Common Carotid Artery Stiffness Is Associated with Left Ventricular Structure and Function and Predicts First Hospitalization for Acute Heart Failure

Are Non-Invasive Modalities for the Assessment of Atherosclerosis Useful for Heart Failure Predictions?

Heart failure (HF) is becoming an increasingly common issue worldwide and is associated with significant morbidity and mortality, making its prevention an important clinical goal. The criteria evaluated using non-invasive modalities such as coronary artery calcification, the ankle-brachial index, and carotid intima-media thickness have been proven to be effective in determining the relative risk of atherosclerotic cardiovascular disease. Notably, risk assessments using these modalities have been proven to be superior to the traditional risk predictors of cardiovascular disease. However, the ability to assess HF risk has not yet been well-established. In this review, we describe the clinical significance of such non-invasive modalities of atherosclerosis assessments and examine their ability to assess HF risk. The predictive value could be influenced by the left ventricular ejection fraction. Specifically, when the ejection fraction is reduced, its predictive value increases because this condition is potentially a result of coronary artery disease. In contrast, using these measures to predict HF with a preserved ejection fraction may be difficult because it is a heterogeneous condition. To overcome this issue, further research, especially on HF with a preserved ejection fraction, is required.

Mir-1, miR-122, miR-132, and miR-133 Are Related to Subclinical Aortic Atherosclerosis Associated with Metabolic Syndrome

Previously, miR-1, miR-122, miR-126, miR-132, miR-133, and miR-370 were found to be related to coronary artery disease (CAD) progression. However, their relationship with subclinical atherosclerosis, especially in subjects with metabolic syndrome, is unknown. Therefore, our aim was to determine their relationship with arterial markers of subclinical atherosclerosis. Metabolic syndrome subjects (n = 182) with high cardiovascular risk but without overt cardiovascular disease (CVD) were recruited from the Lithuanian High Cardiovascular Risk (LitHiR) primary prevention program. The ardio-ankle vascular index (CAVI), augmentation index normalized to a heart rate of 75 bpm (AIxHR75), aortic pulse wave velocity (AoPWV), and carotid artery stiffness were assessed. MicroRNAs (miRs) were analyzed in serum. Pearson correlation and a univariate linear regression t-test showed that miR-1, miR-133b, and miR-133a were negatively associated with CAVI mean, whereas miR-122 was positively associated. MiR-1, miR-133b and miR-133a, and miR-145 were negatively associated with AIxHR75. MiR-122 correlated negatively with AoPWV. In multivariate linear regression models, miR-133b and miR-122 predicted CAVImean, miR-133 predicted AIxHR75, and miR-122 predicted AoPWV. MiR-132 predicted right carotid artery stiffness, and miR-1 predicted left carotid artery stiffness. The addition of smoking to miR-133b and miR-122 enhanced the prediction of CAVI. Age and triglycerides enhanced the prediction of AoPWV by miR-122. A cluster of four miRs are related to subclinical atherosclerosis in subjects with metabolic syndrome. Combined, they may have a more substantial diagnostic or prognostic value than any single miR. Future follow-up studies are needed to establish their clinical relevance.

Associations between carotid-femoral and heart-femoral pulse wave velocity in older adults: the Atherosclerosis Risk In Communities study

BACKGROUND

Carotid-femoral pulse wave velocity (cfPWV) is widely used in epidemiological studies to assess central arterial stiffness. However, despite being superior to traditional risk factors in predicting cardiovascular outcomes, cfPWV is not routinely used in clinical practice. cfPWV assessments require applanation of the carotid artery, which can be cumbersome, and individual-level factors, including carotid artery plaque, may confound the measurements. Heart-femoral PWV (hfPWV) may be a suitable alternative measure of central arterial stiffness.

OBJECTIVES

The aim of this study was to estimate the strength of the agreement between hfPWV and cfPWV.

METHODS

We evaluated 4133 older-aged [75.2 (5.0) years] African-American and white adults in the community-based Atherosclerosis Risk in Communities (ARIC) Study. cfPWV and hfPWV were measured using an automated cardiovascular screening device. Agreement between the two measurements was determined using Pearson's correlation coefficient (r), standard error of estimate (SEE) and Bland-Altman analysis.

RESULTS

There was a strong (r > 0.7) agreement between hfPWV and cfPWV (r = 0.83, 95% CI: 0.82-0.84). Although the mean cfPWV [11.5 m/s (SD: 3.0)] and hfPWV [11.5 m/s (SD: 2.3)] were comparable, the SEE was 1.7 m/s. Inspection of the Bland-Altman plot revealed greater variability and bias for higher PWV values, with higher PWV further away from the regression line.

DISCUSSION

Findings suggest good agreement between hfPWV and cfPWV. hfPWV is a simpler alternative to cfPWV that is less likely to be confounded by individual-level factors. Considering the greater variability for higher PWV values, further work is warranted to determine the importance of local artery mechanics to both measures.

Perturbations of pulsatile hemodynamics and clinical outcomes in patients with acute heart failure and reduced, mid-range or preserved ejection fraction

Background

Heart failure with mid-range ejection fraction (HFmrEF) has been proposed as a new phenotype of heart failure. We therefore investigated the pulsatile hemodynamic characteristics and outcomes in patients with HFmrEF, in comparison with those with reduced (HFrEF) or preserved (HFpEF) ejection fraction.

Methods

The study was composed of two cohorts of patients hospitalized due to acute heart failure. Pulsatile hemodynamic measures, including carotid-femoral pulse wave velocity (cf-PWV), carotid pulse pressure (cPP), amplitude of the backward pressure wave (Pb) and carotid augmentation index (cAIx), were recorded on admission and before discharge in Cohort A (n = 230, mean age 69.9 ±15.4 years), and long-term follow-up was performed in Cohort B (n = 2677, mean age 76.3 ± 33.4 years).

Results

In Cohort A, patients with HFmrEF had persistently greater cf-PWV, cPP, Pb, and cAI than those with HFrEF, both on admission and before discharge. In contrast, patients with HFmrEF and HFpEF had similar pulsatile hemodynamic characteristics. In cohort B, patients with HFmrEF and HFrEF had similar three-year mortality rates and both were significantly higher than that in patients with HFpEF (both P values < 0.05).

Conclusions

Patients with HFmrEF were characterized by a worse left ventricular systolic function than patients with HFpEF and excessive wave reflections than patients with HFrEF. Future studies are required to confirm that the unfavorable ventriculo-arterial coupling in HFmrEF might play a role in the pathogenesis of high long-term mortality in these patients.

Local carotid arterial stiffness is an independent determinant of left ventricular remodeling in never-treated hypertensive patients

PURPOSE

The aim was to investigate the association between blood pressure (BP), carotid stiffness, carotid-femoral pulse wave velocity (cfPWV) and left ventricular (LV) remodeling in never-treated hypertensive patients.

MATERIAL AND METHODS

178 never-treated hypertensive underwent transthoracic echocardiography, 24-hour ambulatory BP monitoring (ABPM), local carotid stiffness and regional cfPWV assessed using a high-definition echo-tracking ultrasound system and a tonometric transducer, respectively. LV parameters and arterial stiffness were also considered in dippers and non-dippers.

RESULTS

Mean night-time BP best correlated with carotid and LV parameters. Carotid stiffness parameters (β-index, pressure-strain elastic modulus, one-point PWV) correlated with LV mass, relative wall thickness, and E/A ratio while cfPWV correlated only with E/A ratio. In multiple regression analysis, age and mean night-time ABPM had a stroger relation with carotid stiffness than cfPWV. In a second multiple regression analysis, day and night ABPM and carotid stiffness were independently related with LV remodeling and left atrial volume. In non-dippers, local carotid stiffness parameters were significantly higher than in dippers, whereas cfPWV was not significantly different.

CONCLUSIONS

Carotid stiffness parameters are independently associated with LV remodeling and have an additive effect to BP and over cfPWV moreover local arterial stiffness is higher in non-dippers.

Predictive Value of Carotid Distensibility Coefficient for Cardiovascular Diseases and All-Cause Mortality: A Meta-Analysis

Aims

The aim of the present study is to determine the pooled predictive value of carotid distensibility coefficient (DC) for cardiovascular (CV) diseases and all-cause mortality.

Background

Arterial stiffness is associated with future CV events. Aortic pulse wave velocity is a commonly used predictor for CV diseases and all-cause mortality; however, its assessment requires specific devices and is not always applicable in all patients. In addition to the aortic artery, the carotid artery is also susceptible to atherosclerosis, and is highly accessible because of the surficial property. Thus, carotid DC, which indicates the intrinsic local stiffness of the carotid artery and may be determined using ultrasound and magnetic resonance imaging, is of interest for the prediction. However, the role of carotid DC in the prediction of CV diseases and all-cause mortality has not been thoroughly characterized, and the pooled predictive value of carotid DC remains unclear.

Methods

A meta-analysis, which included 11 longitudinal studies with 20361 subjects, was performed.

Results

Carotid DC significantly predicted future total CV events, CV mortality and all-cause mortality. The pooled risk ratios (RRs) of CV events, CV mortality and all-cause mortality were 1.19 (1.06–1.35, 95%CI, 9 studies with 18993 subjects), 1.09 (1.01–1.18, 95%CI, 2 studies with 2550 subjects) and 1.65 (1.15–2.37, 95%CI, 6 studies with 3619 subjects), respectively, for the subjects who had the lowest quartile of DC compared with their counterparts who had higher quartiles. For CV events, CV mortality and all-cause mortality, a decrease in DC of 1 SD increased the risk by 13%, 6% and 41% respectively, whereas a decrease in DC of 1 unit increased the risk by 3%, 1% and 6% respectively.

Conclusions

Carotid DC is a significant predictor of future CV diseases and all-cause mortality, which may facilitate the identification of high-risk patients for the early diagnosis and prompt treatment of CV diseases.