortic stiffness to cardiovascular, brain, and kidney disease.
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Affiliation(s)
- Gary F Mitchell
- Cardiovascular Engineering, Incorporated, Norwood, Massachusetts
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61
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Affiliation(s)
- Alberto Giannoni
- Fondazione Toscana Gabriele Monasterio, Pisa, Italy
- Scuola Superiore Sant’Anna, Pisa, Italy
| | - Stefano Masi
- Department of Clinical and Experimental Medicine, University of Pisa, Italy
- Department of Twin Research and Genetic Epidemiology, King’s College London, UK
- National Centre for Cardiovascular Preventions and Outcomes, Institute of Cardiovascular Science, University College London, UK
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62
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Jakovljevic DG. Physical activity and cardiovascular aging: Physiological and molecular insights. Exp Gerontol 2018; 109:67-74. [DOI: 10.1016/j.exger.2017.05.016] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2017] [Accepted: 05/21/2017] [Indexed: 10/19/2022]
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63
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Delsart P, Soquet J, Drumez E, Juthier F, Kutoati S, Koutouzi TN, Fry S, Mallart A, Montaigne D, Mounier-Vehier C. Aortic root size is associated with nocturnal blood pressure in a population of hypertensive patients under treatment for obstructive sleep apnea. Sleep Breath 2018; 23:439-446. [PMID: 30043386 DOI: 10.1007/s11325-018-1698-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Revised: 06/28/2018] [Accepted: 07/12/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND Obstructive sleep apnea (OSA) is associated with an increased aortic root size. This association has never been studied in patients with hypertension undergoing continuous positive airway pressure (CPAP) treatment for OSA. METHODS The 24-h blood pressure (BP) monitoring of 142 hypertensive patients undergoing CPAP treatment for OSA was prospectively documented. Aortic root diameter was assessed by echocardiography. RESULTS The population included 33.8% women, with an overall mean age of 60.7 ± 10.5 years. The median body mass index was 32.7 [29. 5-36.3] kg/m2. The median treatment score was 3 [2-4] anti-hypertensive drugs per day. The median 24-h systolic and diastolic BP were 130 [120-144] and 74.5 [69-82] mmHg, respectively. The night-time systolic and diastolic BP were 119.5 [108-136] and 67 [61-74] mmHg, respectively. The mean diameter of the aorta at the level of the Valsalva sinuses was 34.9 ± 4.4 mm and 20.4 ± 2.3 mm/m when adjusted for height. Patients underwent ventilation for a median duration of 3.8 [1. 7-7.5] years, with a median night-time duration of 6.6 [5. 5-7.5] h per night. The median residual apnea-hypopnea index under ventilation was 2 [1-4] events per hour. A multivariate analysis showed that aortic root size was associated with male gender (p < 0.01) and nocturnal diastolic BP (p < 0.01). When normalized for height, aortic root diameter was positively associated with age (p < 0.01) and nocturnal diastolic BP (p < 0.01). CONCLUSION In OSA patients, the relationship between aortic root diameter and nocturnal BP persists on CPAP therapy. Further studies that evaluate the potential protective effect of OSA treatment on aortic root dilatation should monitor nocturnal diastolic BP.
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Affiliation(s)
- Pascal Delsart
- CHU Lille, Institut Cœur Poumon, Bd Pr Leclercq, F-59000, Lille, France. .,Vascular Medicine and Hypertension Department, Institut-Coeur-Poumon, Boulevard Pr Leclercq, 59037, Lille Cedex, France.
| | - Jerome Soquet
- CHU Lille, Institut Cœur Poumon, Bd Pr Leclercq, F-59000, Lille, France.,University of Lille, CHU Lille, F-59000, Lille, France
| | - Elodie Drumez
- Department of Biostatistics, Univ. Lille, CHU Lille, EA 2694 - Santé publique : épidémiologie et qualité des soins, F-59000, Lille, France
| | - Francis Juthier
- CHU Lille, Institut Cœur Poumon, Bd Pr Leclercq, F-59000, Lille, France.,University of Lille, CHU Lille, F-59000, Lille, France
| | - Seenam Kutoati
- CHU Lille, Institut Cœur Poumon, Bd Pr Leclercq, F-59000, Lille, France
| | | | - Stephanie Fry
- CHU Lille, Institut Cœur Poumon, Bd Pr Leclercq, F-59000, Lille, France
| | - Anne Mallart
- CHU Lille, Institut Cœur Poumon, Bd Pr Leclercq, F-59000, Lille, France
| | - David Montaigne
- CHU Lille, Institut Cœur Poumon, Bd Pr Leclercq, F-59000, Lille, France.,University of Lille, CHU Lille, F-59000, Lille, France
| | - Claire Mounier-Vehier
- CHU Lille, Institut Cœur Poumon, Bd Pr Leclercq, F-59000, Lille, France.,University of Lille, CHU Lille, F-59000, Lille, France
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64
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The aging heart. Clin Sci (Lond) 2018; 132:1367-1382. [PMID: 29986877 DOI: 10.1042/cs20171156] [Citation(s) in RCA: 71] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2018] [Revised: 06/10/2018] [Accepted: 06/13/2018] [Indexed: 12/19/2022]
Abstract
As the elderly segment of the world population increases, it is critical to understand the changes in cardiac structure and function during the normal aging process. In this review, we outline the key molecular pathways and cellular processes that underlie the phenotypic changes in the heart and vasculature that accompany aging. Reduced autophagy, increased mitochondrial oxidative stress, telomere attrition, altered signaling in insulin-like growth factor, growth differentiation factor 11, and 5'- AMP-activated protein kinase pathways are among the key molecular mechanisms underlying cardiac aging. Aging promotes structural and functional changes in the atria, ventricles, valves, myocardium, pericardium, the cardiac conduction system, and the vasculature. We highlight the factors known to accelerate and attenuate the intrinsic aging of the heart and vessels in addition to potential preventive and therapeutic avenues. A greater understanding of the processes involved in cardiac aging may facilitate our ability to mitigate the escalating burden of CVD in older individuals and promote healthy cardiac aging.
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Fakoya AOJ, Otohinoyi DA, Omole AE, Oladele C, Kalejaiye A, Onuegbu A, Nwalie E, Talukdar D, Erinkitola O. Correlating possible predisposing demographics and systemic conditions with the aortic root. Ann Afr Med 2018; 17:133-139. [PMID: 30185682 PMCID: PMC6126053 DOI: 10.4103/aam.aam_51_17] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Background The aortic root is an aggregate of various components that connects the left ventricle to the aorta. The most predominant pathologies have been associated with the dilation of the aortic root leading to aneurysms. Aim This study is designed to measure the role of systemic morbidities such as hypertension, diabetes, and body mass index (BMI) on the dimension of the aortic root. Materials and Methods Participants were volunteers of African descent who were recruited during and after an organized health fair by the medical students' body from All Saints University, School of Medicine. 169 participants consisting of 62 males and 107 females with ages ranging from 9 to 84 years agreed to volunteer by signing the consent after which a questionnaire was administered and a preliminary clinical procedure was used to check for blood pressure (BP), blood glucose (BG), and BMI. The measurement of the aortic root was carried out by an experienced single investigator who was not aware of the purpose of measurements, using a DUS-5000 ultrasound machine (Miami, Florida, USA) at a low-frequency micro-convex transducer preset to "adult cardiac" with a default frequency of 4 MHz. Results Among the participants, 35.03%, 47.80%, and 29.11% had normal BP, BG, and BMI readings, respectively. The Chi-squared analysis identified a significant correlation between the diameter of the aortic annulus (AA) and BMI. Diastolic BP is also correlated with the diameter of the AA. Sinus of Valsalva (SV) showed an unusual correlation with BG as opposed to BP and BMI. Conclusion The disparity in how a systemic factor individually correlates with the AA and the SV is not clear. The study targets to provide educational concept in this regard.
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Affiliation(s)
- Adegbenro Omotuyi John Fakoya
- Department of Anatomical Sciences, University of Medicine and Health Sciences, St. Kitts and Nevis, Roseau, Dominica
- Department of Anatomical Sciences, School of Medicine, All Saints University, Roseau, Dominica
| | | | - Adekunle Ebenezer Omole
- Department of Basic Medical Sciences, American University of Antigua, College of Medicine, St. John's, Antigua
| | - Charles Oladele
- Medical Student, School of Medicine, All Saints University, Roseau, Dominica
| | - Ayoola Kalejaiye
- Medical Student, School of Medicine, All Saints University, Roseau, Dominica
| | - Angel Onuegbu
- Medical Student, School of Medicine, All Saints University, Roseau, Dominica
| | - Esther Nwalie
- Medical Student, School of Medicine, All Saints University, Roseau, Dominica
| | - Debjyoti Talukdar
- Medical Student, School of Medicine, All Saints University, Roseau, Dominica
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66
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Bhave NM, Nienaber CA, Clough RE, Eagle KA. Multimodality Imaging of Thoracic Aortic Diseases in Adults. JACC Cardiovasc Imaging 2018; 11:902-919. [DOI: 10.1016/j.jcmg.2018.03.009] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2017] [Revised: 03/16/2018] [Accepted: 03/20/2018] [Indexed: 12/28/2022]
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67
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Childs BG, Li H, van Deursen JM. Senescent cells: a therapeutic target for cardiovascular disease. J Clin Invest 2018; 128:1217-1228. [PMID: 29608141 DOI: 10.1172/jci95146] [Citation(s) in RCA: 128] [Impact Index Per Article: 21.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Cellular senescence, a major tumor-suppressive cell fate, has emerged from humble beginnings as an in vitro phenomenon into recognition as a fundamental mechanism of aging. In the process, senescent cells have attracted attention as a therapeutic target for age-related diseases, including cardiovascular disease (CVD), the leading cause of morbidity and mortality in the elderly. Given the aging global population and the inadequacy of current medical management, attenuating the health care burden of CVD would be transformative to clinical practice. Here, we review the evidence that cellular senescence drives CVD in a bimodal fashion by both priming the aged cardiovascular system for disease and driving established disease forward. Hence, the growing field of senotherapy (neutralizing senescent cells for therapeutic benefit) is poised to contribute to both prevention and treatment of CVD.
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Affiliation(s)
| | - Hu Li
- Department of Molecular Pharmacology and Experimental Therapeutics, and
| | - Jan M van Deursen
- Department of Biochemistry and Molecular Biology.,Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, Minnesota, USA
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68
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Abstract
The aorta has 2 main functions, conduit and cushion, and is designed to transmit blood to the periphery and buffer pulsatile stress from ventricular contraction. In the interaction between the structural and functional changes of the aorta, aging and disease processes impact on aortic material properties and hemodynamics. For a comprehensive assessment of changes in aortic structure and function associated with aging and disease, noninvasive cardiovascular imaging techniques, especially magnetic resonance imaging, have recently been developed. Magnetic resonance imaging allows for direct and accurate measurement of different aortic characteristics including structural measures such as aortic area or volume, aortic length, curvature, and aortic wall thickness and functional measures such as aortic strain, distensibility, and pulse wave velocity. Excellent reproducibility of magnetic resonance imaging methods allows us to assess the response of the whole aorta to both pharmacological and nonpharmacological therapies. Aortic flow and functional assessment could be added to clinical routine cardiac magnetic resonance as a comprehensive imaging modality primarily performed for the noninvasive evaluation of left ventricular function, left ventricular load, and vascular/ventricular coupling. New techniques such as 4-dimensional flow could provide and further elucidate the combined age-related effects of altered aortic geometry and function. This following review will describe the pathophysiological aspects of the aorta and the ability, value, and prospects of cardiovascular imaging, especially magnetic resonance imaging, to study age-related changes in aortic structure and function and assess the relationship between these alterations and cardiovascular disease.
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Affiliation(s)
- Yoshiaki Ohyama
- Departments of Cardiology/Medicine and Radiology, Johns Hopkins University, Baltimore, MD (Y.O., B.A.V., J.A.C.L.). Sorbonne Universités, UPMC University Paris 06, INSERM 1146, CNRS 7371, Laboratoire d'Imagerie Biomédicale, Paris, France (A.R., N.K.). Department of Cardiovascular Imaging and Interventional Radiology, Institute of Cardiology, Hôpital Pitié-Salpêtrière (AP-HP), Paris, France (A.R.). Clinical Investigation and Research Unit, Gunma University Hospital, Maebashi, Japan (Y.O.)
| | - Alban Redheuil
- Departments of Cardiology/Medicine and Radiology, Johns Hopkins University, Baltimore, MD (Y.O., B.A.V., J.A.C.L.). Sorbonne Universités, UPMC University Paris 06, INSERM 1146, CNRS 7371, Laboratoire d'Imagerie Biomédicale, Paris, France (A.R., N.K.). Department of Cardiovascular Imaging and Interventional Radiology, Institute of Cardiology, Hôpital Pitié-Salpêtrière (AP-HP), Paris, France (A.R.). Clinical Investigation and Research Unit, Gunma University Hospital, Maebashi, Japan (Y.O.)
| | - Nadjia Kachenoura
- Departments of Cardiology/Medicine and Radiology, Johns Hopkins University, Baltimore, MD (Y.O., B.A.V., J.A.C.L.). Sorbonne Universités, UPMC University Paris 06, INSERM 1146, CNRS 7371, Laboratoire d'Imagerie Biomédicale, Paris, France (A.R., N.K.). Department of Cardiovascular Imaging and Interventional Radiology, Institute of Cardiology, Hôpital Pitié-Salpêtrière (AP-HP), Paris, France (A.R.). Clinical Investigation and Research Unit, Gunma University Hospital, Maebashi, Japan (Y.O.)
| | - Bharath Ambale Venkatesh
- Departments of Cardiology/Medicine and Radiology, Johns Hopkins University, Baltimore, MD (Y.O., B.A.V., J.A.C.L.). Sorbonne Universités, UPMC University Paris 06, INSERM 1146, CNRS 7371, Laboratoire d'Imagerie Biomédicale, Paris, France (A.R., N.K.). Department of Cardiovascular Imaging and Interventional Radiology, Institute of Cardiology, Hôpital Pitié-Salpêtrière (AP-HP), Paris, France (A.R.). Clinical Investigation and Research Unit, Gunma University Hospital, Maebashi, Japan (Y.O.)
| | - Joao A C Lima
- Departments of Cardiology/Medicine and Radiology, Johns Hopkins University, Baltimore, MD (Y.O., B.A.V., J.A.C.L.). Sorbonne Universités, UPMC University Paris 06, INSERM 1146, CNRS 7371, Laboratoire d'Imagerie Biomédicale, Paris, France (A.R., N.K.). Department of Cardiovascular Imaging and Interventional Radiology, Institute of Cardiology, Hôpital Pitié-Salpêtrière (AP-HP), Paris, France (A.R.). Clinical Investigation and Research Unit, Gunma University Hospital, Maebashi, Japan (Y.O.).
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69
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Association between common carotid artery diameter and target organ damage in essential hypertension. J Hypertens 2018; 36:537-543. [DOI: 10.1097/hjh.0000000000001590] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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70
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Takenaka T, Suzuki H, Eguchi K, Miyashita H, Shimada K. Elevated pulse amplification in hypertensive patients with advanced kidney disease. Hypertens Res 2018; 41:299-307. [DOI: 10.1038/s41440-017-0010-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2017] [Revised: 08/15/2017] [Accepted: 09/12/2017] [Indexed: 01/30/2023]
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71
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Malek L. Cardiac rehabilitation in patients with thoracic aortic disease: Review of the literature and design of a program. HEART AND MIND 2018. [DOI: 10.4103/hm.hm_25_19] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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72
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Familial Screening for Left-Sided Congenital Heart Disease: What Is the Evidence? What Is the Cost? Diseases 2017; 5:diseases5040029. [PMID: 29292713 PMCID: PMC5750540 DOI: 10.3390/diseases5040029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2017] [Revised: 12/03/2017] [Accepted: 12/05/2017] [Indexed: 11/21/2022] Open
Abstract
Since the American Heart Association’s recommendation for familial screening of adults with congenital heart disease for bicuspid aortic valve, similar recommendations for other left-sided heart defects, such as hypoplastic left heart syndrome (HLHS), have been proposed. However, defining at-risk populations for these heart defects based on genetics is less straightforward due to the wide variability of inheritance patterns and non-genetic influences such as environmental and lifestyle factors. We discuss whether there is sufficient evidence to standardize echocardiographic screening for first-degree relatives of children diagnosed with HLHS. Due to variations in the inclusion of cardiac anomalies linked to HLHS and the identification of asymptomatic individuals with cardiac malformations, published studies are open to interpretation. We conclude that familial aggregation of obstructive left-sided congenital heart lesions in families with history of HLHS is not supported and recommend that additional screening should adopt a more conservative definition of what truly constitutes this heart defect. More thorough consideration is needed before embracing familial screening recommendations of families of patients with HLHS, since this could inflict serious costs on healthcare infrastructure and further burden affected families both emotionally and financially.
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73
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Nwabuo CC, Moreira HT, Vasconcellos HD, Ambale-Venkatesh B, Yoneyama K, Ohyama Y, Sharma RK, Armstrong AC, Ostovaneh MR, Lewis CE, Liu K, Schreiner PJ, Ogunyankin KO, Gidding SS, Lima JAC. Association of Aortic Root Dilation from Early Adulthood to Middle Age with Cardiac Structure and Function: The CARDIA Study. J Am Soc Echocardiogr 2017; 30:1172-1179. [PMID: 28927559 PMCID: PMC5716838 DOI: 10.1016/j.echo.2017.08.001] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2016] [Indexed: 01/22/2023]
Abstract
BACKGROUND The human aorta dilates with advancing age. However, the association between progressive aortic dilation with aging and cardiac remodeling has not been established in studies of community-dwelling adults. The aim of this study was to test the hypothesis that there would be a relationship between aortic size increase over the early adult life span with left ventricular (LV) structural remodeling and subclinical LV dysfunction in middle age, even in the absence of overt cardiovascular and valvular disease. METHODS Included were Coronary Artery Risk Development in Young Adults study participants (N = 2,933) aged 23 to 35 years with available transthoracic echocardiographic measurements during 20 years of follow-up. Multivariate linear regression models assessed sex-specific associations between 20-year change in aortic root diameter with LV structure and function. RESULTS Larger aortic root diameter at 20-year follow-up was associated with greater LV mass (2.77 vs 2.18 g/mm in men and women, respectively, P < .001). In longitudinal analyses, increase in aortic root diameter over 20-year follow-up was associated with a greater 20-year increase in LV mass and ratio of LV mass to LV end-diastolic volume ratio in both sexes. In women but not in men, increased aortic root diameter over 20 years was associated with increased left atrial dimension, impaired E/E', and impaired early diastolic longitudinal and circumferential strain rates assessed by speckle-tracking echocardiography. CONCLUSIONS Progressive increase in aortic root diameter from early adulthood to middle age was associated with increased LV mass and LV concentric remodeling in both sexes and impaired diastolic function predominantly in women.
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Affiliation(s)
- Chike C Nwabuo
- Johns Hopkins University School of Medicine, Baltimore, Maryland
| | | | | | | | - Kihei Yoneyama
- Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Yoshiaki Ohyama
- Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Ravi K Sharma
- Johns Hopkins University School of Medicine, Baltimore, Maryland
| | | | | | | | - Kiang Liu
- Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | | | - Kofo O Ogunyankin
- Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Samuel S Gidding
- Nemours Cardiac Center, Alfred I. duPont Hospital for Children, Wilmington, Delaware
| | - João A C Lima
- Johns Hopkins University School of Medicine, Baltimore, Maryland.
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74
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Hernesniemi JA, Heiskanen J, Ruohonen S, Kartiosuo N, Hutri-Kähönen N, Kähönen M, Jokinen E, Tossavainen P, Kallio M, Laitinen T, Lehtimäki T, Viikari JSA, Juonala M, Raitakari OT. Aortic sinus diameter in middle age is associated with body size in young adulthood. Heart 2017; 104:773-778. [PMID: 29092920 DOI: 10.1136/heartjnl-2017-312136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2017] [Revised: 10/10/2017] [Accepted: 10/11/2017] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE Aortic sinus dilatation can lead to aortic valve regurgitation or even aortic dissection. Our objective was to examine the association between body surface area (BSA) measures from childhood to middle age and aortic sinus diameter in middle age. Understanding the relation of these two clarifies how aortic size is normally determined. METHODS Cardiovascular Risk in Young Finns Study is a longitudinal study with follow-up of over 31 years (1980-2011). The study comprises information of body composition from multiple time points of 1950 subjects with cardiac ultrasound measurements made in 2011. The association between BSA in different ages and aortic sinus diameter in middle age was analysed by linear regression modelling adjusted with age, sex and diastolic blood pressure. Missing BSA values were derived for each life year (ages 3-33 years) from subject-specific curves for body weight and height estimated from longitudinal measurements using mixed model regression splines. RESULTS BSA estimates in early 20s are most strongly associated with aortic sinus diameter in middle age. Top association was observed at age 23 years with one SD increase in estimated BSA corresponding to 1.04 mm (0.87-1.21 mm) increase in aortic diameter. Increase in body weight beyond early 20s does not associate with aortic sinus diameter, and the association between middle age BSA and aortic size is substantially weaker (0.74 mm increase (0.58-0.89 mm)). These results were confirmed in a subpopulation using only measured data. CONCLUSION The association between aortic sinus diameter and BSA is stronger when considering BSA in young adulthood compared with BSA in middle age.
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Affiliation(s)
- Jussi A Hernesniemi
- Department of Cardiology, Tays Heart Hospital, Tampere University Hospital and Faculty of Medicine and Life Sciences, University of Tampere, Tampere, Finland.,Department of Clinical Chemistry, Fimlab Laboratories, and Finnish Cardiovascular Research Center Tampere, Faculty of Medicine and Life Sciences, University of Tampere, Tampere, Finland
| | - Jarkko Heiskanen
- Research Centre of Applied and Preventive Cardiovascular Medicine, University of Turku, Turku, Finland
| | - Saku Ruohonen
- Research Centre of Applied and Preventive Cardiovascular Medicine, University of Turku, Turku, Finland
| | - Noora Kartiosuo
- Research Centre of Applied and Preventive Cardiovascular Medicine, University of Turku, Turku, Finland
| | - Nina Hutri-Kähönen
- Department of Pediatrics, University of Tampere and Tampere University Hospital, Tampere, Finland
| | - Mika Kähönen
- Department of Clinical Physiology, University of Tampere and Tampere University Hospital, Tampere, Finland
| | - Eero Jokinen
- Children's Hospital, University of Helsinki and Helsinki University Central Hospital, Helsinki, Finland
| | - Päivi Tossavainen
- Department of Pediatrics, University of Oulu, Oulu, Finland.,PEDEGO Research Unit and Medical Research Center Oulu, University of Oulu, Oulu, Finland
| | - Merja Kallio
- Department of Pediatrics, University of Oulu, Oulu, Finland.,PEDEGO Research Unit and Medical Research Center Oulu, University of Oulu, Oulu, Finland
| | - Tomi Laitinen
- Department of Clinical Physiology, Kuopio University Hospital, University of Eastern Finland, Kuopio, Finland
| | - Terho Lehtimäki
- Department of Clinical Chemistry, Fimlab Laboratories, and Finnish Cardiovascular Research Center Tampere, Faculty of Medicine and Life Sciences, University of Tampere, Tampere, Finland
| | - Jorma S A Viikari
- Department of Medicine, University of Turku, Turku, Finland.,Division of Medicine, Turku University Hospital, Turku, Finland
| | - Markus Juonala
- Department of Medicine, University of Turku, Turku, Finland.,Division of Medicine, Turku University Hospital, Turku, Finland
| | - Olli T Raitakari
- Research Centre of Applied and Preventive Cardiovascular Medicine, University of Turku, Turku, Finland.,Department of Clinical Physiology and Nuclear Medicine, Turku University Hospital, Turku, Finland
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75
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Barjaktarovic M, Korevaar TIM, Gaillard R, de Rijke YB, Visser TJ, Jaddoe VWV, Peeters RP. Childhood thyroid function, body composition and cardiovascular function. Eur J Endocrinol 2017; 177:319-327. [PMID: 28724570 DOI: 10.1530/eje-17-0369] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2017] [Revised: 06/27/2017] [Accepted: 07/19/2017] [Indexed: 01/02/2023]
Abstract
OBJECTIVE The cardiovascular system is a known target for thyroid hormone. Early-life cardiovascular alterations may lead to a higher risk of cardiovascular disease in adulthood. Little is known about the effects of thyroid hormone on cardiovascular function during childhood, including the role of body composition in this association. DESIGN Population-based prospective cohort of children (n = 4251, median age 6 years, 95% range: 5.7-8.0 years). METHODS Thyroid-stimulating hormone (TSH) and free thyroxine (FT4) concentrations were measured to assess thyroid function. Left ventricular (LV) mass was assessed with echocardiography. Arterial stiffness was assessed with carotid-femoral pulse wave velocity (CFPWV). Systolic and diastolic blood pressure (BP) was measured. Body composition was assessed by dual-energy X-ray absorptiometry scan. RESULTS FT4 was inversely associated with LV mass (P = 0.002), and with lean body mass (P < 0.0001). The association of FT4 with LV mass was partially mediated through variability in lean body mass (55% mediated effect). TSH was inversely associated with LV mass (P = 0.010), predominantly in boys. TSH was positively associated with systolic and diastolic BP (both P < 0.001). FT4 was positively associated with CFPWV and diastolic BP (P < 0.0001, P = 0.008, respectively), and the latter association attenuated after adjustment for CFPWV. CONCLUSIONS At the age of 6 years, higher FT4 is associated with lower LV mass (partially through effects on lean body mass) and with higher arterial stiffness, which may lead to higher BP. Our data also suggest different mechanisms via which TSH and FT4 are associated with cardiovascular function during early childhood.
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Affiliation(s)
| | - Tim I M Korevaar
- The Generation R Study Group
- Department of Internal Medicine
- Rotterdam Thyroid Center
| | - Romy Gaillard
- The Generation R Study Group
- Department of Epidemiology, Erasmus Medical Center, Rotterdam, The Netherlands
| | | | - Theo J Visser
- Department of Internal Medicine
- Rotterdam Thyroid Center
| | - Vincent W V Jaddoe
- The Generation R Study Group
- Department of Epidemiology, Erasmus Medical Center, Rotterdam, The Netherlands
- Department of Pediatrics, Erasmus Medical Center, Sophia Children's Hospital, Rotterdam, The Netherlands
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76
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Histone deacetylase and GATA-binding factor 6 regulate arterial remodeling in angiotensin II-induced hypertension. J Hypertens 2017; 34:2206-19. [PMID: 27512969 DOI: 10.1097/hjh.0000000000001081] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
OBJECTIVE Histone deacetylase (HDAC) inhibitors have been reported to improve essential and secondary hypertension. However, the specific HDAC that might serve as a therapeutic target and the associated upstream and downstream molecules involved in regulating hypertension remain unknown. Our study was aimed at investigating whether a selective inhibitor of class II HDAC (MC1568) modulates hypertension, elucidating the underlying mechanism. METHODS Hypertension was established by administering angiotensin II (Ang II) to mice before treatment with MC1568. SBP was measured. RESULTS Treatment with MC1568 reduced elevated SBP; attenuated arterial remodeling in the kidney's small arteries and thoracic aorta; and inhibited cell cycle regulatory gene expression, vascular smooth muscle cell (VSMC) proliferation, DNA synthesis, and VSMC hypertrophy in vivo and in vitro. Ang II enhanced the expression of phosphorylated HDAC4 and GATA-binding factor 6 (GATA6) proteins, which were specifically localized in the cytoplasm of cells in the arteries of kidneys and in aortas. Forced expression and knockdown of HDAC4 increased and decreased, respectively, the proliferation and expression of cell cycle genes in VSMCs. GATA6, a newly described binding partner of HDAC4, markedly enhanced the size and number of VSMCs. Calcium/calmodulin-dependent kinase IIα (CaMKIIα), but not HDAC4, translocated from the nucleus to the cytoplasm in response to Ang II. CaMKIIα and protein kinase D1 were associated with VSMC hypertrophy and hyperplasia via direct interaction with HDAC4. MC1568 treatment weakened the association between HDAC4 and CaMKIIα. CONCLUSION These results suggest that class II HDAC inhibition attenuates hypertension by negatively regulating VSMC hypertrophy and hyperplasia via the CaMKIIα/protein kinase D1/HDAC4/GATA6 pathway.
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77
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de Roos A, van der Grond J, Mitchell G, Westenberg J. Magnetic Resonance Imaging of Cardiovascular Function and the Brain: Is Dementia a Cardiovascular-Driven Disease? Circulation 2017; 135:2178-2195. [PMID: 28559496 DOI: 10.1161/circulationaha.116.021978] [Citation(s) in RCA: 83] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
The proximal aorta acts as a coupling device between heart and brain perfusion, modulating the amount of pressure and flow pulsatility transmitted into the cerebral microcirculation. Stiffening of the proximal aorta is strongly associated with age and hypertension. The detrimental effects of aortic stiffening may result in brain damage as well as heart failure. The resulting cerebral small vessel disease and heart failure may contribute to early cognitive decline and (vascular) dementia. This pathophysiological sequence of events underscores the role of cardiovascular disease as a contributory mechanism in causing cognitive decline and dementia and potentially may provide a starting point for prevention and treatment. Magnetic resonance imaging is well suited to assess the function of the proximal aorta and the left ventricle (eg, aortic arch pulse wave velocity and distensibility) as well as the various early and late manifestations of cerebral small vessel disease (eg, microbleeds and white matter hyperintensities in strategically important regions of the brain). Specialized magnetic resonance imaging techniques are explored for diagnosing preclinical changes in white matter integrity or brain microvascular pulsatility.
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Affiliation(s)
- Albert de Roos
- From Leiden University Medical Center, Department of Radiology, The Netherlands (A.d.R., J.v.d.G., J.W.); and Cardiovascular Engineering, Inc, Norwood, MA (G.M.).
| | - Jeroen van der Grond
- From Leiden University Medical Center, Department of Radiology, The Netherlands (A.d.R., J.v.d.G., J.W.); and Cardiovascular Engineering, Inc, Norwood, MA (G.M.)
| | - Gary Mitchell
- From Leiden University Medical Center, Department of Radiology, The Netherlands (A.d.R., J.v.d.G., J.W.); and Cardiovascular Engineering, Inc, Norwood, MA (G.M.)
| | - Jos Westenberg
- From Leiden University Medical Center, Department of Radiology, The Netherlands (A.d.R., J.v.d.G., J.W.); and Cardiovascular Engineering, Inc, Norwood, MA (G.M.)
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78
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Gando Y, Murakami H, Yamamoto K, Kawakami R, Ohno H, Sawada SS, Miyatake N, Miyachi M. Greater Progression of Age-Related Aortic Stiffening in Adults with Poor Trunk Flexibility: A 5-Year Longitudinal Study. Front Physiol 2017; 8:454. [PMID: 28713284 PMCID: PMC5491599 DOI: 10.3389/fphys.2017.00454] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2017] [Accepted: 06/14/2017] [Indexed: 11/18/2022] Open
Abstract
Purpose: Having a low level of physical fitness, especially cardiorespiratory fitness, appears to accelerate age-related aortic stiffening. Whereas, some studies have reported that trunk flexibility is a component of physical fitness, it is also negatively associated with arterial stiffening independent of cardiorespiratory fitness in cross-sectional studies. However, no long-term longitudinal study has determined whether poor trunk flexibility accelerates the progression of age-related aortic stiffening. We examined trunk flexibility and aortic stiffness progression in a 5-year longitudinal study. Methods and Results: A total of 305 apparently healthy men and women participated in this study (49.6 ± 9.5 years of age). Trunk flexibility was measured using a sit-and-reach test. Aortic stiffness was assessed using carotid-femoral pulse wave velocity (cfPWV) at baseline and after 5 years. Analysis of covariance (ANCOVA) was used to assess the association of the annual rate of cfPWV across flexibility levels (low, middle, high). There were no significant differences in baseline cfPWV among the three groups (835 ± 164, 853 ± 140, 855 ± 2.68 cm/s; P = 0.577). Annual ΔcfPWV was significantly higher in the low-flexibility group than in the high-flexibility group (P = 0.009). ANCOVA revealed an inverse relationship between flexibility level and annual ΔcfPWV (14.41 ± 2.73, 9.79 ± 2.59, 2.62 ± 2.68 cm/s/year; P for trend = 0.011). Multiple regression analysis revealed that baseline sit and reach (β = −0.12, −0.70 to −0.01) was independently correlated with ΔcfPWV following adjustment for baseline peak oxygen uptake, age, sex, body fat, heart rate, and cfPWV. The 5-year change in cfPWV was not significantly correlated with 5-year change in sit-and-reach performance (P = 0.859). Conclusion: Poor trunk flexibility is associated with greater progression of age-related aortic stiffening in healthy adults. However, we failed to confirm a significant association between 5-year change in aortic stiffness and 5-year change in trunk flexibility. The association between increased age-related increase in aortic stiffness and deterioration in flexibility due to age may require observation for more than 5 years.
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Affiliation(s)
- Yuko Gando
- Department of Physical Activity Research, National Institute of Health and Nutrition, NIBIOHNTokyo, Japan
| | - Haruka Murakami
- Department of Physical Activity Research, National Institute of Health and Nutrition, NIBIOHNTokyo, Japan
| | - Kenta Yamamoto
- Faculty of Pharmaceutical Sciences, Teikyo Heisei UniversityTokyo, Japan
| | - Ryoko Kawakami
- Faculty of Sport Sciences, Waseda UniversitySaitama, Japan
| | - Harumi Ohno
- Department of Physical Activity Research, National Institute of Health and Nutrition, NIBIOHNTokyo, Japan
| | - Susumu S Sawada
- Department of Physical Activity Research, National Institute of Health and Nutrition, NIBIOHNTokyo, Japan
| | - Nobuyuki Miyatake
- Department of Hygiene, Faculty of Medicine, Kagawa UniversityKagawa, Japan
| | - Motohiko Miyachi
- Department of Physical Activity Research, National Institute of Health and Nutrition, NIBIOHNTokyo, Japan
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79
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Masri A, Kalahasti V, Svensson LG, Alashi A, Schoenhagen P, Roselli EE, Johnston DR, Rodriguez LL, Griffin BP, Desai MY. Aortic Cross-Sectional Area/Height Ratio and Outcomes in Patients With Bicuspid Aortic Valve and a Dilated Ascending Aorta. Circ Cardiovasc Imaging 2017; 10:e006249. [DOI: 10.1161/circimaging.116.006249] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2016] [Accepted: 04/21/2017] [Indexed: 12/17/2022]
Abstract
Background—
In patients with bicuspid aortic valve and dilated proximal ascending aorta, we sought to assess (1) factors associated with increased longer-term cardiovascular mortality and (2) incremental prognostic use of indexing aortic root to patient height.
Methods and Results—
We studied 969 consecutive bicuspid aortic valve patients (50±13 years; 87% men) with proximal aorta ≥4 cm, who also had a gated contrast-enhanced thoracic computed tomography or magnetic resonance angiography. A ratio of ascending aortic area/height was calculated on tomography, and ≥10 cm
2
/m was considered abnormal, as previously reported. Society of Thoracic Surgeons score and cardiovascular death were recorded. Greater than or equal to III+ aortic regurgitation and severe aortic stenosis were seen in 37% and 10%, respectively. Society of Thoracic Surgeons score and right ventricular systolic pressure were 2±3 and 15±16 mm Hg, respectively. Abnormal ascending aortic area/height ratio was noted in 33%; 44% underwent ascending aortic surgery at 34 days. At 10.8 years (interquartile range, 9.6–12.3), 82 (9%) died (0.4% in-hospital postoperative mortality). On multivariable Cox survival analysis, ascending aortic area/height ratio (hazard ratio, 2; 95% confidence interval, 1.20–3.35) was associated with cardiovascular death, whereas aortic surgery (hazard ratio, 0.46; confidence interval, 0.26–0.80) was associated with improved survival (both
P
<0.01). Of the 405 patients with ascending aortic diameter of 4.5 to 5.5 cm, 64% had an abnormal ascending aortic area/height ratio, and 70% deaths occurred in patients with an abnormal ratio.
Conclusions—
In bicuspid aortic valve patients with dilated proximal ascending aorta, ascending aortic area/height ratio was independently associated with cardiovascular death.
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Affiliation(s)
- Ahmad Masri
- From the Bicuspid Aortic Valve Center, Heart and Vascular Institute, Cleveland Clinic, OH
| | - Vidyasagar Kalahasti
- From the Bicuspid Aortic Valve Center, Heart and Vascular Institute, Cleveland Clinic, OH
| | - Lars G. Svensson
- From the Bicuspid Aortic Valve Center, Heart and Vascular Institute, Cleveland Clinic, OH
| | - Alaa Alashi
- From the Bicuspid Aortic Valve Center, Heart and Vascular Institute, Cleveland Clinic, OH
| | - Paul Schoenhagen
- From the Bicuspid Aortic Valve Center, Heart and Vascular Institute, Cleveland Clinic, OH
| | - Eric E. Roselli
- From the Bicuspid Aortic Valve Center, Heart and Vascular Institute, Cleveland Clinic, OH
| | - Douglas R. Johnston
- From the Bicuspid Aortic Valve Center, Heart and Vascular Institute, Cleveland Clinic, OH
| | - L. Leonardo Rodriguez
- From the Bicuspid Aortic Valve Center, Heart and Vascular Institute, Cleveland Clinic, OH
| | - Brian P. Griffin
- From the Bicuspid Aortic Valve Center, Heart and Vascular Institute, Cleveland Clinic, OH
| | - Milind Y. Desai
- From the Bicuspid Aortic Valve Center, Heart and Vascular Institute, Cleveland Clinic, OH
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Clinical and prognostic value of hypertensive cardiac damage in the PAMELA Study. Hypertens Res 2016; 40:329-335. [DOI: 10.1038/hr.2016.153] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2016] [Revised: 09/26/2016] [Accepted: 09/26/2016] [Indexed: 11/08/2022]
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Gavish B, Izzo JL. Arterial Stiffness: Going a Step Beyond. Am J Hypertens 2016; 29:1223-1233. [PMID: 27405964 DOI: 10.1093/ajh/hpw061] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2015] [Accepted: 05/23/2016] [Indexed: 01/09/2023] Open
Abstract
Interest in arterial stiffness has been fueled by the scientific and clinical implications of its "vicious cycle" relationship with aging and systolic blood pressure. In physical terms, stiffness is the slope of the relationship between an artery's distending pressure and its cross-sectional area or volume. Pulse wave velocity (PWV, in m/s), the most common arterial stiffness indicator, is usually measured by the foot-to-foot time and distance method and is proportional to [stiffness × area (or volume)]1/2 at a given pressure. Its intrinsic pressure dependency and other flaws in current PWV methods limit its utility. In contrast, the arterial stiffness-arterial pressure relationship is near-linear, with a slope β, the exponent of the curvilinear arterial pressure-arterial volume relationship. The concept of arterial stiffening is related to β and describes a more functionally relevant aspect of arterial behavior: the change in stiffness for a given change in pressure. Arterial stiffening can be estimated from the variability of within-individual BP measurements (24-h ambulatory, home BP, or BP measured at different arm heights) and can be expressed as the pulse stiffening ratio (PSR) = [systolic stiffness]/[diastolic stiffness] or the ambulatory arterial stiffness index (AASI or its symmetric form, sAASI). High arterial stiffness (PWV) and stiffening (β, stiffness index, cardio-ankle vascular index, AASI, and PSR) are associated with increased cardiovascular disease risk, but it remains unclear whether these indicators are useful in improving medical care quality; the standard of care remains stringent BP control.
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Affiliation(s)
- Benjamin Gavish
- Department of Medicine, University at Buffalo, Buffalo, New York, USA
| | - Joseph L Izzo
- Department of Medicine, University at Buffalo, Buffalo, New York, USA
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Masri A, Kalahasti V, Svensson LG, Roselli EE, Johnston D, Hammer D, Schoenhagen P, Griffin BP, Desai MY. Aortic Cross-Sectional Area/Height Ratio and Outcomes in Patients With a Trileaflet Aortic Valve and a Dilated Aorta. Circulation 2016; 134:1724-1737. [PMID: 27770001 DOI: 10.1161/circulationaha.116.022995] [Citation(s) in RCA: 65] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2016] [Accepted: 09/28/2016] [Indexed: 01/15/2023]
Abstract
BACKGROUND In patients with a dilated proximal ascending aorta and trileaflet aortic valve, we aimed to assess (1) factors independently associated with increased long-term mortality and (2) the incremental prognostic utility of indexing aortic root to patient height. METHODS We studied consecutive patients with a dilated aortic root (≥4 cm) that underwent echocardiography and gated contrast-enhanced thoracic aortic computed tomography or magnetic resonance angiography between 2003 and 2007. A ratio of aortic root area over height was calculated (cm2/m) on tomography, and a cutoff of 10 cm2/m was chosen as abnormal, on the basis of previous reports. All-cause death was recorded. RESULTS The cohort comprised 771 patients (63 years [interquartile range, 53-71], 87% men, 85% hypertension, 51% hyperlipidemia, 56% smokers). Inherited aortopathies, moderate to severe aortic regurgitation, and severe aortic stenosis were seen in 7%, 18%, and 2%, whereas 91% and 54% were on β-blockers and angiotensin-converting enzyme inhibitors, respectively. Aortic root area/height ratio was ≥10 cm2/m in 24%. The Society of Thoracic Surgeons score and right ventricular systolic pressure were 3.3±3 and 31±7 mm Hg, respectively. At 7.8 years (interquartile range, 6.6-8.9), 280 (36%) patients underwent aortic surgery (76% within 1 year) and 130 (17%) died (1% in-hospital postoperative mortality). A lower proportion of patients in the surgical (versus nonsurgical) group died (13% versus 19%, P<0.01). On multivariable Cox proportional hazard analysis, aortic root area/height ratio (hazard ratio, 4.04; 95% confidence interval [CI], 2.69-6.231) was associated with death, whereas aortic surgery (hazard ratio, 0.47; 95% CI, 0.27-0.81) was associated with improved survival (both P<0.01). For longer-term mortality, the addition of aortic root area/height ratio ≥10 cm2/m to a clinical model (Society of Thoracic Surgeons score, inherited aortopathies, hypertension, hyperlipidemia, medications, aortic regurgitation, and right ventricular systolic pressure), increased the c-statistic from 0.57 (95% CI, 0.35-0.77) to 0.65 (95% CI, 0.52-0.73) and net reclassification index from 0.17 (95% CI, 0.02-0.31) to 0.23 (95% CI, 0.04-0.34), both P<0.01. Of the 327 patients with aortic root diameter between 4.5 and 5.5 cm, 44% had an abnormal aortic root area/height ratio, of which 78% died. CONCLUSIONS In patients with dilated aortic root and trileaflet aortic valve, a ratio of aortic root area to height provides independent and improved stratification for prediction of death.
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Affiliation(s)
- Ahmad Masri
- From Center for Aortic Disease, Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH
| | - Vidyasagar Kalahasti
- From Center for Aortic Disease, Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH
| | - Lars G Svensson
- From Center for Aortic Disease, Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH
| | - Eric E Roselli
- From Center for Aortic Disease, Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH
| | - Douglas Johnston
- From Center for Aortic Disease, Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH
| | - Donald Hammer
- From Center for Aortic Disease, Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH
| | - Paul Schoenhagen
- From Center for Aortic Disease, Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH
| | - Brian P Griffin
- From Center for Aortic Disease, Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH
| | - Milind Y Desai
- From Center for Aortic Disease, Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH.
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Aortic root dimensions are predominantly determined by genetic factors: a classical twin study. Eur Radiol 2016; 27:2419-2425. [PMID: 27659700 DOI: 10.1007/s00330-016-4590-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2016] [Revised: 07/22/2016] [Accepted: 08/29/2016] [Indexed: 10/21/2022]
Abstract
OBJECTIVES Previous studies using transthoracic echocardiography (TTE) observed moderate heritability of aortic root dimensions. Computed tomography angiography (CTA) might provide more accurate heritability estimates. Our primary aim was to assess the heritability of the aortic root with CTA. Our secondary aim was to derive TTE-based heritability and compare this with the CTA-based results. METHODS In the BUDAPEST-GLOBAL study 198 twin subjects (118 monozygotic, 80 dizygotic; age 56.1 ± 9.4 years; 126 female) underwent CTA and TTE. We assessed the diameter of the left ventricular outflow tract (LVOT), annulus, sinus of Valsalva, sinotubular junction and ascending aorta. Heritability was assessed using ACDE model (A additive genetic, C common environmental, D dominant genetic, E unique environmental factors). RESULTS Based on CTA, additive genetic effects were dominant (LVOT: A = 0.67, E = 0.33; annulus: A = 0.76, E = 0.24; sinus of Valsalva: A = 0.83, E = 0.17; sinotubular junction: A = 0.82, E = 0.18; ascending aorta: A = 0.75, E = 0.25). TTE-derived measurements showed moderate to no genetic influence (LVOT: A = 0.38, E = 0.62; annulus: C = 0.47, E = 0.53; sinus of Valsalva: C = 0.63, E = 0.37; sinotubular junction: C = 0.45, E = 0.55; ascending aorta: A = 0.67, E = 0.33). CONCLUSION CTA-based assessment suggests that aortic root dimensions are predominantly determined by genetic factors. TTE-based measurements showed moderate to no genetic influence. The choice of measurement method has substantial impact on heritability estimates. KEY POINTS • Aortic root dimensions are determined by genetic and environmental effects. • Transthoracic echocardiography (TTE) demonstrated moderate to no genetic effects on aortic root dimensions. • Computed tomography angiography might provide more accurate heritability estimates compared to TTE. • Three-dimensional imaging techniques are needed to reliably quantify aortic root dimensions.
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Totaro S, Rabbia F, Milan A, Urbina EM, Veglio F. Aortic root dilatation in the children and young adults: prevalence, determinants, and association with target organ damage. ACTA ACUST UNITED AC 2016; 10:782-789. [PMID: 27637377 DOI: 10.1016/j.jash.2016.07.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2016] [Revised: 07/10/2016] [Accepted: 07/18/2016] [Indexed: 11/30/2022]
Abstract
Aortic root dilatation is associated with increased cardiovascular risk in hypertensive adults. In the young, few data have been published evaluating the cardiovascular organ damage that may be present in patients with aortic dilatation. The objective was to evaluate the prevalence of proximal aorta dilatation, its possible determinants, and its relation with target organ damage in young subjects. The aorta was measured at the level of the sinus of valsalva and at its proximal ascending aorta (pAA) in a total of 177 young subjects (11-35 years). Linear regression analysis was used to assess the association between aortic size, clinical, and hemodynamic parameters. Prevalence of pAA and sinus of valsalva dilatation was 10.2% and 8.7%, respectively. No significant differences in prevalence were found in hypertensive, diabetic and obese subjects; aortic enlargement was less frequent in African-Americans. Age, sex, and central pulse pressure were the most important determinants of aortic size. Left ventricular mass was increased in patients with aortic enlargement, and aortic size showed an inverse relation with indices of local distensibility. The prevalence of aortic dilatation among young patients is high (10%). As in adults, age and body surface area are the main determinants of aortic size. Dilatation of the ascending aorta is associated with an increased left ventricular mass, as in adults, but not with increased arterial stiffness. Local distensibility is reduced in patients with pAA enlargement.
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Affiliation(s)
- Silvia Totaro
- Division of Internal Medicine and Hypertension Unit, Department of Medical Sciences, University of Turin, Italy.
| | - Franco Rabbia
- Division of Internal Medicine and Hypertension Unit, Department of Medical Sciences, University of Turin, Italy
| | - Alberto Milan
- Division of Internal Medicine and Hypertension Unit, Department of Medical Sciences, University of Turin, Italy
| | - Elaine M Urbina
- Preventive Cardiology, Cincinnati Children's Hospital Medical Centre and University of Cincinnati, OH, USA
| | - Franco Veglio
- Division of Internal Medicine and Hypertension Unit, Department of Medical Sciences, University of Turin, Italy
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Vizzardi E, Maffessanti F, Lorusso R, Sciatti E, Bonadei I, Gelsomino S, Metra M, Pepi M. Ascending Aortic Dimensions in Hypertensive Subjects: Reference Values for Two-Dimensional Echocardiography. J Am Soc Echocardiogr 2016; 29:827-37. [DOI: 10.1016/j.echo.2016.03.016] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2015] [Indexed: 12/13/2022]
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Tosello F, Leone D, Laurent S, Veglio F, Milan A. Out of proportion proximal aortic remodeling: A subclinical marker of early vascular ageing? A systematic review. Int J Cardiol 2016; 223:999-1006. [PMID: 27591699 DOI: 10.1016/j.ijcard.2016.07.302] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2016] [Revised: 07/07/2016] [Accepted: 07/08/2016] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Proximal aorta stiffens and dilates with aging. Aortic stiffening is a well known process, carrying prognostic implications. On the contrary, few data are available about proximal aorta dilatation. It is not known if "out of proportion" aortic remodeling, i.e. in excess for age, sex and body size, could be a marker of early vascular ageing; there is controversy on how it would be accelerated by classical risk factors or would associate with validated markers of cardiovascular organ damage. AIM We conducted a systematic review in order to evaluate the determinants of proximal aortic dimensions, focusing on the association with arterial hypertension, cardiovascular risk factors and markers of organ damage. DETERMINANTS OF PROXIMAL AORTA REMODELING Age, gender and body size explain 40-50% of the variability of aortic dimensions; genetic predisposition accounts for nearly 20%. Among cardiovascular risk factors obesity and hypertension seem to be associated with faster outward aortic remodeling. Arterial hypertension would account for a 0.60-0.78 mm greater diameter at the ascending aorta. Moreover, in hypertension, left ventricular mass showed a strict association with aortic diameter in nearly all studies. Other classical risk factors for atherogenesis such as dyslipidemia and smoking showed a weak influence on proximal aortic dimensions. No study reported a greater aortic remodeling in diabetics. CONCLUSIONS "Out of proportion" proximal aortic remodeling, could represent a subclinical marker of early vascular ageing, describing the cumulative influence of genetic predisposition, arterial hypertension and obesity.
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Affiliation(s)
- Francesco Tosello
- Department of Medical Sciences, Division of Internal Medicine, Hypertension Unit, University Hospital 'S. Giovanni Battista', University of Torino, Italy
| | - Dario Leone
- Department of Medical Sciences, Division of Internal Medicine, Hypertension Unit, University Hospital 'S. Giovanni Battista', University of Torino, Italy
| | - Stéphane Laurent
- Pharmacology Department and INSERM U 970 Hôpital Européen Georges Pompidou, Paris, France
| | - Franco Veglio
- Department of Medical Sciences, Division of Internal Medicine, Hypertension Unit, University Hospital 'S. Giovanni Battista', University of Torino, Italy
| | - Alberto Milan
- Department of Medical Sciences, Division of Internal Medicine, Hypertension Unit, University Hospital 'S. Giovanni Battista', University of Torino, Italy.
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Sahlén A, Hamid N, Amanullah MR, Fam JM, Yeo KK, Lau YH, Lam CSP, Ding ZP. Impact of aortic root size on left ventricular afterload and stroke volume. Eur J Appl Physiol 2016; 116:1355-65. [PMID: 27179797 DOI: 10.1007/s00421-016-3392-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2016] [Accepted: 05/09/2016] [Indexed: 10/21/2022]
Abstract
PURPOSE The left ventricle (LV) ejects blood into the proximal aorta. Age and hypertension are associated with stiffening and dilation of the aortic root, typically viewed as indicative of adverse remodeling. Based on analytical considerations, we hypothesized that a larger aortic root should be associated with lower global afterload (effective arterial elastance, EA) and larger stroke volume (SV). Moreover, as antihypertensive drugs differ in their effect on central blood pressure, we examined the role of antihypertensive drugs for the relation between aortic root size and afterload. METHODS We studied a large group of patients (n = 1250; 61 ± 12 years; 78 % males; 64 % hypertensives) from a single-center registry with known or suspected coronary artery disease. Aortic root size was measured by echocardiography as the diameter of the tubular portion of the ascending aorta. LV outflow tract Doppler was used to record SV. RESULTS In the population as a whole, after adjusting for key covariates in separate regression models, aortic root size was an independent determinant of both SV and EA. This association was found to be heterogeneous and stronger in patients taking a calcium channel blocker (CCB; 10.6 % of entire population; aortic root size accounted for 8 % of the explained variance of EA). CONCLUSION Larger aortic root size is an independent determinant of EA and SV. This association was heterogeneous and stronger in patients on CCB therapy.
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Affiliation(s)
- Anders Sahlén
- National Heart Centre Singapore, 5 Hospital Drive, Singapore, 169609, Singapore. .,Karolinska Institutet, Department of Cardiology, Karolinska University Hospital, 141 86, Stockholm, Sweden.
| | - Nadira Hamid
- National Heart Centre Singapore, 5 Hospital Drive, Singapore, 169609, Singapore
| | | | - Jiang Ming Fam
- National Heart Centre Singapore, 5 Hospital Drive, Singapore, 169609, Singapore
| | - Khung Keong Yeo
- National Heart Centre Singapore, 5 Hospital Drive, Singapore, 169609, Singapore
| | - Yee How Lau
- National Heart Centre Singapore, 5 Hospital Drive, Singapore, 169609, Singapore
| | - Carolyn S P Lam
- National Heart Centre Singapore, 5 Hospital Drive, Singapore, 169609, Singapore
| | - Zee Pin Ding
- National Heart Centre Singapore, 5 Hospital Drive, Singapore, 169609, Singapore
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Barton M, Husmann M, Meyer MR. Accelerated Vascular Aging as a Paradigm for Hypertensive Vascular Disease: Prevention and Therapy. Can J Cardiol 2016; 32:680-686.e4. [PMID: 27118295 DOI: 10.1016/j.cjca.2016.02.062] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2015] [Revised: 02/22/2016] [Accepted: 02/23/2016] [Indexed: 12/21/2022] Open
Abstract
Aging is considered the most important nonmodifiable risk factor for cardiovascular disease and death after age 28 years. Because of demographic changes the world population is expected to increase to 9 billion by the year 2050 and up to 12 billion by 2100, with several-fold increases among those 65 years of age and older. Healthy aging and prevention of aging-related diseases and associated health costs have become part of political agendas of governments around the world. Atherosclerotic vascular burden increases with age; accordingly, patients with progeria (premature aging) syndromes die from myocardial infarctions or stroke as teenagers or young adults. The incidence and prevalence of arterial hypertension also increases with age. Arterial hypertension-like diabetes and chronic renal failure-shares numerous pathologies and underlying mechanisms with the vascular aging process. In this article, we review how arterial hypertension resembles premature vascular aging, including the mechanisms by which arterial hypertension (as well as other risk factors such as diabetes mellitus, dyslipidemia, or chronic renal failure) accelerates the vascular aging process. We will also address the importance of cardiovascular risk factor control-including antihypertensive therapy-as a powerful intervention to interfere with premature vascular aging to reduce the age-associated prevalence of diseases such as myocardial infarction, heart failure, hypertensive nephropathy, and vascular dementia due to cerebrovascular disease. Finally, we will discuss the implementation of endothelial therapy, which aims at active patient participation to improve primary and secondary prevention of cardiovascular disease.
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Affiliation(s)
- Matthias Barton
- Molecular Internal Medicine, University of Zürich, Zürich, Switzerland.
| | - Marc Husmann
- Division of Angiology, University Hospital Zürich, Zürich, Switzerland
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Ohno Y, Kanno Y, Takenaka T. Central blood pressure and chronic kidney disease. World J Nephrol 2016; 5:90-100. [PMID: 26788468 PMCID: PMC4707173 DOI: 10.5527/wjn.v5.i1.90] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2015] [Revised: 11/17/2015] [Accepted: 12/14/2015] [Indexed: 02/06/2023] Open
Abstract
In this review, we focused on the relationship between central blood pressure and chronic kidney diseases (CKD). Wave reflection is a major mechanism that determines central blood pressure in patients with CKD. Recent medical technology advances have enabled non-invasive central blood pressure measurements. Clinical trials have demonstrated that compared with brachial blood pressure, central blood pressure is a stronger risk factor for cardiovascular (CV) and renal diseases. CKD is characterized by a diminished renal autoregulatory ability, an augmented direct transmission of systemic blood pressure to glomeruli, and an increase in proteinuria. Any elevation in central blood pressure accelerates CKD progression. In the kidney, interstitial inflammation induces oxidative stress to handle proteinuria. Oxidative stress facilitates atherogenesis, increases arterial stiffness and central blood pressure, and worsens the CV prognosis in patients with CKD. A vicious cycle exists between CKD and central blood pressure. To stop this cycle, vasodilator antihypertensive drugs and statins can reduce central blood pressure and oxidative stress. Even in early-stage CKD, mineral and bone disorders (MBD) may develop. MBD promotes oxidative stress, arteriosclerosis, and elevated central blood pressure in patients with CKD. Early intervention or prevention seems necessary to maintain vascular health in patients with CKD.
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Mulè G, Nardi E, Morreale M, Castiglia A, Geraci G, Altieri D, Cacciatore V, Schillaci M, Vaccaro F, Cottone S. The Relationship Between Aortic Root Size and Hypertension: An Unsolved Conundrum. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2016; 956:427-445. [PMID: 27873227 DOI: 10.1007/5584_2016_86] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Thoracic aortic aneurysms rupture and dissection are among the most devastating vascular diseases, being characterized by elevated mortality, despite improvements in diagnostic imaging and surgical techniques.An increased aortic root diameter (ARD) represents the main risk factor for thoracic aortic dissection and rupture and for aortic valve regurgitation.Even though arterial hypertension is commonly regarded as a predisposing condition for the development of thoracic aorta aneurysms, the role of blood pressure (BP) as determinant of aortic root enlargement is still controversial. The use of different methods for indexation of ARD may have in part contributed to the heterogeneous findings obtained in the investigations exploring the relationships between ARD and BP. Indeed, the best methods for ARD indexation, as well as the normal values of aortic root size, are still a matter of debate.Several non-hemodynamic factors influence ARD, including age, gender, and anthropometric variables, such as height, weight and their derivatives body surface area (BSA) and body mass index. Of these factors, anthropometric variables have the greatest impact.Several studies documented an association between ARD enlargement, assessed by echocardiography, and some indices of hypertensive target organ damage such as left ventricular hypertrophy, diastolic dysfunction, and carotid intima-media thickening. Recently, we found that ARD, expressed either as absolute values or normalized for BSA (ARD/BSA) or height (ARD/H), was significantly greater in hypertensive subjects with chronic kidney disease (CKD) when compared to their counterparts with normal renal function. Moreover, at univariate analyses estimated glomerular filtration rate (eGFR) showed significant inverse correlations with ARD not indexed and with ARD/BSA and ARD/H. Taking into account the effect of age, sex, duration of hypertension and other potentially confounding factors, in multiple regression analyses, only the association of GFR with ARD/H and that between GFR and ARD/BSA remained statistically significant. The receiver-operating characteristic curve analysis revealed that an estimated GFR of about 50 ml/min/1.73 m2 represents the better threshold to distinguish hypertensive patients with dilated aortic root from those with a normal one.Some population-based studies showed that an enlarged ARD might predict an adverse prognosis, even in absence of aneurysmatic alterations.In the Cardiovascular Health Study, a dilated aortic root was independently associated with an increased risk for stroke, cardiovascular and total mortality in both sexes and with incident congestive heart failure only in men. The relationship between ARD and heart failure has been observed also in the Framingham Heart Study. More recently, the PAMELA (Pressioni Arteriose Monitorate E Loro Associazioni) study demonstrated an independent relationship of ARD/H with incident cardiovascular morbidity and mortality.Although the relationship between BP and aortic root size is still a matter of debate, increasing evidence seems to support the notion that aortic root dilatation, even in absence of aneurysmatic alterations, may be regarded as an hypertensive organ damage paralleling other preclinical markers whose unfavourable prognostic significance is firmly established. Future studies are needed to assess whether or not antihypertensive therapy is able to reduce aortic root dimension and the increased risk associated with its enlargement.
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Affiliation(s)
- Giuseppe Mulè
- Dipartimento Biomedico di Medicina Interna, e Specialistica (DIBIMIS), Cattedra di Nefrologia, European Society of Hypertension Excellence Centre, Università di Palermo, Palermo, Italy.
| | - Emilio Nardi
- Dipartimento Biomedico di Medicina Interna, e Specialistica (DIBIMIS), Cattedra di Nefrologia, European Society of Hypertension Excellence Centre, Università di Palermo, Palermo, Italy
| | - Massimiliano Morreale
- Dipartimento Biomedico di Medicina Interna, e Specialistica (DIBIMIS), Cattedra di Nefrologia, European Society of Hypertension Excellence Centre, Università di Palermo, Palermo, Italy
| | - Antonella Castiglia
- Dipartimento Biomedico di Medicina Interna, e Specialistica (DIBIMIS), Cattedra di Nefrologia, European Society of Hypertension Excellence Centre, Università di Palermo, Palermo, Italy
| | - Giulio Geraci
- Dipartimento Biomedico di Medicina Interna, e Specialistica (DIBIMIS), Cattedra di Nefrologia, European Society of Hypertension Excellence Centre, Università di Palermo, Palermo, Italy
| | - Dario Altieri
- Dipartimento Biomedico di Medicina Interna, e Specialistica (DIBIMIS), Cattedra di Nefrologia, European Society of Hypertension Excellence Centre, Università di Palermo, Palermo, Italy
| | - Valentina Cacciatore
- Dipartimento Biomedico di Medicina Interna, e Specialistica (DIBIMIS), Cattedra di Nefrologia, European Society of Hypertension Excellence Centre, Università di Palermo, Palermo, Italy
| | - Margherita Schillaci
- Dipartimento Biomedico di Medicina Interna, e Specialistica (DIBIMIS), Cattedra di Nefrologia, European Society of Hypertension Excellence Centre, Università di Palermo, Palermo, Italy
| | - Francesco Vaccaro
- Dipartimento Biomedico di Medicina Interna, e Specialistica (DIBIMIS), Cattedra di Nefrologia, European Society of Hypertension Excellence Centre, Università di Palermo, Palermo, Italy
| | - Santina Cottone
- Dipartimento Biomedico di Medicina Interna, e Specialistica (DIBIMIS), Cattedra di Nefrologia, European Society of Hypertension Excellence Centre, Università di Palermo, Palermo, Italy
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Lieb W, Enserro DM, Sullivan LM, Vasan RS. Residual Cardiovascular Risk in Individuals on Blood Pressure-Lowering Treatment. J Am Heart Assoc 2015; 4:e002155. [PMID: 26588944 PMCID: PMC4845218 DOI: 10.1161/jaha.115.002155] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2015] [Accepted: 10/09/2015] [Indexed: 01/20/2023]
Abstract
BACKGROUND Hypertensive individuals on blood pressure (BP)-lowering treatment with BP in the normal or high-normal range have higher cardiovascular risk than untreated persons with usual BP in the same range. This residual risk (relative and absolute) is not well quantified and may be attributable in part to the higher burden of subclinical disease in treated individuals. METHODS AND RESULTS We assigned 3024 Framingham Offspring Cohort participants to 5 categories based on systolic BP (SBP) and diastolic BP (DBP) and use of BP-lowering treatment: (1) untreated SBP/DBP <120/80 mm Hg; (2) untreated SBP/DB ≥120/80 to <140/90 mm Hg; (3) treated SBP/DBP <140/90 mm Hg; (4) untreated SBP/DBP ≥140/90 mm Hg; and (5) treated SBP/DBP ≥140/90 mm Hg. A composite subclinical disease score was constructed, including information on left ventricular hypertrophy, systolic dysfunction, carotid ultrasound abnormality, peripheral artery disease, and microalbuminuria. The prevalence of subclinical disease rose across BP groups, as did the event rates for incident cardiovascular disease (449 events, median follow-up of 11 years; group 1, 0.65 event per 100 person-years; group 5, 3.20 events per 100 person-years; P<0.0001 for trend). On multivariable adjustment, treated hypertensives in groups 3 and 5 had 50% (95% CI 13% to 99%) and 28% (95% CI -6% to 73%) higher hazards, respectively, of developing cardiovascular disease compared with their untreated counterparts with similar levels of BP (groups 1 and 2 and group 4, respectively). The increased risk of cardiovascular disease in treated hypertensives was attributable in part to greater subclinical disease burden. CONCLUSIONS Treated hypertensives have higher subclinical cardiovascular disease burden, which partly explains their higher cardiovascular disease risk compared with untreated persons with similar BP levels.
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Affiliation(s)
- Wolfgang Lieb
- Framingham Heart StudyFraminghamMA
- Institute of EpidemiologyChristian Albrechts University KielKielGermany
| | - Danielle M. Enserro
- Framingham Heart StudyFraminghamMA
- Sections of Preventive Medicine and CardiologyBoston University School of MedicineBostonMA
| | - Lisa M. Sullivan
- Department of BiostatisticsBoston University School of Public HealthBostonMA
| | - Ramachandran S. Vasan
- Framingham Heart StudyFraminghamMA
- Sections of Preventive Medicine and CardiologyBoston University School of MedicineBostonMA
- Department of EpidemiologyBoston University School of Public HealthBostonMA
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de Simone G, Roman MJ, De Marco M, Bella JN, Izzo R, Lee ET, Devereux RB. Hemodynamic Correlates of Abnormal Aortic Root Dimension in an Adult Population: The Strong Heart Study. J Am Heart Assoc 2015; 4:e002309. [PMID: 26416876 PMCID: PMC4845134 DOI: 10.1161/jaha.115.002309] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Background We evaluated the relationship of aortic root dimension (ARD) with flow output and both peripheral and central blood pressure, using multivariable equations predicting ideal sex‐specific ARD at a given age and body height. Methods and Results We measured echocardiographic diastolic ARD at the sinuses of Valsalva in 3160 adults (aged 42±16 years, 61% women) from the fourth examination of the Strong Heart Study who were free of prevalent coronary heart disease, and we compared measured data with the theoretical predicted value to calculate a z score. Central blood pressure was estimated by applanation tonometry of the radial artery in 2319 participants. ARD z scores were divided into tertiles representing small, normal, and large ARD. Participants with large ARD exhibited greater prevalence of central obesity and higher levels of inflammatory markers and lipids (0.05<P<0.0001). Stroke volume, heart rate, and both cuff and central diastolic blood pressure were progressively greater from small to large ARD (all P<0.0001). Pulse pressure was higher in small ARD (P<0.0001). In multivariable analysis, ARD z score was related positively to stroke volume, either cuff or central diastolic blood pressure, and negatively to pulse pressure. Large ARD was also independently correlated to higher waist circumference and percentages of neutrophils and plasminogen activator inhibitor‐1 (all P<0.01). Conclusions Aortic root dilatation is associated with high diastolic blood pressure, high stroke volume, central fat distribution, and inflammatory status. In contrast, at a given diastolic blood pressure and stroke volume, aortic root dilatation is associated with lower pulse pressure and systolic blood pressure.
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Affiliation(s)
- Giovanni de Simone
- Hypertension Research Center, Federico II University, Naples, Italy (G.S., M.D.M., R.I.) Department of Translational Medical Sciences, Federico II University, Naples, Italy (G.S., M.D.M., R.I.) Department of Medicine, Weill-Cornell Medical College, New York, NY (G.S., M.J.R., R.B.D.)
| | - Mary J Roman
- Department of Medicine, Weill-Cornell Medical College, New York, NY (G.S., M.J.R., R.B.D.)
| | - Marina De Marco
- Hypertension Research Center, Federico II University, Naples, Italy (G.S., M.D.M., R.I.) Department of Translational Medical Sciences, Federico II University, Naples, Italy (G.S., M.D.M., R.I.)
| | - Jonathan N Bella
- Bronx-Lebanon Hospital Center, Albert Einstein College of Medicine, Bronx, NY (J.N.B.)
| | - Raffaele Izzo
- Hypertension Research Center, Federico II University, Naples, Italy (G.S., M.D.M., R.I.) Department of Translational Medical Sciences, Federico II University, Naples, Italy (G.S., M.D.M., R.I.)
| | - Elisa T Lee
- Center for American Indian Health Research, University of Oklahoma, Oklahoma City, OK (E.T.L.)
| | - Richard B Devereux
- Department of Medicine, Weill-Cornell Medical College, New York, NY (G.S., M.J.R., R.B.D.)
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Abstract
PURPOSE OF REVIEW To examine the putative measures of arterial stiffness and the mechanisms of adverse effects of stiffness on blood pressure and target organ damage using data from comprehensive hemodynamic profiles obtained in the Framingham Heart Study and the Age, Gene/Environment Susceptibility-Reykjavik Study. RECENT FINDINGS Once thought to be a consequence of longstanding hypertension, recent evidence suggests that aortic stiffness antedates and contributes to the pathogenesis of hypertension and target organ damage in the heart, brain, and kidneys. Carotid-femoral pulse-wave velocity (CFPWV) has emerged as the reference standard measure of aortic stiffness and a powerful predictor of cardiovascular disease risk. Augmentation index, a putative measure of arterial stiffness and wave reflection, has complex relations with stiffness and risk. Recent evidence suggests that wave reflection, which is a normal consequence of impedance mismatch between compliant aorta and stiff muscular arteries, is protective and limits the exposure of target organs to potentially harmful pulsatile energy. Aortic stiffening produces impedance matching that reduces wave reflection and exposes the microcirculation to excessive pulsatile stress, resulting in microvascular target organ damage and dysfunction. SUMMARY CFPWV provides a powerful new tool for risk stratification and elucidation of the pathogenesis of target organ damage in hypertension.
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94
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Chien CY, Liu CC, Po HL, Yen CH, Hou CJY, Kuo JY, Hung CL, Wang SS, Yeh HI, Lam CSP. The Relationship among Carotid Artery Remodeling, Cardiac Geometry, and Serum N-Terminal Pro-B-Type Natriuretic Peptide Level in Asymptomatic Asians: Sex-Differences and Longitudinal GEE Study. PLoS One 2015; 10:e0131440. [PMID: 26132728 PMCID: PMC4489394 DOI: 10.1371/journal.pone.0131440] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2015] [Accepted: 06/01/2015] [Indexed: 11/28/2022] Open
Abstract
Background Carotid artery remodeling is known to be associated with a variety of cardiovascular diseases. However, there is limited information regarding gender differences in carotid remodeling. We sought to investigate the associations among blood pressure (BP), carotid artery remodeling and cardiac geometries, and further explore gender differences. Materials and Methods In a large cohort of asymptomatic adults undergoing routine health screening with repeated observations, we related measures of carotid artery diameter (CCAD) to various BP components, cardiac geometries and blood N-terminal pro-brain natriuretic peptide (NT-proBNP) level, both from baseline cross-sectional and longitudinal dataset using generalized estimating equations (GEE). Results A total of 2,914 person-visits (baseline: n=998, mean age: 47 ± 8.9 years, 34% female) were studied (median: 6 ± 1.73 years follow up). We observed that CCAD was larger in men (p<0.01) and positively related to baseline age or all blood pressure components (including systolic BP [SBP], diastolic BP [DBP] and pulse pressure [PP], all p<0.01) even after accounting for clinical covariates, which did not change significantly at follow up (repeat-visit longitudinal GEE models). At baseline, per each increased unit of CCAD was associated with elevated LV mass index (β-coef: 6.72, with odds ratio [OR]: 1.47, 95% CI: 1.06 to 2.07 for ventricular hypertrophy; AUROC: 0.65, CCAD cut-off: 7.25mm) and NT-proBNP (β-coef: 5.35, OR: 4.22, 95% CI: 1.42 to 12.6 for >=300pg/mL; AUROC: 0.79, CCAD cut-off: 7.95mm, all p<0.05), which remained significant in multi-variate and longitudinal models. There was a prominent sex interaction (p for interaction with age and systolic BP: 0.004 and 0.028 respectively), where the longitudinal associations of age and systolic BP with increasing CCAD as more pronounced in women than men. Conclusion These data demonstrated that carotid artery remodeling may parallel subclinical biomarker of cardiac dysfunction, and further showed greater effects of aging and higher blood pressure on such remodeling process in women than men. Further study is warranted to understand how this predisposition of elderly hypertensive women to vascular remodeling may play a role in clinical settings.
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Affiliation(s)
- Chen-Yen Chien
- Division of Cardiovascular Surgery, Mackay Memorial Hospital, Taipei, Taiwan
- Mackay Medical College, New Taipei City, Taiwan
- Mackay Medicine, Nursing and Management College, Taipei, Taiwan
| | - Chuan-Chuan Liu
- Mackay Medical College, New Taipei City, Taiwan
- Health Evaluation Center, Mackay Memorial Hospital, Taipei, Taiwan
- Department of Medical Technology, Yuanpei University of Science and Technology, Hsin-Chu, Taiwan
- Graduate Institute of Health Care Organization Administration, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Helen L. Po
- Department of Neurology, Mackay Memorial Hospital, Taipei, Taiwan
| | - Chih-Hsuan Yen
- Mackay Medical College, New Taipei City, Taiwan
- Cardiovascular Division, Department of Internal Medicine, Mackay Memorial Hospital, Taipei, Taiwan
- Mackay Medicine, Nursing and Management College, Taipei, Taiwan
| | - Charles Jia-Yin Hou
- Mackay Medical College, New Taipei City, Taiwan
- Cardiovascular Division, Department of Internal Medicine, Mackay Memorial Hospital, Taipei, Taiwan
- Mackay Medicine, Nursing and Management College, Taipei, Taiwan
| | - Jen-Yuan Kuo
- Mackay Medical College, New Taipei City, Taiwan
- Cardiovascular Division, Department of Internal Medicine, Mackay Memorial Hospital, Taipei, Taiwan
- Mackay Medicine, Nursing and Management College, Taipei, Taiwan
| | - Chung-Lieh Hung
- Mackay Medical College, New Taipei City, Taiwan
- Graduate Institute of Health Care Organization Administration, College of Public Health, National Taiwan University, Taipei, Taiwan
- Cardiovascular Division, Department of Internal Medicine, Mackay Memorial Hospital, Taipei, Taiwan
- Mackay Medicine, Nursing and Management College, Taipei, Taiwan
- Department of Health Industry Management, Kainan University, Taoyuan, Taiwan
- Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan
- * E-mail:
| | - Shoei-Shen Wang
- Department of Surgery, National Taiwan University Hospital, Taipei, Taiwan
| | - Hung-I Yeh
- Mackay Medical College, New Taipei City, Taiwan
- Cardiovascular Division, Department of Internal Medicine, Mackay Memorial Hospital, Taipei, Taiwan
- Mackay Medicine, Nursing and Management College, Taipei, Taiwan
| | - Carolyn S. P. Lam
- Yong Loo Lin School of Medicine, NUS, National University Health System, Singapore, Singapore
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95
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Teixido-Tura G, Almeida ALC, Choi EY, Gjesdal O, Jacobs DR, Dietz HC, Liu K, Sidney S, Lewis CE, Garcia-Dorado D, Evangelista A, Gidding S, Lima JAC. Determinants of Aortic Root Dilatation and Reference Values Among Young Adults Over a 20-Year Period: Coronary Artery Risk Development in Young Adults Study. Hypertension 2015; 66:23-9. [PMID: 25941347 PMCID: PMC4465858 DOI: 10.1161/hypertensionaha.115.05156] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2015] [Accepted: 04/06/2015] [Indexed: 01/17/2023]
Abstract
Aortic size increases with age, but factors related to such dilatation in healthy young adult population have not been studied. We aim to evaluate changes in aortic dimensions and its principal correlates among young adults over a 20-year time period. Reference values for aortic dimensions in young adults by echocardiography are also provided. Healthy Coronary Artery Risk Development in Young Adults (CARDIA) study participants aged 23 to 35 years in 1990-1991 (n=3051) were included after excluding 18 individuals with significant valvular dysfunction. Aortic root diameter (ARD) by M-mode echocardiography at year-5 (43.7% men; age, 30.2 ± 3.6 years) and year-25 CARDIA exams was obtained. Univariable and multivariable analyses were performed to assess associations of ARD with clinical data at years-5 and -25. ARD from year-5 was used to establish reference values of ARD in healthy young adults. ARD at year-25 was greater in men (33.3 ± 3.7 versus 28.7 ± 3.4 mm; P<0.001) and in whites (30.9 ± 4.3 versus 30.5 ± 4.1 mm; P=0.006). On multivariable analysis, ARD at year-25 was positively correlated with male sex, white ethnicity, age, height, weight, 20-year gain in weight, active smoking at baseline, and 20-year increase in diastolic, systolic, and mean arterial pressure. A figure showing the estimated 95th percentile of ARD by age and body surface area stratified by race and sex is provided. This study demonstrates that smoking, blood pressure, and increase in body weight are the main modifiable correlates of aortic root dilation during young adulthood. Our study also provides reference values for ARD in young adults.
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Affiliation(s)
- Gisela Teixido-Tura
- From the Department of Medicine and Medical Genetics, Johns Hopkins University, Baltimore, MD (G.T.-T., A.L.C.A., E.-Y.C., O.G., H.C.D., J.A.C.L.); Department of Cardiology, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain (G.T.-T., D.G.-D., A.E.); Department of Epidemiology, University of Minnesota, Minneapolis (D.R.J.); Department of Preventive Medicine, Northwestern University, Chicago, IL (K.L.); Kaiser Permanente, Division of Research, Oakland, CA (S.S.); Division of Preventive Medicine, University of Alabama, Birmingham (C.E.L.); and Division of Cardiology, Nemours Cardiac Center, A. I. DuPont Hospital for Children, Wilmington, DE (S.G.).
| | - Andre L C Almeida
- From the Department of Medicine and Medical Genetics, Johns Hopkins University, Baltimore, MD (G.T.-T., A.L.C.A., E.-Y.C., O.G., H.C.D., J.A.C.L.); Department of Cardiology, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain (G.T.-T., D.G.-D., A.E.); Department of Epidemiology, University of Minnesota, Minneapolis (D.R.J.); Department of Preventive Medicine, Northwestern University, Chicago, IL (K.L.); Kaiser Permanente, Division of Research, Oakland, CA (S.S.); Division of Preventive Medicine, University of Alabama, Birmingham (C.E.L.); and Division of Cardiology, Nemours Cardiac Center, A. I. DuPont Hospital for Children, Wilmington, DE (S.G.)
| | - Eui-Young Choi
- From the Department of Medicine and Medical Genetics, Johns Hopkins University, Baltimore, MD (G.T.-T., A.L.C.A., E.-Y.C., O.G., H.C.D., J.A.C.L.); Department of Cardiology, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain (G.T.-T., D.G.-D., A.E.); Department of Epidemiology, University of Minnesota, Minneapolis (D.R.J.); Department of Preventive Medicine, Northwestern University, Chicago, IL (K.L.); Kaiser Permanente, Division of Research, Oakland, CA (S.S.); Division of Preventive Medicine, University of Alabama, Birmingham (C.E.L.); and Division of Cardiology, Nemours Cardiac Center, A. I. DuPont Hospital for Children, Wilmington, DE (S.G.)
| | - Ola Gjesdal
- From the Department of Medicine and Medical Genetics, Johns Hopkins University, Baltimore, MD (G.T.-T., A.L.C.A., E.-Y.C., O.G., H.C.D., J.A.C.L.); Department of Cardiology, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain (G.T.-T., D.G.-D., A.E.); Department of Epidemiology, University of Minnesota, Minneapolis (D.R.J.); Department of Preventive Medicine, Northwestern University, Chicago, IL (K.L.); Kaiser Permanente, Division of Research, Oakland, CA (S.S.); Division of Preventive Medicine, University of Alabama, Birmingham (C.E.L.); and Division of Cardiology, Nemours Cardiac Center, A. I. DuPont Hospital for Children, Wilmington, DE (S.G.)
| | - David R Jacobs
- From the Department of Medicine and Medical Genetics, Johns Hopkins University, Baltimore, MD (G.T.-T., A.L.C.A., E.-Y.C., O.G., H.C.D., J.A.C.L.); Department of Cardiology, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain (G.T.-T., D.G.-D., A.E.); Department of Epidemiology, University of Minnesota, Minneapolis (D.R.J.); Department of Preventive Medicine, Northwestern University, Chicago, IL (K.L.); Kaiser Permanente, Division of Research, Oakland, CA (S.S.); Division of Preventive Medicine, University of Alabama, Birmingham (C.E.L.); and Division of Cardiology, Nemours Cardiac Center, A. I. DuPont Hospital for Children, Wilmington, DE (S.G.)
| | - Harry C Dietz
- From the Department of Medicine and Medical Genetics, Johns Hopkins University, Baltimore, MD (G.T.-T., A.L.C.A., E.-Y.C., O.G., H.C.D., J.A.C.L.); Department of Cardiology, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain (G.T.-T., D.G.-D., A.E.); Department of Epidemiology, University of Minnesota, Minneapolis (D.R.J.); Department of Preventive Medicine, Northwestern University, Chicago, IL (K.L.); Kaiser Permanente, Division of Research, Oakland, CA (S.S.); Division of Preventive Medicine, University of Alabama, Birmingham (C.E.L.); and Division of Cardiology, Nemours Cardiac Center, A. I. DuPont Hospital for Children, Wilmington, DE (S.G.)
| | - Kiang Liu
- From the Department of Medicine and Medical Genetics, Johns Hopkins University, Baltimore, MD (G.T.-T., A.L.C.A., E.-Y.C., O.G., H.C.D., J.A.C.L.); Department of Cardiology, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain (G.T.-T., D.G.-D., A.E.); Department of Epidemiology, University of Minnesota, Minneapolis (D.R.J.); Department of Preventive Medicine, Northwestern University, Chicago, IL (K.L.); Kaiser Permanente, Division of Research, Oakland, CA (S.S.); Division of Preventive Medicine, University of Alabama, Birmingham (C.E.L.); and Division of Cardiology, Nemours Cardiac Center, A. I. DuPont Hospital for Children, Wilmington, DE (S.G.)
| | - Stephen Sidney
- From the Department of Medicine and Medical Genetics, Johns Hopkins University, Baltimore, MD (G.T.-T., A.L.C.A., E.-Y.C., O.G., H.C.D., J.A.C.L.); Department of Cardiology, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain (G.T.-T., D.G.-D., A.E.); Department of Epidemiology, University of Minnesota, Minneapolis (D.R.J.); Department of Preventive Medicine, Northwestern University, Chicago, IL (K.L.); Kaiser Permanente, Division of Research, Oakland, CA (S.S.); Division of Preventive Medicine, University of Alabama, Birmingham (C.E.L.); and Division of Cardiology, Nemours Cardiac Center, A. I. DuPont Hospital for Children, Wilmington, DE (S.G.)
| | - Cora E Lewis
- From the Department of Medicine and Medical Genetics, Johns Hopkins University, Baltimore, MD (G.T.-T., A.L.C.A., E.-Y.C., O.G., H.C.D., J.A.C.L.); Department of Cardiology, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain (G.T.-T., D.G.-D., A.E.); Department of Epidemiology, University of Minnesota, Minneapolis (D.R.J.); Department of Preventive Medicine, Northwestern University, Chicago, IL (K.L.); Kaiser Permanente, Division of Research, Oakland, CA (S.S.); Division of Preventive Medicine, University of Alabama, Birmingham (C.E.L.); and Division of Cardiology, Nemours Cardiac Center, A. I. DuPont Hospital for Children, Wilmington, DE (S.G.)
| | - David Garcia-Dorado
- From the Department of Medicine and Medical Genetics, Johns Hopkins University, Baltimore, MD (G.T.-T., A.L.C.A., E.-Y.C., O.G., H.C.D., J.A.C.L.); Department of Cardiology, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain (G.T.-T., D.G.-D., A.E.); Department of Epidemiology, University of Minnesota, Minneapolis (D.R.J.); Department of Preventive Medicine, Northwestern University, Chicago, IL (K.L.); Kaiser Permanente, Division of Research, Oakland, CA (S.S.); Division of Preventive Medicine, University of Alabama, Birmingham (C.E.L.); and Division of Cardiology, Nemours Cardiac Center, A. I. DuPont Hospital for Children, Wilmington, DE (S.G.)
| | - Artur Evangelista
- From the Department of Medicine and Medical Genetics, Johns Hopkins University, Baltimore, MD (G.T.-T., A.L.C.A., E.-Y.C., O.G., H.C.D., J.A.C.L.); Department of Cardiology, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain (G.T.-T., D.G.-D., A.E.); Department of Epidemiology, University of Minnesota, Minneapolis (D.R.J.); Department of Preventive Medicine, Northwestern University, Chicago, IL (K.L.); Kaiser Permanente, Division of Research, Oakland, CA (S.S.); Division of Preventive Medicine, University of Alabama, Birmingham (C.E.L.); and Division of Cardiology, Nemours Cardiac Center, A. I. DuPont Hospital for Children, Wilmington, DE (S.G.)
| | - Samuel Gidding
- From the Department of Medicine and Medical Genetics, Johns Hopkins University, Baltimore, MD (G.T.-T., A.L.C.A., E.-Y.C., O.G., H.C.D., J.A.C.L.); Department of Cardiology, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain (G.T.-T., D.G.-D., A.E.); Department of Epidemiology, University of Minnesota, Minneapolis (D.R.J.); Department of Preventive Medicine, Northwestern University, Chicago, IL (K.L.); Kaiser Permanente, Division of Research, Oakland, CA (S.S.); Division of Preventive Medicine, University of Alabama, Birmingham (C.E.L.); and Division of Cardiology, Nemours Cardiac Center, A. I. DuPont Hospital for Children, Wilmington, DE (S.G.)
| | - João A C Lima
- From the Department of Medicine and Medical Genetics, Johns Hopkins University, Baltimore, MD (G.T.-T., A.L.C.A., E.-Y.C., O.G., H.C.D., J.A.C.L.); Department of Cardiology, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain (G.T.-T., D.G.-D., A.E.); Department of Epidemiology, University of Minnesota, Minneapolis (D.R.J.); Department of Preventive Medicine, Northwestern University, Chicago, IL (K.L.); Kaiser Permanente, Division of Research, Oakland, CA (S.S.); Division of Preventive Medicine, University of Alabama, Birmingham (C.E.L.); and Division of Cardiology, Nemours Cardiac Center, A. I. DuPont Hospital for Children, Wilmington, DE (S.G.)
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96
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Abstract
Pathophysiological studies have extensively investigated the structural factor in hypertension, including large and small artery remodeling and functional changes. Here, we review the recent literature on the alterations in small and large arteries in hypertension. We discuss the possible mechanisms underlying these abnormalities and we explain how they accompany and often precede hypertension. Finally, we propose an integrated pathophysiological approach to better understand how the cross-talk between large and small artery changes interacts in pressure wave transmission, exaggerates cardiac, brain and kidney damage, and lead to cardiovascular and renal complications. We focus on patients with essential hypertension because this is the most prevalent form of hypertension, and describe other forms of hypertension only for contrasting their characteristics with those of uncomplicated essential hypertension.
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Affiliation(s)
- Stéphane Laurent
- From the Department of Pharmacology, Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Paris, France (S.L., P.B.); Université Paris-Descartes, Paris, France (S.L., P.B.); and INSERM U 970, Paris, France (S.L., P.B.).
| | - Pierre Boutouyrie
- From the Department of Pharmacology, Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Paris, France (S.L., P.B.); Université Paris-Descartes, Paris, France (S.L., P.B.); and INSERM U 970, Paris, France (S.L., P.B.)
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97
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Ferreira MT, Leite NC, Cardoso CRL, Salles GF. Correlates of aortic stiffness progression in patients with type 2 diabetes: importance of glycemic control: the Rio de Janeiro type 2 diabetes cohort study. Diabetes Care 2015; 38:897-904. [PMID: 25678104 DOI: 10.2337/dc14-2791] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2014] [Accepted: 01/21/2015] [Indexed: 02/03/2023]
Abstract
OBJECTIVE The correlates of serial changes in aortic stiffness in patients with diabetes have never been investigated. We aimed to examine the importance of glycemic control on progression/regression of carotid-femoral pulse wave velocity (cf-PWV) in type 2 diabetes. RESEARCH DESIGN AND METHODS In a prospective study, two cf-PWV measurements were performed with the Complior equipment in 417 patients with type 2 diabetes over a mean follow-up of 4.2 years. Clinical laboratory data were obtained at baseline and throughout follow-up. Multivariable linear/logistic regressions assessed the independent correlates of changes in cf-PWV. RESULTS Median cf-PWV increase was 0.11 m/s per year (1.1% per year). Overall, 212 patients (51%) increased/persisted with high cf-PWV, while 205 (49%) reduced/persisted with low cf-PWV. Multivariate linear regression demonstrated direct associations between cf-PWV changes and mean HbA1c during follow-up (partial correlation 0.14, P = 0.005). On logistic regression, a mean HbA1c ≥7.5% (58 mmol/mol) was associated with twofold higher odds of having increased/persistently high cf-PWV during follow-up. Furthermore, the rate of HbA1c reduction relative to baseline levels was inversely associated with cf-PWV changes (partial correlation -0.11, P = 0.011) and associated with reduced risk of having increased/persistently high aortic stiffness (odds ratio 0.82 [95% CI 0.69-0.96]; P = 0.017). Other independent correlates of progression in aortic stiffness were increases in systolic blood pressure and heart rate between the two cf-PWV measurements, older age, female sex, and presence of dyslipidemia and retinopathy. CONCLUSIONS Better glycemic control, together with reductions in blood pressure and heart rate, was the most important correlate to attenuate/prevent progression of aortic stiffness in patients with type 2 diabetes.
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Affiliation(s)
- Marcel T Ferreira
- Department of Internal Medicine, University Hospital Clementino Fraga Filho, School of Medicine, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Nathalie C Leite
- Department of Internal Medicine, University Hospital Clementino Fraga Filho, School of Medicine, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Claudia R L Cardoso
- Department of Internal Medicine, University Hospital Clementino Fraga Filho, School of Medicine, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Gil F Salles
- Department of Internal Medicine, University Hospital Clementino Fraga Filho, School of Medicine, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
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98
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Liu CY, Chen D, Bluemke DA, Wu CO, Teixido-Tura G, Chugh A, Vasu S, Lima JAC, Hundley WG. Evolution of aortic wall thickness and stiffness with atherosclerosis: long-term follow up from the multi-ethnic study of atherosclerosis. Hypertension 2015; 65:1015-9. [PMID: 25776078 DOI: 10.1161/hypertensionaha.114.05080] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2014] [Accepted: 01/24/2015] [Indexed: 11/16/2022]
Abstract
The study was performed to determine age, sex, and time-dependent changes in aortic wall thickness (AWT) and to evaluate cross-sectional associations between AWT and arterial stiffness in older adults. Three hundred seventy-one longitudinal and 426 cross-sectional measurements of AWT from cardiovascular magnetic resonance imaging studies conducted within the Multi-Ethnic Study of Atherosclerosis were analyzed at 2 points in time, in 2000 to 2002 and then again from follow-up examinations in 2010 to 2012. Aortic wall thickness was determined from a double inversion recovery black-blood fast spin-echo sequence, and aortic stiffness was measured from a phase-contrast cine gradient echo sequence. The thickness of the midthoracic descending aortic wall was measured and correlated to distensibility of the ascending aorta and aortic pulse wave velocity. The average rate of AWT change was 0.032 mm/y. The increase in AWT was greater for those aged 45 to 54 years relative to individuals older than 55 years (P trend<0.001). Ascending aortic distensibility was lower (P<0.001) and pulse wave velocity was higher (P=0.012) for hypertensive subjects. After adjustment for traditional risk factors, distensibility of the ascending aorta was significantly related to AWT in participants without hypertension. Hypertension was associated with increased aortic stiffness independent of aortic wall thickness.
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Affiliation(s)
- Chia-Ying Liu
- From the Department of Radiology and Imaging Sciences, National Institutes of Health (NIH), Bethesda, MD (C.-Y.L., D.A.B.); Department of Radiology, Johns Hopkins Hospital, Baltimore, MD (D.C., D.A.B., J.A.C.L.); Office of Biostatistics Research, National Heart, Lung, and Blood Institutes (NHLBI), Bethesda, MD (C.O.W.); Department of Cardiology, Hospital General Universitari Vall d'Hebron, Universitat Autonoma de Barcelona, Barcelona, Spain (G.T.-T.); Division of Cardiovascular Medicine, University of Louisville School of Medicine, KY (A.C.); and Division of Cardiovascular Medicine, Department of Internal Medicine, Wake Forest University, Winston-Salem, NC (S.V., W.G.H.)
| | - Doris Chen
- From the Department of Radiology and Imaging Sciences, National Institutes of Health (NIH), Bethesda, MD (C.-Y.L., D.A.B.); Department of Radiology, Johns Hopkins Hospital, Baltimore, MD (D.C., D.A.B., J.A.C.L.); Office of Biostatistics Research, National Heart, Lung, and Blood Institutes (NHLBI), Bethesda, MD (C.O.W.); Department of Cardiology, Hospital General Universitari Vall d'Hebron, Universitat Autonoma de Barcelona, Barcelona, Spain (G.T.-T.); Division of Cardiovascular Medicine, University of Louisville School of Medicine, KY (A.C.); and Division of Cardiovascular Medicine, Department of Internal Medicine, Wake Forest University, Winston-Salem, NC (S.V., W.G.H.)
| | - David A Bluemke
- From the Department of Radiology and Imaging Sciences, National Institutes of Health (NIH), Bethesda, MD (C.-Y.L., D.A.B.); Department of Radiology, Johns Hopkins Hospital, Baltimore, MD (D.C., D.A.B., J.A.C.L.); Office of Biostatistics Research, National Heart, Lung, and Blood Institutes (NHLBI), Bethesda, MD (C.O.W.); Department of Cardiology, Hospital General Universitari Vall d'Hebron, Universitat Autonoma de Barcelona, Barcelona, Spain (G.T.-T.); Division of Cardiovascular Medicine, University of Louisville School of Medicine, KY (A.C.); and Division of Cardiovascular Medicine, Department of Internal Medicine, Wake Forest University, Winston-Salem, NC (S.V., W.G.H.)
| | - Colin O Wu
- From the Department of Radiology and Imaging Sciences, National Institutes of Health (NIH), Bethesda, MD (C.-Y.L., D.A.B.); Department of Radiology, Johns Hopkins Hospital, Baltimore, MD (D.C., D.A.B., J.A.C.L.); Office of Biostatistics Research, National Heart, Lung, and Blood Institutes (NHLBI), Bethesda, MD (C.O.W.); Department of Cardiology, Hospital General Universitari Vall d'Hebron, Universitat Autonoma de Barcelona, Barcelona, Spain (G.T.-T.); Division of Cardiovascular Medicine, University of Louisville School of Medicine, KY (A.C.); and Division of Cardiovascular Medicine, Department of Internal Medicine, Wake Forest University, Winston-Salem, NC (S.V., W.G.H.)
| | - Gisela Teixido-Tura
- From the Department of Radiology and Imaging Sciences, National Institutes of Health (NIH), Bethesda, MD (C.-Y.L., D.A.B.); Department of Radiology, Johns Hopkins Hospital, Baltimore, MD (D.C., D.A.B., J.A.C.L.); Office of Biostatistics Research, National Heart, Lung, and Blood Institutes (NHLBI), Bethesda, MD (C.O.W.); Department of Cardiology, Hospital General Universitari Vall d'Hebron, Universitat Autonoma de Barcelona, Barcelona, Spain (G.T.-T.); Division of Cardiovascular Medicine, University of Louisville School of Medicine, KY (A.C.); and Division of Cardiovascular Medicine, Department of Internal Medicine, Wake Forest University, Winston-Salem, NC (S.V., W.G.H.)
| | - Atul Chugh
- From the Department of Radiology and Imaging Sciences, National Institutes of Health (NIH), Bethesda, MD (C.-Y.L., D.A.B.); Department of Radiology, Johns Hopkins Hospital, Baltimore, MD (D.C., D.A.B., J.A.C.L.); Office of Biostatistics Research, National Heart, Lung, and Blood Institutes (NHLBI), Bethesda, MD (C.O.W.); Department of Cardiology, Hospital General Universitari Vall d'Hebron, Universitat Autonoma de Barcelona, Barcelona, Spain (G.T.-T.); Division of Cardiovascular Medicine, University of Louisville School of Medicine, KY (A.C.); and Division of Cardiovascular Medicine, Department of Internal Medicine, Wake Forest University, Winston-Salem, NC (S.V., W.G.H.)
| | - Sujethra Vasu
- From the Department of Radiology and Imaging Sciences, National Institutes of Health (NIH), Bethesda, MD (C.-Y.L., D.A.B.); Department of Radiology, Johns Hopkins Hospital, Baltimore, MD (D.C., D.A.B., J.A.C.L.); Office of Biostatistics Research, National Heart, Lung, and Blood Institutes (NHLBI), Bethesda, MD (C.O.W.); Department of Cardiology, Hospital General Universitari Vall d'Hebron, Universitat Autonoma de Barcelona, Barcelona, Spain (G.T.-T.); Division of Cardiovascular Medicine, University of Louisville School of Medicine, KY (A.C.); and Division of Cardiovascular Medicine, Department of Internal Medicine, Wake Forest University, Winston-Salem, NC (S.V., W.G.H.)
| | - João A C Lima
- From the Department of Radiology and Imaging Sciences, National Institutes of Health (NIH), Bethesda, MD (C.-Y.L., D.A.B.); Department of Radiology, Johns Hopkins Hospital, Baltimore, MD (D.C., D.A.B., J.A.C.L.); Office of Biostatistics Research, National Heart, Lung, and Blood Institutes (NHLBI), Bethesda, MD (C.O.W.); Department of Cardiology, Hospital General Universitari Vall d'Hebron, Universitat Autonoma de Barcelona, Barcelona, Spain (G.T.-T.); Division of Cardiovascular Medicine, University of Louisville School of Medicine, KY (A.C.); and Division of Cardiovascular Medicine, Department of Internal Medicine, Wake Forest University, Winston-Salem, NC (S.V., W.G.H.)
| | - W Gregory Hundley
- From the Department of Radiology and Imaging Sciences, National Institutes of Health (NIH), Bethesda, MD (C.-Y.L., D.A.B.); Department of Radiology, Johns Hopkins Hospital, Baltimore, MD (D.C., D.A.B., J.A.C.L.); Office of Biostatistics Research, National Heart, Lung, and Blood Institutes (NHLBI), Bethesda, MD (C.O.W.); Department of Cardiology, Hospital General Universitari Vall d'Hebron, Universitat Autonoma de Barcelona, Barcelona, Spain (G.T.-T.); Division of Cardiovascular Medicine, University of Louisville School of Medicine, KY (A.C.); and Division of Cardiovascular Medicine, Department of Internal Medicine, Wake Forest University, Winston-Salem, NC (S.V., W.G.H.).
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Multimodality Imaging of Diseases of the Thoracic Aorta in Adults: From the American Society of Echocardiography and the European Association of Cardiovascular Imaging. J Am Soc Echocardiogr 2015; 28:119-82. [DOI: 10.1016/j.echo.2014.11.015] [Citation(s) in RCA: 409] [Impact Index Per Article: 45.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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Kim HL, Seo JB, Chung WY, Kim SH, Zo JH, Kim MA. The association between ambulatory blood pressure profile and brachial–ankle pulse wave velocity in untreated hypertensive subjects. Blood Press 2014; 24:139-46. [DOI: 10.3109/08037051.2014.986953] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Hack-Lyoung Kim
- Division of Cardiology, Department of Internal Medicine, Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea
| | - Jae-Bin Seo
- Division of Cardiology, Department of Internal Medicine, Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea
| | - Woo-Young Chung
- Division of Cardiology, Department of Internal Medicine, Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea
| | - Sang-Hyun Kim
- Division of Cardiology, Department of Internal Medicine, Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea
| | - Joo-Hee Zo
- Division of Cardiology, Department of Internal Medicine, Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea
| | - Myung-A Kim
- Division of Cardiology, Department of Internal Medicine, Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea
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