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Abstract
Arterial compliance is an important cardiovascular parameter characterizing mechanical and structural properties of arteries and significantly influencing ventricular-arterial coupling. Decreased arterial compliance is associated with several physiological states and pathological processes. Furthermore, arterial compliance is influenced by other cardiovascular parameters even at short time scales. Today, there are numerous noninvasive methods of estimation arterial compliance in vivo introducing some level of confusion about selection of the best method for particular application and measurement setting. In this review, the most common noninvasive methods of arterial compliance estimation are summarized, discussed and categorized. Finally, interpretation of estimated arterial compliance in the context of other possible confounders is discussed.
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Affiliation(s)
- D Švec
- Comenius University in Bratislava, Jessenius Faculty of Medicine in Martin, Department of Physiology, Martin, Slovakia.
| | - M Javorka
- Comenius University in Bratislava, Jessenius Faculty of Medicine in Martin, Department of Physiology, Martin, Slovakia
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102
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Trikha SRJ, Lee DM, Ecton KE, Wrigley SD, Vazquez AR, Litwin NS, Thomas KN, Wei Y, Battson ML, Johnson SA, Kuhn KA, Colgan SP, Gentile CL, Weir TL. Transplantation of an obesity-associated human gut microbiota to mice induces vascular dysfunction and glucose intolerance. Gut Microbes 2021; 13:1940791. [PMID: 34313540 PMCID: PMC8317959 DOI: 10.1080/19490976.2021.1940791] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Recent preclinical data suggest that alterations in the gut microbiota may be an important factor linking obesity to vascular dysfunction, an early sign of cardiovascular disease. The purpose of this study was to begin translation of these preclinical data by examining whether vascular phenotypes in humans are transmissible through the gut microbiota. We hypothesized that germ-free mice colonized with gut microbiota from obese individuals would display diminished vascular function compared to germ-free mice receiving microbiota from lean individuals.We transplanted fecal material from obese and lean age-and sex-matched participants with disparate vascular function to germ-free mice. Using Principle Component Analysis, the microbiota of colonized mice separated by donor group along the first principle component, accounting for between 70-93% of the total variability in the dataset. The microbiota of mice receiving transplants from lean individuals was also characterized by increased alpha diversity, as well as increased relative abundance of potentially beneficial bacteria, including Bifidobacterium, Lactobacillus, and Bacteroides ovatis. Endothelium-dependent dilation, aortic pulse wave velocity and glucose tolerance were significantly altered in mice receiving microbiota from the obese donor relative to those receiving microbiota from the lean donor or those remaining germ-free.These data indicate that the obesity-associated human gut microbiota is sufficient to alter the vascular phenotype in germ-free mice in the absence of differences in body weight or dietary manipulation, and provide justification for future clinical trials to test the efficacy of microbiota-targeted therapies in the prevention or treatment of cardiovascular disease.
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Affiliation(s)
- S. Raj J. Trikha
- Department of Food Science & Human Nutrition, Colorado State University, Fort Collins, CO, USA
| | - Dustin M. Lee
- Department of Nutritional Medicine, Brooke Army Medical Center, San Antonio, TX, USA
| | - Kayl E. Ecton
- Department of Food Science & Human Nutrition, Colorado State University, Fort Collins, CO, USA
| | - Scott D. Wrigley
- Department of Food Science & Human Nutrition, Colorado State University, Fort Collins, CO, USA
| | - Allegra R. Vazquez
- Department of Food Science & Human Nutrition, Colorado State University, Fort Collins, CO, USA
| | - Nicole S. Litwin
- Center for Microbiome Innovation, University of California San Diego, La Jolla, CA, USA
| | - Keely N. Thomas
- Department of Food Science & Human Nutrition, Colorado State University, Fort Collins, CO, USA
| | - Yuren Wei
- Department of Food Science & Human Nutrition, Colorado State University, Fort Collins, CO, USA
| | - Micah L. Battson
- Department of Nutrition, Metropolitan State University, Denver, CO, USA
| | - Sarah A. Johnson
- Department of Food Science & Human Nutrition, Colorado State University, Fort Collins, CO, USA
| | - Kristine A. Kuhn
- School of Medicine in the Division of Rheumatology and Gnotobiotic Core Director, University of Colorado School of Medicine, Aurora, CO, USA
| | - Sean P. Colgan
- School of Medicine in the Division of Gastroenterology and Hepatology, University of Colorado School of Medicine, Aurora, CO, USA
| | - Christopher L. Gentile
- Department of Food Science & Human Nutrition, Colorado State University, Fort Collins, CO, USA,CONTACT Christopher L. Gentile 208 Gifford Bldg, 1571 Campus Delivery, Colorado State University, Fort Collins, CO 80523-1571, USA
| | - Tiffany L. Weir
- Department of Food Science & Human Nutrition, Colorado State University, Fort Collins, CO, USA,Tiffany L. Weir 210 Gifford Bldg, 1571 Campus Delivery, Colorado State University, Fort Collins, CO 80523-1571, USA
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103
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Wei H, Hongwei L, Ying S, Dai Z, Man W. The U-shape relationship between pulse pressure level on inpatient admission and long-term mortality in acute coronary syndrome patients undergoing percutaneous coronary intervention. J Clin Hypertens (Greenwich) 2021; 24:58-66. [PMID: 34882954 PMCID: PMC8783356 DOI: 10.1111/jch.14408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Revised: 11/18/2021] [Accepted: 11/20/2021] [Indexed: 11/30/2022]
Abstract
The association between pulse pressure and long-term mortality was investigated among acute coronary syndrome (ACS) patients who received percutaneous coronary intervention (PCI). The study population included 5055 ACS patients in the Department of Cardiology of Beijing Friendship Hospital who were enrolled from January 2013 to July 2019. The median duration of follow-up was 24 months. Multivariate Cox regression was used to analyze the relationships between PP on inpatient admission and mortalities. Non-linear associations were studied by restricted cubic splines. Considering the heart function, the analyses were performed in the whole cohort and the LVEF > = 0.5 cohort separately. Subgroup analyses were performed according to the different diagnosis (the myocardial infarction subgroup and the unstable angina pectoris subgroup). When PP was used as categorical variable, the high PP group (≥61 mm Hg) significantly increased the risk of death compared with the intermediate PP group (50-60 mm Hg) in the both cohorts. When PP was used as continuous variable, a U-shape relationship were found between PP and mortalities in the whole cohort (p (for nonlinearity) = .005 and .003, respectively), with reference PP level of 55 mm Hg. However, this U-shape relationship disappeared in the LVEF > 0.5 cohort (p (for nonlinearity) = .111 and .117, respectively). The similar results were obtained in MI subgroup. From this study, the U-shape relationships between PP level and all-cause and cardiac mortalities were found in ACS patients who underwent PCI. The U-shape relationships disappeared in the LVEF > 0.5 cohort. The reference PP level was 55 mm Hg.
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Affiliation(s)
- Huang Wei
- Department of Geriatrics and Gerontology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Li Hongwei
- Department of Geriatrics and Gerontology, Beijing Friendship Hospital, Capital Medical University, Beijing, China.,Cardiovascular Center, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Sun Ying
- Department of Geriatrics and Gerontology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Zhang Dai
- Department of Geriatrics and Gerontology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Wang Man
- Cardiovascular Center, Beijing Friendship Hospital, Capital Medical University, Beijing, China
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104
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Jeon KH, Kim HL, Lim WH, Seo JB, Kim SH, Zo JH, Kim MA. Associations between measurements of central blood pressure and target organ damage in high-risk patients. Clin Hypertens 2021; 27:23. [PMID: 34847966 PMCID: PMC8638411 DOI: 10.1186/s40885-021-00179-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Accepted: 09/09/2021] [Indexed: 11/17/2022] Open
Abstract
Background It is not well-known which components of central blood pressure (CBP) are more influential to target organ damage (TOD). This study aimed to determine the relationship between CBP measurements and various types of TOD in high-risk patients. Methods A total of 148 patients who had documented atherosclerotic cardiovascular disease or its multiple risk factors were prospectively enrolled. CBP was measured by using applanation tonometry of the radial artery. The following nine TOD parameters were evaluated: left ventricular mass index, relative wall thickness, septal e′ velocity, septal E/e′, brachial-ankle pulse wave velocity, ankle-brachial index, estimated glomerular filtration rate, urine protein and obstructive coronary artery disease. Results The mean age of the study population was 67.1 ± 9.0 years and 108 (73 %) were male. Among four CBP measurements (systolic, diastolic, mean, and pulse pressures), central pulse pressure (CPP) was associated with the largest number of TOD parameters. As CPP increased, the number of TOD increased (P = 0.010), but this association was not observed in other CBP measurements (P > 0.05 for each). Conclusions CPP had a stronger correlation with TOD than other CBP measurements. Non-invasive CPP could be a useful indicator for predicting TOD in patients at high coronary risk.
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Affiliation(s)
- Ki-Hyun Jeon
- Cardiovascular center, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Hack-Lyoung Kim
- Division of Cardiology, Department of Internal Medicine, SMG-SNU Boramae Medical Center, Seoul, Republic of Korea.
| | - Woo-Hyun Lim
- Division of Cardiology, Department of Internal Medicine, SMG-SNU Boramae Medical Center, Seoul, Republic of Korea
| | - Jae-Bin Seo
- Division of Cardiology, Department of Internal Medicine, SMG-SNU Boramae Medical Center, Seoul, Republic of Korea
| | - Sang-Hyun Kim
- Division of Cardiology, Department of Internal Medicine, SMG-SNU Boramae Medical Center, Seoul, Republic of Korea
| | - Joo-Hee Zo
- Division of Cardiology, Department of Internal Medicine, SMG-SNU Boramae Medical Center, Seoul, Republic of Korea
| | - Myung-A Kim
- Division of Cardiology, Department of Internal Medicine, SMG-SNU Boramae Medical Center, Seoul, Republic of Korea
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105
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Liu J, Su X, Nie Y, Zeng Z, Chen H. Dosing Time Matters? Nighttime vs. Daytime Administration of Nifedipine Gastrointestinal Therapeutic System (GITS) or Amlodipine on Non-dipper Hypertension: A Randomized Controlled Trial of NARRAS. Front Cardiovasc Med 2021; 8:755403. [PMID: 34912861 PMCID: PMC8666540 DOI: 10.3389/fcvm.2021.755403] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2021] [Accepted: 11/04/2021] [Indexed: 12/22/2022] Open
Abstract
Background: Non-dipper hypertension is often characterized by a blunted decrease of nocturnal blood pressure (BP) and is associated with increased risk of target organ damage and cardiovascular (CV) events, while the optimal treatment strategy is yet to be established. This trial was designed to evaluate whether nocturnal BP reduction and arterial stiffness improvement differ from antihypertensive agents and time of administration. Methods: Young and middle-aged adults (18-65 years) with non-dipper hypertension were randomly assigned to nifedipine GITS (gastrointestinal therapeutic system) 30 mg or amlodipine besylate 5 mg once daily for 8 weeks, either taken in the morning or at night. Dose was doubled at 4-week if BP is not at goal. Twenty-four hour ambulatory BP monitoring (ABPM) and arterial stiffness were evaluated before and after 8 weeks of pharmacotherapy. The primary efficacy measure was the average nighttime systolic BP reduction. Results: A total of 98 non-dipper hypertensive patients (mean age 46.3 years) were randomized during Dec, 2016 and Dec, 2020, of whom 72 (73%) patients completed all ABPM and follow-up evaluations. Nighttime systolic BP significantly reduced at 8 weeks vs. baseline with nifedipine GITS or amlodipine, irrespective of dosing at nighttime (-9.9 vs -9.9 mmHg, P > 0.05) or daytime (-11.5 vs. -10.9 mmHg, P > 0.05). No difference was seen between these two agents, when combining the data of nighttime and daytime dosing together (-10.8 vs. -10.5 mmHg, respectively, P = 0.898). Daytime, 24-h systolic BP, diastolic BP at different time and pulse wave velocity reduced significantly and comparably, and recovery of dipping rhythm were similar among groups. Conclusion: Nighttime dosing of long-acting antihypertensive preparations, nifedipine GITS or amlodipine demonstrated similar effects on nocturnal BP reduction, dipping rhythm restoration and arterial elasticity improvement in younger subjects with non-dipper hypertension. These effects were comparable with morning dosing.
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Affiliation(s)
- Jing Liu
- Department of Cardiology, Peking University People's Hospital, Beijing, China
| | - Xiaofeng Su
- Department of Cardiology, Peking University People's Hospital, Beijing, China
| | - Ying Nie
- Department of Internal Medicine, Beijing Jiaotong University Hospital, Beijing, China
| | - Zhihuan Zeng
- Department of Cardiology, The First Affiliated Hospital of Guangdong Pharmaceutical University, Guangzhou, China
| | - Hongyan Chen
- Department of Internal Medicine, North China Electric Power University Hospital, Beijing, China
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106
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Angoff R, Mosarla RC, Tsao CW. Aortic Stiffness: Epidemiology, Risk Factors, and Relevant Biomarkers. Front Cardiovasc Med 2021; 8:709396. [PMID: 34820427 PMCID: PMC8606645 DOI: 10.3389/fcvm.2021.709396] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Accepted: 09/30/2021] [Indexed: 12/19/2022] Open
Abstract
Aortic stiffness (AoS) is a maladaptive response to hemodynamic stress and both modifiable and non-modifiable risk factors, and elevated AoS increases afterload for the heart. AoS is a non-invasive marker of cardiovascular health and metabolic dysfunction. Implementing AoS as a diagnostic tool is challenging as it increases with age and varies amongst races. AoS is associated with lifestyle factors such as alcohol and smoking, as well as hypertension and comorbid conditions including metabolic syndrome and its components. Multiple studies have investigated various biomarkers associated with increased AoS, and this area is of particular interest given that these markers can highlight pathophysiologic pathways and specific therapeutic targets in the future. These biomarkers include those involved in the inflammatory cascade, anti-aging genes, and the renin-angiotensin aldosterone system. In the future, targeting AoS rather than blood pressure itself may be the key to improving vascular health and outcomes. In this review, we will discuss the current understanding of AoS, measurement of AoS and the challenges in interpretation, associated biomarkers, and possible therapeutic avenues for modulation of AoS.
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Affiliation(s)
- Rebecca Angoff
- Cardiovascular Division, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, United States
| | - Ramya C Mosarla
- Division of Cardiology, Department of Medicine, New York University Langone Health, New York, NY, United States
| | - Connie W Tsao
- Cardiovascular Division, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, United States
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107
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Zhou H, Pu S, Zhou H, Guo Y. Klotho as Potential Autophagy Regulator and Therapeutic Target. Front Pharmacol 2021; 12:755366. [PMID: 34737707 PMCID: PMC8560683 DOI: 10.3389/fphar.2021.755366] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2021] [Accepted: 10/07/2021] [Indexed: 12/22/2022] Open
Abstract
The protein Klotho can significantly delay aging, so it has attracted widespread attention. Abnormal downregulation of Klotho has been detected in several aging-related diseases, such as Alzheimer’s disease, kidney injury, cancer, chronic obstructive pulmonary disease (COPD), vascular disease, muscular dystrophy and diabetes. Conversely, many exogenous and endogenous factors, several drugs, lifestyle changes and genetic manipulations were reported to exert therapeutic effects through increasing Klotho expression. In recent years, Klotho has been identified as a potential autophagy regulator. How Klotho may contribute to reversing the effects of aging and disease became clearer when it was linked to autophagy, the process in which eukaryotic cells clear away dysfunctional proteins and damaged organelles: the abovementioned diseases involve abnormal autophagy. Interestingly, growing evidence indicates that Klotho plays a dual role as inducer or inhibitor of autophagy in different physiological or pathological conditions through its influence on IGF-1/PI3K/Akt/mTOR signaling pathway, Beclin 1 expression and activity, as well as aldosterone level, which can help restore autophagy to beneficial levels. The present review examines the role of Klotho in regulating autophagy in Alzheimer’s disease, kidney injury, cancer, COPD, vascular disease, muscular dystrophy and diabetes. Targeting Klotho may provide a new perspective for preventing and treating aging-related diseases.
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Affiliation(s)
- Hongjing Zhou
- Department of Pharmacy, Chengdu Fifth People's Hospital, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Shiyun Pu
- Department of Pharmacy, Chengdu Fifth People's Hospital, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Houfeng Zhou
- Department of Pharmacy, Chengdu Fifth People's Hospital, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Yuanxin Guo
- Department of Pharmacy, Chengdu Fifth People's Hospital, Chengdu University of Traditional Chinese Medicine, Chengdu, China
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108
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Vasan RS, Song RJ, Xanthakis V, Mitchell GF. Aortic Root Diameter and Arterial Stiffness: Conjoint Relations to the Incidence of Cardiovascular Disease in the Framingham Heart Study. Hypertension 2021; 78:1278-1286. [PMID: 34601969 PMCID: PMC8516742 DOI: 10.1161/hypertensionaha.121.17702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Accepted: 08/23/2021] [Indexed: 11/16/2022]
Abstract
[Figure: see text].
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Affiliation(s)
- Ramachandran S. Vasan
- Section of Preventive Medicine and Epidemiology, Boston University School of Medicine, Boston, MA
- Framingham Heart Study, Framingham, MA
- Department of Epidemiology, Boston University School of Public Health, Boston, MA
| | - Rebecca J. Song
- Department of Epidemiology, Boston University School of Public Health, Boston, MA
| | - Vanessa Xanthakis
- Section of Preventive Medicine and Epidemiology, Boston University School of Medicine, Boston, MA
- Framingham Heart Study, Framingham, MA
- Department of Biostatistics, Boston University School of Public Health, Boston, MA
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109
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Kim HL, Weber T. Pulsatile Hemodynamics and Coronary Artery Disease. Korean Circ J 2021; 51:881-898. [PMID: 34595882 PMCID: PMC8558570 DOI: 10.4070/kcj.2021.0227] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Revised: 07/22/2021] [Accepted: 07/26/2021] [Indexed: 12/12/2022] Open
Abstract
Coronary artery disease (CAD) is the leading cause of human death and has a high prevalence throughout the world. Therefore, it is important to detect CAD early and to apply individualized therapy according to the patients' risk. There is an increasing interest in pulsatile arterial hemodynamics in the cardiovascular area. Widely used measurements of arterial pulsatile hemodynamics include pulse pressure, pulse wave velocity and augmentation index. Here, we will review underlying pathophysiology linking the association of arterial pulsatile hemodynamics with CAD, and the usefulness of the measurements of pulsatile hemodynamics in the prediction of future cardiovascular events of CAD patients. Clinical and therapeutic implications will be also addressed.
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Affiliation(s)
- Hack-Lyoung Kim
- Division of Cardiology, Department of Internal Medicine, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea
| | - Thomas Weber
- Department of Cardiology, Klinikum Wels-Grieskirchen GmbH, Wels, Austria.
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110
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Kim HL, Lim WH, Seo JB, Kim SH, Zo JH, Kim MA. Prognostic value of arterial stiffness according to the cardiovascular risk profiles. J Hum Hypertens 2021; 35:978-984. [PMID: 33184487 DOI: 10.1038/s41371-020-00441-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2020] [Revised: 09/27/2020] [Accepted: 10/28/2020] [Indexed: 02/03/2023]
Abstract
It is not clear whether the influence of arterial stiffness depends on the subject's cardiovascular risk status. This study was performed to assess the prognostic value of arterial stiffness according to different cardiovascular risk profiles. A total of 11,767 subjects (61 years and 58% males) who underwent brachial-ankle pulse wave velocity (baPWV) measurement were retrospectively analyzed. Subjects were stratified into three groups: (1) those with traditional risk factor ≤1 and without atherosclerotic cardiovascular disease (ASCVD), (2) those with traditional risk factors ≥2 and without ASCVD, or (3) those with documented ASCVD. Composite events of cardiac death, non-fatal myocardial infarction, coronary revascularization and stroke were assessed during the clinical follow-up period. Compared to patients with risk factor ≤1, those with risk factor ≥2 and those with ASCVD were older, and more frequently had unfavorable laboratory findings, and higher baPWV values. During the median follow-up of 1329 days (interquartile range, 570-1,965 days), there were 350 composite events (3.0%). In multivariable Cox regression analyses, higher baPWV value was independently associated with higher incidence rate of composite events even after controlling for potential confounders in all three groups (P < 0.05 for each). In this study, it was found that baPWV was independently associated with the occurrence of cardiovascular events irrespective of baseline cardiovascular risk profiles, suggesting that baPWV is useful for risk stratification in mass screening.
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Affiliation(s)
- Hack-Lyoung Kim
- Division of Cardiology, Department of Internal Medicine, Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea.
| | - Woo-Hyun Lim
- 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
| | - 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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111
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Smooth muscle 22 alpha protein inhibits VSMC foam cell formation by supporting normal LXRα signaling, ameliorating atherosclerosis. Cell Death Dis 2021; 12:982. [PMID: 34686657 PMCID: PMC8536684 DOI: 10.1038/s41419-021-04239-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Revised: 09/11/2021] [Accepted: 09/29/2021] [Indexed: 12/31/2022]
Abstract
Vascular smooth muscle cells (VSMCs) are indispensable components in foam cell formation in atherosclerosis. However, the mechanism behind foam cell formation of VSMCs has not been addressed. We found a potential association between deletion of smooth muscle (SM) 22α and deregulated nuclear receptors liver X receptors (LXRs)/retinoid X receptor (RXR) signaling in mice. Here, we investigated the roles of SM22α in LXRα-modulated cholesterol homeostasis, and explore possible mechanisms underlying this process. We identified that the depletion of SM22α was a primary event driving VSMC cholesterol accumulation and the development of atherosclerosis in mice. Proteomic and lipidomic analysis validated that downregulation of SM22α was correlated with reduced expression of LXRα and ATP-binding cassette transporter (ABCA) 1 and increased cholesteryl ester in phenotypically modulated VSMCs induced by platelets-derived growth factor (PDGF)-BB. Notably, LXRα was mainly distributed in the cytoplasm rather than the nucleus in the neointimal and Sm22α-/- VSMCs. Loss of SM22α inhibited the nuclear import of LXRα and reduced ABCA1-mediated cholesterol efflux via promoting depolymerization of actin stress fibers. Affinity purification and mass spectrometry (AP-MS) analysis, co-immunoprecipitation and GST pull-down assays, confocal microscopy, and stochastic optical reconstruction microscopy (STORM) revealed that globular-actin (G-actin), monomeric actin, interacted with and retained LXRα in the cytoplasm in PDGF-BB-treated and Sm22α-/- VSMCs. This interaction blocked LXRα binding to Importin α, a karyopherin that mediates the trafficking of macromolecules across the nuclear envelope, and the resulting reduction of LXRα transcriptional activity. Increasing SM22α expression restored nuclear localization of LXRα and removed cholesterol accumulation via inducing actin polymerization, ameliorating atherosclerosis. Our findings highlight that LXRα is a mechanosensitive nuclear receptor and that the nuclear import of LXRα maintained by the SM22α-actin axis is a potential target for blockade of VSMC foam cell formation and development of anti-atherosclerosis.
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112
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Association between body fat parameters and arterial stiffness. Sci Rep 2021; 11:20536. [PMID: 34654852 PMCID: PMC8519992 DOI: 10.1038/s41598-021-00175-z] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Accepted: 09/23/2021] [Indexed: 11/17/2022] Open
Abstract
The influence of body fat on arterial stiffness remains controversial. This study was performed to investigate the associations between four different types of body fat parameters and brachial-ankle pulse wave velocity (baPWV). A total of 3758 subjects (mean age, 53.4 ± 8.8 years; females, 36.3%) who underwent health check-up were retrospectively analyzed. Anthropometric parameters including body mass index (BMI), waist circumference (WC) and waist–hip ratio (WHR) were assessed, and visceral fat area (VFA) was calculated by bioelectrical impedance analysis. In simple linear correlation analyses, baPWV was associated with WC, WHR and VFA (P < 0.001 for each), but not with BMI (P = 0.175). In multivariable analyses, BMI and WC were not associated with baPWV (P > 0.05 for each). Even after controlling for potential confounders, higher baPWV was significantly associated not only with higher WHR [for > 0.90 in men and > 0.85 in women: odds ratio (OR), 1.23; 95% confidence interval (CI), 1.06–1.42; P = 0.005; for the highest tertile compared to the lowest tertile: OR, 1.38; 95% CI, 1.15–1.66; P < 0.001], but also with higher VFA (for ≥ 100 cm2: OR, 1.39; 95% CI, 1.20–1.60; P < 0.001; for the highest tertile compared to the lowest tertile: OR, 1.77; 95% CI, 1.48–2.12; P < 0.001). Our study showed that baPWV was correlated with WHR and VFA, but not with BMI and WC. This implies that arterial stiffness may be more strongly associated with abdominal obesity than overall obesity.
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113
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Sultan S, Acharya Y, Hazima M, Salahat H, Parodi JC, Hynes N. Combined thoracic endovascular aortic repair and endovascular aneurysm repair and the long-term consequences of altered cardiovascular haemodynamics on morbidity and mortality: case series and literature review. EUROPEAN HEART JOURNAL-CASE REPORTS 2021; 5:ytab339. [PMID: 34622129 PMCID: PMC8493011 DOI: 10.1093/ehjcr/ytab339] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Revised: 05/18/2021] [Accepted: 08/13/2021] [Indexed: 11/14/2022]
Abstract
Background Thoracic and abdominal aortic stent grafts are firmer and more rigid than the native aorta. Aortic implanted devices have been implicated in the development of acute systolic hypertension, elevated pulse pressure, and reduced coronary perfusion. Case summary We report four cases of staged thoracic endovascular aortic repair (TEVAR) and then endovascular aneurysm repair (EVAR). All patients had TEVAR first for thoracic aortic aneurysm and later on developed infra-renal abdominal aortic aneurysm (AAA) that required EVAR. There were three males and one female with a median age of 74.5 years (range 67.5-78.5). None of the patients developed aortic-related major clinical adverse effects or required any aortic intervention during their follow-up. However, within 2 years, all patients developed symptomatic left ventricular hypertrophy with diastolic dysfunction. All patients had bilateral lower limb oedema, with on and off chest pain and shortness of breath (SOB), necessitating coronary angiograms, which showed no evidence of coronary artery disease. Three patients died from cardiovascular-related morbidities, and the fourth patient is still complaining of SOB despite a normal coronary angiogram. Discussion Aortic-endograft compliance mismatch is an invisible enemy, with troubling consequences for the aorta proximal and distal to the endograft. Aortic stiffness due to vascular endograft could lead to cardiovascular adverse events, even in the absence of direct aortic-related complications. After combined TEVAR and EVAR, the compliance mismatch and elasticity loss are even more pronounced than with TEVAR alone, which necessitates patient monitoring for the development of cardiovascular complications.
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Affiliation(s)
- Sherif Sultan
- Western Vascular Institute, Department of Vascular and Endovascular Surgery, University Hospital Galway, National University of Ireland, Newcastle Road, Galway H91 YR71, Ireland.,Department of Vascular and Endovascular Surgery, Galway Clinic, Doughiska, Royal College of Surgeons in Ireland and the National University of Ireland, Galway Affiliated Hospital, Ireland
| | - Yogesh Acharya
- Western Vascular Institute, Department of Vascular and Endovascular Surgery, University Hospital Galway, National University of Ireland, Newcastle Road, Galway H91 YR71, Ireland.,Department of Vascular and Endovascular Surgery, Galway Clinic, Doughiska, Royal College of Surgeons in Ireland and the National University of Ireland, Galway Affiliated Hospital, Ireland
| | - Mohiey Hazima
- Western Vascular Institute, Department of Vascular and Endovascular Surgery, University Hospital Galway, National University of Ireland, Newcastle Road, Galway H91 YR71, Ireland
| | - Hiba Salahat
- Department of Vascular and Endovascular Surgery, Galway Clinic, Doughiska, Royal College of Surgeons in Ireland and the National University of Ireland, Galway Affiliated Hospital, Ireland
| | - Juan Carlos Parodi
- Department of Vascular Surgery and Biomedical Engineering Department, Alma mater, University of Buenos Aires, Wake Forest University, Washington University in St. Louis, and Trinidad Hospital, Buenos Aires, Argentina
| | - Niamh Hynes
- Department of Vascular and Endovascular Surgery, Galway Clinic, Doughiska, Royal College of Surgeons in Ireland and the National University of Ireland, Galway Affiliated Hospital, Ireland
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114
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Ichikawa N, Shiina Y, Kijima Y, Kodama H, Abe K, Komiyama N, Niwa K. Characteristics of the aortic root morphology in conotruncal anomaly of the congenital heart disease. J Cardiol 2021; 79:277-282. [PMID: 34600781 DOI: 10.1016/j.jjcc.2021.09.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2021] [Revised: 08/17/2021] [Accepted: 09/04/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Aortopathy is a well-known feature of conotruncal anomalies, but it remains unknown whether valve-sparing aortic root replacement, such as the David procedure, is feasible in young patients with severe aortic regurgitation. We assessed the aortic valve complex and aortic root morphology in patients with conotruncal anomalies using echocardiography. Furthermore, we evaluated the relevant factors associated with aortopathy in this population. METHODS A total of 172 adult patients with conotruncal anomalies were enrolled in this study. Dimensions of the aortic valve complex were measured at the level of the sinus of Valsalva (SV) and sinotubular junction (STJ). The geometric height (GH), effective height (EH), and coaptation length (CL) were also assessed to analyze the aortic valve complex in detail. RESULTS Sixteen of 172 patients were excluded due to poor imaging; 105 patients with tetralogy of Fallot, 24 with double outlet right ventricle, and 27 with transposition of the great arteries totaling 156 patients (32+/-11 years old) were included in the analysis. The patients were divided into four groups: Group 1 (98 patients) had no dilatation of SV or STJ; Group 2 (32 patients) had dilated SV and STJ; Group 3 (14 patients) had dilated SV; and Group 4 (12 patients) had dilated STJ. GH and EH in Group 2 were also highest among the four, whereas CL was not significantly shortened. Multivariate analysis revealed that male sex, age, and conduit repair were risk factors for aortopathy in this population. CONCLUSIONS Patients with dilated SV and STJ (Group 2) were the most common among the patients with aortopathy (Groups 2, 3, and 4). The aortic valve leaflets themselves were enlarged, and the poor coaptation of the valve tips was compensated in spite of aortic root dilatation, which plays an important role in preventing severe aortic regurgitation in this population. Overall, valve-sparing aortic valve replacement is more feasible in the young populations than we expected.
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Affiliation(s)
- Naoko Ichikawa
- Clinical Laboratory, St. Luke's International Hospital, Tokyo, Japan
| | - Yumi Shiina
- Cardiovascular center, St. Luke's International Hospital, Tokyo, Japan.
| | - Yasufumi Kijima
- Cardiovascular center, St. Luke's International Hospital, Tokyo, Japan
| | - Hiroyuki Kodama
- Cardiovascular center, St. Luke's International Hospital, Tokyo, Japan
| | - Kohei Abe
- Department of Cardiovascular Surgery, St. Luke's International Hospital, Tokyo, Japan
| | - Nobuyuki Komiyama
- Cardiovascular center, St. Luke's International Hospital, Tokyo, Japan
| | - Koichiro Niwa
- Cardiovascular center, St. Luke's International Hospital, Tokyo, Japan
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115
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Lester GR, Abiusi FS, Bodner ME, Mittermaier PM, Cote AT. The Impact of Fitness Status on Vascular and Baroreceptor Function in Healthy Women and Men. J Vasc Res 2021; 59:16-23. [PMID: 34571505 DOI: 10.1159/000518985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Accepted: 08/10/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Chronic endurance exercise training elicits desirable physiological adaptations in the cardiovascular system. The volume of exercise training required to generate healthy adaptations is unclear. This study assessed the effects of differing exercise training levels on arterial stiffness, compliance, and autonomic function. METHODS Eighty healthy adults (38.5 ± 9.7 years; 44% female) defined as endurance-trained (ET, n = 29), normally active (NA, n = 27), or inactive (IN, n = 24) participated. Cardiovascular markers, including hemodynamics, large arterial compliance and small arterial compliance (LAC and SAC), carotid-femoral pulse wave velocity (PWV), and spontaneous baroreceptor sensitivity (BRS) were assessed. RESULTS ET showed significantly greater LAC values (21.4 ± 6.5) than NA (16.9 ± 2.5; p = 0.002) and IN (14.7 ± 3.2 mL × mm Hg × 10; p = 0.028). Values for SAC and BRS were significantly higher in ET than IN (p < 0.001 and p = 0.028, respectively), but not NA. Compared to IN, PWV values for ET and NA were significantly lower (p < 0.003). After adjusting for covariates (age, sex, and SBP), significant associations with cardiovascular fitness status were noted for all markers but BRS. CONCLUSION Endurance exercise increases LAC likely due to high-volume training; however, lower volumes of physical activity may be sufficient to positively benefit vascular health overall.
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Affiliation(s)
- Garth R Lester
- Faculty of Natural & Applied Sciences, Trinity Western University, Langley, British Columbia, Canada
| | - Francesca S Abiusi
- Faculty of Natural & Applied Sciences, Trinity Western University, Langley, British Columbia, Canada
| | - Michael E Bodner
- School of Human Kinetics, Trinity Western University, Langley, British Columbia, Canada
| | - Peter M Mittermaier
- Faculty of Natural & Applied Sciences, Trinity Western University, Langley, British Columbia, Canada
| | - Anita T Cote
- School of Human Kinetics, Trinity Western University, Langley, British Columbia, Canada.,Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
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116
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Lechner I, Reindl M, Tiller C, Holzknecht M, Niederreiter S, Mayr A, Klug G, Brenner C, Bauer A, Metzler B, Reinstadler SJ. Determinants and prognostic relevance of aortic stiffness in patients with recent ST-elevation myocardial infarction. Int J Cardiovasc Imaging 2021; 38:237-247. [PMID: 34476665 PMCID: PMC8818631 DOI: 10.1007/s10554-021-02383-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2021] [Accepted: 08/16/2021] [Indexed: 12/29/2022]
Abstract
The association between aortic stiffness, cardiovascular risk factors and prognosis in patients with recent ST-elevation myocardial infarction (STEMI) is poorly understood. We analyzed the relationship between cardiovascular risk factors and arterial stiffening and assessed its prognostic significance in patients with recent STEMI. We prospectively enrolled 408 consecutive patients who sustained a first STEMI and underwent primary percutaneous coronary intervention (PPCI). Aortic pulse wave velocity (PWV), the most widely used measure of aortic stiffness, was determined by the transit-time method using velocity-encoded, phase-contrast cardiac magnetic resonance imaging. Patient characteristics were acquired at baseline and major adverse cardiac and cerebrovascular events (MACCE) were assessed at 13 [interquartile range (IQR) 12–31] months. Cox regression- and logistic regression analysis were performed to explore predictors of aortic stiffness and MACCE. Median aortic PWV was 6.6 m/s (IQR 5.6–8.3 m/s). In multivariable analysis, age [odds ratio (OR) 1.10, 95% confidence interval (CI), 1.08–1.14, p < 0.001] and hypertension (OR 2.45, 95% CI, 1.53–3.91, p < 0.001) were independently associated with increased PWV. Sex, diabetes, smoking status, dyslipidemia, and obesity were not significantly associated with PWV in adjusted analysis (all p > 0.05). High PWV significantly and independently predicted occurrence of MACCE in adjusted analysis [hazard ratio (HR) 2.45, 95% CI 1.19–5.04, p = 0.014]. In patients with recent STEMI, the impact of classical cardiovascular risk factors on aortic stiffness is mainly dependent on age and increased blood pressure. Increased aortic stiffness is associated with adverse clinical outcome post-STEMI, suggesting it as a relevant therapeutic target in this population. Trial (NCT04113356).
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Affiliation(s)
- Ivan Lechner
- University Clinic of Internal Medicine III, Cardiology and Angiology, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
| | - Martin Reindl
- University Clinic of Internal Medicine III, Cardiology and Angiology, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
| | - Christina Tiller
- University Clinic of Internal Medicine III, Cardiology and Angiology, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
| | - Magdalena Holzknecht
- University Clinic of Internal Medicine III, Cardiology and Angiology, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
| | - Sarah Niederreiter
- University Clinic of Internal Medicine III, Cardiology and Angiology, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
| | - Agnes Mayr
- Department of Radiology, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
| | - Gert Klug
- University Clinic of Internal Medicine III, Cardiology and Angiology, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
| | - Christoph Brenner
- University Clinic of Internal Medicine III, Cardiology and Angiology, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
| | - Axel Bauer
- University Clinic of Internal Medicine III, Cardiology and Angiology, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
| | - Bernhard Metzler
- University Clinic of Internal Medicine III, Cardiology and Angiology, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
| | - Sebastian Johannes Reinstadler
- University Clinic of Internal Medicine III, Cardiology and Angiology, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria.
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Abstract
Marfan syndrome (MFS) is an autosomal dominant, age-related but highly penetrant condition with substantial intrafamilial and interfamilial variability. MFS is caused by pathogenetic variants in FBN1, which encodes fibrillin-1, a major structural component of the extracellular matrix that provides support to connective tissues, particularly in arteries, the pericondrium and structures in the eye. Up to 25% of individuals with MFS have de novo variants. The most prominent manifestations of MFS are asymptomatic aortic root aneurysms, aortic dissections, dislocation of the ocular lens (ectopia lentis) and skeletal abnormalities that are characterized by overgrowth of the long bones. MFS is diagnosed based on the Ghent II nosology; genetic testing confirming the presence of a FBN1 pathogenetic variant is not always required for diagnosis but can help distinguish MFS from other heritable thoracic aortic disease syndromes that can present with skeletal features similar to those in MFS. Untreated aortic root aneurysms can progress to life-threatening acute aortic dissections. Management of MFS requires medical therapy to slow the rate of growth of aneurysms and decrease the risk of dissection. Routine surveillance with imaging techniques such as transthoracic echocardiography, CT or MRI is necessary to monitor aneurysm growth and determine when to perform prophylactic repair surgery to prevent an acute aortic dissection.
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118
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González-Clemente JM, Cano A, Albert L, Giménez-Palop O, Romero A, Berlanga E, Vendrell J, Llauradó G. Arterial Stiffness in Type 1 Diabetes: The Case for the Arterial Wall Itself as a Target Organ. J Clin Med 2021; 10:3616. [PMID: 34441912 PMCID: PMC8397115 DOI: 10.3390/jcm10163616] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Revised: 08/07/2021] [Accepted: 08/09/2021] [Indexed: 12/11/2022] Open
Abstract
Arterial stiffness (AS) integrates the cumulative burden of known and unknown cardiovascular risk factors on the elastic wall of large arteries along the lifespan of an individual. As a marker of vascular aging, AS is an independent predictor of cardiovascular events and improves cardiovascular risk prediction when added to the Framingham Risk Score. In addition, AS may affect the microvasculature and promote the development of microvascular complications. Its impact on both the macro- and microvasculature has led to the concept that the arterial wall itself should be considered as a target organ. Here, we review the biological and clinical consequences of AS on the macro- and microvasculature and the measurement of AS in routine clinical practice. We also discuss the pathophysiological mechanisms underpinning AS development using diabetes and, in particular, type 1 diabetes, as a disease model with a high risk of cardiovascular events and microvascular complications that are accelerated by AS.
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Affiliation(s)
- José-Miguel González-Clemente
- Department of Endocrinology and Nutrition, Hospital Universitari Parc Taulí, Institut d’Investigació i Innovació Parc Taulí I3PT, Universitat Autònoma de Barcelona, 08208 Sabadell, Spain; (A.C.); (L.A.); (O.G.-P.); (A.R.)
- Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Department of Endocrinology and Nutrition, Instituto de Salud Carlos III, 28029 Madrid, Spain; (J.V.); (G.L.)
| | - Albert Cano
- Department of Endocrinology and Nutrition, Hospital Universitari Parc Taulí, Institut d’Investigació i Innovació Parc Taulí I3PT, Universitat Autònoma de Barcelona, 08208 Sabadell, Spain; (A.C.); (L.A.); (O.G.-P.); (A.R.)
| | - Lara Albert
- Department of Endocrinology and Nutrition, Hospital Universitari Parc Taulí, Institut d’Investigació i Innovació Parc Taulí I3PT, Universitat Autònoma de Barcelona, 08208 Sabadell, Spain; (A.C.); (L.A.); (O.G.-P.); (A.R.)
| | - Olga Giménez-Palop
- Department of Endocrinology and Nutrition, Hospital Universitari Parc Taulí, Institut d’Investigació i Innovació Parc Taulí I3PT, Universitat Autònoma de Barcelona, 08208 Sabadell, Spain; (A.C.); (L.A.); (O.G.-P.); (A.R.)
| | - Ana Romero
- Department of Endocrinology and Nutrition, Hospital Universitari Parc Taulí, Institut d’Investigació i Innovació Parc Taulí I3PT, Universitat Autònoma de Barcelona, 08208 Sabadell, Spain; (A.C.); (L.A.); (O.G.-P.); (A.R.)
| | - Eugenio Berlanga
- Clinical Laboratory, Biochemistry Department, UDIAT, Institut d’Investigació i Innovació Parc Taulí I3PT, Universitat Autònoma de Barcelona, 08208 Sabadell, Spain;
| | - Joan Vendrell
- Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Department of Endocrinology and Nutrition, Instituto de Salud Carlos III, 28029 Madrid, Spain; (J.V.); (G.L.)
- Department of Endocrinology and Nutrition, Hospital Universitari Joan XXIII de Tarragona, Institut d’Investigacions Sanitàries Pere Virgili (IISPV), Universitat Rovira i Virgili, 43005 Tarragona, Spain
| | - Gemma Llauradó
- Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Department of Endocrinology and Nutrition, Instituto de Salud Carlos III, 28029 Madrid, Spain; (J.V.); (G.L.)
- Department of Endocrinology and Nutrition, Institut Hospital del Mar d’Investigacions, Mèdiques (IMIM), Universitat Autònoma de Barcelona, 08003 Barcelona, Spain
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119
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Zheng Y, Thelen BJ, Rajaram N, Krishnamurthy VN, Hamilton J, Funes-Lora MA, Morgan T, Yessayan L, Bishop B, Osborne N, Henke P, Shih AJ, Weitzel WF. Angioplasty Induced Changes in Dialysis Vascular Access Compliance. Ann Biomed Eng 2021; 49:2635-2645. [PMID: 34382112 DOI: 10.1007/s10439-021-02844-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Accepted: 07/29/2021] [Indexed: 11/24/2022]
Abstract
Dialysis vascular access remains vitally important to maintain life and functional capacity with end stage renal disease. Angioplasty is an integral part of maintaining dialysis access function and patency. To understand the effect of angioplasty balloon dilation on vascular wall mechanics, we conducted a clinical study to evaluate the elastic modulus of the anastomosis in five subjects with anastomosis stenoses, before and after six angioplasty procedures, using B-mode ultrasound DICOM data. A novel and open source vascular ultrasound high-resolution speckle tracking software tool was used. The median lumen diameter increased from 3.4 to 5.5 mm after angioplasty. Meanwhile, the median elastic modulus of the 18 measurements at the anastomosis increased by 52.2%, from 2.24 × 103 to 3.41 × 103 mmHg. The results support our hypothesis that the structural changes induced in the vessel wall by balloon dilation lead to reduced vascular compliance and a higher elastic modulus of the vessel wall.
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Affiliation(s)
- Yihao Zheng
- Department of Mechanical Engineering, Worcester Polytechnic Institute, 100 Institute Rd, Worcester, MA, 01609, USA. .,VA Ann Arbor Healthcare System, Ann Arbor, MI, USA.
| | - Brian J Thelen
- VA Ann Arbor Healthcare System, Ann Arbor, MI, USA.,Department of Statistics, University of Michigan, Ann Arbor, MI, USA.,Michigan Tech Research Institute, Michigan Technological University, Ann Arbor, MI, USA
| | - Nirmala Rajaram
- VA Ann Arbor Healthcare System, Ann Arbor, MI, USA.,Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
| | - Venkataramu N Krishnamurthy
- VA Ann Arbor Healthcare System, Ann Arbor, MI, USA.,Departments of Radiology and Surgery, University of Michigan, Ann Arbor, MI, USA
| | - James Hamilton
- VA Ann Arbor Healthcare System, Ann Arbor, MI, USA.,Emerge Now Inc., Los Angeles, CA, USA
| | | | | | - Lenar Yessayan
- VA Ann Arbor Healthcare System, Ann Arbor, MI, USA.,Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| | | | - Nickolas Osborne
- VA Ann Arbor Healthcare System, Ann Arbor, MI, USA.,Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Peter Henke
- VA Ann Arbor Healthcare System, Ann Arbor, MI, USA.,Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Albert J Shih
- Department of Mechanical Engineering, University of Michigan, Ann Arbor, MI, USA
| | - William F Weitzel
- VA Ann Arbor Healthcare System, Ann Arbor, MI, USA.,Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
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120
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Andrikou I, Dimitriadis K, Konstantinidis D, Leontsinis I, Andrikou E, Iliakis P, Liatakis I, Manta E, Karaminas N, Tsioufis P, Magkas N, Georgiopoulos G, Chrysohoou C, Thomopoulos C, Tousoulis D, Tsioufis C. Left ventricular mass versus pulse wave velocity as predictors of coronary artery disease in hypertensive patients: data from a 6-year-follow-up study. J Hum Hypertens 2021; 36:617-621. [PMID: 34326471 DOI: 10.1038/s41371-021-00560-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Revised: 05/27/2021] [Accepted: 06/04/2021] [Indexed: 11/09/2022]
Abstract
In treated hypertensive patients, there is a substantial residual cardiovascular (CV) risk that cannot be assessed by the available prediction models. This risk can be associated with subclinical organ damage, such as increased left ventricular mass (LVM) and arterial stiffness. However, it remains unknown which of these two CV markers better predicts coronary artery disease (CAD). A prospective cohort study was used to answer the above question. The study sample consisted of 1033 patients with hypertension (mean age 55.6 years, 538 males) free of CAD at baseline, who were followed for a mean period of 6 years. At baseline, all subjects underwent a complete echocardiographic study and pulse wave velocity (PWV) measurement. Hypertensive individuals who developed CAD (2.8%) compared to those without CAD at follow-up, had a higher baseline LVM index (by 16.7 g/m2, p < 0.001), higher prevalence of left ventricular hypertrophy (LVH) (21% greater, p = 0.027) and greater prevalence of high PWV levels at baseline (21% greater, p = 0.019). Multivariate Cox regression analysis revealed that baseline age >65 years (HR = 2.067, p = 0.001), male gender (HR = 3.664, p = 0.001), baseline chronic kidney disease (HR = 2.020, p = 0.026), baseline diabetes mellitus (HR = 1.952, p = 0.015) and baseline LVH (HR = 2.124 p = 0.001) turned out to be independent predictors of CAD, whereas high PWV levels were not. LVH proved to be an independent prognosticator of CAD in contrast to arterial stiffness that was not related to CAD after accounting for established confounders. Therefore, LVM can reliably help physicians to identify high-risk hypertensives in whom an intensified therapeutic management is warranted.
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Affiliation(s)
- Ioannis Andrikou
- First Cardiology Clinic, Medical School, National and Kapodistrian University of Athens, Hippokration Hospital, Athens, Greece
| | - Kyriakos Dimitriadis
- First Cardiology Clinic, Medical School, National and Kapodistrian University of Athens, Hippokration Hospital, Athens, Greece
| | - Dimitris Konstantinidis
- First Cardiology Clinic, Medical School, National and Kapodistrian University of Athens, Hippokration Hospital, Athens, Greece
| | - Ioannis Leontsinis
- First Cardiology Clinic, Medical School, National and Kapodistrian University of Athens, Hippokration Hospital, Athens, Greece
| | - Eirini Andrikou
- First Cardiology Clinic, Medical School, National and Kapodistrian University of Athens, Hippokration Hospital, Athens, Greece
| | - Panagiotis Iliakis
- First Cardiology Clinic, Medical School, National and Kapodistrian University of Athens, Hippokration Hospital, Athens, Greece
| | - Ioannis Liatakis
- First Cardiology Clinic, Medical School, National and Kapodistrian University of Athens, Hippokration Hospital, Athens, Greece
| | - Eleni Manta
- First Cardiology Clinic, Medical School, National and Kapodistrian University of Athens, Hippokration Hospital, Athens, Greece
| | - Nikos Karaminas
- First Cardiology Clinic, Medical School, National and Kapodistrian University of Athens, Hippokration Hospital, Athens, Greece
| | - Panagiotis Tsioufis
- First Cardiology Clinic, Medical School, National and Kapodistrian University of Athens, Hippokration Hospital, Athens, Greece
| | - Nikolaos Magkas
- First Cardiology Clinic, Medical School, National and Kapodistrian University of Athens, Hippokration Hospital, Athens, Greece
| | - Georgios Georgiopoulos
- First Cardiology Clinic, Medical School, National and Kapodistrian University of Athens, Hippokration Hospital, Athens, Greece
| | - Christina Chrysohoou
- First Cardiology Clinic, Medical School, National and Kapodistrian University of Athens, Hippokration Hospital, Athens, Greece
| | - Costas Thomopoulos
- First Cardiology Clinic, Medical School, National and Kapodistrian University of Athens, Hippokration Hospital, Athens, Greece
| | - Dimitrios Tousoulis
- First Cardiology Clinic, Medical School, National and Kapodistrian University of Athens, Hippokration Hospital, Athens, Greece
| | - Costas Tsioufis
- First Cardiology Clinic, Medical School, National and Kapodistrian University of Athens, Hippokration Hospital, Athens, Greece.
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121
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Improved Prognostic Value in Predicting Long-Term Cardiovascular Events by a Combination of High-Sensitivity C-Reactive Protein and Brachial-Ankle Pulse Wave Velocity. J Clin Med 2021; 10:jcm10153291. [PMID: 34362075 PMCID: PMC8348415 DOI: 10.3390/jcm10153291] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2021] [Revised: 07/21/2021] [Accepted: 07/23/2021] [Indexed: 11/16/2022] Open
Abstract
Background: Both C-reactive protein (CRP) and arterial stiffness are associated with the development of cardiovascular disease (CVD). This study was performed to investigate whether a combination of these two measurements could improve cardiovascular risk stratification. Methods: A total of 6572 consecutive subjects (mean age, 60.8 ± 11.8 years; female, 44.2%) who underwent both high-sensitivity CRP (hs-CRP) and brachial–ankle pulse wave velocity (baPWV) measurement within 1 week were retrospectively analyzed. Major adverse cardiovascular events (MACE), including cardiovascular death, acute myocardial infarction, coronary revascularization, and stroke were assessed during the clinical follow-up. Results: During a mean follow-up period of 3.75 years (interquartile range, 1.78–5.31 years), there were 182 cases of MACE (2.8%). The elevated baPWV (≥1505 cm/s) (hazard ratio (HR), 4.21; 95% confidence interval (CI), 2.73–6.48; p < 0.001) and hs-CRP (≥3 mg/L) (HR, 1.57; 95% CI, 1.12–2.21; p < 0.001) levels were associated with MACE even after controlling for potential confounders. The combination of baPWV and hs-CRP further stratified the subjects’ risk (subjects with low baPWV and hs-CRP vs. subjects with high baPWV and hs-CRP; HR, 7.08; 95% CI, 3.76−13.30; p < 0.001). Adding baPWV information to clinical factors and hs-CRP had an incremental prognostic value (global Chi-square score, from 126 to 167, p < 0.001). Conclusions: The combination of hs-CRP and baPWV provided a better prediction of future CVD than either one by itself. Taking these two simple measurements simultaneously is clinically useful in cardiovascular risk stratification.
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122
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Murray R, Kitaba N, Antoun E, Titcombe P, Barton S, Cooper C, Inskip HM, Burdge GC, Mahon PA, Deanfield J, Halcox JP, Ellins EA, Bryant J, Peebles C, Lillycrop K, Godfrey KM, Hanson MA. Influence of Maternal Lifestyle and Diet on Perinatal DNA Methylation Signatures Associated With Childhood Arterial Stiffness at 8 to 9 Years. Hypertension 2021; 78:787-800. [PMID: 34275334 PMCID: PMC8357051 DOI: 10.1161/hypertensionaha.121.17396] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Supplemental Digital Content is available in the text. Increases in aortic pulse wave velocity, a measure of arterial stiffness, can lead to elevated systolic blood pressure and increased cardiac afterload in adulthood. These changes are detectable in childhood and potentially originate in utero, where an adverse early life environment can alter DNA methylation patterns detectable at birth. Here, analysis of epigenome-wide methylation patterns using umbilical cord blood DNA from 470 participants in the Southampton’s Women’s Survey identified differential methylation patterns associated with systolic blood pressure, pulse pressure, arterial distensibility, and descending aorta pulse wave velocity measured by magnetic resonance imaging at 8 to 9 years. Perinatal methylation levels at 16 CpG loci were associated with descending aorta pulse wave velocity, with identified CpG sites enriched in pathways involved in DNA repair (P=9.03×10−11). The most significant association was with cg20793626 methylation (within protein phosphatase, Mg2+/Mn2+ dependent 1D; β=−0.05 m/s/1% methylation change, [95% CI, −0.09 to −0.02]). Genetic variation was also examined but had a minor influence on these observations. Eight pulse wave velocity-linked dmCpGs were associated with prenatal modifiable risk factors, with cg08509237 methylation (within palmitoyl-protein thioesterase-2) associated with maternal oily fish consumption in early and late pregnancy. Lower oily fish consumption in early pregnancy modified the relationship between methylation and pulse wave velocity, with lower consumption strengthening the association between cg08509237 methylation and increased pulse wave velocity. In conclusion, measurement of perinatal DNA methylation signatures has utility in identifying infants who might benefit from preventive interventions to reduce risk of later cardiovascular disease, and modifiable maternal factors can reduce this risk in the child.
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Affiliation(s)
- Robert Murray
- From the School of Human Development and Health, Institute of Developmental Sciences Building, Faculty of Medicine (R.M., N.K., E.A., G.C.B., K.M.G., M.A.H.), University of Southampton, United Kingdom
| | - Negusse Kitaba
- From the School of Human Development and Health, Institute of Developmental Sciences Building, Faculty of Medicine (R.M., N.K., E.A., G.C.B., K.M.G., M.A.H.), University of Southampton, United Kingdom
| | - Elie Antoun
- From the School of Human Development and Health, Institute of Developmental Sciences Building, Faculty of Medicine (R.M., N.K., E.A., G.C.B., K.M.G., M.A.H.), University of Southampton, United Kingdom.,Centre for Biological Sciences, Faculty of Natural and Environmental Sciences (E.A., K.L.), University of Southampton, United Kingdom
| | - Philip Titcombe
- MRC Lifecourse Epidemiology Unit (P.T., S.B., C.C., H.M.I., P.A.M., K.M.G.), University of Southampton, United Kingdom
| | - Sheila Barton
- MRC Lifecourse Epidemiology Unit (P.T., S.B., C.C., H.M.I., P.A.M., K.M.G.), University of Southampton, United Kingdom
| | - Cyrus Cooper
- MRC Lifecourse Epidemiology Unit (P.T., S.B., C.C., H.M.I., P.A.M., K.M.G.), University of Southampton, United Kingdom
| | - Hazel M Inskip
- MRC Lifecourse Epidemiology Unit (P.T., S.B., C.C., H.M.I., P.A.M., K.M.G.), University of Southampton, United Kingdom.,NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, United Kingdom (H.M.I., K.L., K.M.G., M.A.H.)
| | - Graham C Burdge
- From the School of Human Development and Health, Institute of Developmental Sciences Building, Faculty of Medicine (R.M., N.K., E.A., G.C.B., K.M.G., M.A.H.), University of Southampton, United Kingdom
| | - Pamela A Mahon
- MRC Lifecourse Epidemiology Unit (P.T., S.B., C.C., H.M.I., P.A.M., K.M.G.), University of Southampton, United Kingdom
| | - John Deanfield
- Institute of Cardiovascular Sciences, University College London, United Kingdom (J.D.)
| | - Julian P Halcox
- Swansea University Medical School, Swansea University, United Kingdom (J.P.H., E.A.E.)
| | - Elizabeth A Ellins
- Swansea University Medical School, Swansea University, United Kingdom (J.P.H., E.A.E.)
| | - Jennifer Bryant
- Department of Cardiac Magnetic Resonance Imaging, National Heart Centre Singapore (J.B.)
| | - Charles Peebles
- Wessex Cardiothoracic Centre, Southampton University Hospitals NHS Trust, United Kingdom (C.P.)
| | - Karen Lillycrop
- Centre for Biological Sciences, Faculty of Natural and Environmental Sciences (E.A., K.L.), University of Southampton, United Kingdom.,NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, United Kingdom (H.M.I., K.L., K.M.G., M.A.H.)
| | - Keith M Godfrey
- From the School of Human Development and Health, Institute of Developmental Sciences Building, Faculty of Medicine (R.M., N.K., E.A., G.C.B., K.M.G., M.A.H.), University of Southampton, United Kingdom.,MRC Lifecourse Epidemiology Unit (P.T., S.B., C.C., H.M.I., P.A.M., K.M.G.), University of Southampton, United Kingdom.,NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, United Kingdom (H.M.I., K.L., K.M.G., M.A.H.)
| | - Mark A Hanson
- From the School of Human Development and Health, Institute of Developmental Sciences Building, Faculty of Medicine (R.M., N.K., E.A., G.C.B., K.M.G., M.A.H.), University of Southampton, United Kingdom.,NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, United Kingdom (H.M.I., K.L., K.M.G., M.A.H.)
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Tyurenkov IN, Perfilova VN, Nesterova AA, Glinka Y. Klotho Protein and Cardio-Vascular System. BIOCHEMISTRY (MOSCOW) 2021; 86:132-145. [PMID: 33832412 DOI: 10.1134/s0006297921020024] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Klotho protein affects a number of metabolic pathways essential for pathogenesis of cardio-vascular diseases and their prevention. It inhibits lipid peroxidation and inflammation, as well as prevents endothelial injury and calcification of blood vessels. Klotho decreases rigidity of blood vessels and suppresses development of the heart fibrosis. Low level of its expression is associated with a number of diseases. Cardioprotective effect of klotho is based on its ability to interact with multiple receptors and ion channels. Being a pleiotropic protein, klotho could be a useful target for therapeutic intervention in the treatment of cardio-vascular diseases. In this review we present data on pharmaceuticals that stimulate klotho expression and suggest some promising research directions.
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Affiliation(s)
- Ivan N Tyurenkov
- Volgograd State Medical University, Ministry of Health of the Russian Federation, Volgograd, 400066, Russia
| | - Valentina N Perfilova
- Volgograd State Medical University, Ministry of Health of the Russian Federation, Volgograd, 400066, Russia.
| | - Alla A Nesterova
- Pyatigorsk Medical and Pharmaceutical Institute, Branch of the Volgograd State Medical University, Ministry of Health of the Russian Federation, Pyatigorsk, 357500, Russia
| | - Yelena Glinka
- Keenan Research Centre, St. Michael's Hospital, Toronto, ON M5B 1W8, Canada
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124
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Fadel BM, Mohty D, Kazzi BE, Alamro B, Arshi F, Mustafa M, Echahidi N, Aboyans V. Ultrasound Imaging of the Abdominal Aorta: A Comprehensive Review. J Am Soc Echocardiogr 2021; 34:1119-1136. [PMID: 34224827 DOI: 10.1016/j.echo.2021.06.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2021] [Revised: 06/10/2021] [Accepted: 06/10/2021] [Indexed: 11/28/2022]
Abstract
Ultrasound is the imaging modality of choice for the initial evaluation of disorders that involve the abdominal aorta (AA). The diagnostic value of ultrasound resides in its ability to allow assessment of the anatomy and structure of the AA using two- dimensional, three-dimensional, and contrast-enhanced imaging. Moreover, ultrasound permits evaluation of the physiologic and hemodynamic consequences of abnormalities through Doppler interrogation of blood flow, thus enabling the identification and quantification of disorders within the AA and beyond its boundaries. The approach to ultrasound imaging of the AA varies, depending on the purpose of the study and whether it is performed in a radiology or vascular laboratory or in an echocardiography laboratory. The aim of this review is to demonstrate the usefulness of ultrasound imaging for the detection and evaluation of disorders that involve the AA, detail the abnormalities that are detected or further assessed, and outline its value for echocardiographers, sonographers, and radiologists.
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Affiliation(s)
- Bahaa M Fadel
- King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia; Alfaisal University, Riyadh, Saudi Arabia.
| | - Dania Mohty
- King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia; Alfaisal University, Riyadh, Saudi Arabia; Department of Cardiology, Dupuytren-2 University Hospital, and Inserm 1094 & IRD, Limoges University, Limoges, France
| | | | - Bandar Alamro
- King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia; Alfaisal University, Riyadh, Saudi Arabia
| | - Fatima Arshi
- King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia
| | - Manal Mustafa
- King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia
| | - Najmeddine Echahidi
- King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia; Department of Cardiology, Dupuytren-2 University Hospital, and Inserm 1094 & IRD, Limoges University, Limoges, France
| | - Victor Aboyans
- Department of Cardiology, Dupuytren-2 University Hospital, and Inserm 1094 & IRD, Limoges University, Limoges, France
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125
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Lee SH, Kim YJ, Yu GN, Jeon JC, Kim WY. Pulse pressure during the initial resuscitative period in patients with septic shock treated with a protocol-driven resuscitation bundle therapy. Korean J Intern Med 2021; 36:924-931. [PMID: 32811131 PMCID: PMC8273825 DOI: 10.3904/kjim.2020.056] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Accepted: 04/26/2020] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND/AIMS Maintaining a mean arterial pressure (MAP) ≥ 65 mmHg during septic shock should be based on individual circumstances, but specific target is poorly understood. We investigated associations between time-weighted average (TWA) hemodynamic parameters during the initial resuscitative period and 28-day mortality. METHODS Prospectively collected data were obtained from a septic shock patient registry, according to the Sepsis-3 definition, between 2016 and 2018. The TWA systolic blood pressure, diastolic blood pressure, MAP, shock index, and pulse pressure (PP) during the first 6 hours after shock recognition were compared. Multivariable regression analysis was performed to assess associations between these parameters and 28-day mortality. RESULTS Of 340 patients with septic shock, 92 died. Only the median TWA PP differed between the survivors and non-survivors (39.2 mmHg vs. 43.0 mmHg, p = 0.020), whereas the other indexes did not. When PP was divided into quartiles (< 34, 34 to 40, 40 to 48, and > 48 mmHg), the mortality rate was higher in the highest quartile (41.2%). Multivariable logistic analysis revealed that PP (odds ratio [OR], 1.28; 95% confidence interval [CI], 1.012 to 1.622; p = 0.039) and PP of > 48 mmHg (OR, 2.25; 95% CI, 1.272 to 3.981; p = 0.005) were independently associated with 28-day mortality. CONCLUSION PP was significantly associated with 28-day mortality in patients with septic shock and MAP maintained at > 65 mmHg during the first 6 hours. Further studies are warranted to optimize strategies for maintaining PP and MAP at > 65 mmHg during the early resuscitative period.
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Affiliation(s)
- Sang-Hun Lee
- Department of Emergency Medicine, Keimyung University Dongsan Medical Center, Daegu, Korea
| | - Youn-Jung Kim
- Department of Emergency Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Gi Na Yu
- Department of Emergency Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jae Cheon Jeon
- Department of Emergency Medicine, Keimyung University Dongsan Medical Center, Daegu, Korea
| | - Won Young Kim
- Department of Emergency Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
- Correspondence to Won Young Kim, M.D. Department of Emergency Medicine, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Korea Tel: +82-2-3010-3350 Fax: +82-2-3010-3360 E-mail:
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126
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Azukaitis K, Jankauskiene A, Schaefer F, Shroff R. Pathophysiology and consequences of arterial stiffness in children with chronic kidney disease. Pediatr Nephrol 2021; 36:1683-1695. [PMID: 32894349 DOI: 10.1007/s00467-020-04732-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Revised: 07/16/2020] [Accepted: 07/28/2020] [Indexed: 12/20/2022]
Abstract
Changes in arterial structure and function are seen early in the course of chronic kidney disease (CKD) and have been causally associated with cardiovascular (CV) morbidity. Numerous potential injuries encompassing both traditional and uremia-specific CV risk factors can induce structural arterial changes and accelerate arterial stiffening. When the buffering capacity of the normally elastic arteries is reduced, damage to vulnerable microcirculatory beds can occur. Moreover, the resultant increase to cardiac afterload contributes to the development of left ventricular hypertrophy and cardiac dysfunction. Adult studies have linked arterial stiffness with increased risk of mortality, CV events, cognitive decline, and CKD progression. Pulse wave velocity (PWV) is currently the gold standard of arterial stiffness assessment but its measurement in children is challenging due to technical difficulties and physiologic aspects related to growth and poor standardization between algorithms for calculating PWV. Nevertheless, studies in pediatric CKD have reported increased arterial stiffness in children with advanced CKD, on dialysis, and after kidney transplantation. Development of arterial stiffness in children with CKD is closely related to mineral-bone disease and hypertension, but other factors may also play a significant role. The clinical relevance of accelerated arterial stiffness in childhood on cardiovascular outcomes in adult life remains unclear, and prospective studies are needed. In this review we discuss mechanisms leading to arterial stiffness in CKD and its clinical implications, along with issues surrounding the technical aspects of arterial stiffness assessment in children.
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Affiliation(s)
- Karolis Azukaitis
- Clinic of Pediatrics, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Santariskiu 4, 08406, Vilnius, Lithuania.
| | - Augustina Jankauskiene
- Clinic of Pediatrics, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Santariskiu 4, 08406, Vilnius, Lithuania
| | - Franz Schaefer
- Division of Pediatric Nephrology, Center for Pediatrics and Adolescent Medicine, Heidelberg University, Heidelberg, Germany
| | - Rukshana Shroff
- Great Ormond Street Hospital for Children NHS Foundation Trust, University College London, Institute of Child Health, London, UK
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127
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Henderson AM, Islam N, Sandor GGS, Panagiotopoulos C, Devlin AM. Greater Arterial Stiffness in Children with or without Second-generation Antipsychotic Treatment for Mental Health Disorders: Rigidité Artérielle Plus Importante Chez Les Enfants Avec ou Sans Traitement Par Antipsychotiques de la Deuxième Génération Pour des Troubles de Santé Mentale. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2021; 66:667-676. [PMID: 34180273 PMCID: PMC8243168 DOI: 10.1177/0706743720974838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Second-generation antipsychotics (SGAs) are used for a variety of mental disorders and are associated with cardiometabolic side effects in children. The objective of this study was to assess the cardiovascular health of children with mental disorders that are SGA-treated or SGA-naive. METHODS SGA-treated (n = 47) or SGA-naive (n = 37) children (aged 6 to 18 years) with mental disorders and control children (n = 83, no mental disorder) underwent assessment for cardiac function and morphology by echocardiography, aortic pulse wave velocity (PWV), and carotid intima-media thickness (cIMT). Body mass index (BMI) z-scores, waist circumference z-scores, systolic and diastolic blood pressure (BP) percentiles for height and sex, and fasting plasma glucose, insulin, triglycerides, and cholesterol were also assessed. Differences between SGA-treated, SGA-naive, and control children were assessed by linear and log-linear regression models. RESULTS SGA-treated children had greater BMI z-scores and overweight/obesity (BMI ≥ 85th percentile for age and sex) and hypertension than SGA-naive and control children. The PWV geometric mean was 11.1% higher in SGA-treated (95%CI, 3.95 to 18.77) and 12.9% higher in SGA-naive children (95% CI, 5.60 to 20.59) compared to controls in models adjusted for age, sex, BMI, and systolic BP percentile. Left ventricular (LV) end-diastolic dimension/body surface area (BSA), LV end-systolic dimension/BSA, and LV ejection fraction were lower in SGA-treated and SGA-naive children compared to controls in models adjusted for sex and age. CONCLUSIONS Children with mental disorders have greater arterial stiffness and altered cardiac structure/function than children with no mental health diagnosis. SGA treatment in children is not associated with alterations in cardiovascular structure/function.
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Affiliation(s)
- Amanda M Henderson
- Department of Pediatrics, BC Children's Hospital Research Institute, 8166The University of British Columbia, Vancouver, British Columbia, Canada
| | - Nazrul Islam
- MRC Epidemiology Unit, University of Cambridge, United Kingdom
| | - George G S Sandor
- Department of Pediatrics, BC Children's Hospital Research Institute, 8166The University of British Columbia, Vancouver, British Columbia, Canada
| | - Constadina Panagiotopoulos
- Department of Pediatrics, BC Children's Hospital Research Institute, 8166The University of British Columbia, Vancouver, British Columbia, Canada
| | - Angela M Devlin
- Department of Pediatrics, BC Children's Hospital Research Institute, 8166The University of British Columbia, Vancouver, British Columbia, Canada
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128
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Niaz T, Johnson JN, Cetta F, Poterucha JT, Hagler DJ. Sex Differences in Children and Young Adults With Bicuspid Aortic Valve Disease in First Two Decades of Life. Mayo Clin Proc 2021; 96:1874-1887. [PMID: 34218860 DOI: 10.1016/j.mayocp.2020.12.033] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Revised: 12/14/2020] [Accepted: 12/22/2020] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To elucidate sex differences in valve morphology, disease phenotype, progression, and outcomes among children and young adults with bicuspid aortic valve (BAV). PATIENTS AND METHODS This is a retrospective cohort study examining all children and young adults (aged ≤22 years) with isolated BAV diagnosed, by excluding patients with concomitant congenital heart defects or genetic syndromes, from January 1, 1990, through December 1, 2016, at Mayo Clinic in Rochester, Minnesota. RESULTS Of 1010 patients with BAV, 558 had isolated BAV. Distributions of morphology were right-left in 65.8% (n=367), right-noncoronary in 34% (n=190), and left-noncoronary cusp fusion in 0.2% (n=1) of patients; with no sex differences. Male to female ratio was 3:1. At the first echocardiographic evaluation in the study, there were no sex differences in terms of frequency of aortic valve stenosis or regurgitation. However, males had significantly higher grades of aortic valve regurgitation at 17 years of age onward (P<.0001). Males had significantly larger mid-ascending aorta (P=.01) and sinus of Valsalva dimensions (z score; P=.0001) as compared with females, with a novel finding of peak aortic dimensions around 8 years of age. Males also had more than 2-fold higher risk for sinus of Valsalva dilation (z score >2) as compared with females (odds ratio, 2.3; 95% CI, 1.2 to 4.2; P=.01). There were no significant sex differences in the primary cardiac outcomes of interventions on aortic valve and/or aorta, aortic dissection, or death. CONCLUSION In children and young adults with BAV, males have a higher grade of aortic regurgitation in late adolescence, significantly larger aortic dimensions, different patterns of aortic growth, and more frequent sinus of Valsalva dilation as compared with females. Overall, the rate of primary cardiac events is lower in young patients, with no significant sex differences.
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Affiliation(s)
- Talha Niaz
- Division of Pediatric Cardiology, Department of Pediatrics, Mayo Clinic, Rochester, MN.
| | - Jonathan N Johnson
- Division of Pediatric Cardiology, Department of Pediatrics, Mayo Clinic, Rochester, MN; Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN
| | - Frank Cetta
- Division of Pediatric Cardiology, Department of Pediatrics, Mayo Clinic, Rochester, MN; Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN
| | - Joseph T Poterucha
- Division of Pediatric Cardiology, Department of Pediatrics, Mayo Clinic, Rochester, MN
| | - Donald J Hagler
- Division of Pediatric Cardiology, Department of Pediatrics, Mayo Clinic, Rochester, MN; Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN.
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129
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Wang Z, Wang D, Han M, Ai Y, Zhang X, Yuan L, Duan Y, Gao F, Yang Y. A Novel Methodology for Semi-automatic Measurement of Arterial Stiffness by Doppler Ultrasound: Clinical Feasibility and Reproducibility. ULTRASOUND IN MEDICINE & BIOLOGY 2021; 47:1725-1736. [PMID: 33858722 DOI: 10.1016/j.ultrasmedbio.2021.03.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Revised: 02/25/2021] [Accepted: 03/06/2021] [Indexed: 06/12/2023]
Abstract
The conventional manual approach to measurement of aortic pulse wave velocity (PWV) by Doppler ultrasonography is time consuming and operator dependent. Here we report a new semi-automated methodology for more efficient and objective measurement of aortic PWV and results of tests of its clinical feasibility and reproducibility. Carotid-femoral pulse wave velocity (cfPWV) was measured in 50 patients with suspected coronary artery disease (aged 59.2 ± 10.0 y, 36 males) by three independent observers, including two experienced sonographers and one cardiologist without ultrasonographic experience. The cfPWV measured by the semi-automatic method (cfPWVA) was compared with reference values obtained by averaging measurements by two experienced sonographers using the conventional standard manual method (cfPWVM). Measurements of cfPWVA were feasible in all 50 patients and exhibited excellent agreement with averaged cfPWVM from the two experienced sonographers, with an intraclass correlation coefficient (ICC) of 0.915 (95% confidence interval: 0.876-0.942). The inexperienced observer-measured cfPWVA did not differ from the cfPWVM measured by the two experienced sonographers (8.04 ± 1.29 vs. 8.14 ± 1.32 m/s, p > 0.05), with a high consistency by ICC of 0.877 (0.793-0.928). Bland-Altman plots further illustrated the good agreement between the two methods and good intra- and inter-observer reproducibility. Time consumption for cfPWV measurement using the new method was significantly less than that for the manual method (122 ± 35 s vs. 455 ± 105 s, p < 0.0001), saving about 73% of the time. This new semi-automatic methodology for aortic PWV measurement not only has an accuracy similar to that of the conventional standard manual method but is also highly feasible and time saving. It may provide a reliable, simple and reproducible approach to arterial stiffness evaluation in clinical settings.
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Affiliation(s)
- Zhen Wang
- School of Aerospace Medicine, Fourth Military Medical University, Xi'an, China
| | - Dingyi Wang
- Department of Ultrasound Medicine, Tangdu Hospital, Fourth Military Medical University, Xi'an, China
| | - Mengyao Han
- Department of Ultrasound Medicine, Tangdu Hospital, Fourth Military Medical University, Xi'an, China
| | - Yongfei Ai
- Department of Cardiology, Tangdu Hospital, Fourth Military Medical University, Xi'an, China
| | - Xing Zhang
- School of Aerospace Medicine, Fourth Military Medical University, Xi'an, China
| | - Lijun Yuan
- Department of Ultrasound Medicine, Tangdu Hospital, Fourth Military Medical University, Xi'an, China
| | - Yunyou Duan
- Department of Ultrasound Medicine, Tangdu Hospital, Fourth Military Medical University, Xi'an, China
| | - Feng Gao
- School of Aerospace Medicine, Fourth Military Medical University, Xi'an, China
| | - Yong Yang
- Department of Ultrasound Medicine, Tangdu Hospital, Fourth Military Medical University, Xi'an, China.
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Pielmus AG, Mühlstef J, Bresch E, Glos M, Jungen C, Mieke S, Orglmeister R, Schulze A, Stender B, Voigt V, Zaunseder S. Surrogate based continuous noninvasive blood pressure measurement. ACTA ACUST UNITED AC 2021; 66:231-245. [PMID: 33565285 DOI: 10.1515/bmt-2020-0209] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Accepted: 12/28/2020] [Indexed: 11/15/2022]
Abstract
Arterial blood pressure is one of the most often measured vital parameters in clinical practice. State-of-the-art noninvasive ABP measurement technologies have noticeable limitations and are mainly based on uncomfortable techniques of complete or partial arterial occlusion by cuffs. Most commonplace devices provide only intermittent measurements, and continuous systems are bulky and difficult to apply correctly for nonprofessionals. Continuous cuffless ABP measurements are still an unmet clinical need and a topic of ongoing research, with only few commercially available devices. This paper discusses surrogate-based noninvasive blood pressure measurement techniques. It covers measurement methods of continuously and noninvasively inferring BP from surrogate signals without applying external pressures, except for reference or initialization purposes. The BP is estimated by processing signal features, so called surrogates, which are modulated by variations of BP. Discussed techniques include well-known approaches such as pulse transit time and pulse arrival time techniques, pulse wave analysis or combinations thereof. Despite a long research history, these methods have not found widespread use in clinical and ambulatory practice, in part due to technical limitations and the lack of a standardized regulatory framework. This work summarizes findings from an invited workshop of experts in the fields covering clinical expertise, engineering aspects, commercialization and standardization issues. The goal is to provide an application driven outlook, starting with clinical needs, and extending to technical actuality. It provides an outline of recommended research directions and includes a detailed overview of clinical use case scenarios for these technologies, opportunities, and limitations.
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Affiliation(s)
| | - Jens Mühlstef
- Research Group 'Patient Care Solutions', Philips Research Europe, Eindhoven, The Netherlands
| | - Erik Bresch
- Research Group 'Patient Care Solutions', Philips Research Europe, Eindhoven, The Netherlands
| | - Martin Glos
- Interdisciplinary Center of Sleep Medicine, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Christiane Jungen
- Klinik und Poliklinik für Kardiologie, Universitäres Herz- und Gefäßzentrum UKE Hamburg, Hamburg, Germany
| | - Stefan Mieke
- Physikalisch-Technische Bundesanstalt, Berlin, Germany
| | - Reinhold Orglmeister
- Electronics and Medical Signal Processing, Technical University of Berlin, Berlin, Germany
| | - Andreas Schulze
- Research Group 'Patient Care Solutions', Philips Research Europe, Eindhoven, The Netherlands
| | | | - Verena Voigt
- Klinik für Anästhesiologie, Sektion Medizintechnik, Uniklinik RWTH Aachen, Aachen, Germany
| | - Sebastian Zaunseder
- Technical University of Dresden, Dresden, Germany.,Fachhochschule Dortmund, Dortmund, Germany
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131
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Altered Cardiovascular Reactivity to and Recovery from Cold Face Test-Induced Parasympathetic Stimulation in Essential Hypertension. J Clin Med 2021; 10:jcm10122714. [PMID: 34205387 PMCID: PMC8235104 DOI: 10.3390/jcm10122714] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 06/11/2021] [Accepted: 06/14/2021] [Indexed: 12/15/2022] Open
Abstract
Essential hypertension is associated with increased sympathetic and diminished parasympathetic activity as well as impaired reactivity to sympathetic stimulation. However, reactivity and recovery from parasympathetic stimulation in hypertension are unknown. We investigated reactivity and recovery to primarily parasympathetic stimulation by Cold Face Test (CFT) in essential hypertension. Moreover, we tested whether chronic stress modulates CFT-reactivity dependent on hypertension status. The CFT was conducted by applying a cold face-mask for 2 min in 24 unmedicated, otherwise healthy hypertensive men and in 24 normotensive controls. Systolic and diastolic blood pressure (BP) and heart rate (HR) were measured repeatedly. Chronic stress was assessed with the Trier-Inventory-for-Chronic-Stress-Screening-Scale. Hypertensives did not exhibit diastolic BP decreases after CFT-cessation (p = 0.59) as did normotensives (p = 0.002) and failed to show HR decreases in immediate response to CFT (p = 0.62) when compared to normotensives (p < 0.001). Systolic BP reactivity and recovery patterns did not differ between hypertensives and normotensives (p = 0.44). Chronic stress moderated HR (p = 0.045) but not BP CFT-reactivity (p′s > 0.64) with chronically stressed normotensives showing similar HR reactivity as hypertensives. Our findings indicate impaired diastolic BP and HR reactivity to and recovery from CFT in hypertensives and a moderating effect of chronic stress on HR reactivity potentially reflecting reduced relaxation ability of the cardiovascular system.
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132
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Giollo A, Cioffi G, Ognibeni F, Orsolini G, Dalbeni A, Bixio R, Adami G, Fassio A, Idolazzi L, Gatti D, Rossini M, Viapiana O. Tumour necrosis factor inhibitors reduce aortic stiffness progression in patients with long-standing rheumatoid arthritis. Arthritis Res Ther 2021; 23:158. [PMID: 34082806 PMCID: PMC8173737 DOI: 10.1186/s13075-021-02546-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Accepted: 05/24/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Aortic stiffness index (AoSI) has to be considered a proxy outcome measure in patients with rheumatoid arthritis (RA). The aim of this study was to comparatively describe AoSI progression in two groups of RA patients on long-term treatment with conventional synthetic disease-modifying anti-rheumatic drugs (csDMARDs) with or without tumour necrosis factor inhibitors (TNFi). METHODS AoSI was evaluated by Doppler echocardiography at the level of the aortic root, using a two-dimensional guided M-mode evaluation. Eligible participants were assessed at baseline and after 12 months. Changes in serum lipids, glucose and arterial blood pressure were assessed. All patients who did not change DMARD treatment during follow-up were consecutively selected for this study. RESULTS We included 107 (64 TNFi and 43 csDMARDs) RA patients. Most patients (74%) were in remission or low disease activity and had some CVD risk factors (45.8% hypertension, 59.8% dyslipidaemia, 45.3% smoking). The two groups did not differ significantly for baseline AoSI (5.95±3.73% vs 6.08±4.20%, p=0.867). Follow-up AoSI was significantly increased from baseline in the csDMARDs group (+1.00%; p<0.0001) but not in the TNFi group (+0.15%, p=0.477). Patients on TNFi had significantly lower follow-up AoSI from baseline than the csDMARDs group (-1.02%, p<0.001; ANCOVA corrected for baseline AoSI, age and systolic blood pressure). Furthermore, follow-up AoSI was significantly lower in TNFi than in csDMARDs users with an increasing number of CVD risk factors. CONCLUSION Long-term treatment with TNFi was associated with reduced aortic stiffness progression in patients with established RA and several CVD risk factors.
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Affiliation(s)
- Alessandro Giollo
- Rheumatology Section, Department of Medicine, University of Verona Hospital Trust, Policlinico G.B. Rossi 10, 37134, Verona, Italy. .,Division of Rheumatology, University of Padova, Padua, Italy.
| | - Giovanni Cioffi
- Rheumatology Section, Department of Medicine, University of Verona Hospital Trust, Policlinico G.B. Rossi 10, 37134, Verona, Italy.,Division of Cardiac Rehabilitation, S. Pancrazio Hospital, Arco di Trento, Trento, Italy
| | - Federica Ognibeni
- Rheumatology Section, Department of Medicine, University of Verona Hospital Trust, Policlinico G.B. Rossi 10, 37134, Verona, Italy
| | - Giovanni Orsolini
- Rheumatology Section, Department of Medicine, University of Verona Hospital Trust, Policlinico G.B. Rossi 10, 37134, Verona, Italy
| | - Andrea Dalbeni
- Internal Medicine and Hypertension Section, Department of Medicine, University of Verona Hospital Trust, Verona, Italy
| | - Riccardo Bixio
- Rheumatology Section, Department of Medicine, University of Verona Hospital Trust, Policlinico G.B. Rossi 10, 37134, Verona, Italy
| | - Giovanni Adami
- Rheumatology Section, Department of Medicine, University of Verona Hospital Trust, Policlinico G.B. Rossi 10, 37134, Verona, Italy
| | - Angelo Fassio
- Rheumatology Section, Department of Medicine, University of Verona Hospital Trust, Policlinico G.B. Rossi 10, 37134, Verona, Italy
| | - Luca Idolazzi
- Rheumatology Section, Department of Medicine, University of Verona Hospital Trust, Policlinico G.B. Rossi 10, 37134, Verona, Italy
| | - Davide Gatti
- Rheumatology Section, Department of Medicine, University of Verona Hospital Trust, Policlinico G.B. Rossi 10, 37134, Verona, Italy
| | - Maurizio Rossini
- Rheumatology Section, Department of Medicine, University of Verona Hospital Trust, Policlinico G.B. Rossi 10, 37134, Verona, Italy
| | - Ombretta Viapiana
- Rheumatology Section, Department of Medicine, University of Verona Hospital Trust, Policlinico G.B. Rossi 10, 37134, Verona, Italy
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Kwak S, Kim HL, In M, Lim WH, Seo JB, Kim SH, Zo JH, Kim MA. Associations of Brachial-Ankle Pulse Wave Velocity With Left Ventricular Geometry and Diastolic Function in Untreated Hypertensive Patients. Front Cardiovasc Med 2021; 8:647491. [PMID: 34041281 PMCID: PMC8143267 DOI: 10.3389/fcvm.2021.647491] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Accepted: 04/13/2021] [Indexed: 11/23/2022] Open
Abstract
Background: Although brachial-ankle pulse wave velocity (baPWV) is simple and convenient, its usefulness as an initial screening test for hypertensive patients is not well-known. This study aimed to investigate the association of baPWV with left ventricular (LV) geometry and diastolic function in treatment-naive hypertensive patients. Methods: A total of 202 untreated hypertensive patients (mean age, 62 years; males, 51.5%) without documented cardiovascular diseases were prospectively enrolled. Both baPWV and transthoracic echocardiography were performed on the same day before antihypertensive treatment. Results: In multiple linear regression analysis after adjustment for potential confounders, baPWV had significant correlations with structural measurements of LV including relative wall thickness (β = 0.219, P = 0.021) and LV mass index (β = 0.286, P = 0.002), and four diastolic parameters including septal e′ velocity (β = −0.199, P = 0.018), E/e′ (β = 0.373, P < 0.001), left atrial volume index (β = 0.334, P < 0.001), and maximal velocity of tricuspid regurgitation (β = 0.401, P < 0.001). The baPWV was significantly increased in patients with LV hypertrophy, abnormal LV remodeling, or diastolic dysfunction, compared to those without (P = 0.008, P = 0.035, and P < 0.001, respectively). In the receiver operating characteristic curve analysis, the discriminant ability of baPWV in predicting LV hypertrophy and diastolic dysfunction had an area under the curve of 0.646 (95% confidence interval 0.544–0.703, P = 0.004) and 0.734 (95% confidence interval 0.648–0.800, P < 0.001), respectively. Conclusion: baPWV was associated with parameters of LV remodeling and diastolic function in untreated hypertensive patients. The baPWV could be a useful screening tool for the early detection of adverse cardiac features among untreated hypertensive patients.
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Affiliation(s)
- Soongu Kwak
- Division of Cardiology, Department of Internal Medicine, Boramae Medical Center, Seoul National University College of Medicine, Seoul, South Korea
| | - Hack-Lyoung Kim
- Division of Cardiology, Department of Internal Medicine, Boramae Medical Center, Seoul National University College of Medicine, Seoul, South Korea
| | - Minjae In
- Seoul National University College of Medicine, Seoul, South Korea
| | - Woo-Hyun Lim
- Division of Cardiology, Department of Internal Medicine, Boramae Medical Center, Seoul National University College of Medicine, Seoul, South Korea
| | - Jae-Bin Seo
- Division of Cardiology, Department of Internal Medicine, Boramae Medical Center, Seoul National University College of Medicine, Seoul, South Korea
| | - Sang-Hyun Kim
- Division of Cardiology, Department of Internal Medicine, Boramae Medical Center, Seoul National University College of Medicine, Seoul, South Korea
| | - Joo-Hee Zo
- Division of Cardiology, Department of Internal Medicine, Boramae Medical Center, Seoul National University College of Medicine, Seoul, South Korea
| | - Myung-A Kim
- Division of Cardiology, Department of Internal Medicine, Boramae Medical Center, Seoul National University College of Medicine, Seoul, South Korea
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Kim ST, Ko Y, Beom JW, Boo KY, Lee JG, Choi JH, Kim SY, Joo SJ. Association of changes of pulse wave velocity and augmentation index after isometric handgrip exercise with coronary lesion extent and revascularization. Clin Hypertens 2021; 27:5. [PMID: 33931135 PMCID: PMC8088004 DOI: 10.1186/s40885-021-00163-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Accepted: 01/13/2021] [Indexed: 11/29/2022] Open
Abstract
Background Arterial stiffness is associated with myocardial ischemia and incident coronary artery disease (CAD), and indexes of arterial stiffness are usually increased in patients with CAD. However, these indexes are often increased in elderly without CAD. Arterial stiffness in patients with CAD may become more evident after isometric handgrip exercise which increases systolic pressure and ventricular afterload. We investigated the association of the change of stiffness indexes after isometric handgrip exercise with the lesion extent of CAD and the necessity for coronary revascularization. Methods Patients who were scheduled a routine coronary angiography via a femoral artery were enrolled. Arterial waveforms were traced at aortic root and external iliac artery using coronary catheters at baseline and 3 min after handgrip exercise. Augmentation index (AIx) was measured on the recorded aortic pressure waveform, and pulse wave velocity (PWV) was calculated using the ECG-gated time difference of the upstroke of arterial waveforms and distance between aortic root and external iliac artery. Results Total 37 patients were evaluated. Both PWV and AIx increased after handgrip exercise. ΔPWV was significantly correlated with ΔAIx (r = 0.344, P = 0.037). Patients were divided into higher and lower ΔPWV or ΔAIx groups based on the median values of 0.4 m/sec and 3.3%, respectively. Patients with higher PWV had more 2- or 3-vessel CAD (69% vs. 27%, P = 0.034), and underwent percutaneous coronary intervention (PCI) more frequently (84% vs. 50%, P = 0.038), but higher ΔAIx was not associated with either the lesion extent or PCI. Area under curve (AUC) of ΔPWV in association with PCI by C-statistics was 0.70 (95% confidence interval [CI] 0.51–0.88; P = 0.056). In multiple logistic regression analysis, ΔPWV was significantly associated with PCI (odds ratio 7.78; 95% CI 1.26–48.02; P = 0.027). Conclusions Higher ΔPWV after isometric handgrip exercise was associated with the lesion extent of CAD and the necessity for coronary revascularization, but higher ΔAIx was not.
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Affiliation(s)
- Seong Taeg Kim
- Department of Internal Medicine, Jeju National University Hospital, 15 Aran 13-gil, Jeju City, Jeju Province, 63241, Republic of Korea
| | - Yeekyoung Ko
- Department of Internal Medicine, Jeju National University Hospital, 15 Aran 13-gil, Jeju City, Jeju Province, 63241, Republic of Korea
| | - Jong-Wook Beom
- Department of Internal Medicine, Jeju National University Hospital, 15 Aran 13-gil, Jeju City, Jeju Province, 63241, Republic of Korea
| | - Ki Yung Boo
- Department of Internal Medicine, Jeju National University Hospital, 15 Aran 13-gil, Jeju City, Jeju Province, 63241, Republic of Korea
| | - Jae-Geun Lee
- Department of Internal Medicine, Jeju National University Hospital, 15 Aran 13-gil, Jeju City, Jeju Province, 63241, Republic of Korea.,Department of Internal Medicine, Jeju National University School of Medicine, 15 Aran 13-gil, Jeju City, Jeju Province, 63241, Republic of Korea
| | - Joon-Hyouk Choi
- Department of Internal Medicine, Jeju National University Hospital, 15 Aran 13-gil, Jeju City, Jeju Province, 63241, Republic of Korea.,Department of Internal Medicine, Jeju National University School of Medicine, 15 Aran 13-gil, Jeju City, Jeju Province, 63241, Republic of Korea
| | - Song-Yi Kim
- Department of Internal Medicine, Jeju National University Hospital, 15 Aran 13-gil, Jeju City, Jeju Province, 63241, Republic of Korea.,Department of Internal Medicine, Jeju National University School of Medicine, 15 Aran 13-gil, Jeju City, Jeju Province, 63241, Republic of Korea
| | - Seung-Jae Joo
- Department of Internal Medicine, Jeju National University Hospital, 15 Aran 13-gil, Jeju City, Jeju Province, 63241, Republic of Korea. .,Department of Internal Medicine, Jeju National University School of Medicine, 15 Aran 13-gil, Jeju City, Jeju Province, 63241, Republic of Korea. .,Institute of Medical Science, Jeju National University, 15 Aran 13-gil, Jeju City, Jeju Province, 63241, Republic of Korea.
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Headid Iii RJ, Park SY. The impacts of exercise on pediatric obesity. Clin Exp Pediatr 2021; 64:196-207. [PMID: 32777917 PMCID: PMC8103043 DOI: 10.3345/cep.2020.00997] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Accepted: 07/10/2020] [Indexed: 12/17/2022] Open
Abstract
Over the last few decades, the rates of pediatric obesity have more than doubled regardless of sociodemographic categorization, and despite these rates plateauing in recent years there continues to be an increase in the severity of obesity in children and adolescents. This review will discuss the pediatric obesity mediated cardiovascular disease (CVD) risk factors such as attenuated levels of satiety and energy metabolism hormones, insulin resistance, vascular endothelial dysfunction, and arterial stiffness. Additionally, early intervention to combat pediatric obesity is critical as obesity has been suggested to track into adulthood, and these obese children and adolescents are at an increased risk of early mortality. Current suggested strategies to combat pediatric obesity are modifying diet, limiting sedentary behavior, and increasing physical activity. The effects of exercise intervention on metabolic hormones such as leptin and adiponectin, insulin sensitivity/resistance, and body fat in obese children and adolescents will be discussed along with the exercise modality, intensity, and duration. Specifically, this review will focus on the differential effects of aerobic exercise, resistance training, and combined exercise on the cardiovascular risks in pediatric obesity. This review outlines the evidence that exercise intervention is a beneficial therapeutic strategy to reduce the risk factors for CVD and the ideal exercise prescription to combat pediatric obesity should contain both muscle strengthening and aerobic components with an emphasis on fat mass reduction and long-term adherence.
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Affiliation(s)
- Ronald J Headid Iii
- School of Health and Kinesiology, University of Nebraska at Omaha, Omaha, NE, USA
| | - Song-Young Park
- School of Health and Kinesiology, University of Nebraska at Omaha, Omaha, NE, USA
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136
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Lin SC, Wu TJ, Wu DA, Hsu BG. Hypoadiponectinemia is associated with aortic stiffness in nondialysis diabetic patients with stage 3-5 chronic kidney disease. Vascular 2021; 30:384-391. [PMID: 33866881 DOI: 10.1177/17085381211007602] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
OBJECTIVES Albuminuria and serum adiponectin levels are factors that have been associated with the development of cardiovascular disease in patients with diabetes mellitus. Here we investigated the relationship between serum adiponectin levels and aortic stiffness in nondialysis diabetic kidney disease patients with stage 3-5 chronic kidney disease. METHODS Fasting blood samples were obtained from 80 nondialysis diabetic kidney disease patients with stage 3-5 chronic kidney disease. Carotid-femoral pulse wave velocity (cfPWV) was measured using applanation tonometry; cfPWV values of >10 m/s were defined as aortic stiffness. Serum adiponectin levels were determined by enzyme immunoassay. RESULTS Forty-two patients (52.5%) with nondialysis diabetic kidney disease were diagnosed with aortic stiffness. The patients in this group were older (p = 0.011), had higher systolic blood pressure (p = 0.002) and urine albumin-to-creatinine ratios (p = 0.013), included fewer females (p = 0.024), and had lower serum adiponectin (p = 0.001) levels than those in the control group. Multivariable logistic regression analysis revealed that serum adiponectin was independently associated with aortic stiffness (odds ratio = 0.930, 95% confidence interval: 0.884-0.978, p = 0.005) and also positively correlated with cfPWV values by multivariable linear regression (β = -0.309, p = 0.002) in nondialysis diabetic kidney disease patients. CONCLUSIONS The results suggested that serum adiponectin levels could be used to predict aortic stiffness in nondialysis diabetic kidney disease patients with stage 3-5 chronic kidney disease.
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Affiliation(s)
- Ssu-Chin Lin
- Division of Nephrology, Department of Medicine, Hualien Armed Forces General Hospital, Hualien.,Department of Nursing, Hualien Armed Forces General Hospital, Hualien
| | - Tsung-Jui Wu
- Division of Nephrology, Department of Medicine, Hualien Armed Forces General Hospital, Hualien
| | - Du-An Wu
- Division of Metabolism and Endocrinology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien.,School of Medicine, Tzu Chi University, Hualien
| | - Bang-Gee Hsu
- School of Medicine, Tzu Chi University, Hualien.,Division of Nephrology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien
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137
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Karpouzas GA, Bui VL, Ronda N, Hollan I, Ormseth SR. Biologics and atherosclerotic cardiovascular risk in rheumatoid arthritis: a review of evidence and mechanistic insights. Expert Rev Clin Immunol 2021; 17:355-374. [PMID: 33673792 DOI: 10.1080/1744666x.2021.1899809] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Introduction: Cardiovascular disease is a leading comorbidity in rheumatoid arthritis. Timely introduction of biologic therapies in a treat-to-target approach has optimized disease-related outcomes and attenuated accrual of comorbidities, including cardiovascular risk.Areas covered: A literature search in MEDLINE (via PubMed) was performed between January 2009 and November 2020. This manuscript explores recent developments in atherosclerotic cardiovascular risk in RA compared with non-RA individuals; it synopsizes differences in vascular function and inflammation, prevalence, burden, vulnerability, and progression of atherosclerotic plaque and their underlying cellular and molecular mechanisms. Finally, it reviews the recent literature on cardioprotective benefits of biologics and draws mechanistic links with inhibition of new plaque formation, stabilization of high-risk lesions and improvement in endothelial function, arterial stiffness, lipid metabolism, and traditional cardiac risk factors.Expert opinion: Increasing evidence points to a solid cardioprotective influence of earlier, longer, and ongoing use of biologic treatments in RA. Nevertheless, the precise mechanistic effects of plaque progression and remodeling, vascular stiffness, endothelial dysfunction, lipid metabolism, and traditional cardiac risk factors are less rigorously characterized.
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Affiliation(s)
- George A Karpouzas
- Division of Rheumatology, The Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, Torrance, CA, USA
| | - Viet L Bui
- Division of Rheumatology, The Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, Torrance, CA, USA
| | - Nicoletta Ronda
- Department of Food and Drug, University of Parma, Parma, Italy
| | - Ivana Hollan
- The Norwegian University of Science and Technology, Gjøvik, Norway.,Beitostølen Sport and Health Centre, Beitostølen, Norway
| | - Sarah R Ormseth
- Division of Rheumatology, The Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, Torrance, CA, USA
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Associations of Small Fiber Neuropathy with Geriatric Nutritional Risk Index and Arterial Stiffness in Hemodialysis. DISEASE MARKERS 2021; 2020:1694218. [PMID: 32509039 PMCID: PMC7254095 DOI: 10.1155/2020/1694218] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/27/2019] [Accepted: 04/28/2020] [Indexed: 12/19/2022]
Abstract
BACKGROUND Peripheral neuropathy is a common neurological complication in uremic patients, and quantitative sensory testing (QST) is effective for diagnosis of small fiber neuropathy. Malnutrition and arterial stiffness are prevalent in patients undergoing hemodialysis (HD). The associations of small fiber neuropathy with nutritional status and arterial stiffness remain uncertain in maintenance HD patients. METHODS A total of 152 HD patients were included. Geriatric nutritional risk index (GNRI), an indicator of nutritional status, was calculated by serum albumin and actual and ideal body weight. Arterial stiffness was defined as brachial-ankle pulse wave velocity (baPWV) > 1400 cm/s. Small fiber neuropathy was assessed by an abnormal QST threshold of cold and warm sensation in patients' hands or feet. Multivariate forward logistic regression analysis was performed to examine the associations among abnormal QST threshold, GNRI, and arterial stiffness. RESULTS baPWV and prevalence of abnormal QST threshold were significantly higher in diabetic patients. Multivariate logistic analyses revealed that older age (OR, 1.081; 95% CI, 1.026-1.139, p = 0.003) and male gender (OR, 4.450; 95% CI, 1.250-15.836, p = 0.021) were associated with abnormal warm threshold of hands. Furthermore, diabetes (OR, 3.966; 95% CI, 1.351-11.819, p = 0.012) and lower GNRI (per 1 unit increase, OR, 0.935, 95% CI, 0.887-0.985, p = 0.012) were associated with abnormal cold threshold of feet. Arterial stiffness (OR, 5.479, 95% CI, 1.132-22.870, p = 0.020) and higher calcium-phosphorus product (OR, 1.071, 95% CI, 1.013-1.132, p = 0.015) were associated with abnormal warm threshold of feet. CONCLUSIONS Lower GNRI and arterial stiffness were significantly associated with small fiber neuropathy in patients undergoing HD. Malnutrition risk and vascular factors might play important roles in small fiber neuropathy among patients undergoing HD.
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139
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Do individuals with autoimmune disease have increased risk of subclinical carotid atherosclerosis and stiffness? Hypertens Res 2021; 44:978-987. [PMID: 33833420 DOI: 10.1038/s41440-021-00655-9] [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: 11/07/2020] [Revised: 03/02/2021] [Accepted: 03/14/2021] [Indexed: 12/13/2022]
Abstract
To explore the role of chronic inflammation inherent to autoimmune diseases in the development of subclinical atherosclerosis and arterial stiffness, this study recruited two population-based samples of individuals with and without autoimmune disease (ratio 1:5) matched by age, sex, and education level and with a longstanding (≥6 years) diagnosis of autoimmune disease. Common carotid intima-media thickness (IMT) and arterial distensibility and compliance were assessed with carotid ultrasound. Multivariable linear and logistic regression models were adjusted for 10-year cardiovascular risk. In total, 546 individuals with and without autoimmune diseases (91 and 455, respectively) were included. The mean age was 66 years (standard deviation 12), and 240 (43.9%) were women. Arterial stiffness did not differ according to the presence of autoimmune diseases. In men, the diagnosis of autoimmune diseases significantly increased common carotid IMT [beta-coefficient (95% confidence interval): 0.058 (0.009; 0.108); p value = 0.022] and the percentage with IMT ≥ 75th percentile [1.012 (0.145; 1.880); p value = 0.022]. Women without autoimmune disease were more likely to have IMT ≥ the 75th percentile [-2.181 (-4.214; -0.149); p value = 0.035], but the analysis of IMT as a continuous variable did not yield significant results. In conclusion, subclinical carotid atherosclerosis, but not arterial stiffness, was more common in men with autoimmune diseases. Women did not show significant differences in any of these carotid features. Sex was an effect modifier in the association between common carotid IMT values and the diagnosis of autoimmune diseases.
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Garcés Iñigo E, Llorens Salvador R, Escrig R, Hervás D, Vento M, Martí-Bonmatí L. Quantitative Evaluation of Neonatal Brain Elasticity Using Shear Wave Elastography. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2021; 40:795-804. [PMID: 32876366 DOI: 10.1002/jum.15464] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 07/09/2020] [Accepted: 07/12/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVES To demonstrate the feasibility of 2-dimensional brain ultrasound shear wave elastography (SWE) and to define the average elasticity values of the gray and white matter in term neonates. METHODS This work was a prospective observational single-center study including 55 healthy term neonates consecutively recruited in the maternity ward between the second and third postnatal days. All were successfully evaluated with a cerebral SWE examination performed with a multifrequency 4-9-MHz transducer. Bilateral sagittal planes of the thalamus and corona radiata were used to measure stiffness using a quantitative SWE method. Several elastograms with 5 to 15 nonoverlapping areas were obtained from the 2 different anatomic locations. The 5 most central measurements were averaged as representative values. RESULTS The 55 neonates ranged from 37 to 40 weeks' gestation. The estimated mean velocity values of the thalamus (1.17 m/s; 95% confidence interval, 1.13, 1.22 m/s) and corona radiata (1.60 m/s; 95% confidence interval, 1.57, 1.64 m/s) were statistically different (P < .001). There was no significant influence of laterality, gestational age, cephalic perimeter, sex, length, or type of delivery on the stiffness measurements. CONCLUSIONS Brain ultrasound SWE is feasible and allows measurements of neonatal brain elasticity. The elasticity of the thalamus and corona radiata at the frontal white matter in healthy term neonates is different. The knowledge of normal SWE ranges in term neonates allows comparative studies under pathologic conditions.
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Affiliation(s)
| | | | - Raquel Escrig
- Department of Pediatrics, Neonatal Research Unit, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - David Hervás
- Data Science, Biostatistics, and Bioinformatics Platform, Instituto de Investigación Sanitaria La Fe, Valencia, Spain
| | - Máximo Vento
- Department of Pediatrics, Neonatal Research Unit, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - Luis Martí-Bonmatí
- Department of Radiology, Hospital Universitario y Politécnico La Fe, Valencia, Spain
- Research Group on Biomedical Imaging, Instituto de Investigación Sanitaria La Fe, Valencia, Spain
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141
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Gul M, Inci S, Aktas H, Yildirim O, Alsancak Y, Ozkan N. Dynamic changes in aortic stiffness after substantial weight loss by laparoscopic sleeve gastrectomy in patients with obesity: a 1-year follow-up study. J Investig Med 2021; 69:1168-1174. [PMID: 33771842 DOI: 10.1136/jim-2021-001778] [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] [Accepted: 03/09/2021] [Indexed: 11/03/2022]
Abstract
Arterial stiffness has been identified as a powerful and independent risk factor for cardiovascular disease. Obesity is associated with an increased risk of aortic stiffness (AS) and adverse cardiovascular events. Herein, we aimed to evaluate the effects of weight loss after laparoscopic sleeve gastrectomy (LSG) on AS in individuals with morbid obesity by using the transthoracic echocardiography (TTE).A total of 53 patients with obesity (17 males, 36 females) who underwent LSG and did not have any known heart disease were included in the study. The AS parameters were measured with TTE. The demographic and echocardiographic data of the patients were studied before, at 1 month and 12 months after surgery.The mean age of the study group was 34.41±11.62, 68% of whom were female. There were no significant differences in terms of the standard echocardiography and Doppler measurements as compared with preoperative values (all p>0.05). When the elastic parameters of the aorta were compared, no significant differences were detected regarding aortic strain (%) ((16.28±4.11) vs (16.68±4.56), p=(0.998)), distensibility (cm2/dyn) ((6.74±1.78) vs (7.03±2.31), p=(0.997)) and Aortic Stiffness Index values ((10.73±3.84) vs (10.63±3.34), p=0.998) between baseline and first month after surgery. In the 12-month follow-up, it was determined that the aortic strain ((16.28±4.11) vs (22.74±5.79), p≤0.001) and distensibility ((6.74±1.78) vs (10.34±3.059), p<0.001)) values increased at significant levels.Weight loss by LSG improves arterial stiffness parameters in patients with obesity over a 1-year follow-up.
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Affiliation(s)
- Murat Gul
- Department of Cardiology, Aksaray University, School of Medicine, Aksaray, Turkey
| | - Sinan Inci
- Department of Cardiology, Aksaray University, School of Medicine, Aksaray, Turkey
| | - Halil Aktas
- Department of Cardiology, Aksaray University, School of Medicine, Aksaray, Turkey
| | - Oguz Yildirim
- Department of Cardiology, Aksaray Education and Research Hospital, Aksaray, Turkey
| | - Yakup Alsancak
- Department of Cardiology, Necmettin Erbakan University, Meram School of Medicine, Konya, Turkey
| | - Namik Ozkan
- Department of General Surgery, Aksaray University, School of Medicine, Aksaray, Turkey
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Enea C, Laffetas P, Pichon A, Delpech N. Arterial Stiffness and Hemodynamics in Young Women: The Effects of Oral Contraceptive Intake and Physical Habits. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18073393. [PMID: 33805931 PMCID: PMC8037745 DOI: 10.3390/ijerph18073393] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Revised: 03/01/2021] [Accepted: 03/23/2021] [Indexed: 12/17/2022]
Abstract
Oral contraceptive (OC) intake seems to be associated with increased central hemodynamics and arterial stiffness. Conversely, physical activity (PA) is known to induce benefits on vascular structure and function, suggesting that the negative effects of the OC pill could be counterbalanced by regular PA. The aim of this cross-sectional study was to determine (1) whether OC intake in young women is associated with higher values of hemodynamic parameters and arterial stiffness and (2) whether these negative effects could be counterbalanced by regular physical activity. Forty-nine young healthy women (21.9 years ± 2.1) were recruited and divided into 4 groups, depending on their hormonal status (OC users: OC+ or non-OC users: OC−) and their physical habits (active/inactive). Assessments of central hemodynamics (central blood pressure, Aix75) and pulse wave velocity (PWV) were performed using applanation tonometry. cBP was higher in OC+ vs. OC−, while PWV was similar between these two groups. No interaction between physical activity and hormonal status was observed for any of these variables. Nevertheless, PWV was lower in young active women compared with age-matched inactive women, suggesting that the positive effect of regular physical exercise on the cardiovascular system is already visible in the first years of women’s adulthood, whatever the hormonal status.
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143
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Bujok J, Miśta D, Wincewicz E, Króliczewska B, Dzimira S, Żuk M. Atherosclerosis Development and Aortic Contractility in Hypercholesterolemic Rabbits Supplemented with Two Different Flaxseed Varieties. Foods 2021; 10:534. [PMID: 33806676 PMCID: PMC8001360 DOI: 10.3390/foods10030534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Revised: 03/01/2021] [Accepted: 03/01/2021] [Indexed: 11/16/2022] Open
Abstract
Alpha-linolenic acid (ALA) is widely regarded as the main beneficial component of flax for the prevention of cardiovascular disease. We evaluated the effect of the transgenic flaxseed W86-which is rich in ALA-on the lipid profile, atherosclerosis progression, and vascular reactivity in hypercholesterolemic rabbits compared to the parental cultivar Linola with a very low ALA content. Rabbits were fed a basal diet (control) or a basal diet supplemented with 1% cholesterol, 1% cholesterol and 10% flaxseed W86, or 1% cholesterol and 10% Linola flaxseed. A high-cholesterol diet resulted in an elevated plasma cholesterol and triglyceride levels compared to the control animals. Aortic sections from rabbits fed Linola had lower deposits of foamy cells than those from rabbits fed W86. A potassium-induced and phenylephrine-induced contractile response was enhanced by a high-cholesterol diet and not influenced by the W86 or Linola flaxseed. Pretreatment of the aortic rings with nitro-L-arginine methyl ester resulted in a concentration-dependent tendency to increase the reaction amplitude in the control and high-cholesterol diet groups but not the flaxseed groups. Linola flaxseed with a low ALA content more effectively reduced the atherosclerosis progression compared with the W86 flaxseed with a high concentration of stable ALA. Aorta contractility studies suggested that flaxseed ameliorated an increased contractility in hypercholesterolemia but had little or no impact on NO synthesis in the vascular wall.
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Affiliation(s)
- Jolanta Bujok
- Department of Animal Physiology and Biostructure, Wroclaw University of Environmental and Life Sciences, C.K. Norwida 31, 50-375 Wrocław, Poland; (D.M.); (E.W.); (B.K.)
| | - Dorota Miśta
- Department of Animal Physiology and Biostructure, Wroclaw University of Environmental and Life Sciences, C.K. Norwida 31, 50-375 Wrocław, Poland; (D.M.); (E.W.); (B.K.)
| | - Edyta Wincewicz
- Department of Animal Physiology and Biostructure, Wroclaw University of Environmental and Life Sciences, C.K. Norwida 31, 50-375 Wrocław, Poland; (D.M.); (E.W.); (B.K.)
| | - Bożena Króliczewska
- Department of Animal Physiology and Biostructure, Wroclaw University of Environmental and Life Sciences, C.K. Norwida 31, 50-375 Wrocław, Poland; (D.M.); (E.W.); (B.K.)
| | - Stanisław Dzimira
- Department of Pathology, Wroclaw University of Environmental and Life Sciences, C.K. Norwida 31, 50-375 Wrocław, Poland;
| | - Magdalena Żuk
- Department of Genetic Biochemistry, Faculty of Biotechnology, University of Wroclaw, Przybyszewskiego 63/77, 51-148 Wrocław, Poland;
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144
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Chung GE, Park HE, Lee H, Choi SY. Clinical significance of increased arterial stiffness associated with atrial fibrillation, according to Framingham risk score. Sci Rep 2021; 11:4955. [PMID: 33654162 PMCID: PMC7925576 DOI: 10.1038/s41598-021-84311-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Accepted: 01/28/2021] [Indexed: 01/17/2023] Open
Abstract
Atrial fibrillation (AF) is the most common arrhythmia in the elderly. Arterial stiffness may predict the risk of AF, but this relationship has not been fully evaluated. We assessed the association between arterial stiffness and prevalent AF. All subjects who had electrocardiography performed and a cardio-ankle vascular index (CAVI) calculated during a screening examination between 2010 and 2019 were enrolled. To evaluate the association between increased arterial stiffness and AF, we divided the population according to their Framingham risk score (FRS) into low-, intermediate-, and high-risk groups. A total of 8048 subjects were evaluated. The multivariate analysis revealed that increased arterial stiffness was significantly associated with AF prevalence, even after adjusting cardiovascular risk factors [odds ratio (OR) 1.685, 95% confidence interval (CI) 1.908–2.588, p = 0.017]. When we subcategorized the subjects according to their FRS, increased arterial stiffness was significantly associated with AF in the intermediate- and high-risk groups (OR 3.062, 95% CI 1.39-6.740 and OR3.877, 95% CI 1.142-13.167, respectively, BMI adjusted. High arterial stiffness shows a significant association with AF in those with intermediate or high cardiovascular risk, and can be used for further risk stratification of patients.
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Affiliation(s)
- Goh Eun Chung
- Division of Gastroenterology, Department of Internal Medicine, Healthcare System Gangnam Center, Seoul National University Hospital, Seoul, Korea
| | - Hyo Eun Park
- Division of Cardiology, Department of Internal Medicine, Healthcare System Gangnam Center, Seoul National University Hospital, 39FL. Gangnam Finance Center 737, Yeoksam-Dong, Gangnam-Gu, Seoul, 135-984, Korea.
| | - Heesun Lee
- Division of Cardiology, Department of Internal Medicine, Healthcare System Gangnam Center, Seoul National University Hospital, 39FL. Gangnam Finance Center 737, Yeoksam-Dong, Gangnam-Gu, Seoul, 135-984, Korea
| | - Su-Yeon Choi
- Division of Cardiology, Department of Internal Medicine, Healthcare System Gangnam Center, Seoul National University Hospital, 39FL. Gangnam Finance Center 737, Yeoksam-Dong, Gangnam-Gu, Seoul, 135-984, Korea
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145
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Jia X, Yang Q, Gao C, Chen X, Li Y, Su H, Zheng Y, Zhang S, Wang Z, Wang H, Jiang LH, Sun Y, Fan Y. Stimulation of vascular smooth muscle cell proliferation by stiff matrix via the IK Ca channel-dependent Ca 2+ signaling. J Cell Physiol 2021; 236:6897-6906. [PMID: 33650160 DOI: 10.1002/jcp.30349] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2020] [Revised: 02/14/2021] [Accepted: 02/16/2021] [Indexed: 12/13/2022]
Abstract
Vascular stiffening, an early and common characteristic of cardiovascular diseases (CVDs), stimulates vascular smooth muscle cell (VSMC) proliferation which reciprocally accelerates the progression of CVDs. However, the mechanisms by which extracellular matrix stiffness accompanying vascular stiffening regulates VSMC proliferation remain largely unknown. In the present study, we examined the role of the intermediate-conductance Ca2+ -activated K+ (IKCa ) channel in the matrix stiffness regulation of VSMC proliferation by growing A7r5 cells on soft and stiff polydimethylsiloxane substrates with stiffness close to these of arteries under physiological and pathological conditions, respectively. Stiff substrates stimulated cell proliferation and upregulated the expression of the IKCa channel. Stiff substrate-induced cell proliferation was suppressed by pharmacological inhibition using TRAM34, an IKCa channel blocker, or genetic depletion of the IKCa channel. In addition, stiff substrate-induced cell proliferation was also suppressed by reducing extracellular Ca2+ concentration using EGTA or intracellular Ca2+ concentration using BAPTA-AM. Moreover, stiff substrate induced activation of extracellular signal-regulated kinases (ERKs), which was inhibited by treatment with TRAM34 or BAPTA-AM. Stiff substrate-induced cell proliferation was suppressed by treatment with PD98059, an ERK inhibitor. Taken together, these results show that substrates with pathologically relevant stiffness upregulate the IKCa channel expression to enhance intracellular Ca2+ signaling and subsequent activation of the ERK signal pathway to drive cell proliferation. These findings provide a novel mechanism by which vascular stiffening regulates VSMC function.
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Affiliation(s)
- Xiaoling Jia
- Beijing Advanced Innovation Centre for Biomedical Engineering, Key Laboratory for Biomechanics and Mechanobiology of Ministry of Education, School of Biological Science and Medical Engineering, Beihang University, Beijing, China.,School of Engineering Medicine, Beihang University, No.37, Xueyuan Road, haidian district, Beijing, China.,School of Biomedical Sciences, Faculty of Biological Sciences, University of Leeds, Leeds, UK
| | - Qingmao Yang
- Beijing Advanced Innovation Centre for Biomedical Engineering, Key Laboratory for Biomechanics and Mechanobiology of Ministry of Education, School of Biological Science and Medical Engineering, Beihang University, Beijing, China.,School of Engineering Medicine, Beihang University, No.37, Xueyuan Road, haidian district, Beijing, China
| | - Chao Gao
- Beijing Advanced Innovation Centre for Biomedical Engineering, Key Laboratory for Biomechanics and Mechanobiology of Ministry of Education, School of Biological Science and Medical Engineering, Beihang University, Beijing, China.,School of Engineering Medicine, Beihang University, No.37, Xueyuan Road, haidian district, Beijing, China
| | - Xinlan Chen
- Beijing Advanced Innovation Centre for Biomedical Engineering, Key Laboratory for Biomechanics and Mechanobiology of Ministry of Education, School of Biological Science and Medical Engineering, Beihang University, Beijing, China.,School of Engineering Medicine, Beihang University, No.37, Xueyuan Road, haidian district, Beijing, China
| | - Yanan Li
- Beijing Advanced Innovation Centre for Biomedical Engineering, Key Laboratory for Biomechanics and Mechanobiology of Ministry of Education, School of Biological Science and Medical Engineering, Beihang University, Beijing, China.,School of Engineering Medicine, Beihang University, No.37, Xueyuan Road, haidian district, Beijing, China
| | - Hao Su
- Beijing Advanced Innovation Centre for Biomedical Engineering, Key Laboratory for Biomechanics and Mechanobiology of Ministry of Education, School of Biological Science and Medical Engineering, Beihang University, Beijing, China.,School of Engineering Medicine, Beihang University, No.37, Xueyuan Road, haidian district, Beijing, China
| | - Yufan Zheng
- Beijing Advanced Innovation Centre for Biomedical Engineering, Key Laboratory for Biomechanics and Mechanobiology of Ministry of Education, School of Biological Science and Medical Engineering, Beihang University, Beijing, China.,School of Engineering Medicine, Beihang University, No.37, Xueyuan Road, haidian district, Beijing, China
| | - Shuwen Zhang
- Beijing Advanced Innovation Centre for Biomedical Engineering, Key Laboratory for Biomechanics and Mechanobiology of Ministry of Education, School of Biological Science and Medical Engineering, Beihang University, Beijing, China.,School of Engineering Medicine, Beihang University, No.37, Xueyuan Road, haidian district, Beijing, China
| | - Ziyu Wang
- Beijing Advanced Innovation Centre for Biomedical Engineering, Key Laboratory for Biomechanics and Mechanobiology of Ministry of Education, School of Biological Science and Medical Engineering, Beihang University, Beijing, China.,School of Engineering Medicine, Beihang University, No.37, Xueyuan Road, haidian district, Beijing, China
| | - Haikun Wang
- Beijing Advanced Innovation Centre for Biomedical Engineering, Key Laboratory for Biomechanics and Mechanobiology of Ministry of Education, School of Biological Science and Medical Engineering, Beihang University, Beijing, China.,School of Engineering Medicine, Beihang University, No.37, Xueyuan Road, haidian district, Beijing, China
| | - Lin-Hua Jiang
- School of Biomedical Sciences, Faculty of Biological Sciences, University of Leeds, Leeds, UK.,Sino-UK Joint Laboratory of Brain Function and Injury of Henan Province and Department of Physiology and Pathophysiology, Xinxiang Medical University, Xinxiang, China
| | - Yan Sun
- Beijing Advanced Innovation Centre for Biomedical Engineering, Key Laboratory for Biomechanics and Mechanobiology of Ministry of Education, School of Biological Science and Medical Engineering, Beihang University, Beijing, China.,School of Engineering Medicine, Beihang University, No.37, Xueyuan Road, haidian district, Beijing, China
| | - Yubo Fan
- Beijing Advanced Innovation Centre for Biomedical Engineering, Key Laboratory for Biomechanics and Mechanobiology of Ministry of Education, School of Biological Science and Medical Engineering, Beihang University, Beijing, China.,School of Engineering Medicine, Beihang University, No.37, Xueyuan Road, haidian district, Beijing, China
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146
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Heidari Pahlavian S, Cen SY, Bi X, Wang DJJ, Chui HC, Yan L. Assessment of carotid stiffness by measuring carotid pulse wave velocity using a single-slice oblique-sagittal phase-contrast MRI. Magn Reson Med 2021; 86:442-455. [PMID: 33543788 DOI: 10.1002/mrm.28677] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Revised: 12/14/2020] [Accepted: 12/18/2020] [Indexed: 11/06/2022]
Abstract
PURPOSE Increased arterial stiffness has been shown to be one of the earliest markers of cerebrovascular dysfunction. As a surrogate marker of arterial stiffness, pulse wave velocity (PWV) quantifications are generally carried out on central and peripheral arteries. The purpose of this study was to develop and evaluate an MRI approach to assess carotid stiffness by measuring carotid PWV (cPWV) using a fast oblique-sagittal phase-contrast MRI sequence. METHODS In 29 volunteers, a single-slice oblique-sagittal phase-contrast MRI sequence with retrospective cardiac gating was used to quantify blood velocity waveforms along a vessel segment covering the common carotid artery (CCA) and the internal carotid artery (ICA). The CCA-ICA segment length was measured from a region of interest selected on the magnitude image. Phase-contrast MRI-measured velocities were also used to quantify the ICA pulsatility index along with cPWV quantification. RESULTS The mean value of cPWV calculated using the middle upslope area algorithm was 2.86 ± 0.71 and 3.97 ± 1.14 m/s in young and elderly subjects, respectively. Oblique-sagittal phase-contrast MRI-derived cPWV measurements showed excellent intrascan and interscan repeatability. cPWV and ICA pulsatility index were significantly greater in older subjects compared to those in the young subjects (P < .01 and P = .01, respectively). Also, increased cPWV values were associated with elevated systolic blood pressure (β = 0.05, P = .03). CONCLUSION This study demonstrated that oblique-sagittal phase-contrast MRI is a feasible technique for the quantification of both cPWV and ICA pulsatility index and showed their potential utility in evaluating cerebroarterial aging and age-related neurovascular disorders.
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Affiliation(s)
- Soroush Heidari Pahlavian
- USC Stevens Neuroimaging and Informatics Institute, Keck School of Medicine, University of Southern California, Los Angeles, California, USA.,Department of Neurology, University of Southern California, Los Angeles, California, USA
| | - Steven Yong Cen
- Department of Neurology, University of Southern California, Los Angeles, California, USA
| | - Xiaoming Bi
- Siemens Medical Solutions USA, Inc., Los Angeles, California, USA
| | - Danny J J Wang
- USC Stevens Neuroimaging and Informatics Institute, Keck School of Medicine, University of Southern California, Los Angeles, California, USA.,Department of Neurology, University of Southern California, Los Angeles, California, USA
| | - Helena Chang Chui
- Department of Neurology, University of Southern California, Los Angeles, California, USA
| | - Lirong Yan
- USC Stevens Neuroimaging and Informatics Institute, Keck School of Medicine, University of Southern California, Los Angeles, California, USA.,Department of Neurology, University of Southern California, Los Angeles, California, USA
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147
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Ameer OZ, Salman IM, Alwadi AY, Ouban A, Abu-Owaimer FM, AlSharari SD, Bukhari IA. Regional functional and structural abnormalities within the aorta as a potential driver of vascular disease in metabolic syndrome. Exp Physiol 2021; 106:771-788. [PMID: 33450088 DOI: 10.1113/ep089213] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2020] [Accepted: 01/06/2021] [Indexed: 12/11/2022]
Abstract
NEW FINDINGS What is the central question of this study? Is aortic dysfunction, a significant contributor to cardiovascular disease in metabolic syndrome, expressed uniformly across both the thoracic and abdominal aorta? What is the main finding and its importance? Our study shows that, in the setting of metabolic syndrome, functional and structural deficits in the aorta are differentially expressed along its length, with the abdominal portion displaying more extensive vascular abnormalities. It is, therefore, likely that early interventional strategies targeting the abdominal aorta might alleviate cardiovascular pathologies driven by the metabolic syndrome. ABSTRACT The extent of vascular dysfunction associated with metabolic syndrome might vary along the length of the aorta. In this study, we investigated regional functional and structural changes in the thoracic and abdominal aorta of a rat model of metabolic syndrome, namely, high-fat diet (HFD) streptozotocin-induced diabetes mellitus (HFD-D). Four-week-old male Wistar albino rats were fed with either HFD or control diet (CD) for 10 weeks. At week 6, 40 mg/kg streptozotocin and its vehicle were injected i.p. into HFD and CD groups, respectively. At the end of the feeding period, rats were euthanised and aortic segments collected for assessment of vascular functional responses and histomorphometry. Tail-cuff systolic blood pressures (154 ± 6 vs. 110 ± 4 mmHg) and areas under the curve for oral glucose and i.p. insulin tolerance tests were greater in HFD-D versus CD rats. Abdominal aortic vasoconstriction in response to noradrenaline and KCl was greater in HFD-D compared with CD rats. Thoracic vasoconstrictor responses to noradrenaline, but not KCl, were greater in the HFD-D group. Abdominal, but not thoracic, endothelium-dependent vasorelaxation in response to acetylcholine was blunted in HFD-D relative to CD rats; however, nitric oxide-dependent vasorelaxation in HFD-D rats was impaired in both thoracic and abdominal segments. The abdominal aorta of HFD-D rats showed deranged interlamellar spacing and increased lipid plaque deposition. In conclusion, vascular dysfunction in metabolic syndrome is expressed differentially along the length of the aorta, with the abdominal aorta exhibiting increased susceptibility to vasoconstrictors and greater deficits in endothelium-dependent relaxation. These vascular functional abnormalities could potentially underlie the development of hypertensive cardiovascular disease associated with the metabolic syndrome.
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Affiliation(s)
- Omar Z Ameer
- College of Pharmacy, Alfaisal University, Riyadh, Kingdom of Saudi Arabia
| | - Ibrahim M Salman
- College of Pharmacy, Alfaisal University, Riyadh, Kingdom of Saudi Arabia
| | - Aiman Y Alwadi
- College of Pharmacy, Alfaisal University, Riyadh, Kingdom of Saudi Arabia
| | - Abderrahman Ouban
- College of Medicine, Alfaisal University, Riyadh, Kingdom of Saudi Arabia
| | | | - Shakir D AlSharari
- College of Pharmacy, King Saud University, Riyadh, Kingdom of Saudi Arabia
| | - Ishfaq A Bukhari
- College of Medicine, King Saud University, Riyadh, Kingdom of Saudi Arabia
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148
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Bia D, Zócalo Y. Physiological Age- and Sex-Related Profiles for Local (Aortic) and Regional (Carotid-Femoral, Carotid-Radial) Pulse Wave Velocity and Center-to-Periphery Stiffness Gradient, with and without Blood Pressure Adjustments: Reference Intervals and Agreement between Methods in Healthy Subjects (3-84 Years). J Cardiovasc Dev Dis 2021; 8:3. [PMID: 33445548 PMCID: PMC7827252 DOI: 10.3390/jcdd8010003] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2020] [Revised: 01/02/2021] [Accepted: 01/08/2021] [Indexed: 12/13/2022] Open
Abstract
In addition to being a marker of cardiovascular (CV) aging, aortic stiffening has been shown to be independently associated with increased CV risk (directly and/or indirectly due to stiffness-gradient attenuation). Arterial stiffness determines the rate at which the pulse pressure wave propagates (i.e., pulse wave velocity, PWV). Thus, propagated PWV (i.e., the distance between pressure-wave recording sites divided by the pulse transit time) was proposed as an arterial stiffness index. Presently, aortic PWV is considered a gold-standard for non-invasive stiffness evaluation. The limitations ascribed to PWV have hampered its use in clinical practice. To overcome the limitations, different approaches and parameters have been proposed (e.g., local PWV obtained by wave separation and pulse wave analysis). In turn, it has been proposed to determine PWV considering blood pressure (BP) levels (β-PWV), so as to evaluate intrinsic arterial stiffness. It is unknown whether the different approaches used to assess PWV or β-PWV are equivalent and there are few data regarding age- and sex-related reference intervals (RIs) for regional and local PWV, β-PWV and PWV ratio. AIMS (1) to evaluate agreement between data from different stiffness indexes, (2) to determine the need for sex-specific RIs, and (3) to define RIs for PWV, β-PWV and PWV ratio in a cohort of healthy children, adolescents and adults. METHODS 3619 subjects (3-90 y) were included, 1289 were healthy and non-exposed to CV risk factors. Carotid-femoral (cfPWV) and carotid-radial (crPWV) PWV were measured (SphygmoCor System (SCOR)) and PWV ratio (cfPWV/crPWV) was quantified. Local aortic PWV was obtained directly from carotid waves (aoPWV-Carotid; SCOR) and indirectly (generalized transfer function use) from radial (aoPWV-Radial; SCOR) and brachial (aoPWV-Brachial; Mobil-O-Graph system (MOG)) recordings. β-PWV was assessed by means of cardio-ankle brachial (CAVI) and BP-corrected CAVI (CAVIo) indexes. Analyses were done before and after adjustment for BP. Data agreement was analyzed (correlation, Bland-Altman). Mean and standard deviation (age- and sex-related) equations were obtained for PWV parameters (regression methods based on fractional polynomials). RESULTS The methods and parameters used to assess aortic stiffness showed different association levels. Stiffness data were not equivalent but showed systematic and proportional errors. The need for sex-specific RIs depended on the parameter and/or age considered. RIs were defined for all the studied parameters. The study provides the largest data set related to agreement and RIs for stiffness parameters obtained in a single population.
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Affiliation(s)
- Daniel Bia
- Departamento de Fisiología, Facultad de Medicina, Centro Universitario de Investigación, Innovación y Diagnóstico Arterial (CUiiDARTE), Universidad de la República, General Flores 2125, 11800 Montevideo, Uruguay
| | - Yanina Zócalo
- Departamento de Fisiología, Facultad de Medicina, Centro Universitario de Investigación, Innovación y Diagnóstico Arterial (CUiiDARTE), Universidad de la República, General Flores 2125, 11800 Montevideo, Uruguay
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149
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Abstract
BACKGROUND Ascending aorta dilatation is found in 13% of hypertensive patients. Little is known about elastic properties of ascending aorta in such patients. Echo-based transverse aortic strain analysis can describe mechanical properties of ascending aorta but has never been applied to patients with ascending aorta dilatation. AIM To assess mechanical properties of ascending aorta by transverse aortic strain analysis (as β2-stiffness index) in hypertensive patients with ascending aorta dilatation and association between mechanical properties of ascending aorta and cardiovascular damage. METHODS A total of 100 hypertensive outpatients underwent transthoracic echocardiography and assessment of pulse wave velocity (PWV). Strain analysis of ascending aorta was performed with echocardiographic speckle-tracking software. Patients were divided in three groups based on ascending aorta diameter: less than 40, 40-45, and at least 45 mm. RESULTS Beta-SI increased exponentially with ascending aorta dimensions (P < 0.001). Patients with ascending aorta dilatation had Beta-SI significantly higher than those with normal ascending aorta diameter. A greater proportion of patient with impaired (i.e., elevated) Beta-SI was present in groups with larger ascending aorta (18.2 vs. 48.4 vs. 80%, respectively, P < 0.05). On multivariate logistic regression only impaired Beta-SI predicted ascending aorta dilatation (P < 0.001). Beta-SI was related to cardiovascular damage in terms of left ventricular (LV) mass (LV mass indexed to BSA, P = 0.030) and PWV (P = 0.028). Patients with high Beta-SI had greater LV mass indexed to BSA (117 ± 47 vs. 94 ± 24 g/m2; P = 0.010) and PWV (10.20 ± 2.99 vs. 8.63 ± 1.88 m/s; P = 0.013). CONCLUSION Ascending aorta dilatation is associated with increased local aortic stiffness in hypertensive patients. Strain analysis adds functional information to the mere morphological evaluation of aortic diameter and could be a useful tool to better define cardiovascular risk in this population.
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150
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Szolnoky G, Gavallér H, Gönczy A, Bihari I, Kemény L, Forster T, Nemes A. The Effects of Below-Knee Medical Compression Stockings on Pulse Wave Velocity of Young Healthy Volunteers. J Strength Cond Res 2021; 35:275-279. [PMID: 29927896 DOI: 10.1519/jsc.0000000000002636] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/20/2023]
Abstract
ABSTRACT Szolnoky, G, Gavallér, H, Gönczy, A, Bihari, I, Kemény, L, Forster, T, and Nemes, A. The effects of below-knee medical compression stockings on pulse wave velocity of young healthy volunteers. J Strength Cond Res 35(1): 275-279, 2021-The effects of graduated medical compression stockings (MCS) on cardiovascular responses are poorly investigated. A simple study was undertaken to investigate whether the application of below-knee leg MCSs with different pressures could influence aortic pulse wave velocity (PWV) as the gold standard for aortic stiffness measurement evaluated by arteriography. Ten volunteers underwent PWV measurement at baseline, then in below-knee compression class (ccl) 1 (18-21 mm Hg), 2 (23-32 mm Hg) and 3 (34-46 mm Hg) MCSs in a consecutive manner. Baseline PWV (mean value: 7.86 ± 1.70 m·s-1) was significantly reduced by ccl 1 MCSs (mean value: 6.55 ± 0.88 m·s-1, p = 0.04). ccl 2 and ccl 3 stockings also notably decreased baseline PWV (mean values: 6.63 ± 0.65 m·s-1, p = 0.058 and 6.62 ± 1.00 m·s-1, p = 0.067; respectively). The application of low compression MCSs (ccl 1) leads to a significant decrease in PWV indicating a beneficial cardiovascular influence.
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Affiliation(s)
- Győző Szolnoky
- Department of Dermatology and Allergology, Albert Szent-Györgyi Clinical Center, University of Szeged, Szeged, Hungary
| | - Henriette Gavallér
- 2nd Department of Medicine and Cardiology Center, Medical Faculty, Albert Szent-Györgyi Clinical Center, University of Szeged, Szeged, Hungary ; and
| | - Anna Gönczy
- 2nd Department of Medicine and Cardiology Center, Medical Faculty, Albert Szent-Györgyi Clinical Center, University of Szeged, Szeged, Hungary ; and
| | | | - Lajos Kemény
- Department of Dermatology and Allergology, Albert Szent-Györgyi Clinical Center, University of Szeged, Szeged, Hungary
| | - Tamás Forster
- 2nd Department of Medicine and Cardiology Center, Medical Faculty, Albert Szent-Györgyi Clinical Center, University of Szeged, Szeged, Hungary ; and
| | - Attila Nemes
- 2nd Department of Medicine and Cardiology Center, Medical Faculty, Albert Szent-Györgyi Clinical Center, University of Szeged, Szeged, Hungary ; and
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