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Candemir M, Kızıltunç E, Nurkoç SG, Cihan B, Şahinarslan A. Predictors of length of hospital stay and in-hospital adverse events in patients with acute decompensated heart failure: in-hospital 24-hour blood pressure monitoring data. Hellenic J Cardiol 2024:S1109-9666(24)00132-5. [PMID: 38925251 DOI: 10.1016/j.hjc.2024.06.008] [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: 05/13/2024] [Revised: 06/12/2024] [Accepted: 06/18/2024] [Indexed: 06/28/2024] Open
Abstract
OBJECTIVE Neurohumoral alterations in heart failure (HF) affect blood pressure variability (BPV) and vascular compliance, but little is known about this subject among patients admitted to the hospital with decompensated HF. This study sought to investigate in-hospital 24-h blood pressure monitoring (BPM)-derived BPV parameters and vascular compliance in patients with decompensated HF and explore the association of these parameters with hospitalization length and in-hospital adverse events. METHODS A 24-h BPM was applied during the first 6 h of admission to the hospital in patients with decompensated HF. Circadian patterns were determined by the study patients. Average real variability (ARV), pulse pressure index (PPI), pulse stiffening ratio (PSR), and ambulatory arterial stiffness index (AASI) values were calculated from in hospital 24-h BPM recordings. Admission and discharge N-terminal pro-B-type natriuretic peptide (NT-proBNP) levels, length of hospitalization, and in-hospital adverse events were recorded. RESULTS A total of 167 patients with decompensated HF were included in the study. The dipper group exhibited a greater NT-proBNP decrease with the treatment than the non-dipper group and reverse dipper group. Hospitalization length was shorter in the dipper group than in the non-dipper and reverse dipper groups. Although ARV, AASI, and PSR were independently associated with the length of hospitalization, ARV, AASI, and PPI were independently associated with in-hospital adverse events. CONCLUSION The post-admission in hospital 24-h BPM-derived parameters (dipper pattern, ARV, PPI, PSR, and AASI) of patients admitted to hospital with decompensated HF provide important prognostic information and predict the length of hospital stay.
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Affiliation(s)
- Mustafa Candemir
- Gazi University, Faculty of Medicine, Department of Cardiology, Ankara 06560, Turkey.
| | - Emrullah Kızıltunç
- Gazi University, Faculty of Medicine, Department of Cardiology, Ankara 06560, Turkey
| | | | - Burcu Cihan
- Gazi University, Faculty of Medicine, Department of Cardiology, Ankara 06560, Turkey
| | - Asife Şahinarslan
- Gazi University, Faculty of Medicine, Department of Cardiology, Ankara 06560, Turkey
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Ivanova NG. A Sole Case of the FGF23 Gene Mutation c.202A>G (p.Thr68Ala) Associated with Multiple Severe Vascular Aneurysms and a Hyperphosphatemic Variant of Tumoral Calcinosis-A Case Report. Life (Basel) 2024; 14:613. [PMID: 38792634 PMCID: PMC11123361 DOI: 10.3390/life14050613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2024] [Revised: 05/02/2024] [Accepted: 05/08/2024] [Indexed: 05/26/2024] Open
Abstract
Tumoral calcinosis is an extremely rare genetic disease caused by mutations in three genes, GALNT3, FGF23, and KL, which disrupt phosphorus metabolism. The hallmark of this condition is the formation of tumors in the soft tissues around the joints. Other phenotypic features of tumoral calcinosis are dental involvement and brain and vascular calcifications. The clinical case reported herein presents for the first time to the scientific community the c.202A>G (p.Thr68Ala) mutation of the FGF23 gene, associated with a hyperphosphatemic variant of tumoral calcinosis and multiple severe vascular aneurysms. A female patient underwent multiple surgeries for tumor formations in her soft tissues that first appeared at the age of 12 months. On this occurrence, the patient was found to have hyperphosphatemia, low phosphate clearance, increased tubular reabsorption with normal levels of total and ionized calcium, vitamin D3, and parathyroid hormone, and no effect of treatment with sevelamer hydrochloride and a low-phosphate diet. At the age of 39, the patient underwent imaging studies due to edema and a pulsating formation in the neck area, which revealed multiple vascular aneurysms with thrombosis, for which she received operative and interventional treatment. In this connection, and because of the established phosphorus metabolism disturbance, a genetic disease was suspected. The sequence analysis and deletion/duplication testing of the 358 genes performed on this occasion revealed that the woman was homozygous for a variant of the c.202A>G (p.Thr68Ala) mutation of the FGF23 gene. The established mutation is not present in population databases. The presented clinical case is the first and only one in the world to demonstrate the role of this type of FGF23 gene mutation in the development of a hyperphosphatemic variant of tumoral calcinosis characterized by aggressive formation of multiple vascular aneurysms.
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Affiliation(s)
- Nevena Georgieva Ivanova
- Department of Urology and General Medicine, Faculty of Medicine, Medical University of Plovdiv, 4000 Plovdiv, Bulgaria; ; Tel.: +35-98-8913-0416
- St Karidad MHAT, Karidad Medical Health Center, 4004 Plovdiv, Bulgaria
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Boos CJ, Hein A, Khattab A. Ambulatory arterial stiffness index, mortality, and adverse cardiovascular outcomes; Systematic review and meta-analysis. J Clin Hypertens (Greenwich) 2024; 26:89-101. [PMID: 38234206 PMCID: PMC10857461 DOI: 10.1111/jch.14755] [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: 08/25/2023] [Revised: 10/30/2023] [Accepted: 11/19/2023] [Indexed: 01/19/2024]
Abstract
The ambulatory arterial stiffness index (AASI) is a novel measure of both blood pressure (BP) variability and arterial stiffness. This systematic review and meta-analysis was designed to evaluate the strength of the association between AASI and mortality and major adverse cardiovascular events (MACE). PubMed, Scopus, CINAHL, Google Scholar. and the Cochrane library were searched for relevant studies to July 31, 2023. Two investigators independently extracted data. The Newcastle-Ottawa Scale (NOS) was used to assess the quality of all included articles. The relationship between baseline AASI and outcomes were examined using relative risk (RR) ratios with 95% confidence intervals (CI) with RevMan web. Thirteen studies were included and representing 28 855 adult patients who were followed up from 2.2 to 15.2 years. A 1-standard deviation (1-SD) increase in AASI was associated with a significant increase in all-cause death (RR 1.12; 95% CI: 0.95-1.32), stroke (RR 1.25; 95% CI: 1.09-1.44), and MACE (RR 1.07; 95% CI: 1.01-1.13; [I2 = 32%]). Higher dichotomized AASI (above vs. below researcher defined cut-offs) was associated with a significant increase in all-cause mortality (RR 1.19; 95% CI: 1.06-1.32), cardiovascular death (RR 1.29; 95% CI: 1.14-1.46), stroke (RR 1.57; 95% CI: 1.33-1.85), and MACE (RR1.29; 95% CI: 1.16-1.44). There was a significant risk of bias in more than 50% of studies with no evidence of significant publication bias. Higher AASI is associated with an increased risk of all-cause and cardiovascular death, stroke, and MACE. Further high-quality studies are warranted to determine reproducible AASI cut-offs to enhance its clinical risk precision.
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Affiliation(s)
| | - Aung Hein
- Faculty of Health & Social SciencesBournemouth UniversityBournemouthUK
| | - Ahmed Khattab
- Faculty of Health & Social SciencesBournemouth UniversityBournemouthUK
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Vallée A. Added value of arterial stiffness index for the 10-year atherosclerotic cardiovascular disease risk determination in a middle-aged population-based study. Clin Res Cardiol 2023; 112:1679-1689. [PMID: 37650913 DOI: 10.1007/s00392-023-02267-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Accepted: 07/12/2023] [Indexed: 09/01/2023]
Abstract
OBJECTIVE Atherosclerotic cardiovascular disease (ASCVD) is considered the leading cause of mortality worldwide. Arterial stiffness, measured by arterial stiffness index (ASI), could be a main predictor in target damage of organs. Uncertainty remains regarding the contribution of ASI to estimated ASCVD risk. This study investigates the added value of ASI in ASCVD risk determination using the general UK Biobank middle-aged population. METHODS Among 100,598 participants from the UK Biobank population, ASI was assessed and associations between ASCVD risk were stratified by sex and estimated using multiple linear and logistic regressions adjusted for heart rate, physical activity, alcohol status, smocking pack years, BMI categories and CKD. RESULTS Males presented higher ASCVD risk than females (8.58% vs. 2.82%, p < 0.001) and higher ASI levels (9.50 m/s vs. 7.00 m/s, p < 0.001). The Youden index was determined at 9.70 m/s in males (p < 0.001) and 10.46 m/s in females (p < 0.001). Among females, participants with ASI > 10.46 m/s showed higher ASCVD risk than others (3.64% vs. 2.56%, p < 0.001), similar results were observed for males (9.92% vs. 7.21%, p < 0.001). In males, ASI showed significant added value information when including overall covariates (AUC = 0.695 vs. AUC = 0.663, p < 0.001). Similar results were observed in females (AUC = 0.693 vs. AUC = 0.687, p = 0.001). In both genders, for the association between ASI and ASCVD risk, nonlinear relationships were observed with higher accuracies than linear models. CONCLUSION Further studies should investigate ASCVD risk stratification management depending on ASI measurement.
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Affiliation(s)
- Alexandre Vallée
- Department of Epidemiology and Public Health, Foch Hospital, 92150, Suresnes, France.
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Vallée A. Association between tobacco smoking and alcohol consumption with arterial stiffness. J Clin Hypertens (Greenwich) 2023; 25:757-767. [PMID: 37408141 PMCID: PMC10423766 DOI: 10.1111/jch.14669] [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: 03/23/2023] [Revised: 05/03/2023] [Accepted: 05/06/2023] [Indexed: 07/07/2023]
Abstract
Few investigations have been performed between tobacco smoking, alcohol, and arterial stiffness. The purpose of our study was to investigate the association between smoking use and alcohol with arterial stiffness index (ASI) in a middle-age population. Smoking pack-years and cigarettes per day were defined as alcohol consumption in units/day. Sex associations between smoking and alcohol with ASI were estimated using multiple linear regressions. Interactions and synergistic effects were investigating. 98 039 individuals of the UK Biobank cohort were included (45 457 men and 52 582 women). ASI levels were higher in men than in women (9.91 vs. 8.71 m/s, p < .001), and showed higher relationship to smoking tobacco in multiple linear regression models in women than in men (FDR logworth 78.4 vs. 52.7). The findings revealed that ASI was higher among current smokers than never smokers in both sex and after adjustment for all covariates (in men 10.4 vs. 9.6 and in women 9.5 vs. 8.5 m/s, p < .001). Alcohol consumption per day was positively associated with higher levels of ASI in both sex, but with a less relationship (FDR logworth for men = 2.8, for women = 2.5). An interaction was observed between smoking information and alcohol in men but not in women. Synergistic effects were observed by adding smoking information on alcohol consumption models in men and women (p = .029, p < .001, respectively). Smoking and alcohol were associated with higher ASI in both sex but with a higher relationship among women. The findings suggest the importance of considering smoking and alcohol consumption cessation in cardiovascular diseases prevention.
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Affiliation(s)
- Alexandre Vallée
- Department of Epidemiology‐Data‐BiostatisticsDelegation of Clinical Research and Innovation (DRCI)Foch HospitalSuresnesFrance
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Vallée A. Arterial stiffness nomogram identification by cluster analysis: A new approach of vascular phenotype modeling. J Clin Hypertens (Greenwich) 2022; 24:1415-1426. [PMID: 36196587 PMCID: PMC9659882 DOI: 10.1111/jch.14571] [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: 08/05/2022] [Revised: 08/22/2022] [Accepted: 08/24/2022] [Indexed: 11/28/2022]
Abstract
Arterial stiffness, measured by arterial stiffness index (ASI), can be considered as a major denominator in cardiovascular diseases. Thus, it remains essential to highlight patient phenotyping profiles with high ASI values. A nomogram of arterial stiffness was evaluated by calculation of ASI nomogram. Theoretical ASI can be performed according to age, sex, mean blood pressure, and heart rate, allowing to form an individual ASI nomogram [(measured ASI - theoretical ASI)/theoretical ASI]. An ASI nomogram > 0 defined AS. This study investigates among UK Biobank participants without cardiovascular diseases, the hypothesis that K-means cluster analysis can be used to identify homogeneous phenotyping subgroups of participants according to ASI levels and then, the phenotype differences observed between these clusters. ASI nomogram was applied on 132 851 participants. K-means clustering was implemented with 10 clusters (optimal CCC value of 105.246). One cluster showed 100% rate of AS, corresponding to 25 393 participants (41.6% of the AS participants) with ASI nomogram = .26 (.22), ASI = 11.6 (2.3)m/s. A second cluster showed a 100% of non-AS, corresponding to 27 844 participants (38.8% of the participants with no arterial stiffness) with ASI nomogram = -.22 (.13), ASI = 7.1 (1.44)m/s. Threshold values of independent factors for differencing these two clusters were total cholesterol > 5.409 mmol/L (P < .001), triglycerides > 1.286 mmol/L (P < .001), smoking pack years > 11.8 pack/years, CRP > .99 (P < .001), daily alcohol consumption > 1.794 units/days and BMI > 26.641 kg/m2 (P < .001). Cluster analysis allowed to highlight homogeneous participants profile with or without AS. Determine the markers differencing these clusters participates in the management of cardiovascular preventive strategies.
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Affiliation(s)
- Alexandre Vallée
- Department of Epidemiology-Data-Biostatistics, Delegation of Clinical Research and Innovation (DRCI), Foch hospital, Suresnes, France
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Ceccherini E, Cecchettini A, Gisone I, Persiani E, Morales MA, Vozzi F. Vascular Calcification: In Vitro Models under the Magnifying Glass. Biomedicines 2022; 10:biomedicines10102491. [PMID: 36289753 DOI: 10.3390/biomedicines10102491] [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: 09/02/2022] [Revised: 10/01/2022] [Accepted: 10/04/2022] [Indexed: 11/16/2022] Open
Abstract
Vascular calcification is a systemic disease contributing to cardiovascular morbidity and mortality. The pathophysiology of vascular calcification involves calcium salt deposition by vascular smooth muscle cells that exhibit an osteoblast-like phenotype. Multiple conditions drive the phenotypic switch and calcium deposition in the vascular wall; however, the exact molecular mechanisms and the connection between vascular smooth muscle cells and other cell types are not fully elucidated. In this hazy landscape, effective treatment options are lacking. Due to the pathophysiological complexity, several research models are available to evaluate different aspects of the calcification process. This review gives an overview of the in vitro cell models used so far to study the molecular processes underlying vascular calcification. In addition, relevant natural and synthetic compounds that exerted anticalcifying properties in in vitro systems are discussed.
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Affiliation(s)
- Elisa Ceccherini
- Institute of Clinical Physiology, National Research Council (CNR), 56124 Pisa, Italy
| | - Antonella Cecchettini
- Institute of Clinical Physiology, National Research Council (CNR), 56124 Pisa, Italy
- Department of Clinical and Experimental Medicine, University of Pisa, 56126 Pisa, Italy
| | - Ilaria Gisone
- Institute of Clinical Physiology, National Research Council (CNR), 56124 Pisa, Italy
| | - Elisa Persiani
- Institute of Clinical Physiology, National Research Council (CNR), 56124 Pisa, Italy
| | - Maria Aurora Morales
- Institute of Clinical Physiology, National Research Council (CNR), 56124 Pisa, Italy
| | - Federico Vozzi
- Institute of Clinical Physiology, National Research Council (CNR), 56124 Pisa, Italy
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Vallée A. Association between serum uric acid and arterial stiffness in a large-aged 40-70 years old population. J Clin Hypertens (Greenwich) 2022; 24:885-897. [PMID: 35748644 PMCID: PMC9278596 DOI: 10.1111/jch.14527] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Revised: 05/25/2022] [Accepted: 05/28/2022] [Indexed: 12/24/2022]
Abstract
Arterial stiffness (AS), measured by arterial stiffness index (ASI), is a determinant in cardiovascular (CV) diseases. A high serum uric acid (SUA) level is a known risk factor for CV disease. The authors investigated the relationship between SUA and ASI in the middle-age UK Biobank population study. AS was defined as ASI > 10 m/s. A cross-sectional study was conducted from 126 663 participants. Participants were divided into four quartiles according to SUA levels and sex. Sex multivariate analyses were performed with adjustment for confounding factors. The average ASI for overall participants was 9.3 m/s (SD: 2.9); 9.9 m/s (SD: 2.8) for men and 8.7 m/s (SD: 2.9) for women (P < .001). Men presented higher SUA rate (351.3 mmol/L (SD:67.9)) than women (270.7 mmol/L (SD:64.4)), P < .001. In men multivariate analysis, SUA remained a determinant of AS, with an increase in the strength of the association between the quartiles, Q4 versus Q1, OR = 1.10 [1.05-1.16], P < .001, Q3 versus Q1, OR = 1.09 [1.04-1.14], P < .001 but not between Q2 and Q1 (P = .136). In women, SUA remained significant for AS, with an increase in the strength of the association between the quartiles, Q4 versus Q1, OR = 1.22 [1.15-1.30], P < .001, Q3 versus Q1, OR = 1.13 [1.07-1.19], P < .001 and no difference between Q2 and Q1 (P = .101). When applying continuous SUA values in the multivariate analysis, SUA remained significant (P < .001), with a Youden index value for men = 338.3 mmol/L and for women = 267.3 mmol/L. High SUA levels were associated with AS, suggesting that SUA could be used as a predictor of atherosclerosis.
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Affiliation(s)
- Alexandre Vallée
- Department of Epidemiology-Data-Biostatistics, Delegation of Clinical Research and Innovation (DRCI), Foch hospital, Suresnes, France
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Vallée A. Association Between Lipids and Arterial Stiffness for Primary Cardiovascular Prevention in a General Middle-Aged European Population. Front Cardiovasc Med 2022; 9:899841. [PMID: 35711343 PMCID: PMC9197205 DOI: 10.3389/fcvm.2022.899841] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2022] [Accepted: 05/03/2022] [Indexed: 11/13/2022] Open
Abstract
Background Dyslipidemia contributes to the progression of arterial stiffness (AS). The purpose of this study was to investigate the association of the different lipid parameters with arterial stiffness index (ASI) in a middle-aged population free of cardiovascular (CV) disease. Methods Among 71,326 volunteers from the UK Biobank population, total cholesterol (TC), triglycerides (TG), low-density lipoprotein cholesterol (LDL), high-density lipoprotein cholesterol (HDL), lipoprotein (a) [Lp(a)], apolipoproteins A and B (Apo A and Apo B), and ASI were measured. Values for non-HDL, TC/HDL, TG/HDL, and LDL/HDL were calculated. AS was defined as an ASI > 10 m/s. Associations between lipid parameters and ASI were performed using multiple linear logistic regressions. The results reported from univariate models were the squared partial correlation coefficient, r 2, and from multivariate models, the adjusted coefficient of determination, R 2, to describe the contribution of ASI variability for each lipid parameter. Results We found that TG/HDL was mainly associated with ASI [β = 0.53 (0.01), r 2 = 3.66%, p < 0.001 and adjusted β = 0.21 (0.01), R 2 = 13.58%, p < 0.001] and AS [odds ratio (OR) = 1.86 (1.80-1.92), r 2 = 1.65%, p < 0.001 and adjusted OR = 1.15 (1.13-1.17), R 2 = 8.54%, p < 0.001] rather than the others. TG/HDL remained the only lipid parameter that showed added value in linear multivariate models. TG/HDL remained less associated with AS than age (r 2 = 5.55%, p < 0.001), mean blood pressure (BP; r 2 = 5.31%, p < 0.001), and gender (r 2 = 4.44%, p < 0.001), but more highly associated than body mass index (BMI; r 2 = 1.95%, p < 0.001), heart rate (HR; r 2 = 0.81%, p < 0.001), fasting glucose (r 2 = 0.18%, p < 0.001), tobacco (r 2 = 0.05%, p < 0.001), and glomerular filtration rate (GFR; r 2 = 0.01%, p < 0.001). Conclusions In primary CV prevention, lipids, especially through the TG/HDL ratio, could be more instructive in preventing the increase in AS than other modifiable factors.
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Affiliation(s)
- Alexandre Vallée
- Department of Epidemiology-Data-Biostatistics, Delegation of Clinical Research and Innovation (DRCI), Foch Hospital, Suresnes, France
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10
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Zaproudina N, Niiranen TJ, Anttila V, Kallela M. Left ventricular hypertrophy and other cardiac risk factors in migraineurs. Acta Neurol Scand 2021; 143:661-665. [PMID: 33733453 DOI: 10.1111/ane.13410] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 02/19/2021] [Accepted: 02/22/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND The influence of cardiovascular risk factors on the probability of cardiovascular diseases in migraineurs is still being discussed. AIMS OF THE STUDY To further elucidate the mechanisms of these relationships, we assessed the associations between migraine and cardiovascular risk factors, including those that have been recently shown to improve the prediction of cardiovascular events. METHODS We used the data of the Finnish Health 2000 Survey (BRIF8901), consisting of 5737 subjects aged 30 years or older. In total, 488 participants reported migraine. In addition to conventional cardiovascular risk factors, educational attainment, presence of electrocardiographic signs of left ventricular hypertrophy and hemoglobin A1c were also included in the logistic regression analyses. RESULTS Migraine was found to be associated with female sex (Odds ratio (OR) = 3.75, p < .001), lower age (B = 0.99, p < .001), lower high-density lipoprotein cholesterol (OR = 1.23, p < .05), higher diastolic blood pressure (OR = 1.31, p < .05), and left ventricular hypertrophy (OR = 1.32, p < .05), the probability of the last one increasing with migraine attack frequency. CONCLUSIONS Left ventricular hypertrophy, most probably as a consequence of migraine-related arterial hypertension and dyslipidemia, may play a role in the relationship between migraine and cardiovascular events. The nature of this finding calls for further studies.
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Affiliation(s)
- Nina Zaproudina
- Institute of Clinical Medicine University of Eastern Finland Kuopio Finland
- Department of Clinical Physiology and Nuclear Medicine Kuopio University Hospital Kuopio Finland
| | - Teemu J. Niiranen
- Department of Medicine Turku University Hospital and University of Turku Turku Finland
- Department of Public Health Solutions National Institute for Health and Welfare Turku Finland
| | - Verneri Anttila
- Analytical and Translational Genetics Unit Department of Medicine Massachusetts General Hospital and Harvard Medical School Boston MA USA
- Program in Medical and Population Genetics Broad Institute of MIT and Harvard Cambridge MA USA
- Stanley Center for Psychiatric Research Broad Institute of MIT and Harvard Cambridge MA USA
| | - Mikko Kallela
- Department of Neurology Helsinki University and Helsinki University Hospital Helsinki Finland
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Boos CJ, Thiri-Toon L, Steadman CD, Khambekar S, Jordan A, Carpenter JP. The Relationship Between Ambulatory Arterial Stiffness Index and Cardiovascular Outcomes in Women. Cardiol Res 2021; 12:161-168. [PMID: 34046110 PMCID: PMC8139754 DOI: 10.14740/cr1189] [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: 10/26/2020] [Accepted: 11/12/2020] [Indexed: 11/30/2022] Open
Abstract
Background The ambulatory arterial stiffness index (AASI) obtained during ambulatory blood pressure monitoring (ABPM) has been cited as an independent predictor of major adverse cardiovascular events (MACEs) including cardiovascular death, stroke and worsening chronic kidney disease (CKD) among mixed-sex adult populations. This study aimed to determine the relationship between AASI and MACE and its predictive precision in women. Methods This work follows the guidelines of the STROBE initiative for cohort studies. This was a retrospective single-center observational study of adult women (aged 18 - 75 years), who underwent 24-h ABPM for the diagnosis of hypertension or its control. The primary endpoint was a composite MACE of cardiovascular death, acute limb ischemia, stroke, acute coronary syndrome (ACS), or progression to stage V CKD. Results A total of 219 women aged 57.4 ± 13.3 years were followed up for a median (interquartile range (IQR)) of 25.5 (18.3 - 31.3) months. Overall, 16 (7.3%) patients suffered one or more MACE events. AASI was significantly higher in patients with known coronary artery disease (CAD), diabetes mellitus, peripheral vascular disease (PVD), heart failure, previous stroke, or transient ischemic attack (TIA). AASI was a significant predictor of MACE (area under the curve: 0.78; P < 0.001) with an optimal cut-off of ≥ 0.56. On Kaplan-Meier analysis AASI ≥ 0.56 was significantly associated with MACE (log-rank test, P < 0.001). The only independent predictors of MACE on Cox proportional hazard analysis were diabetes mellitus, low high-density lipoprotein (HDL) levels, cumulative AASI values, or AASI ≥ 0.56. Conclusions An AASI of ≥ 0.56 is an independent predictor of MACE in women. A further validation study in a larger cohort of women is recommended.
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Affiliation(s)
- Christopher J Boos
- Department of Cardiology, Poole Hospital NHS Foundation Trust, Longfleet Rd., Poole, Dorset, BH15 2JB, UK.,Department of Postgraduate Medical Education, Bournemouth University, Bournemouth, BH1 3LT, UK.,Research Institute for Sport, Physical Activity and Leisure, Leeds Beckett University, Leeds, LS16 5LF, UK
| | - Lin Thiri-Toon
- Department of Cardiology, Poole Hospital NHS Foundation Trust, Longfleet Rd., Poole, Dorset, BH15 2JB, UK
| | - Christopher D Steadman
- Department of Cardiology, Poole Hospital NHS Foundation Trust, Longfleet Rd., Poole, Dorset, BH15 2JB, UK
| | - Sujata Khambekar
- Department of Cardiology, Poole Hospital NHS Foundation Trust, Longfleet Rd., Poole, Dorset, BH15 2JB, UK
| | - Andrew Jordan
- Department of Cardiology, Poole Hospital NHS Foundation Trust, Longfleet Rd., Poole, Dorset, BH15 2JB, UK
| | - John Paul Carpenter
- Department of Cardiology, Poole Hospital NHS Foundation Trust, Longfleet Rd., Poole, Dorset, BH15 2JB, UK
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Analysis of ambulatory blood pressure monitoring data in patients with ankylosing spondylitis without clinically evident cardiovascular disease. J Hum Hypertens 2021; 36:531-536. [PMID: 33953331 DOI: 10.1038/s41371-021-00542-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Revised: 04/08/2021] [Accepted: 04/16/2021] [Indexed: 11/08/2022]
Abstract
Ankylosing spondylitis (AS) is associated with an increased risk of cardiovascular morbidity and mortality. Parameters, such as non-dipper, average real variability (ARV), pulse pressure index (PPI), and ambulatory arterial stiffness index (AASI) obtained from ambulatory blood pressure monitoring (ABPM), provide information about adverse cardiovascular outcomes. In this study, these indexes were evaluated in patients with AS. Sixty-five patients with AS and 65 control subjects were included in this study. Non-dipper pattern, ARV, PPI, and AASI parameters were assessed using 24-h ABPM recordings. Twenty-four-hour systolic, diastolic, mean standard deviation, PPI, ARV, and AASI were higher in patients with AS (p < 0.05 all parameters). Non-dipper (43.1% vs. 21.5%, p = 0.007) and reverse dipper (10.8% vs. 0%, p = 0.013) patterns were more common in patients with AS. In addition, disease duration was moderately correlated with AASI and ARV (r = 0.36, p = 0.003; r = 0.31, p = 0.012, respectively). This study showed that PPI, AASI, ARV, and dipper pattern were impaired in patients with AS evaluated with ABPM.
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Subclinical left ventricular systolic dysfunction by two-dimensional speckle-tracking echocardiography and its relation to ambulatory arterial stiffness index in hypertensive patients. J Hypertens 2021; 38:864-873. [PMID: 31834120 DOI: 10.1097/hjh.0000000000002330] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Increased arterial stiffness is associated with cardiovascular morbidity and mortality among hypertensive patients. OBJECTIVES To assess the relationship between ambulatory arterial stiffness index (AASI) and subclinical left ventricular (LV) systolic dysfunction assessed by 2-D speckle-tracking echocardiography (STE). METHODS We enrolled 70 consecutive patients with hypertension. All patients were evaluated for parameters of ambulatory blood pressure monitoring (ABPM) including AASI. From those patients, 51 underwent conventional echocardiography as well as 2-D STE to assess for subclinical LV systolic dysfunction defined by global longitudinal strain (GLS) and global circumferential strain (GCS). RESULTS The mean age of the patients (n = 51) was 46.3 ± 12.3 years, women represented 59%. Study population were divided into two groups according to blood pressure control as defined by ABPM; controlled (n = 23), and uncontrolled (n = 28). Baseline characteristics were comparable between both groups. There were significant differences in both daytime and night-time mean ABPM (P < 0.05). Posterior wall thickness, as well as LV relative wall thickness were significantly higher in uncontrolled patients (P < 0.05 for each). AASI was significantly, but moderately correlated to GLS. Most ABPM parameters were elevated with the higher AASI values (AASI ≥0.5). Significantly more uncontrolled hypertensive patients were encountered as well. Interestingly, sex and AASI were predictors of impaired GLS by univariate linear regression analysis; however, AASI was the only independent predictor of impaired GLS on multivariate analysis (Beta = 0.3, CI = 0.2--12, and P = 0.04). CONCLUSION AASI might predict subclinical LV systolic dysfunction as assessed by global longitudinal strain. Further wide-scale studies should further explore this intriguing hypothesis.
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Climie RE, Gallo A, Picone DS, Di Lascio N, van Sloten TT, Guala A, Mayer CC, Hametner B, Bruno RM. Measuring the Interaction Between the Macro- and Micro-Vasculature. Front Cardiovasc Med 2019; 6:169. [PMID: 31824963 PMCID: PMC6882776 DOI: 10.3389/fcvm.2019.00169] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Accepted: 11/07/2019] [Indexed: 01/09/2023] Open
Abstract
Structural and functional dysfunction in both the macro- and microvasculature are a feature of essential hypertension. In a healthy cardiovascular system, the elastic properties of the large arteries ensure that pulsations in pressure and flow generated by cyclic left ventricular contraction are dampened, so that less pulsatile pressure and flow are delivered at the microvascular level. However, in response to aging, hypertension, and other disease states, arterial stiffening limits the buffering capacity of the elastic arteries, thus exposing the microvasculature to increased pulsatile stress. This is thought to be particularly pertinent to high flow/low resistance organs such as the brain and kidney, which may be sensitive to excess pressure and flow pulsatility, damaging capillary networks, and resulting in target organ damage. In this review, we describe the clinical relevance of the pulsatile interaction between the macro- and microvasculature and summarize current methods for measuring the transmission of pulsatility between the two sites.
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Affiliation(s)
- Rachel E Climie
- INSERM, U970, Paris Cardiovascular Research Center (PARCC), Paris Descartes University, Paris, France.,Baker Heart and Diabetes Institute, Melbourne, VIC, Australia.,Menzies Institute for Medical Research, University of Tasmanian, Hobart, TAS, Australia
| | - Antonio Gallo
- Cardiovascular Prevention Unit, Department of Endocrinology and Metabolism, Pitié-Salpêtrière Hospital, Paris, France.,Laboratoire d'imagerie Biomédicale, INSERM 1146 - CNRS 7371, Sorbonne University, Paris, France
| | - Dean S Picone
- Menzies Institute for Medical Research, University of Tasmanian, Hobart, TAS, Australia
| | - Nicole Di Lascio
- Institute of Clinical Physiology, National Research Council, Pisa, Italy
| | - Thomas T van Sloten
- INSERM, U970, Paris Cardiovascular Research Center (PARCC), Paris Descartes University, Paris, France.,Cardiovascular Research Institute Maastricht and Department of Internal Medicine, Maastricht University Medical Centre, Maastricht, Netherlands
| | - Andrea Guala
- Department of Cardiology, Hospital Universitari Vall d'Hebron, Vall d'Hebron Institute of Research, Barcelona, Spain
| | - Christopher C Mayer
- AIT Austrian Institute of Technology GmbH, Center for Health & Bioresources, Biomedical Systems, Vienna, Austria
| | - Bernhard Hametner
- AIT Austrian Institute of Technology GmbH, Center for Health & Bioresources, Biomedical Systems, Vienna, Austria
| | - Rosa Maria Bruno
- INSERM, U970, Paris Cardiovascular Research Center (PARCC), Paris Descartes University, Paris, France
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A multilocus genetic risk score is associated with arterial stiffness in hypertensive patients: the CARE NORTH study. J Hypertens 2019; 36:1882-1888. [PMID: 29878972 DOI: 10.1097/hjh.0000000000001773] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
INTRODUCTION Arterial stiffness is recognized as an intermediate phenotype and predictor of cardiovascular disease. Arterial stiffness is complex in origin with contributions from lifestyle and genetic factors. However, the association between single nucleotide polymorphisms (SNPs) and arterial stiffness remains unclear. OBJECTIVE The aim is to assess whether a multilocus genetic risk score (GRS), composed of selected SNPs linked to cardiovascular traits and outcomes, is associated with arterial stiffness in patients with hypertension. DESIGN AND METHODS This study included 730 participants derived from the CARE NORTH study. The arterial stiffness was evaluated by carotid-femoral pulse wave velocity (cfPWV). An adjusted linear regression was used to evaluate the association between cfPWV and each individual SNP using multiple genetic models. The association between a constructed GRS and cfPWV was tested in an unadjusted and adjusted model. RESULTS We selected 13 SNPs found to be associated with cfPWV (P < .05): 6 SNPs in additive, 4 SNPs in recessive and 3 SNPs in dominant mode of inheritance. The GRS based on these SNPs was positively associated with cfPWV both in unadjusted and adjusted models (β = 0.2 m/s, 95% CI 0.11 - 0.29, P = 7.6 × 10 and β = 0.22 m/s, 95% CI 0.15 - 0.28, P = 1.4 × 10, respectively). The GRS explained an additional 3.6% cfPWV variance above clinical covariates. CONCLUSION We demonstrate that the GRS composed of 13 SNPs related to cardiovascular phenotypes is associated with an increased arterial stiffness in hypertensive patients. Our findings may help to clarify genetic basis of arterial stiffening and provide insight into mechanisms underlying this phenotype.
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Zeng X, Jia N, Liu D, Wang L, Xu Z, Zhang Y, Wang H, Zhang R, Zhou J, Pan C, Gan Y, Qiao W. A cross-sectional study of the ambulatory central artery stiffness index in patients with hypertension. Medicine (Baltimore) 2019; 98:e16053. [PMID: 31261512 PMCID: PMC6616313 DOI: 10.1097/md.0000000000016053] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
The present study aimed to investigate the characteristics of the ambulatory central artery stiffness index (AcASI) and its related factors. The association between AcASI and the left ventricular mass index (LVMI), and other factors related to atherosclerosis were explored.Patients with primary hypertension were enrolled into this study. Ambulatory central artery blood pressure (CABP) and ambulatory brachial artery blood pressure (BABP) were assessed using a Mobil-O-Graph NG hemomanometer, whereas AcASI and the ambulatory arterial stiffness index (AASI) were determined. LVMI was assessed by echocardiography.A total of 136 patients with primary hypertension were enrolled from May 2011 to January 2013 in Beijing Hospital. AcASI was significantly associated with AASI (r = 0.879, P < .001). AcASI was significantly lower than AASI (0.422 ± 0.302 vs 0.482 ± 0.270; P < .001). AcASI increased with age, ambulatory brachial mean blood pressure (MBP), and fasting glucose. AcASI was significantly associated with office pulse pressure (PP), ambulatory brachial PP, ambulatory central PP, and pulse wave velocity (PWV). AcASI, but not AASI, was significantly associated with LVMI. Receiver operator characteristic analysis indicated that AcASI and AASI could may be a predictor of left ventricular hypertrophy (LVH). Multiple regression analysis indicated that AcASI, chronic kidney disease, and hypertension course were associated with LVMI, but AASI was not.AcASI, which is obtained from ambulatory CABP monitoring, could be a new marker for the evaluation of atherosclerosis. AcASI may be stronger associated with LVH than AASI.
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Affiliation(s)
| | | | | | | | | | - Yan Zhang
- Special Care Ward, Beijing Hospital, National Center of Gerontology, Beijing, China
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Lima-Junior DD, Farah BQ, Germano-Soares AH, Andrade-Lima A, Silva GO, Rodrigues SLC, Ritti-Dias R. Association between handgrip strength and vascular function in patients with hypertension. Clin Exp Hypertens 2018; 41:692-695. [DOI: 10.1080/10641963.2018.1539096] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Affiliation(s)
- Dalton de Lima-Junior
- Department of Physical Education, Federal University of Pernambuco, Recife, PE, Brazil
| | - Breno Quintella Farah
- Department of Physical Education, Rural Federal University of Pernambuco, Recife, PE, Brazil
| | | | - Aluísio Andrade-Lima
- Department of Physical Education, Federal University of Sergipe, Aracaju, SE, Brazil
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Tjessem IH, Al-Far HFM, Fuglsang J, Lauszus FF. Microvascular disease during pregnancy in type 1 diabetes is associated with ambulatory arterial stiffness. Pregnancy Hypertens 2017; 12:150-154. [PMID: 29199016 DOI: 10.1016/j.preghy.2017.11.011] [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: 06/05/2017] [Revised: 11/19/2017] [Accepted: 11/22/2017] [Indexed: 11/29/2022]
Abstract
OBJECTIVES The objective of this study was to evaluate the association between the ambulatory arterial stiffness index (AASI) and markers of microvascular disease during pregnancy in women with type 1 diabetes. STUDY DESIGN A total of 151 women with type 1 diabetes mellitus were recruited for repeat 24-h BP recordings thrice during pregnancy and once three months post partum. Fifty women without diabetes served as controls. The AASI and pulse pressure (PP) were computed from blood pressure recordings. Repeated measures analysis of variance was used for comparison between groups during and after pregnancy. Linear regression analysis was performed with AASI and PP as dependent variables and albuminuria and retinopathy as independent variables. MAIN OUTCOME MEASURES AASI during diabetic pregnancy and association with microvascular disease. RESULTS Micro- or macroalbuminuria was present in 23% of the women and 58% had either simplex or proliferative retinopathy. The AASI was inversely associated with the coefficient of determination, which means that the stiffer vascular wall the more random variability in BP. CONCLUSION AASI showed a strong association with microvascular disease during pregnancy in women with type 1 diabetes. Together with the flattened circadian rhythm this indicates a pregnancy-related functional change in the vascular bed.
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Affiliation(s)
- Ingvild Holm Tjessem
- Department of Obstetrics/Gynecology, Herning, Herning Hospital, Gl. Landevej 61, DK-7400 Herning, Denmark.
| | | | - Jens Fuglsang
- Department of Obstetrics/Gynecology, Aarhus, Aarhus University Hospital, Nørrebrogade 44, DK-8000 Aarhus C, Denmark
| | - Finn Friis Lauszus
- Department of Obstetrics/Gynecology, Herning, Herning Hospital, Gl. Landevej 61, DK-7400 Herning, Denmark; Department of Obstetrics/Gynecology, Aarhus, Aarhus University Hospital, Nørrebrogade 44, DK-8000 Aarhus C, Denmark
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Woodiwiss AJ, Norton GR, Ben-Dov IZ, Gavish B, Bursztyn M. Association of Blood Pressure Variability Ratio With Glomerular Filtration Rate Independent of Blood Pressure and Pulse Wave Velocity. Am J Hypertens 2017; 30:1177-1188. [PMID: 28992192 DOI: 10.1093/ajh/hpx122] [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: 03/29/2017] [Accepted: 07/13/2017] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Blood pressure variability ratio (BPVR)(derived from within-subject SD of 24-hour ambulatory blood pressure [BP]) predicts all-cause mortality independent of BP and has a similar prognostic ability to ambulatory arterial stiffness (AASI). Whether BPVR, and AASI, offer prognostic information beyond measurements of arterial stiffness at a given pressure, as indexed by pulse wave velocity (PWV), is not known. METHODS We assessed whether BPVR and AASI were associated with indices of subclinical organ damage (TOD) [estimated glomerular filtration rate (eGFR), left ventricular mass index, early-to-late transmitral velocity (E/A), carotid intima-media thickness (IMT)] independent of BP, and whether BPVR-TOD and AASI-TOD relations were independent of PWV (applanation tonometry) in 772 randomly selected participants from an urban, developing community. AASI was derived from 24-hour diastolic BP vs. systolic BP standard linear regression. RESULTS On bivariate analyses, BPVR, AASI, and PWV were correlated with all indices of TOD (P < 0.0005). However, after adjustments for potential confounders including age and 24-hour mean BP, BPVR, and PWV (P < 0.005 to P < 0.0001), but not AASI (P > 0.25), were independently associated with eGFR, but not other indices of TOD. Importantly, the BPVR-eGFR relation was independent of BP variability (P < 0.005) and PWV (P < 0.001). CONCLUSIONS BPVR was negatively associated with eGFR independent of mean BP, BP variability, and PWV. Therefore, in the prediction of cardiovascular risk, measurements of arterial stiffening (BPVR) may provide information beyond the impact of arterial stiffness.
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Affiliation(s)
- Angela J Woodiwiss
- Cardiovascular Pathophysiology and Genomics Research Unit, School of Physiology, University of the Witwatersrand, Johannesburg, South Africa
| | - Gavin R Norton
- Cardiovascular Pathophysiology and Genomics Research Unit, School of Physiology, University of the Witwatersrand, Johannesburg, South Africa
| | - Iddo Z Ben-Dov
- The Nephrology and Hypertension Services, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | | | - Michael Bursztyn
- Department of Medicine, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
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Al-Far HFM, Tjessem IH, Fuglsang J, Lauszus FF. Preeclampsia is associated with increased ambulatory arterial stiffness index in type 1 diabetes mellitus. Eur J Obstet Gynecol Reprod Biol 2017; 216:153-158. [PMID: 28768228 DOI: 10.1016/j.ejogrb.2017.07.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2017] [Revised: 07/22/2017] [Accepted: 07/24/2017] [Indexed: 10/19/2022]
Abstract
INTRODUCTION Treatment of mild to moderate hypertension might not benefit maternal or fetal outcome. This pessimistic point of view may have come about by using non-validated methods for measuring blood pressure in pregnancy combined with inadequate methodology for diagnosis, treatment, and monitoring effects. AIM To determine the association between AASI in women with type 1 diabetes mellitus (T1DM) and preeclampsia, and to assess the ability of AASI to diagnose preeclampsia. MATERIAL AND METHODS Repeated 24-h ambulatory blood pressure recordings were performed three times during pregnancy and once three months postpartum in 151 women with T1DM and 50 control women without diabetes. Circadian rhythm was evaluated as the night day ratio, night blood pressure divided by day blood pressure. RESULTS Of the T1DM women, 33 developed preeclampsia, which was associated with AASI in the 3rd trimester (p<0.05). The best predictor of preeclampsia in T1DM was an AASI of 0.35. The diurnal blood pressure was significantly higher in all trimesters in women who later had preeclampsia. A flattened circadian rhythm was present in T1DM women with preeclampsia compared to women without preeclampsia (night-day ratio: systole 2nd trimester: 0.94±0.07 vs. 0.91±0.05, women with and without preeclampsia, respectively, p=0.015; diastole 2nd trimester: 0.89±0.07 vs. 0.85±0.07, p=0.003). AASI was higher during pregnancy compared to postpartum in women with T1DM (0.31±0.16, 0.31±0.16 and 0.33±0.18 vs. 0.25±0.17; 1st, 2nd and 3rd trimester vs. postpartum). CONCLUSION Women with T1DM and preeclampsia demonstrate increased arterial stiffness and had early manifestations in the non-dipping of blood pressure.
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Affiliation(s)
| | | | - Jens Fuglsang
- Department of Obstetrics/Gynecology and Clinical Institute, Aarhus University Hospital, Denmark
| | - Finn F Lauszus
- Department of Obstetrics/Gynecology, Herning Hospital, Denmark; Department of Obstetrics/Gynecology and Clinical Institute, Aarhus University Hospital, Denmark
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Brandão AA, Amodeo C, Alcântara C, Barbosa E, Nobre F, Pinto F, Vilela-Martin JF, Bastos JM, Yugar-Toledo JC, Mota-Gomes MA, Neves MFT, Malachias MVB, Rodrigues MDC, Passarelli O, Jardim PCBV, Cunha PG, Póvoa R, Fonseca T, Dias VP, Barroso WS, Oigman W. I Luso-Brazilian Positioning on Central Arterial Pressure. Arq Bras Cardiol 2017; 108:100-108. [PMID: 28327876 PMCID: PMC5344653 DOI: 10.5935/abc.20170011] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2016] [Accepted: 11/10/2016] [Indexed: 01/30/2023] Open
Affiliation(s)
- Andréa A Brandão
- Departamento de Hipertensão Arterial da Sociedade Brasileira de Cardiologia, Rio de Janeiro, RJ - Brazil
| | - Celso Amodeo
- Departamento de Hipertensão Arterial da Sociedade Brasileira de Cardiologia, Rio de Janeiro, RJ - Brazil
| | | | - Eduardo Barbosa
- Departamento de Hipertensão Arterial da Sociedade Brasileira de Cardiologia, Rio de Janeiro, RJ - Brazil
| | - Fernando Nobre
- Departamento de Hipertensão Arterial da Sociedade Brasileira de Cardiologia, Rio de Janeiro, RJ - Brazil
| | | | | | | | - Juan Carlos Yugar-Toledo
- Departamento de Hipertensão Arterial da Sociedade Brasileira de Cardiologia, Rio de Janeiro, RJ - Brazil
| | - Marco Antônio Mota-Gomes
- Departamento de Hipertensão Arterial da Sociedade Brasileira de Cardiologia, Rio de Janeiro, RJ - Brazil
| | - Mario Fritsch Toros Neves
- Departamento de Hipertensão Arterial da Sociedade Brasileira de Cardiologia, Rio de Janeiro, RJ - Brazil
| | | | | | - Oswaldo Passarelli
- Departamento de Hipertensão Arterial da Sociedade Brasileira de Cardiologia, Rio de Janeiro, RJ - Brazil
| | - Paulo César B Veiga Jardim
- Departamento de Hipertensão Arterial da Sociedade Brasileira de Cardiologia, Rio de Janeiro, RJ - Brazil
| | | | - Rui Póvoa
- Departamento de Hipertensão Arterial da Sociedade Brasileira de Cardiologia, Rio de Janeiro, RJ - Brazil
| | | | | | - Weimar Sebba Barroso
- Departamento de Hipertensão Arterial da Sociedade Brasileira de Cardiologia, Rio de Janeiro, RJ - Brazil
| | - Wille Oigman
- Departamento de Hipertensão Arterial da Sociedade Brasileira de Cardiologia, Rio de Janeiro, RJ - Brazil
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de Souza-Neto JD, de Oliveira ÍM, Lima-Rocha HA, Oliveira-Lima JW, Bacal F. Hypertension and arterial stiffness in heart transplantation patients. Clinics (Sao Paulo) 2016; 71:494-9. [PMID: 27652829 PMCID: PMC5004574 DOI: 10.6061/clinics/2016(09)02] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2016] [Revised: 04/04/2016] [Accepted: 05/24/2016] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVES Post-transplantation hypertension is prevalent and is associated with increased cardiovascular morbidity and subsequent graft dysfunction. The present study aimed to identify the factors associated with arterial stiffness as measured by the ambulatory arterial stiffness index. METHODS The current study used a prospective, observational, analytical design to evaluate a group of adult heart transplantation patients. Arterial stiffness was obtained by monitoring ambulatory blood pressure and using the ambulatory arterial stiffness index as the surrogate outcome. Multivariate logistic regression analyses were performed to control confounding. RESULTS In a group of 85 adult heart transplantation patients, hypertension was independently associated with arterial stiffness (OR 4.98, CI 95% 1.06-23.4) as well as systolic and diastolic blood pressure averages and nighttime descent. CONCLUSIONS Measurement of ambulatory arterial stiffness index is a new, non-invasive method that is easy to perform, may contribute to better defining arterial stiffness prognosis and is associated with hypertension.
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Affiliation(s)
- João David de Souza-Neto
- Hospital de Messejana Dr. Carlos Alberto Studart Gomes, Unidade de Transplante e Insuficiência Cardíaca, Fortaleza/CE, Brazil
| | - Ítalo Martins de Oliveira
- Hospital de Messejana Dr. Carlos Alberto Studart Gomes, Unidade de Transplante e Insuficiência Cardíaca, Fortaleza/CE, Brazil
| | | | | | - Fernando Bacal
- Universidade de São Paulo USP, Departamento de Cardiologia, São Paulo/SP, Brazil
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László A, Reusz G, Nemcsik J. Ambulatory arterial stiffness in chronic kidney disease: a methodological review. Hypertens Res 2015; 39:192-8. [DOI: 10.1038/hr.2015.137] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2015] [Revised: 09/27/2015] [Accepted: 10/06/2015] [Indexed: 11/09/2022]
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Nichols WW, Denardo SJ, Davidson JB, Huo T, Bairey Merz CN, Pepine CJ. Association of aortic stiffness and wave reflections with coronary flow reserve in women without obstructive coronary artery disease: An ancillary study from the National Heart, Lung, and Blood Institute-sponsored Women's Ischemia Syndrome Evaluation (WISE). Am Heart J 2015; 170:1243-54. [PMID: 26678647 PMCID: PMC4685957 DOI: 10.1016/j.ahj.2015.08.019] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2015] [Accepted: 08/25/2015] [Indexed: 01/03/2023]
Abstract
BACKGROUND Increased aortic stiffness and reduced coronary flow reserve (CFR) independently predict adverse outcomes. But information about relationships between arterial properties and CFR in subjects without obstructive coronary artery disease (CAD) is limited. METHODS CFR was measured (Doppler flow wire and intracoronary adenosine) in 50 women (age 53 ± 11 years) with symptoms and signs of myocardial ischemia without obstructive CAD. Aortic pulse wave velocity (aPWV), a measure of aortic stiffness, was obtained via catheter pullback; radial artery pressure waves were measured by applanation tonometry and central aortic pressure synthesized. RESULTS Overall, CFR (mean 2.61 ± 0.47) was significantly correlated with aPWV (r = -0.51), pulse wave amplification (r = 0.45), augmented pressure (r = -0.48), augmentation index (AIx, r = -0.44), aortic systolic pressure (r = -0.49), left ventricular wasted energy (LVEw, r = -0.47) (all P < .001), systolic pressure time index (r = -0.37, P < .008), and rate pressure product (r = -0.29, P < .04). In the multiple regression model including aPWV, CFR was still significantly correlated with aPWV (P < .008) and aortic systolic pressure (P < .01). No other measures contributed significant additional information. Women with CFR ≤2.5 versus those with CFR >2.5 had greater aPWV (894 ± 117 vs 747 ± 93 cm/s, P < .001), augmented pressure (14 ± 4.9 vs 11 ± 4.1 mmHg, P < .008), AIx (32 ± 6.6 vs 27 ± 6.6%, P < .003), LVEw (30 ± 12 vs 21 ± 10 dyne-s/cm(2) × 10(2), P < .02) and reduced pulse pressure amplification (1.20 ± .07 vs 1.26 ± .10, P < .008) and pressure wave travel time (133 ± 7.3 vs 138 ± 6.9 milliseconds, P < .04). CONCLUSIONS Among symptomatic women without obstructive CAD, CFR was inversely related to aortic systolic pressure and indices of aortic stiffness. These changes in arterial properties increase left ventricular afterload requiring the ventricle to generate additional, but wasted, energy that increases indices of myocardial oxygen demand, reduces CFR and increases vulnerability to ischemia.
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Affiliation(s)
- Wilmer W Nichols
- Division of Cardiovascular Medicine, University of Florida, Gainesville, FL
| | - Scott J Denardo
- Division of Cardiovascular Medicine, Duke University Medical Center, Durham, NC
| | | | - Tianyao Huo
- Division of Cardiovascular Medicine, University of Florida, Gainesville, FL
| | - C Noel Bairey Merz
- Barbra Streisand Women's Heart Center, Cedars-Sinai Heart Institute, Los Angeles, CA
| | - Carl J Pepine
- Division of Cardiovascular Medicine, University of Florida, Gainesville, FL.
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Is arterial stiffness predicted by continuous metabolic syndrome score in obese children? ACTA ACUST UNITED AC 2015; 10:47-54. [PMID: 26684589 DOI: 10.1016/j.jash.2015.10.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2015] [Revised: 10/12/2015] [Accepted: 10/26/2015] [Indexed: 11/24/2022]
Abstract
The aim of the article was to evaluate arterial stiffness, an early marker of increased cardiovascular risk, in relation to obesity. The continuous metabolic syndrome (cMetS) score was calculated as sum of Z score of mean arterial pressure, body mass index, serum glucose, triglyceride, and high-density lipoprotein cholesterol in 144 obese patients and 66 nonobese controls. Ambulatory arterial stiffness index (AASI) was calculated as 1 minus regression slope of diastolic on systolic blood pressure from ambulatory blood pressure measurements. The mean AASI increased progressively with severity of obesity. The receiver operator curve analysis of body mass index and AASI showed area under the curve of 0.64 ± 0.06; cMetS area under the curve was 0.72 ± 0.05 suggesting a better predictive power of the cMetS for an increased AASI (>0.3). Patients with obesity have significantly higher arterial stiffness. A composite score such as cMetS seems to be better predictor of an increased stiffness than individual risk factors.
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García-García Á, García-Ortiz L, Gómez-Marcos MA. Arterial stiffness in assessment of impaired left atrial function. Anatol J Cardiol 2015; 15:814-5. [PMID: 26477720 PMCID: PMC5336967 DOI: 10.5152/anatoljcardiol.2015.16958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- Ángel García-García
- Primary Care Research Unit, La Alamedilla, SACYL, IBSAL; Salamanca-Spain; Department of Emergency, Clinic Hospital of Salamanca; Salamanca-Spain.
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Yilmaz H, Cakmak M, Inan O, Darcin T, Aktas A, Gurel OM, Bilgic MA, Bavbek N, Akcay A. Association of ambulatory arterial stiffness index with sEPCR in newly diagnosed hypertensive patients. Ren Fail 2015; 37:1409-13. [PMID: 26335397 DOI: 10.3109/0886022x.2015.1074472] [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] [Indexed: 11/13/2022] Open
Abstract
AIM Increased arterial stiffness is strongly associated with cardiovascular diseases, while thrombotic events are more common than hemorrhagic events in hypertensive patients. Markers of a hypercoagulable state may also predict future cardiovascular events in hypertensive patients. Here, we speculated that increased arterial stiffness might lead to the development of a hypercoagulable state that can play a role in the thrombotic complications of hypertension. Soluble endothelial protein C receptor (sEPCR) is one such marker of hypercoagulation. The ambulatory arterial stiffness index (AASI) could be accepted as a non-invasive measure of arterial stiffness. The aim of this study was to investigate association of AASI with levels of sEPCR in newly diagnosed hypertensive patients. MATERIALS AND METHODS The study included 263 newly diagnosed essential hypertensive patients and 55 healthy normotensive controls. All subjects underwent 24 h ambulatory blood pressure monitoring (ABPM); the AASI was derived from ABPM tracings. Plasma sEPCR was measured by ELISA. RESULTS Hypertensive patients (n = 263) had higher AASI, C-reactive protein (CRP) and sEPCR versus the normotensive healthy group (n = 55). Univariate analysis showed that AASI was positively associated with age (r = 0.212, p < 0.001) body mass index (r = 0.412, p < 0.001), pulse pressure (r = 0.350, p < 0.001), plasma sEPCR (r = 0.894, p < 0.001), 24-h heart rate (r = 0.176, p = 0.001) and inversely related to high-density lipoprotein (HDL) (r = -0.293, p < 0.001). Multivariate analyses revealed that sEPCR and HDL are independently correlated to AASI. CONCLUSION We suggest that increased AASI is associated with elevated sEPCR. It might be responsible for subsequent thrombotic events in newly diagnosed hypertensive patients.
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Affiliation(s)
- Hakki Yilmaz
- a Department of Internal Medicine, Section of Nephrology , Dr. A. Y. Ankara Oncology Training and Research Hospital , Ankara , Turkey
| | - Muzaffer Cakmak
- b Department of Internal Medicine , Turgut Ozal University, School of Medicine , Ankara , Turkey
| | - Osman Inan
- c Department of Internal Medicine , Yenimahalle Training and Research Hospital , Ankara , Turkey
| | - Tahir Darcin
- d Department of Internal Medicine , Agri State Hospital , Agri , Turkey
| | - Aynur Aktas
- e Department of Internal Medicine, Section of Endocrinology , Dr. A. Y. Ankara Oncology Training and Research Hospital , Ankara , Turkey
| | - Ozgul Malcok Gurel
- f Department of Cardiology , Turgut Ozal University, School of Medicine , Ankara , Turkey , and
| | - Mukadder Ayse Bilgic
- g Department of Internal Medicine, Section of Nephrology , Turgut Ozal University, School of Medicine , Ankara , Turkey
| | - Nuket Bavbek
- g Department of Internal Medicine, Section of Nephrology , Turgut Ozal University, School of Medicine , Ankara , Turkey
| | - Ali Akcay
- g Department of Internal Medicine, Section of Nephrology , Turgut Ozal University, School of Medicine , Ankara , Turkey
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Kalaycıoğlu E, Gökdeniz T, Aykan AÇ, Hatem E, Gürsoy OM, Çavuşoğlu G, Çetin M, Çelik Ş. Ambulatory arterial stiffness index is associated with impaired left atrial mechanical functions in hypertensive diabetic patients: A speckle tracking study. Anatol J Cardiol 2015; 15:807-13. [PMID: 25592109 PMCID: PMC5336966 DOI: 10.5152/akd.2014.5796] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Objective: The ambulatory arterial stiffness index has been proposed as an indicator of arterial stiffness. The aim of this study was to test the hypothesis that increased ambulatory arterial stiffness index might be related with impaired left atrial function in hypertensive diabetic patients with no previous history of cardiovascular disease. Methods: Inclusion criteria included office systolic BP> 130 mm Hg or diastolic BP> 80 mm Hg and absence of secondary causes of HT, whereas exclusion criteria LV ejection fraction <50%, history of significant coronary artery disease, chronic renal failure, atrial fibrillation/flutter, second or third-degree atrioventricular block, moderate to severe valvular heart disease, history of cerebrovascular disease, non-dipper hypertensive pattern and sleep apnea. The study was composed of 121 hypertensive diabetic patients. Twenty-four-hour ambulatory blood pressure monitoring and echocardiography were performed in each patient. The relationship between ambulatory arterial stiffness index and left atrial functions was analyzed. AASI was calculated as 1 minus the regression slope of diastolic BP plotted against systolic BP obtained through individual 24-h ABPM. Results: The univariate analysis showed that ambulatory arterial stiffness index was positively correlated with age (r=:0.287, p=:0.001), hypertension duration (r=:0.388, p<0.001), fasting plasma glucose (r=:0.224, p=:0.014), HbA1c (r=:0.206, p=:0.023), LDL cholesterol (r=:0.254, p=:0.005), and also overall pulse pressure (r=:0.195, p=:0.002), office-pulse pressure (r=:0.188, p=:0.039), carotid intima-media thickness (r=:0.198, p=:0.029), E/E’ (r=:0.248, p=:0.006), and left atrial volume index (r=:0.237, p=:0.009). Moreover, ambulatory arterial stiffness index was negatively correlated with eGFR (r=:(-) 0.242, p=:0.008), peak left atrial strain during ventricular systole [S-LAs (r=:(-) 0.654, p<0.001)], peak left atrial strain at early diastole [S-LAe (r=:(-)0.215, p=:0.018)], and peak left atrial strain rate during ventricular systole [SR-LAs (r=:(-) 0.607, p<0.001)]. The multiple linear regression analysis showed that ambulatory arterial stiffness index was independently associated with peak left atrial strain rate during ventricular systole (SR-LAs) (p<0.001). Conclusion: In hypertensive diabetic patients, increased ambulatory arterial stiffness index is associated with impaired left atrial functions, independent of left ventricular diastolic dysfunction.
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Affiliation(s)
- Ezgi Kalaycıoğlu
- Department of Cardiology, Ahi Evren Chest and Cardiovascular Surgery Education and Research Hospital; Trabzon-Turkey.
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Sosner P, Hulin-Delmotte C, Saulnier PJ, Cabasson S, Gand E, Torremocha F, Piguel X, Miot A, Maréchaud R, Herpin D, Ragot S, Hadjadj S. Cardiovascular prognosis in patients with type 2 diabetes: contribution of heart and kidney subclinical damage. Am Heart J 2015; 169:108-14.e7. [PMID: 25497255 DOI: 10.1016/j.ahj.2014.09.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2014] [Accepted: 09/12/2014] [Indexed: 11/15/2022]
Abstract
BACKGROUND Left ventricular hypertrophy (LVH) and kidney damage (abnormal urinary albumin-to-creatinine ratio [uACR] or estimated glomerular filtration rate [eGFR]) are predictive of major cardiovascular events (MACE) in patients with type 2 diabetes (T2D) but are rarely used in cardiovascular score calculators. Our study aimed to assess their respective prognostic values for MACE and the additive information they provide to score calculators. METHODS A total of 1298 T2D (43% women) aged 65 (SD 11) years were followed up for a median of 65 months, with MACE as a primary composite end point: cardiovascular death, nonfatal myocardial infarction, or stroke. Electrocardiogram (ECG)-derived LVH was defined using Sokolow, Gubner, and Cornell product indexes; uACR was considered as abnormal if >2.5 mg/mmol in men or >3.5 mg/mmol in women and eGFR if <60 mL/min per 1.73 m(2). RESULTS Urinary albumin-to-creatinine ratio was higher in subjects with electrocardiographic LVH (ECG-LVH) than in subjects without (median [interquartile range] 7.61 [43.48] and 2.56 [10.53], respectively; P < .0001). After adjustment for age, history of myocardial infarction, and peripheral artery disease, ECG-LVH and kidney damage were strong predictors for MACE (adjusted hazard ratio [1.64; 95% CI 1.23-2.20], [1.90; 95% CI 1.43-2.53], and [1.85; 95% CI 1.42-2.41] for ECG-LVH, uACR, and eGFR, respectively). Net reclassification improvement was higher with the model including both ECG-LVH and uACR than models with ECG-LVH alone (P < .0001) or uACR alone (P < .0001). In addition, using cardiovascular risk calculators (Framingham score and others), we observed an additional prognostic value of ECG-LVH for each one of them. CONCLUSIONS Electrocardiographic LVH is complementary to kidney damage for MACE prediction in T2D.
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Affiliation(s)
- Philippe Sosner
- CHU de Poitiers, Cardiologie, Poitiers, France; Université de Poitiers, Laboratoire MOVE (EA6314), Poitiers, France; Centre médico-sportif Mon Stade, Paris, France.
| | - Charlotte Hulin-Delmotte
- CHU de Poitiers, Physiologie, Poitiers, France; Université de Poitiers, Faculté de Médecine et de Pharmacie, Poitiers, France
| | - Pierre-Jean Saulnier
- Université de Poitiers, CIC1402, Poitiers, France; CHU de Poitiers, Centre d'Investigation Clinique, Poitiers, France; Inserm, CIC1402, Poitiers, France
| | | | - Elise Gand
- CHU de Poitiers, Endocrinologie, Poitiers, France
| | | | | | - Aurélie Miot
- Université de Poitiers, Faculté de Médecine et de Pharmacie, Poitiers, France; CHU de Poitiers, Endocrinologie, Poitiers, France
| | - Richard Maréchaud
- Université de Poitiers, Faculté de Médecine et de Pharmacie, Poitiers, France; CHU de Poitiers, Endocrinologie, Poitiers, France
| | - Daniel Herpin
- CHU de Poitiers, Cardiologie, Poitiers, France; Université de Poitiers, Faculté de Médecine et de Pharmacie, Poitiers, France
| | - Stéphanie Ragot
- Université de Poitiers, Faculté de Médecine et de Pharmacie, Poitiers, France; Université de Poitiers, CIC1402, Poitiers, France; CHU de Poitiers, Centre d'Investigation Clinique, Poitiers, France; Inserm, CIC1402, Poitiers, France
| | - Samy Hadjadj
- Université de Poitiers, Faculté de Médecine et de Pharmacie, Poitiers, France; Université de Poitiers, CIC1402, Poitiers, France; CHU de Poitiers, Centre d'Investigation Clinique, Poitiers, France; Inserm, CIC1402, Poitiers, France; CHU de Poitiers, Endocrinologie, Poitiers, France
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Qin T, Jiang H, Jiao Y, Ke Y, Sun N, Wang J, Zhu J. Ambulatory arterial stiffness index correlates with ambulatory pulse pressure but not dipping status in patients with grade 1/grade 2 essential hypertension. J Int Med Res 2014; 42:1323-34. [PMID: 25332228 DOI: 10.1177/0300060514548288] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To evaluate the relationship between ambulatory arterial stiffness index (AASI) and other parameters derived from ambulatory blood pressure (BP) monitoring, including dipping status, in patients with grade 1/grade 2 hypertension. METHODS This retrospective analysis included baseline data from Chinese outpatients enrolled into a previous study, who had clinic diastolic BP of 90-109 mmHg and systolic BP <180 mmHg, had undergone 24-h ambulatory BP monitoring and routine blood chemistry investigations, and had estimated glomerular filtration rate (eGFR) data. RESULTS Out of 120 patients screened, 87 were included. No significant difference in 24-h AASI was found between dippers and nondippers. The 24-h AASI significantly correlated with age, systolic BP and pulse pressure, and inversely correlated with 24-h diastolic BP variation and eGFR. In dippers and nondippers, AASI correlated with daytime pulse pressure, daytime diastolic BP variation and eGFR; in nondippers, AASI also correlated with 24-h systolic BP and 24-h pulse pressure. The 24-h AASI was significantly associated with 24-h pulse pressure and daytime pulse pressure. CONCLUSION In patients with grade 1/grade 2 essential hypertension, AASI shows a significant correlation with ambulatory pulse pressure.
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Affiliation(s)
- Tingli Qin
- Department of Cardiology, China-Japan Friendship Hospital, Beijing, China
| | - Hong Jiang
- Department of Cardiology, China-Japan Friendship Hospital, Beijing, China
| | - Yuan Jiao
- Department of Cardiology, China-Japan Friendship Hospital, Beijing, China
| | - Yuannan Ke
- Department of Cardiology, China-Japan Friendship Hospital, Beijing, China
| | - Ningling Sun
- Department of Cardiology, People's Hospital, Peking University, Beijing, China
| | - Jiguang Wang
- Centre for Epidemiological Studies and Clinical Trials, Shanghai Institute of Hypertension, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Junren Zhu
- Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai, China
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Zhang S, Mao HJ, Sun B, Wang NN, Zhang B, Zeng M, Xu L, Yu XB, Liu J, Xing CY. The relationship between AASI and arterial atherosclerosis in ESRD patients. Ren Fail 2014; 37:22-8. [PMID: 25254317 DOI: 10.3109/0886022x.2014.963787] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE To explore the relationship between ambulatory blood pressure and arterial atherosclerosis and provide simple and easy reference indicators for the prediction, prevention and prognosis of cardiovascular events in end-stage renal disease (ESRD) patients. METHOD This prospective study consecutively collected clinical data of 114 ESRD hospitalized patients in the Department of Nephrology, the First Affiliated Hospital of Nanjing Medical University during August 2012 to December 2012. The data included laboratory data, the ambulatory blood pressure monitoring (ABPM), carotid ultrasound, two-dimensional echocardiography and the prognosis scores of the death risk. RESULTS (1) A series of ABPM parameters were closely associated with atherosclerosis (p ≤ 0.05). Ambulatory Arterial Stiffness Index (AASI) was the most representative parameter of ABPM and also the best indicator for atherosclerosis (logistic regression analysis, p = 0.005). (2) AASI was a comprehensive index of atherosclerosis (p < 0.001), which was associated with the increase of left ventricular diameter (p = 0.028) and the risk of death (p < 0.001). The independent risk factors of AASI were the growth of the age (p < 0.001), elevated serum fibrinogen (p = 0.009) and reduced serum albumin (p = 0.022). CONCLUSION AASI, as the representative of ABPM parameters, related well to atherosclerosis, which implied a broader application of ABPM in ESRD patients.
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Affiliation(s)
- Shu Zhang
- Department of Nephrology, The First Affiliated Hospital of Nanjing Medical University , Nanjing , China and
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Kalaycıoğlu E, Gökdeniz T, Aykan AÇ, Hatem E, Gürsoy MO, Ören A, Yaman H, Karadeniz AG, Çelik Ş. Osteoprotegerin is associated with subclinical left ventricular systolic dysfunction in diabetic hypertensive patients: a speckle tracking study. Can J Cardiol 2014; 30:1529-34. [PMID: 25442456 DOI: 10.1016/j.cjca.2014.08.018] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2014] [Revised: 08/11/2014] [Accepted: 08/19/2014] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND Recently, the role of osteoprotegerin (OPG) in the pathogenesis of heart failure through different mechanisms has received much attention. Subclinical changes in left ventricular (LV) function can be identified using quantification of myocardial strain, and global longitudinal strain (GLS) is a superior predictor of outcomes than ejection fraction. We hypothesized that increased OPG levels could predict subclinical LV systolic dysfunction in treated diabetic hypertensive patients with preserved LV ejection fraction. METHODS The study was composed of 86 diabetic hypertensive and 30 nondiabetic hypertensive patients. All patients underwent echocardiography and venous blood samples were taken for determination of OPG. The relation between OPG levels and LV GLS was investigated using 2-dimensional speckle tracking echocardiography. RESULTS Diabetic hypertensive patients had higher diastolic peak early/early diastolic tissue velocity and lower systolic tissue velocity, GLS, GLS rate systolic, and GLS rate early diastolic than nondiabetic hypertensive patients (P = 0.009, P = 0.049, P < 0.001, P = 0.004, and P < 0.001, respectively). Diabetic hypertensive patients were divided into 2 groups according to median GLS value (> 18.5 and ≤ 18.5). The patients with GLS ≤ 18.5 had higher diastolic blood pressure (mm Hg; P = 0.048), OPG (pmol/L; P < 0.001), and hemoglobin A1c (%; P = 0.042) values than those with GLS > 18.5. In multivariate logistic regression analysis, OPG was found to be an independent predictor of impaired GLS (P = 0.001). Receiver operating characteristic curve analysis revealed that OPG values of > 6.45 (pmol/L) identified the patients with GLS ≤ 18.5. CONCLUSIONS Plasma OPG values could predict subclinical LV systolic dysfunction in diabetic hypertensive patients.
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Affiliation(s)
- Ezgi Kalaycıoğlu
- Department of Cardiology, Ahi Evren Chest and Cardiovascular Surgery Education and Research Hospital, Trabzon, Turkey.
| | - Tayyar Gökdeniz
- Department of Cardiology, Kafkas University, Faculty of Medicine, Kars, Turkey
| | - Ahmet Çağrı Aykan
- Department of Cardiology, Ahi Evren Chest and Cardiovascular Surgery Education and Research Hospital, Trabzon, Turkey
| | - Engin Hatem
- Department of Cardiology, Erzurum Regional Training and Research Hospital, Erzurum, Turkey
| | - Mustafa Ozan Gürsoy
- Department of Cardiology, Gaziemir Salih Nevvar İşgören State Hospital, İzmir, Turkey
| | - Asım Ören
- Department of Medical Biochemistry, Karadeniz Technical University Faculty of Medicine, Trabzon, Turkey
| | - Hüseyin Yaman
- Department of Medical Biochemistry, Karadeniz Technical University Faculty of Medicine, Trabzon, Turkey
| | - Ayşe Gül Karadeniz
- Department of Radiology, Ahi Evren Chest and Cardiovascular Surgery Education and Research Hospital, Trabzon, Turkey
| | - Şükrü Çelik
- Department of Cardiology, Ahi Evren Chest and Cardiovascular Surgery Education and Research Hospital, Trabzon, Turkey
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Bagherzadeh A, Nejati-Afkham A, Tajallizade-Khoob Y, Shafiee A, Sharifi F, Esfahani MA, Badamchizade Z, Alatab S, Fakhrzadeh H. Association of cardiac autonomic neuropathy with arterial stiffness in type 2 diabetes mellitus patients. J Diabetes Metab Disord 2013; 12:55. [PMID: 24360252 PMCID: PMC7983836 DOI: 10.1186/2251-6581-12-55] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2013] [Accepted: 09/30/2013] [Indexed: 01/10/2023]
Abstract
Background Diabetic patients are at the risk of cardiac autonomic neuropathy (CAN) and arterial stiffness. This study aimed to investigate the association of heart rate variability (HRV) as an index for CAN and pulse wave velocity (PWV) as an index for arterial stiffness. Methods Uncomplicated diabetes type-2 patients who had no apparent history of cardiovascular condition underwent HRV and PWV measurements and the results were compared with the control group consisting of non-diabetic peers. Also, the findings were adjusted for the cardiovascular risk factors and other confounding factors. Results A total of 64 diabetic patients (age= 52.08±8.50 years; males=33 [51.6%]) were compared with 57 controls (age= 48.74±6.18 years; males=25 [43.9%]) in this study. Hypertension, dyslipidemia, and thereby systolic blood pressure and statin use were significantly more frequent in the diabetic group, while the serum levels of cholesterol, HDL-C and LDL-C were significantly higher in the controls. Pulse wave was significantly increased in the diabetic patients (p<0.001). Main HRV parameters were significantly lower in diabetics than in controls. After adjustment for the confounders, PWV and HRV remained significantly different between the groups (p=0.01 and p=0.004, respectively). Multiple logistic regression of the association between pulse wave velocity and HRV index was independently significant both in diabetics and controls. Conclusions There exists a significant relationship between heart rate variability and arterial stiffness as a measure for atherosclerosis in diabetic patients, although the role of the confounding factors is noteworthy.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Hossein Fakhrzadeh
- Elderly Health Research Center, Endocrinology and Metabolism population Sciences Institute, Tehran University of Medical Sciences, North Karegar Avenue, Dr Shariati Hospital, 5th floor, Tehran 1411413137, Iran.
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Wang C, Zhang J, Li CC, Gong WY, Liu X, Ye ZC, Peng H, Lou TQ. The ambulatory arterial stiffness index and target-organ damage in Chinese patients with chronic kidney disease. BMC Nephrol 2013; 14:257. [PMID: 24245955 PMCID: PMC3840650 DOI: 10.1186/1471-2369-14-257] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2012] [Accepted: 11/07/2013] [Indexed: 01/23/2023] Open
Abstract
Background The ambulatory arterial stiffness index (AASI) can be used to predict cardiovascular morbidity and mortality in hypertensive patients. However, data on AASI in Chinese patients with chronic kidney disease (CKD) is not available. Methods This cross-sectional study enrolled 583 CKD patients. Univariate and multivariate analyses were used to evaluate the relationship between AASI and renal function and parameters of cardiovascular injury. Results Patients with a higher AASI had a higher systolic blood pressure, a lower estimated glomerular filtration rate (eGFR), a higher serum cystatin C, a higher left ventricular mass index (LVMI) and carotid intima-media thickness (cIMT). Univariate analyses showed that AASI was positively correlated with serum cystatin C (r=0.296, P < 0.001), serum creatinine (r=0.182, P < 0.001), and LVMI (r = 0.205, P < 0.001) and negatively correlated with the eGFR (r = –0.200, P < 0.001). Multivariate analyses revealed that serum cystatin C, eGFR, serum creatinine and LVMI were independently correlated with AASI. Conclusions These data suggest that AASI was closely correlated with renal function and parameters of cardiovascular injury in Chinese CKD patients. Good quality, long-term, large longitudinal trials to validate the role of AASI in clinical practice for Chinese CKD patients.
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Affiliation(s)
| | | | | | | | | | | | | | - Tan-Qi Lou
- Division of Nephrology, Department of medicine, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong 510630, China.
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Liu W, Ye H, Tang B, Sun Z, Wen P, Wu W, Bian X, Shen X, Yang J. Comparison of 44-hour and fixed 24-hour ambulatory blood pressure monitoring in dialysis patients. J Clin Hypertens (Greenwich) 2013; 16:63-9. [PMID: 24172171 DOI: 10.1111/jch.12217] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2013] [Revised: 09/16/2013] [Accepted: 09/16/2013] [Indexed: 11/29/2022]
Abstract
The two most commonly used strategies to evaluate dialysis patients' blood pressure (BP) level are 44-hour and 24-hour ambulatory blood pressure monitoring (ABPM). The objective of this study was to find an appropriate 24-hour period that correlated well with the 44-hour BP level and determine the differences between these strategies. In a group of 51 dialysis patients, the authors performed 44-hour ABPM and extracted data for a fixed 24-hour ABPM. The fixed 24-hour ABPM started at 6 am on the nondialysis day. A strong correlation was found between all parameters of 44-hour and the fixed 24-hour ABPM, with paired sample t test showing only small magnitude changes in a few parameters. Both 24-hour ABPM and 44-hour ABPM were superior to clinic BP in predicting left ventricular mass index (LVMI) by multiple regression analysis. It was found that 44-hour ambulatory arterial stiffness index (AASI), but not 24-hour AASI, had a positive association with LVMI (r=0.328, P=.021). However, after adjustment for 44-hour systolic blood pressure, this association disappeared. Fixed 24-hour ABPM is a good surrogate of 44-hour ABPM to some extent, while 44-hour ABPM can provide more accurate and detailed information.
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Affiliation(s)
- Wenjin Liu
- Center for Kidney Disease, Second Affiliated Hospital, Nanjing Medical University, Nanjing, Jiangsu, China
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Redón J, Pascual-Izuel JM, Rodilla E, Vicente A, Oliván J, Bonet J, Torguet JP, Calaforra O, Almirall J. Effects of nebivolol and atenolol on central aortic pressure in hypertensive patients: a multicenter, randomized, double-blind study. Blood Press 2013; 23:181-8. [PMID: 24059690 DOI: 10.3109/08037051.2013.840421] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
INTRODUCTION The main objective was to compare the mean change in augmentation index of hypertensive patients treated with nebivolol or atenolol. METHODS Multicenter, double-blind randomized study conducted in six Spanish centers. We enrolled outpatients between the ages of 40 and 65 years with mild or moderate essential hypertension (systolic blood pressure, SBP ≥ 140 mmHg to ≤ 179 mmHg and diastolic blood pressure, DBP ≥ 90 mmHg to ≤ 109 mmHg after a 2-week run-in placebo period). Patients received nebivolol 5 mg or atenolol 50 mg once daily. At week 3, atenolol could be titrated up to 100 mg qd for non-responders. Additionally, patients not achieving normal blood pressure after 6 weeks could be treated with 25 mg hydrochlorothiazide. Follow-up visits were at 3, 6 and 10 weeks. RESULTS The final study population of 138 patients (58% men; median age 52.6 years, range 40-67 years) was randomized into two groups of 69 patients each. Baseline characteristics of the two groups were similar. At the screening visit, 69% presented with mild hypertension. Nebivolol modified the mean augmentation index to a lesser extent than atenolol after 10 weeks (mean difference 3.1%, 95% CI 0.55-5.69; p = 0.027). A higher proportion of patients in the atenolol group required a diuretic. Reductions in central aortic pressure and peripheral arterial pressure were similar for both treatment groups. CONCLUSIONS The study confirms that nebivolol produces a less pronounced impact on augmentation index than atenolol.
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Affiliation(s)
- Josep Redón
- Hospital Clínico Universitario de Valencia, INCLIVA, University of Valencia and CIBERObn , ISC III
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Relationship between electrocardiographic left ventricular hypertrophy criteria and vascular structure and function parameters in hypertensive patients. J Hum Hypertens 2013; 28:186-92. [PMID: 24048290 DOI: 10.1038/jhh.2013.87] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2013] [Revised: 08/08/2013] [Accepted: 08/16/2013] [Indexed: 11/08/2022]
Abstract
The objective of this study was to determine the electrocardiographic left ventricular hypertrophy (LVH) criterion that best correlated with vascular structure and function parameters in hypertensive patients. A cross-sectional study involving 347 hypertensive patients was performed. The mean age of the subjects was 54.9±11.8 years, and 61% were male. Electrocardiography was used to detect LVH based on the evaluation of 10 criteria, and we defined the voltage-duration product (VDP) complex criterion. The vascular structure was evaluated according to carotid intima-media thickness (C-IMT), and vascular function was evaluated according to pulse wave velocity (PWV), the ambulatory arterial stiffness index (AASI), the home arterial stiffness index, and the peripheral (PAIx) and central (CAIx) augmentation indices. LVH according to at least some electrocardiographic criteria was recorded in 29.10% of the patients (34.10% of females; 25.90% of males). The vascular structure and function parameters showed higher values in the hypertensive patients with LVH. The criterion most closely correlated with C-IMT was Lewis-VDP (r=0.257); with PWV and AASI, the criterion was the Framingham-adjusted Cornell voltage (r=0.228 and r=0.195, respectively); and with CAIx and PAIx, the criterion was Novacode (r=0.226 and r=0.277, respectively). In the multivariate analysis, the association of the vascular structure and function parameters, the VDP complex (multiple linear regression) and the presence of LVH (logistic regression) disappeared after adjusting for age, sex and antihypertensive drugs. The relationship between the electrocardiographic criteria used to detect LVH in hypertensive patients and the vascular structure and function parameters were fundamentally conditioned by age and antihypertensive drug treatment.
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Kim DH, Braam B. Assessment of arterial stiffness using applanation tonometry. Can J Physiol Pharmacol 2013; 91:999-1008. [PMID: 24289069 DOI: 10.1139/cjpp-2013-0010] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Augmentation index (AIx) and pulse wave velocity (PWV) assess functional and structural aspects of the vascular wall and are independent markers of cardiovascular morbidity and mortality. Like blood pressure, many factors, genetic, structural, and physiological, affect AIx and PWV. AIx and PWV can be assessed noninvasively using applanation tonometry. The technique is simple, but comes with a number of practical and technical limitations that have not been well documented and (or) explored. This review considers pulse wave analysis in the context of cardiovascular disease, and considers its limitations. Data are presented indicating that the placement of the probe is critical, and that the amplitude of the obtained signal is related to the variability in measurements. On a more theoretical note, issues are discussed regarding the applied transfer functions that are built in the devices to assess central AIx from peripheral waveforms. Altogether, PWV and its analysis are useful additions to the arsenal of parameters that can be used to assess vascular health and to estimate vascular risk. Yet, our analysis underscores the necessity for precise operating procedures, and calls for transparency regarding the applied transfer functions of commercial devices.
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Affiliation(s)
- David H Kim
- a Department of Medicine, Division of Nephrology and Immunology, University of Alberta Hospital, 11-132 Clinical Sciences Building, Edmonton AB T6G 2G3, Canada
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Symmetric ambulatory arterial stiffness index and 24-h pulse pressure in HIV infection: results of a nationwide cross-sectional study. J Hypertens 2013; 31:560-7; discussion 567. [PMID: 23282895 DOI: 10.1097/hjh.0b013e32835ca949] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE HIV infection has been associated with increased cardiovascular risk. Twenty-four-hour ambulatory blood pressure (BP) is a more accurate and prognostically relevant measure of an individual's BP load than office BP, and the ambulatory BP-derived ambulatory arterial stiffness index (AASI) and symmetric AASI (s-AASI) are established cardiovascular risk factors. METHODS In the setting of the HIV and HYpertension (HIV-HY) study, an Italian nationwide survey on high BP in HIV infection, 100 HIV-infected patients with high-normal BP or untreated hypertension (72% men, age 48 ± 10 years, BP 142/91 ± 12/7 mmHg) and 325 HIV-negative individuals with comparable age, sex distribution, and office BP (68% men, age 48 ± 10 years, BP 141/90 ± 11/8 mmHg) underwent 24-h ambulatory BP monitoring. RESULTS Despite having similar office BP, HIV-infected individuals had higher 24-h SBP (130.6 ± 14 vs. 126.4 ± 10 mmHg) and pulse pressure (49.1 ± 9 vs. 45.9 ± 7 mmHg, both P < 0.001), and a lower day-night reduction of mean arterial pressure (14.3 ± 9 vs. 16.3 ± 7%, P = 0.025). Both s-AASI and AASI were significantly higher in HIV patients (s-AASI, 0.22 ± 0.18 vs. 0.11 ± 0.15; AASI, 0.46 ± 0.22 vs. 0.29 ± 0.17; both P <0.001). In a multivariate regression, s-AASI was independently predicted by HIV infection (β = 0.252, P <0.001), age, female sex, and 24-h SBP. In HIV patients, s-AASI had an inverse relation with CD4 cell count (Spearman's ρ -0.24, P = 0.027). CONCLUSION Individuals with HIV infection and borderline or definite hypertension have higher symmetric AASI and 24-h systolic and pulse pressures than HIV-uninfected controls matched by office BP. High ambulatory BP may play a role in the HIV-related increase in cardiovascular risk.
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Kärkkäinen H, Saarelainen H, Laitinen T, Heiskanen N, Valtonen P, Laitinen T, Vanninen E, Heinonen S. Ambulatory arterial stiffness index and nocturnal blood pressure dipping in pregnancies complicated by hypertension. Clin Physiol Funct Imaging 2013; 34:39-46. [PMID: 23783164 DOI: 10.1111/cpf.12063] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2013] [Accepted: 05/27/2013] [Indexed: 11/30/2022]
Abstract
BACKGROUND The study sets out to examine differences in arterial stiffness and nocturnal blood pressure dipping as outcomes in women with gestational hypertension compared with healthy pregnant women during pregnancy and 3 months after delivery. METHODS AND RESULTS We prospectively studied a cohort of 60 women during the third trimester of pregnancy; of them, 28 suffered pregnancy-induced hypertension or pre-eclampsia and 32 had uncomplicated singleton pregnancies. Subsequently, 42 of these were re-examined 3 months after delivery. In women with a hypertensive disorder, the nocturnal fall in blood pressure (dipping) was significantly smaller than in the normotensive group (systolic, P = 0·031; diastolic, P<0·001), but after pregnancy, this difference disappeared (systolic, P = 0·941; diastolic, P = 0·907). Ambulatory arterial stiffness index (AASI) assessed after pregnancy correlated inversely with fasting glucose level during pregnancy (r = -0·580, P = 0·018), both systolic (r = -0·651, P = 0·012) and diastolic (r = -0·687, P = 0·007) nocturnal dipping and total cholesterol concentration after pregnancy (r = -0·526, P = 0·036). CONCLUSIONS A hypertensive disorder during pregnancy was associated with a flattened circadian blood pressure response, which was restored after delivery. Higher arterial stiffness predicted the signs of postpartum metabolic syndrome and correlated also with non-dipping, especially postpartum.
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Affiliation(s)
- Henna Kärkkäinen
- Department of Obstetrics and Gynaecology, Kuopio University Hospital, University of Eastern Finland, Kuopio, Finland
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Lauszus FF, Fuglsang J, Rosgaard A, Lousen T, Klebe JG. Ambulatory arterial stiffness index in type 1 diabetes mellitus: any different during pregnancy? Eur J Obstet Gynecol Reprod Biol 2013; 169:234-8. [PMID: 23726250 DOI: 10.1016/j.ejogrb.2013.04.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2012] [Revised: 03/26/2013] [Accepted: 04/29/2013] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To analyze the ambulatory arterial stiffness index (AASI) and pulse pressure (PP) during pregnancy and 3 months after delivery in type 1 diabetes mellitus (T1DM) and compare it to healthy pregnant controls. STUDY DESIGN Prospective, descriptive study of 59 women with T1DM and 42 non-diabetic women. Blood pressure was measured using a portable oscillometry monitor and AASI was calculated as 1 minus the regression slope of diastolic on systolic blood pressure obtained from 24-h monitoring. Main outcome measures were comparisons of the AASI and PP between T1DM women and controls examined during pregnancy, and of the AASI and PP during and after pregnancy in T1DM women. RESULTS PP and AASI were higher at all times during pregnancy in T1DM compared to postpartum (p<0.01). AASI and PP were significantly associated with albumin excretion rate when adjusting for retinopathy, preeclampsia, duration of diabetes, HbA1c, age, and BMI. The AASI was positively correlated with night-day ratio in the 1st and 3rd trimesters during pregnancy. No difference was found in AASI compared with non-diabetic controls during pregnancy. CONCLUSIONS AASI and PP increased during diabetic pregnancy and were associated with the women's albuminuria grade.
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Affiliation(s)
- Finn F Lauszus
- Department of Obstetrics/Gynaecology, Herning Hospital, Denmark.
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Li ZY, Xu TY, Zhang SL, Zhou XM, Xu XW, Guan YF, Lo M, Miao CY. Telemetric ambulatory arterial stiffness index, a predictor of cardio-cerebro-vascular mortality, is associated with aortic stiffness-determining factors. CNS Neurosci Ther 2013; 19:667-74. [PMID: 23702193 DOI: 10.1111/cns.12120] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2013] [Revised: 04/13/2013] [Accepted: 04/15/2013] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Ambulatory arterial stiffness index (AASI) has been proposed as a new measure of arterial stiffness for predicting cardio-cerebro-vascular morbidity and mortality. However, there has been no research on the direct relationships between AASI and arterial stiffness-determining factors. METHODS We utilized beat-to-beat intra-aortic blood pressure (BP) telemetry to characterize AASI in Wistar-Kyoto (WKY) and spontaneously hypertensive rats (SHR). By determination of aortic structural components and analysis of their correlations with AASI, we provided the first direct evidence for the associations between AASI and arterial stiffness-determining factors including the collagen content and collagen/elastin. RESULTS Ambulatory arterial stiffness index was positively correlated with pulse pressure in both WKY and SHR, less dependent on BP and BP variability than pulse pressure, and relatively stable, especially the number of BP readings not less than ~36. The correlations between AASI and aortic components were comparable for various AASI values derived from BP readings not less than ~36. Not only AASI but also BP variability and pulse pressure demonstrated a direct relationship with arterial stiffness. CONCLUSIONS These findings indicate AASI may become a routine measure in human arterial stiffness assessment. It is recommended to use a cluster of parameters such as AASI, BP variability, and pulse pressure for evaluating arterial stiffness.
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Affiliation(s)
- Zhi-Yong Li
- Department of Pharmacology, Second Military Medical University, Shanghai, China
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Chinese herbal formulas for treating hypertension in traditional Chinese medicine: perspective of modern science. Hypertens Res 2013; 36:570-9. [PMID: 23552514 PMCID: PMC3703711 DOI: 10.1038/hr.2013.18] [Citation(s) in RCA: 141] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2012] [Revised: 11/26/2012] [Accepted: 12/12/2012] [Indexed: 12/16/2022]
Abstract
Hypertension, which directly threatens quality of life, is a major contributor to cardiovascular and cerebrovascular events. Over the past two decades, domestic and foreign scholars have agreed upon various standards in the treatment of hypertension, and considerable progress has been made in the field of antihypertensive drugs. Oral antihypertensive drugs represent a milestone in hypertension therapy. However, the blood pressure standard for patients with hypertension is far from satisfactory. The study of Chinese herbal formulas for treating hypertension has received much research attention. These studies seek to integrate traditional and Western medicine in China. Currently, Chinese herbal formulas are known to have an outstanding advantage with regard to bodily regulation. Research shows that Chinese medicine has many protective mechanisms. This paper addresses the process of the antihypertensive mechanisms in Chinese herbal formulas for treating hypertension. These mechanisms are to be discussed in future research.
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Catena C, Bernardi S, Sabato N, Grillo A, Ermani M, Sechi LA, Fabris B, Carretta R, Fallo F. Ambulatory arterial stiffness indices and non-alcoholic fatty liver disease in essential hypertension. Nutr Metab Cardiovasc Dis 2013; 23:389-393. [PMID: 22796347 DOI: 10.1016/j.numecd.2012.05.007] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2012] [Revised: 03/26/2012] [Accepted: 05/16/2012] [Indexed: 02/06/2023]
Abstract
BACKGROUND AND AIM Non-alcoholic fatty liver disease (NAFLD) has been found to be strongly related to an increased arterial stiffness in patients with essential hypertension, suggesting a pathophysiologic link between major cardiovascular and metabolic abnormalities associated with liver steatosis and the functional and structural alterations of the arterial wall. The aim of our study was to investigate, in a group of essential hypertensive patients without additional cardiovascular risk factors, the relationship between NAFLD and arterial stiffness. METHODS AND RESULTS Sixty-eight consecutive patients with essential hypertension underwent 24-h ambulatory blood pressure monitoring (ABPM) and were separated according to the presence (n = 40) or absence (n = 28) of NAFLD at liver ultrasonography. The Ambulatory Arterial Stiffness Index (AASI) and Symmetric AASI (Sym-AASI) were derived from ABPM tracings. Patients with diabetes, obesity, hyperlipidaemia or other risk factors for cardiovascular or liver disease were excluded. Hypertensive patients were compared with a normotensive control group.The two hypertensive groups had comparable age, sex distribution and clinic/ABPM blood pressure levels. In hypertensive patients with NAFLD, body mass index, fasting glucose, insulin, homeostasis model of assessment of insulin resistance index and triglyceride levels were higher, whereas plasma adiponectin was lower than in patients without NAFLD. In hypertensive patients, AASI and Sym-AASI were higher (P < 0.001) than in normotensive subjects, but both indices of vascular stiffness were comparable in patients with and without NAFLD. CONCLUSIONS In essential hypertensive patients without additional cardiovascular risk factors, NAFLD is associated with insulin resistance but not with increased arterial stiffness.
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Affiliation(s)
- C Catena
- Department of Experimental and Clinical Medicine, University of Udine, Udine, Italy
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Kärkkäinen H, Laitinen T, Heiskanen N, Saarelainen H, Valtonen P, Lyyra-Laitinen T, Vanninen E, Heinonen S. Need for insulin to control gestational diabetes is reflected in the ambulatory arterial stiffness index. BMC Pregnancy Childbirth 2013; 13:9. [PMID: 23324111 PMCID: PMC3556301 DOI: 10.1186/1471-2393-13-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2012] [Accepted: 01/06/2013] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND The aim was to evaluate the metabolic profile in conjunction with vascular function using the ambulatory arterial stiffness index (AASI) in women with uncomplicated pregnancies and in women with gestational diabetes mellitus (GDM). METHODS Plasma glucose, lipids, HOMA -IR (homeostasis model assessment of insulin resistance) and AASI, as obtained from 24-hour ambulatory blood pressure monitoring in third trimester pregnancy and at three months postpartum, were measured in three groups of women: controls (N=32), women with GDM on diet (N=42) and women with GDM requiring insulin treatment (N=10). RESULTS Women with GDM had poorer glycemic control and higher HOMA-IR during and after pregnancy and their total and LDL (low density lipoprotein) cholesterol levels were significantly higher after pregnancy than in the controls. After delivery, there was an improvement in AASI from 0.26±0.10 to 0.17±0.09 (P=0.002) in women with GDM on diet, but not in women with GDM receiving insulin whose AASI tended to worsen after delivery from 0.30±0.23 to 0.33±0.09 (NS), then being significantly higher than in the other groups (P=0.001-0.047). CONCLUSIONS Women with GDM had more unfavorable lipid profile and higher blood glucose values at three months after delivery, the metabolic profile being worst in women requiring insulin. Interestingly, the metabolic disturbances at three months postpartum were accompanied by a tendency towards arterial stiffness to increase in women requiring insulin.
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Affiliation(s)
- Henna Kärkkäinen
- Department of Obst/Gyn, Kuopio University Hospital, University of Eastern Finland, POB 1777, Kuopio FIN-70211, Finland.
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Guasch B, Torguet P, Garcia I, Calabia J, Martín N, Maté G, Faur D, Barreiro Y, Molina C, Noboa C, Vallès M. Utilidad de la monitorización ambulatoria de la presión arterial en la evaluación de la rigidez arterial. Correlaciones con la velocidad de onda de pulso y las tensiones arteriales centrales. HIPERTENSION Y RIESGO VASCULAR 2013. [DOI: 10.1016/j.hipert.2012.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Differences between daytime and nighttime blood pressure variability regarding systemic atherosclerotic change and renal function. Hypertens Res 2012; 36:232-9. [PMID: 23076404 DOI: 10.1038/hr.2012.162] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Recently, new parameters related to hypertension, such as variability in blood pressure and ambulatory arterial stiffness index (AASI), were demonstrated to correlate with arteriosclerotic change. In this study, we investigated the correlation between circadian variability in blood pressure/AASI and renal function. We also investigated differences in the clinical impact of 24 h, daytime and nighttime blood pressure variability on renal and systemic atherosclerotic changes. We analyzed data from 120 patients who underwent renal Doppler ultrasonography (RDU) and ambulatory blood pressure monitoring (ABPM) at our hospital ward, and investigated the correlation between circadian variability in blood pressure/AASI and renal function, including resistive index (RI) evaluated with RDU, which is thought to be a good indicator of renal vascular resistance. Subjects with higher circadian variability in systolic blood pressure (SBP) had significantly higher RI. Daytime variability in SBP correlated more strongly with RI than nighttime variability. Meanwhile, only nighttime variability, but not daytime variability, in SBP was related to carotid atherosclerosis. Similarly, AASI was significantly correlated with RI. Circadian variability in SBP and AASI were both significantly correlated with renal function. Daytime SBP s.d. was especially more strongly correlated with renal vascular resistance, and nighttime SBP s.d. was significantly correlated with intima-media thickness (IMT) and plaque score. These results indicate that evaluating both daytime and nighttime blood pressure variability enables an assessment of pathological conditions in hypertensive patients to prevent cardiovascular diseases.
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Ratto E, Leoncini G, Viazzi F, Falqui V, Parodi A, Conti N, Tomolillo C, Deferrari G, Pontremoli R. C-reactive protein and target organ damage in untreated patients with primary hypertension. ACTA ACUST UNITED AC 2012; 1:407-13. [PMID: 20409873 DOI: 10.1016/j.jash.2007.09.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2007] [Revised: 08/30/2007] [Accepted: 09/08/2007] [Indexed: 11/30/2022]
Abstract
High sensitivity C-reactive protein (hs-CRP) has been recognized as a risk factor for cardiovascular disease. Asymptomatic organ damage is known to precede cardiovascular events in hypertension. The aim of the present study was to investigate the relationship between hs-CRP and signs of organ damage, namely left ventricular mass index (LVMI), albuminuria, and carotid atherosclerosis in a group of hypertensive patients. One hundred and eighty-two untreated patients with primary hypertension were studied. HS-CRP was measured by immunonephelometry. LVMI was assessed by echocardiography, albuminuria was measured as albumin to creatinine ratio, and carotid atherosclerosis by ultrasonography. Patient stratification according to quartiles of hs-CRP showed a significant trend toward higher age, prevalence of left ventricular hypertrophy, and carotid plaques. Moreover, there was a significant correlation among hs-CRP quartiles and left ventricular mass index, carotid cross-sectional area, carotid plaques, and albuminuria. Multiple regression analysis showed that, after adjusting for established cardiovascular risk factors (ie, age, duration of hypertension, smoking habit, body mass index (BMI), 24-hour systolic and diastolic blood pressures, glucose, creatinine, uric acid, triglycerides, total and low-density lipoprotein cholesterol), hs-CRP remained a strong correlate of target organ damage. These results support the importance of chronic microinflammation in the development of atherosclerotic disease in hypertension.
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Affiliation(s)
- Elena Ratto
- Department of Cardio-Nephrology, Azienda Ospedaliera Universitaria San Martino, Genoa, Italy
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Kollias A, Stergiou GS, Dolan E, O'Brien E. Ambulatory arterial stiffness index: A systematic review and meta-analysis. Atherosclerosis 2012; 224:291-301. [DOI: 10.1016/j.atherosclerosis.2012.03.039] [Citation(s) in RCA: 67] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2011] [Revised: 03/30/2012] [Accepted: 03/31/2012] [Indexed: 11/25/2022]
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Dégi A, Kerti A, Kis E, Cseprekál O, Tory K, Szabó AJ, Reusz GS. Cardiovascular risk assessment in children following kidney transplantation. Pediatr Transplant 2012; 16:564-76. [PMID: 22694162 DOI: 10.1111/j.1399-3046.2012.01730.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
CV diseases are the leading cause of death among patients with ESRD. RTX decreases the CV risk; however, it still remains definitely higher than that of the general population. Large multicenter and longitudinal studies are difficult to perform and hard end-points of CV events are usually missing among pediatric population. Thus, appropriate estimation of CV risk is of crucial importance to define the potential hazards and to evaluate the effect of treatments aimed to reduce the risk. A number of validated non-invasive methods are available to assess the extent of CV damage in adults, such as calcification scores, cIMT, aPWV, 24-h ABPM, AASI, and HRV; however, they need adaptation, standardization, and validation in pediatric studies. cIMT and PWV are the most promising methods, as pediatric normative values are already present. The up-to-date treatment of ESRD aims not only to save life, but to offer the patient a life expectancy approaching that of the healthy population and to ensure a reasonable quality of life.
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Affiliation(s)
- Arianna Dégi
- First Department of Pediatrics, Semmelweis University, Budapest, Hungary
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