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Liu Y, Xu R, Zhou D, Yang Y, Xu G, Zeng S. Pulmonary artery stiffness in fetuses with tetralogy of Fallot. Ultrasonography 2024; 43:220-227. [PMID: 38715210 PMCID: PMC11079504 DOI: 10.14366/usg.23196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2023] [Revised: 04/10/2024] [Accepted: 04/11/2024] [Indexed: 05/12/2024] Open
Abstract
PURPOSE This study evaluated the elastic characteristics of the pulmonary trunk and distal branches in fetuses diagnosed with tetralogy of Fallot (TOF) using Doppler echocardiography. METHODS Data on 42 fetuses diagnosed with TOF and 84 gestational age-matched normal fetuses were prospectively collected from the Second Xiangya Hospital of Central South University between August 2022 and January 2023. The severity of TOF was classified into three categories based on the z-score of the pulmonary annulus diameter: mild (z-score ≥-2), moderate (-4 RESULTS Compared with the normal group, the MPA-PAS in fetuses with TOF was significantly higher, while the DLPA-PAS and DRPA-PAS were notably lower (all P<0.05). The MPA-PAS of fetuses with severe TOF was higher than that of those with mild and moderate TOF (all P<0.05). However, there were no significant differences in the DLPA-PAS or DRPA-PAS among fetuses with mild, moderate, and severe TOF (all P>0.05). CONCLUSION Fetuses diagnosed with TOF exhibited increased vascular stiffness in the MPA and reduced stiffness in the distal pulmonary artery (PA). Larger-scale follow-up studies are required to elucidate the relationships between these changes in vascular stiffness and PA development in patients with TOF.
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Affiliation(s)
- Yushan Liu
- Department of Ultrasound Diagnosis, Second Xiangya Hospital, Central South University, Changsha, China
| | - Ran Xu
- Department of Urology, Second Xiangya Hospital, Central South University, Changsha, China
| | - Dan Zhou
- Department of Ultrasound Diagnosis, Second Xiangya Hospital, Central South University, Changsha, China
| | - Yang Yang
- Department of Ultrasound Diagnosis, Second Xiangya Hospital, Central South University, Changsha, China
| | - Ganqiong Xu
- Department of Ultrasound Diagnosis, Second Xiangya Hospital, Central South University, Changsha, China
| | - Shi Zeng
- Department of Ultrasound Diagnosis, Second Xiangya Hospital, Central South University, Changsha, China
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Zhang H, Leng S, Gao F, Kovalik JP, Wee HN, Chua KV, Ching J, Allen JC, Zhao X, Tan RS, Wu Q, Leiner T, Koh AS, Zhong L. Characteristics of pulmonary artery strain assessed by cardiovascular magnetic resonance imaging and associations with metabolomic pathways in human ageing. Front Cardiovasc Med 2024; 11:1346443. [PMID: 38486706 PMCID: PMC10937542 DOI: 10.3389/fcvm.2024.1346443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Accepted: 02/20/2024] [Indexed: 03/17/2024] Open
Abstract
Background Pulmonary artery (PA) strain is associated with structural and functional alterations of the vessel and is an independent predictor of cardiovascular events. The relationship of PA strain to metabolomics in participants without cardiovascular disease is unknown. Methods In the current study, community-based older adults, without known cardiovascular disease, underwent simultaneous cine cardiovascular magnetic resonance (CMR) imaging, clinical examination, and serum sampling. PA global longitudinal strain (GLS) analysis was performed by tracking the change in distance from the PA bifurcation to the pulmonary annular centroid, using standard cine CMR images. Circulating metabolites were measured by cross-sectional targeted metabolomics analysis. Results Among n = 170 adults (mean age 71 ± 6.3 years old; 79 women), mean values of PA GLS were 16.2 ± 4.4%. PA GLS was significantly associated with age (β = -0.13, P = 0.017), heart rate (β = -0.08, P = 0.001), dyslipidemia (β = -2.37, P = 0.005), and cardiovascular risk factors (β = -2.49, P = 0.001). Alanine (β = -0.007, P = 0.01) and proline (β = -0.0009, P = 0.042) were significantly associated with PA GLS after adjustment for clinical risk factors. Medium and long-chain acylcarnitines were significantly associated with PA GLS (C12, P = 0.027; C12-OH/C10-DC, P = 0.018; C14:2, P = 0.036; C14:1, P = 0.006; C14, P = 0.006; C14-OH/C12-DC, P = 0.027; C16:3, P = 0.019; C16:2, P = 0.006; C16:1, P = 0.001; C16:2-OH, P = 0.016; C16:1-OH/C14:1-DC, P = 0.028; C18:1-OH/C16:1-DC, P = 0.032). Conclusion By conventional CMR, PA GLS was associated with aging and vascular risk factors among a contemporary cohort of older adults. Metabolic pathways involved in PA stiffness may include gluconeogenesis, collagen synthesis, and fatty acid oxidation.
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Affiliation(s)
- Hongzhou Zhang
- Department of Cardiovascular Medicine, First Affiliated Hospital of Gannan Medical University, Ganzhou, Jiangxi, China
- National Heart Research Institute Singapore, National Heart Centre Singapore, Singapore, Singapore
| | - Shuang Leng
- National Heart Research Institute Singapore, National Heart Centre Singapore, Singapore, Singapore
- Duke-NUS Medical School, Singapore, Singapore
| | - Fei Gao
- National Heart Research Institute Singapore, National Heart Centre Singapore, Singapore, Singapore
- Duke-NUS Medical School, Singapore, Singapore
| | - Jean-Paul Kovalik
- Duke-NUS Medical School, Singapore, Singapore
- Department of Endocrinology, Singapore General Hospital, Singapore, Singapore
| | | | | | - Jianhong Ching
- Duke-NUS Medical School, Singapore, Singapore
- KK Research Centre, KK Women’s and Children’s Hospital, Singapore, Singapore
| | | | - Xiaodan Zhao
- National Heart Research Institute Singapore, National Heart Centre Singapore, Singapore, Singapore
| | - Ru-San Tan
- National Heart Research Institute Singapore, National Heart Centre Singapore, Singapore, Singapore
- Duke-NUS Medical School, Singapore, Singapore
| | - Qinghua Wu
- Department of Cardiology, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Tim Leiner
- Department of Radiology, Mayo Clinic, Rochester, MN, United States
| | - Angela S. Koh
- National Heart Research Institute Singapore, National Heart Centre Singapore, Singapore, Singapore
- Duke-NUS Medical School, Singapore, Singapore
| | - Liang Zhong
- National Heart Research Institute Singapore, National Heart Centre Singapore, Singapore, Singapore
- Duke-NUS Medical School, Singapore, Singapore
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A Systematic Review of the Associations of Adiposity and Cardiorespiratory Fitness With Arterial Structure and Function in Nonclinical Children and Adolescents. Pediatr Exerc Sci 2022:1-12. [PMID: 36150705 DOI: 10.1123/pes.2022-0029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 08/02/2022] [Accepted: 08/07/2022] [Indexed: 11/07/2022]
Abstract
PURPOSE To summarize the evidence on associations of adiposity and cardiorespiratory fitness (CRF) with arterial structure and function in nonclinical children and adolescents. METHODS Two researchers conducted a search in 5 electronic databases in April 2022 to find studies in nonclinical youth (age 5-17.9 y) reporting multivariable associations. Studies were eligible if adiposity and/or CRF were used as the predictor and arterial structure and/or function was the outcome. The Quality Assessment Tool for Quantitative Studies was used to assess methodological quality for experimental studies, and a modified version was used for observational studies. RESULTS Ninety-nine studies (72.7% cross-sectional) were included. Ninety-four assessed associations between adiposity and arterial outcomes, most using overall body proportion (n = 71), abdominal (n = 52), or whole-body adiposity (n = 40). Most evidence was inconsistent or nonsignificant, but 59 studies suggested higher abdominal adiposity and worse body proportion were associated with adverse arterial outcomes. Twenty-one assessed associations between CRF and arterial outcomes, with findings inconsistent. Most evidence was rated weak in quality. CONCLUSION While high adiposity may contribute to poor arterial outcomes, evidence is limited regarding CRF. Future studies should disentangle these associations by studying youth with healthy adiposity but poor CRF, or vice versa, using longitudinal or experimental study designs.
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Alberti E, Stucchi L, Feudo CML, Ferrucci F, Zucca E. Feasibility of echocardiographic estimation of Pulmonary Artery Stiffness in horses. J Equine Vet Sci 2022; 112:103921. [PMID: 35271941 DOI: 10.1016/j.jevs.2022.103921] [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: 12/07/2021] [Revised: 02/25/2022] [Accepted: 03/02/2022] [Indexed: 11/30/2022]
Abstract
Pulmonary artery stiffness (PAS) is an index of pulmonary artery elasticity that permits to evaluate the pulmonary vascular bed in humans. It can early detect an increase in pulmonary artery stiffness as a consequence of remodeling of the vessel wall caused by chronic pulmonary and congenital heart diseases. This remodeling can occur also in horses with chronic respiratory diseases. Thus, PAS could be a useful echocardiographic parameter also in horses. However, in literature, there are no studies regarding PAS in horses. The aim of this study is to evaluate the feasibility of PAS in horses. Fifteen healthy horses were included in this prospective study. Maximal frequency shift (MFS) and acceleration time (AT) were measured from the pulsed-wave Doppler trace of the pulmonary artery flow, obtained from the right parasternal short-axis view at the level of the pulmonary artery, and then PAS was calculated as the ratio of MFS to AT. The low variability assessed for intra- and inter-observer variability, day-to-day variability and image acquisition variability suggests that PAS can be measured consistently in horses. Further studies could be useful to assess the clinical usefulness of PAS in unhealthy horses, such as those affected by chronic respiratory diseases.
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Affiliation(s)
- Elena Alberti
- Department of Veterinary Medicine and Animal Sciences, Università degli Studi di Milano, Equine Sports Medicine Laboratory "Franco Tradati", via dell'Università 6 - 26900, Lodi, Italy.
| | - Luca Stucchi
- Veterinary Teaching Hospital, Università degli Studi di Milano, via dell'Università 6 - 26900, Lodi, Italy
| | - Chiara Maria Lo Feudo
- Department of Veterinary Medicine and Animal Sciences, Università degli Studi di Milano, Equine Sports Medicine Laboratory "Franco Tradati", via dell'Università 6 - 26900, Lodi, Italy
| | - Francesco Ferrucci
- Department of Veterinary Medicine and Animal Sciences, Università degli Studi di Milano, Equine Sports Medicine Laboratory "Franco Tradati", via dell'Università 6 - 26900, Lodi, Italy
| | - Enrica Zucca
- Department of Veterinary Medicine and Animal Sciences, Università degli Studi di Milano, Equine Sports Medicine Laboratory "Franco Tradati", via dell'Università 6 - 26900, Lodi, 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: 18] [Impact Index Per Article: 4.5] [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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Yang MC, Liu HK, Su YT, Tsai CC, Wu JR. Serum apoptotic marker M30 is positively correlated with early diastolic dysfunction in adolescent obesity. PLoS One 2019; 14:e0217429. [PMID: 31120986 PMCID: PMC6532906 DOI: 10.1371/journal.pone.0217429] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Accepted: 05/11/2019] [Indexed: 01/28/2023] Open
Abstract
Purpose Obesity in adolescence has been shown to be related to cardiac geometric and functional changes. Cardiac dysfunction in adults with obesity could be attributed to chronic low-grade inflammation, apoptosis of cardiomyocyte, and glucose metabolic disorder. The aforementioned association in adolescents with obesity have never been well studied. Our aim was to determine the types of cardiac dysfunction in adolescents with obesity and survey the association between cardiac dysfunction and chronic low-grade inflammation, apoptosis, and glucose dysregulation in adolescents with obesity. Methods Adolescents aged between 10 and 20 years were enrolled in this study. Body mass index, waist-to-hip ratio, blood pressure, glucose metabolism, and high-sensitivity C-reactive protein (hs-CRP), interleukin-6 (IL-6), tumor necrosis factor-a (TNF-α), and apoptosis marker M30 levels were measured. Echocardiographic indices were also measured. The association between serum biomarkers and echocardiographic function parameters was analyzed. Results Diastolic dysfunction was the major finding in the cardiac functional assessment. The main changes in glucose metabolism were elevated C-peptide level and insulin resistance. Hs-CRP, IL-6, and M30 levels also increased with adolescent obesity. M30 was the major biomarker that was highly correlated to diastolic dysfunction indices in adolescents with obesity. Conclusions Diastolic dysfunction was the main change in adolescent obesity. Insulin resistance, apoptotic marker M30, hs-CRP, and IL-6 were all elevated in adolescents with obesity. Only M30 was related to indices of left ventricular diastolic dysfunction among adolescents with obesity, rather than inflammation or insulin resistance.
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Affiliation(s)
- Ming-Chun Yang
- Department of Pediatrics, E-Da Hospital, Kaohsiung City, Taiwan
- School of Chinese Medicine for Post Baccalaureate, I-Shou University, Kaohsiung City, Taiwan
- School of Medicine for International Students, I-Shou University, Kaohsiung City, Taiwan
| | - Hsien-Kuan Liu
- Department of Pediatrics, E-Da Hospital, Kaohsiung City, Taiwan
| | - Yu-Tsun Su
- Department of Pediatrics, E-Da Hospital, Kaohsiung City, Taiwan
- School of Medicine for International Students, I-Shou University, Kaohsiung City, Taiwan
| | - Ching-Chung Tsai
- Department of Pediatrics, E-Da Hospital, Kaohsiung City, Taiwan
- School of Chinese Medicine for Post Baccalaureate, I-Shou University, Kaohsiung City, Taiwan
- School of Medicine for International Students, I-Shou University, Kaohsiung City, Taiwan
- * E-mail: (JW); (CT)
| | - Jiunn-Ren Wu
- Department of Pediatrics, E-Da Hospital, Kaohsiung City, Taiwan
- * E-mail: (JW); (CT)
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Aortic stiffness index and its association with cardiovascular functions in children before and after transcatheter closure of PDA. Egypt Heart J 2018; 70:261-266. [PMID: 30591740 PMCID: PMC6303348 DOI: 10.1016/j.ehj.2018.09.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2018] [Accepted: 09/19/2018] [Indexed: 11/23/2022] Open
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Willson C, Watanabe M, Tsuji-Hosokawa A, Makino A. Pulmonary vascular dysfunction in metabolic syndrome. J Physiol 2018; 597:1121-1141. [PMID: 30125956 DOI: 10.1113/jp275856] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Accepted: 07/30/2018] [Indexed: 12/20/2022] Open
Abstract
Metabolic syndrome is a critically important precursor to the onset of many diseases, such as cardiovascular disease, and cardiovascular disease is the leading cause of death worldwide. The primary risk factors of metabolic syndrome include hyperglycaemia, abdominal obesity, dyslipidaemia, and high blood pressure. It has been well documented that metabolic syndrome alters vascular endothelial and smooth muscle cell functions in the heart, brain, kidney and peripheral vessels. However, there is less information available regarding how metabolic syndrome can affect pulmonary vascular function and ultimately increase an individual's risk of developing various pulmonary vascular diseases, such as pulmonary hypertension. Here, we review in detail how metabolic syndrome affects pulmonary vascular function.
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Affiliation(s)
- Conor Willson
- Department of Physiology, University of Arizona, Tucson, AZ, USA
| | - Makiko Watanabe
- Department of Physiology, University of Arizona, Tucson, AZ, USA
| | | | - Ayako Makino
- Department of Physiology, University of Arizona, Tucson, AZ, USA
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Floriańczyk T, Gołąbek-Dylewska M, Kucińska B, Werner B. Evaluation of left ventricular function in overweight children and teenagers with arterial hypertension and white coat hypertension. Cardiol J 2017; 26:343-349. [PMID: 29240959 DOI: 10.5603/cj.a2017.0151] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2017] [Revised: 12/14/2017] [Accepted: 11/08/2017] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Obesity in childhood is strongly associated with elevated arterial blood pressure and risk of hypertension. The aim of the study was the evaluation of left ventricular (LV) function in hypertensive and white coat hypertensive overweight children and teenagers. METHODS The study group consisted of 74 overweight patients aged 10.3 ± 3.1 years (range: 6-16 years) diagnosed as hypertensive in standard blood pressure measurement. The control group consisted of 31 normotensive and normoweight children. Ambulatory blood pressure monitoring (ABPM) and echocardiographic assessment of the LV mass and function were performed in all participants. RESULTS Using ABPM hypertension was confirmed in 20 (27%) children. In the 54 (73%) remaining children white coat hypertension was diagnosed. The analysis of echocardiographic parameters revealed higher LV mass index (LVMI) in hypertensive overweight than in normotensive normoweight children (47.5 ± 9.2 g/m2.7 vs. 39.8 ± 12.1 g/m2.7; p < 0.05) and no difference between overweight hypertensive and white coat hypertension-hypertensive groups. The deceleration time of mitral early filling (DCT) was longer in hypertensive normoweight children than in normotensive overweight patients (219.5 ± 110.3 ms vs. 197.8 ± 65.8 ms; p < 0.05). A significant correlation between systolic blood pressure load (SBPL) and DCT (r = 0.57) and moderate correlation between SBPL and LVMI (r: 0.48) as well as between LVMI and isovolumetric relaxation time (r = 0.37) were found. CONCLUSIONS In overweight children the diagnosis of hypertension should be confirmed in ABPM because of the high prevalence of white coat hypertension. Periodic echocardiographic examinations should be recommended in overweight children with increased SBPL and decreased systolic nocturnal deep because of the possibility of LV function impairment.
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Affiliation(s)
- Tomasz Floriańczyk
- Department of Pediatric Cardiology and General Pediatrics. Medical University of Warsaw, Poland
| | | | - Beata Kucińska
- Department of Pediatric Cardiology and General Pediatrics. Medical University of Warsaw, Poland
| | - Bożena Werner
- Department of Pediatric Cardiology and General Pediatrics. Medical University of Warsaw, Poland.
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Schaafs LA, Tzschätzsch H, van der Giet M, Reshetnik A, Steffen IG, Hamm B, Braun J, Sack I, Elgeti T. Time-Harmonic Ultrasound elastography of the Descending Abdominal Aorta: Initial Results. ULTRASOUND IN MEDICINE & BIOLOGY 2017; 43:2550-2557. [PMID: 28818306 DOI: 10.1016/j.ultrasmedbio.2017.07.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/19/2017] [Revised: 06/28/2017] [Accepted: 07/07/2017] [Indexed: 06/07/2023]
Abstract
Stiffening of central large vessels is considered a key pathophysiologic factor within the cardiovascular system. Current diagnostic parameters such as pulse wave velocity (PWV) indirectly measure aortic stiffness, a hallmark of coronary diseases. The aim of the present study was to perform elastography of the proximal abdominal aorta based on externally induced time-harmonic shear waves. Experiments were performed in 30 healthy volunteers (25 young, 5 old, >50 y) and 5 patients with longstanding hypertension (PWV >10 m/s). B-Mode-guided sonographic time-harmonic elastography was used for measurement of externally induced shear waves at 30-Hz vibration frequency. Thirty-hertz shear wave amplitudes (SWAs) within the abdominal aorta were measured and displayed in real time and processed offline for differences in SWA between systole and diastole (ΔSWA). Data were analyzed using the Kruskal-Wallis test and receiver operating characteristic curve analysis. The change in SWA over the cardiac cycle was reduced significantly in all patients as assessed with ΔSWA (volunteers: mean = 10 ± 5 μm, patients: mean = 4 ± 1 μm; p < 0.001). The best separation of healthy volunteers from patients was obtained with a ΔSWA threshold of 4.7 μm, resulting in a sensitivity of 0.9 and a specificity of 1.0, with an overall area under the curve of 0.96. Time harmonic elastography of the abdominal aorta is feasible and shows promise for the exploitation of time-varying shear wave amplitudes as a diagnostic marker for aortic wall stiffening. Patients with elevated PWVs suggesting increased aortic wall stiffness were best identified by ΔSWA-a parameter that could be related to the ability of the vessel walls to distend on passages of the pulse wave.
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Affiliation(s)
- Lars-Arne Schaafs
- Klinik und Hochschulambulanz für Radiologie, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Heiko Tzschätzsch
- Klinik und Hochschulambulanz für Radiologie, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Markus van der Giet
- Medizinische Klinik mit Schwerpunkt Nephrologie, Transplantationszentrum-Hypertoniezentrum, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Alexander Reshetnik
- Medizinische Klinik mit Schwerpunkt Nephrologie, Transplantationszentrum-Hypertoniezentrum, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Ingo G Steffen
- Klinik und Hochschulambulanz für Radiologie, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Bernd Hamm
- Klinik und Hochschulambulanz für Radiologie, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Jürgen Braun
- Institut für Medizinische Informatik, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Ingolf Sack
- Klinik und Hochschulambulanz für Radiologie, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Thomas Elgeti
- Klinik und Hochschulambulanz für Radiologie, Charité-Universitätsmedizin Berlin, Berlin, Germany.
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Gori D, Guaraldi F, Cinocca S, Moser G, Rucci P, Fantini MP. Effectiveness of educational and lifestyle interventions to prevent paediatric obesity: systematic review and meta-analyses of randomized and non-randomized controlled trials. Obes Sci Pract 2017; 3:235-248. [PMID: 29071100 PMCID: PMC5649699 DOI: 10.1002/osp4.111] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2017] [Revised: 04/05/2017] [Accepted: 04/06/2017] [Indexed: 01/21/2023] Open
Abstract
OBJECTIVE This review and meta-analysis aim at updating a previous meta-analysis carried out by Waters et al. on the efficacy of interventions aimed at preventing childhood obesity and at identifying predictors of outcome. METHODS Using an ad-hoc search string, PubMed database was searched for studies assessing body mass index reduction associated with programmes lasting ≥12 weeks in overweight and obese children aged 2-18 years. Studies designed for children with eating disorders or relevant comorbidities were excluded. Studies meeting inclusion criteria were classified according to patient age (<6, 6-12 and 13-18 years), and intervention type (physical activity, diet or both), setting (educational, family or both) and duration (≤1 or >1 year). The search was also extended to other databases. Hand-searching techniques were also applied. The Cochrane 'risk of bias' was applied for quality assessment. RESULTS Seventy-two studies were meta-analysed. Overall, the best results were achieved by programmes combining diet and physical activity (n = 39). With regard to the setting, programmes involving both school and family and lasting ≤1 year were the most efficacious for 6- to 12-year-old children (n = 26); family-based-only interventions were also effective in children <6 years old (n = 2), although results have to be interpreted cautiously because of the small number of patients enrolled and the high study heterogeneity. In 13- to 18-year-old patients, interventions delivered at school (n = 8) were substantially unsuccessful. CONCLUSIONS Interventions for childhood obesity prevention should include both diet and physical activity, be preferentially targeted towards school age children and involve both the school and family setting. However, because of the important methodological limitations associated with currently available literature, additional studies are needed to draw definite conclusions.
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Affiliation(s)
- D Gori
- Department of Biomedical and Neuromotor Sciences (DIBINEM) University of Bologna Bologna Italy
| | - F Guaraldi
- Division of Endocrinology, Diabetes and Metabolism, Department of Medical Sciences University of Turin Turin Italy
| | - S Cinocca
- School of Hygiene and Preventive Medicine University of Bologna Bologna Italy
| | - G Moser
- School of Hygiene and Preventive Medicine University of Bologna Bologna Italy
| | - P Rucci
- Department of Biomedical and Neuromotor Sciences (DIBINEM) University of Bologna Bologna Italy
| | - M P Fantini
- Department of Biomedical and Neuromotor Sciences (DIBINEM) University of Bologna Bologna Italy
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Jing L, Pulenthiran A, Nevius CD, Mejia-Spiegeler A, Suever JD, Wehner GJ, Kirchner HL, Haggerty CM, Fornwalt BK. Impaired right ventricular contractile function in childhood obesity and its association with right and left ventricular changes: a cine DENSE cardiac magnetic resonance study. J Cardiovasc Magn Reson 2017; 19:49. [PMID: 28659144 PMCID: PMC5490166 DOI: 10.1186/s12968-017-0363-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2017] [Accepted: 05/17/2017] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Pediatric obesity is a growing public health problem, which is associated with increased risk of cardiovascular disease and premature death. Left ventricular (LV) remodeling (increased myocardial mass and thickness) and contractile dysfunction (impaired longitudinal strain) have been documented in obese children, but little attention has been paid to the right ventricle (RV). We hypothesized that obese/overweight children would have evidence of RV remodeling and contractile dysfunction. METHODS One hundred and three children, ages 8-18 years, were prospectively recruited and underwent cardiovascular magnetic resonance (CMR), including both standard cine imaging and displacement encoding with stimulated echoes (DENSE) imaging, which allowed for quantification of RV geometry and function/mechanics. RV free wall longitudinal strain was quantified from the end-systolic four-chamber DENSE image. Linear regression was used to quantify correlations of RV strain with LV strain and measurements of body composition (adjusted for sex and height). Analysis of variance was used to study the relationship between RV strain and LV remodeling types (concentric remodeling, eccentric/concentric hypertrophy). RESULTS The RV was sufficiently visualized with DENSE in 70 (68%) subjects, comprising 36 healthy weight (13.6 ± 2.7 years) and 34 (12.1 ± 2.9 years) obese/overweight children. Obese/overweight children had a 22% larger RV mass index (8.2 ± 0.9 vs 6.7 ± 1.1 g/m2.7, p < 0.001) compared to healthy controls. RV free wall longitudinal strain was impaired in obese/overweight children (-16 ± 4% vs -19 ± 5%, p = 0.02). Ten (14%) out of 70 children had LV concentric hypertrophy, and these children had the most impaired RV longitudinal strain compared to those with normal LV geometry (-13 ± 4% vs -19 ± 5%, p = 0.002). RV longitudinal strain was correlated with LV longitudinal strain (r = 0.34, p = 0.004), systolic blood pressure (r = 0.33, p = 0.006), as well as BMI z-score (r = 0.28, p = 0.02), waist (r = 0.31, p = 0.01), hip (r = 0.40, p = 0.004) and abdominal (r = 0.38, p = 0.002) circumference, height and sex adjusted. CONCLUSIONS Obese/overweight children have evidence of RV remodeling (increased RV mass) and RV contractile dysfunction (impaired free wall longitudinal strain). Moreover, RV longitudinal strain correlates with LV longitudinal strain, and children with LV concentric hypertrophy show the most impaired RV function. These results suggest there may be a common mechanism underlying both remodeling and dysfunction of the left and right ventricles in obese/overweight children.
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MESH Headings
- Adolescent
- Child
- Female
- Humans
- Hypertrophy, Left Ventricular/diagnostic imaging
- Hypertrophy, Left Ventricular/etiology
- Hypertrophy, Left Ventricular/physiopathology
- Image Interpretation, Computer-Assisted
- Kentucky
- Linear Models
- Magnetic Resonance Imaging, Cine
- Male
- Myocardial Contraction
- Observer Variation
- Pediatric Obesity/complications
- Pediatric Obesity/diagnosis
- Pediatric Obesity/physiopathology
- Pennsylvania
- Predictive Value of Tests
- Prospective Studies
- Reproducibility of Results
- Ventricular Dysfunction, Left/diagnostic imaging
- Ventricular Dysfunction, Left/etiology
- Ventricular Dysfunction, Left/physiopathology
- Ventricular Dysfunction, Right/diagnostic imaging
- Ventricular Dysfunction, Right/etiology
- Ventricular Dysfunction, Right/physiopathology
- Ventricular Function, Left
- Ventricular Function, Right
- Ventricular Remodeling
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Affiliation(s)
- Linyuan Jing
- Department of Imaging Science and Innovation, Geisinger Health System, 100 North Academy Avenue, Danville, 17822-4400 PA USA
- Biomedical and Translational Informatics Institute, Geisinger Health System, Danville, PA USA
| | - Arichanah Pulenthiran
- Department of Imaging Science and Innovation, Geisinger Health System, 100 North Academy Avenue, Danville, 17822-4400 PA USA
- Biomedical and Translational Informatics Institute, Geisinger Health System, Danville, PA USA
| | - Christopher D. Nevius
- Department of Imaging Science and Innovation, Geisinger Health System, 100 North Academy Avenue, Danville, 17822-4400 PA USA
- Biomedical and Translational Informatics Institute, Geisinger Health System, Danville, PA USA
| | - Abba Mejia-Spiegeler
- Department of Imaging Science and Innovation, Geisinger Health System, 100 North Academy Avenue, Danville, 17822-4400 PA USA
- Biomedical and Translational Informatics Institute, Geisinger Health System, Danville, PA USA
| | - Jonathan D. Suever
- Department of Imaging Science and Innovation, Geisinger Health System, 100 North Academy Avenue, Danville, 17822-4400 PA USA
- Biomedical and Translational Informatics Institute, Geisinger Health System, Danville, PA USA
| | - Gregory J. Wehner
- Department of Biomedical Engineering, University of Kentucky, Lexington, KY USA
| | - H. Lester Kirchner
- Biomedical and Translational Informatics Institute, Geisinger Health System, Danville, PA USA
| | - Christopher M. Haggerty
- Department of Imaging Science and Innovation, Geisinger Health System, 100 North Academy Avenue, Danville, 17822-4400 PA USA
- Biomedical and Translational Informatics Institute, Geisinger Health System, Danville, PA USA
| | - Brandon K. Fornwalt
- Department of Imaging Science and Innovation, Geisinger Health System, 100 North Academy Avenue, Danville, 17822-4400 PA USA
- Biomedical and Translational Informatics Institute, Geisinger Health System, Danville, PA USA
- Department of Radiology, Geisinger Health System, Danville, PA USA
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Arias-Rico J, Cortés-Cortés SM, Ramírez-Moreno E, Sánchez-Padilla ML, Jiménez-Sánchez RC, Saucedo-Molina TDJ. Obesidad infantil y su relación con indicadores cardiopulmonares en escolares mexicanos. AQUICHAN 2016. [DOI: 10.5294/aqui.2016.16.2.3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Objetivo: determinar la relación entre obesidad y anormalidades de parámetros cardiopulmonares en escolares. Materiales y métodos: participaron 78 escolares entre 5 a 11 años de edad, 47 hombres (60,3 %) y 31 mujeres (39,7 %), pertenecientes a una escuela primaria particular de la ciudad de Pachuca (México). Se evaluó: índice de masa corporal (IMC), circunferencia de cintura (CC), grasa corporal (GC), frecuencia cardiaca (FC), presión arterial (PA), frecuencia respiratoria (FR) y espirometría. Se emplearon las pruebas estadísticas chi-cuadrado (x2), odds ratio y correlación de Spearman (rs). Resultados: 23,1 % de los escolares evaluados presentaron sobrepeso y 29,5 %, obesidad. El 38,5 y 11,5 % presentaron FC y PA superiores a los parámetros normales, respectivamente; 3,8 % de la población presentó FR arriba del promedio y 11,5 % mostró valores espirométricos anormales. Se encontraron relaciones entre IMC con GC y CC, GC y CC, CC y FC, GC y PA, y FC y FR. Conclusiones: las prevalencias de sobrepeso y obesidad obtenidas en este estudio fueron altas. Los niños con sobrepeso u obesidad podrían tener mayor riesgo de presentar anormalidades cardiopulmonares en comparación con niños de peso normal. Se sugiere continuar con estudios en el tema en una muestra más amplia.
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14
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Bae HK, Choi HS, Sohn S, Shin HJ, Nam JH, Hong YM. Cardiovascular screening in asymptomatic adolescents with metabolic syndrome. J Cardiovasc Ultrasound 2015; 23:10-9. [PMID: 25883751 PMCID: PMC4398779 DOI: 10.4250/jcu.2015.23.1.10] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2014] [Revised: 01/05/2015] [Accepted: 02/27/2015] [Indexed: 02/06/2023] Open
Abstract
Background In recent days, the prevalence of childhood metabolic syndrome (MS) has increased substantially due to the increasing rate of childhood obesity on a global scale. The aims of this study were to detect the important parameters and provide the screening system to prevent cardiovascular disease in adolescents with MS. Methods Ninety one male adolescents were divided into two groups based on the presence or absence of MS. Anthropometric measurement and laboratory study were studied. Intimal medial thickness and pulse wave velocity were estimated. Left ventricular mass index (LVMI), ejection fraction, myocardial velocity, strain and strain rate were measured by tissue Doppler imaging and strain rate imaging. Results The prevalence of MS was 7.7%. Weight, body mass index (BMI), waist circumference (WC), glucose, insulin, homeostasis model assessment of insulin resistance, triglyceride and LVMI were significantly increased in the MS group. High density lipoprotein-cholesterol (HDL-C), peak early diastolic myocardial velocity (e'), systolic myocardial velocity (s') and global longitudinal strain were significantly lower in the MS group. In univariant analysis, LVMI was significantly correlated with BMI, WC, fat %, fat mass, systolic blood pressure, alanine aminotransferase, total cholesterol (TC) and low density lipoprotein-cholesterol. e' was significantly correlated with BMI, fat %, fat mass, and HDL-C. Global circumferential strain had significant correlation with glucose and TC. Basal anterolateral strain rate was significantly correlated with weight, BMI, WC, fat %, and fat mass. Conclusion LVMI, strain and strain rate are practical and accurate parameters for assessment of left ventricular function in adolescents with MS.
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Affiliation(s)
- Hyun Kyung Bae
- Department of Pediatrics, Ewha Womans University School of Medicine, Seoul, Korea
| | - Han Seul Choi
- Department of Pediatrics, Ewha Womans University School of Medicine, Seoul, Korea
| | - Sejung Sohn
- Department of Pediatrics, Ewha Womans University School of Medicine, Seoul, Korea
| | - Hye-Jung Shin
- Department of Pediatrics, National Medical Center, Seoul, Korea
| | - Jae-Hwan Nam
- Department of Biotechnology, The Catholic University of Korea, Bucheon, Korea
| | - Young Mi Hong
- Department of Pediatrics, Ewha Womans University School of Medicine, Seoul, Korea
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15
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Murray R, Godfrey KM, Lillycrop KA. The Early Life Origins of Cardiovascular Disease. CURRENT CARDIOVASCULAR RISK REPORTS 2015. [DOI: 10.1007/s12170-015-0442-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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16
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Mahfouz RA, Alzaiat A, Gad M. Association of aortic stiffness to brain natriuretic peptide in children before and after device closure of patent ductus arteriosus. J Saudi Heart Assoc 2014; 27:23-30. [PMID: 25544819 DOI: 10.1016/j.jsha.2014.06.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2014] [Revised: 05/27/2014] [Accepted: 06/10/2014] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVES We evaluated the influence of device closure for patent ductus arteriosus (PDA) on the aortic stiffness index (ASI) and brain natriuretic peptide (BNP) and their association with cardiac function. PATIENTS AND METHODS ASI and echocardiography assessment before and after treatment (16 ± 9 months) in 48 children with PDA (mean age 10 ± 4.5) and 52 control children (mean age 9.7 ± 4.6). BNP level was measured pre-closure for all children, and was measured six months after closure only for children with PDA. RESULTS ASI was higher in PDA patients than in controls (P < 0.001). ASI correlated with age (P < 0.05), LVEF% (P < 0.01), E/E' (<0.03), pulmonary artery pressure (P < 0.001), and BNP (P < 0.001). ASI and BNP significantly decreased after closure (P < 0.001). ASI and BNP were independent predictors for post-closure systolic dysfunction (P < 0.001and <0.005, respectively). Receiver operating curve (ROC) analysis showed that ASI ⩾ 13.5, BNP level ⩾75 pg/ml and basal mean pulmonary artery pressure (PAP) ⩾ 23 were powerful predictors for post-closure systolic function. CONCLUSION ASI is significantly associated with BNP and basal PAP in children with PDA. After device closure, aortic distensibility improved significantly and was associated with significant improvement in both systolic and diastolic functions. ASI can be used for monitoring the course of patients with PDA, and may give opportunities for early intervention.
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Affiliation(s)
- Ragab A Mahfouz
- Congenital Unit, Cardiology Department, Zagazig University Hospital, Egypt
| | - Ahmad Alzaiat
- Congenital Unit, Cardiology Department, Zagazig University Hospital, Egypt
| | - Marwa Gad
- Congenital Unit, Cardiology Department, Zagazig University Hospital, Egypt
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Celik M, Yuksel UC, Yalcinkaya E, Gokoglan Y, Yildirim E, Bugan B, Kaya E, Gungor M. Elasticity Properties of Pulmonary Artery in Patients with Bicuspid Aortic Valve. Echocardiography 2013; 31:759-64. [DOI: 10.1111/echo.12455] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Affiliation(s)
- Murat Celik
- School of Medicine; Department of Cardiology; Gulhane Military Medical Academy; Ankara Turkey
| | - Uygar Cagdas Yuksel
- School of Medicine; Department of Cardiology; Gulhane Military Medical Academy; Ankara Turkey
| | - Emre Yalcinkaya
- School of Medicine; Department of Cardiology; Gulhane Military Medical Academy; Ankara Turkey
| | - Yalcin Gokoglan
- School of Medicine; Department of Cardiology; Gulhane Military Medical Academy; Ankara Turkey
| | - Erkan Yildirim
- School of Medicine; Department of Cardiology; Gulhane Military Medical Academy; Ankara Turkey
| | - Baris Bugan
- School of Medicine; Department of Cardiology; Gulhane Military Medical Academy; Ankara Turkey
| | - Erkan Kaya
- School of Medicine; Department of Cardiovascular Surgery; Gulhane Military Medical Academy; Ankara Turkey
| | - Mutlu Gungor
- Department of Cardiology; Ankara Bayindir Sogutozu Hospital; Ankara Turkey
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Cote AT, Harris KC, Panagiotopoulos C, Sandor GGS, Devlin AM. Childhood obesity and cardiovascular dysfunction. J Am Coll Cardiol 2013; 62:1309-19. [PMID: 23954339 DOI: 10.1016/j.jacc.2013.07.042] [Citation(s) in RCA: 311] [Impact Index Per Article: 28.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2013] [Revised: 07/19/2013] [Accepted: 07/22/2013] [Indexed: 12/17/2022]
Abstract
Obesity-related cardiovascular disease in children is becoming more prevalent in conjunction with the rise in childhood obesity. Children with obesity are predisposed to an increased risk of cardiovascular morbidity and mortality in adulthood. Importantly, research in children with obesity over the last decade has demonstrated that children may exhibit early signs of cardiovascular dysfunction as a result of their excess adiposity, often independent of other obesity-related comorbidities such as dyslipidemia and insulin resistance. The clinical evidence is accumulating to suggest that the cardiovascular damage, once observed only in adults, is also occurring in obese children. The objective of this review is to provide a synopsis of the current research on cardiovascular abnormalities in children with obesity and highlight the importance and need for early detection and prevention programs to mitigate this potentially serious health problem.
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Affiliation(s)
- Anita T Cote
- Department of Pediatrics, University of British Columbia, Child and Family Research Institute, Vancouver, British Columbia, Canada
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Mahfouz RA, Abdulmoneim A, Abduo M, Elawady W. The relation of aortic stiffness and in-stent restenosis in patients undergoing percutaneous coronary stenting. Echocardiography 2012; 30:582-7. [PMID: 23565733 DOI: 10.1111/echo.12078] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND There is a suggestion that increased aortic stiffness can be the early manifestations of the atherosclerosis process and is related to decrease coronary flow after coronary stenting. We aimed to evaluate whether aortic stiffness could predict occurrence of in-stent restenosis (ISR) and its relation to coronary flow reserve (CFR) after coronary artery stenting. METHODS AND RESULTS The study population included 126 patients with single vessel coronary artery disease (CAD) undergoing percutaneous coronary intervention (PCI) with bare-metal stenting and at least 12 months of follow-up. All patients underwent noninvasive aortic stiffness index (ASI) assessment before stenting and coronary flow assessment 1 month after stenting. Clinical ISR was observed in 29 (23%) patients, whereas 97 patients remained free of signs or symptoms of recurrent ischemia. ASI was significantly higher in patients with coronary artery disease versus control subjects, and it is significantly increased in patients with restenosis versus those without restenosis (P < 0.0001 and P < 0.001, respectively). There was a significant negative correlation between ASI and CFR (P = 0.0001). The ASI was significantly correlated with C-reactive protein (r = 0.395, P < 0.03). On univariate and multivariate analysis, ASI was the strongest predictor of restenosis (OR 6.8, 95% CI 2.6-13.5). CONCLUSIONS Increased aortic stiffness was an independent predictor of poststenting impaired coronary flow and occurrence of ISR in patients undergoing PCI. Evaluation of aortic stiffness may represent a useful screening tool to stratify patients according to future risk of restenosis.
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