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Schoenborn S, Lorenz T, Kuo K, Fletcher DF, Woodruff MA, Pirola S, Allenby MC. Fluid-structure interactions of peripheral arteries using a coupled in silico and in vitro approach. Comput Biol Med 2023; 165:107474. [PMID: 37703711 DOI: 10.1016/j.compbiomed.2023.107474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Revised: 08/21/2023] [Accepted: 09/04/2023] [Indexed: 09/15/2023]
Abstract
Vascular compliance is considered both a cause and a consequence of cardiovascular disease and a significant factor in the mid- and long-term patency of vascular grafts. However, the biomechanical effects of localised changes in compliance cannot be satisfactorily studied with the available medical imaging technologies or surgical simulation materials. To address this unmet need, we developed a coupled silico-vitro platform which allows for the validation of numerical fluid-structure interaction results as a numerical model and physical prototype. This numerical one-way and two-way fluid-structure interaction study is based on a three-dimensional computer model of an idealised femoral artery which is validated against patient measurements derived from the literature. The numerical results are then compared with experimental values collected from compliant arterial phantoms via direct pressurisation and ring tensile testing. Phantoms within a compliance range of 1.4-68.0%/100 mmHg were fabricated via additive manufacturing and silicone casting, then mechanically characterised via ring tensile testing and optical analysis under direct pressurisation with moderately statistically significant differences in measured compliance ranging between 10 and 20% for the two methods. One-way fluid-structure interaction coupling underestimated arterial wall compliance by up to 14.7% compared with two-way coupled models. Overall, Solaris™ (Smooth-On) matched the compliance range of the numerical and in vivo patient models most closely out of the tested silicone materials. Our approach is promising for vascular applications where mechanical compliance is especially important, such as the study of diseases which commonly affect arterial wall stiffness, such as atherosclerosis, and the model-based design, surgical training, and optimisation of vascular prostheses.
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Affiliation(s)
- S Schoenborn
- BioMimetic Systems Engineering (BMSE) Lab, School of Chemical Engineering, University of Queensland (UQ), St Lucia, QLD, 4072, Australia; Biofabrication and Tissue Morphology (BTM) Group, Faculty of Engineering, Centre for Biomedical Technologies, Queensland University of Technology (QUT), Kelvin Grove, QLD, 4059, Australia
| | - T Lorenz
- Institute of Textile Technology, RWTH Aachen University, 52074, Aachen, Germany
| | - K Kuo
- Institute of Textile Technology, RWTH Aachen University, 52074, Aachen, Germany
| | - D F Fletcher
- School of Chemical and Biomolecular Engineering, University of Sydney, Darlington, NSW, 2006, Australia
| | - M A Woodruff
- Biofabrication and Tissue Morphology (BTM) Group, Faculty of Engineering, Centre for Biomedical Technologies, Queensland University of Technology (QUT), Kelvin Grove, QLD, 4059, Australia
| | - S Pirola
- BHF Centre of Research Excellence, Faculty of Medicine, Institute of Clinical Sciences, Imperial College London, South Kensington Campus, London, SW7 2AZ, United Kingdom; Department of Biomechanical Engineering, Faculty of Mechanical Engineering (3me), Delft University of Technology (TUD), Delft, the Netherlands
| | - M C Allenby
- BioMimetic Systems Engineering (BMSE) Lab, School of Chemical Engineering, University of Queensland (UQ), St Lucia, QLD, 4072, Australia; Biofabrication and Tissue Morphology (BTM) Group, Faculty of Engineering, Centre for Biomedical Technologies, Queensland University of Technology (QUT), Kelvin Grove, QLD, 4059, Australia.
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Zhang M, Wen X, Zhou C, Huang J, He Y. Carotid intima-media thickness and plaques in internal carotid artery as surrogate markers of lower limb arterial lesions in Chinese patients with diabetic foot. ACTA ACUST UNITED AC 2019; 52:e8432. [PMID: 31314853 PMCID: PMC6644526 DOI: 10.1590/1414-431x20198432] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2019] [Accepted: 05/03/2019] [Indexed: 02/05/2023]
Abstract
Peripheral arterial disease (PAD) can impair healing of diabetic foot (DF) in patients with diabetes mellitus. To determine whether carotid intima-media thickness (CIMT) can predict lower limb arterial lesions in patients with DF, this cross-sectional study enrolled patients with DF at West China Hospital (China) between January 2012 and December 2015. Ultrasonography was used to measure CIMT, assess the internal carotid arteries (ICA) for plaques, and evaluate lower limb segmental arteries for stenosis. The optimal CIMT cutoff for detecting lower limb PAD was determined by receiver operating characteristic (ROC) curve analysis. Factors associated with PAD were identified by logistic regression analyses. A total of 167 patients (mean age: 69.7±10.3 years; 102 men) were included. Patients with PAD were older and had higher levels of total cholesterol and low-density lipoprotein than patients without PAD (P<0.05). The area under the ROC curve was 0.747 (P<0.001). At the optimal CIMT cutoff of 0.71 mm, the sensitivity, specificity, positive predictive value, and negative predictive value were 79.65, 61.11, 81.08, and 58.93%, respectively. Compared with those without PAD, more patients with PAD had CIMT ≥0.71 mm (79.65 vs 38.89%; P<0.001) and ICA plaques (66.37vs 11.11%; P<0.001). Multivariate logistic regression revealed that age (odds ratio [OR]: 1.118; 95% confidence interval [95%CI]: 1.056–1.183; P<0.001), ICA plaques (OR: 13.452; 95%CI: 4.450–40.662; P<0.001), and CIMT ≥0.71 mm (OR: 2.802; 95%CI: 1.092–7.188; P=0.032) were associated with PAD.CIMT may be a surrogate marker of PAD in patients with DF.
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Affiliation(s)
- Mei Zhang
- Department of Ultrasound, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Xiaorong Wen
- Department of Ultrasound, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Chenyun Zhou
- Department of Ultrasound, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Jing Huang
- Department of Ultrasound, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Ying He
- Department of Ultrasound, West China Hospital, Sichuan University, Chengdu, Sichuan, China
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Novaković M, Krevel B, Rajkovič U, Vižintin Cuderman T, Janša Trontelj K, Fras Z, Jug B. Moderate-pain versus pain-free exercise, walking capacity, and cardiovascular health in patients with peripheral artery disease. J Vasc Surg 2019; 70:148-156. [PMID: 30922760 DOI: 10.1016/j.jvs.2018.10.109] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2018] [Accepted: 10/22/2018] [Indexed: 12/24/2022]
Abstract
OBJECTIVE Supervised exercise training (walking) is recommended in patients with intermittent claudication, both as a means to improve symptoms (walking distance and quality of life [QoL]) and as a means to improve general cardiovascular health (including vascular function and heart rate variability [HRV]). Our aim was to compare two types of supervised training (moderate-pain and pain-free walking) with comparable intensity based on heart rate, in terms of walking capacity, QoL, vascular function, biomarkers, and HRV in patients with intermittent claudication. METHODS Thirty-six adults with intermittent claudication were randomized to either moderate-pain or pain-free exercise training (36 sessions, two or three times a week) or usual care (no supervised exercise). Initial walking distance and absolute walking distance using treadmill testing, flow-mediated vasodilation and pulse wave velocity using ultrasound, N-terminal pro-B-type natriuretic peptide and fibrinogen levels, HRV, and QoL (36-Item Short Form Health Survey questionnaire) were determined at baseline and after the intervention period. RESULTS Twenty-nine patients (mean age, 64 ± 9 years; 72% male) completed the study. Both training programs similarly improved walking capacity. Initial walking distance and absolute walking distance significantly increased with either moderate-pain walking (median, 50 m to 107 m [P = .005] and 85 m to 194 m [P = .005], respectively) or pain-free walking (median, 53 m to 128 m [P = .003] and 92 m to 163 m [P = .003], respectively). QoL also similarly improved with both training modalities, whereas only moderate-pain walking was also associated with a statistically significant improvement in the vascular parameters flow-mediated vasodilation (4.4% to 8.0%; P = .002) and pulse wave velocity (6.6 m/s to 6.1 m/s; P = .013). Neither training program was associated with changes in biomarker levels and HRV. CONCLUSIONS Both moderate-pain and pain-free training modalities were safe and similarly improved walking capacity and health-related QoL. Conversely, vascular function improvements were associated with only moderate-pain walking.
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Affiliation(s)
- Marko Novaković
- Division of Internal Medicine, Department of Vascular Diseases, University Medical Centre Ljubljana, Ljubljana, Slovenia; Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia.
| | - Barbara Krevel
- Division of Internal Medicine, Department of Vascular Diseases, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Uroš Rajkovič
- Faculty of Organizational Sciences, University of Maribor, Kranj, Slovenia
| | - Tjaša Vižintin Cuderman
- Division of Internal Medicine, Department of Vascular Diseases, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Katja Janša Trontelj
- Division of Internal Medicine, Department of Vascular Diseases, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Zlatko Fras
- Division of Internal Medicine, Department of Vascular Diseases, University Medical Centre Ljubljana, Ljubljana, Slovenia; Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Borut Jug
- Division of Internal Medicine, Department of Vascular Diseases, University Medical Centre Ljubljana, Ljubljana, Slovenia; Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
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Nezami N, Ghabili K, Shokouhi-Gogani B, Mirchi M, Ghojazadeh M, Safa J, Zomorrodi A, Gharadaghi A, Mojadidi MK, Tarzamni MK, Khajir G, Ghorashi S, Revzin M. The Relationship between Carotid and Femoral Artery Intima-Media Thickness and Histopathologic Grade of Atherosclerosis in Patients with Chronic Kidney Disease. Nephron Clin Pract 2018. [PMID: 29514148 DOI: 10.1159/000487491] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND/AIMS Variability in the grade of atherosclerosis among patients with chronic kidney disease (CKD) could affect the ultrasound measurements of intima media thickness (IMT). We sought to investigate IMTs of carotid (cIMT) and femoral (fIMT) arteries in CKD patients and assess the degree of their correlation with histopathological atherosclerosis. METHODS Eighty-nine out of 99 enrolled subjects completed this study. The subjects were divided into 3 groups: 34 patients with CKD (Case group), 31 with coronary artery disease undergoing coronary artery bypass graft (CABG, positive control group), and 24 healthy kidney donors (negative control group). For histopathological assessment of atherosclerosis, arterial tissue samples were obtained from the patients in each study group. The cIMT and fIMTs were measured by ultrasonography. RESULTS Histopathological atherosclerosis was present in 82.3, 100, and 20.8% of CKD, CABG, and donor groups respectively (p < 0.001). CKD patients had higher values of cIMT and fIMT than the donor group (p = 0.01 and 0.004, respectively). cIMT was positively correlated with the grade of atherosclerosis in the CKD group only (p < 0.001), while fIMT was correlated with the grade of atherosclerosis in both CKD and donor groups (p < 0.001 and p = 0.009 respectively). In CKD patients, cIMT >0.65 mm and femoral values >0.57 mm predicted the presence of histopathological atherosclerosis with sensitivities of 96 and 92% respectively. CONCLUSION Higher values of cIMT and fIMT in CKD patients are associated with higher rates and degrees of histopathological atherosclerosis. Additionally, when compared to fIMT, cIMT has a higher sensitivity for detecting atherosclerosis in CKD patients.
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Affiliation(s)
- Nariman Nezami
- Department of Radiology and Biomedical Imaging, Yale University School of Medicine, New Haven, Connecticut, USA.,Drug Applied Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Kamyar Ghabili
- Department of Urology, Yale University School of Medicine, New Haven, Connecticut, USA
| | | | - Mohammad Mirchi
- Department of Radiology, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Morteza Ghojazadeh
- Liver and Gastrointestinal Disease Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Javid Safa
- Department of Nephrology, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Afshar Zomorrodi
- Department of Transplantation, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Abasad Gharadaghi
- Department of Surgery, Tabriz University of Medical Sciences, Tabriz, Iran
| | | | - Mohammad Kazem Tarzamni
- Liver and Gastrointestinal Disease Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Ghazal Khajir
- Tuberculosis and Lung Disease Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Sona Ghorashi
- Southern Connecticut State University, New Haven, Connecticut, USA
| | - Margarita Revzin
- Department of Radiology and Biomedical Imaging, Yale University School of Medicine, New Haven, Connecticut, USA
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Antunes BMM, Cayres SU, Lira FS, Fernandes RA. Arterial Thickness and Immunometabolism: The Mediating role of Chronic Exercise. Curr Cardiol Rev 2016; 12:47-51. [PMID: 26818486 PMCID: PMC4807718 DOI: 10.2174/1573403x12666160126115317] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2015] [Accepted: 11/28/2015] [Indexed: 01/09/2023] Open
Abstract
Metabolic alterations and cardiovascular diseases, such as atherosclerosis, are associated
with lifestyle modifications, particularly the increase of physical inactivity and poor eating habits,
which contribute to one of the main causes of death in modern times. Cardiovascular diseases are
positively correlated with several illnesses, such as obesity, hypertension and dyslipidemia, and these
disorders are known to contribute to changes in immune cells, cytokines and metabolism. Atherosclerosis
is a chronic inflammatory disease characterized by the formation of lipid plaques and fibrous
tissue (atheroma) in the artery walls and this process is related to the oxidation of LDL-c (low density lipoprotein) and the
formation of a particle, termed LDLox, which can generate toxic injury to the vessel wall. In this atherogenic process there
is an inflammatory response generated by the injury in the vascular endothelium, which in itself is able to express and
secrete a variety of molecules, such as myeloid colony-stimulating factors (M-CSF), monocyte chemotactic protein-1
(MCP-1) and tumor necrosis factor alpha (TNF-α), that act as activators of the immune system. Therefore, the main
purpose of this review is to highlight the immuno-metabolic alterations involving the thickening and stiffness of arteries
observed in atherosclerosis, and how chronic exercise can act as an anti-inflammatory and anti-atherogenic approach.
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Affiliation(s)
- B M M Antunes
- Exercise and Immunometabolism Research Group, Department of Physical Education, Universidade Estadual Paulista, UNESP, Rua Roberto Simonsen, 305, 19060-900, Presidente Prudente, São Paulo, Brazil.
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6
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Wise ES, Hocking KM, Luo W, Feldman DL, Song J, Komalavilas P, Cheung-Flynn J, Brophy CM. Traditional graft preparation decreases physiologic responses, diminishes viscoelasticity, and reduces cellular viability of the conduit: A porcine saphenous vein model. Vasc Med 2016; 21:413-421. [PMID: 27216870 DOI: 10.1177/1358863x16649040] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Traditional methods of intraoperative human saphenous vein preparation for use as bypass grafts can be deleterious to the conduit. The purpose of this study was to characterize acute graft preparation injury, and to mitigate this harm via an improved preparation technique. Porcine saphenous veins were surgically harvested (unprepared controls, UnP) and prepared using traditional (TraP) and improved preparations (ImP). The TraP used unregulated radial distension, marking with a surgical skin marker and preservation in heparinized normal saline. ImP used pressure-regulated distension, brilliant blue FCF-based pen marking and preservation in heparinized Plasma-Lyte A. Rings from each preparation were suspended in a muscle bath for characterization of physiologic responses to vasoactive agents and viscoelasticity. Cellular viability was assessed using the methyl thiazolyl tetrazolium (MTT) assay and the terminal deoxynucleotidyl transferase dUTP nick-end labeling (TUNEL) assay for apoptosis. Contractile responses to potassium chloride (110 mM) and phenylephrine (10 µM), and endothelial-dependent and independent vasodilatory responses to carbachol (0.5 µM) and sodium nitroprusside (1 µM), respectively, were decreased in TraP tissues compared to both UnP and ImP tissues (p ⩽ 0.05). TraP tissues demonstrated diminished viscoelasticity relative to UnP and ImP tissues (p ⩽ 0.05), and reduced cellular viability relative to UnP control (p ⩽ 0.01) by the MTT assay. On the TUNEL assay, TraP tissues demonstrated a greater degree of apoptosis relative to UnP and ImP tissues (p ⩽ 0.01). In conclusion, an improved preparation technique prevents vascular graft smooth muscle and endothelial injury observed in tissues prepared using a traditional approach.
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Affiliation(s)
- Eric S Wise
- Department of Surgery, Vanderbilt University, Nashville, TN, USA
| | - Kyle M Hocking
- Department of Surgery, Vanderbilt University, Nashville, TN, USA.,Department of Biomedical Engineering, Vanderbilt University, Nashville, TN, USA
| | - Weifeng Luo
- Department of Surgery, Vanderbilt University, Nashville, TN, USA
| | - Daniel L Feldman
- Department of Surgery, Vanderbilt University, Nashville, TN, USA
| | - Jun Song
- Department of Surgery, Vanderbilt University, Nashville, TN, USA
| | - Padmini Komalavilas
- Department of Surgery, Vanderbilt University, Nashville, TN, USA.,VA Tennessee Valley Healthcare System, Nashville, TN, USA
| | | | - Colleen M Brophy
- Department of Surgery, Vanderbilt University, Nashville, TN, USA.,VA Tennessee Valley Healthcare System, Nashville, TN, USA
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7
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Taniguchi R, Hosaka A, Miyahara T, Hoshina K, Okamoto H, Shigematsu K, Miyata T, Sugiura R, Yokobori AT, Watanabe T. Viscoelastic Deterioration of the Carotid Artery Vascular Wall is a Possible Predictor of Coronary Artery Disease. J Atheroscler Thromb 2014; 22:415-23. [PMID: 25399931 DOI: 10.5551/jat.24513] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
AIM The viscoelastic properties of the artery are known to be altered in patients with vascular diseases. However, few studies have evaluated the viscoelasticity of the vascular wall in humans. We sought to investigate the degree of viscoelastic deterioration of the carotid artery and assess its clinical implications. METHODS Between January 2011 and June 2013, patients in whom the toe-brachial index was measured at the vascular laboratory were included in this single-institute retrospective observational study. I(*), a parameter of viscoelastic deterioration, was computed using a non-invasive ultrasonic Doppler effect sensor on the carotid artery. I(*) is a non-dimensional value, and I(*)>0 is considered abnormal. Other patient characteristics were identified and tested for correlations with I(*). RESULTS The study included 383 patients. The mean I(*) value was 0.13 ± 0.22 with a normal distribution. Factors that increased the I(*) value were a female sex (0.18 ± 0.23 vs. 0.10 ± 0.21, P<0.001), age ≥ 60 (0.14 ± 0.22 vs. 0.06 ± 0.23, P<0.05) and systolic blood pressure of >140 (0.15 ± 0.22 vs. 0.10 ± 0.22, P<0.05). I(*) abnormality was a significant risk factor for coronary artery disease (OR 2.20, 95% CI 1.00-4.80, P<0.05) in a univariate analysis. In the multivariate analysis, I(*) abnormality was also found to be an independent risk factor for coronary artery disease (OR 4.56, 95% CI 1.21-30.1, P<0.05). CONCLUSIONS I(*) may reflect the degree of atherosclerotic changes in the arterial wall and could possibly be used to predict coronary artery disease.
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Affiliation(s)
- Ryosuke Taniguchi
- Division of Vascular Surgery, Department of Surgery, Graduate School of Medicine, The University of Tokyo
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Catalano M, Scandale G, Carzaniga G, Cinquini M, Minola M, Antoniazzi V, Dimitrov G, Carotta M. Aortic augmentation index in patients with peripheral arterial disease. J Clin Hypertens (Greenwich) 2014; 16:782-7. [PMID: 25228305 PMCID: PMC8031844 DOI: 10.1111/jch.12406] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2014] [Revised: 07/22/2014] [Accepted: 07/22/2014] [Indexed: 01/09/2023]
Abstract
Aortic augmentation index (AIx) is used to investigate arterial stiffness. The authors tested the hypothesis that patients with peripheral arterial disease (PAD) demonstrate a higher AIx and also evaluated several related factors. In 97 patients with PAD, identified by ankle-brachial pressure index (ABPI ≤ 0.9), and 97 controls (ABPI ≥ 0.91< 1.4), AIx (%) was determined using tonometry of the radial artery. There was no significant difference between patients and controls in characteristics of age, sex, height, diastolic blood pressure, mean blood pressure, and heart rate. AIx was higher in patients with PAD (32 ± 9 vs 28 ± 9; P = .001). In multivariate regression analysis, AIx was independently associated with heart rate (β = -0.40, P = .0005). This study showed that AIx increased in patients with PAD and that heart rate is a determinant of AIx. Further studies are necessary to assess the pathophysiological and clinical importance of AIx in patients with PAD.
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Affiliation(s)
- Mariella Catalano
- Research Center on Vascular Diseases and Angiology UnitUniversity of MilanMilanItaly
| | - Giovanni Scandale
- Research Center on Vascular Diseases and Angiology UnitUniversity of MilanMilanItaly
| | - Gianni Carzaniga
- Research Center on Vascular Diseases and Angiology UnitUniversity of MilanMilanItaly
| | - Michela Cinquini
- Laboratory for the Development of New Pharmacological StrategiesDepartment of OncologyMario Negri Institute for Pharmacological ResearchMilanItaly
| | - Marzio Minola
- Research Center on Vascular Diseases and Angiology UnitUniversity of MilanMilanItaly
| | - Valeria Antoniazzi
- Research Center on Vascular Diseases and Angiology UnitUniversity of MilanMilanItaly
| | - Gabriel Dimitrov
- Research Center on Vascular Diseases and Angiology UnitUniversity of MilanMilanItaly
| | - Maria Carotta
- Research Center on Vascular Diseases and Angiology UnitUniversity of MilanMilanItaly
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Nezami N, Sepehrvand N, Mirchi M, Salari B, Shokouhi B, Ghojazadeh M, Naghavi-Behzad M, Ghorashi S, Mirzaie F, Noshad H, Zomorrodi A, Gharedaghi A, Babapoor-Farrokhran S, Mirbagheri S, Tarzamni MK. Serum and tissue endothelin-1 are independent from intima-media thickness of peripheral arteries in patients with chronic kidney disease. Vascular 2014; 23:382-90. [PMID: 25245046 DOI: 10.1177/1708538114551195] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
AIM We aimed to study the relationship of peripheral arteries' atherosclerosis with serum and tissue endothelin-1 in chronic kidney disease patients. METHODS Ninety patients were enrolled, including 35 patients with chronic kidney disease (case group), 31 patients with coronary artery diseases who were candidates for coronary artery bypass grafting (positive control group), and 24 living kidney donors (negative control group). Intima-media thickness of the common carotid and femoral arteries was determined by ultrasonography. Serum and tissue endothelin-1 were measured by ELISA method. RESULTS The mean serum and tissue endothelin-1 levels in the donor group were significantly lower than other groups (p < 0.001 for both). The coronary artery bypass grafting group had higher carotid and femoral intima-media thickness than other groups (p < 0.001), and the chronic kidney disease group had higher carotid and femoral intima-media thickness than the donor group (p < 0.001). Regression analysis in all groups did not reveal any correlation between the carotid intima-media thickness/femoral intima-media thickness and the serum/tissue endothelin-1. There was a direct linear correlation between the carotid and femoral intima-media thickness (p < 0.001) in all groups. CONCLUSIONS Endothelin-1 level and intima-media thickness were higher in the chronic kidney disease patients and coronary artery bypass grafting candidates, without any correlation between endothelin-1 and peripheral arteries' intima-media thickness of both groups. Perhaps endothelin-1 rises and remains high upon endothelial damage and initiation of atherosclerosis.
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Affiliation(s)
- Nariman Nezami
- Drug Applied Research Center, Tabriz University of Medical Sciences, Tabriz, Iran The Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins Hospital, Baltimore, USA
| | - Nariman Sepehrvand
- Cardiovascular Research Center, Tabriz University of Medical Sciences, Tabriz, Iran Canadian VIGOUR Centre, University of Alberta, Edmonton, Canada
| | - Mohammad Mirchi
- Department of Radiology, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Behzad Salari
- Drug Applied Research Center, Tabriz University of Medical Sciences, Tabriz, Iran School of Medicine, Harvard University, Boston, USA
| | - Behrooz Shokouhi
- Department of Pathology, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Morteza Ghojazadeh
- Liver and Gastrointestinal Disease Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Mohammad Naghavi-Behzad
- Students' Research Committee, Medical Faculty, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Sona Ghorashi
- Young Researchers Club, Tabriz Branch, Islamic Azad University, Tabriz, Iran
| | - Fariba Mirzaie
- Drug Applied Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Hamid Noshad
- Department of Nephrology, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Afshar Zomorrodi
- Department of Transplantation, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Abasad Gharedaghi
- Department of Surgery, Tabriz University of Medical Sciences, Tabriz, Iran
| | | | - Saeedeh Mirbagheri
- The Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins Hospital, Baltimore, USA
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10
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Lima MCS, Barbosa MF, Diniz TA, Codogno JS, Freitas Júnior IF, Fernandes RA. Early and current physical activity: relationship with intima-media thickness and metabolic variables in adulthood. Braz J Phys Ther 2014; 18:462-9. [PMID: 25372009 PMCID: PMC4228632 DOI: 10.1590/bjpt-rbf.2014.0040] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2014] [Accepted: 04/25/2014] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND It is unclear whether early physical activity has a greater influence on intima-media thickness and metabolic variables than current physical activity. OBJECTIVE To analyze the relationship between current and early physical activity, metabolic variables, and intima-media thickness measures in adults. METHOD The sample was composed of 55 healthy subjects of both sexes (33 men and 22 women). Total body fat and trunk fat were estimated by dual-energy X-ray absorptiometry. Carotid and femoral intima-media thickness were measured using a Doppler ultrasound device. A 12-hour fasting blood sample collection was taken (fasting glucose and lipid profile). Early physical activity was assessed through face-to-face interview, and the current physical activity was assessed by pedometer (Digi-Walker Yamax, SW200), which was used for a period of seven days. RESULTS Current physical activity was negatively related to total cholesterol (rho=-0.31), while early physical activity was negatively related to triglycerides (rho=-0.42), total cholesterol (rho=-0.28), very low density lipoprotein (rho=-0.44), and carotid intima-media thickness (rho=-0.50). In the multivariate model, subjects engaged in sports activities during early life had lower values of very low density lipoprotein (b=-8.74 [b95%CI=-16.1; -1.47]) and carotid intima-media thickness (b=-0.17 [95%CI: -0.28; -0.05]). CONCLUSION Early 95%CI physical activity has a significant influence on carotid intima-media thickness, regardless of the current physical activity.
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Affiliation(s)
- Manoel C S Lima
- Instituto de Biociências, Universidade Estadual Paulista, Rio Claro, SP, Brazil
| | - Maurício F Barbosa
- Departamento de Radiologia e Diagnóstico por Imagem, Universidade Federal de São Paulo, São Paulo, SP, Brazil
| | - Tiego A Diniz
- Departamento de Educação Física, Universidade Estadual Paulista, Presidente Prudente, SP, Brazil
| | - Jamile S Codogno
- Departamento de Educação Física, Universidade Estadual Paulista, Presidente Prudente, SP, Brazil
| | | | - Rômulo A Fernandes
- Instituto de Biociências, Universidade Estadual Paulista, Rio Claro, SP, Brazil
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11
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Beal S, Brewster LP. Femoral and carotid intima media thickness--two different measurements in two different arteries. J Surg Res 2012; 185:511-2. [PMID: 22940034 DOI: 10.1016/j.jss.2012.08.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2012] [Revised: 07/23/2012] [Accepted: 08/03/2012] [Indexed: 01/24/2023]
Affiliation(s)
- Shannon Beal
- Department of Surgery, Emory University Hospital, Decatur, Georgia
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12
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Khamdaeng T, Luo J, Vappou J, Terdtoon P, Konofagou EE. Arterial stiffness identification of the human carotid artery using the stress-strain relationship in vivo. ULTRASONICS 2012; 52:402-11. [PMID: 22030473 PMCID: PMC4009743 DOI: 10.1016/j.ultras.2011.09.006] [Citation(s) in RCA: 85] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/05/2011] [Revised: 09/20/2011] [Accepted: 09/20/2011] [Indexed: 05/06/2023]
Abstract
Arterial stiffness is well accepted as a reliable indicator of arterial disease. Increase in carotid arterial stiffness has been associated with carotid arterial disease, e.g., atherosclerotic plaque, thrombosis, stenosis, etc. Several methods for carotid arterial stiffness assessment have been proposed. In this study, in vivo noninvasive assessment using applanation tonometry and an ultrasound-based motion estimation technique was applied in seven healthy volunteers (age 28±3.6years old) to determine pressure and wall displacement in the left common carotid artery (CCA), respectively. The carotid pressure was obtained using a calibration method by assuming that the mean and diastolic blood pressures remained constant throughout the arterial tree. The regional carotid arterial wall displacement was estimated using a 1D cross-correlation technique on the ultrasound radio frequency (RF) signals acquired at a frame rate of 505-1010Hz. Young's moduli were estimated under two different assumptions: (i) a linear elastic two-parallel spring model and (ii) a two-dimensional, nonlinear, hyperelastic model. The circumferential stress (σ(θ)) and strain (ɛ(θ)) relationship was then established in humans in vivo. A slope change in the circumferential stress-strain curve was observed and defined as the transition point. The Young's moduli of the elastic lamellae (E(1)), elastin-collagen fibers (E(2)) and collagen fibers (E(3)) and the incremental Young's moduli before ( [Formula: see text] ) and after the transition point ( [Formula: see text] ) were determined from the first and second approach, respectively, to describe the contribution of the complex mechanical interaction of the different arterial wall constituents. The average moduli E(1), E(2) and E(3) from seven healthy volunteers were found to be equal to 0.15±0.04, 0.89±0.27 and 0.75±0.29MPa, respectively. The average moduli [Formula: see text] and [Formula: see text] of the intact wall (both the tunica adventitia and tunica media layers) were found to be equal to 0.16±0.04MPa and 0.90±0.25MPa, respectively. The average moduli [Formula: see text] and [Formula: see text] of the tunica adventitia were found to be equal to 0.18±0.05MPa and 0.84±0.22MPa, respectively. The average moduli [Formula: see text] and [Formula: see text] of the tunica media were found to be equal to 0.19±0.05MPa and 0.90±0.25MPa, respectively. The stiffness of the carotid artery increased with strain during the systolic phase. In conclusion, the feasibility of measuring the regional stress-strain relationship and stiffness of the normal human carotid artery was demonstrated noninvasively in vivo.
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Affiliation(s)
- T Khamdaeng
- Department of Mechanical Engineering, Chiang Mai University, Chiang Mai, Thailand
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13
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Cockcroft JR, Pedersen ME. β-blockade: benefits beyond blood pressure reduction? J Clin Hypertens (Greenwich) 2012; 14:112-120. [PMID: 22277144 PMCID: PMC8108973 DOI: 10.1111/j.1751-7176.2011.00553.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2011] [Revised: 09/07/2011] [Accepted: 09/15/2011] [Indexed: 12/20/2022]
Abstract
Hypertension is a major cardiovascular (CV) risk factor, but several other common conditions, including chronic obstructive pulmonary disease (COPD), osteoporosis, and peripheral arterial disease (PAD), have been shown to independently increase the risk of CV events and death. The physiological basis for an increased CV risk in those conditions probably lies in the augmentations of oxidative stress, endothelial dysfunction, systemic inflammation, and arterial stiffness, which all are also hallmarks of hypertension. β-Blockers have been used for the treatment of hypertension for more than 40 years, but a number of meta-analyses have demonstrated that treatment with these agents may be associated with an increased risk of CV events and mortality. However, the majority of primary prevention β-blocker trials employed atenolol, an earlier-generation β(1) -selective blocker whose mechanism of action is based on a reduction of cardiac output. Available evidence suggests that vasodilatory β-blockers may be free of the deleterious effects of atenolol. The purpose of this review is to summarize pathophysiologic mechanisms thought to be responsible for the increased CV risk associated with COPD, osteoporosis, and PAD, and examine the possible benefits of vasodilatory β-blockade in those conditions. Our examination focused on nebivolol, a β(1) -selective agent with vasodilatory effects most likely mediated via β(3) activation.
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Affiliation(s)
- John R. Cockcroft
- From the Department of Cardiology, University of Cardiff, University Hospital, Cardiff, UK;
and the
Royal Brompton Hospital, London, UK
| | - Michala E. Pedersen
- From the Department of Cardiology, University of Cardiff, University Hospital, Cardiff, UK;
and the
Royal Brompton Hospital, London, UK
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14
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Lefthériotis G, Abraham P, Le Corre Y, Le Saux O, Henrion D, Ducluzeau PH, Prunier F, Martin L. Relationship between ankle brachial index and arterial remodeling in pseudoxanthoma elasticum. J Vasc Surg 2011; 54:1390-4. [PMID: 21723076 DOI: 10.1016/j.jvs.2011.04.041] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2011] [Revised: 04/14/2011] [Accepted: 04/14/2011] [Indexed: 11/18/2022]
Abstract
OBJECTIVES Pseudoxanthoma elasticum (PXE) is an inherited metabolic disease characterized by elastic fiber fragmentation and calcification in the cutaneous, ophthalmologic, and vascular tissues. Cardiovascular manifestations such as peripheral arterial disease (PAD) are frequent in PXE. Because of the changes in the elastic properties and medial calcification of the arterial wall in PXE, the impact of the arterial remodeling on the ankle brachial index (ABI), a well-established diagnostic method for the detection and follow-up of PAD, remains to be determined in this disease. METHODS This was a cross-sectional, comparative, open study, which took place at the PXE Consultation Center, University Hospital of Angers. The subjects were 53 patients (mean age, 49 ± 14 years; 35 females) with PXE clinically proven on the basis of established criteria (skin changes, angioid streaks, and skin biopsy). The ABI at rest, symptoms of intermittent claudication (IC), carotid intima-media thickness (IMT), carotid-femoral pulse wave velocity (c-f PWV), compliance (CC), and β stiffness index were measured in a single-center cohort. RESULTS Forty-five percent of the PXE patients had an ABI ≤0.90, but only one patient had an ABI >1.40. IC was found in 23% of the patients with an ABI ≤0.90. There were no significant differences between the patients with a low and normal ABI in terms of IMT (P = .566) or β stiffness index (P = .194), but differences were significant for c-f PWV (P = .010) and CC (P = .011). Adjusted multivariate linear regression for the Framingham-Laurier score showed that patients with a low ABI had less compliant carotid arteries (B = 0.318, P = .039). CONCLUSIONS PAD detected by a low ABI is very frequent in PXE, although with limited prevalence of symptomatic claudication. Unexpectedly, ABI was low in such calcifying PAD and associated with lower CC, independently of atherosclerosis risk factors. These findings demonstrate that PXE represents a unique monogenic model of PAD in which the specific arterial wall remodeling could change the diagnostic value of the ABI to detect PAD.
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15
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Motwani MS, Rafiei Y, Tzifa A, Seifalian AM. In situ endothelialization of intravascular stents from progenitor stem cells coated with nanocomposite and functionalized biomolecules. Biotechnol Appl Biochem 2011; 58:2-13. [DOI: 10.1002/bab.10] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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16
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Liu J, Cao TS, Duan YY, Yang YL, Yuan LJ. Effects of cold pressor-induced sympathetic stimulation on the mechanical properties of common carotid and femoral arteries in healthy males. Heart Vessels 2010; 26:214-21. [PMID: 21174209 DOI: 10.1007/s00380-010-0069-1] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2010] [Accepted: 07/02/2010] [Indexed: 12/16/2022]
Abstract
Our aim was to evaluate the effects of sympathetic excitation and elevation of blood pressure on mechanical properties of common carotid and femoral arteries by wave intensity analysis (WIA). The diameters and arterial stiffness parameters of right common carotid artery (RCCA) and right common femoral artery (RCFA) in healthy young men were measured by WIA at baseline and during cold pressor test (CPT). In addition, the blood pressure and heart rate were recorded simultaneously. The heart rates and blood pressures increased during CPT compared with baseline, while the pulse pressures remained unchanged. The diameters of RCCA increased slightly, while those of RCFA did not change. The Peterson's pressure modulus (Ep), augment index (AI), and pulse wave velocity from β (PWVβ) increased obviously, while arterial compliance (AC) decreased with no change in stiffness index (β) of both arteries during CPT when compared with baseline. There was an obvious increase in pulse wave velocity from wave intensity (PWV_WI) of RCCA, while the PWV_WI of RCFA showed no significant change during CPT. The sympathetic nervous system exerts a more marked tonic restraint on RCFA than on RCCA. The Ep, AC, AI, PWVβ of RCCA, and RCFA are much affected by variations in blood pressure and sympathetic status, while the β of both arteries are less vulnerable to these factors and are more reliable in reflecting the actual arterial stiffness; The PWV_WI appears to be suitable only for evaluating the stiffness of RCCA instead of RCFA.
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Affiliation(s)
- Jie Liu
- Department of Ultrasound Diagnostics, Tangdu Hospital, Fourth Military Medical University, Xi'an, 710038, Shaanxi, China
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17
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Lind L. Arterial stiffness, but not endothelium-dependent vasodilation, is related to a low Ankle-Brachial index. Clin Physiol Funct Imaging 2010; 31:182-7. [DOI: 10.1111/j.1475-097x.2010.00996.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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18
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Dumont D, Dahl J, Miller E, Allen J, Fahey B, Trahey G. Lower-limb vascular imaging with acoustic radiation force elastography: demonstration of in vivo feasibility. IEEE TRANSACTIONS ON ULTRASONICS, FERROELECTRICS, AND FREQUENCY CONTROL 2009; 56:931-44. [PMID: 19473912 PMCID: PMC2813206 DOI: 10.1109/tuffc.2009.1126] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
Acoustic radiation force impulse (ARFI) imaging characterizes the mechanical properties of tissue by measuring displacement resulting from applied ultrasonic radiation force. In this paper, we describe the current status of ARFI imaging for lower-limb vascular applications and present results from both tissue-mimicking phantoms and in vivo experiments. Initial experiments were performed on vascular phantoms constructed with polyvinyl alcohol for basic evaluation of the modality. Multilayer vessels and vessels with compliant occlusions of varying plaque load were evaluated with ARFI imaging techniques. Phantom layers and plaque are well resolved in the ARFI images, with higher contrast than B-mode, demonstrating the ability of ARFI imaging to identify regions of different mechanical properties. Healthy human subjects and those with diagnosed lower-limb peripheral arterial disease were imaged. Proximal and distal vascular walls are well visualized in ARFI images, with higher mean contrast than corresponding B-mode images. ARFI images reveal information not observed by conventional ultrasound and lend confidence to the feasibility of using ARFI imaging during lower-limb vascular workup.
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Affiliation(s)
- Douglas Dumont
- Duke University, Biomedical Engineering, Durham, NC, USA
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19
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Chen Z, Tzima E. PECAM-1 is necessary for flow-induced vascular remodeling. Arterioscler Thromb Vasc Biol 2009; 29:1067-73. [PMID: 19390054 DOI: 10.1161/atvbaha.109.186692] [Citation(s) in RCA: 74] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Vascular remodeling is a physiological process that occurs in response to long-term changes in hemodynamic conditions, but may also contribute to the pathophysiology of intima-media thickening (IMT) and vascular disease. Shear stress detection by the endothelium is thought to be an important determinant of vascular remodeling. Previous work showed that platelet endothelial cell adhesion molecule-1 (PECAM-1) is a component of a mechanosensory complex that mediates endothelial cell (EC) responses to shear stress. METHODS AND RESULTS We tested the hypothesis that PECAM-1 contributes to vascular remodeling by analyzing the response to partial carotid artery ligation in PECAM-1 knockout mice and wild-type littermates. PECAM-1 deficiency resulted in impaired vascular remodeling and significantly reduced IMT in areas of low flow. Inward remodeling was associated with PECAM-1-dependent NFkappaB activation, surface adhesion molecule expression, and leukocyte infiltration as well as Akt activation and vascular cell proliferation. CONCLUSIONS PECAM-1 plays a crucial role in the activation of the NFkappaB and Akt pathways and inflammatory cell accumulation during vascular remodeling and IMT. Elucidation of some of the signals that drive vascular remodeling represent pharmacologically tractable targets for the treatment of restenosis after balloon angioplasty or stent placement.
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Affiliation(s)
- Zhongming Chen
- Department of Cell and Molecular Physiology, University of North Carolina at Chapel Hill, NC 27599, USA
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20
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Bia D, Zócalo Y, Armentano R, Laza S, Pérez H, Craiem D, Saldías M, Alvarez I. Non-invasive biomechanical evaluation of implanted human cryopreserved arterial homografts: comparison with pre-implanted cryografts and arteries from human donors and recipients. Ann Biomed Eng 2009; 37:1273-86. [PMID: 19381813 DOI: 10.1007/s10439-009-9693-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2008] [Accepted: 04/06/2009] [Indexed: 10/20/2022]
Abstract
UNLABELLED Native vessels-grafts biomechanical mismatch (BM) is related to graft failure. The BM could be reduced using human cryopreserved/defrosted arteries (cryografts), but post-thaw cryografts' recovery could be associated with an impaired biomechanical behavior. In vitro, we demonstrated that our cryopreservation methods do not affect arteries' biomechanics, but only post-implant studies would allow determining the cryografts' biomechanical performance. AIM To characterize the biomechanical properties of implanted cryografts, and to compare them with cryografts pre-implant, recipients' native arteries, and arteries from subjects with characteristics similar to those of the recipients and multiorgan donors (MOD) whose arteries were cryopreserved. METHODS Native femoral arteries anastomosed to cryografts, implanted cryografts, and arteries from subjects, recipient-like and MOD-like, were studied. In vitro (pre-implant cryografts) and in vivo non-invasive studies were performed. Arterial pressure, diameter, and wall thickness were obtained to quantify local and regional biomechanical parameters, and to evaluate the arterial remodeling. CONCLUSION Implanted cryografts were remodeled, with an increased wall thickness, wall-to-lumen ratio, and wall cross-sectional area. The proximal-distal gradual transition in stiffness remained unchanged. Implanted cryografts were stiffer than MOD-like arteries, but more compliant than recipients' arteries. The cryografts-native arteries biomechanical differences were lesser than those described for venous grafts or expanded polytetrafluoroethylene.
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Affiliation(s)
- Daniel Bia
- Physiology Department, School of Medicine, Republic University, General Flores 2125, 11800, Montevideo, Uruguay.
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21
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Brachial-ankle pulse wave velocity is associated with walking distance in patients referred for peripheral arterial disease evaluation. Atherosclerosis 2009; 206:173-8. [PMID: 19278681 DOI: 10.1016/j.atherosclerosis.2009.02.003] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2008] [Revised: 01/14/2009] [Accepted: 02/01/2009] [Indexed: 11/23/2022]
Abstract
OBJECTIVE Impaired functional capacity predicts morbidity and increased mortality in patients with PAD. We hypothesized that brachial-ankle pulse wave velocity (baPWV), a measure of arterial stiffness, is associated with functional capacity in patients undergoing noninvasive evaluation for peripheral arterial disease (PAD). METHODS We studied 114 patients (age 68+/-10 years) referred to Mayo Clinic's noninvasive vascular laboratory. Functional capacity was estimated in terms of distance walked in 5 min on a treadmill at a speed of 1.0-2.0 mph. Ankle-brachial index (ABI) was obtained with Doppler method before and 1 min after exercise. baPWV was estimated noninvasively using an oscillometric device. The association of baPWV with walking distance was assessed using accelerated failure time and Cox proportional-hazards models. RESULTS The mean baPWV was higher in patients who were unable to complete the walk test compared to those who successfully completed the test (P=0.008). Higher baPWV was associated with a lower walking distance after adjustment for heart rate, mean arterial pressure, and cardiovascular risk factors (P=0.017) and after additional adjustment for pulse pressure (P=0.034) and ABI (P=0.030). Higher baPWV was associated with failure to complete the treadmill walk test, after adjustment for heart rate, mean arterial pressure, and cardiovascular risk factors (P=0.025) and after additional adjustment for pulse pressure (P=0.041) and ABI (P=0.039). CONCLUSION Increased baPWV, a measure of arterial stiffness, is associated with impaired functional capacity in patients undergoing evaluation for PAD.
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22
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Wykretowicz A, Gerstenberger P, Guzik P, Milewska A, Krauze T, Adamska K, Rutkowska A, Wysocki H. Arterial stiffness in relation to subclinical atherosclerosis. Eur J Clin Invest 2009; 39:11-6. [PMID: 19087126 DOI: 10.1111/j.1365-2362.2008.02057.x] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Increased arterial stiffness or arteriosclerosis, represents a physiological part of ageing. Atherosclerosis is a process that does not affect the arterial bed uniformly but has a variable local distribution and is frequently superimposed on stiffened vessels. We therefore addressed the question of whether any correlation exists between the general characteristics of arterial stiffness or wave reflection and subclinical atherosclerosis as assessed by carotid intima-media thickness (IMT) in a sample of healthy subjects. METHODS A total of 116 healthy subjects (mean age 55 years, 43 female) were evaluated. Arterial stiffness and wave reflection was assessed with the use of digital volume pulse analysis (DVP) and pulse wave analysis (PWA). Subclinical atherosclerosis was assessed by measurement of IMT. RESULTS Stiffness Index (SI(DVP)), the measure of general arterial stiffness correlated significantly with IMT (r = 0.37, P < 0.01). IMT correlated significantly with age (r = 0.5, P < 0.0001), waist to hip ratio (WHR) (r = 0.39, P < 0.0001) and mean blood pressure (BPmean) (r = 0.4, P < 0.0001). IMT did not correlate with measures of wave reflection. SI(DVP) correlated significantly with age (r = 0.32, P < 0.005), WHR (r = 0.36, P < 0.0001), BPmean (r = 0.36, P < 0.0001) and measurements of wave reflection. However analysis of a model which included variables that significantly influenced SI(DVP) and IMT, such as age, WHR and mean BP showed that arterial stiffness is not independently associated with subclinical atherosclerosis. CONCLUSIONS The indices of subclinical atherosclerosis, arterial stiffness and wave reflection, indicate different aspects of vascular status in otherwise healthy subjects.
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Affiliation(s)
- A Wykretowicz
- Department of Internal Medicine, Division of Cardiology-Intensive Therapy, University School of Medicine, Poznan, Poland.
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23
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Measurement of arterial stiffness in subjects with vascular disease: Are vessel wall changes more sensitive than increase in intima-media thickness? Atherosclerosis 2008; 205:477-80. [PMID: 19200543 DOI: 10.1016/j.atherosclerosis.2008.12.030] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2008] [Revised: 12/10/2008] [Accepted: 12/19/2008] [Indexed: 11/20/2022]
Abstract
BACKGROUND AND AIMS It is widely accepted that subjects with vascular disease have increased arterial stiffness and intima-media thickness (IMT) when compared with healthy controls. The aim of this study was to investigate indices of arterial stiffness and IMT in the common carotid arteries (CCAs) of subjects with and without peripheral arterial disease (PAD), in order to look for evidence of change in wall quality and quantity to explain increased stiffness that has been found in the arteries of subjects with vascular disease. METHODS AND RESULTS The arterial distension waveform (ADW), IMT, diameter and brachial blood pressure were measured to calculate Young's Modulus (E) and elastic modulus (Ep) in the common carotid arteries of subjects with and without PAD. 38 subjects with confirmed PAD were compared with 43 normal controls matched for age, sex, smoking and hypertension. The mean diameter (8.35mm [95% CI 7.93-8.77] vs. 6.93mm [6.65-7.20] P<0.001, increase 20%), IMT (0.99mm [0.92-1.07] vs. 0.88mm [0.82-0.93] P=0.020, increase 12.5%), Ep (315kPa [185-444] vs. 190kPa [164-216] P=0.034, increase 66%) and E (1383kPa [836-1930] vs. 744kPa [641-846] P=0.006, increase 86%) were all significantly higher in subjects with PAD. CONCLUSIONS This study suggests that increased stiffness observed in subjects with peripheral vascular disease is a result of change in both quantity and quality of the arterial wall. Changes in indices of arterial stiffness were much higher than changes in IMT and diameter. These preliminary observations may be an indication that indices of arterial stiffness are a sensitive early marker of atherosclerosis.
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24
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de Borst GJ, Meijer R, Lo RH, Vosmeer HWG, Ackerstaff RGA, Moll FL. Effect of Carotid Angioplasty and Stenting on Duplex Velocity Measurements in a Porcine Model. J Endovasc Ther 2008; 15:672-9. [PMID: 19090631 DOI: 10.1583/08-2500.1] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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25
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Reduced arterial stiffness may contribute to angiotensin-converting enzyme inhibitor induced improvements in walking time in peripheral arterial disease patients. J Hypertens 2008; 26:1037-42. [DOI: 10.1097/hjh.0b013e3282f8e3b6] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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26
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Berglund JD, Nerem RM, Sambanis A. Viscoelastic testing methodologies for tissue engineered blood vessels. J Biomech Eng 2006; 127:1176-84. [PMID: 16502660 DOI: 10.1115/1.2073487] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
In order to function in vivo, tissue engineered blood vessels (TEBVs) must encumber pulsatile blood flow and withstand hemodynamic pressures for long periods of time. To date TEBV mechanical assessment has typically relied on single time point burst and/or uniaxial tensile testing to gauge the strengths of the constructs. This study extends this analysis to include creep and stepwise stress relaxation viscoelastic testing methodologies. TEBV models exhibiting diverse mechanical behaviors as a result of different architectures ranging from reconstituted collagen gels to hybrid constructs reinforced with either untreated or glutaraldhyde-crosslinked collagen supports were evaluated after 8 and 23 days of in vitro culturing. Data were modeled using three and four-parameter linear viscoelastic mathematical representations and compared to porcine carotid arteries. While glutaraldhyde-treated hybrid TEBVs exhibited the largest overall strengths and toughness, uncrosslinked hybrid samples exhibited time-dependent behaviors most similar to native arteries. These findings emphasize the importance of viscoelastic characterization when evaluating the mechanical performance of TEBVs. Limits of testing methods and modeling systems are presented and discussed.
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Affiliation(s)
- Joseph D Berglund
- School of Chemical and Biomolecular Engineering, Georgia Institute of Technology, Atlanta, GA 30332, USA
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27
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Sarkar S, Salacinski HJ, Hamilton G, Seifalian AM. The mechanical properties of infrainguinal vascular bypass grafts: their role in influencing patency. Eur J Vasc Endovasc Surg 2006; 31:627-36. [PMID: 16513376 DOI: 10.1016/j.ejvs.2006.01.006] [Citation(s) in RCA: 186] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2005] [Accepted: 01/08/2006] [Indexed: 11/18/2022]
Abstract
When autologous vein is unavailable, prosthetic graft materials, particularly expanded polytetrafluoroethylene are used for peripheral arterial revascularisation. Poor long term patency of prosthetic materials is due to distal anastomotic intimal hyperplasia. Intimal hyperplasia is directly linked to shear stress abnormalities at the vessel wall. Compliance and calibre mismatch between native vessel and graft, as well as anastomotic line stress concentration contribute towards unnatural wall shear stress. High porosity reduces graft compliance by causing fibrovascular infiltration, whereas low porosity discourages the development of an endothelial lining and hence effective antithrombogenicity. Therefore, consideration of mechanical properties is necessary in graft development. Current research into synthetic vascular grafts concentrates on simulating the mechanical properties of native arteries and tissue engineering aims to construct a new biological arterial conduit.
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Affiliation(s)
- S Sarkar
- Academic Division of Surgical and Interventional Sciences, Biomaterials and Tissue Engineering Centre (BTEC), University College London, London, UK
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28
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Ahimastos AA, Natoli AK, Lawler A, Blombery PA, Kingwell BA. Ramipril reduces large-artery stiffness in peripheral arterial disease and promotes elastogenic remodeling in cell culture. Hypertension 2005; 45:1194-9. [PMID: 15897362 DOI: 10.1161/01.hyp.0000168945.44069.aa] [Citation(s) in RCA: 67] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Ramipril improves cardiovascular outcome in patients with peripheral arterial disease; however, the precise mechanisms of benefit remain to be elucidated. The effect of ramipril on large-artery stiffness in patients with peripheral arterial disease was examined. In addition, we determined the effect of ramiprilat on extracellular matrix from human aortic smooth muscle cell culture. Forty patients with peripheral arterial disease were randomized to receive ramipril, 10 mg once daily or placebo for 24 weeks. Arterial stiffness was assessed globally via systemic arterial compliance and augmentation index (carotid tonometry and Doppler velocimetry), and regionally via carotid-femoral pulse wave velocity. Angiotensin-converting enzyme inhibition increased arterial compliance by 0.10+/-0.02 mL/mm Hg, (P<0.001, all probability values relative to placebo) and reduced pulse wave velocity by 1.7+/-0.2 m/s (P<0.001), augmentation index by 4.1+/-0.3% (P<0.001), and systolic blood pressure by 5+/-1 mm Hg (P<0.001). Ramipril did not reduce mean arterial pressure significantly compared with placebo (P=0.59). In cell culture, ramiprilat decreased collagen deposition by >50% and increased elastin and fibrillin-1 deposition by >3- and 4-fold respectively (histochemistry and immunohistochemistry). Fibrillin-1 gene expression was increased 5-fold (real-time reverse-transcriptase polymerase chain reaction). Ramiprilat also reduced gene and protein (Western) expression of both matrix metalloproteinase (MMP)-2 and MMP-3. In conclusion, ramipril promoted an elastogenic matrix profile that may contribute to the observed clinical reduction in large-artery stiffness and carotid pressure augmentation, which occurred independently of mean arterial blood pressure reduction in patients with peripheral arterial disease.
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Affiliation(s)
- Anna A Ahimastos
- Alfred and Baker Medical Unit, Baker Medical Research Institute, P.O. Box 6492, St Kilda Road Central, Melbourne, Victoria, 8008, Australia
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Dijk JM, van der Graaf Y, Grobbee DE, Banga JD, Bots ML. Increased Arterial Stiffness Is Independently Related to Cerebrovascular Disease and Aneurysms of the Abdominal Aorta. Stroke 2004; 35:1642-6. [PMID: 15143289 DOI: 10.1161/01.str.0000130513.77186.26] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background—
Arterial stiffness is a risk factor for stroke and myocardial infarction. We investigated whether carotid arterial stiffness is related to other localizations of manifest arterial disease.
Methods—
Carotid artery stiffness was measured by ultrasonography as the change in diameter in systole relative to the diastolic diameter in patients enrolled in the Second Manifestations of Arterial Disease (SMART) Study, a cohort study among patients with manifest cardiovascular disease or cardiovascular risk factors. The first consecutive 1561 patients with manifest cardiovascular disease were classified in 4 categories: cerebrovascular disease, coronary artery disease, peripheral artery disease, or aneurysm of the abdominal aorta (AAA). Differences in arterial stiffness among the categories were studied by linear regression analyses. Patients with coronary artery disease as single diagnosis (n=482) served as reference group.
Results—
Patients with cerebrovascular disease (arterial distension −42.0 μm [95% CI, −57.2 to −26.8]) and those with an AAA (−64.4 μm [95% CI, −84.8 to −44.0]) had an increased carotid stiffness compared with the reference group. Adjustment for confounders attenuated the relations, which remained statistically significant (−34.2 μm [95% CI, −47.8 to −20.7] and −33.2 μm [95% CI, −51.8 to −14.6], respectively).
Conclusion—
Our study suggests that increased arterial stiffness is important in the pathophysiology of especially cerebrovascular disease and AAA. That the differences in arterial stiffness between disease categories attenuated after adjustment for important risk factors but remained significant suggests that besides being an element in the causal pathway, arterial stiffness is also a risk factor for cardiovascular disease itself.
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Affiliation(s)
- J M Dijk
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Huispostnummer Str 6.131, PO Box 85060, 3508 BA Utrecht, The Netherlands.
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Lal BK, Hobson RW, Goldstein J, Chakhtoura EY, Durán WN. Carotid artery stenting: is there a need to revise ultrasound velocity criteria? J Vasc Surg 2004; 39:58-66. [PMID: 14718815 DOI: 10.1016/j.jvs.2003.10.043] [Citation(s) in RCA: 103] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
OBJECTIVES Ultrasound (US) velocity criteria have not been well-established for patients undergoing carotid artery stenting (CAS). A potential source of error in using US after CAS is that reduced compliance in the stented artery may result in elevated velocity relative to the native artery. We measured arterial compliance in the stented artery, and developed customized velocity criteria for use early after CAS. METHODS US was performed before and within 3 days after CAS, and after 1 month in a subset of 26 patients. Post-procedural peak systolic velocity (PSV) and end-diastolic velocity (EDV) of the internal carotid artery (ICA), PSV/EDV ratio, and internal carotid artery to common carotid artery ratio (ICA/CCA) were recorded. These were compared with degree of in-stent residual stenosis determined at carotid angiography performed at the completion of CAS. Peterson's elastic modulus (Ep) and compliance (Cp) of the ICA were determined in a subgroup of 20 patients at the distal end of the stent and in the same region in the native ICA before stenting. RESULTS Ninety CAS procedures were analyzed. Mean (+/-SD) angiographic residual stenosis after CAS was 5.4 +/- 9.1%, whereas corresponding PSV by US was 120.4 +/- 32.4 cm/s; EDV, 41.4 +/- 18.6 cm/s; PSV/EDV ratio, 3.3 +/- 1.2; and ICA/CCA ratio, 1.6 +/- 0.5. PSV was unchanged at 1 month. Post-CAS PSV and ICA/CCA ratio correlated most with degree of stenosis (P <.0001 for both). Only six patients demonstrated in-stent residual stenosis 20% or greater, but the standard US threshold of PSV 130 cm/s or greater (validated for >20% ICA stenosis in our laboratory) categorized 38 of 90 patients as having stenosis 20% or greater. Receiver operator curve analysis demonstrated that a combined threshold of PSV 150 cm/s or greater and ICA/CCA ratio 2.16 or greater were optimal for detecting residual stenosis of 20% or greater, with sensitivity 100%, specificity 98%, positive predictive value 75%, and negative predictive value 100%. After placement of a stent, the ICA demonstrated significantly increased Ep (1.2 vs 4.4 x 10(3) mm Hg; P =.004) and decreased Cp (9.8 vs 3.2 %mm Hg x 10(-2); P =.0004). CONCLUSIONS Currently accepted US velocity criteria validated in our laboratory for nonstented ICAs falsely classified several stented ICAs with normal diameter on carotid angiograms as having residual in-stent stenosis 20% or greater. We propose a new criterion that defines PSV less than 150 cm/s, with ICA/CCA ratio less than 2.16, as the best correlate to a normal lumen (0%-19% stenosis) in the recently stented ICA. This was associated with increased stiffness of the stented ICA (increased Ep, decreased Cp). These preliminary results suggest that placement of a stent in the carotid artery alters its biomechanical properties, which may cause an increase in US velocity measurements in the absence of a technical error or residual stenotic disease.
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Affiliation(s)
- Brajesh K Lal
- Division of Vascular Surgery, Department of Surgery, University of Medicine and Dentistry of New Jersey-NJ Medical School, 185 S. Orange Avenue, MSB-H578, Newark, NJ 07103, USA.
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Cheng KS, Tiwari A, Boutin A, Denton CP, Black CM, Morris R, Seifalian AM, Hamilton G. Differentiation of primary and secondary Raynaud's disease by carotid arterial stiffness. Eur J Vasc Endovasc Surg 2003; 25:336-41. [PMID: 12651172 DOI: 10.1053/ejvs.2002.1845] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
INTRODUCTION primary Raynaud's disease may be difficult to differentiate clinically from the secondary form with an underlying connective tissue, haematological, neurovascular or drug-induced disorder. We undertook a study to determine the elastic carotid and muscular femoral arterial biomechanical properties and intima-media thickness (IMT) in subjects with primary and secondary Raynaud's disease, to assess whether these parameters could differentiate the two conditions. METHODS twenty patients with primary Raynaud's disease and 53 subjects with secondary Raynaud's associated with scleroderma (systemic sclerosis, SSc) had measurements of their carotid and femoral wall mechanics with a duplex scanner coupled to a Wall Track system. Their age, gender, body mass index, heart rate, systolic and diastolic blood pressures, presumed cardiovascular load, plasma creatinine, fasting cholesterol, triglyceride and glucose concentrations were also measured. RESULTS the carotid elastic properties [mean (SD): elastic modulus: 560 (180) vs 1204 (558) mmHg,p <0.001 and stiffness index: 5.69 (1.35) vs 11.92 (6.4), p<0.001 for primary and secondary Raynaud's respectively] were significantly impaired in patients with secondary Raynaud's disease even after adjustment for potentially influencing physiological and biochemical variables. There were no statistical differences in the femoral elastic properties or the carotid and femoral IMTs between the two groups. CONCLUSION Duplex determination of the carotid elasticity or stiffness is different in primary Raynaud's phenomenon compared with secondary Raynaud's associated with SSc. This may be a useful non-invasive tool, in addition to autoantibody markers and nail-fold capillaroscopy, to differentiate between the two forms of Raynaud's phenomenon.
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Affiliation(s)
- K-S Cheng
- University Department of Primary Care and Population Sciences, Royal Free and University College Medical School, University College London and The Royal Free Hospital, London, NW3 2QG, UK
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