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Vosgin-Dinclaux V, Bertucat P, Dari L, Webster C, Foussard N, Mohammedi K, Ducasse E, Caradu C. Predictors of major adverse lower limb events in patients with tissue loss secondary to critical limb-threatening ischemia. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2024; 64:34-41. [PMID: 38350775 DOI: 10.1016/j.carrev.2024.01.018] [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: 10/18/2023] [Revised: 01/28/2024] [Accepted: 01/29/2024] [Indexed: 02/15/2024]
Abstract
BACKGROUND Chronic limb-threatening ischemia (CLTI) is the end-stage of peripheral arterial disease (PAD) posing a high risk for limb loss and mortality. This study aims to evaluate and list possible predictors of major adverse limb events (MALEs) in CLTI patients with tissue loss. METHODS This retrospective study included all Rutherford-Becker stage 5 or 6 patients who required foot debridement and revascularization in our department from January 2016 to December 2018. The limbs were classified according to the TASC II, GLASS and WiFI grading systems. The primary composite outcome was MALEs at 2 years. The secondary outcomes included all-cause mortality, primary patency, freedom from reintervention, and major amputation. Kaplan-Meier estimates were used to determine the event rates, and Cox proportional hazards model with the index MALE as a time-dependent covariate was used to search for MALEs predictors. RESULTS Of 241 included patients, 19 underwent open surgeries (7.9 %) 207 had endovascular interventions (85.9 %) and 15 required a hybrid approach (6.2 %). On univariate analysis, patients who experienced MALEs (n = 111) more often required hemodialysis (25 vs 15; p = .02), presented with more complex lesions (TASC D on femoropopliteal (p = .05) or below the knee (BTK) arteries (p = .006) with increasing infra-inguinal GLASS Stage (p < .0001)), a history of index limb open (p = .009) or endovascular (p = .049) revascularization, an occluded tibial artery (p = .002 for the posterior tibial and p = .052 for the anterior tibial), or a "desert foot" (p = .02). The CRP level was also higher at admission (p = .001). Technical success of BTK revascularization significantly reduced MALEs (p < .0001) along with the number of patent BTK vessels (p = .0007). Independent predictors of MALEs included hemodialysis (HR = 2.00; 95%CI: 1.14 to 3.39), pulsatile arterial pressure (HR = 1.01; 95%CI: 1.00 to 1.03) and the infra-inguinal GLASS Stage (HR = 2.50; 95%CI: 1.17 to 5.82). We could not correlate our results with the WiFI scores for amputation risk and revascularization benefit. CONCLUSION For patients with CLTI at the stage of trophic disorders, with or without a history of index limb revascularization, the GLASS successfully predicted MALEs. Hemodialysis and high pulsatile arterial pressure increased the risk of MALEs. The WiFI score did not demonstrate its interest in this subgroup of patients.
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Affiliation(s)
| | - Paul Bertucat
- Bordeaux University Hospital, Department of Vascular Surgery, Bordeaux, France
| | - Loubna Dari
- Bordeaux University Hospital, Hôpital Saint-André, Vascular Medicine Department, Bordeaux, France
| | - Claire Webster
- Imperial College London, Department of Vascular Surgery, London, UK
| | - Ninon Foussard
- Bordeaux University Hospital, Hôpital Haut-Lévêque, Department of Endocrinology, Diabetes and Nutrition, Pessac, France
| | - Kamel Mohammedi
- Bordeaux University Hospital, Hôpital Haut-Lévêque, Department of Endocrinology, Diabetes and Nutrition, Pessac, France
| | - Eric Ducasse
- Bordeaux University Hospital, Department of Vascular Surgery, Bordeaux, France
| | - Caroline Caradu
- Bordeaux University Hospital, Department of Vascular Surgery, Bordeaux, France.
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Ti F, Yu C, Li M, Liu S, Lu TJ, Chen X. Cross-scale mechanobiological regulation of cylindrical compressible liquid inclusion via coating. JOURNAL OF PHYSICS. CONDENSED MATTER : AN INSTITUTE OF PHYSICS JOURNAL 2024; 36:395101. [PMID: 38906135 DOI: 10.1088/1361-648x/ad5ace] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Accepted: 06/21/2024] [Indexed: 06/23/2024]
Abstract
The double-bag theory in modern anatomy suggests that structures with coatings are commonly found in human body at various length scales, such as osteocyte processes covered by pericellular matrix and bones covered by muscle tissue. To understand the mechanical behaviors and physiological responses of such biological structures, we develop an analytical model to quantify surface effects on the deformation of a coated cylindrical compressible liquid inclusion in an elastic matrix subjected to remote loading. Our analytical solution reveals that coating can either amplify or attenuate the volumetric strain of the inclusion, depending on the relative elastic moduli of inclusion, coating, and matrix. For illustration, we utilize this solution to explore amplification/attenuation of volumetric strain in musculoskeletal systems, nerve cells, and vascular tissues. We demonstrate that coating often plays a crucial role in mechanical regulation of the development and repair of human tissues and cells. Our model provides qualitative analysis of cross-scale mechanical response of coated liquid inclusions, helpful for constructing mechanical microenvironment of cells.
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Affiliation(s)
- Fei Ti
- State Key Laboratory of Mechanics and Control for Aerospace Structures, Nanjing University of Aeronautics and Astronautics, Nanjing 210016, People's Republic of China
- MIIT Key Laboratory of Multifunctional Lightweight Materials and Structures, Nanjing University of Aeronautics and Astronautics, Nanjing 210016, People's Republic of China
| | - Chenlei Yu
- State Key Laboratory for Strength and Vibration of Mechanical Structures, Xi'an Jiaotong University, Xi'an 710049, People's Republic of China
| | - Moxiao Li
- State Key Laboratory of Mechanics and Control for Aerospace Structures, Nanjing University of Aeronautics and Astronautics, Nanjing 210016, People's Republic of China
- MIIT Key Laboratory of Multifunctional Lightweight Materials and Structures, Nanjing University of Aeronautics and Astronautics, Nanjing 210016, People's Republic of China
| | - Shaobao Liu
- State Key Laboratory of Mechanics and Control for Aerospace Structures, Nanjing University of Aeronautics and Astronautics, Nanjing 210016, People's Republic of China
- MIIT Key Laboratory of Multifunctional Lightweight Materials and Structures, Nanjing University of Aeronautics and Astronautics, Nanjing 210016, People's Republic of China
| | - Tian Jian Lu
- State Key Laboratory of Mechanics and Control for Aerospace Structures, Nanjing University of Aeronautics and Astronautics, Nanjing 210016, People's Republic of China
- MIIT Key Laboratory of Multifunctional Lightweight Materials and Structures, Nanjing University of Aeronautics and Astronautics, Nanjing 210016, People's Republic of China
| | - Xin Chen
- Xi'an Modern Chemistry Research Institute, Xi'an 710065, People's Republic of China
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Yano Y, Suematsu Y, Matsuda T, Tsukahara K, Shirosaki M, Matsuo S, Fujimi K, Miura SI. Usefulness of the cardiopulmonary exercise test up to the anaerobic threshold for pati-ents aged ≥ 80 years with cardiovascular disease on cardiac rehabilitation. J Rehabil Med 2024; 56:jrm19453. [PMID: 38898677 PMCID: PMC11210489 DOI: 10.2340/jrm.v56.19453] [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: 09/15/2023] [Accepted: 05/27/2024] [Indexed: 06/21/2024] Open
Abstract
OBJECTIVE A cardiopulmonary exercise test provides information regarding appropriate exercise intensity, but there have been few reports on its use in patients over 80 years of age. DESIGN Retrospective observational study. PATIENTS A total of 511 cardiovascular disease patients who performed a cardiopulmonary exercise test from February 2011 to January 2020 were investigated. METHODS Patients were stratified according to age: < 70 years, 70-79 years, and ≥ 80 years, and the results of the cardiopulmonary exercise test up to anaerobic threshold were compared. RESULTS Patients in the < 70 age bracket showed higher oxygen consumption, carbon dioxide output, and ventilatory volume and lower ventilation equivalents per oxygen consumption and carbon dioxide output in all time periods. However, there were no significant differences in these parameters or the work rate (70-79 years of age: 41.4 ± 11.7 watts, vs ≥ 80 years: 42.2 ± 10.9 watts, p = 0.95) or oxygen consumption per body weight at anaerobic threshold (12.2 ± 0.2 ml/min/kg, vs 12.1 ± 0.4 ml/min/kg, p = 0.97) between the 70-79 year age bracket and the ≥ 80 year age bracket. CONCLUSION Even for cardiovascular disease patients age ≥ 80 years, a cardiopulmonary exercise test up to anaerobic threshold can supply useful information for guiding cardiac rehabilitation.
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Affiliation(s)
- Yuiko Yano
- Department of Cardiology, Fukuoka University Hospital, Fukuoka, Japan; Miyase Clinic, Fukuoka, Japan (Present affiliation)
| | - Yasunori Suematsu
- Department of Cardiology, Fukuoka University Hospital, Fukuoka, Japan
| | - Takuro Matsuda
- Department of Rehabilitation, Fukuoka University Hospital, Fukuoka, Japan
| | - Kai Tsukahara
- Department of Cardiology, Fukuoka University Hospital, Fukuoka, Japan; Hinoki Clinic, Fukuoka, Japan (Present affiliation)
| | - Miki Shirosaki
- Department of Rehabilitation, Fukuoka University Hospital, Fukuoka, Japan
| | - Sakiko Matsuo
- Department of Nutrition, Fukuoka University Hospital, Fukuoka, Japan
| | - Kanta Fujimi
- Department of Cardiology, Fukuoka University Hospital, Fukuoka, Japan; Department of Rehabilitation, Fukuoka University Hospital, Fukuoka, Japan
| | - Shin-Ichiro Miura
- Department of Cardiology, School of Medicine, Fukuoka University, Fukuoka, Japan; Department of Cardiology, Fukuoka University Nishijin Hospital, Fukuoka, Japan.
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Chandra Sekar N, Khoshmanesh K, Baratchi S. Bioengineered models of cardiovascular diseases. Atherosclerosis 2024; 393:117565. [PMID: 38714426 DOI: 10.1016/j.atherosclerosis.2024.117565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2023] [Revised: 04/15/2024] [Accepted: 04/25/2024] [Indexed: 05/09/2024]
Abstract
Age-associated cardiovascular diseases (CVDs), predominantly resulting from artery-related disorders such as atherosclerosis, stand as a leading cause of morbidity and mortality among the elderly population. Consequently, there is a growing interest in the development of clinically relevant bioengineered models of CVDs. Recent developments in bioengineering and material sciences have paved the way for the creation of intricate models that closely mimic the structure and surroundings of native cardiac tissues and blood vessels. These models can be utilized for basic research purposes and for identifying pharmaceutical interventions and facilitating drug discovery. The advancement of vessel-on-a-chip technologies and the development of bioengineered and humanized in vitro models of the cardiovascular system have the potential to revolutionize CVD disease modelling. These technologies offer pathophysiologically relevant models at a fraction of the cost and time required for traditional experimentation required in vivo. This progress signifies a significant advancement in the field, transitioning from conventional 2D cell culture models to advanced 3D organoid and vessel-on-a-chip models. These innovative models are specifically designed to explore the complexities of vascular aging and stiffening, crucial factors in the development of cardiovascular diseases. This review summarizes the recent progress of various bioengineered in vitro platforms developed for investigating the pathophysiology of human cardiovascular system with more focus on advanced 3D vascular platforms.
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Affiliation(s)
- Nadia Chandra Sekar
- School of Health & Biomedical Sciences, RMIT University, Bundoora, Victoria, 3082, Australia; Baker Heart and Diabetes Institute, Melbourne, Victoria, 3004, Australia
| | - Khashayar Khoshmanesh
- Baker Heart and Diabetes Institute, Melbourne, Victoria, 3004, Australia; School of Engineering, RMIT University, Melbourne, Victoria, 3000, Australia
| | - Sara Baratchi
- School of Health & Biomedical Sciences, RMIT University, Bundoora, Victoria, 3082, Australia; Baker Heart and Diabetes Institute, Melbourne, Victoria, 3004, Australia; Department of Cardiometabolic Health, The University of Melbourne, Parkville, Victoria, 3010, Australia.
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Frișan AC, Mornoș C, Lazăr MA, Șoșdean R, Crișan S, Ionac I, Luca CT. Echocardiographic Myocardial Work: A Novel Method to Assess Left Ventricular Function in Patients with Coronary Artery Disease and Diabetes Mellitus. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:199. [PMID: 38399487 PMCID: PMC10890444 DOI: 10.3390/medicina60020199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Revised: 01/17/2024] [Accepted: 01/22/2024] [Indexed: 02/25/2024]
Abstract
Myocardial ischemia caused by coronary artery disease (CAD) and the presence of metabolic abnormalities and microvascular impairments detected in patients with diabetes mellitus (DM) are a common cause of left ventricular (LV) dysfunction. Transthoracic echocardiography is the most-used, non-invasive imaging method for the assessment of myocardial contractility. The accurate evaluation of LV function is crucial for identifying patients who are at high risk or may have worse outcomes. Myocardial work (MW) is emerging as an alternative tool for the evaluation of LV systolic function, providing additional information on cardiac performance when compared to conventional parameters such as left ventricular ejection fraction (LVEF) and global longitudinal strain (GLS) because it incorporates deformation and load into its analysis. The potential of MW in various conditions is promising and it has gained increased attention. However, larger studies are necessary to further investigate its role and application before giving an answer to the question of whether it can have widespread implementation into clinical practice. The aim of this review is to summarize the actual knowledge of MW for the analysis of LV dysfunction caused by myocardial ischemia and hyperglycemia.
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Affiliation(s)
- Alexandra-Cătălina Frișan
- Cardiology Department, “Victor Babes” University of Medicine and Pharmacy, 2 Eftimie Murgu Sq., 300041 Timisoara, Romania; (A.-C.F.); (R.Ș.); (S.C.); (I.I.); (C.-T.L.)
- Institute of Cardiovascular Diseases Timisoara, 13A Gheorghe Adam Street, 300310 Timisoara, Romania
| | - Cristian Mornoș
- Cardiology Department, “Victor Babes” University of Medicine and Pharmacy, 2 Eftimie Murgu Sq., 300041 Timisoara, Romania; (A.-C.F.); (R.Ș.); (S.C.); (I.I.); (C.-T.L.)
- Institute of Cardiovascular Diseases Timisoara, 13A Gheorghe Adam Street, 300310 Timisoara, Romania
- Research Center of the Institute of Cardiovascular Diseases Timisoara, 13A Gheorghe Adam Street, 300310 Timisoara, Romania
| | - Mihai-Andrei Lazăr
- Cardiology Department, “Victor Babes” University of Medicine and Pharmacy, 2 Eftimie Murgu Sq., 300041 Timisoara, Romania; (A.-C.F.); (R.Ș.); (S.C.); (I.I.); (C.-T.L.)
- Institute of Cardiovascular Diseases Timisoara, 13A Gheorghe Adam Street, 300310 Timisoara, Romania
- Research Center of the Institute of Cardiovascular Diseases Timisoara, 13A Gheorghe Adam Street, 300310 Timisoara, Romania
| | - Raluca Șoșdean
- Cardiology Department, “Victor Babes” University of Medicine and Pharmacy, 2 Eftimie Murgu Sq., 300041 Timisoara, Romania; (A.-C.F.); (R.Ș.); (S.C.); (I.I.); (C.-T.L.)
- Institute of Cardiovascular Diseases Timisoara, 13A Gheorghe Adam Street, 300310 Timisoara, Romania
- Research Center of the Institute of Cardiovascular Diseases Timisoara, 13A Gheorghe Adam Street, 300310 Timisoara, Romania
| | - Simina Crișan
- Cardiology Department, “Victor Babes” University of Medicine and Pharmacy, 2 Eftimie Murgu Sq., 300041 Timisoara, Romania; (A.-C.F.); (R.Ș.); (S.C.); (I.I.); (C.-T.L.)
- Institute of Cardiovascular Diseases Timisoara, 13A Gheorghe Adam Street, 300310 Timisoara, Romania
- Research Center of the Institute of Cardiovascular Diseases Timisoara, 13A Gheorghe Adam Street, 300310 Timisoara, Romania
| | - Ioana Ionac
- Cardiology Department, “Victor Babes” University of Medicine and Pharmacy, 2 Eftimie Murgu Sq., 300041 Timisoara, Romania; (A.-C.F.); (R.Ș.); (S.C.); (I.I.); (C.-T.L.)
- Institute of Cardiovascular Diseases Timisoara, 13A Gheorghe Adam Street, 300310 Timisoara, Romania
| | - Constantin-Tudor Luca
- Cardiology Department, “Victor Babes” University of Medicine and Pharmacy, 2 Eftimie Murgu Sq., 300041 Timisoara, Romania; (A.-C.F.); (R.Ș.); (S.C.); (I.I.); (C.-T.L.)
- Institute of Cardiovascular Diseases Timisoara, 13A Gheorghe Adam Street, 300310 Timisoara, Romania
- Research Center of the Institute of Cardiovascular Diseases Timisoara, 13A Gheorghe Adam Street, 300310 Timisoara, Romania
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Climie RE, Alastruey J, Mayer CC, Schwarz A, Laucyte-Cibulskiene A, Voicehovska J, Bianchini E, Bruno RM, Charlton PH, Grillo A, Guala A, Hallab M, Hametner B, Jankowski P, Königstein K, Lebedeva A, Mozos I, Pucci G, Puzantian H, Terentes-Printzios D, Yetik-Anacak G, Park C, Nilsson PM, Weber T. Vascular ageing: moving from bench towards bedside. Eur J Prev Cardiol 2023; 30:1101-1117. [PMID: 36738307 PMCID: PMC7614971 DOI: 10.1093/eurjpc/zwad028] [Citation(s) in RCA: 23] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Revised: 12/20/2022] [Accepted: 01/12/2023] [Indexed: 02/05/2023]
Abstract
Prevention of cardiovascular disease (CVD) remains one of the largest public health challenges of our time. Identifying individuals at increased cardiovascular risk at an asymptomatic, sub-clinical stage is of paramount importance for minimizing disease progression as well as the substantial health and economic burden associated with overt CVD. Vascular ageing (VA) involves the deterioration in vascular structure and function over time and ultimately leads to damage in the heart, brain, kidney, and other organs. Vascular ageing encompasses the cumulative effect of all cardiovascular risk factors on the arterial wall over the life course and thus may help identify those at elevated cardiovascular risk, early in disease development. Although the concept of VA is gaining interest clinically, it is seldom measured in routine clinical practice due to lack of consensus on how to characterize VA as physiological vs. pathological and various practical issues. In this state-of-the-art review and as a network of scientists, clinicians, engineers, and industry partners with expertise in VA, we address six questions related to VA in an attempt to increase knowledge among the broader medical community and move the routine measurement of VA a little closer from bench towards bedside.
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Affiliation(s)
- Rachel E. Climie
- Menzies Institute for Medical Research, University of Tasmania, 17 Liverpool St, 7000 Hobart, Australia
- Sports Cardiology, Baker Heart and Diabetes Institute, 99 Commercial Rd, Melbourne 3000, Australia
- Integrative Epidemiology of Cardiovascular Disease, Université de Paris, INSERM, U970, Paris Cardiovascular Research Center (PARCC), 56 rue Leblanc, 75015 Paris, France
| | - Jordi Alastruey
- Department of Biomedical Engineering, School of Biomedical Engineering and Imaging Sciences, King’s College London, 249 Westminster Bridge Rd, London SE1 7EH, UK
| | - Christopher C. Mayer
- Medical Signal Analysis, Center for Health & Bioresources, AIT Austrian Institute of Technology, Giefinggasse 4, 1210 Vienna, Austria
| | - Achim Schwarz
- ALF Distribution GmbH, Stephanstrasse 19, 52064 Aachen, Germany
| | - Agne Laucyte-Cibulskiene
- Department of Clinical Sciences, Lund University, Skane University Hospital, Sölvegatan 19 - BMC F12, 221 84 Lund, Malmö, Sweden
- Faculty of Medicine, Vilnius University, M. K. C iurlionio g. 21, 03101 Vilnius, Lithuania
| | - Julija Voicehovska
- Department of Internal Diseases, Riga Stradins University, Dzirciema str. 16, Riga, L-1007, Latvia
- Nephrology and Renal Replacement Therapy Clinics, Riga East University Hospital, Hipokrata str. 2, Riga, LV-1079, Latvia
| | - Elisabetta Bianchini
- Institute of Clinical Physiology, Italian National Research Council (CNR), Via Moruzzi, 1, 56124 Pisa (PI), Italy
| | - Rosa-Maria Bruno
- Integrative Epidemiology of Cardiovascular Disease, Université de Paris, INSERM, U970, Paris Cardiovascular Research Center (PARCC), 56 rue Leblanc, 75015 Paris, France
| | - Peter H. Charlton
- Department of Public Health and Primary Care, University of Cambridge, Strangeways Research Laboratory, 2 Worts Causeway, Cambridge CB1 8RN, UK
| | - Andrea Grillo
- Medicina Clinica, Department of Medicine, Surgery and Health Sciences, University of Trieste, Strada di Fiume 447, 34149 Trieste, Italy
| | - Andrea Guala
- Vall d’Hebron Institut de Recerca (VHIR), Paseo de la Vall d’Hebron, 129, 08035 Barcelona, Spain
| | - Magid Hallab
- Clinique Bizet, 23 Georges Bizet, 75116 Paris, France
| | - Bernhard Hametner
- Medical Signal Analysis, Center for Health & Bioresources, AIT Austrian Institute of Technology, Giefinggasse 4, 1210 Vienna, Austria
| | - Piotr Jankowski
- Department of Internal Medicine and Geriatric Cardiology, Centre of Postgraduate Medical Education, 231 Czerniakowska St., 00-416 Warsaw, Poland
| | - Karsten Königstein
- Department of Sport, Exercise and Health (DSBG) University of Basel, Grosse Allee 6, 4052 Basel, Switzerland
| | - Anna Lebedeva
- Department of Internal Medicine and Cardiology, Dresden Heart Centre, Dresden University of Technology, Fetscher str. 76, 01307 Dresden, Germany
| | - Ioana Mozos
- Department of Functional Sciences-Pathophysiology, Center for Translational Research and Systems Medicine, ‘Victor Babes’ University of Medicine and Pharmacy, T. Vladimirescu Street 14, 300173 Timisoara, Romania
| | - Giacomo Pucci
- Unit of Internal Medicine, Terni University Hospital - Department of Medicine and Surgery, University of Perugia, Terni, Italy
| | - Houry Puzantian
- Hariri School of Nursing, American University of Beirut, P.O. Box 11-0236, Riad El Solh 1107 2020, Beirut, Lebanon
| | - Dimitrios Terentes-Printzios
- First Department of Cardiology, Hippokration Hospital, Medical School, National and Kapodistrian University of Athens, 114 Vasilissis Sofias Avenue, 11527 Athens, Greece
| | - Gunay Yetik-Anacak
- Department of Pharmacology, Faculty of Pharmacy, Acibadem Mehmet Ali Aydinlar University, Kayisdagi Cad. No:32 Atasehir, 34752 Istanbul, Turkey
| | - Chloe Park
- MRC Unit for Lifelong Health and Ageing at UCL, 1-19 Torrington Place, London WC1E 7HB, UK; and
| | - Peter M. Nilsson
- Department of Clinical Sciences, Lund University, Skane University Hospital, Sölvegatan 19 - BMC F12, 221 84 Lund, Malmö, Sweden
| | - Thomas Weber
- Cardiology Department, Klinikum Wels-Grieskirchen, Grieskirchnerstrasse 42, 4600 Wels, Austria
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Park HW, Ozcan I, Toya T, Ahmad A, Kanaji Y, Kushwaha SS, Lerman LO, Lerman A. Invasive aortic pulse pressure is linked to cardiac allograft vasculopathy after heart transplantation. Int J Cardiol 2023; 370:167-174. [PMID: 36346255 DOI: 10.1016/j.ijcard.2022.10.159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Revised: 10/20/2022] [Accepted: 10/25/2022] [Indexed: 11/05/2022]
Abstract
BACKGROUND Pulse pressure (PP) has been linked to an increased risk of extent of coronary atherosclerosis and cardiovascular events. This study aimed to investigate the contribution of aortic PP on cardiac allograft vasculopathy (CAV) progression, and cardiovascular events after heart transplantation (HTx). METHODS A total of 330 HTx patients (mean age 49 ± 25 years, 70.0% male) undergoing routine serial coronary intravascular ultrasound (IVUS) studies and had invasive aortic PP were enrolled. The median time from HTx to first IVUS was 13.6 months. CAV progression was assessed by IVUS as the changes (Δ) in plaque volume divided by the segment length (PV/SL), adjusted for the time between IVUS (median, 3.99 years; interquartile range, 1.99-7.20 years), and was defined as ΔPV/SL ≥0.50 mm3/mm/year. Major adverse cardiovascular event (MACE) was defined as any incidence of mortality, myocardial infarction, coronary revascularization, heart failure hospitalization, or re-transplantation. RESULTS Recipient age, recipient sex, and renal dysfunction were independent determinant of high aortic PP (≥ 50 mmHg). High aortic PP was an independent determinant of CAV progression [odds ratio, 1.72; 95% confidence interval (CI), 1.01-2.93; p = 0.045]. Both high aortic PP (HR 1.46, 95% CI 1.01-2.11, p = 0.044) and high baseline CAV grade on angiogram (≥1, HR 1.50, 95% CI 1.03-2.21, p = 0.037) were independently associated with MACEs over 12 years. CONCLUSION In post-HTx patients, high aortic PP was significantly associated with plaque progression. Both aortic PP and CAV grade are independently associated with MACE during long-term follow-up. These findings suggest that arterial stiffness and CAV can be important predictors of MACEs.
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Affiliation(s)
- Hyun Woong Park
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA; Department of Cardiology in Internal Medicine, Chungnam National University Sejong Hospital, Chungnam National University College of Medicine, Sejong, South Korea
| | - Ilke Ozcan
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
| | - Takumi Toya
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA; Department of Internal Medicine, Saint Luis University School of Medicine, Saint Louis, MO, USA
| | - Ali Ahmad
- Division of Cardiology, National Defense Medical College, Tokorozawa, Saitama, Japan
| | - Yoshihisa Kanaji
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA; Division of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, Ibaraki, Japan
| | - Sudhir S Kushwaha
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
| | - Lilach O Lerman
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN, USA
| | - Amir Lerman
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA.
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Huang D, Cui C, Zheng Q, Li Y, Liu Y, Hu Y, Wang Y, Liu R, Liu L. Quantitative Analysis of Myocardial Work by Non-invasive Left Ventricular Pressure-Strain Loop in Patients With Type 2 Diabetes Mellitus. Front Cardiovasc Med 2021; 8:733339. [PMID: 34660736 PMCID: PMC8517392 DOI: 10.3389/fcvm.2021.733339] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Accepted: 09/08/2021] [Indexed: 12/20/2022] Open
Abstract
Background: Type 2 diabetes mellitus (T2DM) is a common risk factor for cardiovascular diseases. The aims of this study were to evaluate the changes in the left ventricular myocardial work in T2DM patients using the left ventricular pressure-strain loop (PSL) technique, and to explore the risk factors for the left ventricular myocardial work impairment. Methods: Fifty patients with T2DM and 50 normal controls (NCs) were included in the study. In addition to conventional echocardiography and two-dimensional speckle tracking echocardiography, the left ventricular myocardial work parameters were measured using PSL technology. Results: The absolute value for global longitudinal strain (GLS), global work index (GWI) and, global constructive work (GCW) were significantly decreased in the T2DM group (P < 0.05), while the left ventricular ejection fraction (LVEF) was not significantly different between the T2DM and NC groups. Multivariable linear regression analysis showed that hemoglobin A1c (HbA1c) was independently related to GWI (β = −0.452, P < 0.05), while HbA1c and the diabetes duration were independently related to GCW (β = −0.393, P < 0.05 and β = −0.298, P < 0.05, respectively). Conclusions: Changes in the left ventricular myocardial systolic function in T2DM patients were identified using PSL technology. HbA1c was shown to be an independent risk factor affecting GWI, while HbA1c and diabetes duration were demonstrated to be independent risk factors affecting GCW.
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Affiliation(s)
- Danqing Huang
- Department of Ultrasound, Fuwai Central China Cardiovascular Hospital, Central China Fuwai Hospital of Zhengzhou University, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, Zhengzhou, China
| | - Cunying Cui
- Department of Ultrasound, Fuwai Central China Cardiovascular Hospital, Central China Fuwai Hospital of Zhengzhou University, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, Zhengzhou, China
| | - Qiang Zheng
- School of Computer and Control Engineering, Yantai University, Yantai, China
| | - Yanan Li
- Department of Ultrasound, Fuwai Central China Cardiovascular Hospital, Central China Fuwai Hospital of Zhengzhou University, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, Zhengzhou, China
| | - Yuanyuan Liu
- Department of Ultrasound, Fuwai Central China Cardiovascular Hospital, Central China Fuwai Hospital of Zhengzhou University, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, Zhengzhou, China
| | - Yanbin Hu
- Department of Ultrasound, Fuwai Central China Cardiovascular Hospital, Central China Fuwai Hospital of Zhengzhou University, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, Zhengzhou, China
| | - Ying Wang
- Department of Ultrasound, Fuwai Central China Cardiovascular Hospital, Central China Fuwai Hospital of Zhengzhou University, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, Zhengzhou, China
| | - Ruijie Liu
- Department of Ultrasound, Fuwai Central China Cardiovascular Hospital, Central China Fuwai Hospital of Zhengzhou University, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, Zhengzhou, China
| | - Lin Liu
- Department of Ultrasound, Fuwai Central China Cardiovascular Hospital, Central China Fuwai Hospital of Zhengzhou University, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, Zhengzhou, China
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9
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Hidalgo-Santiago JC, Oneto-Otero J, Michán-Doña A, Gomez-Fernández P. Role of increased central arterial stiffness in macro and microvascular damage in patients with coronary artery disease. CLINICA E INVESTIGACION EN ARTERIOSCLEROSIS 2021; 33:224-234. [PMID: 33814197 DOI: 10.1016/j.arteri.2021.02.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Revised: 01/26/2021] [Accepted: 02/03/2021] [Indexed: 11/24/2022]
Abstract
BACKGROUND Patients with heart disease frequently have renal dysfunction manifested by a decrease in glomerular filtration rate (GFR) and / or increase of albuminuria. OBJECTIVES The objective was to study the possible role of increased aortic stiffness in the presence and extent of coronary artery disease (CAD) and kidney dysfunction in a group of patients with suspected CAD. PATIENTS AND METHODS We studied forty-eight patients undergoing coronariography for suspected coronary disease (CAD). Using applanation tonometry on the radial artery and applying a transfer function, central blood pressure values were calculated. The study of aortic stiffness was done by determining the carotid-femoral pulse velocity (Pvc-f). RESULTS Of the 48 patients, 11 had no significant coronary lesions, 24 showed significant lesions in 1 or 2 coronary arteries and 13 in ≥ 3 arteries. The group with a higher degree of CD had significantly higher cPP values than the group without CD. The Pvc-f increased progressively and significantly with the degree of CD. The logistic regression showed that Pvc-f independently predicted the presence of CD. The relative risk of CD increased 2.5 times for each meter of increase in Pvc-f. The GFR was negatively and significantly correlated with age and Pvc-f was associated with albuminuria. CONCLUSIONS In patients with stable CD, Pvc-f, expression of aortic stiffness, is independently associated with the existence of CD and its degree of extension. The increase in arterial stiffness also participates in the decrease in GFR and in the increase in albuminuria.
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Affiliation(s)
| | - Jesús Oneto-Otero
- Servicio de Cardiología, Hospital Universitario de Jerez, Jerez, España
| | - Alfredo Michán-Doña
- Departamento de Medicina, Hospital Universitario de Jerez, Jerez, España; Biomedical Research and Innovation Institute of Cadiz (INiBICA), Cádiz, España
| | - Pablo Gomez-Fernández
- Unidad de Factores de Riesgo Vascular, Hospital Universitario de Jerez, Jerez, España.
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10
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Wang X, Fu Y, Xie Z, Cao M, Qu W, Xi X, Zhong S, Piao M, Peng X, Jia Y, Meng L, Tian J. Establishment of a Novel Mouse Model for Atherosclerotic Vulnerable Plaque. Front Cardiovasc Med 2021; 8:642751. [PMID: 33796572 PMCID: PMC8007762 DOI: 10.3389/fcvm.2021.642751] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Accepted: 02/23/2021] [Indexed: 12/23/2022] Open
Abstract
Background and Aims: Acute coronary syndrome (ACS) is a group of clinical syndromes characterized by rupture or erosion of atherosclerotic unstable plaques. Effective intervention for vulnerable plaques (VP) is of great significance to reduce adverse cardiovascular events. Methods: Fbn1C1039G+/− mice were crossbred with LDLR−/− mice to obtain a novel model for atherosclerotic VP. After the mice were fed with a high-fat diet (HFD) for 12 or 24 weeks, pathological staining and immunohistochemistry analyses were employed to evaluate atherosclerotic lesions. Results: Compared to control mice, Fbn1C1039G+/−LDLR−/− mice developed more severe atherosclerotic lesions, and the positive area of oil red O staining in the aortic sinus was significantly increased after 12 weeks (21.7 ± 2.0 vs. 6.3 ± 2.1) and 24 weeks (32.6 ± 2.5 vs. 18.7 ± 2.6) on a HFD. Additional vulnerable plaque characteristics, including significantly larger necrotic cores (280 ± 19 vs. 105 ± 7), thinner fiber caps (14.0 ± 2.8 vs. 32.6 ± 2.7), apparent elastin fiber fragmentation and vessel dilation (3,010 ± 67 vs. 1,465 ± 49), a 2-fold increase in macrophage number (8.5 ± 1.0 vs. 5.0 ± 0.6), obviously decreased smooth muscle cell number (0.6 ± 0.1 vs. 2.1 ± 0.2) and an ~25% decrease in total collagen content (33.6 ± 0.3 vs. 44.9 ± 9.1) were observed in Fbn1C1039G+/−LDLR−/− mice compared with control mice after 24 weeks. Furthermore, spontaneous plaque rupture, neovascularization, and intraplaque hemorrhage were detected in the model mouse plaque regions but not in those of the control mice. Conclusions: Plaques in Fbn1C1039G+/−LDLR−/− mice fed a HFD show many features of human advanced atherosclerotic unstable plaques. These results suggest that the Fbn1C1039G+/−LDLR−/− mouse is a novel model for investigating the pathological and physiological mechanisms of advanced atherosclerotic unstable plaques.
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Affiliation(s)
- Xueyu Wang
- Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University, Harbin, China.,Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education, Harbin, China
| | - Yahong Fu
- Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University, Harbin, China.,Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education, Harbin, China
| | - Zulong Xie
- Department of Cardiology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Muhua Cao
- Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University, Harbin, China.,Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education, Harbin, China
| | - Wenbo Qu
- Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University, Harbin, China.,Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education, Harbin, China
| | - Xiangwen Xi
- Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University, Harbin, China.,Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education, Harbin, China
| | - Shan Zhong
- Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University, Harbin, China.,Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education, Harbin, China
| | - Minghui Piao
- Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University, Harbin, China.,Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education, Harbin, China
| | - Xiang Peng
- Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University, Harbin, China.,Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education, Harbin, China
| | - Ying Jia
- Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University, Harbin, China.,Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education, Harbin, China
| | - Lingbo Meng
- Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Jinwei Tian
- Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University, Harbin, China
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11
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Predictors of neo-aortic valve regurgitation in the long term after arterial switch operation. Heart Vessels 2020; 36:693-703. [PMID: 33245489 DOI: 10.1007/s00380-020-01729-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Accepted: 11/06/2020] [Indexed: 10/22/2022]
Abstract
Although arterial switch operations (ASOs) have been performed globally to repair d-transposition of the great arteries (d-TGA) in neonates and infants, few studies have been reported regarding the influence of the hemodynamics of patients with d-TGA who have undergone ASO on the development of neo-aortic valve regurgitation (AR). We aimed to investigate the relationship between the hemodynamics and development of AR after ASO in patients with d-TGA by catheter evaluation. This observational study screened 114 consecutive patients who underwent ASO for d-TGA or Taussig-Bing anomaly and who subsequently underwent catheter evaluations in our institution. We reviewed their records for the past 20 years and collected their first catheterization data post-ASO in early childhood. Thirty-six post-ASO patients who underwent catheter evaluations in both the early surgical and long-term phases were finally analyzed. Patients were divided into the following groups according to the presence of significant AR in the long-term phase: the AR group (n = 9 with AR ≥ grade II by the Sellers classification) and the non-AR group (n = 27 with AR < grade II). In the long-term phase, the diastolic blood pressure was significantly lower and the ascending aortic diameter was significantly larger in the AR group than in the non-AR group (p = 0.004 and p = 0.006, respectively). The systolic blood pressure (SBP) and pulse pressure (PP) were similar in both groups. Meanwhile, in the early surgical phase, SBP and PP were significantly higher in the AR group than in the non-AR group (p = 0.029 and p = 0.002, respectively). The receiver operating characteristic curve for late AR showed that the area under the curve for SBP and PP in the early surgical phase were 0.746 and 0.853, respectively. Even though sensitivity analysis was performed, SBP or PP greater than the cutoff value in the early surgical phase was identified as predictors for late AR. Our results suggested that high SBP or PP in the early surgical phase could influence the development of AR in the long term after ASO.
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12
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Georgakis MK, Gill D, Malik R, Protogerou AD, Webb AJS, Dichgans M. Genetically Predicted Blood Pressure Across the Lifespan: Differential Effects of Mean and Pulse Pressure on Stroke Risk. Hypertension 2020; 76:953-961. [PMID: 32623925 PMCID: PMC7418931 DOI: 10.1161/hypertensionaha.120.15136] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Hypertension is the leading risk factor for stroke. Yet, it remains unknown whether blood pressure pulsatility (pulse pressure [PP]) causally affects stroke risk independently of the steady pressure component (mean arterial pressure [MAP]). It is further unknown how the effects of MAP and PP on stroke risk vary with age and stroke cause. Using data from UK Biobank (N=408 228; 38-71 years), we selected genetic variants as instruments for MAP and PP at age ≤55 and >55 years and across age deciles. We applied multivariable Mendelian randomization analyses to explore associations with ischemic stroke, intracerebral hemorrhage, and their subtypes. Higher genetically predicted MAP was associated with higher risk of ischemic stroke and intracerebral hemorrhage across the examined age spectrum. Independent of MAP, higher genetically predicted PP only at age >55 years was further associated with higher risk of ischemic stroke (odds ratio per-SD-increment, 1.23 [95% CI, 1.13-1.34]). Among subtypes, the effect of genetically predicted MAP on large artery stroke was attenuated, whereas the effect of genetically predicted PP was augmented with increasing age. Genetically predicted MAP, but not PP, was associated with small vessel stroke and deep intracerebral hemorrhage homogeneously across age deciles. Neither genetically predicted MAP nor PP were associated with lobar intracerebral hemorrhage. Beyond an effect of high MAP at any age on ischemic and hemorrhagic stroke, our results support an independent causal effect of high PP at older ages on large artery stroke. This finding warrants further investigation for the development of stroke preventive strategies targeting pulsatility in later life.
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Affiliation(s)
- Marios K Georgakis
- From the Institute for Stroke and Dementia Research, University Hospital, LMU Munich, Germany (M.K.G., R.M., M.D.)
| | - Dipender Gill
- Department of Biostatistics and Epidemiology, School of Public Health, Imperial College London, United Kingdom (D.G.)
| | - Rainer Malik
- From the Institute for Stroke and Dementia Research, University Hospital, LMU Munich, Germany (M.K.G., R.M., M.D.)
| | - Athanase D Protogerou
- Cardiovascular Prevention and Research Unit, Department of Pathophysiology, National and Kapodistrian University of Athens, Greece (A.D.P.)
| | - Alastair J S Webb
- Centre for Prevention of Stroke and Dementia, Department of Clinical Neurosciences, University of Oxford, United Kingdom (A.J.S.W.)
| | - Martin Dichgans
- From the Institute for Stroke and Dementia Research, University Hospital, LMU Munich, Germany (M.K.G., R.M., M.D.).,Munich Cluster for Systems Neurology (SyNergy), Munich, Germany (M.D.).,German Centre for Neurodegenerative Diseases (DZNE), Munich, Germany (M.D.)
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13
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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.
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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
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14
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de Faria AP, Modolo R, Chichareon P, Chang CC, Kogame N, Tomaniak M, Takahashi K, Rademaker-Havinga T, Wykrzykowska J, de Winter RJ, Ferreira RC, Sousa A, Lemos PA, Garg S, Hamm C, Juni P, Vranckx P, Valgimigli M, Windecker S, Onuma Y, Steg PG, Serruys PW. Association of Pulse Pressure With Clinical Outcomes in Patients Under Different Antiplatelet Strategies After Percutaneous Coronary Intervention: Analysis of GLOBAL LEADERS. Can J Cardiol 2019; 36:747-755. [PMID: 32139280 DOI: 10.1016/j.cjca.2019.10.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Revised: 10/08/2019] [Accepted: 10/14/2019] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND We evaluated the association of pulse pressure (PP) and different antiplatelet regimes with clinical and safety outcomes in an all-comers percutaneous coronary intervention (PCI) population. METHODS In this analysis of GLOBAL LEADERS (n = 15,936) we compared the experimental therapy of 23 months of ticagrelor after 1 month of dual-antiplatelet therapy (DAPT) vs standard DAPT for 12 months followed by aspirin monotherapy in subjects who underwent PCI and were divided into 2 groups according to the median PP (60 mm Hg). The primary end point (all-cause death or new Q-wave myocardial infarction) and the composite end points: patient-oriented composite end points (POCE), Bleeding Academic Research Consortium (BARC) 3 or 5, and net adverse clinical events (NACE) were evaluated. RESULTS At 2 years, subjects in the high-PP group (n = 7971) had similar rates of the primary end point (4.3% vs 3.9%; P = 0.058), POCE (14.9% vs 12.7%; P = 0.051), and BARC 3 or 5 (2.5% vs 1.7%; P = 0.355) and higher rates of NACE (16.4% vs 13.7%; P = 0.037) compared with the low-PP group (n = 7965). Among patients with PP < 60 mm Hg, the primary end point (3.4% vs 4.4%, adjusted hazard ratio [aHR] 0.77, 95% confidence interval [CI] 0.61-0.96), POCE (11.8% vs 13.5%, aHR 0.86, 95% CI 0.76-0.98), NACE (12.8% vs 14.7%, aHR 0.85, 95% CI 0.76-0.96), and BARC 3 or 5 (1.4% vs 2.1%, aHR 0.69, 95% CI 0.49-0.97) were lower with ticagrelor monotherapy compared with DAPT. The only significant interaction was for BARC 3 or 5 (P = 0.008). CONCLUSIONS After contemporary PCI, subjects with high PP levels experienced high rates of NACE at 2 years. In those with low PP, ticagrelor monotherapy led to a lower risk of bleeding events compared with standard DAPT.
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Affiliation(s)
| | - Rodrigo Modolo
- Department of Cardiology, Amsterdam University Medical Centre, Amsterdam, The Netherlands; Cardiology Division. Department of Internal Medicine, University of Campinas, Campinas, Brazil
| | - Ply Chichareon
- Department of Cardiology, Amsterdam University Medical Centre, Amsterdam, The Netherlands; Division of Cardiology, Department of Internal Medicine, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
| | - Chun-Chin Chang
- Erasmus Medical Centre, Erasmus University, Rotterdam, The Netherlands
| | - Norihiro Kogame
- Department of Cardiology, Amsterdam University Medical Centre, Amsterdam, The Netherlands
| | - Mariusz Tomaniak
- Erasmus Medical Centre, Erasmus University, Rotterdam, The Netherlands; First Department of Cardiology, Medical University of Warsaw, Warsaw, Poland
| | - Kuniaki Takahashi
- Department of Cardiology, Amsterdam University Medical Centre, Amsterdam, The Netherlands
| | | | - Joanna Wykrzykowska
- Department of Cardiology, Amsterdam University Medical Centre, Amsterdam, The Netherlands
| | - Rob J de Winter
- Department of Cardiology, Amsterdam University Medical Centre, Amsterdam, The Netherlands
| | - Rui C Ferreira
- Serviço de Cardiologia, Hospital de Santa Marta, Centro Hospitalar Universitário Lisboa Central, Lisbon, Portugal
| | - Amanda Sousa
- Department of Interventional Cardiology, Instituto Dante Pazzanese de Cardiologia, São Paulo, Brazil
| | - Pedro A Lemos
- Instituto do Coração, Hospital das Clínicas da Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Scot Garg
- East Lancashire Hospitals NHS Trust, Blackburn, Lancashire, United Kingdom
| | - Christian Hamm
- Kerckhoff Heart Center, Campus University of Giessen, Bad Nauheim, Germany
| | - Peter Juni
- Applied Health Research Centre, Li Ka Shing Knowledge Institute, St Michael's Hospital, University of Toronto, Toronto, Canada
| | - Pascal Vranckx
- Department of Cardiology and Critical Care Medicine, Hartcentrum Hasselt, Jessa Ziekenhuis, Hasselt, Belgium
| | - Marco Valgimigli
- Department of Cardiology, Bern University Hospital, Inselspital, University of Bern, Switzerland
| | - Stephan Windecker
- Department of Cardiology, Bern University Hospital, Inselspital, University of Bern, Switzerland
| | - Yoshinobu Onuma
- Galway University Hospital, National University of Ireland, Galway, Ireland
| | - Philippe Gabriel Steg
- French Alliance for Cardiovascular Trials, Hopital Bichat, Assistance Publique-Hopitaux de Paris, Universite Paris-Diderot, and Institut National de la Sante et de la Recherche Medicale U-1148, Paris, France; Royal Brompton Hospital, Imperial College, London, United Kingdom
| | - Patrick W Serruys
- Galway University Hospital, National University of Ireland, Galway, Ireland.
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15
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Sharif S, Visseren FLJ, Spiering W, de Jong PA, Bots ML, Westerink J. Arterial stiffness as a risk factor for cardiovascular events and all-cause mortality in people with Type 2 diabetes. Diabet Med 2019; 36:1125-1132. [PMID: 30920676 PMCID: PMC6767543 DOI: 10.1111/dme.13954] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/25/2019] [Indexed: 01/06/2023]
Abstract
AIM To quantify the risk of different non-invasive arterial stiffness measurements with macrovascular disease and all-cause mortality in high-risk people with Type 2 diabetes. METHODS We conducted a prospective cohort study of 1910 people with Type 2 diabetes included in the Second Manifestations of ARTerial disease (SMART) study. Arterial stiffness was assessed by brachial artery pulse pressure, normal range (≥0.9) ankle-brachial index and carotid artery distension. Cox regression was used to evaluate the effects of arterial stiffness on risk of cardiovascular events (composite of myocardial infarction, stroke and vascular mortality) and all-cause mortality. RESULTS A total of 380 new cardiovascular events and 436 deaths occurred during a median (interquartile range) follow-up of 7.5 (4.1-11.0) years. A 10-mmHg higher brachial pulse pressure was related to higher hazard of cardiovascular events (hazard ratio 1.09, 95% CI 1.02 to 1.16) and all-cause mortality (hazard ratio 1.10, 95% CI 1.03 to 1.16). A 0.1-point lower ankle-brachial index within the normal range was related to a higher hazard of cardiovascular events (hazard ratio 1.13, 95% CI 1.01 to 1.27) and all-cause mortality (hazard ratio 1.17, 95% CI 1.04 to 1.31). A one-unit (10-3 ×kPa-1 ) lower carotid artery distensibility coefficient was related to a higher hazard of vascular mortality (hazard ratio 1.04, 95% CI 1.00 to 1.09) and all-cause mortality (hazard ratio 1.04, 95% CI 1.00 to 1.07). CONCLUSION Increased arterial stiffness, as measured by either increased pulse pressure, normal-range ankle-brachial index or carotid artery distensibility coefficient, is related to increased hazard of cardiovascular events and all-cause mortality in people with Type 2 diabetes.
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Affiliation(s)
- S. Sharif
- Department of Vascular MedicineUniversity Medical Centre UtrechtUtrechtThe Netherlands
| | - F. L. J. Visseren
- Department of Vascular MedicineUniversity Medical Centre UtrechtUtrechtThe Netherlands
| | - W. Spiering
- Department of Vascular MedicineUniversity Medical Centre UtrechtUtrechtThe Netherlands
| | - P. A. de Jong
- Department of RadiologyUniversity Medical Centre UtrechtUtrechtThe Netherlands
| | - M. L. Bots
- Julius Centre for Health Sciences and Primary CareUniversity Medical Centre UtrechtUtrechtThe Netherlands
| | - J. Westerink
- Department of Vascular MedicineUniversity Medical Centre UtrechtUtrechtThe Netherlands
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17
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Tarraf W, Rodríguez CJ, Daviglus ML, Lamar M, Schneiderman N, Gallo L, Talavera GA, Kaplan RC, Fornage M, Conceicao A, González HM. Blood Pressure and Hispanic/Latino Cognitive Function: Hispanic Community Health Study/Study of Latinos Results. J Alzheimers Dis 2018; 59:31-42. [PMID: 28582859 DOI: 10.3233/jad-170017] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
BACKGROUND Hispanics/Latinos are at increased risk for cardiovascular disease and cognitive decline and dementias. High blood pressure (BP) has been implicated in both stroke and dementias. Associations between BP and cognition among diverse Latinos are still unpublished. OBJECTIVE We examined associations between cognition and four BP based measures among diverse Hispanics/Latinos. We hypothesized that higher BP, particularly systolic pressure, and increased arterial stiffness (i.e., pulse pressure), would be associated with lower cognitive function. METHODS We used baseline (2008-2011) Hispanic Community Health Study/Study of Latinos (HCHS/SOL; n = 9,019; ages 45-74 years) data to examine cognition in relation to BP measures. RESULTS In age, sex, and education adjusted models, systolic, pulse, and mean arterial pressure were consistently negatively associated with executive function, psychomotor speed and sustained attention, verbal episodic learning and memory, speech fluency, and mental status measures. These associations were attenuated but remained statistically significant in fully adjusted models. CONCLUSION Among middle-aged and older diverse Hispanics/Latinos, we found modest but consistent associations between indicators of arterial stiffness, and compromised blood flow and lower cognitive function. Clinical management and public health interventions to raise awareness and enhance BP management beginning in midlife could reduce disparities and improve population health by reducing cognitive decline burdens.
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Affiliation(s)
- Wassim Tarraf
- Department of Healthcare Sciences and Wayne State University, Institute of Gerontology, Detroit, MI, USA
| | - Carlos J Rodríguez
- Department of Medicine and Department of Epidemiology, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Martha L Daviglus
- University of Illinois at Chicago, Institute for Minority Health Research, College of Medicine at Chicago, Chicago, IL, USA
| | - Melissa Lamar
- University of Illinois at Chicago, Institute for Minority Health Research, College of Medicine at Chicago, Chicago, IL, USA.,Department of Psychiatry, University of Illinois at Chicago, Chicago, IL, USA
| | - Neil Schneiderman
- Department of Psychology, University of Miami, Coral Gables, FL, USA
| | - Linda Gallo
- San Diego State University, Institute for Behavioral and Community Health, Graduate School of Public Health, San Diego, CA, USA
| | - Gregory A Talavera
- San Diego State University, Institute for Behavioral and Community Health, Graduate School of Public Health, San Diego, CA, USA
| | - Robert C Kaplan
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, New York, NY, USA
| | - Myriam Fornage
- University of Texas Health Science Center, Institute of Molecular Medicine and Human Genetics Center, San Antonio, TX, USA
| | - Alan Conceicao
- Department of Epidemiology and Biostatistics, Michigan State University, East Lansing, MI, USA
| | - Hector M González
- Department of Epidemiology and Biostatistics, Michigan State University, East Lansing, MI, USA
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Yannoutsos A, Ahouah M, Dreyfuss Tubiana C, Topouchian J, Safar ME, Blacher J. Aortic stiffness improves the prediction of both diagnosis and severity of coronary artery disease. Hypertens Res 2017; 41:118-125. [DOI: 10.1038/hr.2017.97] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2017] [Revised: 06/23/2017] [Accepted: 07/03/2017] [Indexed: 01/06/2023]
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19
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Mitrović J, Morović-Vergles J, Horvatić I, Badžak J, Stojić M, Gamulin S. Ambulatory arterial stiffness index and carotid intima-media thickness in hypertensive rheumatoid patients: a comparative cross-sectional study. Int J Rheum Dis 2015; 20:1998-2002. [DOI: 10.1111/1756-185x.12613] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Joško Mitrović
- Division of Clinical Immunology and Rheumatology; Department of Internal Medicine; Dubrava University Hospital; University of Zagreb School of Medicine; Zagreb Croatia
| | - Jadranka Morović-Vergles
- Division of Clinical Immunology and Rheumatology; Department of Internal Medicine; Dubrava University Hospital; University of Zagreb School of Medicine; Zagreb Croatia
| | - Ivica Horvatić
- Division of Nephrology; Department of Internal Medicine; Dubrava University Hospital; University of Zagreb School of Medicine; Zagreb Croatia
| | - Jasna Badžak
- Department of Neurology; Dubrava University Hospital; Zagreb Croatia
| | - Maristela Stojić
- Department of Neurology; Dubrava University Hospital; Zagreb Croatia
| | - Stjepan Gamulin
- Department of Pathophysiology; School of Medicine; University of Zagreb; Zagreb Croatia
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Wang J, Wang L, Yang H, You Y, Xu H, Gong L, Yin X, Wang W, Gao S, Cheng L, Liang R, Liao F. Prevention of atherosclerosis by Yindan Xinnaotong capsule combined with swimming in rats. BMC COMPLEMENTARY AND ALTERNATIVE MEDICINE 2015; 15:109. [PMID: 25886942 PMCID: PMC4406019 DOI: 10.1186/s12906-015-0622-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/03/2014] [Accepted: 03/10/2015] [Indexed: 11/10/2022]
Abstract
BACKGROUND Yindan Xinnaotong capsule has been used for treating cardio-cerebrovascular diseases for several decades in China. Exercise training can protect against the development of atherosclerosis. The aim of the present study is to evaluate the joint effect of YXC and exercise on atherosclerosis in rats. METHODS A combined method involving low shear stress and a high-fat diet was used to establish the atherosclerosis model in rats. Partial ligation of the left common carotid artery was performed, and then the rats were divided into 9 treatment groups according to a 3 × 3 factorial design with two factors and three levels for each factor, swimming of 0, 0.5, 1 h daily and YXC administration of 0, 1, 2 g/kg p.o. daily. Next the interventions of swimming and YXC were executed for 8 weeks. After that, blood samples were collected to determine blood viscosity, plasma viscosity, haematocrit (HCT), fibrinogen (FIB), blood lipid profile (including total cholesterol (TC), low-density lipoprotein-cholesterol (LDL-C), triglyceride (TG) and high-density lipoprotein-cholesterol (HDL-C)), nitric oxide (NO), 6-keto- prostaglandin (PG) F1α, endothelin (ET) and thromboxane (TX) B2. The common carotid arteries of the rats were harvested to examine pathological changes, wall thickness and circumference, and the expression of SM22αwas assayed via immune-histochemistry. RESULTS The early pathological changes were observed. The joint effects of YXC and swimming showed significant changes in the examined parameters: (1) decreases in plasma viscosity, blood viscosity and FIB; (2) increases in NO and 6-keto-PGF1α; (3) decreases in ET and TXB2; and (4) decreases in LDL-C and TG. The combination of 2 g/kg YXC and 1 h of swimming led to synergistic decreases in LDL-C and TG. The interactive effect between YXC and swimming was obvious in decreasing wall thickness. Swimming alone was able to up-regulate the expression of SM22α. CONCLUSIONS In conclusion, this study indicates that the combination of YXC and swimming may prevent atherosclerosis through a synergistic effect between YXC and swimming in improving blood circulation, hemorheological parameters, blood lipids levels and the vascular endothelium in rats. The vascular remodeling may be contributed to the prevention effects on AS by up-regulating SM22α.
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Affiliation(s)
- Jianlu Wang
- China Academy of Chinese Medical Sciences, Institute of Chinese Material Medical, Beijing, China.
| | - Lan Wang
- China Academy of Chinese Medical Sciences, Institute of Chinese Material Medical, Beijing, China.
| | - Hongjun Yang
- China Academy of Chinese Medical Sciences, Institute of Chinese Material Medical, Beijing, China.
| | - Yun You
- China Academy of Chinese Medical Sciences, Institute of Chinese Material Medical, Beijing, China.
| | - Haiyu Xu
- China Academy of Chinese Medical Sciences, Institute of Chinese Material Medical, Beijing, China.
| | - Leilei Gong
- China Academy of Chinese Medical Sciences, Institute of Chinese Material Medical, Beijing, China.
| | - Xiaojie Yin
- China Academy of Chinese Medical Sciences, Institute of Chinese Material Medical, Beijing, China.
| | - Wandan Wang
- School of Traditional Chinese Medicine, Capital Medical University, Beijing, China.
| | - Shuangrong Gao
- China Academy of Chinese Medical Sciences, Institute of Chinese Material Medical, Beijing, China.
| | - Long Cheng
- Chinese Academy of Medical Sciences, Institute of Medicinal Plant Development, Beijing, China.
- Guizhou Bailing Group Pharmaceutical Co., Ltd, Guizhou, China.
| | - Rixin Liang
- China Academy of Chinese Medical Sciences, Institute of Chinese Material Medical, Beijing, China.
| | - Fulong Liao
- China Academy of Chinese Medical Sciences, Institute of Chinese Material Medical, Beijing, China.
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Ikewuchi JC, Ikewuchi CC, Ifeanacho MO, Igboh NM. Blood pressure lowering activity of a flavonoid and phytosterol rich extract of the sclerotia of Pleurotus tuberregium (Fr) Sing in salt-loaded rats. ACTA ACUST UNITED AC 2014. [DOI: 10.1016/j.bionut.2014.02.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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22
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Yoshitomi Y, Kawanishi KI, Yamaguchi A, Sakurai SI, Minai K, Ishii T, Tarutani Y, Tsujibayashi T, Kaneki M, Saitou Y, Suwa S. Effectiveness of the direct renin inhibitor, aliskiren, in patients with resistant hypertension. Int Heart J 2013; 54:88-92. [PMID: 23676368 DOI: 10.1536/ihj.54.88] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Currently there is no consensus regarding which add-on therapy to use in resistant hypertension. We have conducted an open observational study of the use of aliskiren in resistant hypertensive patients. Forty-three patients with resistant hypertension were included in the study. The inclusion criteria were as follows: 1) office blood pressure (BP) > 140/90 mmHg despite treatment with at least three or more antihypertensive drugs; 2) no prior therapy with aliskiren; and 3) no renal insufficiency. Follow-up BP was determined at 1 and 3 months. Baseline BP was 153 ± 12/79 ± 12 mmHg. After 3 months, systolic BP (SBP) and diastolic BP (DBP) dropped significantly: 140 ± 19/73 ± 13 mmHg (P < 0.0001). Twenty-one patients (49%) had an office BP < 140/90 mmHg, and these patients were assigned to the good BP control group. Another 22 were placed into the poor BP control group. BP reductions from baseline in the good BP control group (SBP/ DBP: 19 ± 11/8 ± 7 mmHg) were larger than those in the poor BP control group (5 ± 15/3 ± 9 mmHg, P < 0.05). Mean BP (MBP) values at baseline, 1, and 3 months were higher in the poor BP control group. There was no significant difference in pulse pressure at baseline between the 2 groups. In multivariate analysis, only MBP at baseline correlated with lack of BP control. Aliskiren administration to resistant hypertensive patients was effective in reducing BP. The present findings suggest aliskiren may be useful as a fourth-line or fifth-line treatment added to other drugs in the treatment of resistant hypertension.
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Kim YJ, Lee KS, Lee JR, Na JH, Choi J, Han S, Kook MS. Ocular pulse amplitude as a dynamic parameter and its relationship with 24-h intraocular pressure and blood pressure in glaucoma. Exp Eye Res 2013; 115:65-72. [PMID: 23797045 DOI: 10.1016/j.exer.2013.06.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2013] [Revised: 06/06/2013] [Accepted: 06/07/2013] [Indexed: 10/26/2022]
Abstract
Abnormal ocular blood flow (OBF) has been suspected as one of the underlying mechanisms of glaucoma. The ocular pulse amplitude (OPA) is considered a possible surrogate parameter for ocular blood flow (OBF) measurement and has been studied in its association with glaucoma. Although there have been several studies that reported various ocular and systemic factors in association with OPA, all of these studies were based on a single measurement of these factors as well as OPA. The purpose of this study was to determine the 24-h (h) dynamic variability and any associations between OPA and intraocular pressure (IOP) and blood pressure (BP) variables using 24-h data collected from untreated patients with normal-tension glaucoma (NTG). One hundred and forty-four patients with NTG were consecutively enrolled. All patients underwent 24-h monitoring of IOP, OPA, and BP variables. A cosinor model was used to describe the patterns and statistical significance of the 24-h OPA rhythm, as well as the IOP and BP variables. Associations between 24-h OPA data, IOP and BP variables, and ocular and demographic factors were also assessed using the generalized estimating equation. Over the course of 24-h, OPA (p = 0.007) demonstrated significant dynamic diurnal rhythms that were similar to the other dynamic variables (all p < 0.05). Based on the 24-h data, IOP (p < 0.001), arterial pulse pressure (p = 0.034), and the spherical equivalent (p < 0.001) positively correlated with the OPA, whilst male sex (p < 0.001) negatively correlated with the OPA. These results indicate that OPA is primarily influenced by IOP as well as arterial pulse pressure, spherical equivalent, and gender. In conclusion, OPA is a dynamic ocular parameter that demonstrates a 24-h short-time fluctuation in NTG patients.
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Affiliation(s)
- Yoon Jeon Kim
- Department of Ophthalmology, University of Ulsan, College of Medicine, Asan Medical Center, 388-1 Pungnap-2-dong, Songpa-gu, Seoul 138-736, Republic of Korea
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Male gender, increased blood viscosity, body mass index and triglyceride levels are independently associated with systemic relative hypertension in sickle cell anemia. PLoS One 2013; 8:e66004. [PMID: 23785465 PMCID: PMC3681937 DOI: 10.1371/journal.pone.0066004] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2013] [Accepted: 05/01/2013] [Indexed: 01/28/2023] Open
Abstract
Patients with sickle cell anemia (SCA) have usually lower diastolic, systolic and mean blood pressure (BP) than the general population. However, BP values ≥120/70 mmHg considerably increase the risk for acute and chronic complications in SCA. The aim of this study was to identify biological factors associated with relative hypertension in adults with SCA. We compared the hematological, lipid and hemolytic profiles, as well as blood viscosity, between SCA patients with normal BP (<120/70 mmHg, n = 54) and those with relative hypertension (BP≥120/70 mmHg, n = 43). Our results demonstrated that male gender (OR: 3.49; 95%CI 1.20 to 10.16, p<0.05), triglycerides (OR: 9.19; 95% CI 2.29 to 36.95, p<0.01), blood viscosity (OR: 1.35; 95% CI 1.01 to 1.81, p<0.05) and body mass index (OR: 1.37; 95% CI 1.14 to 1.64, p<0.01) were independent risks factors for relative hypertension in SCA. No association was found between the BP status and the positive history of painful vaso-occlusive crisis or acute chest syndrome. An association between triglycerides level and the occurrence of these two major acute complications was detected. Our study suggests that male gender, increased triglycerides level, BMI and blood viscosity could increase the risk for developing relative hypertension in SCA. In addition, our results support a role of moderately elevated triglycerides in the pathophysiology of vaso-occlusive events.
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25
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Jankowski P, Bednarek A, Olszanecka A, Windak A, Kawecka-Jaszcz K, Czarnecka D. Twenty-four-hour profile of central blood pressure and central-to-peripheral systolic pressure amplification. Am J Hypertens 2013; 26:27-33. [PMID: 23382324 DOI: 10.1093/ajh/hps030] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The significant difference in central and peripheral blood pressure (BP) values has only recently been widely recognized. Ambulatory BP monitoring has been shown to have advantages over office BP measurements because ambulatory monitoring can provide important information not available when only office BP is measured. The aim of this study was to assess the 24-hour central systolic pressure (CSP) profile, CSP short-term variability, and 24-hour systolic pressure amplification profile. METHODS The study group comprised 50 hypertensive subjects and 50 normotensive subjects. All participants underwent 24-hour peripheral and central pressure monitoring. RESULTS CSP was lower than peripheral pressure levels during the day (124.1 ± 15.7 mm Hg vs 133.9 ± 16.3 mm Hg; P < 0.001) and night hours (114.4 ± 14.5 mm Hg vs 121.5 ± 15.2 mm Hg; P < 0.001). The CSP nocturnal fall was lower than the peripheral pressure fall in normotensive subjects as well as in hypertensive subjects. Although 24-hour systolic pressure amplification was similar in subjects with and without hypertension (9.2 ± 3.1 mm Hg and 8.3 ± 2.4 mm Hg; P = NS), it was significantly lower during the night than during the day in both groups. The nocturnal fall in systolic pressure amplification was correlated with the day-night difference in heart rate (r = 0.70; P < 0.001). CONCLUSIONS Central pressure differs significantly from peripheral pressure during regular daily activity as well as during night hours. Moreover, it appears that systolic pressure amplification varies throughout the 24-hour period and that the main factor determining nocturnal fall in systolic pressure amplification is nocturnal drop in the heart rate. More studies are required to demonstrate advantage of this novel technique over traditional pressure monitoring in clinical practice.
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Affiliation(s)
- Piotr Jankowski
- Department of Cardiology and Hypertension, Jagiellonian University Medical College, Kraków, Poland.
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26
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Selwaness M, van den Bouwhuijsen QJ, Verwoert GC, Dehghan A, Mattace-Raso FU, Vernooij M, Franco OH, Hofman A, van der Lugt A, Wentzel JJ, Witteman JC. Blood Pressure Parameters and Carotid Intraplaque Hemorrhage as Measured by Magnetic Resonance Imaging. Hypertension 2013; 61:76-81. [DOI: 10.1161/hypertensionaha.112.198267] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Affiliation(s)
- Mariana Selwaness
- From the Departments of Epidemiology (M.S., Q.J.A.v.d.B., G.C.V., A.D., F.U.S.M.-R., M.V., O.H.F., A.H., J.C.M.W.), Biomedical Engineering (M.S., J.J.W.), Radiology (M.S., Q.J.A.v.d.B., M.V., A.v.d.L.), and Internal Medicine (G.C.V., F.U.S.M.-R.), Erasmus Medical Center, Rotterdam, The Netherlands
| | - Quirijn J.A. van den Bouwhuijsen
- From the Departments of Epidemiology (M.S., Q.J.A.v.d.B., G.C.V., A.D., F.U.S.M.-R., M.V., O.H.F., A.H., J.C.M.W.), Biomedical Engineering (M.S., J.J.W.), Radiology (M.S., Q.J.A.v.d.B., M.V., A.v.d.L.), and Internal Medicine (G.C.V., F.U.S.M.-R.), Erasmus Medical Center, Rotterdam, The Netherlands
| | - Germaine C. Verwoert
- From the Departments of Epidemiology (M.S., Q.J.A.v.d.B., G.C.V., A.D., F.U.S.M.-R., M.V., O.H.F., A.H., J.C.M.W.), Biomedical Engineering (M.S., J.J.W.), Radiology (M.S., Q.J.A.v.d.B., M.V., A.v.d.L.), and Internal Medicine (G.C.V., F.U.S.M.-R.), Erasmus Medical Center, Rotterdam, The Netherlands
| | - Abbas Dehghan
- From the Departments of Epidemiology (M.S., Q.J.A.v.d.B., G.C.V., A.D., F.U.S.M.-R., M.V., O.H.F., A.H., J.C.M.W.), Biomedical Engineering (M.S., J.J.W.), Radiology (M.S., Q.J.A.v.d.B., M.V., A.v.d.L.), and Internal Medicine (G.C.V., F.U.S.M.-R.), Erasmus Medical Center, Rotterdam, The Netherlands
| | - Francesco U.S. Mattace-Raso
- From the Departments of Epidemiology (M.S., Q.J.A.v.d.B., G.C.V., A.D., F.U.S.M.-R., M.V., O.H.F., A.H., J.C.M.W.), Biomedical Engineering (M.S., J.J.W.), Radiology (M.S., Q.J.A.v.d.B., M.V., A.v.d.L.), and Internal Medicine (G.C.V., F.U.S.M.-R.), Erasmus Medical Center, Rotterdam, The Netherlands
| | - Meike Vernooij
- From the Departments of Epidemiology (M.S., Q.J.A.v.d.B., G.C.V., A.D., F.U.S.M.-R., M.V., O.H.F., A.H., J.C.M.W.), Biomedical Engineering (M.S., J.J.W.), Radiology (M.S., Q.J.A.v.d.B., M.V., A.v.d.L.), and Internal Medicine (G.C.V., F.U.S.M.-R.), Erasmus Medical Center, Rotterdam, The Netherlands
| | - Oscar H. Franco
- From the Departments of Epidemiology (M.S., Q.J.A.v.d.B., G.C.V., A.D., F.U.S.M.-R., M.V., O.H.F., A.H., J.C.M.W.), Biomedical Engineering (M.S., J.J.W.), Radiology (M.S., Q.J.A.v.d.B., M.V., A.v.d.L.), and Internal Medicine (G.C.V., F.U.S.M.-R.), Erasmus Medical Center, Rotterdam, The Netherlands
| | - Albert Hofman
- From the Departments of Epidemiology (M.S., Q.J.A.v.d.B., G.C.V., A.D., F.U.S.M.-R., M.V., O.H.F., A.H., J.C.M.W.), Biomedical Engineering (M.S., J.J.W.), Radiology (M.S., Q.J.A.v.d.B., M.V., A.v.d.L.), and Internal Medicine (G.C.V., F.U.S.M.-R.), Erasmus Medical Center, Rotterdam, The Netherlands
| | - Aad van der Lugt
- From the Departments of Epidemiology (M.S., Q.J.A.v.d.B., G.C.V., A.D., F.U.S.M.-R., M.V., O.H.F., A.H., J.C.M.W.), Biomedical Engineering (M.S., J.J.W.), Radiology (M.S., Q.J.A.v.d.B., M.V., A.v.d.L.), and Internal Medicine (G.C.V., F.U.S.M.-R.), Erasmus Medical Center, Rotterdam, The Netherlands
| | - Jolanda J. Wentzel
- From the Departments of Epidemiology (M.S., Q.J.A.v.d.B., G.C.V., A.D., F.U.S.M.-R., M.V., O.H.F., A.H., J.C.M.W.), Biomedical Engineering (M.S., J.J.W.), Radiology (M.S., Q.J.A.v.d.B., M.V., A.v.d.L.), and Internal Medicine (G.C.V., F.U.S.M.-R.), Erasmus Medical Center, Rotterdam, The Netherlands
| | - Jacqueline C.M. Witteman
- From the Departments of Epidemiology (M.S., Q.J.A.v.d.B., G.C.V., A.D., F.U.S.M.-R., M.V., O.H.F., A.H., J.C.M.W.), Biomedical Engineering (M.S., J.J.W.), Radiology (M.S., Q.J.A.v.d.B., M.V., A.v.d.L.), and Internal Medicine (G.C.V., F.U.S.M.-R.), Erasmus Medical Center, Rotterdam, The Netherlands
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Measurement of central aortic pulse pressure: noninvasive brachial cuff-based estimation by a transfer function vs. a novel pulse wave analysis method. Am J Hypertens 2012; 25:1162-9. [PMID: 22874891 DOI: 10.1038/ajh.2012.116] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND The prognostic value of central aortic pulse pressure (PP-C) may have been underestimated due to its measurement inaccuracy. We aimed to investigate the accuracy of noninvasive brachial cuff-based estimation of PP-C by a generalized transfer function (GTF) or a novel pulse wave analysis (PWA) approach to directly estimate PP-C. METHODS Invasive high-fidelity right brachial and central aortic pressure tracings, and left brachial pulse volume plethysmography (PVP) waveforms from an oscillometric blood pressure (BP) monitor were all digitized simultaneously in 40 patients during cardiac catheterization. An aortic-to-brachial GTF and a PWA multivariate prediction model using the PVP waveforms calibrated to brachial cuff systolic BP (SBP) and diastolic BP(DBP) were constructed. Accuracy of the two methods was examined in another 100 patients against invasively measured PP-C. RESULTS The error of cuff PP in estimating PP-C was 1.8 ± 12.4 mm Hg. Application of the GTF on noninvasively calibrated PVP waveforms produced reconstructed aortic pressure waves and PP-C estimates with errors of -3.4 ± 11.6 mm Hg (PP-C = reconstructed aortic SBP - aortic DBP) and -2.3 ± 11.4 mm Hg (PP-C = reconstructed aortic SBP - cuff DBP), respectively. The observed systematic errors were proportional to the magnitudes of PP-C. In contrast, the error of the PWA prediction model was 3.0 ± 7.1 mm Hg without obvious proportional systematic error. CONCLUSIONS Large random and systematic errors are introduced into the PP-C estimates when PP-C is calculated as the difference between the estimated central SBP and central or cuff DBP. The accuracy can be improved substantially with the novel PWA approach.
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Nation DA, Delano-Wood L, Bangen KJ, Wierenga CE, Jak AJ, Hansen LA, Galasko DR, Salmon DP, Bondi MW. Antemortem pulse pressure elevation predicts cerebrovascular disease in autopsy-confirmed Alzheimer's disease. J Alzheimers Dis 2012; 30:595-603. [PMID: 22451309 DOI: 10.3233/jad-2012-111697] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Elevated pulse pressure (PP) is associated with cognitive decline and increased risk of Alzheimer's disease (AD) in older adults, although the mechanisms behind these associations remain unclear. To address this question, we examined whether antemortem late-life PP elevation predicted vascular or AD pathology in autopsy-confirmed AD patients. Sixty-five elderly patients (mean age 74.2 years) clinically diagnosed with possible or probable AD underwent neuropsychological testing and blood pressure examinations. Postmortem histopathological measures of cerebrovascular disease (CVD) and AD neuropathology were later obtained on these same patients. We expected that antemortem PP elevation, but not standard blood pressure measures such as systolic or diastolic blood pressure, would predict the autopsy-based presence of CVD, and possibly AD pathology, in elderly AD patients. Results demonstrated that antemortem PP elevation was associated with the presence and severity of CVD at autopsy. For every 5 mmHg increase in antemortem PP there was an estimated 36% increase in the odds of having CVD at autopsy. Additionally, PP accounted for 12% of variance in CVD severity. No significant associations were present for cerebral amyloid angiopathy or Braak and Braak staging of the severity of AD pathology. Other standard blood pressure measures also did not significantly predict neuropathology. The association between antemortem PP and CVD at autopsy suggests that in older adults with AD, PP elevation may increase the risk of CVD. These findings may have treatment implications since some antihypertensive medications specifically address the pulsatile component of blood pressure (e.g., renin-angiotensin system inhibitors, calcium channel blockers).
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Affiliation(s)
- Daniel A Nation
- Veterans Affairs San Diego Healthcare System, San Diego, CA 92161, USA
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Jankowski P, Czarnecka D. Pulse pressure, blood flow, and atherosclerosis. Am J Hypertens 2012; 25:1040-1. [PMID: 22983362 DOI: 10.1038/ajh.2012.117] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
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Choi J, Lee J, Park SB, Lee KS, Sung KR, Kook MS. Factors affecting ocular pulse amplitude in eyes with open angle glaucoma and glaucoma-suspect eyes. Acta Ophthalmol 2012; 90:552-8. [PMID: 20560890 DOI: 10.1111/j.1755-3768.2010.01954.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
PURPOSE To investigate the associations between ocular pulse amplitude (OPA) as measured by dynamic contour tonometry (DCT) and ocular and systemic factors in patients with open angle glaucoma (OAG) and in glaucoma suspects. METHODS One hundred and seventy-three glaucoma-suspect patients were consecutively enrolled. All subjects underwent intraocular pressure (IOP) measurement by DCT and Goldmann applanation tonometry (GAT), OPA measurement by DCT, Humphrey visual field (HVF) examination and central corneal thickness measurements. Arterial pulse amplitude (APA) and ocular perfusion pressure (OPP) were defined as the difference between systolic and diastolic BP and the difference between mean arterial pressure and IOP, respectively. All subjects also completed a systemized questionnaire on systemic vascular morbidities. RESULTS Seventy-four eyes were diagnosed with OAG, based on HVF results. The overall mean CCT was 538.2±37.6 μm. In all 173 eyes, OPA was associated with spherical equivalent (SE, p<0.001) and with IOP by GAT (p=0.013) by multivariate analysis. Multivariate analysis of the 77 subgroup eyes of patients for whom BP parameters were available also revealed that OPA was associated with SE (p=0.007) and with IOP by GAT (p<0.001). When the subjects were classified into the groups with low, intermediate and high cardiovascular risk based on the questionnaire, there was no difference in OPA among these groups (p>0.05). CONCLUSIONS Ocular pulse amplitude was associated with IOP measured by GAT and SE in patients with OAG and in glaucoma suspects. There was neither significant correlation between systemic hemodynamic parameters and OPA, nor difference of OPA in patients with different cardiovascular risk. OPA is primarily a measure of pressure, and there are certain limitations towards its use as a hemodynamic index.
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Aliskiren inhibits atherosclerosis development and improves plaque stability in APOE*3Leiden.CETP transgenic mice with or without treatment with atorvastatin. J Hypertens 2012; 30:107-16. [DOI: 10.1097/hjh.0b013e32834ddd8e] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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Arterial stiffness, pulse pressure, and cardiovascular disease—Is it possible to break the vicious circle? Atherosclerosis 2011; 218:263-71. [DOI: 10.1016/j.atherosclerosis.2011.04.039] [Citation(s) in RCA: 148] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2010] [Revised: 04/26/2011] [Accepted: 04/27/2011] [Indexed: 01/02/2023]
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Heffernan KS, Ranadive S, Weikert M, Lane A, Yan H, Fernhall B, Motl RW. Pulse pressure is associated with walking impairment in multiple sclerosis. J Neurol Sci 2011; 309:105-9. [PMID: 21821264 DOI: 10.1016/j.jns.2011.07.004] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2011] [Revised: 06/30/2011] [Accepted: 07/05/2011] [Indexed: 10/17/2022]
Abstract
Persons with multiple sclerosis (MS) have reduced gait performance and this is associated with disability and disease progression. The current study sought to test the hypothesis that higher central (aortic and carotid) and peripheral (brachial) pulse pressure (PP), manifestations of ventricular-vascular uncoupling related to increased arterial stiffness and pressure from wave reflections, would be associated with reduced gait performance in persons with MS. Participants consisted of 33 individuals with MS and 33 age/sex matched controls. Central blood pressure (BP) was assessed via applanation tonometry. Brachial BP was measured using an automated oscillometric cuff. PP was defined as systolic BP--diastolic BP. Gait performance was measured as 6-minute walk (6 MW) distance. Within the sample with MS, the 6 MW distance was significantly associated with brachial (r = -.49, p<.005), aortic (r = -.52, p<.001), and carotid (r = -.57, p<.001) pulse pressure. There was no association between any PP measure and 6 MW distance in controls (p>0.05 for all). In conclusion, PP is a predictor of gait performance in persons with MS. These findings suggest that vascular senescence and altered ventricular-vascular coupling may contribute, in part, to the deterioration of physical function in persons with MS.
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Affiliation(s)
- Kevin S Heffernan
- Department of Exercise Science, Syracuse University, Syracuse, NY, USA
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Michell A, Bodey A, Caulfield M. Evolution, essential hypertension and the high arterial pressures in certain athletic breeds of dogs. Vet J 2011; 188:125-7. [DOI: 10.1016/j.tvjl.2011.03.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2010] [Revised: 03/11/2011] [Accepted: 03/12/2011] [Indexed: 11/16/2022]
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Cho SW, Kim BO, Kim JH, Byun YS, Goh CW, Rhee KJ, Kim HK. The relation of non-invasively and invasively assessed aortic pulsatile indices to the presence and severity of coronary artery disease. Blood Press 2011; 20:309-16. [DOI: 10.3109/08037051.2011.570055] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Safar ME, Jankowski P. Antihypertensive therapy and de-stiffening of the arteries. Expert Opin Pharmacother 2010; 11:2625-34. [DOI: 10.1517/14656566.2010.496452] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
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Abstract
Recent research suggests that pulse pressure (PP), a putative marker of vascular integrity, may be associated with brain microvascular damage and age-related cognitive decline. Thus, the present study examined the relationship between PP and cognition in a sample of healthy nondemented older adults. One hundred nine participants were administered neurological and neuropsychological evaluations and determined to be nondemented. Regression analyses were used to examine the relationships among pulse pressure (PP) [systolic blood pressure (SBP)--diastolic blood pressure (DBP)], age, and cognition. PP and related measures were inversely correlated with global cognitive functioning and scores on a composite measure of language function, even after adjusting for age, education, and relevant vascular risk factors. Results indicate that increases in the pulsatile component of blood pressure may convey added risk of global cognitive decline and specific impairment in language abilities.
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Subherwal S, de las Fuentes L, Waggoner AD, Heuerman S, Spence KE, Davila-Roman VG. Central aortic pressure is independently associated with diastolic function. Am Heart J 2010; 159:1081-8. [PMID: 20569723 DOI: 10.1016/j.ahj.2010.02.024] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2009] [Accepted: 02/24/2010] [Indexed: 11/17/2022]
Abstract
BACKGROUND Studies investigating the association between central aortic pressures and diastolic function have been limited. METHODS Consecutive ambulatory patients (n = 281, mean age 49 +/- 13 years, 49% male) with normal left ventricular (LV) systolic function were included. The LV filling pressure (E/Em) was estimated by Doppler-derived ratio of mitral inflow velocity (E) to septal (Em) by tissue Doppler, LV relaxation by Em, and central aortic pressures by radial tonometry. Central aortic systolic (cSBP), diastolic (cDBP), mean (cMAP) and pulse pressure (cPP) were entered individually into stepwise linear regression models to determine their association with E/Em or Em. RESULTS In univariate analysis, cPP correlated most strongly with E/Em (Spearman's rho = 0.45, P < .001), whereas cSBP correlated most strongly with Em (Spearman's rho = -0.51, P < .001). Multivariate analysis demonstrated that the pulsatile component of afterload, cPP, contributed most to E/Em (partial r(2) = 23%); meanwhile, the nonpulsatile components (cDBP and cMAP) were significant but small contributors (partial r(2) of 6% and 5%, respectively) of LV relaxation (Em). CONCLUSION The nonpulsatile components of aortic afterload (cMAP and cDBP) exhibited a weak but significant association with LV relaxation, whereas the pulsatile component of afterload, cPP, exhibited strong association with LV filling pressure.
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Advance of studies on anti-atherosclerosis mechanism of berberine. Chin J Integr Med 2010; 16:188-92. [PMID: 20473748 DOI: 10.1007/s11655-010-0188-7] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2008] [Indexed: 02/07/2023]
Abstract
Coptis Chinensis is a traditional Chinese medicine herb that has the effect of clearing heat and drying dampness, purging fire to eliminate toxin. Berberine is the main alkaloid of Coptis Chinensis, and, recent researches showed that berberine had the effect of anti-atherosclerosis. This paper reviewed the anti-atherosclerosis mechanism of berberine, which may be related to regulating lipids, anti-inflammation, decompression, reducing blood sugar, and inhibiting vascular smooth muscle cell proliferation.
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Temmar M, Jankowski P, Peltier M, Mouquet V, Dębicka-Dąbrowska D, Hamida F, Kawecka-Jaszcz K, Safar ME. Intraaortic Pulse Pressure Amplification in Subjects at High Coronary Risk. Hypertension 2010; 55:327-32. [DOI: 10.1161/hypertensionaha.109.142851] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Mohamed Temmar
- From the Division of Clinical Pharmacology and Cardiology (M.T.) and Department of Cardiology (M.P., V.M.), Amiens University South Hospital, INSERM ERI 12, Amiens, France; Le Telomere Cardiology Center of Ghardaïa (M.T.), Ghardaïa, Algeria; I Department of Cardiology and Hypertension (P.J., D.D.-D., K.K.-J.), Institute of Cardiology, Jagiellonian University Medical College, Kraków, Poland; Department of Cardiology (F.H.), Blida University Hospital, Blida, Algeria; Assistance Publique-Hôpitaux
| | - Piotr Jankowski
- From the Division of Clinical Pharmacology and Cardiology (M.T.) and Department of Cardiology (M.P., V.M.), Amiens University South Hospital, INSERM ERI 12, Amiens, France; Le Telomere Cardiology Center of Ghardaïa (M.T.), Ghardaïa, Algeria; I Department of Cardiology and Hypertension (P.J., D.D.-D., K.K.-J.), Institute of Cardiology, Jagiellonian University Medical College, Kraków, Poland; Department of Cardiology (F.H.), Blida University Hospital, Blida, Algeria; Assistance Publique-Hôpitaux
| | - Marcel Peltier
- From the Division of Clinical Pharmacology and Cardiology (M.T.) and Department of Cardiology (M.P., V.M.), Amiens University South Hospital, INSERM ERI 12, Amiens, France; Le Telomere Cardiology Center of Ghardaïa (M.T.), Ghardaïa, Algeria; I Department of Cardiology and Hypertension (P.J., D.D.-D., K.K.-J.), Institute of Cardiology, Jagiellonian University Medical College, Kraków, Poland; Department of Cardiology (F.H.), Blida University Hospital, Blida, Algeria; Assistance Publique-Hôpitaux
| | - Vincent Mouquet
- From the Division of Clinical Pharmacology and Cardiology (M.T.) and Department of Cardiology (M.P., V.M.), Amiens University South Hospital, INSERM ERI 12, Amiens, France; Le Telomere Cardiology Center of Ghardaïa (M.T.), Ghardaïa, Algeria; I Department of Cardiology and Hypertension (P.J., D.D.-D., K.K.-J.), Institute of Cardiology, Jagiellonian University Medical College, Kraków, Poland; Department of Cardiology (F.H.), Blida University Hospital, Blida, Algeria; Assistance Publique-Hôpitaux
| | - Dorota Dębicka-Dąbrowska
- From the Division of Clinical Pharmacology and Cardiology (M.T.) and Department of Cardiology (M.P., V.M.), Amiens University South Hospital, INSERM ERI 12, Amiens, France; Le Telomere Cardiology Center of Ghardaïa (M.T.), Ghardaïa, Algeria; I Department of Cardiology and Hypertension (P.J., D.D.-D., K.K.-J.), Institute of Cardiology, Jagiellonian University Medical College, Kraków, Poland; Department of Cardiology (F.H.), Blida University Hospital, Blida, Algeria; Assistance Publique-Hôpitaux
| | - Farah Hamida
- From the Division of Clinical Pharmacology and Cardiology (M.T.) and Department of Cardiology (M.P., V.M.), Amiens University South Hospital, INSERM ERI 12, Amiens, France; Le Telomere Cardiology Center of Ghardaïa (M.T.), Ghardaïa, Algeria; I Department of Cardiology and Hypertension (P.J., D.D.-D., K.K.-J.), Institute of Cardiology, Jagiellonian University Medical College, Kraków, Poland; Department of Cardiology (F.H.), Blida University Hospital, Blida, Algeria; Assistance Publique-Hôpitaux
| | - Kalina Kawecka-Jaszcz
- From the Division of Clinical Pharmacology and Cardiology (M.T.) and Department of Cardiology (M.P., V.M.), Amiens University South Hospital, INSERM ERI 12, Amiens, France; Le Telomere Cardiology Center of Ghardaïa (M.T.), Ghardaïa, Algeria; I Department of Cardiology and Hypertension (P.J., D.D.-D., K.K.-J.), Institute of Cardiology, Jagiellonian University Medical College, Kraków, Poland; Department of Cardiology (F.H.), Blida University Hospital, Blida, Algeria; Assistance Publique-Hôpitaux
| | - Michel E. Safar
- From the Division of Clinical Pharmacology and Cardiology (M.T.) and Department of Cardiology (M.P., V.M.), Amiens University South Hospital, INSERM ERI 12, Amiens, France; Le Telomere Cardiology Center of Ghardaïa (M.T.), Ghardaïa, Algeria; I Department of Cardiology and Hypertension (P.J., D.D.-D., K.K.-J.), Institute of Cardiology, Jagiellonian University Medical College, Kraków, Poland; Department of Cardiology (F.H.), Blida University Hospital, Blida, Algeria; Assistance Publique-Hôpitaux
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Van Herck JL, De Meyer GRY, Martinet W, Van Hove CE, Foubert K, Theunis MH, Apers S, Bult H, Vrints CJ, Herman AG. Impaired fibrillin-1 function promotes features of plaque instability in apolipoprotein E-deficient mice. Circulation 2010; 120:2478-87. [PMID: 19948973 DOI: 10.1161/circulationaha.109.872663] [Citation(s) in RCA: 67] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
BACKGROUND Arterial stiffness has been associated with an increased cardiovascular risk. The aim of this study was to investigate the interaction between arterial stiffness and atherosclerosis. METHODS AND RESULTS Mice with a mutation C1039G+/-) in the fibrillin-1 gene leading to fragmentation of the elastic fibers were crossbred with apolipoprotein E-deficient (ApoE-/-) mice. Subsequently, ApoE-/- and ApoE-/-C1039G+/- mice were fed a Western-type diet for 10 or 20 weeks. Our results show that the interaction between arterial stiffness and atherosclerosis is bidirectional. On the one hand, arterial stiffness in ApoE-/-C1039G+/- mice increased more rapidly in the presence of atherosclerotic plaques. On the other hand, arterial stiffness promoted the development of larger and more unstable plaques in ApoE-/-C1039G+/- mice. The plaque area at the aortic root was increased 1.5- and 2.1-fold in ApoE-/-C1039G+/- mice after 10 and 20 weeks of Western-type diet, respectively. After 10 weeks of Western-type diet, plaques of ApoE-/-C1039G+/- mice showed increased apoptosis of smooth muscle cells, which was associated with a decrease in collagen content, an enlargement of the necrotic core, and an increase in macrophages. After 20 weeks of Western-type diet, the number of buried fibrous caps was increased in atherosclerotic lesions of ApoE-/-C1039G+/- mice, not only at the level of the aortic valves but also in the brachiocephalic artery and in the upper, middle, and lower thoracic aorta. Furthermore, acute plaque rupture was observed. CONCLUSIONS These results indicate that fragmentation of the elastic fibers leads to increased vascular stiffness, which promotes features of multifocal plaque instability.
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Affiliation(s)
- Jozef L Van Herck
- Antwerp University Hospital, Division of Cardiology, Wilrijkstraat 10, B-2650 Edegem, Belgium.
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Cyclic stretch downregulates arterial vascular connexin43 protein expression: an ex vivo study. Biomech Model Mechanobiol 2009; 9:203-11. [DOI: 10.1007/s10237-009-0171-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2009] [Accepted: 08/10/2009] [Indexed: 11/26/2022]
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Mechanotransduction in vascular physiology and atherogenesis. Nat Rev Mol Cell Biol 2009; 10:53-62. [PMID: 19197332 DOI: 10.1038/nrm2596] [Citation(s) in RCA: 805] [Impact Index Per Article: 53.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Forces that are associated with blood flow are major determinants of vascular morphogenesis and physiology. Blood flow is crucial for blood vessel development during embryogenesis and for regulation of vessel diameter in adult life. It is also a key factor in atherosclerosis, which, despite the systemic nature of major risk factors, occurs mainly in regions of arteries that experience disturbances in fluid flow. Recent data have highlighted the potential endothelial mechanotransducers that might mediate responses to blood flow, the effects of atheroprotective rather than atherogenic flow, the mechanisms that contribute to the progression of the disease and how systemic factors interact with flow patterns to cause atherosclerosis.
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Central blood pressure and hypertension: role in cardiovascular risk assessment. Clin Sci (Lond) 2009; 116:273-82. [DOI: 10.1042/cs20080072] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Although the differences between central and peripheral BP (blood pressure) have been known for decades, the consequences of decision-making based on peripheral rather than central BP have only recently been recognized. The influence of cyclic stretch (owing to cyclic changes in BP) on the aortic wall in atherosclerosis has been documented at every stage of its development. Apart from mediating atherosclerosis progression and plaque instability, the pulsatile component of BP is the main mechanism leading to plaque rupture and, consequently, to acute coronary syndromes and other vascular complications. The principal goal of the present review is to evaluate the role of central BP measurements, principally systolic and pulse pressure, for cardiovascular risk assessment. Recent findings suggest that the pulsatile component of BP (when represented by central pulse pressure or central pulsatility) is one of the most important factors determining event-free survival. Results of several prospective studies (using both invasive and non-invasive measurements of central BP) indicate not only an independent predictive value of central pulse pressure, but also its advantage over brachial pressure. Recent evidence suggests that some antihypertensive drugs can influence central BP more consistently when compared with peripheral BP. This is especially true for agents acting on the renin–angiotensin system. Nevertheless, large prospective studies aiming at the comparison of the predictive value of peripheral and central BP in the general population, as well as studies comparing the effectiveness of hypertension management based on peripheral compared with central BP measurements, are needed before algorithms based on central BP can be recommended for clinical practice.
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Hahn C, Schwartz MA. The role of cellular adaptation to mechanical forces in atherosclerosis. Arterioscler Thromb Vasc Biol 2008; 28:2101-7. [PMID: 18787190 DOI: 10.1161/atvbaha.108.165951] [Citation(s) in RCA: 69] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Atherosclerosis is a chronic inflammatory disease that originates at regions of arteries exposed to disturbances in fluid flow and results in progressive plaque formation in those areas. Recent work on cellular responses to flow has identified potential mechanosensors and pathways that may influence disease progression. These results led us to hypothesize that the same mechanisms that mediate adaptive responses in the vasculature become maladaptive at sites of disturbed flow. Subsequent changes in gene expression and matrix remodeling help to entrain these inflammatory pathways. These events synergize with systemic risk factors such as hyperlipidemia, smoking, and diabetes, leading to disease progression.
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Affiliation(s)
- Cornelia Hahn
- Department of Microbiology, Robert M. Berne Cardiovascular Research Center, University of Virginia, Charlottesville, VA 22908, USA
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Jankowski P, Kawecka-Jaszcz K. Response to Central Pulse Pressure: Is It Really an Independent Predictor of Cardiovascular Risk? Hypertension 2008. [DOI: 10.1161/hypertensionaha.108.115295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Piotr Jankowski
- Department of Cardiology and Hypertension, Jagiellonian University, Medical College, Kraków, Poland
| | - Kalina Kawecka-Jaszcz
- Department of Cardiology and Hypertension, Jagiellonian University, Medical College, Kraków, Poland
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Jankowski P, Kawecka-Jaszcz K, Czarnecka D, Brzozowska-Kiszka M, Styczkiewicz K, Loster M, Kloch-Badełek M, Wiliński J, Curyło AM, Dudek D. Pulsatile but not steady component of blood pressure predicts cardiovascular events in coronary patients. Hypertension 2008; 51:848-55. [PMID: 18268136 DOI: 10.1161/hypertensionaha.107.101725] [Citation(s) in RCA: 205] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Although the differences between central and peripheral blood pressure (BP) values have been known for decades, the consequences of decision making based on peripheral rather than central BP have only recently been recognized. There are only a few studies assessing the relationship between intraaortic BP and cardiovascular risk. In addition, the relationship between central BP and the risk of cardiovascular events in a large group of coronary patients has not yet been evaluated. Therefore, the aim of the study was to determine the prognostic significance of central BP-derived indices in patients undergoing coronary angiography. Invasive central BPs were taken at baseline, and study end points were ascertained during over a 4.5-year follow-up in 1109 consecutive patients. The primary end point (cardiovascular death or myocardial infarction or stroke or cardiac arrest or heart transplantation or myocardial revascularization) occurred in 246 (22.2%) patients. Central pulsatility was the most powerful predictor of the primary end point (hazard ratio [HR] 1.30, 95% confidence interval [CI] 1.14 to 1.48). Central pulse pressure was also independently related to the primary end point (HR 1.25, 95% CI 1.09 to 1.43). Central mean BP as well as peripheral BP parameters were not independently related to the primary end point risk. Central pulsatility was also related to risk of cardiovascular death or myocardial infarction or stroke. The pulsatile component of BP is the most important factor related to the cardiovascular risk in coronary patients. It is more closely associated with cardiovascular risk than steady component of BP.
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Affiliation(s)
- Piotr Jankowski
- I Department of Cardiology and Hypertension, Collegium Medicum Jagiellonian University, Kraków, Poland.
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