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Cuspidi C, Facchetti R, Quarti-Trevano F, Dell'Oro R, Mancia G, Grassi G. Cardio-Ankle Vascular Index as a Marker of Left Ventricular Hypertrophy in Treated Hypertensives: Findings From the Pamela Study. Am J Hypertens 2024; 37:399-406. [PMID: 38441300 DOI: 10.1093/ajh/hpae022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Revised: 02/28/2024] [Accepted: 02/29/2024] [Indexed: 05/16/2024] Open
Abstract
BACKGROUND Findings regarding the association between Cardio-Ankle Vascular Index (CAVI) and cardiac hypertension-mediated organ damage (HMOD), such as left ventricular hypertrophy (LVH) assessed by echocardiography, in elderly hypertensive patients are scanty. We sought to investigate this issue in the hypertensive fraction of the general population treated with anti-hypertensive drugs enrolled in the Pressioni Monitorate E Loro Associazioni (PAMELA) study. METHODS The study included 239 out of 562 participants who attended the second and third surveys of the PAMELA study performed after 10 and 25 years from the initial evaluation. Data collection included medical history, anthropometric parameters, office, home, ambulatory blood pressure (BP), blood examinations, echocardiography, and CAVI measurements. RESULTS In the whole study sample (age 69 ± 9 years, 54% males), CAVI was positively correlated with age, office, home, ambulatory systolic BP, LV mass (LVM) index, and negatively associated with body mass index (BMI). In multivariate analysis, CAVI was associated with the LVM index (P < 0.05) independently of major confounders. The participants with LVH exhibited significantly higher CAVI (10.6 ± 2.8 vs. 9.2 ± 1.8 m/s P < 0.001), larger left atrial diameter, and lower LV ejection fraction values than their counterparts without it. The CAVI value of 9.4 m/s was the best cut-off for prediction of LVH in the whole sample. CONCLUSIONS Our study provides new evidence of an independent association between CAVI and LVH in treated elderly hypertensive patients and suggests that the use of this metric of arterial stiffness could not only be used to evaluate vascular damage but also to stratify the risk of LVH.
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Affiliation(s)
- Cesare Cuspidi
- Department of Medicine and Surgery, University of Milano-Bicocca, Milano, Italy
| | - Rita Facchetti
- Department of Medicine and Surgery, University of Milano-Bicocca, Milano, Italy
| | | | - Raffaella Dell'Oro
- Department of Medicine and Surgery, University of Milano-Bicocca, Milano, Italy
| | - Giuseppe Mancia
- Department of Medicine and Surgery, University of Milano-Bicocca, Milano, Italy
| | - Guido Grassi
- Department of Medicine and Surgery, University of Milano-Bicocca, Milano, Italy
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Gavish B, Bursztyn M, Thijs L, Wei DM, Melgarejo JD, Zhang ZY, Boggia J, Hansen TW, Asayama K, Ohkubo T, Kikuya M, Yang WY, Stolarz-Skrzypek K, Malyutina S, Casiglia E, Lind L, Li Y, Kawecka-Jaszcz K, Filipovský J, Tikhonoff V, Gilis-Malinowska N, Dolan E, Sandoya E, Narkiewicz K, Wang JG, Imai Y, Maestre GE, O’Brien E, Staessen JA. Predictive power of 24-h ambulatory pulse pressure and its components for mortality and cardiovascular outcomes in 11 848 participants recruited from 13 populations. J Hypertens 2022; 40:2245-2255. [PMID: 35950994 PMCID: PMC10366954 DOI: 10.1097/hjh.0000000000003258] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
BACKGROUND The role of pulse pressure (PP) 'widening' at older and younger age as a cardiovascular risk factor is still controversial. Mean PP, as determined from repeated blood pressure (BP) readings, can be expressed as a sum of two components: 'elastic PP' (elPP) and 'stiffening PP' (stPP) associated, respectively, with stiffness at the diastole and its relative change during the systole. We investigated the association of 24-h ambulatory PP, elPP, and stPP ('PP variables') with mortality and composite cardiovascular events in different age classes. METHOD Longitudinal population-based cohort study of adults with baseline observations that included 24-h ambulatory BP. Age classes were age 40 or less, 40-50, 50-60, 60-70, and over 70 years. Co-primary endpoints were total mortality and composite cardiovascular events. The relative risk expressed by hazard ratio per 1SD increase for each of the PP variables was calculated from multivariable-adjusted Cox regression models. RESULTS The 11 848 participants from 13 cohorts (age 53 ± 16 years, 50% men) were followed for up for 13.7 ± 6.7 years. A total of 2946 participants died (18.1 per 1000 person-years) and 2093 experienced a fatal or nonfatal cardiovascular event (12.9 per 1000 person-years). Mean PP, elPP, and stPP were, respectively, 49.7, 43.5, and 6.2 mmHg, and elPP and stPP were uncorrelated ( r = -0.07). At age 50-60 years, all PP variables displayed association with risk for almost all outcomes. From age over 60 years to age over 70 years, hazard ratios of of PP and elPP were similar and decreased gradually but differently for pulse rate lower than or higher than 70 bpm, whereas stPP lacked predictive power in most cases. For age 40 years or less, elPP showed protective power for coronary events, whereas stPP and PP predicted stroke events. Adjusted and unadjusted hazard ratio variations were similar over the entire age range. CONCLUSION This study provides a new basis for associating PP components with outcome and arterial properties in different age groups and at different pulse rates for both old and young age. The similarity between adjusted and unadjusted hazard ratios supports the clinical usefulness of PP components but further studies are needed to assess the prognostic significance of the PP components, especially at the young age.
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Affiliation(s)
| | - Michael Bursztyn
- Faculty of Medicine Hebrew University, Jerusalem, Hypertension Clinic Hadassah Medical Center Mount-Scopus, Jerusalem and Department of Medicine D, Beilinson Hospital, Petach-Tikva, Israel
| | - Lutgarde Thijs
- Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium
| | - Dong-Mei Wei
- Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium
| | - Jesus D. Melgarejo
- Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium
- Laboratory of Neurosciences, Faculty of Medicine, University of Zulia, Maracaibo, Zulia, Venezuela
| | - Zhen-Yu Zhang
- Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium
| | - Jose Boggia
- Centro de Nefrología and Departamento de Fisiopatología, Hospital de Clínicas, Universidad de la República, Montevideo, Uruguay
| | - Tine W. Hansen
- Steno Diabetes Center Copenhagen, Gentofte and Research Centre for Prevention and Health, Capital Region of Denmark, Denmark
| | - Kei Asayama
- Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium
- Department of Hygiene and Public Health, Teikyo University School of Medicine, Tokyo
- Tohoku Institute for Management of Blood Pressure, Sendai, Japan
| | - Takayoshi Ohkubo
- Department of Hygiene and Public Health, Teikyo University School of Medicine, Tokyo
- Tohoku Institute for Management of Blood Pressure, Sendai, Japan
| | - Masahiro Kikuya
- Department of Hygiene and Public Health, Teikyo University School of Medicine, Tokyo
| | - Wen-Yi Yang
- Department of Cardiology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Katarzyna Stolarz-Skrzypek
- First Department of Cardiology, Interventional Electrocardiology and Hypertension, Jagiellonian University Medical College, Kraków, Poland
| | - Sofia Malyutina
- Institute of Internal and Preventive Medicine, Internal and Preventive Medicine - Branch of the Institute of Cytology and Genetics, Siberian Branch of the Russian Academy of Science, Novosibirsk, Russian Federation
| | | | - Lars Lind
- Section of Geriatrics, Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
| | - Yan Li
- Department of Cardiovascular Medicine, Shanghai Institute of Hypertension, Shanghai Key Laboratory of Hypertension, China
| | - Kalina Kawecka-Jaszcz
- First Department of Cardiology, Interventional Electrocardiology and Hypertension, Jagiellonian University Medical College, Kraków, Poland
| | - Jan Filipovský
- Faculty of Medicine, Charles University, Pilsen, Czech Republic
| | | | | | - Eamon Dolan
- Conway Institute, University College Dublin, Dublin, Ireland
- Stroke and Hypertension Unit, Blanchardstown, Dublin, Ireland
| | - Edgardo Sandoya
- Asociación Española Primera de Socorros Mutuos, Montevideo, Uruguay
| | | | - Ji-Guang Wang
- Department of Cardiovascular Medicine, Shanghai Institute of Hypertension, Shanghai Key Laboratory of Hypertension, China
| | - Yutaka Imai
- Tohoku Institute for Management of Blood Pressure, Sendai, Japan
| | - Gladys E. Maestre
- Department of Neurosciences and Department of Human Genetics, University of Texas Rio Grande Valley School of Medicine, Brownsville, Texas, USA
| | - Eoin O’Brien
- Conway Institute, University College Dublin, Dublin, Ireland
| | - Jan A. Staessen
- Research Institute Alliance for the Promotion of Preventive Medicine, Mechelen
- Biomedical Science Group, University of Leuven, Leuven, Belgium
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Image-free ultrasound for local and regional vascular stiffness assessment: the ARTSENS Plus. J Hypertens 2022; 40:1537-1544. [PMID: 35730407 DOI: 10.1097/hjh.0000000000003181] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVE The combined assessment of vascular health markers is crucial for identifying the cumulative burden of vascular risk factors early on, as well as the extent of vascular aging for effective prediction of future cardiovascular events. This work addresses the need for a currently nonexistent device or system that facilitates such combined assessment in clinical practice and large-scale screening settings. We report an image-free ultrasound device - ARTSENS Plus - developed for the measurement of local and regional arterial stiffness, central and peripheral blood pressure (BP), and vessel dimensions, all in one examination. METHODS A preclinical study on 90 asymptomatic individuals verified the device's functionality under ARTERY Society guidelines. The device's accuracy of stiffness measures was validated against the reference measures. RESULTS The interoperator and intraoperator variability was less than 7%. Carotid artery's lumen diameter and local stiffness indices and carotid-femoral regional pulse wave velocity showed excellent agreement with the references (absolute errors were less than 4.1, 9, and 4.1%, respectively). The carotid SBP was 10.02% lower than that of the brachial artery, as expected. CONCLUSION The study demonstrated the device's ability to perform an effortless and reliable evaluation of the local and regional vascular stiffness and central BP with an accuracy that meets clinical standards.
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Nabeel PM, Chandran DS, Kaur P, Thanikachalam S, Sivaprakasam M, Joseph J. Association of incremental pulse wave velocity with cardiometabolic risk factors. Sci Rep 2021; 11:15413. [PMID: 34326391 PMCID: PMC8322136 DOI: 10.1038/s41598-021-94723-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Accepted: 07/06/2021] [Indexed: 02/07/2023] Open
Abstract
We investigate the association of incremental pulse wave velocity (ΔC; the change in pulse wave velocity over a cardiac cycle) with cardiometabolic risk factors and report the first and (currently) the largest population-level data. In a cross-sectional study performed in a cohort of 1373 general population participants, ΔC was measured using clinically validated ARTSENS devices. There were 455 participants in the metabolic syndrome (MetS) group whose average ΔC was ~ 28.4% higher than that of the non-metabolic syndrome (Non-MetS) group. Females with MetS showed ~ 10.9% elevated average ΔC compared to males of the Non-MetS group. As the number of risk factors increased from 0 to 5, the average ΔC escalated by ~ 55% (1.50 ± 0.52 m/s to 2.33 ± 0.91 m/s). A gradual increase in average ΔC was observed across each decade from the younger (ΔC = 1.53 ± 0.54 m/s) to geriatric (ΔC = 2.34 ± 0.59 m/s) populations. There was also a significant difference in ΔC among the blood pressure categories. Most importantly, ΔC ≥ 1.81 m/s predicted a constellation of ≥ 3 risks with AUC = 0.615, OR = 2.309, and RR = 1.703. All statistical trends remained significant, even after adjusting for covariates. The study provides initial evidence for the potential use of ΔC as a tool for the early detection and screening of vascular dysfunction, which opens up avenues for active clinical and epidemiological studies. Further investigations are encouraged to confirm and establish the causative mechanism for the reported associations.
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Affiliation(s)
- P. M. Nabeel
- grid.417969.40000 0001 2315 1926Healthcare Technology Innovation Centre, IIT Madras, Chennai, 600113 India
| | - Dinu S. Chandran
- grid.413618.90000 0004 1767 6103Department of Physiology, All India Institute of Medical Sciences, New Delhi, 110029 India
| | - Prabhdeep Kaur
- grid.419587.60000 0004 1767 6269National Institute of Epidemiology, Indian Council of Medical Research, Chennai, 600077 India
| | - Sadagopan Thanikachalam
- grid.412734.70000 0001 1863 5125Sri Ramachandra Institute of Higher Education and Research, Chennai, 600116 India
| | - Mohanasankar Sivaprakasam
- grid.417969.40000 0001 2315 1926Healthcare Technology Innovation Centre, IIT Madras, Chennai, 600113 India ,grid.417969.40000 0001 2315 1926Department of Electrical Engineering, Indian Institute of Technology Madras, Chennai, 600036 India
| | - Jayaraj Joseph
- grid.417969.40000 0001 2315 1926Department of Electrical Engineering, Indian Institute of Technology Madras, Chennai, 600036 India
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Manoj R, P M N, V V A, Kiran V R, Joseph J, Sivaprakasam M. Demonstration of Pressure-Dependent Inter and Intra-Cycle Variations in Local Pulse Wave Velocity Using Excised Bovine Carotid Artery. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2020; 2020:2707-2710. [PMID: 33018565 DOI: 10.1109/embc44109.2020.9175712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Pulse wave velocity (PWV) is a function of the artery's material property, and its incremental nature in elastic modulus led to the concept of incremental PWV. Recent advancements in technology paved the way for reliable measurement of the variation in PWV within a cardiac cycle. This change in PWV has shown its potential as a biomarker for advanced cardiovascular diagnostics, screening, and has recently started using as a vascular screening tool and medical device development. In this work, we have demonstrated the concept of inter and intra-cycle variations of PWV with pressure using an excised bovine carotid artery. Results demonstrated that local PWV measured at the foot of the waveform followed the same trend as of the pressure. As the pressure level was increased to 68% across the cycles, resulting PWV increased up to 81%. An exponential PWV-Pressure relationship was obtained, in agreement with the widely used models. The incremental nature of PWV was recorded in a reflection-free region of the pressure pulse wave. This was further demonstrated in continuous pulse cycles with varying pressure ranges, by comparing the PWV values at two fiduciary points selected in the upstroke of the pressure wave. On average, a 48.11% increase in PWV was observed for 31.04% increase in pressure between the selected fiducial points within a pulse cycle. The article concludes, highlighting the clinical significance of incremental PWV.Clinical Relevance- This experimental study supplements the evidence for the incremental nature of PWV within a cardiac cycle, which has the potential for being a biomarker for advanced cardiovascular screening and diagnostics.
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Raj KV, Joseph J, M NP, Sivaprakasam M. Automated measurement of compression-decompression in arterial diameter and wall thickness by image-free ultrasound. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2020; 194:105557. [PMID: 32474251 DOI: 10.1016/j.cmpb.2020.105557] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Revised: 04/26/2020] [Accepted: 05/17/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND AND OBJECTIVE The manual measurement of arterial diameter and wall thickness using imaging modalities demand expertise, and the state-of-art automated or semi-automated measurement features are seldom available in the entry-level systems. The advanced ultrasound modalities are expensive, non-scalable, and less favorable for field and resource-constrained settings. In this work, we present a novel method to measure arterial diameter (D), surrogate intima-media thickness (sIMT), and with them their intra-cardiac cycle changes by employing an affordable image-free ultrasound technology. METHODS The functionality of the method was systematically validated on a simulation testbed, phantoms and, 40 human subjects. The accuracy, agreement, inter-beat, and inter-operator variabilities were quantified. The in-vivo measurement performance of the method was compared against two reference B-mode tools - Carotid Studio and CAROLAB. RESULTS Simulations revealed that for the A-mode frames with SNR > 10 dB, the proposed method identifies the desired arterial wall interfaces with an RMSE < 20 μm. The RMSE for the diameter and wall thickness measurements from the static phantom were 111 μm and 14 μm, and for the dynamic phantom were 117 μm and 18 μm, respectively. Strong agreement was seen between the in-vivo measurements of the proposed method and the two reference tools. The mean absolute errors against the two references and the inter-beat variability were smaller than 0.18 mm for D and smaller than 36 μm for sIMT measurements. Likewise, the respective inter-observer variabilities were 0.16 ± 0.23 mm and 43 ± 25 μm. CONCLUSION Acceptable accuracy and repeatability were observed during the validation, that were on a par with the recently reported B-mode techniques in the literature. The technology being real-time, automated, and relatively inexpensive, is promising for field and low-resource settings.
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Affiliation(s)
- Kiran V Raj
- Department of Electrical Engineering, Indian Institute of Technology Madras, Chennai, Tamil Nadu, India.
| | - Jayaraj Joseph
- Healthcare Technology Innovation Centre, Indian Institute of Technology Madras, Chennai, Tamil Nadu, India
| | - Nabeel P M
- Healthcare Technology Innovation Centre, Indian Institute of Technology Madras, Chennai, Tamil Nadu, India
| | - Mohanasankar Sivaprakasam
- Department of Electrical Engineering, Indian Institute of Technology Madras, Chennai, Tamil Nadu, India; Healthcare Technology Innovation Centre, Indian Institute of Technology Madras, Chennai, Tamil Nadu, India
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Takahashi K, Yamamoto T, Tsuda S, Maruyama M, Shirai K. The Background of Calculating CAVI: Lesson from the Discrepancy Between CAVI and CAVI 0. Vasc Health Risk Manag 2020; 16:193-201. [PMID: 32547046 PMCID: PMC7251085 DOI: 10.2147/vhrm.s223330] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Accepted: 04/09/2020] [Indexed: 12/18/2022] Open
Abstract
Arterial stiffness is a good predictor of cardiovascular events. As a substitute for elastic modulus representing stiffness, pulse wave velocity (PWV) has been used for over a century as it is easy to measure; however, PWV is known to essentially depend on blood pressure at the time of measurement. The cardio-ankle vascular index (CAVI) is a relatively new index of global arterial stiffness of the origin of the aorta to the ankle arteries. The characteristic feature is its independency from blood pressure at the measuring time. Recently, a variant index CAVI0 was proposed, which was claimed to be a more accurate arterial stiffness index than CAVI, considering independency from blood pressure. The purpose of this review is to evaluate the properties of CAVI more precisely by comparing with CAVI0, and to confirm the true meaning of CAVI as an index of arterial stiffness. First, the properties of PWV depending on the blood pressure and the variation of PWV values in the cardiac cycle were analyzed. Then, we attempted to clarify the point at which the PWV, adopted in CAVI or in CAVI0, was measured in cardiac cycle. A comprehensive comparison of the clinical data of CAVI and CAVI0 showed that CAVI is more appropriate than CAVI0. In conclusion, CAVI is reconfirmed to be a reliable and useful index of blood pressure-independent arterial stiffness composed of both organic and functional stiffness.
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Cooke AB, Dasgupta K, Spronck B, Sharman JE, Daskalopoulou SS. Adults With Type 2 Diabetes Mellitus Exhibit a Greater Exercise-Induced Increase in Arterial Stiffness and Vessel Hemodynamics. Hypertension 2020; 75:1565-1573. [DOI: 10.1161/hypertensionaha.120.14778] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Individuals with type 2 diabetes mellitus (T2DM) have a greater blood pressure (BP) response to acute maximal exercise compared to those without T2DM; however, whether they exhibit a different arterial stiffness response to maximal exercise has yet to be explored. Adults with (n=66) and without T2DM (n=61) underwent an arterial stress test: at rest and immediately postexercise, carotid-femoral pulse wave velocity, the gold standard measure of arterial stiffness, brachial BP, heart rate, and other hemodynamic measurements were assessed. Linear regression models were used to evaluate between-group differences at rest, and the response to exercise (postexercise value), adjusting for covariates including BP and heart rate when relevant, and the corresponding baseline value of each parameter. All participants (mean±SD: age 59.3±10.6 years; body mass index 31.2±3.9 kg/m
2
) had hypertension (mean BP 130±14/80±9 mm Hg). At rest, participants with T2DM had significantly higher carotid-femoral pulse wave velocity (10.3±2.7 versus 9.1±1.9 m/s), heart rate (69±11 versus 66±10 beats/min), and lower diastolic BP (79±9 versus 83±9 mm Hg), but systolic BP (129±15 versus 131±13 mm Hg) was similar. In response to exercise, participants with T2DM showed greater increases in carotid-femoral pulse wave velocity (1.6 [95% CI, 0.4–2.9 m/s]) and systolic BP (9 [95% CI, 1–17 mm Hg]) than participants without T2DM. A greater proportion of participants with T2DM had a hypertensive response to exercise compared to participants without T2DM (n=23, 35% versus n=11, 18%;
P
=0.033). By incorporating exercise as a vascular stressor, we provide evidence of a greater increase in arterial stiffness in individuals with T2DM, independently of resting arterial stiffness, and the BP postexercise.
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Affiliation(s)
- Alexandra B. Cooke
- From the Department of Medicine, McGill University Health Centre (A.B.C., K.D., S.S.D.), McGill University, Montreal, QC, Canada
- Centre for Outcomes Research and Evaluation (CORE), Research Institute of the McGill University Health Centre (A.B.C., K.D.), McGill University, Montreal, QC, Canada
| | - Kaberi Dasgupta
- From the Department of Medicine, McGill University Health Centre (A.B.C., K.D., S.S.D.), McGill University, Montreal, QC, Canada
- Centre for Outcomes Research and Evaluation (CORE), Research Institute of the McGill University Health Centre (A.B.C., K.D.), McGill University, Montreal, QC, Canada
| | - Bart Spronck
- Department of Biomedical Engineering, School of Engineering and Applied Science, Yale University, New Haven, CT (B.S.)
- Department of Biomedical Engineering, CARIM School for Cardiovascular Diseases, Maastricht University, the Netherlands (B.S.)
| | - James E. Sharman
- Menzies Research Institute Tasmania, University of Tasmania, Hobart, Australia (J.E.S.)
| | - Stella S. Daskalopoulou
- From the Department of Medicine, McGill University Health Centre (A.B.C., K.D., S.S.D.), McGill University, Montreal, QC, Canada
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Nabeel PM, Kiran VR, Joseph J, Abhidev VV, Sivaprakasam M. Local Pulse Wave Velocity: Theory, Methods, Advancements, and Clinical Applications. IEEE Rev Biomed Eng 2019; 13:74-112. [PMID: 31369386 DOI: 10.1109/rbme.2019.2931587] [Citation(s) in RCA: 55] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Local pulse wave velocity (PWV) is evolving as one of the important determinants of arterial hemodynamics, localized vessel stiffening associated with several pathologies, and a host of other cardiovascular events. Although PWV was introduced over a century ago, only in recent decades, due to various technological advancements, has emphasis been directed toward its measurement from a single arterial section or from piecewise segments of a target arterial section. This emerging worldwide trend in the exploration of instrumental solutions for local PWV measurement has produced several invasive and noninvasive methods. As of yet, however, a univocal opinion on the ideal measurement method has not emerged. Neither have there been extensive comparative studies on the accuracy of the available methods. Recognizing this reality, makes apparent the need to establish guideline-recommended standards for the measurement methods and reference values, without which clinical application cannot be pursued. This paper enumerates all major local PWV measurement methods while pinpointing their salient methodological considerations and emphasizing the necessity of global standardization. Further, a summary of the advancements in measuring modalities and clinical applications is provided. Additionally, a detailed discussion on the minimally explored concept of incremental local PWV is presented along with suggestions of future research questions.
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Pan FS, Yu L, Luo J, Wu RD, Xu M, Liang JY, Zheng YL, Xie XY. Carotid Artery Stiffness Assessment by Ultrafast Ultrasound Imaging: Feasibility and Potential Influencing Factors. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2018; 37:2759-2767. [PMID: 29672890 DOI: 10.1002/jum.14630] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/16/2017] [Revised: 01/31/2018] [Accepted: 02/20/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVES To evaluate the feasibility of the ultrafast ultrasound pulsed wave velocity (PWV) for carotid stiffness assessment and potential influencing factors. METHODS Ultrafast PWV measurements of 442 carotid arteries in 162 consecutive patients (patient group) and 66 healthy volunteers (control group) were performed. High- and very high-frequency transducers were used in 110 carotid segments. The ultrafast PWVs at the beginning and end of systole were automatically measured. The correlations between the intima-media thickness (IMT) and ultrafast PWV and the equipment and carotid factors influencing the utility of ultrafast PWV were analyzed. RESULTS Each ultrafast PWV acquisition was completed within 1 minute. The intraobserver variability showed mean differences ± SD of 0.12 ± 1.28 m/s for the PWV before systole and 0.06 ± 1.30 m/s for the PWV at the end of systole. Ultrafast PWV measurements were more likely obtained with the very high- frequency transducer when the IMT was less than 1.5 mm (P < .05). A generalized linear mixed-effects model analysis showed that the very high-frequency transducer had a greater ability to obtain a valid carotid ultrafast PWV measurement with an IMT of less than 1.5 mm (P < .05). The IMT was positively correlated with the PWV before systole and at the end of systole (r = 0.207-0.771; all P < .05) in the control group, patient group, and carotid subgroup with an IMT of less than 1.5 mm. A multiple regression analysis showed that the IMT and plaque were important independent factors in predicting failure of the ultrafast PWV (P < .001). CONCLUSIONS The ultrafast PWV is an effective and user-friendly method for evaluating carotid stiffness. The IMT and transducer type are factors influencing the ability to obtain an ultrafast PWV measurement.
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Affiliation(s)
- Fu-Shun Pan
- Department of Medical Ultrasonics, Institute of Diagnostic and Interventional Ultrasound, Guangzhou, China
| | - Liang Yu
- Department of Vascular and Thyroid Surgery, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Jia Luo
- Department of Medical Ultrasonics, Institute of Diagnostic and Interventional Ultrasound, Guangzhou, China
| | - Ri-Dong Wu
- Department of Vascular and Thyroid Surgery, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Ming Xu
- Department of Medical Ultrasonics, Institute of Diagnostic and Interventional Ultrasound, Guangzhou, China
| | - Jin-Yu Liang
- Department of Medical Ultrasonics, Institute of Diagnostic and Interventional Ultrasound, Guangzhou, China
| | - Yan-Ling Zheng
- Department of Medical Ultrasonics, Institute of Diagnostic and Interventional Ultrasound, Guangzhou, China
| | - Xiao-Yan Xie
- Department of Medical Ultrasonics, Institute of Diagnostic and Interventional Ultrasound, Guangzhou, China
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Nabeel PM, Raj Kiran V, Jayaraj J, Mohanasankar S. Local Evaluation of Variation in Pulse Wave Velocity over the Cardiac Cycle using Single-Element Ultrasound Transducer. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2018; 2018:4560-4563. [PMID: 30441366 DOI: 10.1109/embc.2018.8513151] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
A method and system for single-site measurement of local pulse wave velocity (PWV) and its variation over the cardiac cycle are presented. The proposed system employs a single-element ultrasound transducer and associated custom technology to record arterial diameter and wall thickness waveforms in real-time. Simultaneously acquired blood pressure, diameter and wall thickness parameters were used to evaluate diastolic local PWV (CD) and systolic local PWV (Cs) from an arterial site of interest. The developed prototype system was validated on a cohort of 15 subjects (age $=43\pm 12$ years) that includes normotensives and hypertensives. Cs and CD measurements were obtained from the left carotid artery. A significant difference between carotid Cs and CD $(\Delta \mathrm{C})$ was observed in all recruited subjects (group average $\Delta \mathrm{C} = 0.92\pm 0.76\mathrm{m}/\mathrm{s})$, illustrating the arterial pressure dependency of local PWV. The absolute values of Cs and CD were within a range of 3.39 m/s to 7.5 m/s and 3.12 m/s to 5.82 m/s respectively. Normotensive versus hypertensive group-wise analysis was performed to investigate the degree of variation in the carotid local PWV over a cardiac cycle among different BP categories. Study results demonstrated that the proposed approach has a potential to provide valuable surrogate markers for cardiovascular risk assessment.
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Hybrid Optical Unobtrusive Blood Pressure Measurements. SENSORS 2017; 17:s17071541. [PMID: 28671576 PMCID: PMC5539707 DOI: 10.3390/s17071541] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/21/2017] [Revised: 06/15/2017] [Accepted: 06/28/2017] [Indexed: 11/17/2022]
Abstract
Blood pressure (BP) is critical in diagnosing certain cardiovascular diseases such as hypertension. Some previous studies have proved that BP can be estimated by pulse transit time (PTT) calculated by a pair of photoplethysmography (PPG) signals at two body sites. Currently, contact PPG (cPPG) and imaging PPG (iPPG) are two feasible ways to obtain PPG signals. In this study, we proposed a hybrid system (called the ICPPG system) employing both methods that can be implemented on a wearable device, facilitating the measurement of BP in an inconspicuous way. The feasibility of the ICPPG system was validated on a dataset with 29 subjects. It has been proved that the ICPPG system is able to estimate PTT values. Moreover, the PTT measured by the new system shows a correlation on average with BP variations for most subjects, which could facilitate a new generation of BP measurement using wearable and mobile devices.
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The systolic–diastolic difference in carotid stiffness is increased in type 2 diabetes. J Hypertens 2017; 35:1052-1060. [DOI: 10.1097/hjh.0000000000001298] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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Schillaci G, Battista F, D'Abbondanza M, Pucci G. The impact of the cardio-ankle vascular index on left ventricular structure and function. Eur Heart J Suppl 2017. [DOI: 10.1093/eurheartj/suw062] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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16
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Noninvasive measurement of regional pulse wave velocity in human ascending aorta with ultrasound imaging. J Hypertens 2016; 34:2026-37. [DOI: 10.1097/hjh.0000000000001060] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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17
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Gao M, Cheng HM, Sung SH, Chen CH, Olivier NB, Mukkamala R. Estimation of Pulse Transit Time as a Function of Blood Pressure Using a Nonlinear Arterial Tube-Load Model. IEEE Trans Biomed Eng 2016; 64:1524-1534. [PMID: 28113300 DOI: 10.1109/tbme.2016.2612639] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE pulse transit time (PTT) varies with blood pressure (BP) throughout the cardiac cycle, yet, because of wave reflection, only one PTT value at the diastolic BP level is conventionally estimated from proximal and distal BP waveforms. The objective was to establish a technique to estimate multiple PTT values at different BP levels in the cardiac cycle. METHODS a technique was developed for estimating PTT as a function of BP (to indicate the PTT value for every BP level) from proximal and distal BP waveforms. First, a mathematical transformation from one waveform to the other is defined in terms of the parameters of a nonlinear arterial tube-load model accounting for BP-dependent arterial compliance and wave reflection. Then, the parameters are estimated by optimally fitting the waveforms to each other via the model-based transformation. Finally, PTT as a function of BP is specified by the parameters. The technique was assessed in animals and patients in several ways including the ability of its estimated PTT-BP function to serve as a subject-specific curve for calibrating PTT to BP. RESULTS the calibration curve derived by the technique during a baseline period yielded bias and precision errors in mean BP of 5.1 ± 0.9 and 6.6 ± 1.0 mmHg, respectively, during hemodynamic interventions that varied mean BP widely. CONCLUSION the new technique may permit, for the first time, estimation of PTT values throughout the cardiac cycle from proximal and distal waveforms. SIGNIFICANCE the technique could potentially be applied to improve arterial stiffness monitoring and help realize cuff-less BP monitoring.
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Antonova LV, Seifalian AM, Kutikhin AG, Sevostyanova VV, Krivkina EO, Mironov AV, Burago AY, Velikanova EA, Matveeva VG, Glushkova TV, Sergeeva EA, Vasyukov GY, Kudryavtseva YA, Barbarash OL, Barbarash LS. Bioabsorbable Bypass Grafts Biofunctionalised with RGD Have Enhanced Biophysical Properties and Endothelialisation Tested In vivo. Front Pharmacol 2016; 7:136. [PMID: 27252652 PMCID: PMC4879758 DOI: 10.3389/fphar.2016.00136] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2016] [Accepted: 05/10/2016] [Indexed: 01/01/2023] Open
Abstract
Small diameter arterial bypass grafts are considered as unmet clinical need since the current grafts have poor patency of 25% within 5 years. We have developed a 3D scaffold manufactured from natural and synthetic biodegradable polymers, poly(3-hydroxybutyrate-co-3-hydroxyvalerate) (PHBV) and poly(𝜀-caprolactone) (PCL), respectively. Further to improve the biophysical properties as well as endothelialisation, the grafts were covalently conjugated with arginine-glycine-aspartic acid (RGD) bioactive peptides. The biophysical properties as well as endothelialisation of PHBV/PCL and PCL 2 mm diameter bypass grafts were assessed with and without biofunctionalisation with RGD peptides in vitro and in vivo. Morphology of the grafts was assessed by scanning electron microscopy, whereas physico-mechanical properties were evaluated using a physiological circulating system equipped with a state of art ultrasound vascular wall tracking system. Endothelialisation of the grafts in vitro and in vivo were assessed using a cell viability assay and rat abdominal aorta replacement model, respectively. The biofunctionalisation with RGD bioactive peptides decreased mean fiber diameter and mean pore area in PHBV/PCL grafts; however, this was not the case for PCL grafts. Both PHBV/PCL and PCL grafts with RGD peptides had lower durability compared to those without; these durability values were similar to those of internal mammary artery. Modification of PHBV/PCL and PCL grafts with RGD peptides increased endothelial cell viability in vitro by a factor of eight and enhanced the formation of an endothelial cell monolayer in vivo 1 month postimplantation. In conclusion, PHBV/PCL small-caliber graft can be a suitable 3D scaffold for the development of a tissue engineering arterial bypass graft.
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Affiliation(s)
- Larisa V Antonova
- Research Institute for Complex Issues of Cardiovascular Diseases Kemerovo, Russia
| | - Alexander M Seifalian
- Centre for Nanotechnology and Regenerative Medicine, UCL Division of Surgery and Interventional Science, University College LondonLondon, UK; NanoRegMed LtdLondon, UK
| | - Anton G Kutikhin
- Research Institute for Complex Issues of Cardiovascular Diseases Kemerovo, Russia
| | | | - Evgeniya O Krivkina
- Research Institute for Complex Issues of Cardiovascular Diseases Kemerovo, Russia
| | - Andrey V Mironov
- Research Institute for Complex Issues of Cardiovascular Diseases Kemerovo, Russia
| | - Andrey Y Burago
- Research Institute for Complex Issues of Cardiovascular Diseases Kemerovo, Russia
| | - Elena A Velikanova
- Research Institute for Complex Issues of Cardiovascular Diseases Kemerovo, Russia
| | - Vera G Matveeva
- Research Institute for Complex Issues of Cardiovascular Diseases Kemerovo, Russia
| | - Tatiana V Glushkova
- Research Institute for Complex Issues of Cardiovascular Diseases Kemerovo, Russia
| | - Evgeniya A Sergeeva
- Research Institute for Complex Issues of Cardiovascular Diseases Kemerovo, Russia
| | - Georgiy Y Vasyukov
- Research Institute for Complex Issues of Cardiovascular Diseases Kemerovo, Russia
| | | | - Olga L Barbarash
- Research Institute for Complex Issues of Cardiovascular Diseases Kemerovo, Russia
| | - Leonid S Barbarash
- Research Institute for Complex Issues of Cardiovascular Diseases Kemerovo, Russia
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Abstract
BACKGROUND Arterial stiffness measures such as pulse wave velocity (PWV) have a known dependence on actual blood pressure, requiring consideration in cardiovascular risk assessment and management. Given the impact of ageing on arterial wall structure, the pressure-dependence of PWV may vary with age. METHODS Using a noninvasive model-based approach, combining carotid artery echo-tracking and tonometry waveforms, we obtained pressure-area curves in 23 hypertensive patients at baseline and after 3 months of antihypertensive treatment. We predicted the follow-up PWV decrease using modelled baseline curves and follow-up pressures. In addition, on the basis of these curves, we estimated PWV values for two age groups (mean ages 41 and 64 years) at predefined hypertensive (160/90 mmHg) and normotensive (120/80 mmHg) pressure ranges. RESULTS Follow-up measurements showed a near 1 m/s decrease in carotid PWV when compared with baseline, which fully agreed with our model-prediction given the roughly 10 mmHg decrease in diastolic pressure. The stiffness-blood pressure-age pattern was in close agreement with corresponding data from the 'Reference Values for Arterial Stiffness' study, linking the physical and empirical bases of our findings. CONCLUSION Our study demonstrates that the innate pressure-dependence of arterial stiffness may have implications for the clinical use of arterial stiffness measurements, both in risk assessment and in treatment monitoring of individual patients. We propose a number of clinically feasible approaches to account for the blood pressure effect on PWV measurements.
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Carotid stiffness change over the cardiac cycle by ultrafast ultrasound imaging in healthy volunteers and vascular Ehlers–Danlos syndrome. J Hypertens 2015; 33:1890-6; discussion 1896. [DOI: 10.1097/hjh.0000000000000617] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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Mukkamala R, Hahn JO, Inan OT, Mestha LK, Kim CS, Töreyin H, Kyal S. Toward Ubiquitous Blood Pressure Monitoring via Pulse Transit Time: Theory and Practice. IEEE Trans Biomed Eng 2015; 62:1879-901. [PMID: 26057530 PMCID: PMC4515215 DOI: 10.1109/tbme.2015.2441951] [Citation(s) in RCA: 378] [Impact Index Per Article: 42.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Ubiquitous blood pressure (BP) monitoring is needed to improve hypertension detection and control and is becoming feasible due to recent technological advances such as in wearable sensing. Pulse transit time (PTT) represents a well-known potential approach for ubiquitous BP monitoring. The goal of this review is to facilitate the achievement of reliable ubiquitous BP monitoring via PTT. We explain the conventional BP measurement methods and their limitations; present models to summarize the theory of the PTT-BP relationship; outline the approach while pinpointing the key challenges; overview the previous work toward putting the theory to practice; make suggestions for best practice and future research; and discuss realistic expectations for the approach.
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Affiliation(s)
- Ramakrishna Mukkamala
- Department of Electrical and Computer Engineering, Michigan State University, East Lansing, MI, USA (phone: 517-353-3120; fax: 517-353-1980; )
| | - Jin-Oh Hahn
- Department of Mechanical Engineering, University of Maryland, College Park, MD, USA,
| | - Omer T. Inan
- The School of Electrical and Computer Engineering, Georgia Institute of Technology, Atlanta, GA, 30308, USA,
| | - Lalit K. Mestha
- Palo Alto Research Center East (a Xerox Company), Webster, NY, 14580, USA,
| | - Chang-Sei Kim
- Department of Mechanical Engineering, University of Maryland, College Park, MD, USA,
| | - Hakan Töreyin
- The School of Electrical and Computer Engineering, Georgia Institute of Technology, Atlanta, GA, 30308, USA,
| | - Survi Kyal
- Palo Alto Research Center East (a Xerox Company), Webster, NY, 14580, USA,
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Erdei T, Aakhus S, Marino P, Paulus WJ, Smiseth OA, Fraser AG. Pathophysiological rationale and diagnostic targets for diastolic stress testing. Heart 2015; 101:1355-60. [PMID: 26001845 DOI: 10.1136/heartjnl-2014-307040] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2014] [Accepted: 04/27/2015] [Indexed: 12/25/2022] Open
Abstract
Cardiopulmonary functional reserve measured as peak oxygen uptake is predicted better at rest by measures of cardiac diastolic function than by systolic function. Normal adaptations in the trained heart include resting bradycardia, increased LV end-diastolic volume and augmented early diastolic suction on exercise. In normal populations early diastolic relaxation declines with age and end-diastolic stiffness increases, but in healthy older subjects who have exercised throughout their lives diastolic function can be well preserved. The mechanisms by which LV diastolic filling and pressures can be impaired during exercise include reduced early diastolic recoil and suction (which can be exacerbated by increased late systolic loading), increased preload and reduced compliance. Abnormal ventricular-arterial coupling and enhanced ventricular interaction may contribute in particular circumstances. One common final pathway that causes breathlessness is an increase in LV filling pressure and left atrial pressure. Testing elderly subjects with breathlessness of unknown aetiology in order to detect worsening diastolic function during stress is proposed to diagnose heart failure with preserved EF. In invasive studies, the most prominent abnormality is an early and rapid rise in pulmonary capillary wedge pressure. A systematic non-invasive diagnostic strategy would use validated methods to assess different mechanisms of inducible diastolic dysfunction and not just single parameters that offer imprecise estimates of mean LV filling pressure. Protocols should assess early diastolic relaxation and filling as well as late diastolic filling and compliance, as these may be affected separately. Better refined diagnostic targets may translate to more focused treatment.
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Affiliation(s)
- Tamás Erdei
- Wales Heart Research Institute, Cardiff University, Cardiff, UK
| | - Svend Aakhus
- Department of Cardiology, Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | - Paolo Marino
- Cardiology Clinic, Universita Piemonte Orientale, Novara, Italy
| | - Walter J Paulus
- Department of Physiology, Institute for Cardiovascular Research, VU University Medical Center, Amsterdam, The Netherlands
| | - Otto A Smiseth
- Department of Cardiology, Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | - Alan G Fraser
- Wales Heart Research Institute, Cardiff University, Cardiff, UK
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Spronck B, Heusinkveld MHG, Donders WP, de Lepper AGW, Op't Roodt J, Kroon AA, Delhaas T, Reesink KD. A constitutive modeling interpretation of the relationship among carotid artery stiffness, blood pressure, and age in hypertensive subjects. Am J Physiol Heart Circ Physiol 2015; 308:H568-82. [DOI: 10.1152/ajpheart.00290.2014] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Aging has a profound influence on arterial wall structure and function. We have previously reported the relationship among pulse wave velocity, age, and blood pressure in hypertensive subjects. In the present study, we aimed for a quantitative interpretation of the observed changes in wall behavior with age using a constitutive modeling approach. We implemented a model of arterial wall biomechanics and fitted this to the group-averaged pressure-area ( P-A) relationship of the “young” subgroup of our study population. Using this model as our take-off point, we assessed which parameters had to be changed to let the model describe the “old” subgroup’s P-A relationship. We allowed elastin stiffness and collagen recruitment parameters to vary and adjusted residual stress parameters according to published age-related changes. We required wall stress to be homogeneously distributed over the arterial wall and assumed wall stress normalization with age by keeping average “old” wall stress at the “young” level. Additionally, we required axial force to remain constant over the cardiac cycle. Our simulations showed an age-related shift in pressure-load bearing from elastin to collagen, caused by a decrease in elastin stiffness and a considerable increase in collagen recruitment. Correspondingly, simulated diameter and wall thickness increased by about 20 and 17%, respectively. The latter compared well with a measured thickness increase of 21%. We conclude that the physiologically realistic changes in constitutive properties we found under physiological constraints with respect to wall stress could well explain the influence of aging in the stiffness-pressure-age pattern observed.
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Affiliation(s)
- Bart Spronck
- Department of Biomedical Engineering, CARIM School for Cardiovascular Diseases, Maastricht University, Maastricht, The Netherlands
| | - Maarten H. G. Heusinkveld
- Department of Biomedical Engineering, CARIM School for Cardiovascular Diseases, Maastricht University, Maastricht, The Netherlands
- Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - Wouter P. Donders
- Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
- Department of Biomedical Engineering, MHeNS School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands; and
| | - Anouk G. W. de Lepper
- Department of Biomedical Engineering, CARIM School for Cardiovascular Diseases, Maastricht University, Maastricht, The Netherlands
| | - Jos Op't Roodt
- Department of Internal Medicine, CARIM School for Cardiovascular Diseases, Maastricht University, Maastricht, The Netherlands
| | - Abraham A. Kroon
- Department of Internal Medicine, CARIM School for Cardiovascular Diseases, Maastricht University, Maastricht, The Netherlands
| | - Tammo Delhaas
- Department of Biomedical Engineering, CARIM School for Cardiovascular Diseases, Maastricht University, Maastricht, The Netherlands
| | - Koen D. Reesink
- Department of Biomedical Engineering, CARIM School for Cardiovascular Diseases, Maastricht University, Maastricht, The Netherlands
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Dependence of arterial stiffness on pressure quantified in the realm of the cardiac cycle: towards a patient-specific approach? J Hypertens 2014; 33:257-9. [PMID: 25535877 DOI: 10.1097/hjh.0000000000000443] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Schillaci G, Battista F, Settimi L, Anastasio F, Pucci G. Cardio-ankle vascular index and subclinical heart disease. Hypertens Res 2014; 38:68-73. [PMID: 25231254 DOI: 10.1038/hr.2014.138] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2014] [Revised: 07/13/2014] [Accepted: 08/03/2014] [Indexed: 12/20/2022]
Abstract
The relationship between arterial stiffness, measured as pulse wave velocity (PWV), and the left ventricle is confounded by the effects of blood pressure. We evaluated the relationship between carotid-femoral PWV and cardio-ankle vascular index (CAVI), a less pressure-dependent measurement of the stiffness constant (β) of the aorta and the iliac, femoral and tibial arteries, and obtained prognostically relevant measurements of left ventricular structure and systolic function. CAVI, carotid-femoral PWV and echocardiographic left ventricular mass and systolic function were determined in 133 subjects with either hypertension or high-normal blood pressure (33% treated; 56 ± 16 years, blood pressure 145/89 ± 21/12 mm Hg). Carotid-femoral PWV exhibited a direct relationship with systolic and diastolic blood pressure (r = 0.33/0.26, P < 0.001/0.014), whereas CAVI demonstrated no such relationship (r = 0.12/-0.05, both P > 0.1). Both CAVI and PWV correlated significantly with left ventricular mass index (r = 0.31, P<0.001; r = 0.21, P = 0.014). Subjects with inappropriately high left ventricular masses for a given cardiac workload (n = 44) had higher CAVI values (9.1 ± 2.0 vs. 7.9 ± 1.6, P < 0.001), but not higher PWV values (8.5 ± 2.5 vs. 8.7 ± 2.4, P>0.1). In a multivariate regression model, CAVI was independently associated with inappropriate left ventricular mass (β = 0.40, P < 0.001), along with body mass index. CAVI also demonstrated a negative relationship with left ventricular midwall fractional shortening (r = -0.41, P = 0.001) that was independent of age, sex, blood pressure and left ventricular mass in a multivariate analysis. In conclusion, a high CAVI is associated with inappropriately high left ventricular mass and low midwall systolic function. As a marker of arterial diastolic-to-systolic stiffening, CAVI may have a relationship with left ventricular structure and function that is independent of blood pressure levels.
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Affiliation(s)
- Giuseppe Schillaci
- 1] Dipartimento di Medicina, Università di Perugia, Perugia, Italy [2] Struttura Complessa di Medicina Interna, Azienda Ospedaliero-Universitaria di Terni, Terni, Italy
| | - Francesca Battista
- 1] Dipartimento di Medicina, Università di Perugia, Perugia, Italy [2] Struttura Complessa di Medicina Interna, Azienda Ospedaliero-Universitaria di Terni, Terni, Italy
| | - Laura Settimi
- Dipartimento di Medicina, Università di Perugia, Perugia, Italy
| | - Fabio Anastasio
- 1] Dipartimento di Medicina, Università di Perugia, Perugia, Italy [2] Struttura Complessa di Medicina Interna, Azienda Ospedaliero-Universitaria di Terni, Terni, Italy
| | - Giacomo Pucci
- 1] Dipartimento di Medicina, Università di Perugia, Perugia, Italy [2] Struttura Complessa di Medicina Interna, Azienda Ospedaliero-Universitaria di Terni, Terni, Italy
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Di Lascio N, Stea F, Kusmic C, Sicari R, Faita F. Non-invasive assessment of pulse wave velocity in mice by means of ultrasound images. Atherosclerosis 2014; 237:31-7. [PMID: 25194332 DOI: 10.1016/j.atherosclerosis.2014.08.033] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2014] [Revised: 07/18/2014] [Accepted: 08/14/2014] [Indexed: 12/28/2022]
Abstract
OBJECTIVE Pulse wave velocity (PWV) is considered as a surrogate marker of arterial stiffness and could be useful for characterizing cardiovascular disease progression even in mouse models. Aim of this study was to develop an image process algorithm for assessing arterial PWV in mice using ultrasound images only and test it on the evaluation of age-associated differences in abdominal aorta PWV. METHODS Ultrasound scans were obtained from ten adult (mean age: 5.5 months) and nine old (mean age: 15.5 months) wild type male mice (strain C57BL6) under gaseous anesthesia. For each mouse, instantaneous values of diameter and flow velocity were obtained from abdominal aorta B-mode and PW-Doppler, respectively. Single-beat mean diameter and velocity were calculated providing the velocity-diameter (lnD-V) loop. PWV values for both the early systolic phase (aaPWV) and the late systolic one (aaPWVls) were obtained from the slope of the corresponding linear parts of the loop. Relative distension (relD) was calculated from the mean diameter signal. RESULTS aaPWV values for adult mice (1.91 ± 0.44 m/s) were significantly lower (p < 0.01) than those obtained for older ones (2.71 ± 0.63 m/s) and the same result was found for aaPWVls (2.68 ± 0.68 vs 3.67 ± 0.95 m/s; p < 0.05). relD measurements were significantly higher (p < 0.01) in adult (22.7% ± 5.2%) compared with older animal evaluations (15.8% ± 3.9%). CONCLUSIONS The proposed system discriminates well between age groups and supplies a non-invasive evaluation of anatomical and functional parameters of the mouse abdominal aorta. Since it provides a non-invasive PWV assessment from ultrasound (US) images only, it may offer a simple and useful system for evaluation of local vascular stiffness at other arterial site in the mouse, such as the carotid artery.
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Affiliation(s)
- Nicole Di Lascio
- Institute of Clinical Physiology, National Research Council, Via G. Moruzzi 1, 56124 Pisa, Italy.
| | - Francesco Stea
- Institute of Clinical Physiology, National Research Council, Via G. Moruzzi 1, 56124 Pisa, Italy
| | - Claudia Kusmic
- Institute of Clinical Physiology, National Research Council, Via G. Moruzzi 1, 56124 Pisa, Italy
| | - Rosa Sicari
- Institute of Clinical Physiology, National Research Council, Via G. Moruzzi 1, 56124 Pisa, Italy
| | - Francesco Faita
- Institute of Clinical Physiology, National Research Council, Via G. Moruzzi 1, 56124 Pisa, Italy
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Roef GL, Taes YE, Kaufman JM, Van Daele CM, De Buyzere ML, Gillebert TC, Rietzschel ER. Thyroid hormone levels within reference range are associated with heart rate, cardiac structure, and function in middle-aged men and women. Thyroid 2013; 23:947-54. [PMID: 23339744 PMCID: PMC3752520 DOI: 10.1089/thy.2012.0471] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
BACKGROUND Triiodothyronine (T3) has many effects on the heart, and marked changes in cardiac function and structure occur in patients with (subclinical) thyroid disease. We investigated whether between-subject variation in thyroid hormone levels within the euthyroid range is also associated with heart rate and echocardiographic heart function and structure. METHODS Subjects were selected from the Asklepios study (n=2524), a population-representative random sample of patients aged between 35 and 55 years, free from overt cardiovascular disease at baseline. Analyses were restricted to 2078 subjects (1013 women and 1065 men), not using antihypertensive or thyroid medication nor having antithyroperoxidase antibody levels above clinical cut-off or thyrotropin (TSH) levels outside the reference range. All subjects were phenotyped in-depth and underwent comprehensive echocardiography, including diastolic evaluation. Thyroid function parameters were determined by automated electrochemiluminescence. RESULTS Heart rate was robustly positively associated with (quartiles of) free T3 (FT3) and T3, both in subjects with TSH levels within reference (0.27-4.2 μU/L) and in narrow TSH range (0.5-2.5 μU/L; p<0.0001). FT3 and T3 were negatively associated with left ventricular (LV) end-diastolic volume but positively associated with relative wall thickness. Total T3 (TT3) was associated with enhanced ventricular contraction (as assessed by tissue Doppler imaging). Free thyroxine, FT3, and TT3 were positively associated with late ventricular filling, and TT3 was associated with early ventricular filling. CONCLUSION We have demonstrated a strong positive association between thyroid hormone levels within the euthyroid range and heart rate, and more subtle effects on cardiac function and structure. More specifically, we suggest a smaller LV cavity size (with increased relative wall thickness), an enhanced atrial and ventricular contraction, and LV relaxation with higher circulating thyroid hormones. These results illustrate that variation in thyroid hormone levels, even within the reference range, exerts effects on the heart.
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Affiliation(s)
- Greet L Roef
- Department of Endocrinology, Ghent University Hospital, Ghent, Belgium.
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Pucci G, Battista F, Schillaci G. Aerobic physical exercise and arterial de-stiffening: a recipe for vascular rejuvenation? Hypertens Res 2012; 35:964-6. [PMID: 22786568 DOI: 10.1038/hr.2012.107] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Giacomo Pucci
- Unit of Internal Medicine, Department of Clinical and Experimental Medicine, University of Perugia, S. Maria Hospital, Terni, Italy
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