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Kim HL, Jo SH. Arterial Stiffness and Heart Failure With Preserved Ejection Fraction. J Korean Med Sci 2024; 39:e195. [PMID: 38887204 PMCID: PMC11182699 DOI: 10.3346/jkms.2024.39.e195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2024] [Accepted: 05/20/2024] [Indexed: 06/20/2024] Open
Abstract
Heart failure with preserved ejection fraction (HFpEF) is prevalent and associated with a poor prognosis, imposing a significant burden on society. Arterial stiffness is increasingly recognized as a crucial factor in the pathophysiology of HFpEF, affecting diagnosis, management, and prognosis. As a hallmark of vascular aging, arterial stiffness contributes to increased afterload on the left ventricle (LV), leading to diastolic dysfunction, a key feature of HFpEF. Elevated arterial stiffness is linked with common cardiovascular risk factors in HFpEF, such as hypertension, diabetes and obesity, exacerbating the progression of disease. Studies have demonstrated that patients with HFpEF exhibit significantly higher levels of arterial stiffness compared to those without HFpEF, highlighting the value of arterial stiffness measurements as both diagnostic and prognostic tools. Moreover, interventions aimed at reducing arterial stiffness, whether through pharmacological therapies or lifestyle modifications, have shown potential in improving LV diastolic function and patient outcomes. Despite these advancements, the precise mechanisms by which arterial stiffness contributes to HFpEF are still not fully understood, necessitating the need for further research.
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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
| | - Sang-Ho Jo
- Division of Cardiology, Department of Internal Medicine, Hallym University Sacred Heart Hospital, Anyang, Korea.
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Sigl M, Winter L, Schumacher G, Helmke SC, Shchetynska-Marinova T, Amendt K, Duerschmied D, Hohneck AL. Comparison of Functional and Morphological Estimates of Vascular Age. In Vivo 2023; 37:2178-2187. [PMID: 37652489 PMCID: PMC10500512 DOI: 10.21873/invivo.13317] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Revised: 06/01/2023] [Accepted: 06/02/2023] [Indexed: 09/02/2023]
Abstract
BACKGROUND/AIM Vascular age (VA) is an emerging metric in preventive cardiovascular (CV) medicine. VA can be derived from morphological parameters such as carotid intima-media thickness (CIMT), or functional parameters such as pulse wave analysis (PWA), which celebrates its 100th birthday. This study aimed to investigate whether the results of both approaches are comparable. PATIENTS AND METHODS On the occasion of the double 100th anniversary of PWA and the Mannheim Clinic, 100 volunteers underwent a) bilateral CIMT assessment using high-resolution ultrasound and b) oscillometric PWA at the brachial forearm site. The respective VAs were calculated using previously published equations. RESULTS Median age of the participants was 53.6 years (range=39.8-62.6 years), and 56% were female. Median CIMT was 632.5 μm (range=548.8-730.0 μm). Median PWA-derived VA was 55.3 years (36.5-70.5 years). Different values were obtained for CIMT-derived VA, depending on the reference cohort used as calculation basis, ranging from median 43.7 (26.2-59.5 years) to median 64.0 years (43.5-82.1 years). In 46% of the participants divergent VAs were found, that is, the calculated age was higher according to one method and lower according to the other. Correlation analysis revealed a strong dependence of VA (both PWA- and CIMT-derived) and chronological age, as well as an increase in CV risk factors and the detection of plaques with age. CONCLUSION Different approaches for estimating VA are not comparable and often produce contradictory results. The current methods and their validity must be critically assessed if they are not standardized.
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Affiliation(s)
- Martin Sigl
- Department of Cardiology, Angiology, Haemostaseology and Medical Intensive Care, University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
- European Center for AngioScience (ECAS) and German Center for Cardiovascular Research (DZHK) partner site Heidelberg/Mannheim, Mannheim, Germany
| | - Laura Winter
- Department of Cardiology, Angiology, Haemostaseology and Medical Intensive Care, University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
- European Center for AngioScience (ECAS) and German Center for Cardiovascular Research (DZHK) partner site Heidelberg/Mannheim, Mannheim, Germany
| | | | | | - Tetyana Shchetynska-Marinova
- Department of Cardiology, Angiology, Haemostaseology and Medical Intensive Care, University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
- European Center for AngioScience (ECAS) and German Center for Cardiovascular Research (DZHK) partner site Heidelberg/Mannheim, Mannheim, Germany
| | - Klaus Amendt
- Department of Cardiology, Angiology, Haemostaseology and Medical Intensive Care, University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
- European Center for AngioScience (ECAS) and German Center for Cardiovascular Research (DZHK) partner site Heidelberg/Mannheim, Mannheim, Germany
| | - Daniel Duerschmied
- Department of Cardiology, Angiology, Haemostaseology and Medical Intensive Care, University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
- European Center for AngioScience (ECAS) and German Center for Cardiovascular Research (DZHK) partner site Heidelberg/Mannheim, Mannheim, Germany
| | - Anna Lena Hohneck
- Department of Cardiology, Angiology, Haemostaseology and Medical Intensive Care, University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany;
- European Center for AngioScience (ECAS) and German Center for Cardiovascular Research (DZHK) partner site Heidelberg/Mannheim, Mannheim, Germany
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Handgrip strength is inversely associated with augmentation index in patients with type 2 diabetes. Sci Rep 2023; 13:1125. [PMID: 36670237 PMCID: PMC9860021 DOI: 10.1038/s41598-023-28392-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Accepted: 01/18/2023] [Indexed: 01/22/2023] Open
Abstract
Handgrip strength (HGS) is a measure of overall skeletal muscle strength and is used to identify risks for cardiovascular disease and mortality. Furthermore, HGS is an indicator of arterial stiffness that leads to atherosclerotic cardiovascular disease. This study aimed to examine the relationship between HGS and augmentation index (AIx) in patients with type 2 diabetes. A cross-sectional study was conducted to examine patients with type 2 diabetes whose HGS and AIx were measured in our hospital. AIx was measured noninvasively using an applanation tonometer, and multiple regression analyses were conducted to assess the independent relationship between HGS and AIx. This study included 404 patients. After adjusting for age, gender, body mass index, duration of diabetes, smoking and exercise habit, biochemical parameters, and physiological parameters related to arterial stiffness, HGS was found to be independently and inversely associated with AIx (β = - 0.270, p = 0.006). HGS was independently and inversely associated with AIx in patients with type 2 diabetes. Patients with diminished HGS should be subjected to intensive exercise therapy for reducing the risk of arterial stiffness and cardiovascular disease.Trial registration: UMIN000023010.
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Nedogoda SV, Salasyuk AS, Barykina IN, Lutova VO, Popova EA. Identifying Early Vascular Ageing in Patients With Metabolic Syndrome: Unresolved Issues and a Proposed Novel VAmets Score. Heart Lung Circ 2021; 30:1752-1761. [PMID: 34426074 DOI: 10.1016/j.hlc.2021.06.533] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Revised: 05/26/2021] [Accepted: 06/02/2021] [Indexed: 01/09/2023]
Abstract
PURPOSE To identify the features of early vascular ageing (EVA) in patients with metabolic syndrome (MetS), to assess the accuracy of existing methods for determining vascular age in MetS, and to derive a new score (VAmets) for the calculation of vascular age and predicting EVA in patients with MetS. METHODS Prospective open cohort study using routinely collected data from general practice. A total of 750 patients (age, 35-80 yrs old) with MetS were examined. EVA syndrome was detected in 484 patients with MetS and carotid-femoral pulse wave velocity (cfPWV) values exceeding average expected for age values by 2 or more standard deviations (SD). RESULTS The presence of type 2 diabetes and insulin resistance (IR) were associated with greater risk of EVA in MetS patients; the odds ratios were 2.75 (95% confidence interval [CI]: 2.34, 3.35) and 1.57 (95% CI: 1.16, 2.00), respectively. In addition, the risk of EVA increased by 76% with an increase in homeostatic model assessment ofinsulin resistance (HOMA-IR) by 1 unit, by 17% with an increase in high-sensitivity C-reactive protein (hs-CRP) by 1 mg/L, by 4% with an increase in diastolic blood pressure (DBP) by 1 mmHg, and by 1% with each (1) μmol/L increase in the level of uric acid (UA). The area under the curve (AUC) for predicting EVA in patients with MetS was 0.949 (95% CI: 0.936-0.963), 0.630 (95% CI: 0.589-0.671), 0.697 (95% CI: 0.659-0.736) and 0.686 (95% CI: 0.647-0.726), for vascular age calculated from carotid-femoral pulse wave velocity (cfPWV), Systematic COronary Risk Evaluation (SCORE) scale, QRESEARCH cardiovascular risk algorithm (QRISK-3) scale, and Framingham scale, respectively. Diabetes mellitus and clinical markers of IR (yes/no), HOMA-IR and UA level were used to develop a new VAmets score for EVA prediction providing a total accuracy of 0.830 (95% CI: 0.799-0.860). Based on the results of the study, a VAmets calculator was developed for diagnosing EVA in patients with MetS. (The calculator is available online at https://apps.medhub.pro/evams/) CONCLUSION: Carotid-femoral pulse wave velocity is at present the most widely studied index of arterial stiffness and fulfils most of the stringent criteria for a clinically useful biomarker of EVA in patients with MetS. There are parallel efforts for the effective identification and integration of a simple clinical score into clinical practice. Our score (VAmets) may accurately identify patients with MetS and EVA on the basis of widely available clinical variables and classic cardiovascular risk factors, and may assist in prioritising the calculation and use of vascular age in routine care.
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Affiliation(s)
- Sergey V Nedogoda
- Volgograd State Medical University Under Ministry of Health of the Russian Federation, Volgograd, Russia
| | - Alla S Salasyuk
- Volgograd State Medical University Under Ministry of Health of the Russian Federation, Volgograd, Russia.
| | - Irina N Barykina
- Volgograd State Medical University Under Ministry of Health of the Russian Federation, Volgograd, Russia
| | - Viktoria O Lutova
- Volgograd State Medical University Under Ministry of Health of the Russian Federation, Volgograd, Russia
| | - Ekaterina A Popova
- Volgograd State Medical University Under Ministry of Health of the Russian Federation, Volgograd, Russia
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Betge S, Drinda S, Neumann T, Bäz L, Pfeil A, Schulze C, Mrowka R, Jung C, Franz M. Influence of Macitentan on the Vascular Tone and Recruitment of Finger Capillaries Under Hypobaric Hypoxia in High Altitude. High Alt Med Biol 2020; 21:336-345. [PMID: 32758029 DOI: 10.1089/ham.2019.0120] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Betge, Stefan, Stefan Drinda, Thomas Neumann, Laura Bäz, Alexander Pfeil, Christian Schulze, Ralf Mrowka, Christian Jung, and Marcus Franz. Influence of macitentan on the vascular tone and recruitment of finger capillaries under hypobaric hypoxia in high altitude. High Alt Med Biol. 21:336-345, 2020. Introduction: Acute normobaric (NH) and hypobaric hypoxia (HH) has effects on the vascular tone of larger arteries and may have effects on the microcirculation. These effects may be noninvasively detectable by automated devices. A part of these effects may be mediated by endothelin (ET) and should be influenced by macitentan (MAC), a dual endothelin receptor antagonist (ERA). Methods: We used photoplethysmographic sensors, fingertip volume sensors, nailfold capillaroscopy, and laser Doppler probes at rest and after a 5-minute forearm ischemia in healthy study subjects under NH, under HH, and under HH plus a single dose of MAC. Results: NH at simulated 4000 m led to increased heart rates (HR) and pulse wave velocities (PWV) and reduced augmentation index (AIX). The values for the AIX showed a high SD and differed between the used devices. At simulated 5500 m, only baseline mean value (BMV; EndoPAT) showed a further change, indicating less filled capillaries of the fingertips. HH (2978 m) increased HR, blood pressure values, and PWV. Focusing on the microcirculation of the fingertips, HH reduced the BMV and the nailfold capillary density and the postischemic capillary recruitment. MAC had no effect on the BMV, but antagonized the effects of HH on the nailfold capillaries and led to a strongly increased postischemic diameter of the arterial limbs. Concordantly, the postischemic blood flow velocity increment, measured through ultrasound Doppler, was increased at ALT+MAC. Conclusions: The BMV may be a parameter for changes of the microcirculation of the finger tips. A single dose of MAC blocked hypoxia-induced capillary rarefaction and enhanced postischemic hyperemia of the fingertips. These results indicate the importance of ET-1 for the regulation of the microcirculation under hypoxia. The German Registry of Clinical Studies (DRKS) ID: 00005459.
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Affiliation(s)
- Stefan Betge
- Clinic of Internal Medicine and Angiology, Helios Klinikum Salzgitter, Salzgitter, Germany
| | - Stefan Drinda
- Department of Rheumatology, Klinik St. Katharinental, Spital Thurgau AG, Diessenhofen, Switzerland
| | - Thomas Neumann
- Clinic of Rheumatology, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - Laura Bäz
- Division of Cardiology, Department of Internal Medicine I, University Hospital Jena, Jena, Germany
| | - Alexander Pfeil
- Division of Rheumatology, Department of Internal Medicine III, University Hospital Jena, Jena, Germany
| | - Christian Schulze
- Division of Cardiology, Department of Internal Medicine I, University Hospital Jena, Jena, Germany
| | - Ralf Mrowka
- Experimental Nephrology, Clinic of Internal Medicine III, University Hospital Jena, Friedrich Schiller University Jena, Jena, Germany
| | - Christian Jung
- Division of Cardiology, Pulmonology, and Vascular Medicine, Medical Faculty, University Duesseldorf, Duesseldorf, Germany
| | - Marcus Franz
- Division of Cardiology, Department of Internal Medicine I, University Hospital Jena, Jena, Germany
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Yasuhara J, Kuno T, Kumamoto T, Kojima T, Shimizu H, Yoshiba S, Kobayashi T, Sumitomo N. Comparison of transcatheter patent ductus arteriosus closure between children and adults. Heart Vessels 2020; 35:1605-1613. [PMID: 32494943 DOI: 10.1007/s00380-020-01639-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Accepted: 05/29/2020] [Indexed: 10/24/2022]
Abstract
The data comparing the characteristics and effect of transcatheter patent ductus arteriosus (PDA) closure between children and adults is scarce. We analyzed 54 consecutive patients who underwent transcatheter PDA closures. We divided the patients into 2 groups of < 18 years and ≥ 18 years and compared the hemodynamic changes before and after the PDA closure. Adults had a higher incidence of heart failure on admission, diagnoses by heart failure and incidental echocardiography, PDA calcifications, and procedural complications than children (all P < 0.05). The left ventricular end-diastolic volume index (LVEDVI), left atrial diameter index (LADI), and LV mass index (LVMI) decreased after the PDA closure in children but not in adults. The LV ejection fraction (LVEF) significantly decreased 1 day after the PDA closure in both groups but remained low at 6 months after the procedure in only adults. The percent change in the LVEDVI, LADI, LVMI, and LVEF from baseline to 6 months after the procedure was significantly lesser in adults than children (LVEDVI: - 5.2 ± 29.1% vs. - 34.9 ± 18.9%, LADI: - 7.0 ± 13.2% vs. - 22.1 ± 18.9%, LVMI: - 11.0 ± 16.5% vs. - 34.1 ± 15.7%, LVEF: - 5.9 ± 7.6% vs. 6.1 ± 9.1%, all P < 0.05). Transcatheter PDA closure was not associated with a reduction in the LV and LA volume as well as an improvement in the LV hypertrophy and LV function in adults as compared to children. We suggested that an early diagnosis and transcatheter PDA closure during childhood might provide clinical benefit before progressive LV remodeling and heart failure.
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Affiliation(s)
- Jun Yasuhara
- Department of Pediatric Cardiology, Saitama Medical University International Medical Center, 1397-1, Yamane, Hidaka City, Saitama, 350-1298, Japan.,Center for Cardiovascular Research and Heart Center, Nationwide Children's Hospital, Columbus, OH, USA
| | - Toshiki Kuno
- Department of Medicine, Icahn School of Medicine at Mount Sinai, Mount Sinai Beth Israel, New York, NY, USA
| | - Takashi Kumamoto
- Department of Pediatric Cardiology, Saitama Medical University International Medical Center, 1397-1, Yamane, Hidaka City, Saitama, 350-1298, Japan.,Department of Pediatrics, Saga University Hospital, Saga, Japan
| | - Takuro Kojima
- Department of Pediatric Cardiology, Saitama Medical University International Medical Center, 1397-1, Yamane, Hidaka City, Saitama, 350-1298, Japan
| | - Hiroyuki Shimizu
- Department of Pediatric Cardiology, Saitama Medical University International Medical Center, 1397-1, Yamane, Hidaka City, Saitama, 350-1298, Japan.,Department of Intensive Care, Kanagawa Children's Medical Center, Kanagawa, Japan
| | - Shigeki Yoshiba
- Department of Pediatric Cardiology, Saitama Medical University International Medical Center, 1397-1, Yamane, Hidaka City, Saitama, 350-1298, Japan
| | - Toshiki Kobayashi
- Department of Pediatric Cardiology, Saitama Medical University International Medical Center, 1397-1, Yamane, Hidaka City, Saitama, 350-1298, Japan
| | - Naokata Sumitomo
- Department of Pediatric Cardiology, Saitama Medical University International Medical Center, 1397-1, Yamane, Hidaka City, Saitama, 350-1298, Japan.
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Ren J, Dong X, Nao J. Serum cystatin C is associated with carotid atherosclerosis in patients with acute ischemic stroke. Neurol Sci 2020; 41:2793-2800. [PMID: 32281037 DOI: 10.1007/s10072-020-04383-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Accepted: 03/28/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Accumulating studies have shown that cystatin C may play important roles in the pathogenesis of arteriosclerosis. However, the association between serum cystatin C and the characteristics of carotid plaques has not been elucidated. Furthermore, the diagnostic value of serum cystatin C in carotid stenosis has not been studied. METHODS Serum cystatin C in 156 patients with acute ischemic stroke (AIS) in the carotid artery was measured by ELISA. Intima-media thickness (IMT), stenosis of the symptomatic common carotid artery (CCA), extra/intracranial internal carotid artery (ICA) stenosis, and plaque characteristics were measured and recorded. Receiver operating characteristic (ROC) curves were used to assess the diagnostic value of serum cystatin C in carotid stenosis. RESULTS One hundred fifty-six patients were divided into two groups based on their cystatin C levels. The degree of arteriosclerosis, the severity of plaques, and stenosis of the symptomatic CCA were significantly higher in the patients with high cystatin C levels. In addition, the rate of unstable plaques was significantly higher in those with high cystatin C. Serum cystatin C levels of 1.075 and 1.125 mg/L had diagnostic value in distinguishing stenosis of CCA and extracranial ICA, respectively. CONCLUSIONS Higher cystatin C levels were strongly correlated with symptomatic CCA stenosis and the rate of unstable plaques. Analysis of cystatin C levels may be useful for the identification of CCA stenosis and extracranial ICA in patients with AIS.
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Affiliation(s)
- Jing Ren
- Department of Neurology, Shengjing Hospital of China Medical University, 36 Sanhao Street, Heping District, Shenyang, 110004, Liaoning, People's Republic of China
| | - Xiaoyu Dong
- Department of Neurology, Shengjing Hospital of China Medical University, 36 Sanhao Street, Heping District, Shenyang, 110004, Liaoning, People's Republic of China
| | - Jianfei Nao
- Department of Neurology, Shengjing Hospital of China Medical University, 36 Sanhao Street, Heping District, Shenyang, 110004, Liaoning, People's Republic of China.
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Photoplethysmographic Prediction of the Ankle-Brachial Pressure Index through a Machine Learning Approach. APPLIED SCIENCES-BASEL 2020. [DOI: 10.3390/app10062137] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Cardiovascular disease is a leading cause of death. Several markers have been proposed to predict cardiovascular morbidity. The ankle-brachial index (ABI) marker is defined as the ratio between the ankle and the arm systolic blood pressures, and it is generally assessed through sphygmomanometers. An alternative tool for cardiovascular status assessment is Photoplethysmography (PPG). PPG is a non-invasive optical technique that measures volumetric blood changes induced by pulse pressure propagation within arteries. However, PPG does not provide absolute pressure estimation, making assessment of cardiovascular status less direct. The capability of a multivariate data-driven approach to predict ABI from peculiar PPG features was investigated here. ABI was measured using a commercial instrument (Enverdis Vascular Explorer, VE-ABI), and it was then used for a General Linear Model estimation of ABI from multi-site PPG in a supervised learning framework (PPG-ABI). A Receiver Operating Characteristic (ROC) analysis allowed to investigate the capability of PPG-ABI to discriminate cardiovascular impairment as defined by VE-ABI. Findings suggested that ABI can be estimated form PPG (r = 0.79) and can identify pathological cardiovascular status (AUC = 0.85). The advantages of PPG are simplicity, speed and operator-independency, allowing extensive screening of cardiovascular status and associated cardiovascular risks.
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Perpetuini D, Chiarelli AM, Maddiona L, Rinella S, Bianco F, Bucciarelli V, Gallina S, Perciavalle V, Vinciguerra V, Merla A, Fallica G. Multi-Site Photoplethysmographic and Electrocardiographic System for Arterial Stiffness and Cardiovascular Status Assessment. SENSORS (BASEL, SWITZERLAND) 2019; 19:E5570. [PMID: 31861123 PMCID: PMC6960562 DOI: 10.3390/s19245570] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Revised: 12/12/2019] [Accepted: 12/15/2019] [Indexed: 01/13/2023]
Abstract
The development and validation of a system for multi-site photoplethysmography (PPG) and electrocardiography (ECG) is presented. The system could acquire signals from 8 PPG probes and 10 ECG leads. Each PPG probe was constituted of a light-emitting diode (LED) source at a wavelength of 940 nm and a silicon photomultiplier (SiPM) detector, located in a back-reflection recording configuration. In order to ensure proper optode-to-skin coupling, the probe was equipped with insufflating cuffs. The high number of PPG probes allowed us to simultaneously acquire signals from multiple body locations. The ECG provided a reference for single-pulse PPG evaluation and averaging, allowing the extraction of indices of cardiovascular status with a high signal-to-noise ratio. Firstly, the system was characterized on optical phantoms. Furthermore, in vivo validation was performed by estimating the brachial-ankle pulse wave velocity (baPWV), a metric associated with cardiovascular status. The validation was performed on healthy volunteers to assess the baPWV intra- and extra-operator repeatability and its association with age. Finally, the baPWV, evaluated via the developed instrumentation, was compared to that estimated with a commercial system used in clinical practice (Enverdis Vascular Explorer). The validation demonstrated the system's reliability and its effectiveness in assessing the cardiovascular status in arterial ageing.
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Affiliation(s)
- David Perpetuini
- Department of Neuroscience and Imaging, Institute for Advanced Biomedical Technologies, University G. D’Annunzio of Chieti-Pescara, Via Luigi Polacchi 13, 66100 Chieti, Italy; (A.M.C.); (S.G.); (A.M.)
| | - Antonio Maria Chiarelli
- Department of Neuroscience and Imaging, Institute for Advanced Biomedical Technologies, University G. D’Annunzio of Chieti-Pescara, Via Luigi Polacchi 13, 66100 Chieti, Italy; (A.M.C.); (S.G.); (A.M.)
| | - Lidia Maddiona
- STMicroelectronics, ADG R&D, Stradale Primosole 50, 95121 Catania, Italy; (L.M.); (V.V.); (G.F.)
| | - Sergio Rinella
- Physiology Section, Department of Biomedical and Biotechnological Sciences, University of Catania, Via Santa Sofia 97, 95123 Catania, Italy; (S.R.); (V.P.)
| | - Francesco Bianco
- Institute of Cardiology, University G. D’Annunzio of Chieti-Pescara, Via Dei Vestini 5, 66100 Chieti, Italy; (F.B.); (V.B.)
| | - Valentina Bucciarelli
- Institute of Cardiology, University G. D’Annunzio of Chieti-Pescara, Via Dei Vestini 5, 66100 Chieti, Italy; (F.B.); (V.B.)
| | - Sabina Gallina
- Department of Neuroscience and Imaging, Institute for Advanced Biomedical Technologies, University G. D’Annunzio of Chieti-Pescara, Via Luigi Polacchi 13, 66100 Chieti, Italy; (A.M.C.); (S.G.); (A.M.)
- Institute of Cardiology, University G. D’Annunzio of Chieti-Pescara, Via Dei Vestini 5, 66100 Chieti, Italy; (F.B.); (V.B.)
| | - Vincenzo Perciavalle
- Physiology Section, Department of Biomedical and Biotechnological Sciences, University of Catania, Via Santa Sofia 97, 95123 Catania, Italy; (S.R.); (V.P.)
- Kore University, Department of Sciences of Life, Viale delle Olimpiadi, 94100 Enna, Italy
| | - Vincenzo Vinciguerra
- STMicroelectronics, ADG R&D, Stradale Primosole 50, 95121 Catania, Italy; (L.M.); (V.V.); (G.F.)
| | - Arcangelo Merla
- Department of Neuroscience and Imaging, Institute for Advanced Biomedical Technologies, University G. D’Annunzio of Chieti-Pescara, Via Luigi Polacchi 13, 66100 Chieti, Italy; (A.M.C.); (S.G.); (A.M.)
| | - Giorgio Fallica
- STMicroelectronics, ADG R&D, Stradale Primosole 50, 95121 Catania, Italy; (L.M.); (V.V.); (G.F.)
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Aortic Augmentation Index is Dependent on Bodyside in Healthy Young Subjects. High Blood Press Cardiovasc Prev 2019; 26:375-382. [PMID: 31420833 DOI: 10.1007/s40292-019-00335-3] [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: 03/31/2019] [Accepted: 07/31/2019] [Indexed: 10/26/2022] Open
Abstract
INTRODUCTION Aortic augmentation index (AIx) is a commonly used measure to evaluate the arterial stiffness of large elastic arteries. It has been used as an indicator for cardiovascular risk in clinical practice. AIM To evaluate the difference in the aortic AIx assessed from the left and the right hand in a group of healthy young adults using SphygmoCor and Arteriograph devices. METHODS 32 subjects were enrolled in this study (27 ± 7 years), 16 male and 16 female volunteers participated. Equally, half of the gender groups were left-handed and another half right-handed. RESULTS It was found that the aortic AIx values assessed from the pressure waveforms of the right and the left hand are different and significantly higher in the left hand. Using a SphygmoCor device, the mean difference between the aortic AIx values from the right and the left hand among the whole study group was found - 4.78 ± 4.31% and using an Arteriograph the aortic AIx values were - 3.92 ± 3.90%. Aortic AIx values assessed from the right and the left hand were linearly related to each other for both devices. Moreover, it was found that the values of the aortic. CONCLUSIONS AIx are independent of the subject's handedness. It has to be pointed out that subjects who cannot be subjected to assessment of the aortic AIx from one side of the body could have different AIx values estimated from the recorded pressure waveform from the other bodyside.
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Inoue Y, Adachi M, Maruyama Y. Investigation of arterial–cardiac–pulmonary interaction. Heart Vessels 2019; 34:1325-1331. [DOI: 10.1007/s00380-019-01362-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2018] [Accepted: 02/15/2019] [Indexed: 11/27/2022]
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Short-Duration High-Intensity Interval Exercise Training Is More Effective Than Long Duration for Blood Pressure and Arterial Stiffness But Not for Inflammatory Markers and Lipid Profiles in Patients With Stage 1 Hypertension. J Cardiopulm Rehabil Prev 2019; 39:50-55. [DOI: 10.1097/hcr.0000000000000377] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Effects on bone metabolism markers and arterial stiffness by switching to rivaroxaban from warfarin in patients with atrial fibrillation. Heart Vessels 2017; 32:977-982. [PMID: 28233091 DOI: 10.1007/s00380-017-0950-2] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2016] [Accepted: 01/20/2017] [Indexed: 10/20/2022]
Abstract
In recent years, direct oral anticoagulants (DOACs) of dabigatran, rivaroxaban, apixaban, edoxaban, which are all alternatives to warfarin, have been released. The use of DOACs is becoming more widespread in the clinical management of thrombotic stroke risk in patients with atrial fibrillation (AF). In large-scale clinical trials of each drug, DOACs were reported to inhibit intracranial hemorrhage, stroke, and death compared to warfarin. Warfarin is an endogenous vitamin K antagonist; therefore, patients who are taking warfarin must be prohibited from taking vitamin K. Vitamin K is an essential cofactor required for the ɤ-carboxylation of vitamin K-dependent proteins including coagulation factors, osteocalcin (OC), matrix Gla protein (MGP), and the growth arrest-specific 6 (GAS6). OC is a key factor for bone matrix formation. MGP is a local inhibitor of soft tissue calcification in the vessel wall. GAS6 prevents the apoptosis of vascular smooth muscle cells. Therefore, decrease of blood vitamin K levels may cause osteoporosis, vascular calcification, and the inhibition of vessels angiogenesis. This study aimed to evaluate the effects of changing from warfarin to rivaroxaban on bone mineral metabolism, vascular calcification, and vascular endothelial dysfunction. We studied 21 consecutive patients with persistent or chronic AF, who were treated with warfarin at least for 12 months. Warfarin administration was changed to rivaroxaban (10 or 15 mg/day) in all patients. Osteopontin (OPN), bone alkaline phosphatase (BAP), and under-carboxylated osteocalcin (ucOC) were measured. Pulse wave velocity (PWV) and augmentation index (AI) were also measured as atherosclerosis assessments. All measurements were done before and six months after the rivaroxaban treatment. There was a significant increase in serum level of BAP compared to baseline (12.5 ± 4.6 to 13.4 ± 4.1 U/L, P < 0.01). In contrast, there was a significant decrease in the serum level of ucOC (9.5 ± 5.0 to 2.7 ± 1.3 ng/ml, P < 0.01). Also, in the ucOC levels, there was a significant negative correlation between baseline values and baseline to 6-months changes in high ucOC group (r = -0.97, P < 0.01). The atherosclerosis- and osteoporosis-related biomarker, serum level of OPN were significantly decreased compared to baseline (268.3 ± 46.8 to 253.4 ± 47.1 ng/ml, P < 0.01). AI and PWV were significantly decreased after 6 months of treatment with rivaroxaban (33.9 ± 18.4 to 24.7 ± 18.4%, P = 0.04; 1638.8 ± 223.0 to 1613.0 ± 250.1 m/s, P = 0.03, respectively). Switching to rivaroxaban from warfarin in patients with atrial fibrillation was associated with an increase of bone formation markers and a decrease of bone resorption markers, and also improvements of PWV and AI.
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Kiuchi S, Hisatake S, Watanabe I, Toda M, Kabuki T, Oka T, Dobashi S, Ikeda T. Pulse Pressure and Upstroke Time Are Useful Parameters for the Diagnosis of Peripheral Artery Disease in Patients With Normal Ankle Brachial Index. Cardiol Res 2016; 7:161-166. [PMID: 28197286 PMCID: PMC5295562 DOI: 10.14740/cr508e] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/27/2016] [Indexed: 01/11/2023] Open
Abstract
Background Some peripheral artery disease (PAD) patients have normal ankle brachial index (ABI) (0.9 - 1.4), although ABI is a useful parameter for the diagnosis of PAD. We investigated whether other parameters of ABI report sheet are useful to detect these patients. Methods We initially enrolled 3,912 patients (7,824 limbs) who underwent ABI for the first time. Subjects who have normal ABI were divided into the PAD group (n = 136) and the non-PAD group (n = 240) by lower extremity ultrasonography. We investigated blood pressures (BP) (systolic (SBP), diastolic (DBP), mean (mBP) and pulse pressure (PP)), heart rate, upstroke time (UT), and %mean arterial pressure (%MAP). Results SBP, mBP, PP, UT, and %MAP in the PAD group were significantly higher. A multivariate analysis showed that mBP, DBP, PP, UT and %MAP were independently associated with the presence of PAD (mBP: odds ratio (OR) 2.30, 95% confidence interval (CI) 1.22 - 4.37, P = 0.010; DBP: OR 0.52, 95% CI 0.28 - 0.97, P = 0.039; PP: OR 1.30, 95% CI 0.69 - 2.46, P = 0.041; UT: OR 3.40, 95% CI 2.03 - 5.83, P < 0.001; %MAP: OR 1.77, 95% CI 1.05 - 2.98, P = 0.031). Maximal area under the curve (AUC) of BPs for associating PAD was PP. The cut-off value of PP was 53.0 mm Hg (sensitivity 0.500, specificity 0.721, AUC 0.628, 95% CI 0.569 - 0.687). Conclusions The present study demonstrated that BPs are associated with PAD in patients with normal ABI. The measurement of BPs could provide additional information for the diagnosis of PAD.
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Affiliation(s)
- Shunsuke Kiuchi
- Department of Cardiovascular Medicine, Toho University Faculty of Medicine, Tokyo, Japan
| | - Shinji Hisatake
- Department of Cardiovascular Medicine, Toho University Faculty of Medicine, Tokyo, Japan
| | - Ippei Watanabe
- Department of Cardiovascular Medicine, Toho University Faculty of Medicine, Tokyo, Japan
| | - Mikihito Toda
- Department of Cardiovascular Medicine, Toho University Faculty of Medicine, Tokyo, Japan
| | - Takayuki Kabuki
- Department of Cardiovascular Medicine, Toho University Faculty of Medicine, Tokyo, Japan
| | - Takashi Oka
- Department of Cardiovascular Medicine, Toho University Faculty of Medicine, Tokyo, Japan
| | - Shintaro Dobashi
- Department of Cardiovascular Medicine, Toho University Faculty of Medicine, Tokyo, Japan
| | - Takanori Ikeda
- Department of Cardiovascular Medicine, Toho University Faculty of Medicine, Tokyo, Japan
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