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Porras CP, Teraa M, Damen JAA, Hazenberg CEVB, Bots ML, Verhaar MC, Vernooij RWM. Editor's Choice - Prognostic Factors and Models to Predict Mortality Outcomes in Patients with Peripheral Arterial Disease: A Systematic Review. Eur J Vasc Endovasc Surg 2024; 68:361-377. [PMID: 38795905 DOI: 10.1016/j.ejvs.2024.05.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Revised: 04/18/2024] [Accepted: 05/14/2024] [Indexed: 05/28/2024]
Abstract
OBJECTIVE Predicting adverse outcomes in patients with peripheral arterial disease (PAD) is a complex task owing to the heterogeneity in patient and disease characteristics. This systematic review aimed to identify prognostic factors and prognostic models to predict mortality outcomes in patients with PAD Fontaine stage I - III or Rutherford category 0 - 4. DATA SOURCES PubMed, Embase, and Cochrane Database of Systematic Reviews were searched to identify studies examining individual prognostic factors or studies aiming to develop or validate a prognostic model for mortality outcomes in patients with PAD. REVIEW METHODS Information on study design, patient population, prognostic factors, and prognostic model characteristics was extracted, and risk of bias was evaluated. RESULTS Sixty nine studies investigated prognostic factors for mortality outcomes in PAD. Over 80 single prognostic factors were identified, with age as a predictor of death in most of the studies. Other common factors included sex, diabetes, and smoking status. Six studies had low risk of bias in all domains, and the remainder had an unclear or high risk of bias in at least one domain. Eight studies developed or validated a prognostic model. All models included age in their primary model, but not sex. All studies had similar discrimination levels of > 70%. Five of the studies on prognostic models had an overall high risk of bias, whereas two studies had an overall unclear risk of bias. CONCLUSION This systematic review shows that a large number of prognostic studies have been published, with heterogeneity in patient populations, outcomes, and risk of bias. Factors such as sex, age, diabetes, hypertension, and smoking are significant in predicting mortality risk among patients with PAD Fontaine stage I - III or Rutherford category 0 - 4.
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Affiliation(s)
- Cindy P Porras
- Department of Nephrology and Hypertension, University Medical Centre Utrecht, Utrecht, The Netherlands; Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Martin Teraa
- Department of Vascular Surgery, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Johanna A A Damen
- Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht University, Utrecht, The Netherlands
| | | | - Michiel L Bots
- Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Marianne C Verhaar
- Department of Nephrology and Hypertension, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Robin W M Vernooij
- Department of Nephrology and Hypertension, University Medical Centre Utrecht, Utrecht, The Netherlands; Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht University, Utrecht, The Netherlands.
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Kim HL, Lee KS, Joh HS, Lim WH, Seo JB, Kim SH, Zo JH, Kim MA. Prognostic Value of Brachial-Ankle Pulse Wave Velocity According to Subjects' Clinical Characteristics: Data From Analysis of 10,597 Subjects. J Korean Med Sci 2023; 38:e414. [PMID: 38147838 PMCID: PMC10752741 DOI: 10.3346/jkms.2023.38.e414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Accepted: 10/12/2023] [Indexed: 12/28/2023] Open
Abstract
BACKGROUND To make good use of the prognostic value of arterial stiffness, it is important to identify the population with the greatest benefit. In this study, we compared the prognostic value of brachial-ankle pulse wave velocity (baPWV) according to various clinical characteristics. METHODS A total of 10,597 subjects who underwent baPWV measurement (mean age, 61.4 ± 9.5 years; female proportion, 42.5%) were retrospectively analyzed. Major adverse cardiovascular events (MACEs), defined as a composite of cardiac death, non-fatal myocardial infarction, coronary revascularization, and ischemic stroke were assessed during the clinical follow-up period. RESULTS In the multivariate analysis, clinical variables with more than 4,000 subjects were selected as grouping variables, which were sex (men and women), age (≥ 65 and < 65 years), body mass index (BMI) (≥ 25 and < 25 kg/m²), hypertension (presence and absence), estimated glomerular filtration rate (≥ 90 and < 90 mL/min/1.73 m²), and statin use (user and non-user). During the median clinical follow-up duration of 3.58 years (interquartile range, 1.43-5.38 years), there were 422 MACEs (4.0%). In total study subjects, baseline higher baPWV was associated with increased risk of MACE occurrence (hazard ratio for baPWV ≥ 1,800 cm/s compared to baPWV < 1,400 cm/s, 4.04; 95% confidence interval, 2.62-6.21; P < 0.001). The prognostic value of baPWV was statistically significant regardless of sex, age, BMI, hypertension, renal function, and statin use. CONCLUSION Our results suggest that baPWV is not only effective in specific clinical situations, but can be effectively applied to predict cardiovascular prognosis in various clinical situations.
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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, Korea.
| | - Kyu-Sun Lee
- Division of Cardiology, Department of Internal Medicine, Daejeon Eulji University Hospital, Daejeon, Korea
| | - Hyun Sung Joh
- Division of Cardiology, Department of Internal Medicine, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, Korea
| | - Woo-Hyun Lim
- Division of Cardiology, Department of Internal Medicine, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, Korea
| | - Jae-Bin Seo
- Division of Cardiology, Department of Internal Medicine, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, Korea
| | - Sang-Hyun Kim
- Division of Cardiology, Department of Internal Medicine, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, Korea
| | - Joo-Hee Zo
- Division of Cardiology, Department of Internal Medicine, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, Korea
| | - Myung-A Kim
- Division of Cardiology, Department of Internal Medicine, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, Korea
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Toprak K, Balaban İ, Pala S. The effect of successful lower extremity revascularization on aortic stiffness in patients with peripheral arterial disease. Vascular 2023; 31:1253-1261. [PMID: 36796873 DOI: 10.1177/17085381231153223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
Abstract
OBJECTIVE Peripheral arterial disease (PAD) is a global health problem and associated with poor outcomes. It causes increased arterial stiffness. The association of PAD with aortic arterial stiffness was investigated in previous studies. However, there is limited data regarding the effect of peripheral revascularization on arterial stiffness. The aim of our study is to investigate the effect of peripheral revascularization on aortic stiffness parameters in patients with symptomatic PAD. METHODS A total of 48 patients with PAD who underwent peripheral revascularization were included in the study. Echocardiography was performed before and after the procedure, and aortic stiffness parameters were obtained by using aortic diameters and arterial blood pressure measurements. RESULTS Post-procedural aortic strain (5.1 [1.3-14] vs. 6.3 [2.8-6.3], p = 0.009) and aortic distensibility (0.2 [0.0-0.9] vs. 0.3 [0.1-1.1], p = 0.001) measurements were significantly increased compared to pre-procedural values. Patients were also compared according to the lesion laterality, site and treatment methods. It was found that the change in aortic strain (p = 0.031) and distensibility (p = 0.043) were significantly higher in unilateral lesion compared to bilateral lesion. Also, the change in aortic strain (p = 0.042) and distensibility (p = 0.033) were significantly higher in iliac site lesion compared to superficial femoral artery (SFA) site lesion. Moreover, the change in aortic strain was significantly higher (p = 0.013) in patients treated with stent compared to only balloon angioplasty. CONCLUSION Our study showed that successful percutaneous revascularization significantly reduced aortic stiffness in PAD. The change in aortic stiffness was significantly higher in unilateral lesions, iliac site lesions and stent-treated lesions.
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Affiliation(s)
- Kenan Toprak
- Department of Cardiology, Faculty of Medicine, Harran University, Sanliurfa, Turkey
| | - İsmail Balaban
- Clinic of Cardiology, Kartal Koşuyolu High Specialization Training and Research Hospital, İstanbul, Turkey
| | - Selçuk Pala
- Clinic of Cardiology, Kartal Koşuyolu High Specialization Training and Research Hospital, İstanbul, Turkey
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Anghel R, Adam CA, Marcu DTM, Mitu O, Roca M, Tinica G, Mitu F. Cardiac Rehabilitation in Peripheral Artery Disease in a Tertiary Center-Impact on Arterial Stiffness and Functional Status after 6 Months. Life (Basel) 2022; 12:life12040601. [PMID: 35455092 PMCID: PMC9024562 DOI: 10.3390/life12040601] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 04/07/2022] [Accepted: 04/15/2022] [Indexed: 12/12/2022] Open
Abstract
Background and Objectives: Cardiac rehabilitation (CR) plays an essential role in peripheral artery disease (PAD), leading to improved functional status, increased quality of life, and reduced arterial stiffness. We aimed to assess factors associated with clinical improvement 6 months after enrolment in a rehabilitation program at an academic medical center in north-eastern Europe. Materials and Methods: We conducted a prospective cohort study on 97 patients with PAD admitted to a single tertiary referral center. At the 6-months follow-up, 75 patients (77.3%) showed improved clinical status. We analyzed demographics and clinical and paraclinical parameters in order to explore factors associated with a favorable outcome. Results: Hypertension (p = 0.002), diabetes mellitus (p = 0.002), dyslipidemia (p = 0.045), and obesity (p = 0.564) were associated with no clinical improvement. Smoking cessation (p < 0.001), changing sedentary lifestyle (p = 0.032), and improvement of lipid and carbohydrate profile as well as functional status parameters and ambulatory arterial stiffness index (p = 0.008) were factors associated with clinical improvement at the 6-months follow-up. Conclusions: PAD patients require an integrative, multidisciplinary management to maintain functional status and increase quality of life. Improving carbohydrate and lipid profile, adopting a healthy lifestyle, quitting smoking and increasing exercise capacity are predictors for clinical improvement 6 months after enrolment in a CR program.
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Affiliation(s)
- Razvan Anghel
- Clinical Rehabilitation Hospital, Cardiovascular Rehabilitation Clinic, Pantelimon Halipa Street nr 14, 700661 Iași, Romania; (R.A.); (C.A.A.); (M.R.); (F.M.)
- Department of Internal Medicine, University of Medicine and Pharmacy “Grigore T. Popa”, University Street nr 16, 700115 Iași, Romania;
| | - Cristina Andreea Adam
- Clinical Rehabilitation Hospital, Cardiovascular Rehabilitation Clinic, Pantelimon Halipa Street nr 14, 700661 Iași, Romania; (R.A.); (C.A.A.); (M.R.); (F.M.)
| | - Dragos Traian Marius Marcu
- Department of Internal Medicine, University of Medicine and Pharmacy “Grigore T. Popa”, University Street nr 16, 700115 Iași, Romania;
| | - Ovidiu Mitu
- Department of Internal Medicine, University of Medicine and Pharmacy “Grigore T. Popa”, University Street nr 16, 700115 Iași, Romania;
- “Sf. Spiridon” Clinical Emergency Hospital, Independence Boulevard nr 1, 700111 Iași, Romania
- Correspondence:
| | - Mihai Roca
- Clinical Rehabilitation Hospital, Cardiovascular Rehabilitation Clinic, Pantelimon Halipa Street nr 14, 700661 Iași, Romania; (R.A.); (C.A.A.); (M.R.); (F.M.)
- Department of Internal Medicine, University of Medicine and Pharmacy “Grigore T. Popa”, University Street nr 16, 700115 Iași, Romania;
| | - Grigore Tinica
- Department of Cardiovascular Surgery, University of Medicine and Pharmacy “Grigore T. Popa”, University Street nr 16, 700115 Iași, Romania;
- Institute of Cardiovascular Diseases “Prof. Dr. George I.M. Georgescu”, 700503 Iași, Romania
| | - Florin Mitu
- Clinical Rehabilitation Hospital, Cardiovascular Rehabilitation Clinic, Pantelimon Halipa Street nr 14, 700661 Iași, Romania; (R.A.); (C.A.A.); (M.R.); (F.M.)
- Department of Internal Medicine, University of Medicine and Pharmacy “Grigore T. Popa”, University Street nr 16, 700115 Iași, Romania;
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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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Mendes-Pinto D, Rodrigues-Machado MDG, Navarro TP, Dardik A. Association Between Critical Limb Ischemia, the Society for Vascular Surgery Wound, Ischemia and Foot Infection (WIfI) Classification System and Arterial Stiffness. Ann Vasc Surg 2020; 63:250-258.e2. [DOI: 10.1016/j.avsg.2019.07.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2019] [Revised: 07/25/2019] [Accepted: 07/29/2019] [Indexed: 12/17/2022]
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Kuusik K, Kepler T, Zilmer M, Eha J, Vähi M, Kals J. Effects of Remote Ischaemic Preconditioning on Arterial Stiffness in Patients Undergoing Lower Limb Angiographic Procedures: A Randomised Clinical Trial. Eur J Vasc Endovasc Surg 2019; 58:875-882. [PMID: 31648881 DOI: 10.1016/j.ejvs.2019.06.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Revised: 05/09/2019] [Accepted: 06/09/2019] [Indexed: 02/06/2023]
Abstract
OBJECTIVES Remote ischaemic preconditioning (RIPC) is a phenomenon that promotes protection of tissues and organs against ischaemia reperfusion injury. RIPC has been shown to reduce myocardial and renal injury but its effect on arterial stiffness in patients undergoing lower limb digital subtraction angiography (DSA) is unknown. The aim of this study was to evaluate the effect of RIPC on arterial stiffness in patients with peripheral arterial disease (PAD) undergoing lower limb DSA. METHODS In the RIPC intervention, the blood pressure cuff on the arm was inflated to 200 mmHg or to 20 mmHg above systolic pressure, and in the sham intervention to 20 mmHg. For both, the procedure was repeated for four five minute cycles at five minute intervals between the cycles. Changes in heart rate corrected augmentation index (AIx@75), augmentation index (AIx), carotid femoral pulse wave velocity (PWV), and haemodynamic parameters were measured before and 24 h after DSA. RESULTS 111 (RIPC 54, sham 57) patients with symptomatic lower limb PAD scheduled for DSA were randomised. 102 patients (RIPC 47, sham 55) were included in final analysis. RIPC significantly improved AIx (-5.46% in RIPC and -1.45% in sham group; p = .05), but not AIx@75 (-4.88% in RIPC and -1.38% in sham group; p = .07) or PWV (-0.41 m/s in RIPC and -0.27 m/s in sham group; p = .74). In the RIPC group a significant reduction in AIx (p = .002) and AIx@75 (p = .003) was noted after stenting when compared with the sham intervention. AIx (p = .001), AIx@75 (p = .002), mean arterial (p = .01), peripheral (p = .02), and central systolic blood pressure (p = .006) were significantly reduced only in the RIPC group 24 h after DSA. CONCLUSION This study evaluates for the first time the effects of RIPC on arterial stiffness parameters in patients with symptomatic PAD following DSA. RIPC may modulate arterial stiffness following a DSA procedure and is more pronounced in patients after stent placement.
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Affiliation(s)
- Karl Kuusik
- Department of Cardiology, Institute of Clinical Medicine, University of Tartu, Tartu, Estonia; Heart Clinic, Tartu University Hospital, Tartu, Estonia; Department of Biochemistry, Institute of Biomedicine and Translational Medicine, Centre of Excellence for Genomics and Translational Medicine, University of Tartu, Tartu, Estonia.
| | - Teele Kepler
- Department of Biochemistry, Institute of Biomedicine and Translational Medicine, Centre of Excellence for Genomics and Translational Medicine, University of Tartu, Tartu, Estonia; Department of Surgery, Institute of Clinical Medicine, University of Tartu, Tartu, Estonia
| | - Mihkel Zilmer
- Department of Biochemistry, Institute of Biomedicine and Translational Medicine, Centre of Excellence for Genomics and Translational Medicine, University of Tartu, Tartu, Estonia
| | - Jaan Eha
- Department of Cardiology, Institute of Clinical Medicine, University of Tartu, Tartu, Estonia; Heart Clinic, Tartu University Hospital, Tartu, Estonia
| | - Mare Vähi
- Institute of Mathematics and Statistics, University of Tartu, Tartu, Estonia
| | - Jaak Kals
- Department of Biochemistry, Institute of Biomedicine and Translational Medicine, Centre of Excellence for Genomics and Translational Medicine, University of Tartu, Tartu, Estonia; Department of Surgery, Institute of Clinical Medicine, University of Tartu, Tartu, Estonia; Department of Vascular Surgery, Surgery Clinic, Tartu University Hospital, Tartu, Estonia
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8
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Arterial stiffness and 5-year mortality in patients with peripheral arterial disease. J Hum Hypertens 2019; 34:505-511. [DOI: 10.1038/s41371-019-0254-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Revised: 09/03/2019] [Accepted: 09/06/2019] [Indexed: 12/12/2022]
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Vallerio P, Maloberti A, D'Alessio I, Lista A, Varrenti M, Castelnuovo S, Marone M, Piccinelli E, Grassi G, Palmieri B, Giannattasio C. Cardiovascular Remodeling after Endovascular Treatment for Thoracic Aortic Injury. Ann Vasc Surg 2019; 61:134-141. [PMID: 31344466 DOI: 10.1016/j.avsg.2019.04.015] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Revised: 03/29/2019] [Accepted: 04/06/2019] [Indexed: 12/20/2022]
Abstract
BACKGROUND Thoracic endovascular aortic repair (TEVAR) currently represents the gold standard of treatment for thoracic aortic injury (TAI). Nevertheless, there is an ongoing debate surrounding its safety and subsequent cardiovascular effects. Our aim is to assess heart and vascular structure and function remodeling after TEVAR in TAI young patients. METHODS We evaluated 20 patients (18 men, age 41 ± 14 years, 11 treated with Gore CTAG, 9 with Medtronic Valiant) with office and 24-hr blood pressure (BP) with specific vascular stiffness analysis (Mobil-O-Graph), aortic diameters (computed tomography scan) and left ventricular mass index (LVMI echocardiogram). Evaluation was done after a median time of 5.0 ± 3.5 years from the trauma. RESULTS After TAI 12 patients (55%) developed hypertension. When patients were divided according to treating time, those treated for more than 3 years show higher LVMI, PWV, and ascending aorta dilatation. CONCLUSIONS Our study shows that TEVAR for TAI is associated with heart and vascular remodeling. The presence of TEVAR modifies aortic functional properties and could induce an increase in BP that can promote aortic and cardiac damage, even in young patients.
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Affiliation(s)
- Paola Vallerio
- Cardiology IV, "A. De Gasperis" Department, ASST Niguarda Ca' Granda, Milan, Italy
| | - Alessandro Maloberti
- Cardiology IV, "A. De Gasperis" Department, ASST Niguarda Ca' Granda, Milan, Italy; School of Medicine and Surgery, Milano-Bicocca University, Milan, Italy
| | - Ilenia D'Alessio
- School of Medicine and Surgery, Milano-Bicocca University, Milan, Italy
| | - Alfredo Lista
- Vascular Surgery, ASST Niguarda Ca' Granda, Milan, Italy
| | - Marisa Varrenti
- Cardiology II, "A. De Gasperis" Department, ASST Niguarda Ca' Granda, Milan, Italy
| | | | - Matteo Marone
- Vascular Surgery, ASST Niguarda Ca' Granda, Milan, Italy
| | - Enrico Piccinelli
- Cardiology IV, "A. De Gasperis" Department, ASST Niguarda Ca' Granda, Milan, Italy; School of Medicine and Surgery, Milano-Bicocca University, Milan, Italy
| | - Guido Grassi
- School of Medicine and Surgery, Milano-Bicocca University, Milan, Italy
| | - Bruno Palmieri
- Vascular Surgery, ASST Niguarda Ca' Granda, Milan, Italy
| | - Cristina Giannattasio
- Cardiology IV, "A. De Gasperis" Department, ASST Niguarda Ca' Granda, Milan, Italy; School of Medicine and Surgery, Milano-Bicocca University, Milan, Italy.
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Mendes-Pinto D, Ribeiro JM, Rodrigues-Machado MDG. Association between critical limb ischemia and arterial stiffness measured by brachial artery oscillometry. J Vasc Bras 2019; 18:e20180073. [PMID: 31258553 PMCID: PMC6582766 DOI: 10.1590/1677-5449.007318] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Accepted: 11/03/2018] [Indexed: 11/22/2022] Open
Abstract
Background Elevated arterial stiffness is associated with increased cardiovascular mortality. The relationship between arterial stiffness and critical limb ischemia (CLI) is not well established. Objectives The objective of this study is to analyze the relationship between arterial stiffness indices and the degree of limb ischemia measured by the ankle-brachial index (ABI). Methods A cross-sectional study comparing patients with CLI and controls. Arterial stiffness was measured using brachial artery oscillometry. The arterial stiffness indices pulse wave velocity (PWV) and augmentation index normalized to 75 beats/min (AIx@75) were determined. Multiple linear regression was applied to identify predictors of arterial stiffness indices. Results Patients in the CLI group had higher PWV (12.1±1.9 m/s vs. 10.1±1.9 m/s, p < 0.01) and AIx@75 (31.8±7.8% vs. 17.5±10.8%, p < 0.01) than controls. Central systolic pressure was higher in the CLI group (129.2±18.4 mmHg vs. 115.2±13.1 mmHg, p < 0.01). There was an inverse relationship between AIx@75 and ABI (Pearson coefficient = 0.24, p = 0.048), but there was no relationship between ABI and PWV (Pearson coefficient = 0.19, p = 0.12). In multiple regression analysis, reduced ABI was a predictor of elevated levels of AIx@75 (β = -25.02, p < 0.01). Conclusions Patients with CLI have high arterial stiffness measured by brachial artery oscillometry. The degree of limb ischemia, as measured by the ABI, is a predictor of increased AIx@75. The increased AIx@75 observed in CLI may have implications for the prognosis of this group of patients with advanced atherosclerosis.
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Affiliation(s)
- Daniel Mendes-Pinto
- Hospital Felício Rocho, Departamento de Cirurgia Vascular, Belo Horizonte, MG, Brasil.,Faculdade de Ciências Médicas de Minas Gerais - FCM-MG, Belo Horizonte, MG, Brasil
| | - José Márcio Ribeiro
- Faculdade de Ciências Médicas de Minas Gerais - FCM-MG, Belo Horizonte, MG, Brasil.,Hospital Felício Rocho, Departamento de Cardiologia, Belo Horizonte, MG, Brasil
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11
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Kepler T, Kuusik K, Lepner U, Starkopf J, Zilmer M, Eha J, Lieberg J, Vähi M, Kals J. The Effect of Remote Ischaemic Preconditioning on Arterial Stiffness in Patients Undergoing Vascular Surgery: A Randomised Clinical Trial. Eur J Vasc Endovasc Surg 2019; 57:868-875. [PMID: 31126835 DOI: 10.1016/j.ejvs.2018.12.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2018] [Accepted: 12/01/2018] [Indexed: 12/17/2022]
Abstract
OBJECTIVES The main aim of this study was to evaluate the effect of remote ischaemic preconditioning (RIPC) on arterial stiffness in patients undergoing vascular surgery. METHODS This was a randomised, sham controlled, double blind, single centre study. Patients undergoing open abdominal aortic aneurysm repair, surgical lower limb revascularisation surgery or carotid endarterectomy were recruited. A RIPC or a sham procedure was performed, using a blood pressure cuff, along with preparation for anaesthesia. The RIPC protocol consisting of four cycles of 5 min of ischaemia, followed by 5 min of reperfusion was applied. Arterial stiffness and haemodynamic parameters were measured pre-operatively and 20-28 h after surgery. Two primary outcomes were selected: augmentation index and pulse wave velocity. RESULTS Ninety-eight patients were randomised. After dropouts 44 and 46 patients were included in the RIPC and sham groups, respectively. Both groups were comparable. There were no statistically significant differences in augmentation index (p = .8), augmentation index corrected for heart rate of 75 beats per minute (p = .8), pulse wave velocity (p = .7), large artery elasticity indices (p = .8), small artery elasticity indices (p = .6), or mean arterial pressure (p = .7) changes between the RIPC and sham groups. There occurred statistically significant (p ≤ .01) improvement in augmentation index (-5.8% vs. -5.5%), augmentation index corrected for a heart rate of 75 beats per minute (-2.5% vs. -2%), small artery elasticity indices (0.7 mL/mmHg × 100 vs. 0.9 mL/mmHg × 100), and mean arterial pressure post-operatively in both the RIPC and the sham groups (change median values in RIPC and sham groups, respectively). CONCLUSIONS RIPC had no significant effect on arterial stiffness, but there was significant improvement in arterial stiffness after surgery in both groups. Arterial stiffness and haemodynamics may be influenced by surgery or anaesthesia or oxidative stress or all factors combined. Further studies are needed to clarify these findings. CLINICALTRIALS.GOV: NCT02689414.
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Affiliation(s)
- Teele Kepler
- Department of Surgery, Institute of Clinical Medicine, University of Tartu, Tartu, Estonia; Department of Biochemistry, Institute of Biomedicine and Translational Medicine, Centre of Excellence for Genomics and Translational Medicine, University of Tartu, Tartu, Estonia.
| | - Karl Kuusik
- Department of Biochemistry, Institute of Biomedicine and Translational Medicine, Centre of Excellence for Genomics and Translational Medicine, University of Tartu, Tartu, Estonia; Department of Cardiology, Institute of Clinical Medicine, University of Tartu, Tartu, Estonia
| | - Urmas Lepner
- Department of Surgery, Institute of Clinical Medicine, University of Tartu, Tartu, Estonia; Tartu University Hospital, Estonia
| | - Joel Starkopf
- Department of Anaesthesiology and Intensive Care, Institute of Clinical Medicine, University of Tartu, Tartu, Estonia; Tartu University Hospital, Estonia
| | - Mihkel Zilmer
- Department of Biochemistry, Institute of Biomedicine and Translational Medicine, Centre of Excellence for Genomics and Translational Medicine, University of Tartu, Tartu, Estonia; Tartu University Hospital, Estonia
| | - Jaan Eha
- Department of Cardiology, Institute of Clinical Medicine, University of Tartu, Tartu, Estonia; Tartu University Hospital, Estonia
| | - Jüri Lieberg
- Department of Surgery, Institute of Clinical Medicine, University of Tartu, Tartu, Estonia; Tartu University Hospital, Estonia
| | - Mare Vähi
- Institute of Mathematics and Statistics, University of Tartu, Tartu, Estonia
| | - Jaak Kals
- Department of Surgery, Institute of Clinical Medicine, University of Tartu, Tartu, Estonia; Department of Biochemistry, Institute of Biomedicine and Translational Medicine, Centre of Excellence for Genomics and Translational Medicine, University of Tartu, Tartu, Estonia; Tartu University Hospital, Estonia
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12
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Ramirez JL, Spaulding KA, Zahner GJ, Khetani SA, Schaller MS, Gasper WJ, Hills NK, Marlene Grenon S. Radial Artery Tonometry is Associated With Major Adverse Cardiac Events in Patients With Peripheral Artery Disease. J Surg Res 2019; 235:250-257. [PMID: 30691803 PMCID: PMC6355158 DOI: 10.1016/j.jss.2018.09.088] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Revised: 08/09/2018] [Accepted: 09/28/2018] [Indexed: 11/16/2022]
Abstract
BACKGROUND Peripheral artery disease (PAD) is associated with increased arterial stiffness, as measured by an increasing radial artery augmentation index (AIX). However, it has not yet been clearly demonstrated whether AIX is associated with adverse cardiovascular outcomes in a PAD population. MATERIALS AND METHODS Seventy-two patients with PAD were recruited between 2011 and 2016. Radial artery applanation tonometry was performed at a baseline visit, and the central AIX, normalized to 75 beats/min, and the peripheral AIX were calculated using pulse wave analysis. Incident major adverse cardiac events (MACEs) were identified by subsequent chart review. RESULTS Study subjects had comorbidities commonly associated with PAD including a high prevalence of hypertension (93%), hyperlipidemia (85%), coronary artery disease (39%), and diabetes mellitus (39%). During a median follow-up period of 34 mo (interquartile range 29-38), 14 patients experienced a MACE. In a univariate Cox proportional hazards model, a 10-unit increase in the peripheral AIX was significantly associated with a 54% increased rate of MACE (hazard ratio [HR] 1.54, 95% confidence interval [CI] 1.06-2.22, P = 0.02), but central AIX, normalized to 75 beats/min, was not (HR 1.33, 95% CI 0.71-2.47, P = 0.37). In a multivariable model adjusted for coronary artery disease, age, and Rutherford category the peripheral AIX remained significantly associated with MACE (HR 1.70, 95% CI 1.10-2.62, P = 0.02). CONCLUSIONS Increased arterial stiffness, as measured by the peripheral AIX, was independently associated with an increased rate of MACE in patients with PAD. The use of radial artery tonometry should be contemplated as a tool for risk stratification in patients with PAD.
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Affiliation(s)
- Joel L Ramirez
- Department of Surgery, University of California, San Francisco, San Francisco, California
| | - Kimberly A Spaulding
- Department of Surgery, University of California, San Francisco, San Francisco, California; Vascular Surgery Section, Veterans Affairs Medical Center, San Francisco, California
| | - Greg J Zahner
- Department of Surgery, University of California, San Francisco, San Francisco, California
| | - Sukaynah A Khetani
- Department of Surgery, University of California, San Francisco, San Francisco, California; Vascular Surgery Section, Veterans Affairs Medical Center, San Francisco, California
| | - Melinda S Schaller
- Department of Surgery, University of California, San Francisco, San Francisco, California
| | - Warren J Gasper
- Department of Surgery, University of California, San Francisco, San Francisco, California; Vascular Surgery Section, Veterans Affairs Medical Center, San Francisco, California
| | - Nancy K Hills
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California
| | - S Marlene Grenon
- Department of Surgery, University of California, San Francisco, San Francisco, California; Vascular Surgery Section, Veterans Affairs Medical Center, San Francisco, California.
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13
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Zhang C, Tao J. Expert consensus on clinical assessment and intervention of vascular aging in China (2018). Aging Med (Milton) 2018; 1:228-237. [PMID: 31942501 PMCID: PMC6880715 DOI: 10.1002/agm2.12049] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2018] [Accepted: 11/11/2018] [Indexed: 12/18/2022] Open
Abstract
With the development of geriatric medicine, more and more reported research has found that as humans grow old, their blood vessels also age. Blood vessels are vital components of various organs. Vascular aging is an important physiological and pathological basis for the aging of organs and systems of the human body and is the common pathogenesis of various chronic diseases in the elderly. Early detection of vascular aging and the use of correct methods to delay and treat vascular aging are of great significance to prevent and control chronic diseases in the elderly and to deal with the increasingly serious problems of population aging. For this purpose, this consensus is formulated for use by geriatric doctors and related personnel.
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Affiliation(s)
- Cuntai Zhang
- Department of GeriatricsTongji Medical College of Huazhong University of Science and TechnologyWuhanHubeiChina
| | - Jun Tao
- Department of Hypertension and Vascular DiseaseThe First Affiliated HospitalSun Yat‐Sen UniversityGuangzhouGuangdongChina
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14
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Ismaeel A, Brumberg RS, Kirk JS, Papoutsi E, Farmer PJ, Bohannon WT, Smith RS, Eidson JL, Sawicki I, Koutakis P. Oxidative Stress and Arterial Dysfunction in Peripheral Artery Disease. Antioxidants (Basel) 2018; 7:antiox7100145. [PMID: 30347720 PMCID: PMC6210426 DOI: 10.3390/antiox7100145] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2018] [Revised: 10/16/2018] [Accepted: 10/17/2018] [Indexed: 02/07/2023] Open
Abstract
Peripheral artery disease (PAD) is an atherosclerotic disease characterized by a narrowing of the arteries in the lower extremities. Disease manifestations are the result of more than just reduced blood flow, and include endothelial dysfunction, arterial stiffness, and inflammation. Growing evidence suggests that these factors lead to functional impairment and decline in PAD patients. Oxidative stress also plays an important role in the disease, and a growing amount of data suggest a link between arterial dysfunction and oxidative stress. In this review, we present the current evidence for the involvement of endothelial dysfunction, arterial stiffness, and inflammation in the pathophysiology of PAD. We also discuss the links between these factors and oxidative stress, with a focus on nicotinamide adenine dinucleotide phosphate (NADPH) oxidase 2 (NOX2)-derived reactive oxygen species (ROS) and decreased nitric oxide (NO) bioavailability. Finally, the potential therapeutic role of NOX2 antioxidants for improving arterial function and functional status in PAD patients is explored.
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Affiliation(s)
- Ahmed Ismaeel
- Department of Nutrition, Food and Exercise Sciences, Florida State University, Tallahassee, FL 32304, USA.
| | - Robert S Brumberg
- Department of Surgery, Vascular Surgery Associates, Florida State University School of Medicine, Tallahassee Memorial Hospital, Tallahassee, FL 32308, USA.
| | - Jeffrey S Kirk
- Department of Surgery, Capital Regional Medical Center, Tallahassee, FL 32308, USA.
| | - Evlampia Papoutsi
- Department of Nutrition, Food and Exercise Sciences, Florida State University, Tallahassee, FL 32304, USA.
| | - Patrick J Farmer
- Department of Chemistry and Biochemistry, Baylor University, Waco, TX 76798, USA.
| | - William T Bohannon
- Department of Surgery, Baylor Scott and White Medical Center, Temple, TX 76508, USA.
| | - Robert S Smith
- Department of Surgery, Baylor Scott and White Medical Center, Temple, TX 76508, USA.
| | - Jack L Eidson
- Department of Surgery, Baylor Scott and White Medical Center, Temple, TX 76508, USA.
| | - Ian Sawicki
- Department of Surgery, Baylor Scott and White Medical Center, Temple, TX 76508, USA.
| | - Panagiotis Koutakis
- Department of Nutrition, Food and Exercise Sciences, Florida State University, Tallahassee, FL 32304, USA.
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15
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Stoner L, Hanson ED, Gram M, Allen JD, Malin SK. Research Toolbox for Peripheral Arterial Disease - Minimally Invasive Assessment of the Vasculature and Skeletal Muscle. Circ J 2018; 82:2462-2469. [PMID: 30058605 DOI: 10.1253/circj.cj-18-0283] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
In 2010, more than 200 million people were afflicted with peripheral arterial disease (PAD). Because it is atherosclerotic in etiology, it is not surprising that PAD is a leading cause of cardiovascular morbidity. Cardiovascular disease (CVD) risk can be decreased if ambulatory physical function is improved. However, physical function is limited by a mismatch between oxygen supply and demand in the legs, which results in exertional pain, leg weakness, and balance problems. Therefore, a key factor for improving physical function, and decreasing CVD outcomes, is ensuring oxygen supply meets the oxygen demand. The purpose of this review is to highlight and evaluate practical and minimally invasive tools for assessing PAD etiology, with a specific focus on tools suited to studies focusing on improving physical function and CVD outcomes. Specifically, the macrovascular, microvascular, and skeletal muscle pathology of PAD is briefly outlined. Subsequently, the tools for assessing each of these components is discussed, including, where available, the evidence to contextualize these tools to PAD pathology as well as physical function and CVD outcomes. The goal of this review is to guide researchers to the appropriate tools with respect to their methodological design.
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Affiliation(s)
- Lee Stoner
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill
| | - Erik D Hanson
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill
| | - Martin Gram
- School of Sport and Exercise, Massey University
| | - Jason D Allen
- Department of Kinesiology, University of Virginia.,Division of Cardiovascular Medicine, University of Virginia
| | - Steven K Malin
- Department of Kinesiology, University of Virginia.,Division of Endocrinology & Metabolism, University of Virginia.,Robert M. Berne Cardiovascular Research Center, University of Virginia
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16
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Zahner GJ, Spaulding KA, Ramirez JL, Schaller MS, Walker SC, Hills NK, Gasper WJ, Grenon SM. Characterizing the relationship between flow-mediated vasodilation and radial artery tonometry in peripheral artery disease. J Surg Res 2018; 224:121-131. [PMID: 29506827 PMCID: PMC5844355 DOI: 10.1016/j.jss.2017.11.062] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2017] [Revised: 11/18/2017] [Accepted: 11/22/2017] [Indexed: 01/22/2023]
Abstract
BACKGROUND Arterial stiffness, measured by the augmentation index (AIX) from radial artery tonometry, and endothelial dysfunction, measured by brachial-artery flow-mediated vasodilation (FMD), have each been associated with increased risk of cardiovascular events. However, their interrelationship in peripheral artery disease (PAD) patients is poorly understood. MATERIALS AND METHODS In a cross-sectional analysis of 123 vascular surgery outpatients, the association between FMD and AIX was examined in controls with atherosclerotic risk factors (n = 32) and patients with PAD (n = 91). PAD was defined as claudication symptoms with an ankle-brachial index of <0.9 or a history of revascularization for symptomatic PAD. Controls had an ankle-brachial index ≥0.9 and no history of atherosclerotic vascular disease. RESULTS Compared to controls, patients with PAD had lower FMD (6.3 ± 3.8 versus 8.4 ± 3.7, P = 0.008), while central AIX normalized to 75 beats per minute (25.5 ± 9.0 versus 19.3 ± 8.6, P = 0.001) and peripheral AIX (91.3 ± 14.5 versus 81.3 ± 11.4, P = 0.001) were higher. FMD was not significantly correlated with either central or peripheral AIX (central AIX: P = 0.58; peripheral AIX: P = 0.89) across the entire cohort, or in either the patients with PAD (central AIX: P = 0.48; peripheral AIX: P = 0.23) or controls (central AIX: P = 0.43; peripheral AIX: P = 0.92). In a multivariate model including FMD, higher AIX remained independently associated with PAD. CONCLUSIONS In an analysis of vascular surgery outpatients, no correlation between FMD and AIX was detected. Larger prospective studies are needed to determine whether the inclusion of both parameters improves predictive models for the early identification and potential risk stratification of PAD patients.
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Affiliation(s)
- Greg J Zahner
- Department of Surgery, University of California, San Francisco, San Francisco, California
| | - Kimberly A Spaulding
- Department of Surgery, University of California, San Francisco, San Francisco, California; Vascular Surgery Section, Veterans Affairs Medical Center, San Francisco, California
| | - Joel L Ramirez
- Department of Surgery, University of California, San Francisco, San Francisco, California
| | - Melinda S Schaller
- Department of Surgery, University of California, San Francisco, San Francisco, California
| | - Shane C Walker
- Department of Surgery, University of California, San Francisco, San Francisco, California
| | - Nancy K Hills
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California
| | - Warren J Gasper
- Department of Surgery, University of California, San Francisco, San Francisco, California; Vascular Surgery Section, Veterans Affairs Medical Center, San Francisco, California
| | - S Marlene Grenon
- Department of Surgery, University of California, San Francisco, San Francisco, California; Vascular Surgery Section, Veterans Affairs Medical Center, San Francisco, California.
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17
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Tootsi K, Kals J, Zilmer M, Paapstel K, Ottas A, Märtson A. Medium- and long-chain acylcarnitines are associated with osteoarthritis severity and arterial stiffness in end-stage osteoarthritis patients: a case-control study. Int J Rheum Dis 2018; 21:1211-1218. [DOI: 10.1111/1756-185x.13251] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Kaspar Tootsi
- Department of Traumatology and Orthopaedics; University of Tartu; Tartu Estonia
- Endothelial Centre; University of Tartu; Tartu Estonia
- Institute of Biomedicine and Translational Medicine; Department of Biochemistry; Centre of Excellence for Genomics and Translational Medicine; University of Tartu; Tartu Estonia
| | - Jaak Kals
- Endothelial Centre; University of Tartu; Tartu Estonia
- Institute of Biomedicine and Translational Medicine; Department of Biochemistry; Centre of Excellence for Genomics and Translational Medicine; University of Tartu; Tartu Estonia
- Department of Surgery; University of Tartu; Tartu Estonia
| | - Mihkel Zilmer
- Institute of Biomedicine and Translational Medicine; Department of Biochemistry; Centre of Excellence for Genomics and Translational Medicine; University of Tartu; Tartu Estonia
| | - Kaido Paapstel
- Endothelial Centre; University of Tartu; Tartu Estonia
- Institute of Biomedicine and Translational Medicine; Department of Biochemistry; Centre of Excellence for Genomics and Translational Medicine; University of Tartu; Tartu Estonia
| | - Aigar Ottas
- Institute of Biomedicine and Translational Medicine; Department of Biochemistry; Centre of Excellence for Genomics and Translational Medicine; University of Tartu; Tartu Estonia
| | - Aare Märtson
- Department of Traumatology and Orthopaedics; University of Tartu; Tartu Estonia
- Institute of Biomedicine and Translational Medicine; Department of Biochemistry; Centre of Excellence for Genomics and Translational Medicine; University of Tartu; Tartu Estonia
- Traumatology and Orthopaedics Clinic; Tartu University Hospital; Tartu Estonia
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18
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Zahner GJ, Gruendl MA, Spaulding KA, Schaller MS, Hills NK, Gasper WJ, Grenon SM. Association between arterial stiffness and peripheral artery disease as measured by radial artery tonometry. J Vasc Surg 2017; 66:1518-1526. [PMID: 28756044 DOI: 10.1016/j.jvs.2017.06.068] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2017] [Accepted: 06/15/2017] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Arterial stiffness and peripheral artery disease (PAD) are both associated with an elevated risk of major adverse cardiac events; however, the association between arterial stiffness and PAD is less well characterized. The goal of this study was to examine the association between parameters of radial artery tonometry, a noninvasive measure of arterial stiffness, and PAD. METHODS We conducted a cross-sectional study of 134 vascular surgery outpatients (controls, 33; PAD, 101) using arterial applanation tonometry. Central augmentation index (AIX) normalized to 75 beats/min and peripheral AIX were measured using radial artery pulse wave analysis. Pulse wave velocity was recorded at the carotid and femoral arteries. PAD was defined as symptomatic claudication with an ankle-brachial index of <0.9 or a history of peripheral revascularization. Controls had no history of atherosclerotic vascular disease and an ankle-brachial index ≥0.9. RESULTS Among the 126 participants with high-quality tonometry data, compared with controls (n = 33), patients with PAD (n = 93) were older, with higher rates of hypertension, hyperlipidemia, diabetes, and smoking (P < .05). Patients with PAD also had greater arterial stiffness as measured by central AIX, peripheral AIX, and pulse wave velocity (P < .05). In a multivariable model, a significantly increased odds of PAD was associated with each 10-unit increase in central AIX (odds ratio, 2.1; 95% confidence interval, 1.1-3.9; P = .03) and peripheral AIX (odds ratio, 1.9; 95% confidence interval, 1.2-3.2; P = .01). In addition, central and peripheral AIX were highly correlated (r120 = 0.76; P < .001). CONCLUSIONS In a cross-sectional analysis, arterial stiffness as measured by the AIX is independently associated with PAD, even when adjusting for several atherosclerotic risk factors. Further prospective data are needed to establish whether radial artery tonometry could be a tool for risk stratification in the PAD population.
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Affiliation(s)
- Greg J Zahner
- Department of Surgery, University of California, San Francisco, Calif
| | | | - Kimberly A Spaulding
- Department of Surgery, University of California, San Francisco, Calif; Vascular Surgery Section, Veterans Affairs Medical Center, San Francisco, Calif
| | | | - Nancy K Hills
- Department of Epidemiology and Biostatistics, University of California, San Francisco, Calif
| | - Warren J Gasper
- Department of Surgery, University of California, San Francisco, Calif; Vascular Surgery Section, Veterans Affairs Medical Center, San Francisco, Calif
| | - S Marlene Grenon
- Department of Surgery, University of California, San Francisco, Calif; Vascular Surgery Section, Veterans Affairs Medical Center, San Francisco, Calif.
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19
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Massmann A, Stemler J, Fries P, Kubale R, Kraushaar LE, Buecker A. Automated oscillometric blood pressure and pulse-wave acquisition for evaluation of vascular stiffness in atherosclerosis. Clin Res Cardiol 2017; 106:514-524. [PMID: 28168512 PMCID: PMC5486635 DOI: 10.1007/s00392-017-1080-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2016] [Accepted: 01/10/2017] [Indexed: 11/27/2022]
Abstract
OBJECTIVE Evaluation of diagnostic accuracy of an oscillometry-based device (VascAssist) combining fully automated ankle-brachial index (ABI) and pulse-wave velocity (PWV) assessment for detection of peripheral arterial disease (PAD). SUBJECTS AND METHODS 110 consecutive subjects including symptomatic PAD patients (n = 41) and healthy PAD-free participants (n = 69) were recruited. All subjects underwent standard manual Doppler-based ABI (sABI) and oscillometry-based automated ABI (aABI) measurements (VascAssist). Oscillometry by the VascAssist included central and peripheral PWV assessment. Additionally, arterial stiffness (AS) was evaluated by flow-mediated vasodilation (FMD) of the brachial artery in all patients. All symptomatic PAD patients underwent catheter angiography for endovascular intervention and post-interventional acquisition of sABI, aABI, PWV and FMD. RESULTS Sensitivity, specificity, PPV and NPV of aABI for detecting PAD was 73%, 100%, 100%, and 86% as compared to 80%, 96%, 92%, and 89% for sABI. Pearson-correlation for diabetics was r = 0.81; (P < .001) and for non-diabetics r = 0.77; (P < .001). Bland-Altman-analysis revealed a difference (95% CI) for diabetics of 0.09 (-0.22-0.4] and non-diabetics 0.022 [-0.25-0.295]. Weak correlation exists for FMD/AS analysis (pre-interventional R = 0.386, P = .043; post-interventional R = -0.06; P = .76) and significant increase of pre-/post-interventional PWV analysis (P < .001). CONCLUSION Combined automatic ABI and PWV acquisition with the VascAssist device showed excellent diagnostic accuracy for detection of PAD. Compared to FMD, AS analysis may serve as an investigator-independent (screening) tool for determination of functional vascular damage in atherosclerosis.
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Affiliation(s)
- Alexander Massmann
- Clinic of Diagnostic and Interventional Radiology, Saarland University Medical Center, Kirrberger Straße, Geb. 50.1, 66421 Homburg/saar, Germany
| | - Jennifer Stemler
- Clinic of Diagnostic and Interventional Radiology, Saarland University Medical Center, Kirrberger Straße, Geb. 50.1, 66421 Homburg/saar, Germany
| | - Peter Fries
- Clinic of Diagnostic and Interventional Radiology, Saarland University Medical Center, Kirrberger Straße, Geb. 50.1, 66421 Homburg/saar, Germany
| | - Reinhard Kubale
- Clinic of Diagnostic and Interventional Radiology, Saarland University Medical Center, Kirrberger Straße, Geb. 50.1, 66421 Homburg/saar, Germany
| | | | - Arno Buecker
- Clinic of Diagnostic and Interventional Radiology, Saarland University Medical Center, Kirrberger Straße, Geb. 50.1, 66421 Homburg/saar, Germany
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20
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Tootsi K, Märtson A, Zilmer M, Paapstel K, Kals J. Increased arterial stiffness in patients with end-stage osteoarthritis: a case-control study. BMC Musculoskelet Disord 2016; 17:335. [PMID: 27515421 PMCID: PMC4982219 DOI: 10.1186/s12891-016-1201-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2015] [Accepted: 08/03/2016] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Both osteoarthritis (OA) and cardiovascular diseases (CVD) are prevalent conditions which often co-exist. Vascular involvement in the pathogenesis of these diseases, as well as increased cardiovascular risk in OA patients give occasion to investigate arterial stiffness in OA. The aim of this study was to establish associations between OA and arterial stiffness. METHODS The characteristics of arterial stiffness were measured with Sphygmocor and HDI devices in 48 patients (age 63 ± 7 years (mean ± SD)) with end-stage OA awaiting knee and hip replacement and in 49 age and gender matched controls (61 ± 7 years). Independent Student's t-test or the Mann-Whitney U test was used to compare means between the groups. Correlation between variables was determined using Pearson's or Spearman's correlation analysis and stepwise multiple regression analysis. RESULTS Carotid-femoral pulse wave velocity (car-fem PWV) was increased in the patients with OA compared to the controls (9.6 ± 2.4 and 8.4 ± 1.9 m/s, p = 0.015 respectively). High-sensitivity C-reactive protein and white blood cells count were significantly higher in the OA patients compared with the controls (1.80 ± 1.10 and 1.48 ± 1.32 mg/l, p = 0.042; 6.5 ± 1.5 and 5.6 ± 1.9 10(9)/l, p = 0.001 respectively). In multiple regression analysis age (p < 0.001), mean arterial blood pressure (p = <0.001) and OA status (p = 0.029) were found to be independent predictors of car-fem PWV. CONCLUSIONS This study showed that patients with OA had increased aortic stiffness compared to non-OA controls. The potential link between arterial stiffening and OA suggests that vascular alterations are involved in OA pathogenesis and could be responsible for increased cardiovascular risk in end-stage OA patients.
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Affiliation(s)
- Kaspar Tootsi
- Department of Traumatology and Orthopaedics, University of Tartu, Puusepa street 8, Tartu, Estonia.
| | - Aare Märtson
- Department of Traumatology and Orthopaedics, University of Tartu, Puusepa street 8, Tartu, Estonia.,Clinic of Traumatology and Orthopaedics, Tartu University Hospital, Tartu, Estonia
| | - Mihkel Zilmer
- Institute of Biomedicine and Translational Medicine, Centre of Excellence for Genomics and Translational Medicine, University of Tartu, Tartu, Estonia
| | - Kaido Paapstel
- Department of Vascular Surgery, Tartu University Hospital, Tartu, Estonia
| | - Jaak Kals
- Institute of Biomedicine and Translational Medicine, Centre of Excellence for Genomics and Translational Medicine, University of Tartu, Tartu, Estonia.,Department of Vascular Surgery, Tartu University Hospital, Tartu, Estonia.,Department of Surgery, University of Tartu, Tartu, Estonia
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21
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Nilsson PM, Magnusson M. Metabolomic signatures in atherosclerotic disease: what is the potential use? Hypertens Res 2016; 39:576-7. [DOI: 10.1038/hr.2016.44] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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22
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van den Bosch H, Westenberg J, Setz-Pels W, Kersten E, Tielbeek A, Duijm L, Post J, Teijink J, de Roos A. Prognostic value of cardiovascular MR imaging biomarkers on outcome in peripheral arterial disease: a 6-year follow-up pilot study. Int J Cardiovasc Imaging 2016; 32:1281-8. [PMID: 27209283 DOI: 10.1007/s10554-016-0908-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2016] [Accepted: 04/15/2016] [Indexed: 11/25/2022]
Abstract
The objective of this pilot study was to explore the prognostic value of outcome of cardiovascular magnetic resonance (MR) imaging biomarkers in patients with symptomatic peripheral arterial disease (PAD) in comparison with traditional risk factors. Forty-two consecutive patients (mean age 64 ± 11 years, 22 men) referred for contrast-enhanced MR angiography (CE-MRA) were included. At baseline a comprehensive cardiovascular MRI examination was performed: CE-MRA of the infra-renal aorta and run-off vessels, carotid vessel wall imaging, cardiac cine imaging and aortic pulse wave velocity (PWV) assessment. Patients were categorized for outcome at 72 ± 5 months follow-up. One patient was lost to follow-up. Over 6 years, six patients had died (mortality rate 14.6 %), six patients (14.6 %) had experienced a cardiac event and three patients (7.3 %) a cerebral event. The mean MRA stenosis class (i.e., average stenosis severity visually scored over 27 standardized segments) was a significant independent predictor for all-cause mortality (beta 3.0 ± standard error 1.3, p = 0.02). Descending aorta PWV, age and diabetes mellitus were interrelated with stenosis severity but none of these were significant independent predictors. For cardiac morbidity, left ventricular ejection fraction (LVEF) and mean MRA stenosis class were associated, but only LVEF was a significant independent predictor (beta -0.14 ± 0.05, p = 0.005). Diabetes mellitus was a significant independent predictor for cerebral morbidity (beta 2.8 ± 1.3, p = 0.03). Significant independent predictors for outcome in PAD are mean MRA stenosis class for all-cause mortality, LVEF for cardiac morbidity and diabetes mellitus for cerebral morbidity.
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Affiliation(s)
| | - Jos Westenberg
- Department of Radiology, Leiden University Medical Centre, Leiden, The Netherlands
| | - Wikke Setz-Pels
- Department of Radiology, Catharina Hospital, Eindhoven, The Netherlands
| | - Erik Kersten
- Department of Radiology, Catharina Hospital, Eindhoven, The Netherlands
| | | | - Lucien Duijm
- Department of Radiology, Canisius-Wilhelmina Hospital, Nijmegen, The Netherlands
| | - Johannes Post
- Department of Cardiology, Catharina Hospital, Eindhoven, The Netherlands
| | - Joep Teijink
- Department of Vascular Surgery, Catharina Hospital, Eindhoven, The Netherlands
| | - Albert de Roos
- Department of Radiology, Leiden University Medical Centre, Leiden, The Netherlands
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Response to Aboyans, et al.: Estimation of pulse wave velocity in patients with peripheral artery disease: a word of caution. Hypertens Res 2016; 39:618-9. [PMID: 27075828 DOI: 10.1038/hr.2016.34] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Li YH, Lin SY, Sheu WHH, Lee IT. Relationship between percentage of mean arterial pressure at the ankle and mortality in participants with normal ankle-brachial index: an observational study. BMJ Open 2016; 6:e010540. [PMID: 27016246 PMCID: PMC4809088 DOI: 10.1136/bmjopen-2015-010540] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES Peripheral arterial disease (PAD) is associated with all-cause mortality. Ankle-brachial index (ABI) is the most widely used tool for detecting PAD, but can yield false-negative results in patients with non-compressible vessels. Pulse volume recording may be an alternative tool for assessing PAD in such patients. However, the association between pulse volume recording and all-cause mortality has seldom been reported. We hypothesised that the percentage of mean arterial pressure (%MAP) and upstroke time (UT), which are indexes of the arterial wave obtained on pulse volume recording, can predict mortality. DESIGN We conducted this as a retrospective cohort study. SETTING Data were collected from the Taichung Veterans General Hospital. PARTICIPANTS We included 314 participants with complete data on ABI and pulse volume recording performed between June 2007 and November 2011. PRIMARY OUTCOME MEASURE Mortality data served as the follow-up outcome. Mortality data were obtained from the Collaboration Center of Health Information Application, Ministry of Health and Welfare, Executive Yuan, Taiwan. RESULTS Participants with ABI ≤ 0.9 showed a highest mortality rate (p<0.001 in the log-rank test), but the mortality rate was not significantly different between participants with 0.9<ABI≤1.1 and those with 1.1<ABI≤1.3 (p=0.553). Among the participants with 0.9<ABI≤1.3, the high %MAP (>45%) group showed a higher risk of all-cause mortality than the low %MAP (≤ 45%) group (HR=5.389, p=0.004) after adjustment for ABI, pulse wave velocity, UT, age, sex, blood pressure, serum cholesterol, and history of cardiovascular disease and diabetes. CONCLUSIONS We thus demonstrated that a high %MAP based on pulse volume recording in participants with 0.9<ABI≤1.3 could predict all-cause mortality during 20.3 months of follow-up.
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Affiliation(s)
- Yu-Hsuan Li
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung City, Taiwan
| | - Shih-Yi Lin
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung City, Taiwan
- Center for Geriatrics and Gerontology, Taichung Veterans General Hospital, Taichung City, Taiwan
- School of Medicine, National Yang-Ming University, Taipei City, Taiwan
| | - Wayne Huey-Herng Sheu
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung City, Taiwan
- School of Medicine, National Yang-Ming University, Taipei City, Taiwan
- School of Medicine, Chung Shan Medical University, Taichung City, Taiwan
| | - I-Te Lee
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung City, Taiwan
- School of Medicine, National Yang-Ming University, Taipei City, Taiwan
- School of Medicine, Chung Shan Medical University, Taichung City, Taiwan
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25
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Shin HS, Jung Park M, Nyeo Jeon K, Min Cho J, Soo Bae K, Seob Choi D, Boem Na J, Cheol Choi H, Young Choi H, Eun Kim J, Bueum Cho S, Eun Park S. Lower Extremity Arterial Calcification as a Predictor of Coronary Atherosclerosis in Patients with Peripheral Arterial Disease. IRANIAN JOURNAL OF RADIOLOGY 2016; 13:e33179. [PMID: 27703657 PMCID: PMC5037928 DOI: 10.5812/iranjradiol.33179] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/16/2015] [Revised: 10/29/2015] [Accepted: 11/07/2015] [Indexed: 01/07/2023]
Abstract
Background Until now, there has been no study on the relationship between the calcification of the lower extremity arteries and significant coronary arterial disease (CAD). Objectives To evaluate whether lower extremity calcium scores (LECS) are associated with CAD and whether this can predict multivessel-CAD in patients with peripheral arterial disease (PAD). Patients and Methods We retrospectively enrolled 103 PAD patients without cardiac symptoms or known CAD. All patients underwent cardiac computed tomography (CT) and lower extremity CT within 1 month and were categorized as nonsignificant CAD, single-CAD, or multivessel-CAD. The coronary calcium scores (CCS) were quantitatively measured according to the Agatston method and LECS were semi-quantitatively measured according to the presence of lower extremity calcification in the segment. The extent of CAD was evaluated according to the presence of ≥ 50% luminal diameter stenosis in the segment of CAD. Results LECS in multivessel-CAD were significantly higher than those in nonsignificant CAD (10.0 ± 5.8 versus 4.0 ± 3.1, P < 0.001). LECS significantly correlated with CCS (r = 0.831, P < 0.001) and the extent of CAD (r = 0.631, P < 0.001). Multivariate regression analysis demonstrated LECS and log-transformed CCS were independent predictors for multivessel-CAD. In receiver operating characteristic curve analysis, the diagnostic performance of LECS was 0.807 (95% confidence interval = 0.724-0.891, P < 0.001) for predicting multivessel-CAD. Conclusion Peripheral arterial calcification is significantly correlated with CAD extent in patients with PAD. Peripheral arterial calcification can be a useful marker for predicting multivessel-CAD.
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Affiliation(s)
- Hwa Seon Shin
- Department of Radiology, Gyeongsang National University Hospital, Gyeongsang National University School of Medicine, Jinju, Republic of Korea
| | - Mi Jung Park
- Department of Radiology, Gyeongsang National University Hospital, Gyeongsang National University School of Medicine, Jinju, Republic of Korea
- Corresponding author: Mi Jung Park, Department of Radiology, Gyeongsang National University Hospital, Gyeongsang National University School of Medicine, Jinju, Republic of Korea. Tel: +82-557508814, Fax: +82-557581568, E-mail:
| | - Kyung Nyeo Jeon
- Department of Radiology, Gyeongsang National University Hospital, Gyeongsang National University School of Medicine, Jinju, Republic of Korea
| | - Jae Min Cho
- Department of Radiology, Gyeongsang National University Hospital, Gyeongsang National University School of Medicine, Jinju, Republic of Korea
| | - Kyung Soo Bae
- Department of Radiology, Gyeongsang National University Hospital, Gyeongsang National University School of Medicine, Jinju, Republic of Korea
| | - Dae Seob Choi
- Department of Radiology, Gyeongsang National University Hospital, Gyeongsang National University School of Medicine, Jinju, Republic of Korea
| | - Jae Boem Na
- Department of Radiology, Gyeongsang National University Hospital, Gyeongsang National University School of Medicine, Jinju, Republic of Korea
| | - Ho Cheol Choi
- Department of Radiology, Gyeongsang National University Hospital, Gyeongsang National University School of Medicine, Jinju, Republic of Korea
| | - Hye Young Choi
- Department of Radiology, Gyeongsang National University Hospital, Gyeongsang National University School of Medicine, Jinju, Republic of Korea
| | - Ji Eun Kim
- Department of Radiology, Gyeongsang National University Hospital, Gyeongsang National University School of Medicine, Jinju, Republic of Korea
| | - Soo Bueum Cho
- Department of Radiology, Gyeongsang National University Hospital, Gyeongsang National University School of Medicine, Jinju, Republic of Korea
| | - Sung Eun Park
- Department of Radiology, Gyeongsang National University Hospital, Gyeongsang National University School of Medicine, Jinju, Republic of Korea
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26
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Akdag S, Akyol A, Cakmak HA, Gunbatar H, Asker M, Babat N, Tosu AR, Yaman M, Gumrukcuoglu HA. A Novel Echocardiographic Method for Assessing Arterial Stiffness in Obstructive Sleep Apnea Syndrome. Korean Circ J 2015; 45:500-9. [PMID: 26617653 PMCID: PMC4661366 DOI: 10.4070/kcj.2015.45.6.500] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2015] [Revised: 03/31/2015] [Accepted: 06/02/2015] [Indexed: 11/20/2022] Open
Abstract
Background and Objectives Obstructive sleep apnea syndrome (OSAS) is associated with increased arterial stiffness and cardiovascular complications. The objective of this study was to assess whether the color M-mode-derived propagation velocity of the descending thoracic aorta (aortic velocity propagation, AVP) was an echocardiographic marker for arterial stiffness in OSAS. Subjects and Methods The study population included 116 patients with OSAS and 90 age and gender-matched control subjects. The patients with OSAS were categorized according to their apnea hypopnea index (AHI) as follows: mild to moderate degree (AHI 5-30) and severe degree (AHI≥30). Aortofemoral pulse wave velocity (PWV), carotid intima-media thickness (CIMT), brachial artery flow-mediated dilatation (FMD), and AVP were measured to assess arterial stiffness. Results AVP and FMD were significantly decreased in patients with OSAS compared to controls (p<0.001). PWV and CIMT were increased in the OSAS group compared to controls (p<0.001). Moreover, AVP and FMD were significantly decreased in the severe OSAS group compared to the mild to moderate OSAS group (p<0.001). PWV and CIMT were significantly increased in the severe group compared to the mild to moderate group (p<0.001). AVP was significantly positively correlated with FMD (r=0.564, p<0.001). However, it was found to be significantly inversely related to PWV (r=-0.580, p<0.001) and CIMT (r=-0.251, p<0.001). Conclusion The measurement of AVP is a novel and practical echocardiographic method, which may be used to identify arterial stiffness in OSAS.
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Affiliation(s)
- Serkan Akdag
- Department of Cardiology, Yuzuncu Yil University Medical Faculty, Van, Turkey
| | - Aytac Akyol
- Department of Cardiology, Yuzuncu Yil University Medical Faculty, Van, Turkey
| | | | - Hulya Gunbatar
- Department of Pulmonary Diseas, Yuzuncu Yil University Medical Faculty, Van, Turkey
| | - Muntecep Asker
- Department of Cardiology, Yuzuncu Yil University Medical Faculty, Van, Turkey
| | - Naci Babat
- Department of Cardiology, Yuzuncu Yil University Medical Faculty, Van, Turkey
| | - Aydin Rodi Tosu
- Department of Cardiology, Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Education and Training Hospital, Istanbul, Turkey
| | - Mehmet Yaman
- Department of Cardiology, Samsun Education and Training Hospital, Samsun, Turkey
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Paapstel K, Zilmer M, Eha J, Tootsi K, Piir A, Kals J. Association Between Fibulin-1 and Aortic Augmentation Index in Male Patients with Peripheral Arterial Disease. Eur J Vasc Endovasc Surg 2015; 51:76-82. [PMID: 26507503 DOI: 10.1016/j.ejvs.2015.09.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2015] [Accepted: 09/03/2015] [Indexed: 11/19/2022]
Abstract
BACKGROUND Fibulin-1 (FBLN-1), a newly identified biomarker for vascular stiffness in type 2 diabetes, may participate in the pathophysiological processes leading to progression of arterial stiffness in atherosclerosis. In the present study, the relationship between FBLN-1 and arterial stiffness was examined in patients with atherosclerosis and in healthy subjects. METHODS Thirty-eight patients with peripheral arterial disease (PAD) (age 62.4 ± 9.0 years), 38 patients with coronary artery disease (CAD) (age 64.0 ± 9.5 years), and 30 apparently healthy controls (age 61.1 ± 6.4 years) were studied. Serum FBLN-1, oxidized low density lipoprotein (oxLDL), resistin and plasminogen activator inhibitor-1 (PAI-1) levels were measured using the enzyme linked immunosorbent assay method. The technique of applanation tonometry was used for non-invasive pulse wave analysis and pulse wave velocity assessments. RESULTS The levels of FBLN-1 (PAD = 9.4 [4.9-17.8] vs. CAD = 7.1 [4.8-11.8] vs. controls = 5.6 [4.1-8.4] μg/mL; p = .005), carotid-femoral pulse wave velocity (cf-PWV) (9.8 ± 2.2 vs. 9.5 ± 2.2 vs. 8.3 ± 2.2 m/s; p = .023) and the heart rate corrected augmentation index (AIx@75) (29.4 ± 7.2 vs. 19.2 ± 7.2 vs. 15.4 ± 7.1%; p < .001), differed among the three groups. A correlation between FBLN-1 and AIx@75 was observed only in patients with PAD (rho = 0.37, p = .021). The relationship retained statistical significance in a multiple regression model after adjustment for potential confounders. CONCLUSIONS An independent association was demonstrated between serum FBLN-1 and AIx@75 in the PAD group. Thus, the findings suggest that FBLN-1 may play a role in arterial stiffening in patients with atherosclerosis.
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Affiliation(s)
- K Paapstel
- Department of Biochemistry, Centre of Excellence for Translational Medicine, University of Tartu, Tartu, Estonia; Endothelial Centre, University of Tartu, Tartu, Estonia.
| | - M Zilmer
- Department of Biochemistry, Centre of Excellence for Translational Medicine, University of Tartu, Tartu, Estonia; Endothelial Centre, University of Tartu, Tartu, Estonia
| | - J Eha
- Endothelial Centre, University of Tartu, Tartu, Estonia; Department of Cardiology, University of Tartu, Tartu, Estonia
| | - K Tootsi
- Endothelial Centre, University of Tartu, Tartu, Estonia
| | - A Piir
- Department of Biochemistry, Centre of Excellence for Translational Medicine, University of Tartu, Tartu, Estonia
| | - J Kals
- Department of Biochemistry, Centre of Excellence for Translational Medicine, University of Tartu, Tartu, Estonia; Endothelial Centre, University of Tartu, Tartu, Estonia; Department of Vascular Surgery, Tartu University Hospital, Tartu, Estonia
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28
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Zagura M, Kals J, Kilk K, Serg M, Kampus P, Eha J, Soomets U, Zilmer M. Metabolomic signature of arterial stiffness in male patients with peripheral arterial disease. Hypertens Res 2015; 38:840-6. [PMID: 26134123 DOI: 10.1038/hr.2015.71] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2015] [Revised: 03/26/2015] [Accepted: 04/16/2015] [Indexed: 11/09/2022]
Abstract
Arterial stiffness is an independent determinant of cardiovascular risk and a marker of subclinical organ damage. Metabolomics may facilitate identification of novel low-molecular cardiovascular risk factors. The aim of the present study was to compare metabolic signatures and functional-biochemical characteristics of patients with peripheral arterial disease (PAD) and clinically healthy subjects. We studied 42 men with symptomatic PAD (aged 66±7 years) and 46 healthy men (aged 66±8 years). Aortic pulse wave velocity (aPWV) was assessed by applanation tonometry using the Sphygmocor device. Metabolic profiling was performed with high-performance liquid chromatography and mass spectrometry. Serum oxidized low-density lipoprotein (oxLDL) level was measured by enzyme-linked immunosorbent assay. The aPWV as well as serum levels of lactate, free carnitine and 11 amino acids including tyrosine were higher among the patients with PAD. In contrast, serum levels of pyruvate, citrate, α-ketoglutarate, aconitate and cysteine were higher in the control group. In multiple regression models, aPWV was independently determined by log-tyrosine and log-oxLDL in the patients (R(2)=0.61; P<0.001) and by age, log-pyruvate and log-oxLDL in the controls (R(2)=0.52; P<0.001). Our study describes for the first time significant differences in metabolomic signature of patients with advanced atherosclerosis compared with clinically healthy controls. The aPWV is independently associated with serum levels of tyrosine and oxLDL in the patients with PAD and is related to pyruvate and oxLDL levels in the control group. The measurement of low-molecular metabolites, which are related to changes in vascular phenotypes, may lead to identification of novel vascular risk markers.
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Affiliation(s)
- Maksim Zagura
- Department of Biochemistry, Institute of Biomedicine and Translational Medicine, Centre of Excellence for Translational Medicine, University of Tartu, Tartu, Estonia.,Endothelial Centre, University of Tartu, Tartu, Estonia.,Department of Cardiology, University of Tartu, Tartu, Estonia
| | - Jaak Kals
- Department of Biochemistry, Institute of Biomedicine and Translational Medicine, Centre of Excellence for Translational Medicine, University of Tartu, Tartu, Estonia.,Endothelial Centre, University of Tartu, Tartu, Estonia.,Department of Vascular Surgery, Tartu University Hospital, Tartu, Estonia
| | - Kalle Kilk
- Department of Biochemistry, Institute of Biomedicine and Translational Medicine, Centre of Excellence for Translational Medicine, University of Tartu, Tartu, Estonia
| | - Martin Serg
- Endothelial Centre, University of Tartu, Tartu, Estonia.,Department of Cardiology, University of Tartu, Tartu, Estonia
| | - Priit Kampus
- Endothelial Centre, University of Tartu, Tartu, Estonia.,Department of Cardiology, University of Tartu, Tartu, Estonia
| | - Jaan Eha
- Endothelial Centre, University of Tartu, Tartu, Estonia.,Department of Cardiology, University of Tartu, Tartu, Estonia
| | - Ursel Soomets
- Department of Biochemistry, Institute of Biomedicine and Translational Medicine, Centre of Excellence for Translational Medicine, University of Tartu, Tartu, Estonia
| | - Mihkel Zilmer
- Department of Biochemistry, Institute of Biomedicine and Translational Medicine, Centre of Excellence for Translational Medicine, University of Tartu, Tartu, Estonia.,Endothelial Centre, University of Tartu, Tartu, Estonia
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29
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Gul CB, Yildiz A, Ersoy A, Kahvecioglu S, Asiltas B, Yildirim F, Ermurat S, Sag S, Oruc A, Gullulu S, Gullulu M. Correlation between arterial stiffness and inflammatory markers in autosomal dominant polycystic kidney disease patients with preserved renal function. Int Urol Nephrol 2015; 47:1187-94. [PMID: 26047596 DOI: 10.1007/s11255-015-1022-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2015] [Accepted: 05/27/2015] [Indexed: 12/13/2022]
Abstract
AIM To evaluate the association between arterial stiffness and inflammatory markers including C-reactive protein (CRP), pentraxin 3 (PTX3) and neutrophil-to-lymphocyte ratio (NLR) in autosomal dominant polycystic kidney disease (ADPKD) patients with preserved renal function. METHODS A total of 52 ADPKD patients [mean (SD) age 38.2 (12.8) years, 69.2 % were females] with preserved renal function and 25 healthy volunteers [mean (SD) age 35.5 (6.5) years, 48.0 % were females] were included. Data on patient characteristics, blood biochemistry, inflammatory markers [PTX3 (pg/mL), CRP (mg/dL) and NLR] and arterial stiffness [large artery elasticity index (LAEI) (mL/mmHg × 10) and small artery elasticity index (SAEI) (mL/mmHg × 100)] were recorded in patient and control groups. Correlation between inflammatory markers and arterial stiffness parameters was analysed in patients. RESULTS Overall, 42.3 % of ADPKD patients were hypertensive and 44.4 % were receiving renin-angiotensin-aldosterone system (RAAS) blockade therapy. Median levels for PTX3 [442.0 (20.0-4140.0) pg/mL vs. 220.5 (14.7-393.0) pg/mL, p < 0.001] and SAEI [4.90 (1.60-11.80) mL/mmHg × 100 vs. 6.45 (2.80-15.70) mL/mmHg × 10, p = 0.013] were significantly higher in ADPKD patients than in controls. PTX3 and CRP were not correlated with arterial elasticity, while NLR was significantly correlated with LAEI negatively (Rho = -0.278, p = 0.042). CONCLUSION In conclusion, our findings revealed increased PTX3 levels and reduced SAEI in patients as compared with controls, while no correlation between inflammatory markers studied and the small artery elasticity.
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Affiliation(s)
- Cuma Bulent Gul
- Department of Nephrology, Sevket Yılmaz Training and Research Hospital, Bursa, Turkey,
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