1
|
Abrahams T, Nicholls SJ, Nelson AJ. Optimal Medical Therapy for Stable Ischemic Heart Disease in 2024: Focus on Blood Pressure and Lipids. Med Clin North Am 2024; 108:441-453. [PMID: 38548456 DOI: 10.1016/j.mcna.2023.12.005] [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: 04/02/2024]
Abstract
Hypertension and dyslipidemia are 2 highly prevalent and modifiable risk factors in patients with stable ischemic heart disease. Multiple lines of evidence demonstrate that lowering blood pressure and low-density lipoprotein cholesterol improves clinical outcomes in patients with ischemic heart disease. Accordingly, clinical guidelines recommend intensive treatment targets for these high-risk patients. This article summarizes the pathophysiology, supporting evidence, and treatment recommendations for management of hypertension and dyslipidemia among patients with manifest ischemic heart disease and points to future research and unmet clinical needs.
Collapse
Affiliation(s)
- Timothy Abrahams
- Victorian Heart Institute, Monash University, Melbourne, Victoria, Australia
| | - Stephen J Nicholls
- Victorian Heart Institute, Monash University, Melbourne, Victoria, Australia
| | - Adam J Nelson
- Victorian Heart Institute, Monash University, Melbourne, Victoria, Australia; Adelaide Medical School, University of Adelaide, Adelaide, South Australia.
| |
Collapse
|
2
|
McIntyre CW. Update on Hemodialysis-Induced Multiorgan Ischemia: Brains and Beyond. J Am Soc Nephrol 2024; 35:653-664. [PMID: 38273436 PMCID: PMC11149050 DOI: 10.1681/asn.0000000000000299] [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: 06/30/2023] [Accepted: 12/17/2023] [Indexed: 01/27/2024] Open
Abstract
Hemodialysis is a life-saving treatment for patients with kidney failure. However, patients requiring hemodialysis have a 10-20 times higher risk of cardiovascular morbidity and mortality than that of the general population. Patients encounter complications such as episodic intradialytic hypotension, abnormal perfusion to critical organs (heart, brain, liver, and kidney), and damage to vulnerable vascular beds. Recurrent conventional hemodialysis exposes patients to multiple episodes of circulatory stress, exacerbating and being aggravated by microvascular endothelial dysfunction. This promulgates progressive injury that leads to irreversible multiorgan injury and the well-documented higher incidence of cardiovascular disease and premature death. This review aims to examine the underlying pathophysiology of hemodialysis-related vascular injury and consider a range of therapeutic approaches to improving outcomes set within this evolved rubric..
Collapse
Affiliation(s)
- Christopher W McIntyre
- Lilibeth Caberto Kidney Clinical Research Unit, Lawson Health Research Institute, London, Ontario, Canada, and Departments of Medicine, Medical Biophysics and Pediatrics, Western University, London, Ontario, Canada
| |
Collapse
|
3
|
Ratner M, Chang H, Rockman C, Jacobowitz G, Cayne N, Patel V, Jung A, Ramkhelawon B, Siracuse JJ, Garg K. Depressed Ejection Fraction Does Not Affect Perioperative Mortality After Thoracic Endovascular Aortic Repair for Type B Aortic Dissection. Ann Vasc Surg 2023; 96:81-88. [PMID: 37253406 DOI: 10.1016/j.avsg.2023.05.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Revised: 05/02/2023] [Accepted: 05/07/2023] [Indexed: 06/01/2023]
Abstract
BACKGROUND Despite the expanded application of thoracic endovascular aortic repair (TEVAR) in patients with significant cardiac comorbidities, the effect of decreased left ventricular ejection fraction (EF) on outcomes remains unknown. The aim of this study was to compare outcomes in patients with normal and abnormal EFs undergoing TEVAR for type-B aortic dissection (TBAD). METHODS The Vascular Quality Initiative database was reviewed from 2012 to 2020. Patients were categorized into severely reduced (EF ≤ 30%), reduced (EF 30-50%) and normal EF (EF>50%). Baseline characteristics, procedural details and 18-month outcomes were compared. Multivariable logistic regression identified factors associated with mortality, major adverse cardiac events (MACEs), and aortic-related reintervention. RESULTS Of 1,993 patients, 38 (2%) and 208 (10%) patients had severely reduced ejection fraction (SREF) and reduced ejection fraction (REF). Patients with abnormal EF were more likely to have cardiac comorbidities and be prescribed angiotensin-converting enzyme inhibitors and anticoagulants. Perioperatively, patients with SREF were more likely to experience mortality (13.2% vs. 6.7% vs. 4.4%, P = 0.018), MACE (26.3% vs. 11.5% vs. 8%, P < 0.001), hemodialysis (13.5% vs. 5% vs. 2.9%, P = 0.001) and aortic related reintervention (21.1% vs. 13% vs. 10%, P = 0.041), compared to REF and normal ejection fraction (NEF) patients. However, these associations were not present on multivariable analysis. At 18 months, mortality was significantly higher in patients with SREF, which was confirmed on multivariable analysis, but depressed EF was not associated with increased aortic reintervention compared to NEF. CONCLUSIONS SREF was not independently associated with perioperative mortality or MACE compared to NEF. REF had similar risk of morbidity and mortality compared to NEF in both the perioperative and early postoperative periods. TEVAR-related complications were similar among the cohorts. As such, TEVAR may be offered to appropriately selected patients regardless of EF.
Collapse
Affiliation(s)
- Molly Ratner
- Division of Vascular Surgery, Department of Surgery, New York University Langone Medical Center, New York, NY.
| | - Heepeel Chang
- Division of Vascular Surgery, Department of Surgery, Westchester Medical Center, Valhalla, NY
| | - Caron Rockman
- Division of Vascular Surgery, Department of Surgery, New York University Langone Medical Center, New York, NY
| | - Glenn Jacobowitz
- Division of Vascular Surgery, Department of Surgery, New York University Langone Medical Center, New York, NY
| | - Neal Cayne
- Division of Vascular Surgery, Department of Surgery, New York University Langone Medical Center, New York, NY
| | - Virendra Patel
- Division of Cardiac, Thoracic and Vascular Surgery, Department of Surgery, New York Presbyterian/Columbia University Irving Medical Center, New York, NY
| | - Albert Jung
- Division of Cardiology, Department of Medicine, New York University Langone Medical Center, New York, NY
| | - Bhama Ramkhelawon
- Division of Vascular Surgery, Department of Surgery, New York University Langone Medical Center, New York, NY
| | - Jeffrey J Siracuse
- Division of Vascular and Endovascular Surgery, Department of Surgery, Boston Medical Center, Boston, MA
| | - Karan Garg
- Division of Vascular Surgery, Department of Surgery, New York University Langone Medical Center, New York, NY
| |
Collapse
|
4
|
Tomiyama H. Vascular function: a key player in hypertension. Hypertens Res 2023; 46:2145-2158. [PMID: 37369849 DOI: 10.1038/s41440-023-01354-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Revised: 06/06/2023] [Accepted: 06/11/2023] [Indexed: 06/29/2023]
Abstract
The major functions of the arterial system are to "efficiently deliver blood to the peripheral organs and maintain vascular homeostasis". Both the endothelial and medial layer contribute to the three major functions, namely, conversion of pulsatile to steady blood flow, appropriate distribution of blood flow to the target organs, and vascular protection and homeostasis. Vascular dysfunction contributes to the development of cardiovascular diseases through a combination of several mechanisms, including impaired coronary perfusion, cardiac systolic/diastolic dysfunction, microvascular damage, and abnormal hemodynamics in the arterial tree. The representative marker of endothelial function is flow-mediated vasodilatation and that of the medial layer function is pulse wave velocity, and that of the blood supply function of the arterial tree is the ankle-brachial pressure index. In hypertension, vascular dysfunction could also lead to the development of isolated systolic hypertension, isolated diastolic hypertension, and systolic/diastolic hypertension. Vascular dysfunction is involved in a vicious cycle with abnormal blood pressure variability. Furthermore, a vicious cycle may also exist between vascular dysfunction and hypertension. While the significances of vascular function tests to predict future cardiovascular events has been established in cases of hypertension, their usefulness in assessing the effectiveness of management of the vascular functions in hypertension on the cardiovascular outcomes has not yet been fully clarified. Thus, vascular dysfunction plays crucial roles in the pathophysiology of hypertension, and further research is warranted to establish strategies to improve vascular dysfunction in cases of hypertension. Vascular functions in the pathophysiology of hypertension. Vascular dysfunction and elevation of blood pressure are components of a vicious cycle even from their early stages, which including abnormal blood pressure variabilities. This vicious cycle is associated with hypertensive organ damage and also adverse cardiovascular outcomes. Strategies to break this vicious cycle have not yet been fully established.
Collapse
Affiliation(s)
- Hirofumi Tomiyama
- Department of Cardiology, Tokyo Medical University, Tokyo, Japan.
- Division of Preemptive Medicine for Vascular Damage, Tokyo Medical University, Tokyo, Japan.
| |
Collapse
|
5
|
Zhou C, Yi Q, Luo Y, Wei H, Ge H, Liu H, Li X, Zhang J, Pan P, Yi M, Cheng L, Liu L, Zhang J, Peng L, Aili A, Liu Y, Pu J, Zhou H. Low diastolic blood pressure and adverse outcomes in inpatients with acute exacerbation of chronic obstructive pulmonary disease: A multicenter cohort study. Chin Med J (Engl) 2023; 136:941-950. [PMID: 37192019 PMCID: PMC10278704 DOI: 10.1097/cm9.0000000000002666] [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: 08/02/2022] [Indexed: 05/18/2023] Open
Abstract
BACKGROUND Although intensively studied in patients with cardiovascular diseases (CVDs), the prognostic value of diastolic blood pressure (DBP) has little been elucidated in patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD). This study aimed to reveal the prognostic value of DBP in AECOPD patients. METHODS Inpatients with AECOPD were prospectively enrolled from 10 medical centers in China between September 2017 and July 2021. DBP was measured on admission. The primary outcome was all-cause in-hospital mortality; invasive mechanical ventilation and intensive care unit (ICU) admission were secondary outcomes. Least absolute shrinkage and selection operator (LASSO) and multivariable Cox regressions were used to identify independent prognostic factors and calculate the hazard ratio (HR) and 95% confidence interval (CI) for adverse outcomes. RESULTS Among 13,633 included patients with AECOPD, 197 (1.45%) died during their hospital stay. Multivariable Cox regression analysis showed that low DBP on admission (<70 mmHg) was associated with increased risk of in-hospital mortality (HR = 2.16, 95% CI: 1.53-3.05, Z = 4.37, P <0.01), invasive mechanical ventilation (HR = 1.65, 95% CI: 1.32-2.05, Z = 19.67, P <0.01), and ICU admission (HR = 1.45, 95% CI: 1.24-1.69, Z = 22.08, P <0.01) in the overall cohort. Similar findings were observed in subgroups with or without CVDs, except for invasive mechanical ventilation in the subgroup with CVDs. When DBP was further categorized in 5-mmHg increments from <50 mmHg to ≥100 mmHg, and 75 to <80 mmHg was taken as reference, HRs for in-hospital mortality increased almost linearly with decreased DBP in the overall cohort and subgroups of patients with CVDs; higher DBP was not associated with the risk of in-hospital mortality. CONCLUSION Low on-admission DBP, particularly <70 mmHg, was associated with an increased risk of adverse outcomes among inpatients with AECOPD, with or without CVDs, which may serve as a convenient predictor of poor prognosis in these patients. CLINICAL TRIAL REGISTRATION Chinese Clinical Trail Registry, No. ChiCTR2100044625.
Collapse
Affiliation(s)
- Chen Zhou
- West China School of Medicine, Sichuan University, Chengdu, Sichuan 610041, China
| | - Qun Yi
- Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, China
- Sichuan Cancer Hospital and Institution, Sichuan Cancer Center, Cancer Hospital Affiliated to School of Medicine, UESTC, Chengdu, Sichuan 610041, China
| | - Yuanming Luo
- State Key Laboratory of Respiratory Disease, Guangzhou Medical University, Guangzhou, Guangdong 510120, China
| | - Hailong Wei
- Department of Respiratory and Critical Care Medicine, People's Hospital of Leshan, Leshan, Sichuan 614000, China
| | - Huiqing Ge
- Department of Respiratory and Critical Care Medicine, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang 310016, China
| | - Huiguo Liu
- Department of Respiratory and Critical Care Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030, China
| | - Xianhua Li
- Department of Respiratory and Critical Care Medicine, The First People's Hospital of Neijiang City, Neijiang, Sichuan 641000, China
| | - Jianchu Zhang
- Department of Respiratory and Critical Care Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430022, China
| | - Pinhua Pan
- Department of Respiratory and Critical Care Medicine, Xiangya Hospital, Central South University, Changsha, Hunan 410008, China
| | - Mengqiu Yi
- Department of Emergency, the First People's Hospital of Jiujiang, Jiujiang, Jiangxi 332000, China
| | - Lina Cheng
- Department of Emergency, the First People's Hospital of Jiujiang, Jiujiang, Jiangxi 332000, China
| | - Liang Liu
- Department of Respiratory and Critical Care Medicine, The Affiliated Hospital of Chengdu University, Chengdu, Sichuan 610041, China
| | - Jiarui Zhang
- Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, China
| | - Lige Peng
- Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, China
| | - Adila Aili
- Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, China
| | - Yu Liu
- Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, China
| | - Jiaqi Pu
- Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, China
| | - Haixia Zhou
- Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, China
| |
Collapse
|
6
|
Handgrip strength is inversely associated with augmentation index in patients with type 2 diabetes. Sci Rep 2023; 13:1125. [PMID: 36670237 PMCID: PMC9860021 DOI: 10.1038/s41598-023-28392-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Accepted: 01/18/2023] [Indexed: 01/22/2023] Open
Abstract
Handgrip strength (HGS) is a measure of overall skeletal muscle strength and is used to identify risks for cardiovascular disease and mortality. Furthermore, HGS is an indicator of arterial stiffness that leads to atherosclerotic cardiovascular disease. This study aimed to examine the relationship between HGS and augmentation index (AIx) in patients with type 2 diabetes. A cross-sectional study was conducted to examine patients with type 2 diabetes whose HGS and AIx were measured in our hospital. AIx was measured noninvasively using an applanation tonometer, and multiple regression analyses were conducted to assess the independent relationship between HGS and AIx. This study included 404 patients. After adjusting for age, gender, body mass index, duration of diabetes, smoking and exercise habit, biochemical parameters, and physiological parameters related to arterial stiffness, HGS was found to be independently and inversely associated with AIx (β = - 0.270, p = 0.006). HGS was independently and inversely associated with AIx in patients with type 2 diabetes. Patients with diminished HGS should be subjected to intensive exercise therapy for reducing the risk of arterial stiffness and cardiovascular disease.Trial registration: UMIN000023010.
Collapse
|
7
|
Houben IB, Chu AKY, Yang B, Kim KM, Fukuhara S, van Herwaarden JA, Moll FL, Nordsletten DA, Figueroa CA, Burris NS, Patel HJ. Left ventricular remodeling following aortic root and ascending aneurysm repair. Front Cardiovasc Med 2022; 9:944786. [DOI: 10.3389/fcvm.2022.944786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2022] [Accepted: 10/03/2022] [Indexed: 11/13/2022] Open
Abstract
ObjectiveAdverse left ventricular remodeling due to a mismatch between stiffness of native aortic tissue and current polyester grafts may be under-recognized. This study was conducted to evaluate the impact of proximal aortic replacement on adverse remodeling of the left ventricle.Materials and methodsAll aortic root and ascending aortic aneurysm patients were identified (n = 2,001, 2006–2019). The study cohort consisted of a subset of patients (n = 98) with two or more electrocardiogram (ECG)-gated CT angiograms, but without concomitant aortic valve disease or bicuspid aortic valve, connective tissue disease, acute aortic syndrome or prior history of aortic repair or mitral valve surgery. LV myocardial mass was measured from CT data and indexed to body surface area (LVMI). The study cohort was divided into a surgery group (n = 47) and a control group; optimal medical therapy group (OMT, n = 51).ResultsThe mean age was 60 ± 11 years (80% male). Beta-blocker use was significantly more frequent in the surgery group (89 vs. 57%, p < 0.001), whereas, all other antihypertensive drugs were more frequent in the OMT group. The average follow-up was 9.1 ± 4.0 months for the surgery group and 13.7 ± 6.3 months for the OMT group. Average LVMI at baseline was similar in both groups (p = 0.934). LVMI increased significantly in the surgery group compared to the OMT group (3.7 ± 4.1 vs. 0.6 ± 4.4 g/m2, p = 0.001). Surgery, baseline LVMI, age, and sex were found to be independent predictors of LVMI increased on multivariable analysis.ConclusionProximal aortic repair with stiff polyester grafts was associated with increased LV mass in the first-year post-operative and may promote long-term adverse cardiac remodeling. Further studies should be considered to evaluate the competing effects of aortic aneurysm related mortality against risks of long-term graft induced aortic stiffening and the potential implications on current size thresholds for intervention.
Collapse
|
8
|
Portilla-Fernandez E, Klarin D, Hwang SJ, Biggs ML, Bis JC, Weiss S, Rospleszcz S, Natarajan P, Hoffmann U, Rogers IS, Truong QA, Völker U, Dörr M, Bülow R, Criqui MH, Allison M, Ganesh SK, Yao J, Waldenberger M, Bamberg F, Rice KM, Essers J, Kapteijn DMC, van der Laan SW, de Knegt RJ, Ghanbari M, Felix JF, Ikram MA, Kavousi M, Uitterlinden AG, Roks AJM, Danser AHJ, Tsao PS, Damrauer SM, Guo X, Rotter JI, Psaty BM, Kathiresan S, Völzke H, Peters A, Johnson C, Strauch K, Meitinger T, O’Donnell CJ, Dehghan A. Genetic and clinical determinants of abdominal aortic diameter: genome-wide association studies, exome array data and Mendelian randomization study. Hum Mol Genet 2022; 31:3566-3579. [PMID: 35234888 PMCID: PMC9558840 DOI: 10.1093/hmg/ddac051] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Revised: 11/10/2021] [Accepted: 11/11/2021] [Indexed: 11/13/2022] Open
Abstract
Progressive dilation of the infrarenal aortic diameter is a consequence of the ageing process and is considered the main determinant of abdominal aortic aneurysm (AAA). We aimed to investigate the genetic and clinical determinants of abdominal aortic diameter (AAD). We conducted a meta-analysis of genome-wide association studies in 10 cohorts (n = 13 542) imputed to the 1000 Genome Project reference panel including 12 815 subjects in the discovery phase and 727 subjects [Partners Biobank cohort 1 (PBIO)] as replication. Maximum anterior-posterior diameter of the infrarenal aorta was used as AAD. We also included exome array data (n = 14 480) from seven epidemiologic studies. Single-variant and gene-based associations were done using SeqMeta package. A Mendelian randomization analysis was applied to investigate the causal effect of a number of clinical risk factors on AAD. In genome-wide association study (GWAS) on AAD, rs74448815 in the intronic region of LDLRAD4 reached genome-wide significance (beta = -0.02, SE = 0.004, P-value = 2.10 × 10-8). The association replicated in the PBIO1 cohort (P-value = 8.19 × 10-4). In exome-array single-variant analysis (P-value threshold = 9 × 10-7), the lowest P-value was found for rs239259 located in SLC22A20 (beta = 0.007, P-value = 1.2 × 10-5). In the gene-based analysis (P-value threshold = 1.85 × 10-6), PCSK5 showed an association with AAD (P-value = 8.03 × 10-7). Furthermore, in Mendelian randomization analyses, we found evidence for genetic association of pulse pressure (beta = -0.003, P-value = 0.02), triglycerides (beta = -0.16, P-value = 0.008) and height (beta = 0.03, P-value < 0.0001), known risk factors for AAA, consistent with a causal association with AAD. Our findings point to new biology as well as highlighting gene regions in mechanisms that have previously been implicated in the genetics of other vascular diseases.
Collapse
Affiliation(s)
- Eliana Portilla-Fernandez
- Department of Epidemiology, Erasmus University Medical Center, Rotterdam, The Netherlands
- Department of Internal Medicine, Division of Vascular Medicine and Pharmacology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Derek Klarin
- Center for Genomic Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Program in Medical and Population Genetics, Broad Institute of MIT and Harvard, Cambridge, MA, USA
- Department of Surgery, Massachusetts General Hospital, Boston, MA, USA
| | - Shih-Jen Hwang
- Population Sciences Branch, Division of Intramural Research, NHLBI/NIH, Bethesda MD, USA
- National Heart Lung and Blood Institute's Intramural Research Program's Framingham Heart Study, Framingham, MA, USA
| | - Mary L Biggs
- Cardiovascular Health Research Unit, Department of Medicine, University of Washington, Seattle, WA, USA
- Department of Biostatistics, University of Washington, Seattle, WA, USA
| | - Joshua C Bis
- Cardiovascular Health Research Unit, Department of Medicine, University of Washington, Seattle, WA, USA
| | - Stefan Weiss
- Department of Functional Genomics, Interfaculty Institute for Genetics and Functional Genomics, University Medicine Greifswald, Greifswald, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Greifswald, Greifswald, Germany
| | - Susanne Rospleszcz
- Institute of Epidemiology, Helmholtz Zentrum München – German Research Center for Environmental Health, Neuherberg, Germany
| | - Pradeep Natarajan
- Center for Genomic Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Program in Medical and Population Genetics, Broad Institute of MIT and Harvard, Cambridge, MA, USA
- Cardiovascular Research Center, Massachusetts General Hospital, Boston, MA, USA
- Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Udo Hoffmann
- Department of Radiology, Massachusetts General Hospital, Boston, MA, USA
| | - Ian S Rogers
- Division of Cardiovascular Medicine, Stanford University, Stanford, CA, USA
| | - Quynh A Truong
- Department of Radiology, Weill Cornell Medicine, New York, NY, USA
| | - Uwe Völker
- Department of Functional Genomics, Interfaculty Institute for Genetics and Functional Genomics, University Medicine Greifswald, Greifswald, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Greifswald, Greifswald, Germany
| | - Marcus Dörr
- Department of Internal Medicine, University Medicine Greifswald, Greifswald, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Greifswald, Greifswald, Germany
| | - Robin Bülow
- Department of Diagnostic Radiology and Neuroradiology, University Medicine Greifswald, Greifswald, Germany
| | - Michael H Criqui
- Department of Family Medicine, University of California, San Diego, CA, USA
| | - Matthew Allison
- Department of Family Medicine, University of California, San Diego, CA, USA
| | - Santhi K Ganesh
- Department of Internal Medicine and Human Genetics, University of Michigan, Ann Arbor, MI, USA
| | - Jie Yao
- The Institute for Translational Genomics and Population Sciences, Department of Pediatrics, The Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, Torrance, CA, USA
| | - Melanie Waldenberger
- DZHK (German Centre for Cardiovascular Research), Partner Site Greifswald, Greifswald, Germany
- Research Unit Molecular Epidemiology, Institute of Epidemiology, Helmholtz Zentrum München – German Research Center for Environmental Health, Neuherberg, Germany
| | - Fabian Bamberg
- Department of Diagnostic and Interventional Radiology, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Kenneth M Rice
- Department of Biostatistics, University of Washington, Seattle, WA, USA
| | - Jeroen Essers
- Department of Molecular Genetics, Erasmus University Medical Center, Rotterdam, The Netherlands
- Department of Radiation Oncology, Erasmus University Medical Center, Rotterdam, The Netherlands
- Department of Vascular Surgery, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Daniek M C Kapteijn
- Laboratory of Experimental Cardiology, Division Heart and Lungs, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Sander W van der Laan
- Laboratory of Clinical Chemistry & Hematology, Division Laboratories, Pharmacy, and Biomedical Genetics, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Rob J de Knegt
- Department of Gastroenterology and Hepatology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Mohsen Ghanbari
- Department of Epidemiology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Janine F Felix
- Department of Epidemiology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - M Arfan Ikram
- Department of Epidemiology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Maryam Kavousi
- Department of Epidemiology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Andre G Uitterlinden
- Department of Internal Medicine, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Anton J M Roks
- Department of Internal Medicine, Division of Vascular Medicine and Pharmacology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - A H Jan Danser
- Department of Internal Medicine, Division of Vascular Medicine and Pharmacology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Philip S Tsao
- Department of Medicine, Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, CA, USA
- School of Medicine, Stanford University, Stanford, CA, USA
| | - Scott M Damrauer
- Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA, USA
| | - Xiuqing Guo
- The Institute for Translational Genomics and Population Sciences, Department of Pediatrics, The Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, Torrance, CA, USA
| | - Jerome I Rotter
- The Institute for Translational Genomics and Population Sciences, Department of Pediatrics, The Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, Torrance, CA, USA
| | - Bruce M Psaty
- Cardiovascular Health Research Unit, Department of Medicine, University of Washington, Seattle, WA, USA
- Department of Epidemiology, University of Washington, Seattle, WA, USA
- Department of Health Services, University of Washington, Seattle, WA, USA
| | - Sekar Kathiresan
- Center for Genomic Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Program in Medical and Population Genetics, Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | - Henry Völzke
- DZHK (German Centre for Cardiovascular Research), Partner Site Greifswald, Greifswald, Germany
- Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany
| | - Annette Peters
- Institute of Epidemiology, Helmholtz Zentrum München – German Research Center for Environmental Health, Neuherberg, Germany
- Chair of Epidemiology, Institute for Medical Information Processing, Biometry, and Epidemiology, Faculty of Medicine, Ludwig-Maximilians-Universität München, Munich, Germany
- German Center for Diabetes Research, Neuherberg, Germany
| | - Craig Johnson
- Collaborative Health Studies Coordinating Center, Department of Biostatistics in the School of Public Health, University of Washington, Seattle, WA, USA
| | - Konstantin Strauch
- Institute of Genetic Epidemiology, Helmholtz Zentrum München – German Research Center for Environmental Health, Neuherberg, Germany
- Chair of Genetic Epidemiology, Institute for Medical Information Processing, Biometry, and Epidemiology, Faculty of Medicine, Ludwig-Maximilians-Universität München, Munich, Germany
- Institute of Medical Biostatistics, Epidemiology and Informatics (IMBEI), University Medical Center, Johannes Gutenberg University, Mainz, Germany
| | - Thomas Meitinger
- DZHK (German Centre for Cardiovascular Research), Partner Site Greifswald, Greifswald, Germany
- Institute of Human Genetics, Helmholtz Zentrum München – German Research Center for Environmental Health, Neuherberg, Germany
- Institute of Human Genetics, Technische Universität München, München, Germany
| | - Christopher J O’Donnell
- Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
- Massachusetts Veterans Epidemiology Research and Information Center (MAVERIC), VA Boston Healthcare System, Boston, MA, USA
| | - Abbas Dehghan
- Department of Epidemiology and Biostatistics, Imperial College London, London, UK
- MRC Centre for Environment and Health, School of Public Health, Imperial College London, London, UK
| | | |
Collapse
|
9
|
Said Ouamer D, Guerchani M, Azaza A, Benkhedda S. Arterial stiffness assessed by pulse wave velocity in young athletes practicing endurance or intense resistance training. Sci Sports 2022. [DOI: 10.1016/j.scispo.2022.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
|
10
|
Kim HL, Weber T. Pulsatile Hemodynamics and Coronary Artery Disease. Korean Circ J 2021; 51:881-898. [PMID: 34595882 PMCID: PMC8558570 DOI: 10.4070/kcj.2021.0227] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Revised: 07/22/2021] [Accepted: 07/26/2021] [Indexed: 12/12/2022] Open
Abstract
Coronary artery disease (CAD) is the leading cause of human death and has a high prevalence throughout the world. Therefore, it is important to detect CAD early and to apply individualized therapy according to the patients' risk. There is an increasing interest in pulsatile arterial hemodynamics in the cardiovascular area. Widely used measurements of arterial pulsatile hemodynamics include pulse pressure, pulse wave velocity and augmentation index. Here, we will review underlying pathophysiology linking the association of arterial pulsatile hemodynamics with CAD, and the usefulness of the measurements of pulsatile hemodynamics in the prediction of future cardiovascular events of CAD patients. Clinical and therapeutic implications will be also addressed.
Collapse
Affiliation(s)
- Hack-Lyoung Kim
- Division of Cardiology, Department of Internal Medicine, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea
| | - Thomas Weber
- Department of Cardiology, Klinikum Wels-Grieskirchen GmbH, Wels, Austria.
| |
Collapse
|
11
|
Kim ST, Ko Y, Beom JW, Boo KY, Lee JG, Choi JH, Kim SY, Joo SJ. Association of changes of pulse wave velocity and augmentation index after isometric handgrip exercise with coronary lesion extent and revascularization. Clin Hypertens 2021; 27:5. [PMID: 33931135 PMCID: PMC8088004 DOI: 10.1186/s40885-021-00163-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Accepted: 01/13/2021] [Indexed: 11/29/2022] Open
Abstract
Background Arterial stiffness is associated with myocardial ischemia and incident coronary artery disease (CAD), and indexes of arterial stiffness are usually increased in patients with CAD. However, these indexes are often increased in elderly without CAD. Arterial stiffness in patients with CAD may become more evident after isometric handgrip exercise which increases systolic pressure and ventricular afterload. We investigated the association of the change of stiffness indexes after isometric handgrip exercise with the lesion extent of CAD and the necessity for coronary revascularization. Methods Patients who were scheduled a routine coronary angiography via a femoral artery were enrolled. Arterial waveforms were traced at aortic root and external iliac artery using coronary catheters at baseline and 3 min after handgrip exercise. Augmentation index (AIx) was measured on the recorded aortic pressure waveform, and pulse wave velocity (PWV) was calculated using the ECG-gated time difference of the upstroke of arterial waveforms and distance between aortic root and external iliac artery. Results Total 37 patients were evaluated. Both PWV and AIx increased after handgrip exercise. ΔPWV was significantly correlated with ΔAIx (r = 0.344, P = 0.037). Patients were divided into higher and lower ΔPWV or ΔAIx groups based on the median values of 0.4 m/sec and 3.3%, respectively. Patients with higher PWV had more 2- or 3-vessel CAD (69% vs. 27%, P = 0.034), and underwent percutaneous coronary intervention (PCI) more frequently (84% vs. 50%, P = 0.038), but higher ΔAIx was not associated with either the lesion extent or PCI. Area under curve (AUC) of ΔPWV in association with PCI by C-statistics was 0.70 (95% confidence interval [CI] 0.51–0.88; P = 0.056). In multiple logistic regression analysis, ΔPWV was significantly associated with PCI (odds ratio 7.78; 95% CI 1.26–48.02; P = 0.027). Conclusions Higher ΔPWV after isometric handgrip exercise was associated with the lesion extent of CAD and the necessity for coronary revascularization, but higher ΔAIx was not.
Collapse
Affiliation(s)
- Seong Taeg Kim
- Department of Internal Medicine, Jeju National University Hospital, 15 Aran 13-gil, Jeju City, Jeju Province, 63241, Republic of Korea
| | - Yeekyoung Ko
- Department of Internal Medicine, Jeju National University Hospital, 15 Aran 13-gil, Jeju City, Jeju Province, 63241, Republic of Korea
| | - Jong-Wook Beom
- Department of Internal Medicine, Jeju National University Hospital, 15 Aran 13-gil, Jeju City, Jeju Province, 63241, Republic of Korea
| | - Ki Yung Boo
- Department of Internal Medicine, Jeju National University Hospital, 15 Aran 13-gil, Jeju City, Jeju Province, 63241, Republic of Korea
| | - Jae-Geun Lee
- Department of Internal Medicine, Jeju National University Hospital, 15 Aran 13-gil, Jeju City, Jeju Province, 63241, Republic of Korea.,Department of Internal Medicine, Jeju National University School of Medicine, 15 Aran 13-gil, Jeju City, Jeju Province, 63241, Republic of Korea
| | - Joon-Hyouk Choi
- Department of Internal Medicine, Jeju National University Hospital, 15 Aran 13-gil, Jeju City, Jeju Province, 63241, Republic of Korea.,Department of Internal Medicine, Jeju National University School of Medicine, 15 Aran 13-gil, Jeju City, Jeju Province, 63241, Republic of Korea
| | - Song-Yi Kim
- Department of Internal Medicine, Jeju National University Hospital, 15 Aran 13-gil, Jeju City, Jeju Province, 63241, Republic of Korea.,Department of Internal Medicine, Jeju National University School of Medicine, 15 Aran 13-gil, Jeju City, Jeju Province, 63241, Republic of Korea
| | - Seung-Jae Joo
- Department of Internal Medicine, Jeju National University Hospital, 15 Aran 13-gil, Jeju City, Jeju Province, 63241, Republic of Korea. .,Department of Internal Medicine, Jeju National University School of Medicine, 15 Aran 13-gil, Jeju City, Jeju Province, 63241, Republic of Korea. .,Institute of Medical Science, Jeju National University, 15 Aran 13-gil, Jeju City, Jeju Province, 63241, Republic of Korea.
| |
Collapse
|
12
|
Vartela V, Armenis I, Leivadarou D, Toutouzas K, Makrilakis K, Athanassopoulos GD, Karatasakis G, Kolovou G, Mavrogeni S, Perrea D. Reduced global longitudinal strain at rest and inadequate blood pressure response during exercise treadmill testing in male heterozygous familial hypercholesterolemia patients. INTERNATIONAL JOURNAL CARDIOLOGY HYPERTENSION 2021; 9:100083. [PMID: 34095810 PMCID: PMC8167294 DOI: 10.1016/j.ijchy.2021.100083] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Revised: 04/01/2021] [Accepted: 04/15/2021] [Indexed: 01/04/2023]
Abstract
Background Heterozygous familial hypercholesterolemia (heFH) is a genetic disorder leading to premature coronary artery disease (CAD). We hypothesized that the subclinical pathophysiologic consequences of hypercholesterolemia may be detected before the occurrence of clinically overt CAD by stress testing and myocardial strain imaging. Patients-methods We evaluated the treadmill tests (ETTs) of 46 heFH men without known arterial hypertension/diabetes mellitus/vasculopathy like CAD and of 39 healthy men matched for age, baseline systolic/diastolic blood pressure (BP) and heart rate (HR), using Bruce protocol. Global longitudinal strain (GLS) of the left ventricle (LV) additionally to ejection fraction was obtained. Results heFH men reached a significantly higher peak systolic and diastolic BP compared to controls (p = 0.002 and p < 0.001, respectively). Mean rate pressure product was significantly higher in heFH patients (p = 0.038). Both duration of the ETT and workload in metabolic equivalents was lower in the heFH group (p < 0.001 and p < 0.001, respectively). Baseline to peak rise of systolic and diastolic BP in heFH men was higher (p = 0.008 and p < 0.001 for systolic and diastolic BP, respectively). Furthermore, heFH men had higher rise of HR from baseline to peak, compared to controls; (p = 0.047). GLS in heHF men was slightly decreased (p = 0.014), although the ejection fraction was similar in both groups. Conclusion heFH men have a higher rise in systolic/diastolic BP during ETT, which may reflect early, preclinical hypertension. Furthermore, slight impairment of LV GLS is present, despite the absence of apparent myocardial dysfunction in conventional 2D echocardiography.
Collapse
Key Words
- Arterial blood pressure
- BP, blood pressure
- CAD, coronary artery disease
- Coronary artery disease
- DBP, diastolic blood pressure
- EDV, end-diastolic volume
- ESV, end-systolic volume
- ETT, Exercise treadmill test
- Exercise treadmill test
- FH, Familial hypercholesterolemia
- GLS, Global longitudinal strain
- Global longitudinal strain
- HDL, high density lipoprotein
- HR, heart rate
- Heterozygous familial hypercholesterolemia
- LDL, low-density lipoprotein
- LV, left ventricle
- LVEF, LV ejection fraction
- METs, metabolic equivalents
- RPP, rate pressure product
- SBP, systolic blood pressure
- TC, total cholesterol
- TG, triglyceride
- heFH, heterozygous familial hypercholesterolemia
- hoFH, homozygous familial hypercholesterolemia
Collapse
Affiliation(s)
- Vasiliki Vartela
- Onassis Cardiac Surgery Center, Department of Cardiology, Athens, Greece
| | - Iakovos Armenis
- Onassis Cardiac Surgery Center, Department of Cardiology, Athens, Greece
| | | | - Konstantinos Toutouzas
- National and Kapodistrian University of Athens, Medical School, Greece.,Hippokration Hospital, First Department of Cardiology, National and Kapodistrian University of Athens, Medical School, Greece
| | - Konstantinos Makrilakis
- Internal Medicine, National and Kapodistrian University of Athens Medical School, Greece.,Hellenic Diabetes Association, Athens, Greece.,Laikon Hospital, First Department of Propaedeutic Internal Medicine, National and Kapodistrian University of Athens Medical School, Athens, Greece
| | | | - George Karatasakis
- Onassis Cardiac Surgery Center, Department of Cardiology, Athens, Greece
| | | | - Sophia Mavrogeni
- Onassis Cardiac Surgery Center, Department of Cardiology, Athens, Greece
| | - Despina Perrea
- National and Kapodistrian University of Athens, Division of Experimental Surgery, Greece
| |
Collapse
|
13
|
Cardiovascular outcomes in patients at high cardiovascular risk with previous myocardial infarction or stroke. J Hypertens 2021; 39:1602-1610. [PMID: 34188004 DOI: 10.1097/hjh.0000000000002822] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Guidelines recommend to start blood pressure (BP)-lowering drugs also according to cardiovascular risk including history of cardiovascular events. We hypothesized that in patients with a history of myocardial infarction (MI), stroke, both or none of those, the index events predict the next event and have different SBP risk associations to different cardiovascular outcomes. DESIGN AND MEASUREMENTS In this pooled posthoc, nonprespecified analysis, we assessed outcome data from high-risk patients aged 55 years or older with a history of cardiovascular events or proven cardiovascular disease, randomized to the Ongoing Telmisartan Alone and in Combination with Ramipril Global Endpoint Trial and to Telmisartan Randomized Assessment Study in ACE Intolerant Subjects with Cardiovascular Disease Trial investigating telmisartan, ramipril and their combination with a median follow-up of 56 months. Standardized office BP was measured every 6 months. Associations of mean achieved BP on treatment were investigated on MI, stroke and cardiovascular death. We identified patients with previous MI (N = 13 487), stroke (N = 4985), both (N = 1509) or none (N = 10 956) of these index events. Analyses were done by Cox regression, analysis of variance and Chi2-test. 30 937 patients with complete data were enrolled between 1 December 2001 and 31 July 2003, and followed until 31 July 2008. Data of both trials were pooled as the outcomes were similar. RESULTS Patients with MI as index event had a higher risk to experience a second MI [hazard ratio 1.42 (confidence interval (CI) 1.20-1.69), P < 0.0001] compared with patients with no events but no increased risk for a stroke as a next event [hazard ratio 0.95 (CI 0.73-1.23), n.s.]. The risk was roughly doubled when they had both, MI and stroke before [hazard ratio 2.07 (CI 1.58-2.71), P < 0.0001]. Patients with a stroke history had a roughly three-fold higher likelihood to experience a second stroke [hazard ratio 2.89 (CI 2.37-3.53) P < 0.0001] but not MI [hazard ratio 1.07 (CI 0.88-1.32), n.s.]. Both types of index events increased roughly three-fold the risk of a second stroke compared with no previous events. The SBP-risk relationship was not meaningfully altered by the event history. After MI and stroke the risk for subsequent events and cardiovascular death was increased over the whole SBP spectrum. A J-shape relationship between BP and outcome was only observed for cardiovascular death. CONCLUSION Previous MI and previous stroke are associated with increased risk for the same event in the future, independent of achieved SBP. Thus, secondary prevention may also be chosen according to the event history of patients. CLINICAL TRIAL REGISTRATION http://clinicaltrials.gov. Unique identifier: NCT00153101.
Collapse
|
14
|
Verner VA, Mel'nik MV, Knjazeva SA. [Cardio-ankle vascular index (CAVI) in diagnostics, risk and severity evaluation of magistral vessels lesion in patients with cardio-vascular diseases and type 2 diabetes]. TERAPEVT ARKH 2021; 93:87-93. [PMID: 33720632 DOI: 10.26442/00403660.2021.01.200599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Accepted: 02/25/2021] [Indexed: 11/22/2022]
Abstract
Assesment of arterial stiffness the substantional prognostic factor for evaluating complications of cardiovascular diseases (CVD) in patients with atherosclerosis, hypertension and type 2 diabetes, may be performed using different parameters, including cardio-ankle vascular index (CAVI). The main purpose of this review is to analyze data from studies where CAVI is used to test the arterial wall stiffness in magistral vessels. CAVI measurement is non-invasive and performed by portable devices which makes it comfortable for ambulatory use in patients who come for a check-up and also in those who already are hospitalized. It does not require any special knowledge from investigator and the test lasts a couple of minutes long. CAVI does not depend on blood pressure changes and is more specific in structural changes of arterial wall assessment than brachial-ankle pulse wave velocity (baPWV). CAVI shows considerable correlation with markers of CVD like atherosclerotic plaques in vessels, diastolic disfunction of left ventricle and angina pectoris. CAVI may be used for early monitoring and assessing the lesions of target organs in patients with atherosclerosis, chronic hypertension and type 2 diabetes. Establishing CAVI as a standart parameter in assessing patients who are at risk of CVD can help to improve complications prevention, reduce mortality and prolong their lifespan.
Collapse
Affiliation(s)
- V A Verner
- Sechenov First Moscow State Medical University (Sechenov University)
| | - M V Mel'nik
- Sechenov First Moscow State Medical University (Sechenov University)
| | - S A Knjazeva
- Sechenov First Moscow State Medical University (Sechenov University)
| |
Collapse
|
15
|
Role of arterial stiffness in the association between hand grip strength and cardiovascular events: the Korean Genome and Epidemiology Study. J Hypertens 2021; 39:1203-1209. [PMID: 33399303 DOI: 10.1097/hjh.0000000000002753] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Hand grip strength (HGS) has been associated with cardiovascular events. However, the exact mechanism responsible for the inverse association between HGS and cardiovascular events has not been established. The aim of this study was to assess whether arterial stiffness mediates this association. METHODS We studied 1508 participants (age; 60 ± 5, men; 47.5%) from the Ansan cohort of the Korean Genome Epidemiology Study. Participants were assessed for various parameters of arterial stiffness as well as HGS. The augmentation index (AIx) and brachial-ankle pulse wave velocity (baPWV) were evaluated by using an applanation tonometer and automated waveform analyzer, respectively. Carotid intima medial thickness (IMT) was measured by B-mode ultrasonogram with a 7.5-MHz linear array transducer. HGS was evaluated using a Jamar dynamometer. RESULTS With increased grip strength, AIx decreased (r = 0.437, P < 0.001). baPWV (r = 0.044, P = 0.107) and carotid IMT (r = 0.005, P = 0.856) had no significant correlation with grip strength. This trend was consistently observed regardless of hypertension, but was more pronounced in participants with hypertension. CONCLUSION HGS was significantly correlated with AIx, but not with baPWV and carotid IMT. Our findings suggest that central arterial stiffness could mediate the association between HGS and cardiovascular events.
Collapse
|
16
|
Hametner B, Wassertheurer S, Mayer CC, Danninger K, Binder RK, Weber T. Aortic Pulse Wave Velocity Predicts Cardiovascular Events and Mortality in Patients Undergoing Coronary Angiography: A Comparison of Invasive Measurements and Noninvasive Estimates. Hypertension 2021; 77:571-581. [PMID: 33390046 DOI: 10.1161/hypertensionaha.120.15336] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Aortic pulse wave velocity (PWV) is directly related to arterial stiffness. Different methods for the determination of PWV coexist. The aim of this prospective study was to evaluate the prognostic value of PWV in high-risk patients with suspected coronary artery disease undergoing invasive angiography and to compare 3 different methods for assessing PWV. In 1040 patients, invasive PWV (iPWV) was measured during catheter pullback. Additionally, PWV was estimated with a model incorporating age, central systolic blood pressure, and pulse waveform characteristics obtained from noninvasive measurements (estimated PWV). As a third method, PWV was calculated with a formula solely based on age and blood pressure (formula-based PWV). Survival analysis was based on continuous PWV as well as using cutoff values. After a median follow-up duration of 1565 days, 24% of the patients reached the combined end point (cardiovascular events or mortality). Cox proportional hazard ratios per 1 SD were 1.35 for iPWV, 1.37 for estimated PWV, and 1.28 for formula-based PWV (P<0.0001 for all 3 methods) in univariate analysis, remaining statistically significant after comprehensive multivariable adjustments. In a model including a modified risk score for coronary artery disease, iPWV and estimated PWV remained borderline significant. The net reclassification improvement was significant for iPWV (0.173), formula-based PWV (0.181), and estimated PWV (0.230). All 3 methods for the determination of PWV predicted cardiovascular events and mortality in patients with suspected coronary artery disease. This indicates that iPWV as well as both noninvasive estimation methods are suitable for the assessment of arterial stiffness, bearing in mind their individual characteristics.
Collapse
Affiliation(s)
- Bernhard Hametner
- From the AIT Austrian Institute of Technology, Center for Health & Bioresources, Vienna (B.H., S.W., C.C.M.)
| | - Siegfried Wassertheurer
- From the AIT Austrian Institute of Technology, Center for Health & Bioresources, Vienna (B.H., S.W., C.C.M.)
| | - Christopher Clemens Mayer
- From the AIT Austrian Institute of Technology, Center for Health & Bioresources, Vienna (B.H., S.W., C.C.M.)
| | - Kathrin Danninger
- Klinikum Wels-Grieskirchen, Cardiology Department, Wels, Austria (K.D., R.K.B., T.W.)
| | - Ronald K Binder
- Klinikum Wels-Grieskirchen, Cardiology Department, Wels, Austria (K.D., R.K.B., T.W.)
| | - Thomas Weber
- Klinikum Wels-Grieskirchen, Cardiology Department, Wels, Austria (K.D., R.K.B., T.W.)
| |
Collapse
|
17
|
van Bakel TMJ, Arthurs CJ, Nauta FJH, Eagle KA, van Herwaarden JA, Moll FL, Trimarchi S, Patel HJ, Figueroa CA. Cardiac remodelling following thoracic endovascular aortic repair for descending aortic aneurysms. Eur J Cardiothorac Surg 2020; 55:1061-1070. [PMID: 30535179 DOI: 10.1093/ejcts/ezy399] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2018] [Revised: 10/27/2018] [Accepted: 10/29/2018] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVES Current endografts for thoracic endovascular aortic repair (TEVAR) are much stiffer than the aorta and have been shown to induce acute stiffening. In this study, we aimed to estimate the impact of TEVAR on left ventricular (LV) stroke work (SW) and mass using a non-invasive image-based workflow. METHODS The University of Michigan database was searched for patients treated with TEVAR for descending aortic pathologies (2013-2016). Patients with available pre-TEVAR and post-TEVAR computed tomography angiography and echocardiography data were selected. LV SW was estimated via patient-specific fluid-structure interaction analyses. LV remodelling was quantified through morphological measurements using echocardiography and electrocardiographic-gated computed tomography angiography data. RESULTS Eight subjects were included in this study, the mean age of the patients was 68 (73, 25) years, and 6 patients were women. All patients were prescribed antihypertensive drugs following TEVAR. The fluid-structure interaction simulations computed a 26% increase in LV SW post-TEVAR [0.94 (0.89, 0.34) J to 1.18 (1.11, 0.65) J, P = 0.012]. Morphological measurements revealed an increase in the LV mass index post-TEVAR of +26% in echocardiography [72 (73, 17) g/m2 to 91 (87, 26) g/m2, P = 0.017] and +15% in computed tomography angiography [52 (46, 29) g/m2 to 60 (57, 22) g/m2, P = 0.043]. The post- to pre-TEVAR LV mass index ratio was positively correlated with the post- to pre-TEVAR ratios of SW and the mean blood pressure (ρ = 0.690, P = 0.058 and ρ = 0.786, P = 0.021, respectively). CONCLUSIONS TEVAR was associated with increased LV SW and mass during follow-up. Medical device manufacturers should develop more compliant devices to reduce the stiffness mismatch with the aorta. Additionally, intensive antihypertensive management is needed to control blood pressure post-TEVAR.
Collapse
Affiliation(s)
- Theodorus M J van Bakel
- Department of Surgery, University of Michigan, Ann Arbor, MI, USA.,Department of Vascular Surgery, University Medical Center Utrecht, Utrecht, Netherlands.,Thoracic Aortic Research Center, Policlinico San Donato IRCCS, San Donato Milanese, Italy
| | - Christopher J Arthurs
- Division of Imaging Sciences and Biomedical Engineering, King's College London, London, UK
| | - Foeke J H Nauta
- Department of Surgery, University of Michigan, Ann Arbor, MI, USA.,Department of Vascular Surgery, University Medical Center Utrecht, Utrecht, Netherlands.,Thoracic Aortic Research Center, Policlinico San Donato IRCCS, San Donato Milanese, Italy
| | - Kim A Eagle
- Department of Cardiology, University of Michigan, Ann Arbor, MI, USA
| | | | - Frans L Moll
- Department of Vascular Surgery, University Medical Center Utrecht, Utrecht, Netherlands
| | - Santi Trimarchi
- Thoracic Aortic Research Center, Policlinico San Donato IRCCS, San Donato Milanese, Italy.,Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
| | - Himanshu J Patel
- Department of Cardiac Surgery, University of Michigan, Ann Arbor, MI, USA
| | - C Alberto Figueroa
- Department of Surgery, University of Michigan, Ann Arbor, MI, USA.,Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI, USA
| |
Collapse
|
18
|
Hiraoka A, Toki M, Hayashida A, Chikazawa G, Yoshida K, Sakaguchi T, Yoshitaka H. Exercise stress echocardiogram for the evaluation of change in the ventricular-arterial interaction after thoracic endovascular aortic repair. Eur J Cardiothorac Surg 2020; 55:632-638. [PMID: 30351345 DOI: 10.1093/ejcts/ezy342] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Revised: 09/13/2018] [Accepted: 09/15/2018] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES The aim of this study was to explore, with exercise echocardiography, the potential impact of thoracic endovascular aortic repair (TEVAR) on the ventricle-aorta coupling, based on the hypothesis that the interaction between the ventricle and aorta may be influenced by an increase in aortic stiffness due to the stent graft. METHODS Of the patients who underwent isolated TEVAR for thoracic aortic diseases between April 2016 and December 2016, changes found in haemodynamic and echocardiographic parameters between the control (n = 17) and TEVAR (n = 30) groups were analysed by a stress echocardiogram. RESULTS The end-systolic elastance significantly increased with stress in both groups [from 3.0 (2.5-4.5) mmHg/ml to 4.8 (3.7-6.5) mmHg/ml, P < 0.001, in the control group and from 2.9 (2.0-3.5) mmHg/ml to 3.4 (2.6-4.2) mmHg/ml, P < 0.001, in the TEVAR group]. The arterial elastance significantly elevated only in the TEVAR group [from 1.6 (1.3-1.8) mmHg/ml to 1.7 (1.5-2.0) mmHg/ml, P = 0.007] and arterial elastance/end-systolic elastance (ventricular-arterial coupling) significantly decreased only in the control group [from 0.5 (0.4-0.7) to 0.4 (0.3-0.5), P = 0.002, in the control group and from 0.6 (0.4-0.8) to 0.5 (0.4-0.6), P = 0.10, in the TEVAR group]. In the control group, the change in end-systolic elastance and ventricular-arterial coupling tended to be greater (P = 0.002 and 0.07). CONCLUSIONS An exercise echocardiogram showed the underlying influences of TEVAR on the interaction between the heart and aorta. TEVAR may have the potential to suppress left ventricular contractile capacity and increase cardiac afterload during exercise. CLINICAL TRIAL REGISTRATION NUMBER A201770-01.
Collapse
Affiliation(s)
- Arudo Hiraoka
- Department of Cardiovascular Surgery, The Sakakibara Heart Institute of Okayama, Okayama, Japan
| | - Misako Toki
- Department of Clinical Laboratory, The Sakakibara Heart Institute of Okayama, Okayama, Japan
| | - Akihiro Hayashida
- Department of Cardiology, The Sakakibara Heart Institute of Okayama, Okayama, Japan
| | - Genta Chikazawa
- Department of Cardiovascular Surgery, The Sakakibara Heart Institute of Okayama, Okayama, Japan
| | - Kiyoshi Yoshida
- Department of Cardiology, The Sakakibara Heart Institute of Okayama, Okayama, Japan
| | - Taichi Sakaguchi
- Department of Cardiovascular Surgery, The Sakakibara Heart Institute of Okayama, Okayama, Japan
| | - Hidenori Yoshitaka
- Department of Cardiovascular Surgery, The Sakakibara Heart Institute of Okayama, Okayama, Japan
| |
Collapse
|
19
|
Kumrular M, Karaca Ozer P, Elitok A. The Role of Aortic Stiffness Parameters in Evaluating Myocardial Ischemia. Cardiol Res 2020; 11:328-336. [PMID: 32849968 PMCID: PMC7430893 DOI: 10.14740/cr1125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2020] [Accepted: 07/07/2020] [Indexed: 12/02/2022] Open
Abstract
Background Arterial stiffness is a process resulting in deterioration of hemodynamic function of the aorta, a decrease in its compliance and elasticity, caused by the proportional change of components of the extracellular matrix. Although many researches have been done to determine the etiologies of myocardial ischemia in the absence of obstructive coronary artery disease, none of them has investigated the relation between the parameters of aortic stiffness and the myocardial ischemia documented by the exercise stress test. The present cross-sectional study aimed to investigate the difference of aortic stiffness parameters between the groups separated by exercise stress test result as positive and negative ischemic findings in the absence of obstructive coronary artery disease. Methods The present study included 79 patients who were admitted to Istanbul Faculty of Medicine, Department of Cardiology with complaint of chest pain. Forty patients (21 women and 19 men) have ischemic findings on the exercise electrocardiography (ECG) test and 39 patients (20 women and 19 men) have normal exercise ECG results. The patients who have positive exercise ECG findings underwent coronary angiography and all the patients had non-obstructive coronary artery disease. Demographic features (age, sex and comorbidities) were statistically similar between the groups. Aortic stiffness measurements (pulse wave velocity, pulse pressure, aortic augmented pressure, augmentation index, systolic pressure-time index, diastolic pressure-time index and subendocardial viability ratio) were done with tonometric methods. Results There was no significant difference between the two groups in terms of the aortic stiffness parameters. Systolic blood pressure (P = 0.33), diastolic blood pressure (P = 0.24), pulse pressure (P = 0.60), systolic pressure-time index (P = 0.10), diastolic pressure-time index (P = 0.91), subendocardial viability ratio (P = 0.19), aortic augmented pressure (P = 0.87), augmentation index (P = 0.58) and pulse wave velocity (P = 0.56) were detected between the two groups. Biochemical parameters were found similar between the two groups. Only low-density lipoprotein levels were slightly higher in patients with negative exercise stress test result (139 vs. 123 mg/dL, P = 0.02). Conclusion There is no finding supporting that the aortic stiffness identifies the patients with non-obstructive coronary artery disease but with signs of myocardial ischemia and further investigation of other causes of myocardial ischemia is required.
Collapse
Affiliation(s)
| | - Pelin Karaca Ozer
- Department of Cardiology, Istanbul University Istanbul Medical Faculty, Istanbul, Turkey
| | - Ali Elitok
- Department of Cardiology, Istanbul University Istanbul Medical Faculty, Istanbul, Turkey
| |
Collapse
|
20
|
Coronary heart disease diagnosis by artificial neural networks including aortic pulse wave velocity index and clinical parameters. J Hypertens 2020; 37:1682-1688. [PMID: 30870247 DOI: 10.1097/hjh.0000000000002075] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
BACKGROUND Cardiovascular disease, such as coronary heart disease (CHD), are the main cause of mortality and morbidity worldwide. CHD is not entirely predicted by classic risk factors; however, they are preventable. Facing this major problem, the development of novel methods for CHD risk prediction is of practical interest. The purpose of our study was to construct an artificial neural networks (ANNs)-based diagnostic model for CHD risk using a complex of clinical and haemodynamics factors of this disease and aortic pulse wave velocity (PWV) index. METHODS A total of 437 patients were included from 2012 to 2017: 99 CHD and 338 non-CHD patients. Theoretical PWV was calculated, on 93 patients free of hypertension, diabetes and CHD, according to age, blood pressure, sex and heart rate. The results were expressed as an index [(measured PWV - theoretical PWV)/theoretical PWV] for each patient. The original database for ANNs included clinical, haemodynamic and laboratory characteristics. Multilayered perceptron ANNs architecture were applied. The performance of prediction was evaluated by accuracy values based on standard definitions. RESULTS By changing the types of ANNs and the number of input factors applied, we created models that demonstrated 0.63-0.93 accuracy. The best accuracy was obtained with ANNs topology of multilayer perceptron with three hidden layers for models, parameters included by both biological factors, carotid plaque and PWV index. CONCLUSION ANNs models including a PWV index could be used as promising approaches for predicting CHD risk without the need for invasive diagnostic methods and may help in the clinical decision.
Collapse
|
21
|
Cross-Sectional Relationship between Carotid-Femoral Pulse Wave Velocity and Biomarkers in Vascular-Related Diseases. Int J Hypertens 2020; 2020:6578731. [PMID: 32537254 PMCID: PMC7267861 DOI: 10.1155/2020/6578731] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2019] [Accepted: 05/12/2020] [Indexed: 11/17/2022] Open
Abstract
Objectives The present study was done to investigate the relationship between carotid-femoral pulse wave velocity (CFPWV) and biomarkers such as homocysteine (Hcy), N-terminal pro-brain natriuretic peptide (NT-proBNP), and urine albumin (microalbumin) (UAE) in vascular-related diseases. Methods 656 subjects were enrolled into our study. There were 377 patients with hypertension, 231 with coronary heart disease, 154 with diabetes mellitus, and 186 healthy subjects. They were divided into four groups according to the number of suffered diseases: group 1 had only one of three diseases, group 2 had two, and group 3 had all of three diseases. CFPWV was measured by Complior apparatus. Results CFPWV was significantly higher in group 3 than in the healthy group, group 1, and group 2 (12.71 ± 2.38 vs 10.11 ± 2.28, 10.70 ± 2.12, and 11.92 ± 2.55, all p < 0.05). The level of Hcy was significantly higher in group1, group 2, and group 3 than in healthy subjects, respectively. Levels of Log NT-proBNP and Log UAE were significantly higher in group 3 than in group 1 (2.27 ± 0.4 vs 2.10 ± 0.4, 1.00 ± 0.65 vs 0.68 ± 0.56, both p < 0.05). Positive correlation between CFWV and Hcy, Log UAE, and Log NT-proBNP was found in the entire study group (r = 0.109, 0.196, and 0.119, all p < 0.05). Multivariate analysis showed that pulse pressure, age, fasting plasma glucose, diastolic blood pressure, body mass index, and Log UAE were independent associating factors of CFPWV in all subjects (β = 0.334, p < 0.001; β = 0.333, p < 0.001; β = 0.126, p=0.004; β = 0.137, p=0.003; β = −0.142, p=0.002; and β = 0.098, p=0.031). Conclusions CFPWV was significantly higher in subjects with hypertension, CHD, and DM. There was correlation between CFPWV and biomarkers such as NT-proBNP, Hcy, and urine albumin (microalbumin).
Collapse
|
22
|
Böhm M, Ferreira JP, Mahfoud F, Duarte K, Pitt B, Zannad F, Rossignol P. Myocardial reperfusion reverses the J-curve association of cardiovascular risk and diastolic blood pressure in patients with left ventricular dysfunction and heart failure after myocardial infarction: insights from the EPHESUS trial. Eur Heart J 2020; 41:1673-1683. [DOI: 10.1093/eurheartj/ehaa132] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Revised: 11/15/2019] [Accepted: 02/20/2020] [Indexed: 01/14/2023] Open
Abstract
Abstract
Aims
The described association of low diastolic blood pressure (DBP) with increased cardiovascular outcomes could be due to reduced coronary perfusion or is simply due to reverse causation. If DBP is physiologically relevant, coronary reperfusion after myocardial infarction (MI) might influence DBP–risk association.
Methods and results
The relation of achieved DBP with cardiovascular death or cardiovascular hospitalization, cardiovascular death, and all-cause death was explored in 5929 patients after acute myocardial infarction (AMI) with impaired left ventricular function, signs and symptoms of heart failure, or diabetes in the EPHESUS trial according to their reperfusion status. Cox regression models were used to assess the impact of reperfusion status on the association of DBP and systolic blood pressure (SBP) with outcomes in an adjusted fashion. In patients without reperfusion, lower DBP <70 mmHg was associated with increased risk for all-cause death [adjusted hazard ratios (HRs) 1.80, 95% confidence interval (CI) 1.41–2.30; P < 0.001], cardiovascular death (HR 1.70, 95% CI 1.3–3.22; P < 0.001), cardiovascular death or cardiovascular hospitalization (HR 1.54, 95% CI 1.26–1.87; P < 0.001). In patients with reperfusion, the risk increase at low DBP was not observed. At low SBP, risk increased independently of reperfusion. A sensitivity analysis in the subgroup of patients with optimal SBP of 120–130 mmHg showed again risk reduction of reperfusion at low DBP. Adding the treatment allocation to eplerenone or placebo into the models had no effects on the results.
Conclusion
Patients after AMIs with a low DBP had an increased risk, which was sensitive to reperfusion therapy. Low blood pressure after MI identifies in patients with particular higher risk. These data support the hypothesis that low DBP in patients with stenotic coronary lesions is associated with risk, potentially involving coronary perfusion pressure and the recommendations provided by guidelines suggesting lower DBP boundaries for these high-risk patients.
Collapse
Affiliation(s)
- Michael Böhm
- Klinik für Innere Medizin III, Universitätsklinikum des Saarlandes, Saarland University, Kardiologie, Angiologie und Internistische Intensivmedizin, Kirrberger Str. 1, 66421 Homburg/Saar, Germany
| | - João Pedro Ferreira
- Centre d‘Investigation Clinique Plurithématique Pierre Drouin—INSERM CHU de Nancy, Nancy, France
- Université de Lorraine, FCRIN INI-CRCT (Cardiovascular and Renal Clinical Trialists) Network, Nancy, France
| | - Felix Mahfoud
- Klinik für Innere Medizin III, Universitätsklinikum des Saarlandes, Saarland University, Kardiologie, Angiologie und Internistische Intensivmedizin, Kirrberger Str. 1, 66421 Homburg/Saar, Germany
| | - Kevin Duarte
- Centre d‘Investigation Clinique Plurithématique Pierre Drouin—INSERM CHU de Nancy, Nancy, France
- Université de Lorraine, FCRIN INI-CRCT (Cardiovascular and Renal Clinical Trialists) Network, Nancy, France
| | - Bertram Pitt
- Division of Cardiology, Department of Internal Medicine, University of Michigan, 3910 Taubman, 1500 E Medical Center, Ann Arbor, MI 48109-066, USA
| | - Faiez Zannad
- Centre d‘Investigation Clinique Plurithématique Pierre Drouin—INSERM CHU de Nancy, Nancy, France
- Université de Lorraine, FCRIN INI-CRCT (Cardiovascular and Renal Clinical Trialists) Network, Nancy, France
| | - Patrick Rossignol
- Centre d‘Investigation Clinique Plurithématique Pierre Drouin—INSERM CHU de Nancy, Nancy, France
- Université de Lorraine, FCRIN INI-CRCT (Cardiovascular and Renal Clinical Trialists) Network, Nancy, France
| |
Collapse
|
23
|
Jha AK, Lata S. Kidney transplantation and cardiomyopathy: Concepts and controversies in clinical decision-making. Clin Transplant 2020; 34:e13795. [PMID: 31991012 DOI: 10.1111/ctr.13795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Revised: 08/21/2019] [Accepted: 01/24/2020] [Indexed: 11/30/2022]
Abstract
Increasing comorbidities and an aging population have led to a tremendous increase in the burden of both kidney and cardiac dysfunction. Concomitant cardiomyopathy exposes the patients with kidney disease to further physiological, hemodynamic, and pathologic alterations. Kidney transplantation imposes lesser anesthetic and surgical complexities compared to another solid organ transplant. The surgical decision-making remains an unsettled issue in these conditions. The surgical choices, techniques, and sequences in kidney transplant and cardiac surgery depend on the pathophysiological perturbations and perioperative outcomes. The absence of randomized controlled trials eludes us from suggesting definite management protocol in patients with end-stage kidney disease with cardiomyopathy. Nevertheless, in this review, we extracted data from published literature to understand the pathophysiologic interactions between end-stage renal diseases with cardiomyopathy and also proposed the management algorithm in this challenging scenario. The proposed management algorithm would ensure consensus across all stakeholders involved in decision-making. Our simplistic evidence-based approach would augur future randomized trials and would further ensure refinement in our management approach after the emergence of more definitive evidence.
Collapse
Affiliation(s)
- Ajay Kumar Jha
- Department of Anesthesiology and Critical Care, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Suman Lata
- Department of Anesthesiology and Critical Care, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| |
Collapse
|
24
|
Kiuchi MG, Ho JK, Nolde JM, Gavidia LML, Carnagarin R, Matthews VB, Schlaich MP. Sympathetic Activation in Hypertensive Chronic Kidney Disease - A Stimulus for Cardiac Arrhythmias and Sudden Cardiac Death? Front Physiol 2020; 10:1546. [PMID: 32009970 PMCID: PMC6974800 DOI: 10.3389/fphys.2019.01546] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Accepted: 12/09/2019] [Indexed: 12/11/2022] Open
Abstract
Studies have revealed a robust and independent correlation between chronic kidney disease (CKD) and cardiovascular (CV) events, including death, heart failure, and myocardial infarction. Recent clinical trials extend this range of adverse CV events, including malignant ventricular arrhythmias and sudden cardiac death (SCD). Moreover, other studies point out that cardiac structural and electrophysiological changes are a common occurrence in this population. These processes are likely contributors to the heightened hazard of arrhythmias in CKD population and may be useful indicators to detect patients who are at a higher SCD risk. Sympathetic overactivity is associated with increased CV risk, specifically in the population with CKD, and it is a central feature of the hypertensive state, occurring early in its clinical course. Sympathetic hyperactivity is already evident at the earliest clinical stage of CKD and is directly related to the progression of renal failure, being most pronounced in those with end-stage renal disease. Sympathetic efferent and afferent neural activity in kidney failure is a crucial facilitator for the perpetuation and evolvement of the disease. Here, we will revisit the role of the feedback loop of the sympathetic neural cycle in the context of CKD and how it may aggravate several of the risk factors responsible for causing SCD. Targeting the overactive sympathetic nervous system therapeutically, either pharmacologically or with newly available device-based approaches, may prove to be a pivotal intervention to curb the substantial burden of cardiac arrhythmias and SCD in the high-risk population of patients with CKD.
Collapse
Affiliation(s)
- Márcio Galindo Kiuchi
- Dobney Hypertension Centre, School of Medicine - Royal Perth Hospital Unit/Medical Research Foundation, The University of Western Australia, Perth, WA, Australia
| | - Jan K Ho
- Dobney Hypertension Centre, School of Medicine - Royal Perth Hospital Unit/Medical Research Foundation, The University of Western Australia, Perth, WA, Australia
| | - Janis Marc Nolde
- Dobney Hypertension Centre, School of Medicine - Royal Perth Hospital Unit/Medical Research Foundation, The University of Western Australia, Perth, WA, Australia
| | - Leslie Marisol Lugo Gavidia
- Dobney Hypertension Centre, School of Medicine - Royal Perth Hospital Unit/Medical Research Foundation, The University of Western Australia, Perth, WA, Australia
| | - Revathy Carnagarin
- Dobney Hypertension Centre, School of Medicine - Royal Perth Hospital Unit/Medical Research Foundation, The University of Western Australia, Perth, WA, Australia
| | - Vance B Matthews
- Dobney Hypertension Centre, School of Medicine - Royal Perth Hospital Unit/Medical Research Foundation, The University of Western Australia, Perth, WA, Australia
| | - Markus P Schlaich
- Dobney Hypertension Centre, School of Medicine - Royal Perth Hospital Unit/Medical Research Foundation, The University of Western Australia, Perth, WA, Australia.,Departments of Cardiology and Nephrology, Royal Perth Hospital, Perth, WA, Australia.,Neurovascular Hypertension & Kidney Disease Laboratory, Baker Heart and Diabetes Institute, Melbourne, VIC, Australia
| |
Collapse
|
25
|
Vallée A, Cinaud A, Protogerou A, Zhang Y, Topouchian J, Safar ME, Blacher J. Arterial Stiffness and Coronary Ischemia: New Aspects and Paradigms. Curr Hypertens Rep 2020; 22:5. [PMID: 31925555 DOI: 10.1007/s11906-019-1006-z] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
PURPOSE OF REVIEW Aortic stiffness (AS) is widely associated with hypertension and considered as a major predictor of coronary heart disease (CHD). AS is measured using carotid-femoral pulse wave velocity (PWV), particularly when this parameter is associated with an index involving age, gender, heart rate, and mean blood pressure. The present review focuses on the interest of measurement of PWV and the calculation of individual PWV index for the prediction of CHD, in addition with the use of new statistical nonlinear models enabling results with very high levels of accuracy. RECENT FINDINGS PWV index may so constitute a substantial marker of large arteries prediction and damage in CHD and may be also used in cerebrovascular and renal circulations models. PWV index determinations are particularly relevant to consider in angiographic CHD decisions and in the presence of vulnerable plaques with high cardiovascular risk. Due to the variability in symptoms and clinical characteristics of patients, together with some imperfections in results, there is no very simple adequate diagnosis approach enabling to improve the so defined CHD prediction in usual clinical practice. In recent works in relation to "artificial intelligence" and involving "decision tree" models and "artificial neural networks," it has been possible to determine consistent pathways introducing predictive medicine and enabling to obtain efficient algorithm classification models of coronary prediction.
Collapse
Affiliation(s)
- Alexandre Vallée
- Diagnosis and Therapeutic Center, Hypertension and Cardiovascular Prevention Unit, Hôtel-Dieu Hospital, Paris-Descartes University, AP-HP, Paris, France.
| | - Alexandre Cinaud
- Diagnosis and Therapeutic Center, Hypertension and Cardiovascular Prevention Unit, Hôtel-Dieu Hospital, Paris-Descartes University, AP-HP, Paris, France
| | - Athanase Protogerou
- Cardiovascular Prevention and Research Unit, Department of Pathophysiology, National and Kapodistrian University of Athens, Athens, Greece
| | - Yi Zhang
- Department of Cardiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
| | - Jirar Topouchian
- Diagnosis and Therapeutic Center, Hypertension and Cardiovascular Prevention Unit, Hôtel-Dieu Hospital, Paris-Descartes University, AP-HP, Paris, France
| | - Michel E Safar
- Diagnosis and Therapeutic Center, Hypertension and Cardiovascular Prevention Unit, Hôtel-Dieu Hospital, Paris-Descartes University, AP-HP, Paris, France
| | - Jacques Blacher
- Diagnosis and Therapeutic Center, Hypertension and Cardiovascular Prevention Unit, Hôtel-Dieu Hospital, Paris-Descartes University, AP-HP, Paris, France
| |
Collapse
|
26
|
|
27
|
Abstract
ZusammenfassungErhöhter Blutdruck bleibt eine Hauptursache von kardiovaskulären Erkrankungen, Behinderung und frühzeitiger Sterblichkeit in Österreich, wobei die Raten an Diagnose, Behandlung und Kontrolle auch in rezenten Studien suboptimal sind. Das Management von Bluthochdruck ist eine häufige Herausforderung für Ärztinnen und Ärzte vieler Fachrichtungen. In einem Versuch, diagnostische und therapeutische Strategien zu standardisieren und letztendlich die Rate an gut kontrollierten Hypertoniker/innen zu erhöhen und dadurch kardiovaskuläre Erkrankungen zu verhindern, haben 13 österreichische medizinische Fachgesellschaften die vorhandene Evidenz zur Prävention, Diagnose, Abklärung, Therapie und Konsequenzen erhöhten Blutdrucks gesichtet. Das hier vorgestellte Ergebnis ist der erste Österreichische Blutdruckkonsens. Die Autoren und die beteiligten Fachgesellschaften sind davon überzeugt, daß es einer gemeinsamen nationalen Anstrengung bedarf, die Blutdruck-assoziierte Morbidität und Mortalität in unserem Land zu verringern.
Collapse
|
28
|
The Acute Effects of High-Intensity Cycling Exercise on Arterial Stiffness in Adolescent Wrestlers. J Hum Kinet 2019; 69:99-107. [PMID: 31666893 PMCID: PMC6815092 DOI: 10.2478/hukin-2018-0100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
The aim of this study was to determine the acute effects of high‐intensity cycling exercise on the variables of carotid artery compliance, distensibility and beta stiffness index in elite adolescent wrestlers. The subjects were elite athletes competing in national, European and World Championships, who attended a training camp in the province of Kahramanmaras organized by the Turkish Centre for Olympic Preparation. The study sample comprised 31 male elite wrestlers with a mean age of 15.90 ± 0.87 years, body height of 165.97 ± 9.7 cm and body mass of 66.3 ± 18.45 kg. The arterial stiffness variables of the wrestlers were measured with high‐resolution Doppler ultrasonography before and 5 min after 30 s of high‐intensity cycling exercise (the Wingate Anaerobic Cycling test). The results showed a statistically significant correlation between mean power performance and carotid artery compliance at the 5th min after a single cycling sprint exercise (p < 0.05). No correlation was determined between peak power and the arterial stiffness variables (p > 0.05). The study results indicate that acute changes in arterial stiffness variables are associated with the performance level of high‐intensity cycling exercise in a group of elite adolescent wrestlers.
Collapse
|
29
|
Reply: High Pulse Pressure: Complex PCI or Complex Patients? J Am Coll Cardiol 2019; 74:2012-2013. [PMID: 31601376 DOI: 10.1016/j.jacc.2019.08.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Accepted: 08/11/2019] [Indexed: 11/21/2022]
|
30
|
Nelson AJ, Puri R, Nicholls SJ, Dundon BK, Richardson JD, Sidharta SL, Teo KS, Worthley SG, Worthley MI. Aortic distensibility is associated with both resting and hyperemic coronary blood flow. Am J Physiol Heart Circ Physiol 2019; 317:H811-H819. [DOI: 10.1152/ajpheart.00067.2019] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
A large body of evidence demonstrates an independent association between arterial stiffness and prospective risk of cardiovascular events. A reduction in coronary perfusion is presumed to underscore this association; however, studies confirming this are lacking. This study compared invasive measures of coronary blood flow (CBF) with cardiac magnetic resonance (CMR)-derived aortic distensibility (AD). Following coronary angiography, a Doppler FloWire and infusion microcatheter were advanced into the study vessel. Average peak velocity (APV) was acquired at baseline and following intracoronary adenosine to derive coronary flow velocity reserve (CFVR = hyperemic APV/resting APV) and CBF [π × (diameter)2 × APV × 0.125]. Following angiography, patients underwent CMR to evaluate distensibility at the ascending aorta (AA), proximal descending aorta (PDA) and distal descending aorta (DDA). Fifteen participants (53 ± 13 yr) with minor epicardial disease (maximum stenosis <30%) were enrolled. Resting CBF was 44.1 ± 11.9 mL/min, hyperemic CBF was 143.8 ± 37.4 mL/min, and CFVR was 3.15 ± 0.48. AD was 3.89 ± 1.72·10−3mmHg−1 at the AA, 4.08 ± 1.80·10−3mmHg−1 at the PDA, and 4.42 ± 1.67·10−3mmHg−1 at the DDA. All levels of distensibility correlated with resting CBF ( R2 = 0.350–0.373, P < 0.05), hyperemic CBF ( R2 = 0.453–0.464, P < 0.01), and CFVR ( R2 = 0.442–0.511, P < 0.01). This study demonstrates that hyperemic and, to a lesser extent resting CBF, are significantly associated with measures of aortic stiffness in patients with only minor angiographic disease. These findings provide further in vivo support for the observed prognostic capacity of large artery function in cardiovascular event prediction. NEW & NOTEWORTHY Cardiac magnetic resonance-derived aortic distensibility is associated with invasive measures of coronary blood flow. Large artery function is more strongly correlated with hyperemic than resting blood flow. Increased stiffness may represent a potential target for novel antianginal medications.
Collapse
Affiliation(s)
- Adam J. Nelson
- Department of Cardiology, Royal Adelaide Hospital, Adelaide, Australia
| | - Rishi Puri
- Department of Cardiovascular Medicine, and Cleveland Clinic Coordinating Center for Clinical Research (C5R), Cleveland Clinic, Cleveland, Ohio
| | - Stephen J. Nicholls
- Monash Cardiovascular Research Centre, Monash University, Melbourne, Australia
| | - Benjamin K. Dundon
- Monash Cardiovascular Research Centre, Monash University, Melbourne, Australia
| | - James D. Richardson
- Northern General Hospital, Sheffield Teaching Hospitals National Health Service, Sheffield, United Kingdom
| | - Samuel L. Sidharta
- Department of Cardiology, Royal Adelaide Hospital, Adelaide, Australia
- GenesisCare, HeartCare, Adelaide, Australia
| | - Karen S. Teo
- Department of Cardiology, Royal Adelaide Hospital, Adelaide, Australia
| | - Stephen G. Worthley
- Department of Cardiology, Royal Adelaide Hospital, Adelaide, Australia
- GenesisCare, HeartCare, Adelaide, Australia
| | | |
Collapse
|
31
|
Baman JR, Knapper J, Raval Z, Harinstein ME, Friedewald JJ, Maganti K, Cuttica MJ, Abecassis MI, Ali ZA, Gheorghiade M, Flaherty JD. Preoperative Noncoronary Cardiovascular Assessment and Management of Kidney Transplant Candidates. Clin J Am Soc Nephrol 2019; 14:1670-1676. [PMID: 31554619 PMCID: PMC6832054 DOI: 10.2215/cjn.03640319] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
The pretransplant risk assessment for patients with ESKD who are undergoing evaluation for kidney transplant is complex and multifaceted. When considering cardiovascular disease in particular, many factors should be considered. Given the increasing incidence of kidney transplantation and the growing body of evidence addressing ESKD-specific cardiovascular risk profiles, there is an important need for a consolidated, evidence-based model that considers the unique cardiovascular challenges that these patients face. Cardiovascular physiology is altered in these patients by abrupt shifts in volume status, altered calcium-phosphate metabolism, high-output states (in the setting of arteriovenous fistulization), and adverse geometric and electrical remodeling, to name a few. Here, we present a contemporary review by addressing cardiomyopathy/heart failure, pulmonary hypertension, valvular dysfunction, and arrhythmia/sudden cardiac death within the ESKD population.
Collapse
Affiliation(s)
| | | | - Zankhana Raval
- Division of Cardiology, Department of Medicine, Columbia University Medical Center, New York Presbyterian Hospital, New York, New York; and
| | - Matthew E Harinstein
- Division of Cardiology, Cardiovascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - John J Friedewald
- Division of Nephrology, Department of Medicine.,Division of Transplantation, Department of Surgery, and
| | | | - Michael J Cuttica
- Division of Pulmonary and Critical Care, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | | | - Ziad A Ali
- Division of Cardiology, Department of Medicine, Columbia University Medical Center, New York Presbyterian Hospital, New York, New York; and
| | | | | |
Collapse
|
32
|
Vallée A, Zhang Y, Protogerou A, Safar ME, Blacher J. Added value of aortic pulse wave velocity index for the detection of coronary heart disease by elective coronary angiography. Blood Press 2019; 28:375-384. [PMID: 31293183 DOI: 10.1080/08037051.2019.1641400] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Background: Non-invasive tests leading to elective coronary angiography (CAG) have low diagnostic yield for obstructive coronary heart disease (CHD). Aortic stiffness, an independent predictor of CHD events can be easily measured by pulse wave velocity (PWV). We aimed at retrospectively evaluating the diagnostic accuracy PWV index to detect CHD in consecutive patients with suspected CHD that underwent CAG.Method: In population of 86 healthy patients with available PWV data, a theoretical PWV was derived. In different population of 62 individuals who underwent CAG for suspected CHD, PWV index was calculated as index [(measured PWV - theoretical PWV)/theoretical PWV]. Logistic regression and comparisons between ROC curves were used to add value of CAG indication performance of PWV index.Results: Out of 62, seventeen patients presented obstructive CHD and 22 patients had non-obstructive CHD. PWV index and severity of CHD were positively correlated (p < 0.0001). After applying several models that included classical CHD predictor, the higher performance to detect abnormal CAG was obtained with the combined classifier PWV index/carotid plaque with 87% sensitivity, 93% specificity, 0.92 accuracy and 0.31 threshold. To detect obstructive CAG, individual classifier PWV index presents 94% sensitivity, 91% specificity, 0.95 accuracy and 0.46 threshold.Conclusion: PWV index is individualized approach that optimizes CHD diagnostic strategies and thus might be clinically useful for reducing the rate of unnecessary invasive CAG.
Collapse
Affiliation(s)
- Alexandre Vallée
- Hypertension and Cardiovascular Prevention Unit, Hôtel-Dieu Hospital, Diagnosis and Therapeutic Center, AP-HP, Paris-Descartes University, Paris, France
| | - Yi Zhang
- Department of Cardiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
| | - Athanase Protogerou
- Cardiovascular Prevention and Research Unit, Department of Pathophysiology, National and Kapodistrian University of Athens, Greece
| | - Michel E Safar
- Hypertension and Cardiovascular Prevention Unit, Hôtel-Dieu Hospital, Diagnosis and Therapeutic Center, AP-HP, Paris-Descartes University, Paris, France
| | - Jacques Blacher
- Hypertension and Cardiovascular Prevention Unit, Hôtel-Dieu Hospital, Diagnosis and Therapeutic Center, AP-HP, Paris-Descartes University, Paris, France
| |
Collapse
|
33
|
Warren J, Nanayakkara S, Andrianopoulos N, Brennan A, Dinh D, Yudi M, Clark D, Ajani AE, Reid CM, Selkrig L, Shaw J, Hiew C, Freeman M, Kaye D, Kingwell BA, Dart AM, Duffy SJ, Reid C, Andrianopoulos N, Brennan A, Dinh D, Reid C, Ajani A, Duffy S, Clark D, Freeman M, Hiew C, Andrianopoulos N, Oqueli E, Brennan A, Duffy S, Shaw J, Walton A, Dart A, Broughton A, Federman J, Keighley C, Hengel C, Peter K, Stub D, Chan W, Warren J, O’Brien J, Selkrig L, Huntington R, Clark D, Farouque O, Horrigan M, Johns J, Oliver L, Brennan J, Chan R, Proimos G, Dortimer T, Chan B, Nadurata V, Huq R, Fernando D, Al-Fiadh A, Yudi M, Sugumar H, Ramchand J, Han H, Picardo S, Brown L, Oqueli E, Hengel C, Sharma A, Zhu B, Ryan N, Harrison T, New G, Roberts L, Freeman M, Rowe M, Proimos G, Cheong Y, Goods C, Fernando D, Teh A, Parfrey S, Ramzy J, Koshy A, Venkataraman P, Flannery D, Hiew C, Sebastian M, Yip T, Mok M, Jaworski C, Hutchinson A, Cimenkaya C, Ngu P, Khialani B, Salehi H, Turner M, Dyson J, McDonald B, Van Den Nouwelant D, Halliburton K, Reid C, Andrianopoulos N, Brennan A, Dinh D, Yan B, Ajani A, Warren R, Eccleston D, Lefkovits J, Iyer R, Gurvitch R, Wilson W, Brooks M, Biswas S, Yeoh J. Impact of Pre-Procedural Blood Pressure on Long-Term Outcomes Following Percutaneous Coronary Intervention. J Am Coll Cardiol 2019; 73:2846-2855. [DOI: 10.1016/j.jacc.2019.03.493] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Revised: 03/06/2019] [Accepted: 03/07/2019] [Indexed: 11/28/2022]
|
34
|
Lønnebakken MT, Eskerud I, Larsen TH, Midtbø HB, Kokorina MV, Gerdts E. Impact of aortic stiffness on myocardial ischaemia in non-obstructive coronary artery disease. Open Heart 2019; 6:e000981. [PMID: 31217997 PMCID: PMC6546180 DOI: 10.1136/openhrt-2018-000981] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2018] [Revised: 04/03/2019] [Accepted: 04/14/2019] [Indexed: 12/24/2022] Open
Abstract
Objective High aortic stiffness may reduce myocardial perfusion pressure and contribute to development of myocardial ischaemia. Whether high aortic stiffness is associated with myocardial ischaemia in patients with stable angina and non-obstructive coronary artery disease (CAD) is less explored. Methods Aortic stiffness was assessed as carotid-femoral pulse wave velocity (PWV) by applanation tonometry in 125 patients (62±8 years, 58% women) with stable angina and non-obstructive CAD participating in the Myocardial Ischemia in Non-obstructive CAD project. PWV in the highest tertile (>8.7 m/s) was taken as higher aortic stiffness. Stress-induced myocardial ischaemia was detected as delayed myocardial contrast replenishment during stress echocardiography, and the number of left ventricular (LV) segments with delayed contrast replenishment as the extent of ischaemia. Results Patients with higher aortic stiffness were older with higher LV mass index and lower prevalence of obesity (all p<0.05), while angina symptoms, sex, prevalence of hypertension, diabetes, smoking or LV ejection fraction did not differ between groups. Stress-induced myocardial ischaemia was more common (73% vs 42%, p=0.001) and the extent of ischaemia was larger (4±3 vs 2±3 LV segments, p=0.005) in patients with higher aortic stiffness. In multivariable logistic regression analysis, higher aortic stiffness was associated with stress-induced myocardial ischaemia independent of other known covariables (OR 4.74 (95% CI 1.51 to 14.93), p=0.008). Conclusions In patients with stable angina and non-obstructive CAD, higher aortic stiffness was associated with stress-induced myocardial ischaemia. Consequently, assessment of aortic stiffness may add to the diagnostic evaluation in patients with non-obstructive CAD. Trial registration number NCT01853527.
Collapse
Affiliation(s)
- Mai Tone Lønnebakken
- Department of Clinical Science, University of Bergen, Bergen, Norway.,Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
| | - Ingeborg Eskerud
- Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Terje Hjalmar Larsen
- Department of Heart Disease, Haukeland University Hospital, Bergen, Norway.,Department of Biomedicine, University of Bergen, Bergen, Norway
| | | | | | - Eva Gerdts
- Department of Clinical Science, University of Bergen, Bergen, Norway
| |
Collapse
|
35
|
Abstract
See Article Yamamoto et al
Collapse
Affiliation(s)
- Anthony M Dart
- 1 Department of Cardiovascular Medicine Alfred Hospital Melbourne Victoria Australia
| |
Collapse
|
36
|
Vallée A, Petruescu L, Kretz S, Safar ME, Blacher J. Added Value of Aortic Pulse Wave Velocity Index in a Predictive Diagnosis Decision Tree of Coronary Heart Disease. Am J Hypertens 2019; 32:375-383. [PMID: 30624553 DOI: 10.1093/ajh/hpz004] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2018] [Revised: 01/01/2019] [Accepted: 01/08/2019] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Coronary heart disease (CHD) is among the main causes of death in the world. Individual study of cardiovascular risk is an important way to predict CHD risk. The aim of this study was to evaluate the added role of the aortic pulse wave velocity (PWV) index in the prediction of CHD risk. METHODS A cross-sectional study was conducted from December 2012 to September 2017; 530 patients were included: 99 CHD, 338 non-CHD patients, and 93 nonhypertensives, nondiabetics and non-CHD subjects, whose theoretical PWV were calculated. Theoretical PWV was calculated according to age, blood pressure, gender, and heart rate. The results were expressed as an index ((measured PWV - theoretical PWV)/theoretical PWV) for each patient. The differences observed, the differential diagnostic performance, and the quantification of the added value of diagnostic performance of PWV index were tested using logistic regression, comparisons between receiver operating characteristic (ROC) curves, and decision tree nonlinear methodology. RESULTS PWV index (P = 0.006), carotid plaque (P = 0.005), and dyslipidemia (P = 0.04) were the independent modulators of CHD diagnosis. PWV index appears to be the highest specific classifier (81%) compared to carotid plaque (75%) and dyslipidemia (78%). For the decision tree, sensitivity, specificity, and area under the ROC curve for CHD diagnosis were 62%, 83%, and 0.87, respectively. CONCLUSIONS PWV index yielded added value to CHD by assessment of combined classifiers with clinical determinants and decision tree construction and significantly increased the specificity of the differential diagnostic performances of the common risk factors of CHD in daily clinical practice.
Collapse
Affiliation(s)
- Alexandre Vallée
- Paris-Descartes University, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
- Diagnosis and Therapeutic Center, Hypertension and Cardiovascular Prevention Unit, Hôtel-Dieu Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
| | - Laura Petruescu
- Paris-Descartes University, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
- Diagnosis and Therapeutic Center, Hypertension and Cardiovascular Prevention Unit, Hôtel-Dieu Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
| | - Sandrine Kretz
- Paris-Descartes University, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
- Diagnosis and Therapeutic Center, Hypertension and Cardiovascular Prevention Unit, Hôtel-Dieu Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
| | - Michel E Safar
- Paris-Descartes University, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
- Diagnosis and Therapeutic Center, Hypertension and Cardiovascular Prevention Unit, Hôtel-Dieu Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
| | - Jacques Blacher
- Paris-Descartes University, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
- Diagnosis and Therapeutic Center, Hypertension and Cardiovascular Prevention Unit, Hôtel-Dieu Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
| |
Collapse
|
37
|
Namasivayam M, McEniery CM, Wilkinson IB, Yasmin, Cockroft JR, McDonnell BJ, Adji A, O’Rourke MF. Different Effects of Vascular Aging on Ischemic Predisposition in Healthy Men and Women. Hypertension 2018; 72:1294-1300. [DOI: 10.1161/hypertensionaha.118.11642] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Affiliation(s)
- Mayooran Namasivayam
- From the Faculty of Medicine, University of New South Wales, Sydney, Australia (M.N., M.F.O.)
| | - Carmel M. McEniery
- Division of Experimental Medicine and Immunotherapeutics, University of Cambridge, United Kingdom (C.M.M., I.B.W., Y.)
| | - Ian B. Wilkinson
- Division of Experimental Medicine and Immunotherapeutics, University of Cambridge, United Kingdom (C.M.M., I.B.W., Y.)
| | - Yasmin
- Division of Experimental Medicine and Immunotherapeutics, University of Cambridge, United Kingdom (C.M.M., I.B.W., Y.)
| | - John R. Cockroft
- School of Health Sciences, Cardiff Metropolitan University, United Kingdom (J.R.C., B.J.M.)
| | - Barry J. McDonnell
- School of Health Sciences, Cardiff Metropolitan University, United Kingdom (J.R.C., B.J.M.)
| | - Audrey Adji
- Faculty of Medical and Health Sciences, Macquarie University, Sydney, Australia (A.A.)
| | - Michael F. O’Rourke
- From the Faculty of Medicine, University of New South Wales, Sydney, Australia (M.N., M.F.O.)
| | | |
Collapse
|
38
|
The First Harmonic of Radial Pulse as an Early Predictor of Silent Coronary Artery Disease and Adverse Cardiac Events in Type 2 Diabetic Patients. Cardiol Res Pract 2018; 2018:5128626. [PMID: 30425857 PMCID: PMC6218742 DOI: 10.1155/2018/5128626] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2018] [Revised: 09/11/2018] [Accepted: 09/23/2018] [Indexed: 02/02/2023] Open
Abstract
Background It has been reported that harmonics of radial pulse is related to coronary artery disease (CAD) in patients with type 2 diabetes mellitus (T2DM). It is still unclear whether or not the first harmonics of the radial pulse spectrum is an early independent predictor of silent coronary artery disease (SCAD) and adverse cardiac events (ACE). Objectives To measure the risk of SCAD in patients with T2DM and also to survey whether or not an increment of the first harmonic (C1) of the radial pulse increases ACE. Methods 1968 asymptomatic individuals with T2DM underwent radial pulse wave measurement. First harmonic of the radial pressure wave, C1, was calculated. Next, the new occurrence of ACE and the new symptoms and signs of coronary artery disease were recorded. The follow-up period lasted for 14.7 ± 3.5 months. Results Out of 1968 asymptomatic individuals with T2DM, ACE was detected in 239 (12%) of them during the follow-up period. The logrank test demonstrated that the cumulative incidence of ACE in patients with C1 above 0.96 was greater than that in those patients with C1 below 0.89 (P < 0.01). By comparing the data of patients with C1 smaller than the first quartile and the patients with C1 greater than the third quartile, the hazard ratios were listed as follows: ACE (hazard ratio, 2.29; 95% CI, 1.55–3.37), heart failure (hazard ratio, 2.22; 95% CI, 1.21–4.09), myocardial infarction (hazard ratio, 2.44; 95% CI, 1.51–3.93), left ventricular dysfunction (Hazard ratio, 2.01; 95% CI, 0.86–4.70), and new symptoms and signs for coronary artery disease (hazard ratio, 2.03; 95% CI, 1.45–2.84). As C1 increased, the risk for composite ACE (P < 0.001 for trend) and for coronary disease (P < 0.001 for trend) also increased. The hazard ratio and trend for cardiovascular-cause mortality were not significant. Conclusions This study showed that C1 of the radial pulse wave is correlated with cardiovascular events. Survival analysis showed that C1 value is an independent predictor of ACE and SCAD in asymptomatic patients with T2DM. Thus, screening for the first harmonic of the radial pulse may improve the risk stratification of cardiac events and SCAD in asymptomatic patients although they had no history of coronary artery disease or angina-related symptom.
Collapse
|
39
|
Alves AJ, Oliveira NL, Lopes S, Ruescas-Nicolau MA, Teixeira M, Oliveira J, Ribeiro F. Arterial Stiffness is Related to Impaired Exercise Capacity in Patients With Coronary Artery Disease and History of Myocardial Infarction. Heart Lung Circ 2018; 28:1614-1621. [PMID: 30318391 DOI: 10.1016/j.hlc.2018.08.023] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2018] [Revised: 08/04/2018] [Accepted: 08/31/2018] [Indexed: 12/15/2022]
Abstract
BACKGROUND Augmented arterial stiffness and reduced cardiorespiratory fitness are associated with increased morbidity and mortality from coronary artery disease (CAD). The relationship between exercise capacity and arterial stiffness is independent of known influencing variables in CAD. This study aimed to analyse the interaction between exercise capacity, arterial stiffness and early vascular ageing in patients with CAD. METHODS This cross-sectional study included 96 CAD patients with myocardial infarction (55.9±10.9years, 81 men) referred to cardiac rehabilitation. Arterial stiffness was assessed using carotid-femoral pulse wave velocity (cf-PWV). Cardiopulmonary exercise test was performed to measure VO2peak. Comparisons of VO2peak across cf-PWV risk threshold values (high-risk cf-PWV≥10m/s) and tertile groups, and across cf-PWV threshold values and age groups (younger group<60 years) were performed. Correlation tests were used to study the association between pair of variables. RESULTS Patients with high-risk cf-PWV had lower VO2peak than those with low-risk cf-PWV (p<0.001). VO2peak decreased across tertiles of cf-PWV, showing significantly lower values in the third tertile (p<0.001). There were no differences in the VO2peak between younger patients with high-risk cf-PWV and older patients irrespective of their cf-PWV values. VO2peak showed an upward trend in younger patients with low-risk cf-PWV compared to their age-mates with high-risk cf-PWV (p=0.09). VO2peak was strongly and inversely correlated with cf-PWV (r=-0.502, p<0.001). CONCLUSIONS Arterial stiffening is associated with lower cardiorespiratory fitness in CAD patients with myocardial infarction. When its values are above risk threshold, exercise capacity is impaired regardless of the relationship between age and arterial stiffness.
Collapse
Affiliation(s)
- Alberto Jorge Alves
- Research Center in Sports Sciences, Health Sciences and Human Development, CIDESD, University Institute of Maia, Maia, Portugal.
| | - Norton Luís Oliveira
- Research Center in Physical Activity, Health and Leisure, CIAFEL, Faculty of Sport, University of Porto, Porto, Portugal; Exercise Pathophysiology Research Laboratory, Hospital de Clínicas de Porto Alegre, Rio Grande do Sul, Brazil
| | - Susana Lopes
- School of Health Sciences and Institute of Biomedicine - iBiMED, University of Aveiro, Aveiro, Portugal
| | | | - Madalena Teixeira
- Cardiology Department, Centro Hospitalar de Gaia/Espinho, Vila Nova de Gaia, Portugal
| | - José Oliveira
- Research Center in Physical Activity, Health and Leisure, CIAFEL, Faculty of Sport, University of Porto, Porto, Portugal
| | - Fernando Ribeiro
- School of Health Sciences and Institute of Biomedicine - iBiMED, University of Aveiro, Aveiro, Portugal
| |
Collapse
|
40
|
Bacelova MG, Nikolova JG, Deneva T, Nikolov PF. Arterial stiffness, plasma atherogenic index and soluble cell adhesion molecules in healthy young adults with reduced physical activity. Arch Physiol Biochem 2018; 124:357-360. [PMID: 29183155 DOI: 10.1080/13813455.2017.1408661] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVE To examine some anthropometric parameters, arterial stiffness, lipid profile, and soluble adhesion molecules in young adults with reduced physical activity. MATERIAL AND METHODS The study is carried on 54 healthy young adults aged 20.97 ± 2.04 years. Two groups: 23 with reduced physical activity (INAC) and 31 with optimal physical activity (AC). Body mass index (BMI), basal metabolic rate (BMR), central aortic systolic blood pressure (CSBP, mmHg), plasma atherogenic index (AIP), and serum soluble cell adhesion molecules (sICAM-1, sVCAM-1) are followed up. RESULTS CSBP [115.56 ± 10.22 vs. 105.13 ± 9.88*], AIP [-0.04 ± 0.18 vs. -0.08 ± 0.08**] and sICAM-1 [362.5 ± 49.95 vs. 281.75 ± 80.39**] are significantly higher, and BMR [1431 ± 297.9 vs. 1674.6 ± 365.57*] is significantly lower in the physically inactive young healthy adults. CONCLUSIONS CSBP, AIP, and sICAM-1 are higher in young adults with reduced physical activity. This plays substantial role in the acceleration of atherogenic process and in long-term perspective could promote cardiovascular diseases.
Collapse
Affiliation(s)
- Mariana G Bacelova
- a Department of Physiology, Medical Faculty , Medical University , Plovdiv , Bulgaria
| | - Julia G Nikolova
- a Department of Physiology, Medical Faculty , Medical University , Plovdiv , Bulgaria
| | - Tania Deneva
- b Department of Clinical Laboratory, Medical Faculty , Medical University , Plovdiv , Bulgaria
| | - Petar F Nikolov
- c First Department of Internal Diseases, Section of Cardiology, Medical Faculty , Medical University , Plovdiv , Bulgaria
| |
Collapse
|
41
|
Auer J, Sharman JE, Weber T. J-curves in hypertension: what do they tell us about treatment of high blood pressure? Eur Heart J 2018; 39:3115-3118. [DOI: 10.1093/eurheartj/ehy337] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Johann Auer
- Department of Cardiology and Intensive Care, St Josef Hospital, Braunau, Austria
| | - James E Sharman
- Menzies Institute for Medical Research, University of Tasmania, Australia
| | - Thomas Weber
- Cardiology Department, Klinikum Wels-Grieskirchen, Wels, Austria
| |
Collapse
|
42
|
Murakami T. Enhanced Aortic Pressure Wave Reflection in Patients with Aortic Coarctation after Aortic Arch Repair. Pulse (Basel) 2018; 5:82-87. [PMID: 29761081 DOI: 10.1159/000478530] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2017] [Revised: 06/09/2017] [Indexed: 11/19/2022] Open
Abstract
Background In patients with aortic coarctation after successful aortic arch repair, it is well known that early-onset cardiovascular diseases can develop. Summary We studied the pressure waveform in patients after aortic arch repair focusing on a pressure wave reflection. In patients after aortic arch repair, the repaired portion generates a new reflected pressure wave. As a result, the newly generated pressure wave causes aortic pressure augmentation, loss of pressure amplification, and left ventricular hypertrophy with fibrosis. Balloon dilatation of the aortic arch may also generate a new pressure wave reflection. Key Messages In patients with aortic coarctation after aortic arch repair, the reconstructed site generates a new pressure wave reflection. This could be one of the causes of their future cardiovascular diseases.
Collapse
Affiliation(s)
- Tomoaki Murakami
- Department of Cardiology, Chiba Children's Hospital, Chiba, Japan
| |
Collapse
|
43
|
Early and late preeclampsia are characterized by high cardiac output, but in the presence of fetal growth restriction, cardiac output is low: insights from a prospective study. Am J Obstet Gynecol 2018; 218:517.e1-517.e12. [PMID: 29474844 DOI: 10.1016/j.ajog.2018.02.007] [Citation(s) in RCA: 74] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2017] [Revised: 01/30/2018] [Accepted: 02/08/2018] [Indexed: 11/22/2022]
Abstract
BACKGROUND Preeclampsia and fetal growth restriction are considered to be placentally mediated disorders. The clinical manifestations are widely held to relate to gestation age at onset with early- and late-onset preeclampsia considered to be phenotypically distinct. Recent studies have reported conflicting findings in relation to cardiovascular function, and in particular cardiac output, in preeclampsia and fetal growth restriction. OBJECTIVE We conducted this study to examine the possible relation between cardiac output and peripheral vascular resistance in preeclampsia and fetal growth restriction. STUDY DESIGN We investigated maternal cardiovascular function in relation to clinical subtype in 45 pathological pregnancies (14 preeclampsia only, 16 fetal growth restriction only, 15 preeclampsia and fetal growth restriction) and compared these with 107 healthy person observations. Cardiac output was the primary outcome measure and was assessed using an inert gas-rebreathing method (Innocor), from which peripheral vascular resistance was derived; arterial function was assessed by Vicorder, a cuff-based oscillometric device. Cardiovascular parameters were normalized for gestational age in relation to healthy pregnancies using Z scores, thus allowing for comparison across the gestational range of 24-40 weeks. RESULTS Compared with healthy control pregnancies, women with preeclampsia had higher cardiac output Z scores (1.87 ± 1.35; P = .0001) and lower peripheral vascular resistance Z scores (-0.76 ± 0.89; P = .025); those with fetal growth restriction had higher peripheral vascular resistance Z scores (0.57 ± 1.18; P = .04) and those with both preeclampsia and fetal growth restriction had lower cardiac output Z scores (-0.80 ± 1.3 P = .007) and higher peripheral vascular resistance Z scores (2.16 ± 1.96; P = .0001). These changes were not related to gestational age of onset. All those affected by preeclampsia and/or fetal growth restriction had abnormally raised augmentation index and pulse wave velocity. Furthermore, in preeclampsia, low cardiac output was associated with low birthweight and high cardiac output with high birthweight (r = 0.42, P = .03). CONCLUSION Preeclampsia is associated with high cardiac output, but if preeclampsia presents with fetal growth restriction, the opposite is true; both conditions are nevertheless defined by hypertension. Fetal growth restriction without preeclampsia is associated with high peripheral vascular resistance. Although early and late gestation preeclampsias are considered to be different diseases, we show that the hemodynamic characteristics of preeclampsia were unrelated to gestational age at onset but were strongly associated with the presence or absence of fetal growth restriction. Fetal growth restriction more commonly coexists with preeclampsia at early gestation, thus explaining the conflicting results of previous studies. Furthermore, antihypertensive agents act by reducing cardiac output or peripheral vascular resistance and are administered without reference to cardiovascular function in preeclampsia. The underlying pathology (preeclampsia, fetal growth restriction, preeclampsia and fetal growth restriction) defines cardiovascular phenotype, providing a rational basis for choice of therapy in which high or low cardiac output or peripheral vascular resistance is the predominant feature.
Collapse
|
44
|
Broufa M, Wassertheurer S, Hametner B, Zweiker R, Binder RK, Weber T. Pulsatile Hemodynamics Are Associated With Exercise Capacity in Patients With Exertional Dyspnea and Preserved Left Ventricular Ejection Fraction. Am J Hypertens 2018; 31:574-581. [PMID: 29324983 DOI: 10.1093/ajh/hpy001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2017] [Accepted: 01/07/2018] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Pulsatile hemodynamics are associated with left ventricular filling pressures and diastolic dysfunction. We investigated their relationship with maximum workload and peak oxygen uptake (peak VO2) in patients with exertional dyspnea and preserved left ventricular ejection fraction (LVEF). METHODS Radial waveforms from tonometry were processed with a transfer function, pulse wave analysis and wave separation analysis, yielding central aortic pressures and measures of forward (amplitude of forward wave-Pf) and reflected waves (augmentation index-AIx, augmentation pressure-AP, amplitude of backward wave-Pb) and their ratio (reflection magnitude). Aortic pulse wave velocity (aoPWV) was estimated with a validated formula from single-point waveforms. Ergospirometry for assessment of exercise capacity was performed on a bicycle ergometer, using a ramp protocol. RESULTS Sixty-six patients were included (43 females; mean age 66 years; 83% hypertensives; mean body mass index 28.3 kg/m2). Mean peak VO2 was 17.0 ml/min/kg, mean achieved maximum workload 104.5 watts (80.9% of a reference population). Maximum workload and peak VO2 showed significant inverse relationships with AIx, AP, Pb, and aoPWV (r = -0.26 to -0.57). In multiple adjusted regression models, brachial and aortic pulse pressure, AP, Pf, Pb, and aoPWV were significant independent predictors of maximum workload, whereas AP, AIx75, Pf, Pb, and aoPWV were independently related to peak VO2. CONCLUSIONS Pulsatile hemodynamics are independently associated with objective measures of exercise capacity in patients with normal LVEF.
Collapse
Affiliation(s)
- Maria Broufa
- Cardiology Department, University Teaching Hospital, Klinikum Wels-Grieskirchen, Austria
| | - Siegfried Wassertheurer
- Biomedical systems, Center for Health and Bioresources, AIT – Austrian Institute of Technology, Vienna, Austria
| | - Bernhard Hametner
- Biomedical systems, Center for Health and Bioresources, AIT – Austrian Institute of Technology, Vienna, Austria
| | - Robert Zweiker
- Department of Cardiology, Medical University of Graz, Graz, Austria
| | - Ronald K Binder
- Cardiology Department, University Teaching Hospital, Klinikum Wels-Grieskirchen, Austria
| | - Thomas Weber
- Cardiology Department, University Teaching Hospital, Klinikum Wels-Grieskirchen, Austria
| |
Collapse
|
45
|
Central diastolic pressure decay mediates the relationship between aortic stiffness and myocardial viability: potential implications for aortosclerosis-induced myocardial ischemia. J Hypertens 2018; 35:2034-2043. [PMID: 28614093 DOI: 10.1097/hjh.0000000000001436] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Stiffening of the aorta often precedes coronary events, but little is known about the aetiological mechanism. We hypothesized that the predisposition to myocardial ischemia could be attributable to aortosclerosis-induced alterations in the central haemodynamics during diastole. METHODS Using noninvasive tonometry and ultrasonography, we investigated the arterial pressure pulse waveforms, pulse wave velocities (PWVs) and compliance in 222 patients with hypertension. The diastolic pressure decay was quantified by fitting a mono-exponential curve as P(t) = P0e [λ: decay index; P0: end-systolic pressure; t: time from end-systole]. The myocardial oxygen supply/demand balance was estimated from the subendocardial viability index (SVI). RESULTS The aortic pressure decay fit to an exponential curve significantly (R = 0.98 ± 0.02) and more closely than the radial pressure decay (P < 0.001). The aortic decay index (median, 0.59 s) was associated with the aortic PWV and compliance (but not with the peripheral PWV or resistance), even after controlling for age, sex, renal function, diabetes and hypercholesterolemia (P < 0.001). Also, both the aortic PWV and compliance (together with the augmentation index) were related to the SVI, although these relationships were no longer significant after accounting for the decay index. Mediation analysis revealed substantial mediating effects of the decay index on the relationship between aortic PWV or compliance and SVI (75-100%), despite the lack of similar effects of the augmentation index. CONCLUSION Aortic stiffening with reduced compliance potentially impairs myocardial viability by accelerating the diastolic exponential decay (rather than through enhancing late-systolic augmentation) of the central blood pressure, thus predisposing hypertensive patients to ischemic heart disease.
Collapse
|
46
|
Echeverri D, Pizano A, Cabrales J, Moreno K. Validation of Central and Peripheral Non-Invasive Hemodynamic Variables Using an Oscillometric Method. High Blood Press Cardiovasc Prev 2017; 25:65-77. [PMID: 29081017 DOI: 10.1007/s40292-017-0238-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2017] [Accepted: 10/21/2017] [Indexed: 01/28/2023] Open
Abstract
INTRODUCTION Peripheral and central blood pressures are parameters of arterial stiffness and important cardiovascular risk markers. Today, there are non-invasive methods that measure these pressures. AIM To validate the non-invasive oscillometric method, compared with invasive pressure measurements obtained by cardiac catheterization. METHODS An open, prospective cohort clinical study in 100 patients, 64 ± 11 years old. The measurement of peripheral and central blood pressures obtained using the Arteriograph® system oscillometric method, (TensioMed, Budapest-Hungary, Ltd.) was validated in an adult population undergoing simultaneous, contralateral left cardiac catheterization (gold standard) using the radial technique, evaluating the correlation and agreement between the two methods. This study fulfils the latest standardized protocol for central blood pressure validation published by ARTERY Society. RESULTS The pressures obtained with the Arteriograph® show a high correlation with the pressures measured using the gold standard. Overall, the intraclass correlation coefficient for brachial pressures was 0.80 (p < 0.001), and 0.91 (p < 0.001) for central pressures. The good agreement between the two methods was demonstrated equally by the Bland-Altman method and independent linear regressions for each variable. CONCLUSIONS The oscillometric noninvasive method employed is easy to use and valid for estimating hemodynamic variables such as central and peripheral arterial pressure, having good agreement and conformity with the gold standard in a different type of patients and conditions. This technique can help optimize cardiovascular assessment in primary and secondary prevention, enhance treatment in selected patients and it could be an important element for future cardiovascular prevention.
Collapse
Affiliation(s)
- Darío Echeverri
- Vascular Function Research Laboratory, Interventional Cardiology Department, Fundación CardioInfantil-Instituto de Cardiología, Calle 163 A número 13B-60, Torre H. 3 Piso, Bogotá, Colombia
| | - Alejandro Pizano
- Vascular Function Research Laboratory, Interventional Cardiology Department, Fundación CardioInfantil-Instituto de Cardiología, Calle 163 A número 13B-60, Torre H. 3 Piso, Bogotá, Colombia.
| | - Jaime Cabrales
- Vascular Function Research Laboratory, Interventional Cardiology Department, Fundación CardioInfantil-Instituto de Cardiología, Calle 163 A número 13B-60, Torre H. 3 Piso, Bogotá, Colombia
| | - Karen Moreno
- Research Department, Fundación CardioInfantil-Instituto de Cardiología, Bogotá, Colombia
| |
Collapse
|
47
|
Foo FL, McEniery CM, Lees C, Khalil A. Assessment of arterial function in pregnancy: recommendations of the International Working Group on Maternal Hemodynamics. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2017; 50:324-331. [PMID: 28667668 DOI: 10.1002/uog.17565] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/10/2017] [Revised: 05/29/2017] [Accepted: 06/08/2017] [Indexed: 06/07/2023]
Abstract
There is strong evidence supporting the role of maternal arterial dysfunction in pregnancy-specific disorders such as pre-eclampsia and intrauterine growth restriction. As more work is focused towards this field, it is important that methods and interpretation of arterial function assessment are applied appropriately. Here, we summarize techniques and devices commonly used in maternal health studies, with consideration of their technical application in pregnant cohorts. Copyright © 2017 ISUOG. Published by John Wiley & Sons Ltd.
Collapse
Affiliation(s)
- F L Foo
- Division of Cancer & Surgery, Imperial College London, Institute for Reproductive & Developmental Biology, London, UK
| | - C M McEniery
- Division of Experimental Medicine & Immunotherapeutics, University of Cambridge, ACCI, Addenbrookes Hospital, Cambridge, UK
| | - C Lees
- Division of Cancer & Surgery, Imperial College London, Institute for Reproductive & Developmental Biology, London, UK
| | - A Khalil
- St George's, University of London & St George's University Hospitals NHS Foundation Trust, Molecular and Clinical Sciences Research Institute, London, UK
| |
Collapse
|
48
|
Evaluation of local carotid stiffness and inflammatory biomarkers in stable angina pectoris. ADVANCES IN INTERVENTIONAL CARDIOLOGY 2017; 13:122-129. [PMID: 28798782 PMCID: PMC5545659 DOI: 10.5114/pwki.2017.68046] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2016] [Accepted: 02/07/2017] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Arterial stiffness (AS) is a well-accepted and reliable predictor of atherosclerotic diseases. Inflammation plays an important role in the development of AS. AIM To evaluate local carotid stiffness (CS) together with fibrinogen and high-sensitivity C-reactive protein (hsCRP) levels in stable angina pectoris (SAP) patients. MATERIAL AND METHODS The study consisted of 353 consecutive patients with SAP. All underwent coronary angiography (CAG) after the evaluation of local CS parameters and carotid intima-media thickness (IMT) from both common carotid arteries by a real-time echo-tracking system. Baseline inflammatory biomarkers, serum hsCRP and fibrinogen levels were measured. Based on CAG findings, the patients were classified into 4 groups: control subjects with normal coronary arteries (group 1, n = 86), single-vessel disease (group 2, n = 104), double-vessel disease (group 3, n = 95) and triple-vessel disease (group 4, n = 68). RESULTS The mean carotid pulse wave velocity (PWV) in patients with angiographically confirmed coronary artery disease (CAD) was significantly higher than that in patients with normal coronary arteries (7.82 ±1.76 vs. 6.51 ±0.85 cm/s, p = 0.001). The mean carotid IMT was detected to be significantly higher in group 4 patients compared to those in group 1 (p < 0.001) and group 2 (p = 0.001). Significant correlations were observed between both inflammatory biomarkers and the number of diseased vessels and carotid PWV. Using multi-variate analysis, carotid stiffness, carotid IMT, hsCRP and fibrinogen were independently associated with the presence and extent of CAD. CONCLUSIONS Local CS, carotid IMT, hsCRP and fibrinogen levels are significant predictors of atherosclerotic burden and they may facilitate the identification of high-risk patients for the early diagnosis and prompt treatment of CAD.
Collapse
|
49
|
Cervi E, Nodari F, Botteri E, Mazzeo G, Stefano B. Appearance and rapid evolution of thoraco-abdominal intramural hematoma after TEVAR. JRSM Cardiovasc Dis 2017; 6:2048004017710884. [PMID: 28616205 PMCID: PMC5461912 DOI: 10.1177/2048004017710884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2017] [Revised: 04/23/2017] [Accepted: 04/25/2017] [Indexed: 12/02/2022] Open
Abstract
Some studies consider the different physical properties of the stent graft when compared with the blood vessel on the basis of vascular lesions that may require further intervention. We present a case in which a patient developed an intramural hematoma at the distal landing of previous thoracic endovascular aortic repair (TEVAR) that required the relining with a flared prosthesis. During follow-up, we observed the appearance of more caudal hematoma. We decided to observe this lesion with close radiological controls. In order to prevent serious complication after the induction of TEVAR, accurate planning of the procedure is very important to study the impact of the prosthesis implanted in the cardiovascular system. In particular, oversize, radial forces and length of coverage have been taken into account. The adherence to follow-up is very important to precociously detect the lesions to avoid the onset of complication.
Collapse
Affiliation(s)
- Edoardo Cervi
- Vascular Surgery, Department of Clinical and Experimental Sciences, University of Brescia, Spedali Civili Hospital, Brescia, Italy
| | - Franco Nodari
- Vascular Surgery, Department of Clinical and Experimental Sciences, University of Brescia, Spedali Civili Hospital, Brescia, Italy
| | - Emanuele Botteri
- Vascular Surgery, Department of Clinical and Experimental Sciences, University of Brescia, Spedali Civili Hospital, Brescia, Italy
| | - Girolomina Mazzeo
- Vascular Surgery, Department of Clinical and Experimental Sciences, University of Brescia, Spedali Civili Hospital, Brescia, Italy
| | - Bonardelli Stefano
- Vascular Surgery, Department of Clinical and Experimental Sciences, University of Brescia, Spedali Civili Hospital, Brescia, Italy
| |
Collapse
|
50
|
Kiuchi MG, Chen S, Rodrigues Paz LM, Pürerfellner H. Renal sympathetic denervation guided by renal nerve stimulation to treat ventricular arrhythmia in CKD patients with ICD. Oncotarget 2017; 8:37296-37307. [PMID: 28415795 PMCID: PMC5513716 DOI: 10.18632/oncotarget.16278] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2017] [Accepted: 03/01/2017] [Indexed: 02/07/2023] Open
Abstract
Chronic kidney disease (CKD) patients on stage 4 present greater risk rates for malignant ventricular arrhythmia events. This study examined patients with CKD in stages 1, 2, 3 and 4, left ventricular dysfunction and automatic implantable cardioverter-defibrillator (ICD). Our goal was to record the appropriate therapies, "Anti-tachycardia Therapy Pacing" (ATP) and shock events during the 18 months of follow-up and compare the incidence and severity of these at different stages of CKD, mainly in patients with CKD stage 4 underwent renal sympathetic denervation (RSD) guided by renal nerve stimulation (RNS). One hundred and fifteen patients were evaluated once every three months till 18 months of follow-up. The arrhythmic events were assessed at each follow-up visit. Comparing the groups, we can see the number of ATP and shock events recorded by ICD during 18 months of follow-up, and differences in the number of therapeutic events between the various stages of CKD. The hazard ratio (HR), 95% confidence interval (CI) and P value for ATP and shock events between all the CKD stages were evaluated by the log-rank/Mantel-Haenszel test. At the 18th month of follow-up, 75% of patients with CKD stage 4 received ATP, and 70% were treated with shock while only 20% of the subjects with CKD stage 4 that were submitted to RSD received ATP and 20% were treated with shock, P<0.0001 and P=0.0002, respectively. In our study, a decline occurred in the incidence of arrhythmias, and therefore, appropriate ICD therapies in advanced stages of CKD, reducing the risk rates for these events in patients with CKD on stage 4 after RSD guided by RNS in comparison to the other CKD stages. Our results suggest that RSD can control the higher incidence of malignant arrhythmias in advanced CKD stages.
Collapse
Affiliation(s)
- Márcio Galindo Kiuchi
- Department of Medicine, Division of Artificial Cardiac Stimulation, Hospital e Clínica São Gonçalo, São Gonçalo, Rio de Janeiro, Brazil
- Department of Cardiology, Elisabethinen University Teaching Hospital Linz, Linz, Austria
| | - Shaojie Chen
- Department of Cardiology, Shanghai First People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Department of Cardiology, Elisabethinen University Teaching Hospital Linz, Linz, Austria
| | - Luis Marcelo Rodrigues Paz
- Department of Medicine, Division of Artificial Cardiac Stimulation, Hospital e Clínica São Gonçalo, São Gonçalo, Rio de Janeiro, Brazil
| | - Helmut Pürerfellner
- Department of Cardiology, Elisabethinen University Teaching Hospital Linz, Linz, Austria
| |
Collapse
|