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Lin M, Zhang Z, Gao X, Bian Y, Wu RS, Park G, Lou Z, Zhang Z, Xu X, Chen X, Kang A, Yang X, Yue W, Yin L, Wang C, Qi B, Zhou S, Hu H, Huang H, Li M, Gu Y, Mu J, Yang A, Yaghi A, Chen Y, Lei Y, Lu C, Wang R, Wang J, Xiang S, Kistler EB, Vasconcelos N, Xu S. A fully integrated wearable ultrasound system to monitor deep tissues in moving subjects. Nat Biotechnol 2024; 42:448-457. [PMID: 37217752 DOI: 10.1038/s41587-023-01800-0] [Citation(s) in RCA: 28] [Impact Index Per Article: 28.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Accepted: 04/21/2023] [Indexed: 05/24/2023]
Abstract
Recent advances in wearable ultrasound technologies have demonstrated the potential for hands-free data acquisition, but technical barriers remain as these probes require wire connections, can lose track of moving targets and create data-interpretation challenges. Here we report a fully integrated autonomous wearable ultrasonic-system-on-patch (USoP). A miniaturized flexible control circuit is designed to interface with an ultrasound transducer array for signal pre-conditioning and wireless data communication. Machine learning is used to track moving tissue targets and assist the data interpretation. We demonstrate that the USoP allows continuous tracking of physiological signals from tissues as deep as 164 mm. On mobile subjects, the USoP can continuously monitor physiological signals, including central blood pressure, heart rate and cardiac output, for as long as 12 h. This result enables continuous autonomous surveillance of deep tissue signals toward the internet-of-medical-things.
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Affiliation(s)
- Muyang Lin
- Department of Nanoengineering, University of California San Diego, La Jolla, CA, USA
| | - Ziyang Zhang
- Department of Computer Science Engineering, University of California San Diego, La Jolla, CA, USA
| | - Xiaoxiang Gao
- Department of Nanoengineering, University of California San Diego, La Jolla, CA, USA
| | - Yizhou Bian
- Department of Nanoengineering, University of California San Diego, La Jolla, CA, USA
| | - Ray S Wu
- Department of Nanoengineering, University of California San Diego, La Jolla, CA, USA
| | - Geonho Park
- Department of Nanoengineering, University of California San Diego, La Jolla, CA, USA
| | - Zhiyuan Lou
- Department of Nanoengineering, University of California San Diego, La Jolla, CA, USA
| | - Zhuorui Zhang
- Department of Mechanical Engineering, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Xiangchen Xu
- Department of Nanoengineering, University of California San Diego, La Jolla, CA, USA
| | - Xiangjun Chen
- Materials Science and Engineering Program, University of California San Diego, La Jolla, CA, USA
| | - Andrea Kang
- Department of Electrical and Computer Engineering, University of California San Diego, La Jolla, CA, USA
| | - Xinyi Yang
- Materials Science and Engineering Program, University of California San Diego, La Jolla, CA, USA
| | - Wentong Yue
- Department of Nanoengineering, University of California San Diego, La Jolla, CA, USA
| | - Lu Yin
- Department of Nanoengineering, University of California San Diego, La Jolla, CA, USA
| | - Chonghe Wang
- Department of Mechanical Engineering, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Baiyan Qi
- Materials Science and Engineering Program, University of California San Diego, La Jolla, CA, USA
| | - Sai Zhou
- Materials Science and Engineering Program, University of California San Diego, La Jolla, CA, USA
| | - Hongjie Hu
- Department of Nanoengineering, University of California San Diego, La Jolla, CA, USA
| | - Hao Huang
- Department of Nanoengineering, University of California San Diego, La Jolla, CA, USA
| | - Mohan Li
- Department of Electrical and Computer Engineering, University of California San Diego, La Jolla, CA, USA
| | - Yue Gu
- Materials Science and Engineering Program, University of California San Diego, La Jolla, CA, USA
- Department of Neurosurgery, Yale University, New Haven, CT, USA
| | - Jing Mu
- Materials Science and Engineering Program, University of California San Diego, La Jolla, CA, USA
| | - Albert Yang
- Department of Bioengineering, University of California San Diego, La Jolla, CA, USA
| | - Amer Yaghi
- Department of Nanoengineering, University of California San Diego, La Jolla, CA, USA
| | - Yimu Chen
- Department of Nanoengineering, University of California San Diego, La Jolla, CA, USA
| | - Yusheng Lei
- Department of Nanoengineering, University of California San Diego, La Jolla, CA, USA
- Department of Chemical Engineering, Stanford University, Stanford, CA, USA
| | - Chengchangfeng Lu
- Department of Electrical and Computer Engineering, University of California San Diego, La Jolla, CA, USA
| | - Ruotao Wang
- Department of Nanoengineering, University of California San Diego, La Jolla, CA, USA
| | - Joseph Wang
- Department of Nanoengineering, University of California San Diego, La Jolla, CA, USA
| | | | - Erik B Kistler
- Department of Bioengineering, University of California San Diego, La Jolla, CA, USA
- Department of Anesthesiology and Critical Care, University of California San Diego, La Jolla, CA, USA
| | - Nuno Vasconcelos
- Department of Electrical and Computer Engineering, University of California San Diego, La Jolla, CA, USA
| | - Sheng Xu
- Department of Nanoengineering, University of California San Diego, La Jolla, CA, USA.
- Materials Science and Engineering Program, University of California San Diego, La Jolla, CA, USA.
- Department of Electrical and Computer Engineering, University of California San Diego, La Jolla, CA, USA.
- Department of Bioengineering, University of California San Diego, La Jolla, CA, USA.
- Department of Radiology, School of Medicine, University of California San Diego, La Jolla, CA, USA.
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Bauer P, Tello K, Kraushaar L, Dörr O, Keranov S, Husain-Syed F, Nef H, Hamm CW, Most A. Normative values of non-invasively assessed RV function and pulmonary circulation coupling for pre-participation screening derived from 497 male elite athletes. Clin Res Cardiol 2023; 112:1362-1371. [PMID: 36102951 PMCID: PMC10562270 DOI: 10.1007/s00392-022-02099-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2022] [Accepted: 09/02/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Reference values for right ventricular function and pulmonary circulation coupling were recently established for the general population. However, normative values for elite athletes are missing, even though exercise-related right ventricular enlargement is frequent in competitive athletes. METHODS We examined 497 healthy male elite athletes (age 26.1 ± 5.2 years) of mixed sports with a standardized transthoracic echocardiographic examination. Tricuspid annular plane excursion (TAPSE) and systolic pulmonary artery pressure (SPAP) were measured. Pulmonary circulation coupling was calculated as TAPSE/SPAP ratio. Two age groups were defined (18-29 years and 30-39 years) and associations of clinical parameters with the TAPSE/SPAP ratio were determined and compared for each group. RESULTS Athletes aged 18-29 (n = 349, 23.8 ± 3.5 years) displayed a significantly lower TAPSE/SPAP ratio (1.23 ± 0.3 vs. 1.31 ± 0.33 mm/mmHg, p = 0.039), TAPSE/SPAP to body surface area (BSA) ratio (0.56 ± 0.14 vs. 0.6 ± 0.16 mm*m2/mmHg, p = 0.017), diastolic blood pressure (75.6 ± 7.9 vs. 78.8 ± 10.7 mmHg, p < 0.001), septal wall thickness (10.2 ± 1.1 vs. 10.7 ± 1.1 mm, p = 0.013) and left atrial volume index (27.5 ± 4.5 vs. 30.8 ± 4.1 ml/m2, p < 0.001), but a higher SPAP (24.2 ± 4.5 vs. 23.2 ± 4.4 mmHg, p = 0.035) compared to athletes aged 30-39 (n = 148, 33.1 ± 3.4 years). TAPSE was not different between the age groups. The TAPSE/SPAP ratio was positively correlated with left ventricular stroke volume (r = 0.133, p = 0.018) and training amount per week (r = 0.154, p = 0.001) and negatively correlated with E/E' lat. (r = -0.152, p = 0.005). CONCLUSION The reference values for pulmonary circulation coupling determined in this study could be used to interpret and distinguish physiological from pathological cardiac remodeling in male elite athletes.
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Affiliation(s)
- Pascal Bauer
- Department of Cardiology and Angiology, Justus-Liebig-University Giessen, 35390, Giessen, Germany.
| | - Khodr Tello
- Department of Internal Medicine, Member of the German Center for Lung Research, Universities of Giessen and Marburg Lung Center, Justus-Liebig-University Giessen, Giessen, Germany
| | | | - Oliver Dörr
- Department of Cardiology and Angiology, Justus-Liebig-University Giessen, 35390, Giessen, Germany
| | - Stanislav Keranov
- Department of Cardiology and Angiology, Justus-Liebig-University Giessen, 35390, Giessen, Germany
| | - Faeq Husain-Syed
- Department of Internal Medicine, Member of the German Center for Lung Research, Universities of Giessen and Marburg Lung Center, Justus-Liebig-University Giessen, Giessen, Germany
| | - Holger Nef
- Department of Cardiology and Angiology, Justus-Liebig-University Giessen, 35390, Giessen, Germany
| | - Christian W Hamm
- Department of Cardiology and Angiology, Justus-Liebig-University Giessen, 35390, Giessen, Germany
- Department of Cardiology, Kerckhoff Clinic GmbH, Bad Nauheim, Germany
| | - Astrid Most
- Department of Cardiology and Angiology, Justus-Liebig-University Giessen, 35390, Giessen, Germany
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Bonfioli GB, Rodella L, Rosati R, Carrozza A, Metra M, Vizzardi E. Aortopathies: From Etiology to the Role of Arterial Stiffness. J Clin Med 2023; 12:3949. [PMID: 37373642 DOI: 10.3390/jcm12123949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Revised: 06/05/2023] [Accepted: 06/06/2023] [Indexed: 06/29/2023] Open
Abstract
The aorta and aortic wall have a complex biological system of structural, biochemical, biomolecular, and hemodynamic elements. Arterial stiffness could be considered a manifestation of wall structural and functional variations, and it has been revealed to have a strong connection with aortopathies and be a predictor of cardiovascular risk, especially in patients affected by hypertension, diabetes mellitus, and nephropathy. Stiffness affects the function of different organs, especially the brain, kidneys, and heart, promoting remodeling of small arteries and endothelial dysfunction. This parameter could be easily evaluated using different methods, but pulse-wave velocity (PWV), the speed of transmission of arterial pressure waves, is considered the gold standard for a good and precise assessment. An increased PWV value indicates an elevated level of aortic stiffness because of the decline in elastin synthesis and activation of proteolysis and the increase in fibrosis that contributes to parietal rigidity. Higher values of PWV could also be found in some genetic diseases, such as Marfan syndrome (MFS) or Loeys-Dietz syndrome (LDS). Aortic stiffness has emerged as a major new cardiovascular disease (CVD) risk factor, and its evaluation using PWV could be very useful to identify patients with a high cardiovascular risk, giving some important prognostic information but also being used to value the benefits of therapeutic strategies.
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Affiliation(s)
- Giovanni Battista Bonfioli
- Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, ASST Spedali Civili di Brescia, Cardiology University of Brescia, 25123 Brescia, Italy
| | - Luca Rodella
- Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, ASST Spedali Civili di Brescia, Cardiology University of Brescia, 25123 Brescia, Italy
| | - Roberta Rosati
- Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, ASST Spedali Civili di Brescia, Cardiology University of Brescia, 25123 Brescia, Italy
| | - Alberto Carrozza
- Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, ASST Spedali Civili di Brescia, Cardiology University of Brescia, 25123 Brescia, Italy
| | - Marco Metra
- Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, ASST Spedali Civili di Brescia, Cardiology University of Brescia, 25123 Brescia, Italy
| | - Enrico Vizzardi
- Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, ASST Spedali Civili di Brescia, Cardiology University of Brescia, 25123 Brescia, Italy
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4
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Non-invasive assessment of ventricular-arterial coupling: correlation between myocardial work and the pulse wave velocity parameters. COR ET VASA 2023. [DOI: 10.33678/cor.2022.102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
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The Value of SIRT1/FOXO1 Signaling Pathway in Early Detection of Cardiovascular Risk in Children with β-Thalassemia Major. Biomedicines 2022; 10:biomedicines10102601. [PMID: 36289866 PMCID: PMC9599077 DOI: 10.3390/biomedicines10102601] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2022] [Revised: 10/10/2022] [Accepted: 10/11/2022] [Indexed: 11/25/2022] Open
Abstract
Background: Atherosclerosis represents one of the major causes of morbidity in children with β-thalassemia major (β-TM). Aim: This study was designed to investigate SIRT1-FOXO1 signaling in β-TM children and their role in early detection of premature atherosclerosis. Methods: We equally subdivided 100 Egyptian children aged 6−14 years with β-TM according to carotid intima media thickness (CIMT) into 50 with CIMT < 0.5 mm and 50 with CIMT ≥ 0.5 mm, and 50 healthy children of matched age were included. They were subjected to evaluation of SIRT1, heat shock protein 72 (HSP72), and hepcidin levels via ELISA and forkhead box protein 1 (FOXO1) mRNA expression using real-time PCR in PBMCs; meanwhile, malondialdehyde (MDA), superoxide dismutase (SOD), and catalase activities were evaluated spectrophotometrically. Results: Our results show significantly high values for CIMT, β-stiffness, atherogenic index of plasma (AIP), MDA, HSP72 and FOXO1, ferritin with significantly low hepcidin, SOD, catalase, and SIRT1 in β-TM as compared to controls with a more significant difference in β-TM with CIMT ≥ 0.5 mm than those with CIMT < 0.5 mm. A significant positive correlation between CIMT and MDA, HSP72, and FOXO1 gene expression was found, while a significant negative correlation with hepcidin, SOD, catalase, and SIRT1 was found. FOXO1 gene expression and HSP72 levels were the strongest independent determinants of CIMT. Conclusion: In β-TM, FOXO1 signaling is activated with low levels of SIRT1, and this is attributed to accelerated atherosclerosis in β-TM, which would be crucial in prediction of atherosclerosis.
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Zhou D, Xu R, Zhou J, Xie L, Xu G, Liu M, Zeng S. Aortic Elasticity and Cardiac Function in Fetuses With Aortic Coarctation. Front Cardiovasc Med 2022; 9:870683. [PMID: 35656404 PMCID: PMC9152082 DOI: 10.3389/fcvm.2022.870683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Accepted: 03/31/2022] [Indexed: 11/25/2022] Open
Abstract
Objective The purpose of the study was to observe the elasticity of the ascending aorta (AAo) in normal fetuses and fetuses with coarctation of the aorta (CoA) by M-mode echocardiography. Methods This was a prospective clinical study performed on 16 fetuses with CoA and 48 gestational-age matched normal fetuses. The minimum internal diameter in the diastolic phase (Dmin) and the maximum internal diameter in the systolic phase (Dmax) of the AAo were measured by M-mode echocardiography. The aortic strain was calculated using the formula 100 × (Dmax−Dmin)/Dmin). Doppler echocardiography was performed to measure the cardiac function parameters. Correlations between aortic strain and cardiac function were assessed in fetuses with CoA. Results The aortic strain of the ascending aorta in the fetuses with CoA was significantly lower than that in normal fetuses (18.12 ± 4.88% vs. 25.22 ± 4.92%, p < 0.01). The fetuses with CoA showed significantly higher combined cardiac output than the controls (471.89 ± 93.98 vs. 411.57 ± 46.35 ml/min/kg, p < 0.05). Compared with the normal group, the early diastolic velocities (E') and peak systolic velocities (S') of the left side were obviously decreased in the CoA group (p < 0.05), while the left early diastolic velocity ratio (E/E') was significantly increased in the fetuses with CoA (p < 0.01). For the fetuses with CoA, the aortic strain of the AAo was correlated with the left E/E' and S' (r = −0.522 and 0.504, respectively, P < 0.05). Conclusions The aortic strain of the ascending aorta was significantly decreased in fetuses with CoA in middle-late gestation. The impaired strain of the ascending aorta was correlated with the left ventricle function in the fetuses with CoA. These findings imply that the abnormalities of the intrinsic aortic wall of CoA might develop early in utero.
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Affiliation(s)
- Dan Zhou
- Department of Ultrasound Diagnosis, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Ran Xu
- Department of Urology, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Jiawei Zhou
- Department of Ultrasound Diagnosis, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Li Xie
- Department of Cardiology and Cardiovascular Surgery, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Ganqiong Xu
- Department of Ultrasound Diagnosis, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Minghui Liu
- Department of Ultrasound Diagnosis, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Shi Zeng
- Department of Ultrasound Diagnosis, The Second Xiangya Hospital, Central South University, Changsha, China
- *Correspondence: Shi Zeng
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Tso JV, Turner CG, Liu C, Ahmad S, Ali A, Selvaraj S, Galante A, Gilson CR, Clark C, Williams BR, Quyyumi AA, Baggish AL, Kim JH. Hypertension and Ventricular-Arterial Uncoupling in Collegiate American Football Athletes. J Am Heart Assoc 2022; 11:e023430. [PMID: 35199554 PMCID: PMC9075286 DOI: 10.1161/jaha.121.023430] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Ventricular–arterial (VA) coupling is defined as the ratio between arterial elastance (EA) and left ventricular elastance (ELV). VA uncoupling, as occurs in hypertensive heart disease, is associated with adverse outcomes. This study sought to determine the relationship between American football (AF)–associated hypertension and VA uncoupling. Methods and Results This was a multicenter, longitudinal, and repeated measures observational study of collegiate AF athletes across 3 years of AF participation. Of 200 freshman athletes initially enrolled, 142 (67 Black [47%]/75 White [53%], 58 linemen [41%]/84 nonlinemen [59%]) were prospectively studied with echocardiography and applanation tonometry. Primary echocardiographic VA coupling outcome measures were EA/ELV and ΔEA/ELV, with increased EA/ELV indicating VA uncoupling. Adjusting for race and player position, AF athletes demonstrated increased EA/ELV (mean [95% CI]Δ, 0.10 [0.04–0.15]; P=0.001) and systolic blood pressure (SBP) (mean [95% CI]Δ, 11.4 [8.3–14.5] mm Hg, P<0.001) over their collegiate AF careers. In combination with longitudinal VA uncoupling, hypertension prevalence (including both stage 1 and 2) increased from 54% at baseline to 77% (44% stage 2) at the end of the study period (P<0.001). In multivariable mixed‐effects linear regression analysis, higher SBP (β=0.021, P=0.02), lower E′ (β=−0.010, P=0.03), and worse global longitudinal strain (β=0.036, P<0.001) were associated with higher EA/ELV. Increased SBP (ΔSBP, β=0.029, P=0.02) and worsened global longitudinal strain (Δglobal longitudinal strain, β=0.045, P<0.001) also predicted increased ΔEA/ELV. Conclusions VA uncoupling is associated with pathologically increased SBP and subclinical impairments in left ventricular systolic function in collegiate AF athletes, indicating a key mechanism underlying maladaptive cardiovascular phenotypes observed in this population. Future studies analyzing whether targeted clinical interventions improve VA coupling and health outcomes are warranted.
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Affiliation(s)
- Jason V Tso
- Division of Cardiology Emory Clinical Cardiovascular Research Institute Atlanta GA
| | - Casey G Turner
- Division of Cardiology Emory Clinical Cardiovascular Research Institute Atlanta GA
| | - Chang Liu
- Division of Cardiology Emory Clinical Cardiovascular Research Institute Atlanta GA
| | - Syed Ahmad
- Division of Cardiology Emory Clinical Cardiovascular Research Institute Atlanta GA
| | - Abbas Ali
- Division of Cardiology Emory Clinical Cardiovascular Research Institute Atlanta GA
| | - Steve Selvaraj
- Division of Cardiology Emory Clinical Cardiovascular Research Institute Atlanta GA
| | - Angelo Galante
- Sports Medicine Georgia Institute of Technology Atlanta GA
| | - Carla R Gilson
- Sports Medicine Georgia Institute of Technology Atlanta GA
| | - Craig Clark
- Sports Medicine Furman University Greenville SC
| | - B Robinson Williams
- Division of Cardiology Emory Clinical Cardiovascular Research Institute Atlanta GA
| | - Arshed A Quyyumi
- Division of Cardiology Emory Clinical Cardiovascular Research Institute Atlanta GA
| | - Aaron L Baggish
- Cardiovascular Performance Program Massachusetts General Hospital Boston MA
| | - Jonathan H Kim
- Division of Cardiology Emory Clinical Cardiovascular Research Institute Atlanta GA.,Sports Medicine Georgia Institute of Technology Atlanta GA
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Duan Q, Zhang D, Dong Q, Liao K, Yang Y, Ye L, Ge P, Qin S. Impact of Brachial-Ankle Pulse Wave Velocity on Myocardial Work by Non-invasive Left Ventricular Pressure-Strain in Non-hypertensive and Hypertensive Patients With Preserved Left Ventricular Ejection Fraction. Front Cardiovasc Med 2022; 9:814326. [PMID: 35224047 PMCID: PMC8866308 DOI: 10.3389/fcvm.2022.814326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Accepted: 01/12/2022] [Indexed: 11/13/2022] Open
Abstract
Objective Data regarding the influence of arterial stiffness on myocardial work (MW) has been scarce. This study was performed to investigate the association between brachial-ankle pulse wave velocity (baPWV) and MW by non-invasive left ventricular pressure–strain in a population of non-hypertensive and hypertensive individuals. Methods Two hundred and eight participants (104 hypertensive and 104 non-hypertensive individuals) were prospectively enrolled into the study. All participants underwent conventional echocardiography, as well as 2D speckle-tracking echocardiography to assess MW by non-invasive left ventricular pressure–strain and global longitudinal strain (GLS). baPWV measurements were made at the same day as the echocardiography. Then, participants were categorized according to baPWV tertiles. Correlation between baPWV and MW were analyzed. Predicting ability of baPWV for abnormal WM was analyzed using receiver operating characteristic (ROC) curve. Results The median baPWV from the low to high tertile groups were 1286.5 (1197.5–1343.5), 1490.0 (1444.5–1544.0), and 1803.8(1708.3–1972.0) cm/s, respectively. In simple linear regression analysis, baPWV had a significant positive association with global work index (GWI), global constructed work (GCW), and global wasted work (GWW), and a negative association with global work efficiency (GWE). The association remained significant after adjusting for major confounding factors in multiple linear regression analysis. The areas under the ROC curve of baPWV for predicting abnormal GWI, GCW, GWW, and GWE were 0.653, 0.666, 0.725, and 0.688, respectively (all p < 0.05). Conclusions BaPWV is significantly associated with all four components of MW using non-invasive left ventricular pressure-strain method in a mixed population of non-hypertensive and hypertensive individuals.
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Affiliation(s)
- Qin Duan
- Department of Cardiology, The First Branch, The First Affiliated Hospital of Chongqing Medical University, Chognqing, China
| | - Dongying Zhang
- Department of Cardiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Qian Dong
- Department of Cardiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Kangla Liao
- Department of Cardiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Yunjin Yang
- Department of Cardiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Liu Ye
- Department of Cardiology, The First Branch, The First Affiliated Hospital of Chongqing Medical University, Chognqing, China
| | - Ping Ge
- Department of Cardiology, The First Branch, The First Affiliated Hospital of Chongqing Medical University, Chognqing, China
- *Correspondence: Ping Ge
| | - Shu Qin
- Department of Cardiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
- Shu Qin
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Lester GR, Abiusi FS, Bodner ME, Mittermaier PM, Cote AT. The Impact of Fitness Status on Vascular and Baroreceptor Function in Healthy Women and Men. J Vasc Res 2021; 59:16-23. [PMID: 34571505 DOI: 10.1159/000518985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Accepted: 08/10/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Chronic endurance exercise training elicits desirable physiological adaptations in the cardiovascular system. The volume of exercise training required to generate healthy adaptations is unclear. This study assessed the effects of differing exercise training levels on arterial stiffness, compliance, and autonomic function. METHODS Eighty healthy adults (38.5 ± 9.7 years; 44% female) defined as endurance-trained (ET, n = 29), normally active (NA, n = 27), or inactive (IN, n = 24) participated. Cardiovascular markers, including hemodynamics, large arterial compliance and small arterial compliance (LAC and SAC), carotid-femoral pulse wave velocity (PWV), and spontaneous baroreceptor sensitivity (BRS) were assessed. RESULTS ET showed significantly greater LAC values (21.4 ± 6.5) than NA (16.9 ± 2.5; p = 0.002) and IN (14.7 ± 3.2 mL × mm Hg × 10; p = 0.028). Values for SAC and BRS were significantly higher in ET than IN (p < 0.001 and p = 0.028, respectively), but not NA. Compared to IN, PWV values for ET and NA were significantly lower (p < 0.003). After adjusting for covariates (age, sex, and SBP), significant associations with cardiovascular fitness status were noted for all markers but BRS. CONCLUSION Endurance exercise increases LAC likely due to high-volume training; however, lower volumes of physical activity may be sufficient to positively benefit vascular health overall.
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Affiliation(s)
- Garth R Lester
- Faculty of Natural & Applied Sciences, Trinity Western University, Langley, British Columbia, Canada
| | - Francesca S Abiusi
- Faculty of Natural & Applied Sciences, Trinity Western University, Langley, British Columbia, Canada
| | - Michael E Bodner
- School of Human Kinetics, Trinity Western University, Langley, British Columbia, Canada
| | - Peter M Mittermaier
- Faculty of Natural & Applied Sciences, Trinity Western University, Langley, British Columbia, Canada
| | - Anita T Cote
- School of Human Kinetics, Trinity Western University, Langley, British Columbia, Canada.,Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
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Orabona R, Sciatti E, Vizzardi E, Bonadei I, Metra M, Sartori E, Frusca T, Pinna A, Bellocco R, Prefumo F. Maternal hemodynamics, arterial stiffness and elastic aortic properties in twin pregnancy. Physiol Meas 2021; 41:125001. [PMID: 33385315 DOI: 10.1088/1361-6579/abb760] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVE There is scant information about maternal cardiovascular hemodynamic change during twin pregnancies. Aim of the study is to investigate longitudinal changes in maternal arterial stiffness, elastic aortic properties and ventricular-arterial coupling (VAC) in uncomplicated twin pregnancies compared to singleton ones. APPROACH In this prospective longitudinal study, we performed applanation tonometry and transthoracic echocardiography in the first (T1; 10-15 weeks' gestation (w)), second (T2; 19-26 w) and third trimesters (T3; 30-38 w) in women with uncomplicated twin pregnancies, both monochorionic and dichorionic. Heart-rate-corrected augmentation index (AIx@75) was studied as indicator of arterial stiffness. Aortic diameters and elastic properties were calculated. VAC was defined as the ratio between aortic elastance (Ea) and left ventricular end-systolic elastance (Ees). Finally, stroke volume (SV), cardiac output (CO) and total vascular resistance (TVR) were evaluated. The findings were compared to those of women with uncomplicated singleton pregnancies. MAIN RESULTS Thirty women with twin gestations (11 monochorionic) and 30 singleton controls were obtained for analysis. Blood pressure and TVR significantly decreased from T1 to T2 and then rose in T3, with higher values in twins than in singletons. AIx@75 showed the same trend in both groups with lower values at T2 in twins. SV and CO linearly increased throughout gestation with no significant intergroup difference. Aortic diameters and elastic properties remained stable throughout gestation, with no significant intergroup differences. Both Ea and Ees were greater (i.e. worse) in twins than in singletons at T1 and T3, showing a significant linear trend towards reduction in the two groups, meaning lower vascular and ventricular loads. Using longitudinal analysis blood pressure, TVR, Ea and Ees depended from both multiple gestation and gestational age. SIGNIFICANCE In twins, maternal hemodynamics does not seem to undergo more significant changes than in singletons being characterized by higher blood pressures and TVR with no differences in CO, SV, aortic dimensions and elastic properties. Despite VAC is maintained within its normal range, total vascular load (i.e., Ea) resulted higher in twin than singleton pregnancies throughout gestation. It is conceivable that these findings may represent one of the underlying cause for the increased risk of adverse obstetric outcomes described in multiple gestations.
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Affiliation(s)
- Rossana Orabona
- Department of Obstetrics and Gynecology, University of Brescia, Brescia, Italy. Equally contributors
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Noninvasive estimation of aortic hemodynamics and cardiac contractility using machine learning. Sci Rep 2020; 10:15015. [PMID: 32929108 PMCID: PMC7490416 DOI: 10.1038/s41598-020-72147-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Accepted: 08/13/2020] [Indexed: 02/07/2023] Open
Abstract
Cardiac and aortic characteristics are crucial for cardiovascular disease detection. However, noninvasive estimation of aortic hemodynamics and cardiac contractility is still challenging. This paper investigated the potential of estimating aortic systolic pressure (aSBP), cardiac output (CO), and end-systolic elastance (Ees) from cuff-pressure and pulse wave velocity (PWV) using regression analysis. The importance of incorporating ejection fraction (EF) as additional input for estimating Ees was also assessed. The models, including Random Forest, Support Vector Regressor, Ridge, Gradient Boosting, were trained/validated using synthetic data (n = 4,018) from an in-silico model. When cuff-pressure and PWV were used as inputs, the normalized-RMSEs/correlations for aSBP, CO, and Ees (best-performing models) were 3.36 ± 0.74%/0.99, 7.60 ± 0.68%/0.96, and 16.96 ± 0.64%/0.37, respectively. Using EF as additional input for estimating Ees significantly improved the predictions (7.00 ± 0.78%/0.92). Results showed that the use of noninvasive pressure measurements allows estimating aSBP and CO with acceptable accuracy. In contrast, Ees cannot be predicted from pressure signals alone. Addition of the EF information greatly improves the estimated Ees. Accuracy of the model-derived aSBP compared to in-vivo aSBP (n = 783) was very satisfactory (5.26 ± 2.30%/0.97). Future in-vivo evaluation of CO and Ees estimations remains to be conducted. This novel methodology has potential to improve the noninvasive monitoring of aortic hemodynamics and cardiac contractility.
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Li S, Wan X, Laudanski K, He P, Yang L. Left-Sided Ventricular-arterial Coupling and Volume Responsiveness in Septic Shock Patients. Shock 2020; 52:577-582. [PMID: 30807525 DOI: 10.1097/shk.0000000000001327] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND Suboptimal ventricular arterial coupling (VAC) is one of the pivotal determinants of inefficient heart performance despite appropriate administration of fluids or vasopressors in shocks. Here, we investigate the performance of VAC in patients who are unresponsive to fluid administration in septic shock. METHODS This is a retrospective observational study of septic shock patients (n = 35). VAC was evaluated by effective arterial elastance (EaI), left ventricular end-systolic elastance (EesI), and EaI/EesI. Septic shock patients successfully fluid resuscitated after pulse indicator continuous cardiac output (PiCCO) monitoring, defined as an increase in general end-diastolic ventricular volume (GEDVI) more than 10%, were divided into volume responsive (VVr), and volume unresponsive (VVur) groups based on a cardiac index increase above 10%. We hypothesize that two groups of patients will exhibit dissimilarities of VAC variation, defined as EaI/EesI variation (ΔEaI/EesI). RESULTS Variations of EaI (ΔEaI), and EaI/EesI (ΔEaI/EesI), and systemic vascular resistance index (ΔSVRI) were significantly lower in the VVr group than those in the VVur group (P < 0.05). Variations of cardiac index (ΔCI), stroke volume index (ΔSVI), and EesI (ΔEesI) were significantly higher in patients with ΔEaI/EesI ≤ 0. Concomitantly, ΔEaI and ΔSVRI were significantly diminished as compared with patients with ΔEaI/EesI > 0 (P < 0.05). ΔCI has an inverse relationship with both ΔEaI (r = -0.46, P = 0.006), ΔEaI/EesI (r = -0.65, P < 0.001), and ΔSVRI (r = -0.59, P < 0.001). We observed more patients who were fluid responsive in the ΔEaI/EesI ≤ 0 group than in the group with ΔEaI/EesI > 0 (88.89% vs. 26.92%, P = 0.01). CONCLUSIONS Variation of VAC is often related to suboptimal ventricular volume responsiveness among patients with septic shock.
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Affiliation(s)
- Suwei Li
- Department of Critical Care Medicine, First Hospital affiliated to Dalian Medical University, Dalian, People's Republic of China
| | - Xianyao Wan
- Department of Critical Care Medicine, First Hospital affiliated to Dalian Medical University, Dalian, People's Republic of China
| | - Krzysztof Laudanski
- Department of Anesthesiology and Critical Care Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Ping He
- Department of Critical Care Medicine, First Hospital affiliated to Dalian Medical University, Dalian, People's Republic of China
| | - Lihui Yang
- Department of Critical Care Medicine, Center Hospital of Huludao, Huludao, People's Republic of China
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Aortic stiffness-Is kynurenic acid a novel marker? Cross-sectional study in patients with persistent atrial fibrillation. PLoS One 2020; 15:e0236413. [PMID: 32735567 PMCID: PMC7394382 DOI: 10.1371/journal.pone.0236413] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2020] [Accepted: 07/05/2020] [Indexed: 12/16/2022] Open
Abstract
Objective Although a number of modifiable and non-modifiable causes were implicated in arterial stiffness, its pathogenesis remains elusive, and very little is known about aortic elasticity in supraventricular arrhythmias. The potential role of disturbed kynurenine metabolism in the pathogenesis of cardiovascular disease has been recently suggested. Thus, we studied the correlations of aortic stiffness and echocardiographic parameters with biochemical markers and serum level of kynurenic acid (KYNA), an endothelial derivative of tryptophan, formed along the kynurenine pathway, among patients with atrial fibrillation (AF). Methods Study cohort comprised 100 patients with persistent AF (43 females/57 males). Arterial stiffness index (ASI), structural and functional indices of left atrium (LA) and left ventricle (LV) were evaluated electrocardiographically. Biochemical analyses included the measurements of serum KYNA (HPLC) and of the selected markers of lipids and glucose metabolism, thyroid status, kidney function, inflammation and coagulation. Results KYNA (β = 0.389, P = 0.029), homocysteine (β = 0.256, P = 0.40), total cholesterol (β = 0.814; P = 0.044), LDL (β = 0.663; P = 0.44), TSH (β = 0.262, P = 0.02), fT3 (β = -0.333, P = 0.009), fT4 (β = -0.275, P = 0.043) and creatinine (β = 0.374, P = 0.043) were independently correlated with ASI. ASI was also independently associated with LV end-systolic diameter (LVEDd; β = 1.751, P = 0.045), midwall fractional shortening (mFS; β = -1.266, P = 0.007), ratio mFS/end-systolic stress (mFS/ESS; β = -0.235, P = 0.026), LV shortening fraction (FS; β = -0.254, P = 0.017), and LA volume index (LAVI; β = 0.944, P = 0.022). Conclusions In patients with AF, aortic stiffness correlated positively with KYNA, biochemical risk factors of atherosclerosis and with the indices of diastolic dysfunction of LV and LA. Revealed relationship between ASI and KYNA is an original observation, suggesting a potential role of disturbed kynurenine metabolism in the pathogenesis of arterial stiffening. KYNA, synthesis of which is influenced by homocysteine, emerges as a novel, non-classical factor associated with ASI in patients with AF.
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Sciatti E, Orabona R, Prefumo F, Vizzardi E, Bonadei I, Valcamonico A, Metra M, Frusca T. Elastic properties of ascending aorta and ventricular-arterial coupling in women with previous pregnancy complicated by HELLP syndrome. J Hypertens 2020; 37:356-364. [PMID: 30234780 DOI: 10.1097/hjh.0000000000001888] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
OBJECTIVE To compare the elastic properties of the ascending aorta and ventricular-arterial coupling (VAC) in women with a previous pregnancy complicated by hemolysis, elevated liver enzymes, and low platelets (HELLP) syndrome, women who experienced preeclampsia, and healthy controls. METHODS Women with a history of preeclampsia (n = 60) or HELLP syndrome (n = 49) and matched healthy controls (n = 60) underwent transthoracic echocardiography at 6 months to 4 years after delivery. Aortic M-mode and tissue Doppler imaging (TDI) parameters were measured. Aortic diameters were assessed at end-diastole at four levels: Valsalva sinuses, sinotubular junction, tubular tract, and aortic arch. Aortic compliance, distensibility, stiffness index, Peterson's elastic modulus, pulse-wave velocity, and M-mode strain were calculated using standard formulae. Aortic expansion velocity, early and late diastolic retraction velocities, and peak systolic tissue strain (TDI-ε) were determined. VAC was defined as the ratio between aortic elastance (Ea) and left ventricular end-systolic elastance (Ees). All women were free from cardiovascular risk factors. RESULTS Women with a history of HELLP syndrome showed larger aortas than those with previous preeclampsia or controls, probably related to a higher blood pressure. Aortic elastic properties, including Ea, were similar between HELLP and preeclampsia groups, even comparing cases with early-onset preeclampsia and HELLP. In contrast, Ees was more impaired in the HELLP group than in the other two. Consequently, about one-quarter of women who experienced HELLP syndrome had a pathological VAC, whereas only 5% of previously preeclamptic patients did. Multivariate analysis confirmed the association between HELLP syndrome and VAC, whereas other parameters including aortic compliance, distensibility, stiffness index, and elastic modulus are linked only to gestational age at preeclampsia onset, ad also Ea and Ees did. CONCLUSIONS We found a significant overlap between the aortic elastic properties in women with a history of preeclampsia and those with a previous HELLP syndrome, suggesting a common pathophysiologic pathway. However, women who experienced HELLP syndrome showed a higher blood pressure than other cases and controls, probably determining larger aortas. In addition, VAC was more altered in the HELLP group than in the others because of a higher Ea and a lower Ees.
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Affiliation(s)
- Edoardo Sciatti
- Section of Cardiovascular Diseases, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health
| | - Rossana Orabona
- Maternal Fetal Medicine Unit, Department of Obstetrics and Gynecology, University of Brescia, Brescia
| | - Federico Prefumo
- Maternal Fetal Medicine Unit, Department of Obstetrics and Gynecology, University of Brescia, Brescia
| | - Enrico Vizzardi
- Section of Cardiovascular Diseases, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health
| | - Ivano Bonadei
- Section of Cardiovascular Diseases, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health
| | - Adriana Valcamonico
- Maternal Fetal Medicine Unit, Department of Obstetrics and Gynecology, University of Brescia, Brescia
| | - Marco Metra
- Section of Cardiovascular Diseases, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health
| | - Tiziana Frusca
- Maternal Fetal Medicine Unit, Department of Obstetrics and Gynecology, University of Brescia, Brescia.,Department of Obstetrics and Gynecology, University of Parma, Parma, Italy
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Corica D, Oreto L, Pepe G, Calabrò MP, Longobardo L, Morabito L, Pajno GB, Alibrandi A, Aversa T, Wasniewska M. Precocious Preclinical Cardiovascular Sonographic Markers in Metabolically Healthy and Unhealthy Childhood Obesity. Front Endocrinol (Lausanne) 2020; 11:56. [PMID: 32194501 PMCID: PMC7062712 DOI: 10.3389/fendo.2020.00056] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Accepted: 01/29/2020] [Indexed: 12/14/2022] Open
Abstract
Background: Childhood obesity is related to a wide spectrum of cardiovascular and metabolic comorbidities. Objectives: (1) To identify precocious, preclinical, cardiovascular sonographic modifications, in a cohort of overweight (OW) and obese (OB) children and adolescents compared to lean controls; (2) to investigate the association between clinical and metabolic variables and cardiovascular sonographic parameters; (3) to evaluate their relation with two different phenotypes of obesity: metabolically healthy obesity (MHO) and metabolically unhealthy obesity (MUO). Materials and Methods: Fifty-nine OW and OB children and adolescents (9.8 ± 2.9 years) and 20 matched lean controls underwent anthropometric, biochemical, echocardiography assessment, and sonographic evaluation of carotid artery and ascending aorta (AA). OW and OB subjects were divided in MHO and MUO, according to the Camhi et al. definition. Results: OW and OB children showed significantly higher left ventricular (LV) dimensions and mass, carotid artery intima-media thickness (CIMT), carotid stiffness [β-index, pulse wave velocity (PWV)], significantly lower mitral peak early (E) and late (A) velocity ratio (E/A ratio), and significantly impaired global longitudinal strain (GLS) compared to controls. BMI SD and HOMA-IR were positively significantly related to LV dimensions, LA volume and epicardial adipose tissue (EAT), and negative to E/A ratio. Waist circumference (WC) was positively correlated to LV dimensions, LA volume, CIMT, PWV, AA diameter, and EAT. Furthermore, WC was a strong predictor of LV dimensions, LA volume and strain, AA stiffness and diameter; BMI SD was significantly associated with EAT, LVM index, and E/A ratio; HOMA-IR and triglycerides were significant predictors of GLS. MUO patients showed higher BMI SD (p = 0.02), WC (p = 0.001), WHtR (p = 0.001), HOMA-IR (p = 0.004), triglycerides (p = 0.01), SBP (p = 0.001), as well as LV dimensions, EAT (p = 0.03), CIMT (p = 0.01), AA diameter (p = 0.02), β-index (p = 0.03) and PWV (p = 0.002), AA stiffness (p = 0.006), and significantly impaired GLS (p = 0.042) compared to MHO. Conclusions: Severity of overweight, abdominal obesity, insulin resistance, and MUO phenotype negatively affect cardiovascular remodeling and subclinical myocardial dysfunction in OW and OB children. MUO phenotype is likely to increase the risk of developing cardiometabolic complications since the pediatric age. Distinction between MHO and MUO phenotypes might be useful in planning a personalized follow-up approach in obese children.
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Affiliation(s)
- Domenico Corica
- Department of Human Pathology of Adulthood and Childhood “G. Barresi”, University of Messina, Messina, Italy
- *Correspondence: Domenico Corica
| | - Lilia Oreto
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Giorgia Pepe
- Department of Human Pathology of Adulthood and Childhood “G. Barresi”, University of Messina, Messina, Italy
| | - Maria Pia Calabrò
- Department of Human Pathology of Adulthood and Childhood “G. Barresi”, University of Messina, Messina, Italy
| | - Luca Longobardo
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Letteria Morabito
- Department of Human Pathology of Adulthood and Childhood “G. Barresi”, University of Messina, Messina, Italy
| | - Giovanni Battista Pajno
- Department of Human Pathology of Adulthood and Childhood “G. Barresi”, University of Messina, Messina, Italy
| | | | - Tommaso Aversa
- Department of Human Pathology of Adulthood and Childhood “G. Barresi”, University of Messina, Messina, Italy
| | - Malgorzata Wasniewska
- Department of Human Pathology of Adulthood and Childhood “G. Barresi”, University of Messina, Messina, Italy
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Correlations between invasively measured aortic pressures and left ventricular end-diastolic pressure in patients undergoing coronary angiography. Blood Press Monit 2019; 24:241-247. [PMID: 31490246 DOI: 10.1097/mbp.0000000000000399] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVE Data on ventricular-arterial coupling using invasive hemodynamic studies are limited. This study was performed to clarify the interaction between aortic pressures and left ventricular end-diastolic pressure (LVEDP) using invasive catheterization. PATIENTS AND METHODS A total of 104 consecutive stable patients (mean age, 65.8 ± 10.0 years; 56% men) undergoing invasive coronary angiography (ICA) were prospectively evaluated. LVEDP and central aortic pressures [systolic blood pressure (aSBP) and diastolic blood pressure (aDBP)] were sequentially measured using a pigtail catheter before ICA. Aortic pulse pressure (aPP) was defined by the difference between aSBP and aDBP. RESULTS A total of 82 patients (79%) had obstructive coronary artery disease (≥50% stenosis). The mean LVEDP value was 18.7 ± 6.4 mmHg. Univariable analyses showed that aSBP (r = 0.309, P = 0.001) and aPP (r = 0.286, P = 0.003) significantly correlated with LVEDP, whereas aDBP was not correlated with LVEDP (P > 0.05). Multivariable analysis revealed that aSBP (β = 0.345, P = 0.001) and aPP (β = 0.276, P = 0.018) remained independent predictors of LVEDP even after controlling for potential confounders. CONCLUSION Invasively measured aSBP and aPP were independently associated with invasively measured LVEDP in patients undergoing ICA. This result provides additional evidence of a close interaction between central aortic pressure and LV diastolic function in this population.
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Myasoedova EI, Voronina LP, Polunina OS, Shvarts YG. [Indicators of the left ventricular-arterial coupling interaction in chronic forms of ischemic heart disease: relationships of the protradenomedullin and N-terminal probrain natriuretic peptide]. KARDIOLOGIIA 2019; 59:41-50. [PMID: 31340748 DOI: 10.18087/cardio.2627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Accepted: 07/24/2019] [Indexed: 06/10/2023]
Abstract
PURPOSE OF THE STUDY Analyze the parameters of the interaction between the left ventricle and the arterial system in patients with chronic forms of coronary heart disease and to identify relationships with levels of proadrenomedullin (MR‑proADM) and N‑terminal precursor of the brain natriuretic peptide B (NT‑proBNP). MATERIALS AND METHODS 240 patients with chronic forms of coronary heart disease (median - 55,9 [43; 63] years) and Q‑forming myocardial infarction in the past were examined. Of these, 110 patients with myocardial infarction and preserved lef ventricular ejection fraction and 130 patients with ischemic cardiomyopathy. All patients were calculated parameters of lef ventricular‑arterial interaction and the determination in blood serum levels of MR‑proADM and NT‑proBNP. RESULTS In patients with ischemic cardiomyopathy, an increase in the lef ventricular‑arterial interaction index was detected (2,51 [1,18; 5,00]), which reflects a decrease in the functional abilities and efficiency of the heart. In patients with myocardial infarction and a preserved left ventricular ejection fraction, this indicator was in the range of normal values (0,78 [0,55; 1,07]), which indicates an effective cardiac work. A study of MR‑proADM and NT‑proBNP levels demonstrated an increase in both groups (1,72 [1,56; 1,98] nmol/l and 779,3 [473; 2193] pg/ml in the group of patients with ischemic cardiomyopathy; 0,89 [0,51; 1,35] nmol/l and 246 [118; 430] pg/ml in the group of patients with myocardial infarction and preserved left ventricular ejection fraction), and the correlation analysis with left ventricular‑arterial coupling interaction parameters allowed identify statistically significant connections (in the group of patients with ischemic cardiomyopathy: with the level of MR‑proADM ‑ r=0,67, p=0,006, with the level of NT‑proBNP ‑ r=0,78, p<0,001; in the group of patients with myocardial infarction and preserved left ventricular ejection fraction: with MR‑proADM level ‑ r=‑0,52, p=0,024, with NT‑proBNP level ‑ r =‑0,38, p=0,037). CONCLUSION The findings suggest a pathogenetic association between the biomarkers under study and the parameters of left ventricular‑arterial coupling interaction.
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Affiliation(s)
| | | | | | - Yu G Shvarts
- V. I. Razumovsky Saratov State Medical University
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Vallerio P, Maloberti A, D'Alessio I, Lista A, Varrenti M, Castelnuovo S, Marone M, Piccinelli E, Grassi G, Palmieri B, Giannattasio C. Cardiovascular Remodeling after Endovascular Treatment for Thoracic Aortic Injury. Ann Vasc Surg 2019; 61:134-141. [PMID: 31344466 DOI: 10.1016/j.avsg.2019.04.015] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Revised: 03/29/2019] [Accepted: 04/06/2019] [Indexed: 12/20/2022]
Abstract
BACKGROUND Thoracic endovascular aortic repair (TEVAR) currently represents the gold standard of treatment for thoracic aortic injury (TAI). Nevertheless, there is an ongoing debate surrounding its safety and subsequent cardiovascular effects. Our aim is to assess heart and vascular structure and function remodeling after TEVAR in TAI young patients. METHODS We evaluated 20 patients (18 men, age 41 ± 14 years, 11 treated with Gore CTAG, 9 with Medtronic Valiant) with office and 24-hr blood pressure (BP) with specific vascular stiffness analysis (Mobil-O-Graph), aortic diameters (computed tomography scan) and left ventricular mass index (LVMI echocardiogram). Evaluation was done after a median time of 5.0 ± 3.5 years from the trauma. RESULTS After TAI 12 patients (55%) developed hypertension. When patients were divided according to treating time, those treated for more than 3 years show higher LVMI, PWV, and ascending aorta dilatation. CONCLUSIONS Our study shows that TEVAR for TAI is associated with heart and vascular remodeling. The presence of TEVAR modifies aortic functional properties and could induce an increase in BP that can promote aortic and cardiac damage, even in young patients.
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Affiliation(s)
- Paola Vallerio
- Cardiology IV, "A. De Gasperis" Department, ASST Niguarda Ca' Granda, Milan, Italy
| | - Alessandro Maloberti
- Cardiology IV, "A. De Gasperis" Department, ASST Niguarda Ca' Granda, Milan, Italy; School of Medicine and Surgery, Milano-Bicocca University, Milan, Italy
| | - Ilenia D'Alessio
- School of Medicine and Surgery, Milano-Bicocca University, Milan, Italy
| | - Alfredo Lista
- Vascular Surgery, ASST Niguarda Ca' Granda, Milan, Italy
| | - Marisa Varrenti
- Cardiology II, "A. De Gasperis" Department, ASST Niguarda Ca' Granda, Milan, Italy
| | | | - Matteo Marone
- Vascular Surgery, ASST Niguarda Ca' Granda, Milan, Italy
| | - Enrico Piccinelli
- Cardiology IV, "A. De Gasperis" Department, ASST Niguarda Ca' Granda, Milan, Italy; School of Medicine and Surgery, Milano-Bicocca University, Milan, Italy
| | - Guido Grassi
- School of Medicine and Surgery, Milano-Bicocca University, Milan, Italy
| | - Bruno Palmieri
- Vascular Surgery, ASST Niguarda Ca' Granda, Milan, Italy
| | - Cristina Giannattasio
- Cardiology IV, "A. De Gasperis" Department, ASST Niguarda Ca' Granda, Milan, Italy; School of Medicine and Surgery, Milano-Bicocca University, Milan, Italy.
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Nabeel PM, Jayaraj J, Srinivasa K, Mohanasankar S, Chenniappan M. Bi-Modal Arterial Compliance Probe for Calibration-Free Cuffless Blood Pressure Estimation. IEEE Trans Biomed Eng 2018; 65:2392-2404. [DOI: 10.1109/tbme.2018.2866332] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Taran IN, Belevskaya AA, Saidova MA, Martynyuk TV, Chazova IE. Initial Riociguat Monotherapy and Transition from Sildenafil to Riociguat in Patients with Idiopathic Pulmonary Arterial Hypertension: Influence on Right Heart Remodeling and Right Ventricular-Pulmonary Arterial Coupling. Lung 2018; 196:745-753. [PMID: 30182153 PMCID: PMC6244659 DOI: 10.1007/s00408-018-0160-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Accepted: 08/30/2018] [Indexed: 11/28/2022]
Abstract
Purpose To evaluate the influence of riociguat on World Health Organization functional class (WHO FC), 6-min walk distance (6MWD), right heart remodeling, and right ventricular–pulmonary arterial (RV–PA) coupling in patients with idiopathic pulmonary arterial hypertension (IPAH) who are treatment-naïve or who have failed to achieve treatment goals with sildenafil therapy. Methods Twenty patients with IPAH were enrolled: 12 had not previously received PAH-targeted therapy (treatment-naïve subgroup) and 8 had been receiving sildenafil therapy but failed to achieve treatment goals; on entering this pilot study these 8 patients were switched from sildenafil to riociguat therapy (treatment-switch subgroup). Patients received riociguat individually dose-adjusted up to a maximum of 2.5 mg three times daily. After 12 weeks, patients were assessed for WHO FC, 6MWD, right heart remodeling, and RV–PA coupling. Results Riociguat significantly improved WHO FC in treatment-naïve patients (from 0/4/8/0 patients in WHO I/II/III/IV at baseline to 1/6/5/0 at week 12) and in treatment-switch patients (from 0/4/4/0 patients in WHO I/II/III/IV at baseline to 1/4/3/0 at week 12). Additionally, treatment-naïve and treatment-switch patients showed significant improvements at week 12 versus baseline in 6MWD (increases of + 76.8 m and + 71.6 m, respectively), RV systolic function, and RV–PA coupling. Conclusion These results support the proven efficacy of riociguat in patients with IPAH, including treatment-naïve patients and those switching to riociguat following failure to achieve treatment goals with sildenafil, and suggest that it may be possible to delay disease progression in this patient group. Electronic supplementary material The online version of this article (10.1007/s00408-018-0160-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Irina N Taran
- Department of Pulmonary Hypertension and Heart Diseases, Scientific Research Institute of Clinical Cardiology of A.L. Myasnikov, Russian Cardiology Research and Production Complex of the Ministry of Health of the Russian Federation, Moscow, Russia.
| | - Anna A Belevskaya
- Ultrasonic Diagnostic Techniques Laboratory, Scientific Research Institute of Clinical Cardiology of A. L. Myasnikov, Russian Cardiology Research and Production Complex of the Ministry of Health of the Russian Federation, Moscow, Russia
| | - Marina A Saidova
- Department of Ultrasonic Diagnostic Techniques, Scientific Research Institute of Clinical Cardiology of A.L. Myasnikov, Russian Cardiology Research and Production Complex of the Ministry of Health of the Russian Federation, Moscow, Russia
| | - Tamila V Martynyuk
- Department of Pulmonary Hypertension and Heart Diseases, Scientific Research Institute of Clinical Cardiology of A.L. Myasnikov, Russian Cardiology Research and Production Complex of the Ministry of Health of the Russian Federation, Moscow, Russia
| | - Irina E Chazova
- Department of Hypertension, Scientific Research Institute of Clinical Cardiology of A.L. Myasnikov, Russian Cardiology Research and Production Complex of the Ministry of Health of the Russian Federation, Moscow, Russia
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21
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Vriz O, Bertin N, Bossone E, Palatini P. Aortic Diameters and Mild Functional Aortic Regurgitation in Hypertensive and Normotensive People: Do They Carry the Same Meaning? JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2018; 37:2171-2180. [PMID: 29451314 DOI: 10.1002/jum.14567] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/04/2017] [Revised: 12/12/2017] [Accepted: 12/13/2017] [Indexed: 06/08/2023]
Abstract
OBJECTIVES The association between the aortic root diameter and aortic regurgitation in hypertensive and normotensive people is still disputed, and the underlying mechanisms remain to be clearly elucidated. We aimed to investigate the relationship between the aortic root diameter and trivial to mild functional aortic regurgitation in never-treated hypertensive patients with a new diagnosis compared with healthy normotensive participants. METHODS A total of 182 hypertensives and 232 age-matched normotensives were included in the study. Anthropometric and office blood pressure (BP) measurements, echocardiography, and a carotid stiffness assessment were performed in all of the participants. Aortic measures for the annulus, sinuses of Valsalva, sinotubular junction, and ascending aorta were taken in late diastole according to the leading-edge method. RESULTS The mean age of all participants was 52 years. Hypertensive patients had a significantly higher body surface area, mean arterial pressure, and pulse pressure (P < .0001) than normotensive participants. Annulus and sinotubular junction diameters adjusted for confounders and indexed to the body surface area were significantly higher in normotensives than in hypertensives. The prevalence of functional aortic regurgitation was higher in hypertensives (34.8% versus 15.4%; P < .0001). Among the hypertensives, no difference in aortic diameters was found between patients with or without functional aortic regurgitation, whereas normotensives with functional aortic regurgitation had larger aortic root diameters. Aging and BP among the hypertensives were the main determinants of functional aortic regurgitation. CONCLUSIONS Hypertensive patients had a smaller indexed aortic root diameter than normotensive participants but had a higher prevalence of trivial to mild functional aortic regurgitation. The aging process is the main determinant of functional aortic regurgitation in both groups, but high BP also plays an important role in hypertensives.
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Affiliation(s)
- Olga Vriz
- Cardiology and Emergency Department, Sant'Antonio Hospital, San Daniele del Friuli, Italy
| | - Nicole Bertin
- Cardiology and Emergency Department, Sant'Antonio Hospital, San Daniele del Friuli, Italy
| | - Eduardo Bossone
- Department of Cardiology, Cava de' Tirreni and Amalfi Coast Hospital, Heart Department, University of Salerno, Salerno, Italy
| | - Paolo Palatini
- Department of Internal Medicine, University of Padova, Padua, Italy
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22
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Rosenberg AJ, Lane-Cordova AD, Wee SO, White DW, Hilgenkamp TIM, Fernhall B, Baynard T. Healthy aging and carotid performance: strain measures and β-stiffness index. Hypertens Res 2018; 41:748-755. [PMID: 29968848 DOI: 10.1038/s41440-018-0065-x] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Revised: 02/01/2018] [Accepted: 02/18/2018] [Indexed: 11/09/2022]
Abstract
Arterial stiffness is related to the risk of cardiovascular disease (CVD) and increases with aging. Functional impairment of the arterial wall can occur before structural changes and can be detectable before CVD symptoms. The elastic properties of the carotid arterial wall during the cardiac cycle can be evaluated by standard 2-dimensional (2D) ultrasound longitudinal or circumferential imaging of vascular deformation (strain) using speckle tracking. The purpose of this study was to compare standard 2D ultrasound circumferential and longitudinal images of vascular tissue motion and strain using speckle tracking in young and older individuals. Participants underwent recording of 2D ultrasound circumferential and longitudinal images of the common carotid artery. Circumferential carotid strain (CS) and CS rate were obtained and analyzed via speckle tracking software. Following the strain analysis, the circumferential strain β-stiffness (C-β) was calculated. Conventional longitudinal β-stiffness (L-β) was calculated and non-invasive blood pressure measurements were obtained from carotid artery pressure measurements in a resting supine position using applanation tonometry. C-β was significantly higher than L-β, and the association with age was greater (r = .824 vs. r = .547). CS and CS rate were significantly higher in the young compared to the older group. L-β does not explain as much of the age-dependent differences in the carotid artery compared with C-β. This is possibly due to the inclusion of whole arterial wall motion and deformation observed in the CS image. The ability of C-β to accurately predict the future risk of CVD independent of age still needs further investigation.
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Affiliation(s)
- Alexander J Rosenberg
- Department of Kinesiology and Nutrition, Integrative Physiology Laboratory, University of Illinois at Chicago, Chicago, IL, USA.
| | - Abbi D Lane-Cordova
- Department of Preventive Medicine, Northwestern University, Chicago, IL, USA
| | - Sang Ouk Wee
- Department of Kinesiology and Nutrition, Integrative Physiology Laboratory, University of Illinois at Chicago, Chicago, IL, USA.,Department of Kinesiology, California State University San Bernardino, San Bernardino, CA, USA
| | - Daniel W White
- Department of Kinesiology and Nutrition, Integrative Physiology Laboratory, University of Illinois at Chicago, Chicago, IL, USA.,Department of Biomedical Sciences, University of Houston-Victoria, Victoria, TX, USA
| | - Thessa I M Hilgenkamp
- Department of General Practice, Intellectual Disability Medicine, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Bo Fernhall
- Department of Kinesiology and Nutrition, Integrative Physiology Laboratory, University of Illinois at Chicago, Chicago, IL, USA
| | - Tracy Baynard
- Department of Kinesiology and Nutrition, Integrative Physiology Laboratory, University of Illinois at Chicago, Chicago, IL, USA
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23
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Gulsin GS, Swarbrick DJ, Hunt WH, Levelt E, Graham-Brown MPM, Parke KS, Wormleighton JV, Lai FY, Yates T, Wilmot EG, Webb DR, Davies MJ, McCann GP. Relation of Aortic Stiffness to Left Ventricular Remodeling in Younger Adults With Type 2 Diabetes. Diabetes 2018; 67:1395-1400. [PMID: 29661781 DOI: 10.2337/db18-0112] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2018] [Accepted: 04/09/2018] [Indexed: 11/13/2022]
Abstract
Individuals with type 2 diabetes have a three- to fivefold increased risk of developing heart failure. Diabetic cardiomyopathy is typified by left ventricular (LV) concentric remodeling, which is a recognized predictor of adverse cardiovascular events. Although the mechanisms underlying LV remodeling in type 2 diabetes are unclear, progressive aortic stiffening may be a key determinant. The aim of this study was to assess the relationship between aortic stiffness and LV geometry in younger adults with type 2 diabetes, using multiparametric cardiovascular MRI. We prospectively recruited 80 adults (aged 18-65 years) with type 2 diabetes and no cardiovascular disease and 20 age- and sex-matched healthy control subjects. All subjects underwent comprehensive bio-anthropometric assessment and cardiac MRI, including measurement of aortic stiffness by aortic distensibility (AD). Type 2 diabetes was associated with increased LV mass, concentric LV remodeling, and lower AD compared with control subjects. On multivariable linear regression, AD was independently associated with concentric LV remodeling in type 2 diabetes. Aortic stiffness may therefore be a potential therapeutic target to prevent the development of heart failure in type 2 diabetes.
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Affiliation(s)
- Gaurav S Gulsin
- Department of Cardiovascular Sciences, University of Leicester and Leicester National Institute for Health Research Biomedical Research Centre, Glenfield Hospital, Leicester, U.K
| | - Daniel J Swarbrick
- Department of Cardiovascular Sciences, University of Leicester and Leicester National Institute for Health Research Biomedical Research Centre, Glenfield Hospital, Leicester, U.K
| | - William H Hunt
- Department of Cardiovascular Sciences, University of Leicester and Leicester National Institute for Health Research Biomedical Research Centre, Glenfield Hospital, Leicester, U.K
| | - Eylem Levelt
- Department of Cardiovascular Sciences, University of Leicester and Leicester National Institute for Health Research Biomedical Research Centre, Glenfield Hospital, Leicester, U.K
| | | | - Kelly S Parke
- Department of Cardiovascular Sciences, University of Leicester and Leicester National Institute for Health Research Biomedical Research Centre, Glenfield Hospital, Leicester, U.K
| | - Joanne V Wormleighton
- Department of Cardiovascular Sciences, University of Leicester and Leicester National Institute for Health Research Biomedical Research Centre, Glenfield Hospital, Leicester, U.K
| | - Florence Y Lai
- Department of Cardiovascular Sciences, University of Leicester and Leicester National Institute for Health Research Biomedical Research Centre, Glenfield Hospital, Leicester, U.K
| | - Thomas Yates
- National Centre of Sport and Exercise Medicine, University of Loughborough, Loughborough, U.K
| | - Emma G Wilmot
- Department of Endocrinology and Diabetes, Royal Derby Hospital, Derby, U.K
| | - David R Webb
- Diabetes Research Centre, University of Leicester and Leicester National Institute for Health Research Biomedical Research Centre, Leicester General Hospital, Leicester, U.K
| | - Melanie J Davies
- Diabetes Research Centre, University of Leicester and Leicester National Institute for Health Research Biomedical Research Centre, Leicester General Hospital, Leicester, U.K
| | - Gerry P McCann
- Department of Cardiovascular Sciences, University of Leicester and Leicester National Institute for Health Research Biomedical Research Centre, Glenfield Hospital, Leicester, U.K.
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24
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Sciatti E, Vizzardi E, Bonadei I, Fabbricatore D, Prati F, Pagnoni M, Metra M. Prognostic evaluation of the elastic properties of the ascending aorta in dilated cardiomyopathy. Eur J Clin Invest 2018; 48:e12950. [PMID: 29754460 DOI: 10.1111/eci.12950] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2018] [Accepted: 05/05/2018] [Indexed: 12/28/2022]
Abstract
BACKGROUND Nowadays there is an increased interest in the role of aortic stiffness in the pathophysiology of heart failure (HF), as it is a major determinant of left ventricular (LV) performance. We aimed at assessing the predictive value of the aortic stiffness parameters, measured by echocardiography, in patients affected by nonischaemic dilated cardiomyopathy (DCM) regarding three end-points: death, HF rehospitalization, combined death or HF rehospitalization in a long-term follow-up. MATERIALS AND METHODS A total of 202 patients affected by nonischaemic DCM underwent an outpatient examination by echocardiography and blood pressure check at the brachial artery, in order to calculate aortic elastic properties (ie, compliance, distensibility, stiffness index, Peterson's elastic modulus, M-mode strain). ROC curves, Kaplan-Meier curves and multivariable Cox regressions (correcting for age, LV ejection fraction (LVEF), atrial fibrillation, cardiac resynchronization therapy (CRT)) were run to assess the predictive ability of aortic elastic properties against the 3 end-points. RESULTS Mean follow-up was 9.83 ± 2.80 years. 24.8% of patients died, while 34.7% were rehospitalized for HF cause and 44.6% experienced the combined end-point. LVEF did not correlate with aortic elastic properties. ROC curves and Kaplan-Meier curves were elaborated. Aortic stiffness did not predict death in our cohort. Otherwise, all aortic elastic properties predicted HF rehospitalization and combined death or HF rehospitalization, after correcting for age, LVEF, atrial fibrillation, CRT. CONCLUSIONS Elastic properties of the ascending aorta measured by echocardiography in patients with nonischaemic DCM predict long-term HF rehospitalization and combined death or HF rehospitalization, also after correcting for the confounding factors.
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Affiliation(s)
- Edoardo Sciatti
- Cardiology Unit, University and ASST Spedali Civili, Brescia, Italy
| | - Enrico Vizzardi
- Cardiology Unit, University and ASST Spedali Civili, Brescia, Italy
| | - Ivano Bonadei
- Cardiology Unit, University and ASST Spedali Civili, Brescia, Italy
| | | | - Francesco Prati
- Cardiology Unit, University and ASST Spedali Civili, Brescia, Italy
| | - Mattia Pagnoni
- Cardiology Unit, University and ASST Spedali Civili, Brescia, Italy
| | - Marco Metra
- Cardiology Unit, University and ASST Spedali Civili, Brescia, Italy
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25
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Łoboz-Rudnicka M, Jaroch J, Kruszyńska E, Bociąga Z, Rzyczkowska B, Dudek K, Szuba A, Łoboz-Grudzień K. Gender-related differences in the progression of carotid stiffness with age and in the influence of risk factors on carotid stiffness. Clin Interv Aging 2018; 13:1183-1191. [PMID: 29983553 PMCID: PMC6027709 DOI: 10.2147/cia.s161711] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background In recent years, there has been growing interest in the impact of gender-related factors on the function and structure of the arterial tree. The aim of our study was to identify gender-specific differences in the progression of carotid stiffness parameters with age and in the impact of risk factors on carotid stiffness. Subjects and methods The study group included 256 subjects (mean age: 54.7 years): 134 women (52%) and 122 men (48%) with cardiovascular risk factors: hypertension, type 2 diabetes mellitus, dyslipidemia, smoking, and obesity. Local parameters of carotid stiffness: β stiffness index (β), Peterson’s elastic modulus (Ep), pulse wave velocity β (PWV-β) and arterial compliance (AC) were determined with ultrasound echo-tracking software application. Results Women were characterized by lower AC than men (women: 0.57 mm2/kPa vs men: 0.69 mm2/kPa, p < 0.001) and the subanalysis in three age groups revealed that the difference in AC value between genders became significant over the age of 45 years. Although no significant difference in the value of β, Ep and PWV-β were found between genders in the whole study group, women <45 years were characterized by lower values of β and Ep than their men counterparts (β: women: 5.4 vs men: 6.6, p = 0.002; Ep: women: 72 kPa vs men: 84 kPa, p = 0.015). Among analyzed risk factors, the significant determinants of carotid stiffness were age, blood pressure components (pulse pressure and mean arterial pressure), type 2 diabetes mellitus and heart rate. The relationship between carotid stiffness and pulse pressure was observed only in women and between carotid stiffness and heart rate – only in men. Conclusion There are gender-related differences in the progression of carotid stiffness parameters with age and in the influence of risk factors on carotid stiffness.
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Affiliation(s)
| | - Joanna Jaroch
- Department of Cardiology, T. Marciniak Hospital, Wrocław, Poland,
| | - Ewa Kruszyńska
- Department of Cardiology, T. Marciniak Hospital, Wrocław, Poland,
| | - Zbigniew Bociąga
- Department of Cardiology, T. Marciniak Hospital, Wrocław, Poland,
| | | | - Krzysztof Dudek
- Faculty of Mechanical Engineering, Wrocław University of Technology, Wrocław, Poland
| | - Andrzej Szuba
- Division of Angiology, Wrocław Medical University, Wrocław, Poland
| | - Krystyna Łoboz-Grudzień
- Department of Cardiology, T. Marciniak Hospital, Wrocław, Poland, .,Public Health Department, Wrocław Medical University, Wrocław, Poland
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26
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Capoccia M, Marconi S, Singh SA, Pisanelli DM, De Lazzari C. Simulation as a preoperative planning approach in advanced heart failure patients. A retrospective clinical analysis. Biomed Eng Online 2018; 17:52. [PMID: 29720187 PMCID: PMC5930731 DOI: 10.1186/s12938-018-0491-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Accepted: 04/23/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Modelling and simulation may become clinically applicable tools for detailed evaluation of the cardiovascular system and clinical decision-making to guide therapeutic intervention. Models based on pressure-volume relationship and zero-dimensional representation of the cardiovascular system may be a suitable choice given their simplicity and versatility. This approach has great potential for application in heart failure where the impact of left ventricular assist devices has played a significant role as a bridge to transplant and more recently as a long-term solution for non eligible candidates. RESULTS We sought to investigate the value of simulation in the context of three heart failure patients with a view to predict or guide further management. CARDIOSIM© was the software used for this purpose. The study was based on retrospective analysis of haemodynamic data previously discussed at a multidisciplinary meeting. The outcome of the simulations addressed the value of a more quantitative approach in the clinical decision process. CONCLUSIONS Although previous experience, co-morbidities and the risk of potentially fatal complications play a role in clinical decision-making, patient-specific modelling may become a daily approach for selection and optimisation of device-based treatment for heart failure patients. Willingness to adopt this integrated approach may be the key to further progress.
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Affiliation(s)
- Massimo Capoccia
- Department of Cardiac Surgery, University Hospitals of Leicester NHS Trust, Leicester, UK.,Department of Biomedical Engineering, University of Strathclyde, Glasgow, UK
| | - Silvia Marconi
- National Research Council, Institute of Clinical Physiology, Rome, Italy
| | | | - Domenico M Pisanelli
- National Research Council, Institute of Cognitive Sciences and Technologies, Rome, Italy
| | - Claudio De Lazzari
- National Research Council, Institute of Clinical Physiology, Rome, Italy. .,National Institute for Cardiovascular Research (I.N.R.C.), Bologna, Italy.
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27
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Left ventricular pumping during the transition-adaptation sequence in preterm infants: impact of the patent ductus arteriosus. Pediatr Res 2018. [PMID: 29538367 DOI: 10.1038/pr.2018.22] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BackgroundPostnatally, the immature left ventricle (LV) is subjected to high systemic afterload. Hypothesizing that LV pumping would change during transition-adaptation, we analyzed the LV in preterm infants (GA≤32+6), clinically stable or with a hemodynamically significant patent ductus arteriosus (hPDA) by applying a pump model.MethodsPumping was characterized by EA (effective arterial elastance, reflecting afterload), EES (end-systolic LV elastance, reflecting contractility), EA/EES coupling ratios, descriptive EA:EES relations, and EA/EES graphs. Data calculated from echocardiography and blood pressure were analyzed by diagnosis (S group: clinically stable, no hPDA, n=122; hPDA group, n=53) and by periods (early transition: days of life 1-3; late transition: 4-7; and adaptation: 8-30).ResultsS group: LV pumping was characterized by an increased EA/EES coupling ratio of 0.65 secondary to low EES in early transition, a tandem rise of both EA and EES in late transition, and an EA/EES coupling ratio of 0.45 secondary to high EES in adaptation; hPDA group: time-trend analyses showed significantly lower EA (P<0.0001) and EES (P=0.006). Therefore, LV pumping was characterized by a lower EA/EES coupling ratio (P=0.088) throughout transition-adaptation.ConclusionsIn stable infants, facing high afterload, the immature LV, enhanced by the physiological PDA, increases its contractility. In hPDA, facing low afterload, the overloaded immature LV exhibits a consistently lower contractility.
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28
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Antonini-Canterin F, Di Nora C, Poli S, Sparacino L, Cosei I, Ravasel A, Popescu AC, Popescu BA. Obesity, Cardiac Remodeling, and Metabolic Profile: Validation of a New Simple Index beyond Body Mass Index. J Cardiovasc Echogr 2018; 28:18-25. [PMID: 29629255 PMCID: PMC5875131 DOI: 10.4103/jcecho.jcecho_63_17] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Aim: The body mass index (BMI), the most used anthropometric index of obesity, has an important limitation, not taking into consideration the distribution of body fat. We developed a new simple index: the waist-corrected BMI (wBMI), calculated as waist circumference (WC) × BMI. The study aim was to assess the role of wBMI, compared to BMI, WC, and Waist-to-Height Ratio (WHtR) in predicting abnormal cardiac geometry, insulin resistance, increased arterial stiffness, and dyslipidemia. Methods: This was a cross-sectional study that included 805 patients referred to our Department of Preventive Cardiology for risk factors evaluation and treatment. Eleven echographic and laboratory parameters were determined, and receiver operating characteristic (ROC) curves were derived. Areas under ROC curves (AUC) were used to assess the accuracy of the four indexes to identify unfavorable characteristics. Results: There were 29% overweight, 59% obese, and 77% hypertensive patients. Of 11 echographic and laboratory parameters, wBMI, BMI, WHtR, and WC had the largest AUC for identifying 3, 1, 6, and 1 parameters, respectively, but with overlapping 95% confidence intervals. wBMI had the largest AUC for increased arterial stiffness and insulin resistance; also, it was superior to BMI for increased left atrial volume, relative wall thickness, and triglyceride level. Conclusions: In a large population with a high prevalence of obesity and hypertension, all four indexes were associated with unfavorable characteristics. wBMI has the theoretical advantage of taking into account simultaneously the global fat mass and distribution and might be useful for a better cardiovascular risk assessment.
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Affiliation(s)
- Francesco Antonini-Canterin
- Ospedale Riabilitativo di Alta Specializzazione, Cardiologia Riabilitativa, Motta Di Livenza, Trieste, Italy
| | - Concetta Di Nora
- "Ospedali Riuniti" di Trieste, Cardiovascular Department, Trieste, Italy
| | - Stefano Poli
- "Ospedali Riuniti" di Trieste, Cardiovascular Department, Trieste, Italy
| | - Lina Sparacino
- ARC Ospedale di Sacile, Cardiologia Riabilitativa, Sacile, Italy
| | - Iulian Cosei
- Institute of Cardiovascular Diseases "Prof. Dr. C.C. Iliescu", Cardiology Department, Bucharest, Romania
| | - Andreea Ravasel
- Institute of Cardiovascular Diseases "Prof. Dr. C.C. Iliescu", Cardiology Department, Bucharest, Romania
| | - Andreea Catarina Popescu
- Elias Emergency Hospital, Cardiology Department, Bucharest, Romania.,University of Medicine and Pharmacy "Carol Davila" Bucharest, Romania
| | - Bogdan Alexandru Popescu
- Institute of Cardiovascular Diseases "Prof. Dr. C.C. Iliescu", Cardiology Department, Bucharest, Romania.,University of Medicine and Pharmacy "Carol Davila" Bucharest, Romania
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29
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Bonadei I, Sciatti E, Vizzardi E, Fabbricatore D, Pagnoni M, Rossi L, Carubelli V, Lombardi CM, Metra M. Effects of ivabradine on endothelial function, aortic properties and ventricular-arterial coupling in chronic systolic heart failure patients. Cardiovasc Ther 2018; 36:e12323. [PMID: 29460403 DOI: 10.1111/1755-5922.12323] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2017] [Revised: 12/30/2017] [Accepted: 02/15/2018] [Indexed: 12/28/2022] Open
Abstract
AIM Heart rate (HR) is an important prognostic factor in patients affected by chronic heart failure (CHF); ivabradine has been demonstrated to significantly reduce nonfatal myocardial infarction and hospitalization rate for acute heart failure and to improve left ventricular (LV) reverse remodeling, quality of life, exercise capacity, and arterial elastance (Ea) in these patients. We aimed at evaluating the short-term effects of ivabradine on ventricular-arterial coupling (VAC), aortic stiffness, and endothelial function in stable patients with CHF. METHODS We evaluated 30 consecutive CHF patients (LVEF≤ 35%, NYHA class II) with sinus rhythm and HR ≥ 70 bpm on optimized pharmacological therapy. All of them underwent both transthoracic echocardiogram to assess aortic elastic properties (aortic distensibility, AD; aortic stiffness index, ASI; systolic aortic strain, SAS) and VAC, and peripheral arterial tonometry to measure endothelial function. Therapy with ivabradine 5 mg bid was added and each patient was evaluated with the same examinations after 4 months. RESULTS At the baseline, 73% of patients had impaired VAC and 63% endothelial dysfunction. After 4 months, there was a significant improvement in the VAC value (ΔVAC -0.10 ± 0.18, P = .021), mainly linked to Ea (ΔEa -0.40 ± 0.23 mm Hg/mL; P = .003). All the parameters of aortic elasticity underwent significant improvement (ΔAD 1.82 ± 1.43 cm² × dyn- ¹, P = .004; ΔASI -4.73 ± 6.07, P = .033; ΔSAS -7.98 ± 4.37%, P = .003). Lastly, we also noted a significant improvement of endothelial function (Δ RHI 0.35 ± 0.35; P < .001). At follow-up 40% of patients had impaired VAC (P = .018) and 33% endothelial dysfunction (P = .038). CONCLUSION In patients with CHF adding ivabradine on top to the standard optimized medical therapy, when indicated, seems to improve endothelial function, aortic properties, and VAC.
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Affiliation(s)
- Ivano Bonadei
- Cardiology Unit, University and ASST Spedali Civili, Brescia, Italy
| | - Edoardo Sciatti
- Cardiology Unit, University and ASST Spedali Civili, Brescia, Italy
| | - Enrico Vizzardi
- Cardiology Unit, University and ASST Spedali Civili, Brescia, Italy
| | | | - Mattia Pagnoni
- Cardiology Unit, University and ASST Spedali Civili, Brescia, Italy
| | - Laura Rossi
- Cardiology Unit, University and ASST Spedali Civili, Brescia, Italy
| | | | - Carlo M Lombardi
- Cardiology Unit, University and ASST Spedali Civili, Brescia, Italy
| | - Marco Metra
- Cardiology Unit, University and ASST Spedali Civili, Brescia, Italy
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30
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Abstract
There are multiple intrinsic mechanisms for diastolic dysfunction ranging from molecular to structural derangements in ventricular myocardium. The molecular mechanisms regulating the progression from normal diastolic function to severe dysfunction still remain poorly understood. Recent studies suggest a potentially important role of core cardio-enriched transcription factors (TFs) in the control of cardiac diastolic function in health and disease through their ability to regulate the expression of target genes involved in the process of adaptive and maladaptive cardiac remodeling. The current relevant findings on the role of a variety of such TFs (TBX5, GATA-4/6, SRF, MYOCD, NRF2, and PITX2) in cardiac diastolic dysfunction and failure are updated, emphasizing their potential as promising targets for novel treatment strategies. In turn, the new animal models described here will be key tools in determining the underlying molecular mechanisms of disease. Since diastolic dysfunction is regulated by various TFs, which are also involved in cross talk with each other, there is a need for more in-depth research from a biomedical perspective in order to establish efficient therapeutic strategies.
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31
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de Roos A, van der Grond J, Mitchell G, Westenberg J. Magnetic Resonance Imaging of Cardiovascular Function and the Brain: Is Dementia a Cardiovascular-Driven Disease? Circulation 2017; 135:2178-2195. [PMID: 28559496 DOI: 10.1161/circulationaha.116.021978] [Citation(s) in RCA: 83] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
The proximal aorta acts as a coupling device between heart and brain perfusion, modulating the amount of pressure and flow pulsatility transmitted into the cerebral microcirculation. Stiffening of the proximal aorta is strongly associated with age and hypertension. The detrimental effects of aortic stiffening may result in brain damage as well as heart failure. The resulting cerebral small vessel disease and heart failure may contribute to early cognitive decline and (vascular) dementia. This pathophysiological sequence of events underscores the role of cardiovascular disease as a contributory mechanism in causing cognitive decline and dementia and potentially may provide a starting point for prevention and treatment. Magnetic resonance imaging is well suited to assess the function of the proximal aorta and the left ventricle (eg, aortic arch pulse wave velocity and distensibility) as well as the various early and late manifestations of cerebral small vessel disease (eg, microbleeds and white matter hyperintensities in strategically important regions of the brain). Specialized magnetic resonance imaging techniques are explored for diagnosing preclinical changes in white matter integrity or brain microvascular pulsatility.
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Affiliation(s)
- Albert de Roos
- From Leiden University Medical Center, Department of Radiology, The Netherlands (A.d.R., J.v.d.G., J.W.); and Cardiovascular Engineering, Inc, Norwood, MA (G.M.).
| | - Jeroen van der Grond
- From Leiden University Medical Center, Department of Radiology, The Netherlands (A.d.R., J.v.d.G., J.W.); and Cardiovascular Engineering, Inc, Norwood, MA (G.M.)
| | - Gary Mitchell
- From Leiden University Medical Center, Department of Radiology, The Netherlands (A.d.R., J.v.d.G., J.W.); and Cardiovascular Engineering, Inc, Norwood, MA (G.M.)
| | - Jos Westenberg
- From Leiden University Medical Center, Department of Radiology, The Netherlands (A.d.R., J.v.d.G., J.W.); and Cardiovascular Engineering, Inc, Norwood, MA (G.M.)
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Evaluation of local carotid stiffness and inflammatory biomarkers in stable angina pectoris. ADVANCES IN INTERVENTIONAL CARDIOLOGY 2017; 13:122-129. [PMID: 28798782 PMCID: PMC5545659 DOI: 10.5114/pwki.2017.68046] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2016] [Accepted: 02/07/2017] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Arterial stiffness (AS) is a well-accepted and reliable predictor of atherosclerotic diseases. Inflammation plays an important role in the development of AS. AIM To evaluate local carotid stiffness (CS) together with fibrinogen and high-sensitivity C-reactive protein (hsCRP) levels in stable angina pectoris (SAP) patients. MATERIAL AND METHODS The study consisted of 353 consecutive patients with SAP. All underwent coronary angiography (CAG) after the evaluation of local CS parameters and carotid intima-media thickness (IMT) from both common carotid arteries by a real-time echo-tracking system. Baseline inflammatory biomarkers, serum hsCRP and fibrinogen levels were measured. Based on CAG findings, the patients were classified into 4 groups: control subjects with normal coronary arteries (group 1, n = 86), single-vessel disease (group 2, n = 104), double-vessel disease (group 3, n = 95) and triple-vessel disease (group 4, n = 68). RESULTS The mean carotid pulse wave velocity (PWV) in patients with angiographically confirmed coronary artery disease (CAD) was significantly higher than that in patients with normal coronary arteries (7.82 ±1.76 vs. 6.51 ±0.85 cm/s, p = 0.001). The mean carotid IMT was detected to be significantly higher in group 4 patients compared to those in group 1 (p < 0.001) and group 2 (p = 0.001). Significant correlations were observed between both inflammatory biomarkers and the number of diseased vessels and carotid PWV. Using multi-variate analysis, carotid stiffness, carotid IMT, hsCRP and fibrinogen were independently associated with the presence and extent of CAD. CONCLUSIONS Local CS, carotid IMT, hsCRP and fibrinogen levels are significant predictors of atherosclerotic burden and they may facilitate the identification of high-risk patients for the early diagnosis and prompt treatment of CAD.
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Di Bello V, Fabiani I, Calogero E, Colonna P, Carerj S, Canterin FA, Benedetto F, La Carrubba S, Pugliese NR, Barletta V, Conte L. Clinical Usefulness of Cardio-ankle Vascular Index, Local Artery Carotid Stiffness and Global Longitudinal Strain in Subjects with Cardiovascular Risk Factors. J Cardiovasc Echogr 2017; 27:81-87. [PMID: 28758058 PMCID: PMC5516445 DOI: 10.4103/jcecho.jcecho_10_17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Vitantonio Di Bello
- Department of Cardiothoracic, Cisanello Hospital, University of Pisa, Pisa, Italy
| | - Iacopo Fabiani
- Department of Cardiothoracic, Cisanello Hospital, University of Pisa, Pisa, Italy
| | - Enrico Calogero
- Department of Cardiothoracic, Cisanello Hospital, University of Pisa, Pisa, Italy
| | | | - Scipione Carerj
- G. Martino Hospital, Division of Cardiology, University of Messina, Messina, Italy
| | | | - Frank Benedetto
- Division of Cardiology, Bianchi-Melacrino-Morelli Hospital, Reggio Calabria, Italy
| | - Salvatore La Carrubba
- Villa Sofia-Cervello Hospital, Division of General Internal Medicine, Palermo, Italy
| | - Nicola R Pugliese
- Department of Cardiothoracic, Cisanello Hospital, University of Pisa, Pisa, Italy
| | - Valentina Barletta
- Department of Cardiothoracic, Cisanello Hospital, University of Pisa, Pisa, Italy
| | - Lorenzo Conte
- Department of Cardiothoracic, Cisanello Hospital, University of Pisa, Pisa, Italy
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Abstract
Cardiologists could view empagliflozin as a cardiovascular drug that also has a beneficial effect on reducing hyperglycemia in patients with type 2 diabetes mellitus (T2DM). The effects of empagliflozin in lowering the risk of cardiovascular death and hospitalization for heart failure in T2DM patients with high cardiovascular risk during the recent Empagliflozin Cardiovascular Outcome Event Trial in Type 2 Diabetes Mellitus Patients-Removing Excess Glucose (EMPA-REG OUTCOME) trial may be explained principally in terms of changes to cardiovascular physiology; namely, by the potential ability of empagliflozin to reduce cardiac workload and myocardial oxygen consumption by lowering blood pressure, improving aortic compliance, and improving ventricular arterial coupling. These concepts and hypotheses are discussed in this report.
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Abstract
Cardiologists could view empagliflozin as a cardiovascular drug that also has a beneficial effect on reducing hyperglycemia in patients with type 2 diabetes mellitus (T2DM). The effects of empagliflozin in lowering the risk of cardiovascular death and hospitalization for heart failure in T2DM patients with high cardiovascular risk during the recent Empagliflozin Cardiovascular Outcome Event Trial in Type 2 Diabetes Mellitus Patients-Removing Excess Glucose (EMPA-REG OUTCOME) trial may be explained principally in terms of changes to cardiovascular physiology; namely, by the potential ability of empagliflozin to reduce cardiac workload and myocardial oxygen consumption by lowering blood pressure, improving aortic compliance, and improving ventricular arterial coupling. These concepts and hypotheses are discussed in this report.
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Cusmà Piccione M, Zito C, Khandheria B, Madaffari A, Oteri A, Falanga G, Donato D, D'Angelo M, Carerj ML, Di Bella G, Imbalzano E, Pugliatti P, Carerj S. Cardiovascular maladaptation to exercise in young hypertensive patients. Int J Cardiol 2017; 232:280-288. [DOI: 10.1016/j.ijcard.2017.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2016] [Revised: 12/27/2016] [Accepted: 01/03/2017] [Indexed: 10/20/2022]
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Calabrò MP, Carerj S, Russo MS, Luca FLD, Onofrio MTN, Antonini-Canterin F, Zito C, Oreto L, Manuri L, Khandheria BK, Oreto G. Carotid artery intima-media thickness and stiffness index β changes in normal children: role of age, height and sex. J Cardiovasc Med (Hagerstown) 2017; 18:19-27. [PMID: 26406394 DOI: 10.2459/jcm.0000000000000295] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AIMS The need for early markers of atherosclerosis in paediatric ages has been emphasized recently. Few data are available on the behaviour of carotid intima-media thickness (cIMT) and arterial stiffness in normal children. METHODS We studied prospectively 131 healthy children (78 boys), aged 3-16 years, by high-definition ultrasonography and echo-tracking technique in order to evaluate cIMT and stiffness index β. RESULTS Stiffness index β underwent a significant age-related increase (P < 0.001), and a positive relationship between cIMT and height was found in boys. In addition, stiffness index β and cIMT were not related to each other (P = 0.97). CONCLUSION This study provides information about two markers of subclinical atherosclerosis, cIMT and carotid stiffness index β, in normal children aged 3-16 years. We found a significant age-related and height-related increase of stiffness index β in both sexes, whereas cIMT was positively related to height only in boys.
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Affiliation(s)
- Maria Pia Calabrò
- aDepartment of Pediatric, Gynecologic, Microbiologic and Biomedical Sciences bDepartment of Clinical and Experimental Medicine cDepartment of SEFISAT, University of Messina, Messina dDepartment of Cardiovascular and Atherosclerotic Pathology, Pordenone, Italy eAurora Cardiovascular Services, Aurora Sinai/Aurora St. Luke's Medical Centers, University of Wisconsin School of Medicine and Public Health, Milwaukee, Wisconsin, USA
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Dumas L, El Bouti T, Lucor D. A Robust and Subject-Specific Hemodynamic Model of the Lower Limb Based on Noninvasive Arterial Measurements. J Biomech Eng 2017; 139:2565258. [PMID: 27685182 DOI: 10.1115/1.4034833] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2016] [Indexed: 11/08/2022]
Abstract
Cardiovascular diseases are currently the leading cause of mortality in the population of developed countries, due to the constant increase in cardiovascular risk factors, such as high blood pressure, cholesterol, overweight, tobacco use, lack of physical activity, etc. Numerous prospective and retrospective studies have shown that arterial stiffening is a relevant predictor of these diseases. Unfortunately, the arterial stiffness distribution across the human body is difficult to measure experimentally. We propose a numerical approach to determine the arterial stiffness distribution of an arterial network using a subject-specific one-dimensional model. The proposed approach calibrates the optimal parameters of the reduced-order model, including the arterial stiffness, by solving an inverse problem associated with the noninvasive in vivo measurements. An uncertainty quantification analysis has also been carried out to measure the contribution of the model input parameters variability, alone or by interaction with other inputs, to the variation of clinically relevant hemodynamic indices, here the arterial pulse pressure. The results obtained for a lower limb model, demonstrate that the numerical approach presented here can provide a robust and subject-specific tool to the practitioner, allowing an early and reliable diagnosis of cardiovascular diseases based on a noninvasive clinical examination.
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Affiliation(s)
- Laurent Dumas
- Professor Lab. de Mathématiques de Versailles, CNRS, UVSQ, Université Paris-Saclay, Versailles 78035, France e-mail:
| | - Tamara El Bouti
- MINES ParisTech PSL, Centre D'efficacité Énergétique des Systèmes, 5 rue Léon Blum, Palaiseau 91120, France e-mail:
| | - Didier Lucor
- LIMSI, CNRS, Université Paris-Saclay, Campus Universitaire, bât 508, Rue John von Neumann, Orsay Cedex F-91405, France e-mail:
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Vriz O, Magne J, Driussi C, Brosolo G, Ferrara F, Palatini P, Aboyans V, Bossone E. Comparison of arterial stiffness/compliance in the ascending aorta and common carotid artery in healthy subjects and its impact on left ventricular structure and function. Int J Cardiovasc Imaging 2016; 33:521-531. [PMID: 27885494 DOI: 10.1007/s10554-016-1032-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2016] [Accepted: 11/21/2016] [Indexed: 12/21/2022]
Abstract
Arterial stiffness and compliance parameters from two adjacent elastic arteries [aorta and common carotid artery (CCA)] were compared and their relationship with left ventricular (LV) structure and function and clinical parameters was assessed. 584 healthy subjects were prospectively enrolled [mean age 47.8 ± 18.4 years, range 16-94; 318 (54.4%) men]. They underwent comprehensive transthoracic echocardiography; M-mode diameters were measured at the level of the ascending aorta in systole and diastole and by echo-tracking at the level of the left CCA. The β-stiffness, pressure-strain elastic modulus, arterial compliance and one-point pulse wave velocity were derived. A significant correlation was observed between aortic and CCA stiffness and compliance parameters (p < 0.0001 for all). At multiple regression analysis, CCA stiffness parameters were constantly correlated with age and systolic blood pressure, and accounted for up to 56% of the variability (vs. only 29% in aortic stiffness and compliance). CCA stiffness parameters were found to better predict LV structure, diastolic function than aortic stiffness parameters. Aortic and CCA stiffness and compliance were found to correlate with each other and with age, with the correlation being higher for CCA stiffness. At multiple regression analysis, CCA stiffness parameters were better predictors of LV structure and function than aortic stiffness.
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Affiliation(s)
- Olga Vriz
- Cardiology and Emergency Department, San Antonio Hospital, Via Trento-Trieste, 33038, Udine, San Daniele Del Friuli, Italy.
| | - Julien Magne
- Department of Cardiology, Dupuytren University Hospital, Limoges, France
| | - Caterina Driussi
- Cardiology and Emergency Department, San Antonio Hospital, Via Trento-Trieste, 33038, Udine, San Daniele Del Friuli, Italy
| | | | - Francesco Ferrara
- Cardiology Division, "Cava de' Tirreni and Amalfi Coast" Hospital Heart Department, University of Salerno, Salerno, Italy
| | - Paolo Palatini
- Department of Medicine, University of Padova, Padova, Italy
| | - Victor Aboyans
- Department of Cardiology, Dupuytren University Hospital, Limoges, France
| | - Eduardo Bossone
- Cardiology Division, "Cava de' Tirreni and Amalfi Coast" Hospital Heart Department, University of Salerno, Salerno, Italy
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Abnormal Ventricular and Aortic Wall Properties Can Cause Inconsistencies in Grading Aortic Regurgitation Severity: A Computer Simulation Study. J Am Soc Echocardiogr 2016; 29:1122-1130.e4. [DOI: 10.1016/j.echo.2016.07.015] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2015] [Indexed: 11/20/2022]
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Prevalence of arterial stiffness and the risk of myocardial diastolic dysfunction in women. Biosci Rep 2016; 36:BSR20160276. [PMID: 27653526 PMCID: PMC5091468 DOI: 10.1042/bsr20160276] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2016] [Accepted: 09/20/2016] [Indexed: 12/31/2022] Open
Abstract
The present study reports markers of vascular function among a general female population and shows that left ventricular diastolic dysfunction (LVDD) is significantly associated with pathological PWV (⩾9.7 m/s), a waist circumference >80 cm and age. The present study determines the prevalence of vascular dysfunction and arterial stiffness (ASt) in a female urban population by measuring the brachial augmentation index (AIx) and aortic pulse wave velocity (PWV). The study tests the hypothesis that the measurement of AIx and PWV is useful in addition to that of traditional cardiovascular risk factors when assessing the risk for left ventricular diastolic dysfunction (LVDD). This cross-sectional study recruited 965 women aged 25–75 years from 12 districts of Berlin. The ASt indices, brachial AIx, aortic PWV and the central blood pressure were measured by an oscillometric method. A randomly selected subgroup (n=343) was examined by echocardiography. Trans-mitral inflow E/A ratio and diastolic mitral annulus velocity (é) were assessed. Questionnaires, medical history and blood sampling were used for the evaluation of individual risk factors. Normal vascular function was found in 55% of the women included. The prevalence of women with pathological AIx only (AIx ⩾ −10%, PWV normal) was 21.5%, whereas 17.9% were affected by increased AIx and PWV (AIx ⩾ −10%, PWV ⩾9.7 m/s), and 6% with only pathological PWV values. The prevalence of LVDD was 31.7%. LVDD was significantly associated with pathological PWV ⩾ 9.7 m/s [OR: 1.27, 95%CI: 1.02–1.57], age [OR: 4.17, 95%CI: 2.87–6.07] and a waist circumference >80 cm [OR: 3.61, 95%CI: 1.85–7.04] in multiple regression analysis. The high prevalence of markers for vascular dysfunction and ASt in a general female population and their importance as a mediator of diastolic dysfunction should encourage implementation of aortic PWV measurement to improve cardiovascular-risk assessment in particular to identify subclinical myocardial diastolic dysfunction.
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Impact of insulin resistance on cardiac and vascular function. Int J Cardiol 2016; 221:1095-9. [DOI: 10.1016/j.ijcard.2016.07.087] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2016] [Accepted: 07/04/2016] [Indexed: 12/25/2022]
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O'Regan DP. Stiff Arteries, Stiff Ventricles: Correlation or Causality in Heart Failure? Circ Cardiovasc Imaging 2016; 9:CIRCIMAGING.116.005150. [PMID: 27353853 DOI: 10.1161/circimaging.116.005150] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Declan P O'Regan
- From the Cardiovascular Magnetic Resonance Imaging and Genetics Group, MRC Clinical Sciences Centre (CSC), London, United Kingdom.
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Todaro MC, Khandheria BK, Longobardo L, Zito C, Cusmà-Piccione M, Di Bella G, Oreto L, Mohammed M, Oreto G, Carerj S. New diagnostic perspectives on heart failure with preserved ejection fraction: systolic function beyond ejection fraction. J Cardiovasc Med (Hagerstown) 2016; 16:527-37. [PMID: 25469729 DOI: 10.2459/jcm.0000000000000199] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Although preserved ejection fraction is found in more than 50% of patients with heart failure, its acceptance as a specific clinical entity is limited. More understanding of the physiopathology, early diagnosis and medical management is needed. With no existing systematic information in the literature, the aim of this review is to provide a comprehensive overview of the new imaging techniques for diagnosing heart failure with preserved ejection fraction, particularly in the early stages of the disease, underlying the pivotal role of new technologies such as two-dimensional speckle tracking echocardiography and vascular stiffness.
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Affiliation(s)
- Maria Chiara Todaro
- aClinical and Experimental Department of Medicine and Pharmacology, University of Messina, Messina, Italy bAurora Cardiovascular Services, Aurora Sinai/Aurora St. Luke's Medical Centers, University of Wisconsin School of Medicine and Public Health, Milwaukee, Wisconsin, USA
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Orabona R, Sciatti E, Vizzardi E, Bonadei I, Valcamonico A, Metra M, Frusca T. Elastic properties of ascending aorta in women with previous pregnancy complicated by early- or late-onset pre-eclampsia. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2016; 47:316-323. [PMID: 25754870 DOI: 10.1002/uog.14838] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/29/2014] [Revised: 02/23/2015] [Accepted: 02/27/2015] [Indexed: 06/04/2023]
Abstract
OBJECTIVES To evaluate the elastic properties of the ascending aorta in women with a previous pregnancy complicated by early-onset (EO) or late-onset (LO) pre-eclampsia (PE) and the correlation with gestational age (GA), systolic/diastolic blood pressure (SBP/DBP) and mean uterine artery pulsatility index (UtA-PI) at diagnosis of the disease as well as with birth weight of the neonate. METHODS Thirty women who had a previous pregnancy complicated by EO-PE, 30 with a previous pregnancy complicated by LO-PE and 30 normal controls were selected retrospectively from our electronic database and then recalled for assessment from 6 months to 4 years after delivery. Data regarding GA, SBP/DBP and mean UtA-PI at the diagnosis of PE were obtained from medical records. At our assessment, aortic M-mode and tissue Doppler imaging (TDI) parameters were measured. Aortic diameters were assessed at end-diastole at four levels: Valsalva sinuses, sinotubular junction, tubular tract and aortic arch. Aortic compliance, distensibility, stiffness index (SI), Peterson's elastic modulus (EM), pulse-wave velocity and M-mode strain were calculated using standard formulae. Aortic expansion velocity, early and late diastolic retraction velocities and peak systolic tissue strain (TDI-ϵ) were determined. RESULTS Aortic diameters at the four levels were significantly greater in both EO-PE and LO-PE groups than in controls. Aortic compliance and distensibility and TDI-ϵ were lower in EO-PE than in LO-PE (P = 0.001, P = 0.002 and P = 0.011, respectively) and controls (P = 0.037, P = 0.044 and P = 0.013, respectively). SI and EM were higher in EO-PE than in LO-PE (P = 0.001 and P < 0.001, respectively) and than in controls (P = 0.035 and P = 0.036, respectively). Multivariate analysis showed GA, DBP and UtA-PI at diagnosis of PE to be independent predictors of aortic elastic properties. CONCLUSIONS Elastic properties of the ascending aorta were altered in women with a previous pregnancy complicated by EO-PE, but not in those with LO-PE. Copyright © 2015 ISUOG. Published by John Wiley & Sons Ltd.
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Affiliation(s)
- R Orabona
- Maternal Fetal Medicine Unit, Department of Obstetrics and Gynecology, University of Brescia, Brescia, Italy
| | - E Sciatti
- Section of Cardiovascular Diseases, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - E Vizzardi
- Section of Cardiovascular Diseases, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - I Bonadei
- Section of Cardiovascular Diseases, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - A Valcamonico
- Maternal Fetal Medicine Unit, Department of Obstetrics and Gynecology, University of Brescia, Brescia, Italy
| | - M Metra
- Section of Cardiovascular Diseases, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - T Frusca
- Maternal Fetal Medicine Unit, Department of Obstetrics and Gynecology, University of Brescia, Brescia, Italy
- Department of Obstetrics and Gynecology, University of Parma, Parma, Italy
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Teixeira R, Vieira MJ, Gonçalves A, Cardim N, Gonçalves L. Ultrasonographic vascular mechanics to assess arterial stiffness: a review. Eur Heart J Cardiovasc Imaging 2015; 17:233-46. [DOI: 10.1093/ehjci/jev287] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2015] [Accepted: 10/04/2015] [Indexed: 12/21/2022] Open
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Cusmà-Piccione M, Zito C, Khandheria BK, Pizzino F, Di Bella G, Antonini-Canterin F, Vriz O, Bello VAD, Zimbalatti C, La Carrubba S, Oreto G, Carerj S. How arterial stiffness may affect coronary blood flow: a challenging pathophysiological link. J Cardiovasc Med (Hagerstown) 2015; 15:797-802. [PMID: 25251941 DOI: 10.2459/jcm.0000000000000185] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AIMS A relationship between arterial stiffening and coronary flow abnormalities, although not fully elucidated, has been observed. The purpose of this study was to investigate the relationship among carotid stiffness, measured using echo-tracking, and Doppler parameters of coronary blood flow, sampled at the left anterior descending (LAD) artery. METHODS We studied 88 consecutive patients (49 men, mean age 51.2 ± 16.2 years) with cardiovascular risk factors but without history of cardiovascular diseases. Each patient underwent echocardiographic evaluation for measurement of the diastolic velocity time integral (DVTI) and calculation of the diastolic velocity time integral coronary index (DVTICI), the ratio between DVTI and total velocity time integral of LAD artery flow × 100, and carotid ultrasound for measurement of carotid intima media thickness (IMT) and stiffness parameters such as β index and elastic modulus (Ep). RESULTS DVTICI was significantly greater in men than in women (median 82, interquartile range 78-86 vs. median 80, interquartile range 73-83, respectively; P < 0.016). After correlating DVTICI with other variables, a significant inverse relation was obtained with β index (Rho = -0.449, P < 0.001), Ep (Rho = -0.478, P < 0.001), age (Rho = -0.52, P < 0.001), left ventricular mass index (Rho = -0.543, P < 0.001), E/E' (Rho = -0.411, P < 0.001), pulse pressure (Rho = -0.417, P < 0.001) and IMT (Rho = -0.480, P < 0.001). With linear multiple regression analysis, only β index (P < 0.001), Ep (P < 0.001), male sex (P < 0.001) and left ventricular mass index (P = 0.008) were independently associated with reduction of DVTICI. CONCLUSION Increased arterial stiffness, directly affecting coronary perfusion, is associated with reduced diastolic coronary flow. Echo-tracking for feasible measurement of carotid artery stiffness parameters may be valuable in more accurate cardiovascular risk stratification.
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Affiliation(s)
- Maurizio Cusmà-Piccione
- aClinical and Experimental Department of Medicine, University of Messina, Messina, Italy bAurora Cardiovascular Services, Aurora Sinai/Aurora St. Luke's Medical Centers, University of Wisconsin School of Medicine and Public Health, Milwaukee, Wisconsin, USA cCardiology Unit, ARC, S. Maria degli Angeli Hospital, Pordenone dCardiology Unit, O.C. San Antonio, San Daniele del Friuli, Udine eCardiac Thoracic and Vascular Department, University of Pisa, Pisa fInternal Medicine, Villa Sofia Hospital, Palermo, Italy
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Kim HL, Seo JB, Chung WY, Kim SH, Kim MA, Zo JH. Independent association between brachial-ankle pulse wave velocity and global longitudinal strain of left ventricle. Int J Cardiovasc Imaging 2015; 31:1563-70. [DOI: 10.1007/s10554-015-0744-5] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2015] [Accepted: 08/13/2015] [Indexed: 12/01/2022]
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Antonini-Canterin F, Mateescu AD, Vriz O, La Carrubba S, Di Bello V, Carerj S, Zito C, Sparacino L, Uşurelu C, Ticulescu R, Ginghină C, Nicolosi GL, Popescu BA. Impact of metabolic syndrome traits on cardiovascular function: should the Adult Treatment Panel III definition be further stratified? J Cardiovasc Med (Hagerstown) 2015; 15:752-8. [PMID: 25050530 DOI: 10.2459/jcm.0000000000000118] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AIMS The aims of the study were to evaluate whether a further classification of metabolic syndrome according to the number of traits (based on the Adult Treatment Panel III definition) could better explain the impact on cardiovascular remodeling and function, and to assess the role of single metabolic syndrome components in this regard. METHODS We studied by echocardiography and carotid ultrasound 435 asymptomatic patients with metabolic syndrome. Patients with coronary artery disease or more than mild valvular heart disease were excluded. Carotid stiffness index (β) was measured using a high-resolution echo-tracking system. Patients with metabolic syndrome were divided into two groups: metabolic syndrome with three traits (Gr.1) and metabolic syndrome with four or five traits (Gr. 2). RESULTS Patients in Gr. 2 had higher left ventricular mass index (P < 0.001), left ventricular end-diastolic volume index (P = 0.029), left atrial volume index (P = 0.002), E/e' ratio (P = 0.002), intima-media thickness (P = 0.031), and prevalence of plaques (P = 0.01) than patients in Gr. 1. Left ventricular ejection fraction was similar in both groups. The mean carotid β index tended to be higher in Gr. 2. Considering metabolic syndrome traits separately, in an age-corrected multivariate analysis, abdominal obesity was found to have the strongest association with cardiac structure and carotid artery atherosclerosis and stiffness. CONCLUSION An increasing number of metabolic syndrome traits had a significantly worse impact on cardiac remodeling and function and carotid artery atherosclerosis. Abdominal obesity showed the strongest association with cardiac structure, carotid artery stiffness, and intima-media thickness. Prospective studies are needed to evaluate whether a new classification of metabolic syndrome using the number of traits could add prognostic information.
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Affiliation(s)
- Francesco Antonini-Canterin
- aCardiologia Preventiva e Riabilitativa, ARC, Azienda Ospedaliera S. Maria degli Angeli, Pordenone bCardiologia, Ospedale S. Antonio, San Daniele del Friuli cMedicina Interna, Ospedale Villa Sofia, Palermo dCardiologia, Università di Pisa, Pisa eCardiologia, Università di Messina, Messina, Italy f'Carol Davila' University of Medicine and Pharmacy, 'Prof. Dr C.C. Iliescu' Institute of Cardiovascular Diseases, Bucharest, Romania gCardiologia, ARC, Azienda Ospedaliera S. Maria degli Angeli, Pordenone, Italy
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