1
|
Zhang S, Tamargo RJ, Bergmann J, Gottschalk A, Steppan J. The relationship between intraoperative surrogates of vascular stiffness, cerebral aneurysms, and surgical outcomes. J Stroke Cerebrovasc Dis 2024; 33:108003. [PMID: 39251046 DOI: 10.1016/j.jstrokecerebrovasdis.2024.108003] [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: 04/03/2024] [Revised: 09/05/2024] [Accepted: 09/06/2024] [Indexed: 09/11/2024] Open
Abstract
OBJECTIVE Increased arterial stiffness has been linked to aneurysm formation in the systemic and cerebral circulations, though the role played by arterial stiffness in the cerebral vasculature continues to be refined. This study assesses whether intraoperative surrogates of arterial stiffness differ between patients with cerebral aneurysms and controls, and the extend that these indices relate to outcomes following open surgical treatment. METHODS We evaluated patients in a prospectively maintained database who underwent cerebral aneurysm surgery, and compared them to controls without cerebral aneurysms. Arterial stiffness was estimated using the intraoperative ambulatory arterial stiffness index (AASI) and average pulse pressure (PP). RESULTS We analyzed 214 cerebral aneurysm patients and 234 controls. Patients in the aneurysm group were predominantly female and had a higher incidence of hypertension, diabetes mellitus, and vascular disease. They also demonstrate elevated AASI and average PP. When stratified by the occurrence of subarachnoid hemorrhage (SAH) or unfavorable neurological outcome, the AASI and average PP were not highly associated with the occurrence of SAH but were highly associated with unfavorable neurological outcomes. After multivariable analysis, both the AASI and average PP were no longer associated with unfavorable neurological outcomes, however elevated age, strongly linked with arterial stiffness, became a key predictive variable. CONCLUSION Readily obtained intraoperative surrogates of arterial stiffening demonstrates its presence in those with cerebral aneurysm disease and the extent that it does it may meaningfully direct their clinical course. However, multivariable analysis demonstrates limitations of using arterial stiffness measures to predict clinical outcomes.
Collapse
Affiliation(s)
- Shu Zhang
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
| | - Rafael J Tamargo
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
| | - Jules Bergmann
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
| | - Allan Gottschalk
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
| | - Jochen Steppan
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
| |
Collapse
|
2
|
Gardikioti V, Georgakopoulos C, Solomou E, Lazarou E, Fasoulakis K, Terentes-Printzios D, Tsioufis K, Iliopoulos D, Vlachopoulos C. Effect of FluoRoquinolones on Aortic Growth, aortic stIffness and wave refLEctionS (FRAGILES study). Life (Basel) 2024; 14:992. [PMID: 39202735 PMCID: PMC11355559 DOI: 10.3390/life14080992] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2024] [Revised: 07/29/2024] [Accepted: 08/05/2024] [Indexed: 09/03/2024] Open
Abstract
Background: The widespread use of fluoroquinolones has been associated with the formation, dissection, and rupture of aortic aneurysms. Arterial biomarkers are established predictors of cardiovascular events. The present study was designed to investigate the effect of quinolones on arterial stiffness and aortic size for the first time. Methods: We studied 28 subjects receiving short-term (<15 days) antibiotic therapy involving quinolones and 27 age- and sex-matched subjects receiving an alternative to quinolone antibiotics. The follow-up period was approximately 2 months. The study's primary endpoint was the carotid-femoral pulse wave velocity (cfPWV) difference between the two groups 2 months after therapy initiation. Secondary endpoints were the augmentation index corrected for heart rate (AIx@75) and sonographically assessed aortic diameters 2 months after the initial treatment. Results: Subjects had similar values of arterial biomarkers, blood pressure measurements, and aortic diameters at baseline. At follow-up, no significant change was observed between the two groups regarding the hemodynamic parameters and arterial biomarkers (p > 0.05 for all), i.e., cfPWV (7.9 ± 2.6 m/s for the control group vs. 8.1 ± 2.4 m/s for the fluoroquinolones group; p = 0.79), AIx@75 (22.6 ± 9.0% for the control group vs. 26.6 ± 8.1% for the fluoroquinolones group; p = 0.09), and aortic diameters. Conclusions: To our knowledge, FRAGILES is the first study to provide insights into the possible effects of fluoroquinolones on arterial biomarkers, showing that, at least in the short term, treatment with fluoroquinolones does not affect aortic function and diameter.
Collapse
Affiliation(s)
- Vasiliki Gardikioti
- First Department of Cardiology, Hippokration General Hospital, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | - Christos Georgakopoulos
- First Department of Cardiology, Hippokration General Hospital, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | - Eirini Solomou
- First Department of Cardiology, Hippokration General Hospital, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | - Emilia Lazarou
- First Department of Cardiology, Hippokration General Hospital, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | | | - Dimitrios Terentes-Printzios
- First Department of Cardiology, Hippokration General Hospital, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | - Konstantinos Tsioufis
- First Department of Cardiology, Hippokration General Hospital, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | - Dimitrios Iliopoulos
- Laboratory of Experimental Surgery and Surgical Research, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | - Charalambos Vlachopoulos
- First Department of Cardiology, Hippokration General Hospital, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece
| |
Collapse
|
3
|
Tscheuschner L, Tzafriri AR. Cardiovascular Tissue Engineering Models for Atherosclerosis Treatment Development. Bioengineering (Basel) 2023; 10:1373. [PMID: 38135964 PMCID: PMC10740643 DOI: 10.3390/bioengineering10121373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Revised: 11/25/2023] [Accepted: 11/27/2023] [Indexed: 12/24/2023] Open
Abstract
In the early years of tissue engineering, scientists focused on the generation of healthy-like tissues and organs to replace diseased tissue areas with the aim of filling the gap between organ demands and actual organ donations. Over time, the realization has set in that there is an additional large unmet need for suitable disease models to study their progression and to test and refine different treatment approaches. Increasingly, researchers have turned to tissue engineering to address this need for controllable translational disease models. We review existing and potential uses of tissue-engineered disease models in cardiovascular research and suggest guidelines for generating adequate disease models, aimed both at studying disease progression mechanisms and supporting the development of dedicated drug-delivery therapies. This involves the discussion of different requirements for disease models to test drugs, nanoparticles, and drug-eluting devices. In addition to realistic cellular composition, the different mechanical and structural properties that are needed to simulate pathological reality are addressed.
Collapse
Affiliation(s)
- Linnea Tscheuschner
- Department of Vascular Surgery, National and Kapodistrian University of Athens, 15772 Athens, Greece
| | - Abraham R. Tzafriri
- Department of Research and Innovation, CBSET Inc., Lexington, MA 02421, USA;
| |
Collapse
|
4
|
Yao Y, Goh HM, Kim JE. The Roles of Carotenoid Consumption and Bioavailability in Cardiovascular Health. Antioxidants (Basel) 2021; 10:1978. [PMID: 34943081 PMCID: PMC8750451 DOI: 10.3390/antiox10121978] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Revised: 12/05/2021] [Accepted: 12/08/2021] [Indexed: 12/30/2022] Open
Abstract
Carotenoids are natural pigments generally with a polyene chain consisting of 9-11 double bonds. In recent years, there has been increasing research interest in carotenoids because of their protective roles in cardiovascular diseases (CVDs). While the consumption of carotenoids may have a beneficial effect on CVDs, the literature shows inconsistencies between carotenoid consumption and reductions in the risk of CVDs. Therefore, this review aims to provide a summary of the association between dietary carotenoid intake and the risk of CVDs from published epidemiological studies. Meanwhile, to further elucidate the roles of carotenoid intake in CVD protection, this review outlines the evidence reporting the effects of carotenoids on cardiovascular health from randomized controlled trials by assessing classical CVD risk factors, oxidative stress, inflammatory markers and vascular health-related parameters, respectively. Given the considerable discrepancies among the published results, this review underlines the importance of bioavailability and summarizes the current dietary strategies for improving the bioavailability of carotenoids. In conclusion, this review supports the protective roles of carotenoids against CVDs, possibly by attenuating oxidative stress and mitigating inflammatory response. In addition, this review suggests that the bioavailability of carotenoids should be considered when evaluating the roles of carotenoids in CVD protection.
Collapse
Affiliation(s)
| | | | - Jung Eun Kim
- Department of Food Science and Technology, National University of Singapore, Singapore 117543, Singapore; (Y.Y.); (H.M.G.)
| |
Collapse
|
5
|
Fedintsev A, Moskalev A. Stochastic non-enzymatic modification of long-lived macromolecules - A missing hallmark of aging. Ageing Res Rev 2020; 62:101097. [PMID: 32540391 DOI: 10.1016/j.arr.2020.101097] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Revised: 05/05/2020] [Accepted: 06/04/2020] [Indexed: 12/12/2022]
Abstract
Damage accumulation in long-living macromolecules (especially extracellular matrix (ECM) proteins, nuclear pore complex (NPC) proteins, and histones) is a missing hallmark of aging. Stochastic non-enzymatic modifications of ECM trigger cellular senescence as well as many other hallmarks of aging affect organ barriers integrity and drive tissue fibrosis. The importance of it for aging makes it a key target for interventions. The most promising of them can be AGE inhibitors (chelators, O-acetyl group or transglycating activity compounds, amadorins and amadoriases), glucosepane breakers, stimulators of elastogenesis, and RAGE antagonists.
Collapse
Affiliation(s)
- Alexander Fedintsev
- Institute of Biology of FRC of Komi Scientific Center, Ural Branch of Russian Academy of Sciences, Syktyvkar, Russia
| | - Alexey Moskalev
- Institute of Biology of FRC of Komi Scientific Center, Ural Branch of Russian Academy of Sciences, Syktyvkar, Russia.
| |
Collapse
|
6
|
Aykan AÇ, Çetin M, Kalaycıoğlu E, Menteşe Ü. Assessment of cardio-ankle vascular index in patients with abdominal aortic aneurysm: An observational study. Vascular 2020; 29:190-195. [PMID: 32757746 DOI: 10.1177/1708538120946549] [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] [Indexed: 11/16/2022]
Abstract
OBJECTIVES Arterial stiffness is associated with major adverse cardiovascular events. The aim of this study is to investigate arterial stiffness by cardio-ankle vascular index (CAVI) in patients with abdominal aortic aneurysm (AAA). METHODS This observational and cross-sectional study involved 59 subjects with AAA and 32 healthy subjects. All subjects underwent ultrasonography examination. CAVI was measured by VaSera-1000 CAVI instrument. RESULTS Mean abdominal aortic diameter of AAA patients and controls were 43.88 ± 9.28 mm and 20.43 ± 3.14 mm, consecutively. Baseline clinical characteristics of the patients and controls were similar for age, presence of hypertension, diabetes, dyslipidemia, coronary artery disease and smoking. Left ventricle ejection fraction and Left ventricle mass index (LVMI) were similar between groups. CAVI was significantly higher in patients with AAA than controls (9.74 ± 1.50 vs. 7.60 ± 1.07, p < 0.001). CAVI was positively correlated with AAA diameter (r = 0.461, p < 0.001) and negatively correlated with left ventricle ejection fraction (r= -0.254, p = 0.015). CAVI >8.3 had a sensitivity 89.8% and a specificity of 78.1% for predicting the presence of AAA in ROC analysis (area under curve = 0.897, 95%CI = 0.816-0.951, p < 0.001). CONCLUSION CAVI is increased in patients with AAA. Increased arterial stiffness may be a mechanical link between AAA, coronary artery disease and peripheral artery disease or a common mechanism effects the arterial stiffness, coronary artery disease, peripheral artery disease and AAA. Therefore, CAVI may be used as a valuable marker for risk stratification for the development of AAA in susceptible patients.
Collapse
Affiliation(s)
- Ahmet Çağrı Aykan
- Department of Cardiology, Faculty of Medicine, Kahramanmaras Sutcu Imam University, Kahramanmaras, Turkey.,Department of Cardiology, Ahi Evren Chest and Cardiovascular Surgery Education and Research Hospital, Trabzon, Turkey
| | - Mustafa Çetin
- Department of Cardiology, Faculty of Medicine, Rize Recep Tayyip Erdoğan University, Rize, Turkey
| | - Ezgi Kalaycıoğlu
- Department of Cardiology, Ahi Evren Chest and Cardiovascular Surgery Education and Research Hospital, Trabzon, Turkey
| | - Ümit Menteşe
- Department of Cardiovascular Surgery, Ahi Evren Chest and Cardiovascular Surgery Education and Research Hospital, Trabzon, Turkey
| |
Collapse
|
7
|
Association of Uric Acid in Serum and Urine with Arterial Stiffness: Hanzhong Adolescent Hypertension Study. DISEASE MARKERS 2020; 2020:1638515. [PMID: 32724482 PMCID: PMC7382737 DOI: 10.1155/2020/1638515] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/01/2019] [Revised: 06/15/2020] [Accepted: 06/30/2020] [Indexed: 12/26/2022]
Abstract
Background Hyperuricemia has long been associated with increased cardiovascular risk, and arterial stiffness is proposed as a mediator. The present study is aimed at examining the associations of uric acid (UA) in blood and urine with arterial stiffness in a Chinese cohort. Methods A total of 2296 participants (mean age: 43.0 years) from our previously established cohort of Hanzhong Adolescent Hypertension Study were included. The participants were classified as subjects with or without arterial stiffness, which was defined as brachial-ankle pulse wave velocity (baPWV) ≥ 1400 cm/s and/or carotid intima-media thickness (CIMT) ≥ 0.9 mm. Multivariate regression analyses were used to examine the relationship between serum and urinary UA and the risk of arterial stiffness after adjusting for age, gender, systolic blood pressure, fasting glucose, BMI, heart rate, total cholesterol, and triglycerides. Results baPWV was positively correlated with urinary uric acid/creatinine ratio (uUA/Cre) (β = 0.061, P < 0.001), while CIMT was correlated with uUA/Cre (β = 0.085, P < 0.001) and fractional excretion of uric acid (FEUA) (β = 0.044, P = 0.033) in all subjects. In addition, uUA/Cre was significantly associated with the risk of high baPWV [1.032 (1.019-1.045)] and arterial stiffness [1.028 (1.016-1.040)]. Conclusion Our study showed that urinary UA excretion was significantly associated with the risk of arterial stiffness in Chinese adults. These findings suggest that UA, especially urinary UA, may be used as a simple, noninvasive marker for early detection of arterial stiffness in otherwise healthy subjects.
Collapse
|
8
|
Yao L, Folsom AR, Alonso A, Lutsey PL, Pankow JS, Guan W, Cheng S, Lederle FA, Tang W. Association of carotid atherosclerosis and stiffness with abdominal aortic aneurysm: The atherosclerosis risk in communities (ARIC) study. Atherosclerosis 2018; 270:110-116. [PMID: 29407878 PMCID: PMC5844275 DOI: 10.1016/j.atherosclerosis.2018.01.044] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2017] [Revised: 01/20/2018] [Accepted: 01/24/2018] [Indexed: 11/23/2022]
Abstract
BACKGROUND AND AIMS Individuals with atherosclerosis and stiffness often have increased abdominal aortic diameters, but prospective evidence linking them to the risk of abdominal aortic aneurysm (AAA) is limited. METHODS We prospectively examined the relationship of carotid atherosclerosis and stiffness with future risk of AAA in ARIC. At Visits 1 (1987-89) or 2 (1990-1992), we assessed carotid atherosclerosis (represented by greater carotid intima-media thickness [cIMT] or presence of atherosclerotic plaque) and lower carotid distensibility (reflected by a higher carotid Beta Index). We identified incident, clinical AAAs during follow-up through 2011 using hospital discharge codes, Medicare outpatient diagnoses, or death certificates. RESULTS Participants' mean age at baseline was 54.2 years (SD 5.8), 45% were male and 73% white. During a median of 22.5 years of follow-up, 542 clinical AAAs were ascertained. After multivariable adjustment, the presence of carotid atherosclerotic plaque at baseline was associated with 1.31 (95% CI: 1.10-1.57; p = 0.003) times higher risk of clinical AAA. Greater cIMT and Beta Index were also associated with clinical AAA with a dose-response across quartiles (p trend for both: 0.006; hazard ratios [95% CI] for the highest vs. lowest quartiles: 1.55 [1.13-2.11] and 1.68 [1.16-2.43], respectively). The associations of cIMT and Beta Index with AAA were independent of each other. CONCLUSIONS This prospective population-based study found that indices of greater carotid atherosclerosis and lower carotid distensibility are markers of increased AAA risk.
Collapse
Affiliation(s)
- Lu Yao
- Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, MN, USA
| | - Aaron R Folsom
- Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, MN, USA
| | - Alvaro Alonso
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Pamela L Lutsey
- Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, MN, USA
| | - James S Pankow
- Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, MN, USA
| | - Weihua Guan
- Division of Biostatistics, University of Minnesota, Minneapolis, MN, USA
| | - Susan Cheng
- Cardiovascular Division, Brigham and Women's Hospital, Boston, MA, USA
| | - Frank A Lederle
- Center for Chronic Disease Outcomes Research, Veterans Affairs Medical Center, Minneapolis, MN, USA
| | - Weihong Tang
- Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, MN, USA.
| |
Collapse
|
9
|
Schaafs LA, Tzschätzsch H, van der Giet M, Reshetnik A, Steffen IG, Hamm B, Braun J, Sack I, Elgeti T. Time-Harmonic Ultrasound elastography of the Descending Abdominal Aorta: Initial Results. ULTRASOUND IN MEDICINE & BIOLOGY 2017; 43:2550-2557. [PMID: 28818306 DOI: 10.1016/j.ultrasmedbio.2017.07.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/19/2017] [Revised: 06/28/2017] [Accepted: 07/07/2017] [Indexed: 06/07/2023]
Abstract
Stiffening of central large vessels is considered a key pathophysiologic factor within the cardiovascular system. Current diagnostic parameters such as pulse wave velocity (PWV) indirectly measure aortic stiffness, a hallmark of coronary diseases. The aim of the present study was to perform elastography of the proximal abdominal aorta based on externally induced time-harmonic shear waves. Experiments were performed in 30 healthy volunteers (25 young, 5 old, >50 y) and 5 patients with longstanding hypertension (PWV >10 m/s). B-Mode-guided sonographic time-harmonic elastography was used for measurement of externally induced shear waves at 30-Hz vibration frequency. Thirty-hertz shear wave amplitudes (SWAs) within the abdominal aorta were measured and displayed in real time and processed offline for differences in SWA between systole and diastole (ΔSWA). Data were analyzed using the Kruskal-Wallis test and receiver operating characteristic curve analysis. The change in SWA over the cardiac cycle was reduced significantly in all patients as assessed with ΔSWA (volunteers: mean = 10 ± 5 μm, patients: mean = 4 ± 1 μm; p < 0.001). The best separation of healthy volunteers from patients was obtained with a ΔSWA threshold of 4.7 μm, resulting in a sensitivity of 0.9 and a specificity of 1.0, with an overall area under the curve of 0.96. Time harmonic elastography of the abdominal aorta is feasible and shows promise for the exploitation of time-varying shear wave amplitudes as a diagnostic marker for aortic wall stiffening. Patients with elevated PWVs suggesting increased aortic wall stiffness were best identified by ΔSWA-a parameter that could be related to the ability of the vessel walls to distend on passages of the pulse wave.
Collapse
Affiliation(s)
- Lars-Arne Schaafs
- Klinik und Hochschulambulanz für Radiologie, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Heiko Tzschätzsch
- Klinik und Hochschulambulanz für Radiologie, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Markus van der Giet
- Medizinische Klinik mit Schwerpunkt Nephrologie, Transplantationszentrum-Hypertoniezentrum, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Alexander Reshetnik
- Medizinische Klinik mit Schwerpunkt Nephrologie, Transplantationszentrum-Hypertoniezentrum, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Ingo G Steffen
- Klinik und Hochschulambulanz für Radiologie, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Bernd Hamm
- Klinik und Hochschulambulanz für Radiologie, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Jürgen Braun
- Institut für Medizinische Informatik, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Ingolf Sack
- Klinik und Hochschulambulanz für Radiologie, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Thomas Elgeti
- Klinik und Hochschulambulanz für Radiologie, Charité-Universitätsmedizin Berlin, Berlin, Germany.
| |
Collapse
|
10
|
McGarry M, Nauleau P, Apostolakis I, Konofagou E. In vivo repeatability of the pulse wave inverse problem in human carotid arteries. J Biomech 2017; 64:136-144. [PMID: 29050824 DOI: 10.1016/j.jbiomech.2017.09.017] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2017] [Revised: 08/08/2017] [Accepted: 09/19/2017] [Indexed: 10/18/2022]
Abstract
Accurate arterial stiffness measurement would improve diagnosis and monitoring for many diseases. Atherosclerotic plaques and aneurysms are expected to involve focal changes in vessel wall properties; therefore, a method to image the stiffness variation would be a valuable clinical tool. The pulse wave inverse problem (PWIP) fits unknown parameters from a computational model of arterial pulse wave propagation to ultrasound-based measurements of vessel wall displacements by minimizing the difference between the model and measured displacements. The PWIP has been validated in phantoms, and this study presents the first in vivo demonstration. The common carotid arteries of five healthy volunteers were imaged five times in a single session with repositioning of the probe and subject between each scan. The 1D finite difference computational model used in the PWIP spanned from the start of the transducer to the carotid bifurcation, where a resistance outlet boundary condition was applied to approximately model the downstream reflection of the pulse wave. Unknown parameters that were estimated by the PWIP included a 10-segment linear piecewise compliance distribution and 16 discrete cosine transformation coefficients for each of the inlet boundary conditions. Input data was selected to include pulse waves resulting from the primary pulse and dicrotic notch. The recovered compliance maps indicate that the compliance increases close to the bifurcation, and the variability of the average pulse wave velocity estimated through the PWIP is on the order of 11%, which is similar to that of the conventional processing technique which tracks the wavefront arrival time (13%).
Collapse
Affiliation(s)
- Matthew McGarry
- Department of Biomedical Engineering, Columbia University, New York, NY, United States; Thayer School of Engineering, Dartmouth College, Hanover, NH, United States
| | - Pierre Nauleau
- Department of Biomedical Engineering, Columbia University, New York, NY, United States
| | - Iason Apostolakis
- Department of Biomedical Engineering, Columbia University, New York, NY, United States
| | - Elisa Konofagou
- Department of Biomedical Engineering, Columbia University, New York, NY, United States; Department of Radiology, Columbia University, New York, NY, United States.
| |
Collapse
|
11
|
Abstract
An abdominal aortic aneurysm (AAA) is a focal full thickness dilatation of the abdominal aorta, greater than 1.5 times its normal diameter. Although some patients with AAA experience back or abdominal pain, most remain asymptomatic until rupture. The prognosis after AAA rupture is poor. Management strategies for patients with asymptomatic AAAs include risk factor reduction, such as smoking cessation, optimizing antihypertensive treatment, and treating dyslipidemia, as well as surveillance by ultrasound. Currently, aneurysm diameter alone is often used to assess risk of rupture. Once the aneurysm diameter reaches 5.5 cm, the risk of rupture is considered greater than the risk of intervention and elective aneurysm repair is undertaken. There is increasing interest in detecting AAAs early, and national screening programs are now in place. Furthermore, there is increasing research interest in biomarkers, genetics, and functional imaging to improve detection of AAAs at risk of progression and rupture. In this review, we discuss risk factors for AAA rupture, which should be considered during the management process, to advance current deficiencies in management pathways.
Collapse
|
12
|
Lee HS, Lee HL, Han HS, Yeo M, Kim JS, Lee SH, Lee SS, Shin DI. Clinical usefulness of ankle brachial index and brachial-ankle pulse wave velocity in patients with ischemic stroke. J Biomed Res 2016; 30:285-91. [PMID: 27533937 PMCID: PMC4946319 DOI: 10.7555/jbr.30.2016k0006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2015] [Revised: 10/05/2015] [Accepted: 02/02/2016] [Indexed: 11/13/2022] Open
Abstract
Ankle brachial index (ABI) and brachial-ankle pulse wave velocity (baPWV) are widely used noninvasive modalities to evaluate atherosclerosis. Recently, evidence has increased supporting the use of ABI and baPWV as markers of cerebrovascular disease. This study sought to examine the relationship between ABI and baPWV with ischemic stroke. This study also aimed to determine which pathogenic mechanism, large artery disease (LAD) or small vessel disease (SVD), is related to ABI or baPWV. Retrospectively, 121 patients with ischemic stroke and 38 subjects with no obvious ischemic stroke history were recruited. First, ABI and baPWV were compared between the groups. Then, within the stroke group, the relevance of ABI and baPWV with regard to SVD and LAD, which were classified by brain magnetic resonance image (MRI) and magnetic resonance angiography (MRA) or computed tomography angiography (CTA) findings, was assessed. The baPWV was higher in the stroke group than non-stroke group (1,944.18±416.6 cm/s vs. 1,749.76±669.6 cm/s, P<0.01). Regarding LAD, we found that mean ABI value was lower in the group with extracranial large artery stenosis (P<0.01), and there was an inverse linear correlation between ABI and the grade of extracranial large artery stenosis (P<0.01). For SVD, there was a significant correlation between SVD and baPWV (2,057.6±456.57 cm/s in the SVD (+) group vs. 1,491±271.62 cm/s in the SVD (-) group; P<0.01). However, the grade of abnormalities detected in SVD did not correlate linearly with baPWV. These findings show that baPWV is a reliable surrogate marker of ischemic stroke. Furthermore, baPWV and ABI can be used to indicate the presence of small vessel disease and large arterial disease, respectively.
Collapse
Affiliation(s)
- Hyung-Suk Lee
- Department of Neurology, Yuseong Sun General Hospital, Daejeon 34084, Korea
| | - Hye Lim Lee
- Department of Neurology, Chungbuk National University College of Medicine, Chungbuk National University Hospital, Cheongju 28644, Korea
| | - Ho-Seong Han
- Department of Neurology, Yuseong Sun General Hospital, Daejeon 34084, Korea
| | - Minju Yeo
- Department of Neurology, Chungbuk National University College of Medicine, Chungbuk National University Hospital, Cheongju 28644, Korea
| | - Ji Seon Kim
- Department of Neurology, Chungbuk National University College of Medicine, Chungbuk National University Hospital, Cheongju 28644, Korea
| | - Sung-Hyun Lee
- Department of Neurology, Chungbuk National University College of Medicine, Chungbuk National University Hospital, Cheongju 28644, Korea
| | - Sang-Soo Lee
- Department of Neurology, Chungbuk National University College of Medicine, Chungbuk National University Hospital, Cheongju 28644, Korea
| | - Dong-Ick Shin
- Department of Neurology, Chungbuk National University College of Medicine, Chungbuk National University Hospital, Cheongju 28644, Korea.
| |
Collapse
|
13
|
Chiu HY, Lo PC, Huang WF, Tsai YW, Tsai TF. Increased risk of aortic aneurysm (AA) in relation to the severity of psoriasis: A national population-based matched-cohort study. J Am Acad Dermatol 2016; 75:747-754. [PMID: 27473449 DOI: 10.1016/j.jaad.2016.06.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2016] [Revised: 05/06/2016] [Accepted: 06/01/2016] [Indexed: 01/10/2023]
Abstract
BACKGROUND Inflammation of systemic and vascular tissues besides the skin in psoriasis is associated with cardiovascular morbidity and mortality. OBJECTIVE We sought to investigate whether or not patients with psoriasis have an increased risk of aortic aneurysm (AA). METHODS This population-based cohort study identified 34,301 patients with psoriasis in the Taiwan National Health Insurance Research Database during 2004 to 2006, who were matched for age and sex with 137,204 control subjects without psoriasis from the Taiwan Longitudinal Health Insurance Database 2000. Each individual was individually followed up for 5 years to identify those who subsequently developed AA. RESULTS After adjusting for medical history and medication use, patients with psoriasis were at increased overall risk of AA (adjusted hazard ratio [HR] 1.80; 95% confidence interval 1.25-2.61). The risk for AA increased with the severity of psoriasis. The adjusted HRs were higher for male than female patients (adjusted HR 1.84 vs 1.56), and for patients younger than 50 years versus older patients (adjusted HR 2.81 vs 1.64). LIMITATIONS There is a lack of information regarding patients' Psoriasis Area and Severity Index score, daily tobacco use, or alcohol consumption. CONCLUSION Patients with psoriasis are predisposed to developing AA: this risk increases with psoriasis severity and is independent of established cardiovascular risk factors.
Collapse
Affiliation(s)
- Hsien-Yi Chiu
- Institute of Biomedical Engineering, College of Medicine and College of Engineering, National Taiwan University, Taipei, Taiwan; Department of Dermatology, National Taiwan University Hospital Hsin-Chu Branch, Hsinchu, Taiwan; Department of Dermatology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Po-Ching Lo
- Institute of Health and Welfare Policy, National Yang-Ming University, Taipei, Taiwan
| | - Weng-Foung Huang
- Institute of Health and Welfare Policy, National Yang-Ming University, Taipei, Taiwan
| | - Yi-Wen Tsai
- Institute of Health and Welfare Policy, National Yang-Ming University, Taipei, Taiwan
| | - Tsen-Fang Tsai
- Department of Dermatology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan.
| |
Collapse
|
14
|
Bailey DM, Evans TG, Thomas KG, White RD, Twine CP, Lewis MH, Williams IM. Intervisceral artery origins in patients with abdominal aortic aneurysmal disease; evidence for systemic vascular remodelling. Exp Physiol 2016; 101:1143-53. [DOI: 10.1113/ep085804] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2016] [Accepted: 05/03/2016] [Indexed: 11/08/2022]
Affiliation(s)
- Damian M. Bailey
- Faculty of Life Sciences and Education; University of South Wales; Pontypridd UK
| | - Tom G. Evans
- Department of Surgery; Royal Glamorgan Hospital; Llantrisant UK
| | | | | | | | - Michael H. Lewis
- Faculty of Life Sciences and Education; University of South Wales; Pontypridd UK
- Department of Surgery; Royal Glamorgan Hospital; Llantrisant UK
| | - Ian M. Williams
- Department of Surgery; University Hospital Wales; Cardiff UK
| |
Collapse
|
15
|
Wu J, Shadden SC. Stability analysis of a continuum-based constrained mixture model for vascular growth and remodeling. Biomech Model Mechanobiol 2016; 15:1669-1684. [PMID: 27116383 DOI: 10.1007/s10237-016-0790-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2015] [Accepted: 04/08/2016] [Indexed: 01/27/2023]
Abstract
A stabilizing criterion is derived for equations governing vascular growth and remodeling. We start from the integral state equations of the continuum-based constrained mixture theory of vascular growth and remodeling and obtain a system of time-delayed differential equations describing vascular growth. By employing an exponential form of the constituent survival function, the delayed differential equations can be reduced to a nonlinear ODE system. We demonstrate the degeneracy of the linearized system about the homeostatic state, which is a fundamental cause of the neutral stability observations reported in prior studies. Due to this degeneracy, stability conclusions for the original nonlinear system cannot be directly inferred. To resolve this problem, a sub-system is constructed by recognizing a linear relation between two states. Subsequently, Lyapunov's indirect method is used to connect stability properties between the linearized system and the original nonlinear system, to rigorously establish the neutral stability properties of the original system. In particular, this analysis leads to a stability criterion for vascular expansion in terms of growth and remodeling kinetic parameters, geometric quantities and material properties. Numerical simulations were conducted to evaluate the theoretical stability criterion under broader conditions, as well as study the influence of key parameters and physical factors on growth properties. The theoretical results are also compared with prior numerical and experimental findings in the literature.
Collapse
Affiliation(s)
- Jiacheng Wu
- Department of Mechanical Engineering, University of California, Berkeley, CA, USA
| | - Shawn C Shadden
- Department of Mechanical Engineering, University of California, Berkeley, CA, USA.
| |
Collapse
|
16
|
Dale MA, Suh MK, Zhao S, Meisinger T, Gu L, Swier VJ, Agrawal DK, Greiner TC, Carson JS, Baxter BT, Xiong W. Background differences in baseline and stimulated MMP levels influence abdominal aortic aneurysm susceptibility. Atherosclerosis 2015; 243:621-9. [PMID: 26546710 DOI: 10.1016/j.atherosclerosis.2015.10.006] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2015] [Revised: 09/10/2015] [Accepted: 10/05/2015] [Indexed: 01/10/2023]
Abstract
OBJECTIVE Evidence has demonstrated profound influence of genetic background on cardiovascular phenotypes. Murine models in Marfan syndrome (MFS) have shown that genetic background-related variations affect thoracic aortic aneurysm formation, rupture, and lifespan of mice. MFS mice with C57Bl/6 genetic background are less susceptible to aneurysm formation compared to the 129/SvEv genetic background. In this study, we hypothesize that susceptibility to abdominal aortic aneurysm (AAA) will be increased in 129/SvEv mice versus C57Bl/6 mice. We tested this hypothesis by assessing differences in aneurysm size, tissue properties, immune response, and MMP expression. METHODS Mice of C57Bl/6 or 129/SvEv background underwent AAA induction by periaortic application of CaCl2. Baseline aortic diameters, tissue properties and MMP levels were measured. After aneurysm induction, diameters, MMP expression, and immune response (macrophage infiltration and bone marrow transplantation) were measured. RESULTS Aneurysms were larger in 129/SvEv mice than C57Bl/6 mice (83.0% ± 13.6 increase compared to 57.8% ± 6.4). The aorta was stiffer in the 129/SvEv mice compared to C57Bl/6 mice (952.5 kPa ± 93.6 versus 621.4 kPa ± 84.2). Baseline MMP-2 and post-aneurysm MMP-2 and -9 levels were higher in 129/SvEv aortas compared to C57Bl/6 aortas. Elastic lamella disruption/fragmentation and macrophage infiltration were increased in 129/SvEv mice. Myelogenous cell reversal by bone marrow transplantation did not affect aneurysm size. CONCLUSIONS These data demonstrate that 129/SvEv mice are more susceptible to AAA compared to C57Bl/6 mice. Intrinsic properties of the aorta between the two strains of mice, including baseline expression of MMP-2, influence susceptibility to AAA.
Collapse
MESH Headings
- Animals
- Aorta, Abdominal/enzymology
- Aorta, Abdominal/immunology
- Aorta, Abdominal/pathology
- Aortic Aneurysm, Abdominal/chemically induced
- Aortic Aneurysm, Abdominal/enzymology
- Aortic Aneurysm, Abdominal/genetics
- Aortic Aneurysm, Abdominal/immunology
- Aortic Aneurysm, Abdominal/pathology
- Bone Marrow Transplantation
- Calcium Chloride
- Dilatation, Pathologic
- Disease Models, Animal
- Elastic Modulus
- Genetic Predisposition to Disease
- Macrophages/enzymology
- Macrophages/immunology
- Male
- Matrix Metalloproteinase 2/metabolism
- Matrix Metalloproteinase 9/metabolism
- Mice, 129 Strain
- Mice, Inbred C57BL
- Pancreatic Elastase/metabolism
- Species Specificity
- Tropoelastin/metabolism
- Up-Regulation
- Vascular Stiffness
Collapse
Affiliation(s)
- Matthew A Dale
- Department of Surgery, University of Nebraska Medical Center, Omaha, NE, USA; Department of Pathology and Microbiology, University of Nebraska Medical Center, Omaha, NE, USA
| | - Melissa K Suh
- Department of Surgery, University of Nebraska Medical Center, Omaha, NE, USA
| | - Shijia Zhao
- Department of Mechanical & Materials Engineering, University of Nebraska-Lincoln, Lincoln, NE, USA
| | - Trevor Meisinger
- Department of Surgery, University of Nebraska Medical Center, Omaha, NE, USA
| | - Linxia Gu
- Department of Mechanical & Materials Engineering, University of Nebraska-Lincoln, Lincoln, NE, USA
| | - Vicki J Swier
- Department of Biomedical Sciences, Creighton University School of Medicine, Omaha, NE, USA
| | - Devendra K Agrawal
- Department of Biomedical Sciences, Creighton University School of Medicine, Omaha, NE, USA
| | - Timothy C Greiner
- Department of Pathology and Microbiology, University of Nebraska Medical Center, Omaha, NE, USA
| | - Jeffrey S Carson
- Department of Surgery, University of Nebraska Medical Center, Omaha, NE, USA
| | - B Timothy Baxter
- Department of Surgery, University of Nebraska Medical Center, Omaha, NE, USA; Department of Pathology and Microbiology, University of Nebraska Medical Center, Omaha, NE, USA
| | - Wanfen Xiong
- Department of Surgery, University of Nebraska Medical Center, Omaha, NE, USA.
| |
Collapse
|
17
|
Golledge J, Hankey GJ, Yeap BB, Almeida OP, Flicker L, Norman PE. Reported high salt intake is associated with increased prevalence of abdominal aortic aneurysm and larger aortic diameter in older men. PLoS One 2014; 9:e102578. [PMID: 25036037 PMCID: PMC4103816 DOI: 10.1371/journal.pone.0102578] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2014] [Accepted: 06/20/2014] [Indexed: 11/18/2022] Open
Abstract
Background Salt intake has been implicated in the pathogenesis of abdominal aortic aneurysm (AAA) through studies in rodent models but not previously studied in humans. The aim of this study was to examine the association between reported addition of salt to food and the prevalence of AAA. Methods A risk factor questionnaire which contained a question about salt intake was included as part of a population screening study for AAA in 11742 older men. AAA presence was assessed by abdominal ultrasound imaging using a reproducible protocol. Results The prevalence of AAA was 6.9, 8.5 and 8.6% in men who reported adding salt to food never, sometimes and always, respectively, p = 0.005. Addition of salt to food sometimes (odds ratio [OR]: 1.22, 95% confidence interval [CI]: 1.03–1.44) or always (OR: 1.23, 95% CI 1.04–1.47) was independently associated with AAA after adjustment for other risk factors including age, waist-hip ratio, blood pressure, history of hypertension, high cholesterol, angina, diabetes, myocardial infarction and stroke. Salt intake was also independently associated with aortic diameter (beta 0.023, p = 0.012). In men with no prior history of hypertension, high cholesterol, angina, myocardial infarction or stroke (n = 4185), the association between addition of salt to food sometimes (OR: 1.41, 95% CI 0.96–2.08) or always (OR: 1.52, 95% CI 1.04–2.22) and AAA remained evident. Conclusion Reported salt intake is associated with AAA in older men. Additional studies are needed to determine whether reducing salt intake would protect against AAA.
Collapse
Affiliation(s)
- Jonathan Golledge
- Queensland Research Centre for Peripheral Vascular Disease, School of Medicine and Dentistry, James Cook University, Townsville, Australia
- Department of Vascular and Endovascular Surgery, The Townsville Hospital, Townsville, Australia
- * E-mail:
| | - Graeme J. Hankey
- School of Medicine and Pharmacology, University of Western Australia, Perth, Australia
- Department of Neurology, Royal Perth Hospital, Perth, Australia
| | - Bu B. Yeap
- School of Medicine and Pharmacology, University of Western Australia, Perth, Australia
- Department of Endocrinology, Fremantle Hospital, Fremantle, Australia
| | - Osvaldo P. Almeida
- School of Psychiatry & Clinical Neurosciences, University of Western Australia, Perth, Australia
- WA Centre for Health & Ageing, Centre for Medical Research, Perth, Australia
- Department of Psychiatry, Royal Perth Hospital, Perth, Australia
| | - Leon Flicker
- School of Medicine and Pharmacology, University of Western Australia, Perth, Australia
- WA Centre for Health & Ageing, Centre for Medical Research, Perth, Australia
- Department of Geriatric Medicine, Royal Perth Hospital, Perth, Australia
| | - Paul E. Norman
- School of Surgery, University of Western Australia, Perth, Australia
| |
Collapse
|
18
|
Carotid-femoral pulse wave velocity is negatively correlated with aortic diameter. Hypertens Res 2014; 37:926-32. [DOI: 10.1038/hr.2014.101] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2014] [Revised: 04/23/2014] [Accepted: 05/01/2014] [Indexed: 11/08/2022]
|
19
|
Kanber B, Hartshorne TC, Horsfield MA, Naylor AR, Robinson TG, Ramnarine KV. Wall motion in the stenotic carotid artery: association with greyscale plaque characteristics, the degree of stenosis and cerebrovascular symptoms. Cardiovasc Ultrasound 2013; 11:37. [PMID: 24139162 PMCID: PMC3818684 DOI: 10.1186/1476-7120-11-37] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2013] [Accepted: 10/04/2013] [Indexed: 11/23/2022] Open
Abstract
Background Systolic dilation of the atherosclerotic carotid artery depends on several factors including arterial compliance and the haemodynamic environment. The purpose of this study was to quantify wall motion in stenotic carotid arteries and investigate any associations with the ultrasound greyscale plaque characteristics, the degree of stenosis, and the presence of cerebrovascular symptoms. Methods Variations in the lumen diameters of 61 stenotic carotid arteries (stenosis range 10%-95%) from 47 patients were measured before the proximal shoulder of the atherosclerotic plaque using ultrasound image sequences over several cardiac cycles. Absolute and percentage diameter changes from diastole to systole were calculated and their relationship to the degree of stenosis, greyscale plaque characteristics, and the presence of ipsilateral hemispheric symptoms were studied. Results The mean absolute diameter change from diastole to systole was 0.45 mm (s.d. 0.17), and the mean percentage diameter change was 6.9% (s.d. 3.1%). Absolute and percentage diameter changes did not have a statistically significant relationship to the degree of stenosis, greyscale plaque characteristics, or the presence of ipsilateral hemispheric symptoms (p > 0.05). Parameters significantly correlated with the presence of symptoms were the degree of stenosis (p = 0.01), plaque greyscale median (p = 0.02) and the plaque surface irregularity index (p = 0.02). Conclusions Our study confirmed the degree of stenosis, plaque greyscale median and our surface irregularity index were significant predictors of symptoms, but found no significant correlation between diameter changes of stenosed carotid arteries and the presence of ipsilateral hemispheric symptoms.
Collapse
Affiliation(s)
| | | | | | | | | | - Kumar V Ramnarine
- Department of Medical Physics, University Hospitals of Leicester NHS Trust, Leicester, LE1 5WW UK.
| |
Collapse
|
20
|
Hirasada K, Niimura H, Kubozono T, Nakamura A, Tatebo M, Ogawa S, Tsunematsu N, Chiba S, Matsushita T, Kusano K, Miyata M, Takezaki T. Values of cardio-ankle vascular index (CAVI) between Amami islands and Kagoshima mainland among health checkup examinees. J Atheroscler Thromb 2011; 19:69-80. [PMID: 22104173 DOI: 10.5551/jat.6627] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
AIM To investigate the prevalence and geographical variation of high arterial stiffness in groups from the Amami islands (Amami) and Kagoshima mainland (mainland), Japan, using the cardio-ankle vascular index (CAVI) as a surrogate marker of arterial stiffness. METHODS We recruited 4,523 health checkup examinees from Amami and 440 examinees from the mainland, with an age range of 40-69 years. The frequency of high arterial stiffness (CAVI≥9.0) was geographically compared between the regions, and both mean CAVI values were compared with those of the healthy Japanese population with less risk factors for coronary artery disease. Clinical, lifestyle, and regional factors for increased CAVI values were estimated by the multiple linear regression model. RESULTS The frequency of high arterial stiffness on Amami was significantly lower than on the mainland. Mean CAVI values on Amami were similar in males and lower in females than in the healthy Japanese population, but those on the mainland were higher for both sexes. Age, systolic blood pressure, triglycerides, fasting blood glucose, and a history of hypertension and diabetes mellitus were positively related to increased CAVI values on Amami. The regional factor of Amami, compared with the mainland, was negatively related to increased CAVI values in both sexes after adjusting for traditional cardiovascular risk factors. CONCLUSION CAVI values in Amami residents were significantly lower than in mainland residents, suggesting that environmental or genetic factors might have improved arterial stiffness in the Amami population.
Collapse
Affiliation(s)
- Kazuyo Hirasada
- Department of International Island and Community Medicine, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Japan
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
21
|
Markert MS, Della-Morte D, Cabral D, Roberts EL, Gardener H, Dong C, Wright CB, Elkind MSV, Sacco RL, Rundek T. Ethnic differences in carotid artery diameter and stiffness: the Northern Manhattan Study. Atherosclerosis 2011; 219:827-32. [PMID: 21906739 DOI: 10.1016/j.atherosclerosis.2011.08.028] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2011] [Revised: 07/28/2011] [Accepted: 08/16/2011] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Race/ethnic differences in carotid arterial function and structure exist among those with cerebrovascular disease, but whether differences persist among healthy populations is unknown. Our objective was to investigate differences in carotid artery diameter and stiffness between race/ethnic groups, and examine whether these race/ethnic differences were age-dependent. METHODS Carotid diameters were assessed by B-mode ultrasound among 1536 participants from the Northern Manhattan Study (NOMAS), and carotid stiffness metrics were calculated. We used multivariable linear regression models to determine the relationship between race/ethnicity and both carotid arterial stiffness and carotid diastolic diameter. RESULTS Mean participant age was 70 ± 9 years (Hispanics = 68 ± 8, blacks = 72 ± 9, and whites = 74 ± 9, p < 0.0001). Mean DDIAM was 6.2 ± 1.0mm (Hispanics = 6.2 ± 0.9 mm, blacks = 6.3 ± 1.0 mm, and whites = 6.3 ± 1.0 mm, p < 0.005) and mean STIFF was 8.7 ± 6.3 (Hispanics = 8.5 ± 5.7, blacks = 9.2 ± 6.2 and whites = 8.9 ± 6.9, p < 0.02). In a model that adjusted for sociodemographics and vascular risk factors including hypertension, diabetes, dislipidemia, renal function, physical acticity and a history of known coronary artery diseases; age was positively associated with greater DDIAM in Hispanics (p < 0.0001) but not among blacks or whites. Older age was associated with greater stiffness among Hispanics (p < 0.0001) and blacks (p < 0.003), but not among whites. CONCLUSIONS We found race/ethnic differences in the association between age and arterial stiffness and diameter, including age-dependent arterial dilation observed in Hispanics that was not observed among blacks or whites.
Collapse
Affiliation(s)
- Matthew S Markert
- Department of Neurology, Miller School of Medicine, University of Miami, Miami, FL 33101, USA
| | | | | | | | | | | | | | | | | | | |
Collapse
|
22
|
A prediction model for left ventricular mass in patients at high cardiovascular risk. ACTA ACUST UNITED AC 2011; 17:621-7. [PMID: 20814310 DOI: 10.1097/hjr.0b013e328332d4bc] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND Left ventricular (LV) mass has a continuous relation with cardiovascular risk, and regression of LV mass induced by pharmacological treatment is associated with improved prognosis. Therefore, early identification of patients with a large LV mass is desired. We developed a model to predict LV mass in individual hypertensives at high cardiovascular risk. DESIGN AND METHODS We analyzed data of 536 hypertensives with symptomatic extracardiac atherosclerotic disease or marked risk factors for atherosclerosis from a cross-sectional study in a tertiary referral center. LV mass was measured by cardiac MRI. We developed the prediction rule with multivariable linear regression analysis and stepwise backward elimination. Internal validation was assessed with bootstrap sampling to obtain an estimate of model performance (R²) that may be expected for new patients. RESULTS Important predictors for LV mass included sex, height, body mass index, systolic blood pressure, and previous aneurysm of the abdominal aorta. R² of the prediction model was 45% after internal validation, which was considerably higher than the R² of previously reported models (range 1-38%). Addition of electrocardiography data showed limited improvement of the model performance (R²=47%). CONCLUSION We present a prediction model for LV mass in hypertensives at high cardiovascular risk. After external validation, this model may be used in clinical practice to estimate LV mass for early identification of large LV mass. The predictions of the model may support appropriate medical care in the prevention of cardiovascular disease.
Collapse
|
23
|
Masugata H, Senda S, Hoshikawa J, Okuyama H, Inukai M, Himoto T, Imai M, Goda F. Differences between hypertensive and atherosclerotic lesions in retinal arteries assessed by Scheie's classification in hypertensive patients following stroke. Clin Exp Hypertens 2010; 32:335-40. [PMID: 21028995 DOI: 10.3109/10641960903443574] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Scheie's classification regarding hypertensive and atherosclerotic lesions in retinal arteries is generally used to assess the severity of hypertensive retinopathy and the risks of cardiovascular events in hypertensive patients. However, the differences between these two types of retinal artery lesions have not been fully examined. Both arterial stiffness and aortic root diameter are increased in hypertensive patients. The aim of this study was to elucidate differences in the two types of lesions by comparing their relationships to arterial stiffness and aortic root diameter in hypertensive patients following stroke. Fifty-two hypertensive patients following stroke were divided into five stages according to Scheie's classification of hypertensive (H stage 0-4) and atherosclerotic (S stage 0-4) lesions by ophthalmologists. Arterial stiffness was measured as brachial-ankle pulse wave velocity (baPWV) using an automatic waveform analyzer. Aortic root diameter was measured using M-mode echocardiography. The H and S stages in retinal arteries correlated with each other (ρ = 0.443, p < 0.001). However, the S stage correlated with baPWV (ρ = 0.385, p = 0.005) and the aortic root diameter (ρ = 0.285, p = 0.043), while the H stage did not correlate with these parameters. Multiple stepwise regression analysis demonstrated that the aortic root diameter was independently associated with S stage (β = 0.373, p = 0.006), even though baPWV was independently associated with neither S stage nor H stage. In conclusion, hypertensive lesions (H stage) in retinal arteries are associated with atherosclerotic lesions (S stage) in retinal arteries. However, S stage may reflect arterial stiffening and aortic root dilatation better than H stage in hypertensive patients following stroke. This difference between H and S stages of Scheie's classification should be kept in mind when considering the association between retinal microcirculation and large vessel arteriosclerosis.
Collapse
Affiliation(s)
- Hisashi Masugata
- Department of Integrated Medicine, Kagawa University, Kagawa, Japan.
| | | | | | | | | | | | | | | |
Collapse
|
24
|
Luc M, Polonsky T, Lammertin G, Spencer K. Automated Border Detection for Assessing the Mechanical Properties of the Carotid Arteries: Comparison with Carotid Intima–Media Thickness. J Am Soc Echocardiogr 2010; 23:567-72. [DOI: 10.1016/j.echo.2010.01.024] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2009] [Indexed: 12/01/2022]
|
25
|
Oulis P, Kouzoupis A, Kyrkou K, Masdrakis VG, Georgiopoulos G, Karapoulios E, Georgiou S, Karakatsanis NA, Lykka M, Papadimitriou GN, Papamichael C, Stamatelopoulos K. Reversal of increased arterial stiffness in severely depressed women after 6-week antidepressant treatment. J Affect Disord 2010; 122:164-6. [PMID: 19729203 DOI: 10.1016/j.jad.2009.08.003] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2009] [Accepted: 08/04/2009] [Indexed: 10/20/2022]
Abstract
BACKGROUND Increased arterial stiffness (AS) might be one significant acute mediator of the well-attested association between female depression and cardiovascular disease. METHODS We tested this hypothesis in an inpatient sample of 20 drug-free women undergoing a new clinically severe major depressive episode of recent onset with an adequately matched mentally healthy control group. Patients' clinical (Hamilton Depression Rating Scale) and vascular (Pulse-Wave-Velocity, PWV) assessments were performed both before the initiation and after the completion of their six-week antidepressant treatment. RESULTS Although initially patients exhibited significantly higher PWV values than controls, this was decreased and reached comparable levels to controls after treatment completion. Moreover, full-responders exhibited significantly greater vascular improvement than their partial-responders counterparts and the magnitude of their amelioration was strongly associated with the magnitude of their clinical improvement. LIMITATIONS Our sample-size was small and patients' follow-up short. CONCLUSIONS Our findings provide support to the hypothesis that current severe major depressive episode in women leads acutely to aggravation of arterial stiffness, reversible however upon timely and effective antidepressant treatment.
Collapse
Affiliation(s)
- Panagiotis Oulis
- Athens University Medical School, 1st Department of Psychiatry, Eginition Hospital, 11528 Athens, Greece.
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
26
|
Deguchi JO, Huang H, Libby P, Aikawa E, Whittaker P, Sylvan J, Lee RT, Aikawa M. Genetically engineered resistance for MMP collagenases promotes abdominal aortic aneurysm formation in mice infused with angiotensin II. J Transl Med 2009; 89:315-26. [PMID: 19153555 PMCID: PMC2932654 DOI: 10.1038/labinvest.2008.167] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Clinical evidence links increased aortic collagen content and stiffness to abdominal aortic aneurysm (AAA) formation. However, the possibility that excess collagen contributes to AAA formation remains untested. We investigated the hypothesis that augmented collagen promotes AAA formation, and employed apoE-null mice expressing collagenase-resistant mutant collagen (Col(R/R)/apoE(-/-)), heterozygote (Col(R/+)/apoE(-/-)), or wild-type collagen (Col(+/+)/apoE(-/-)) infused with angiotensin II to induce AAA. As expected, the aortas of Col(R/R)/apoE(-/-) mice contained more interstitial collagen than those from the other groups. Angiotensin II treatment elicited more AAA formation in Col(R/R)/apoE(-/-) mice than Col(R/+)/apoE(-/-) or Col(+/+)/apoE(-/-) mice. Aortic circumferences correlated positively with collagen content, determined by picrosirius red and Masson trichrome staining. Mechanical testing of aortas of Col(R/R)/apoE(-/-) mice showed increased stiffness and susceptibility to mechanical failure compared to those of Col(+/+)/apoE(-/-) mice. Optical analysis further indicated altered collagen fiber orientation in the adventitia of Col(R/R)/apoE(-/-) mice. These results demonstrate that collagen content regulates aortic biomechanical properties and influences AAA formation.
Collapse
Affiliation(s)
- Jun-o Deguchi
- Cardiovascular Division, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA
| | - Hayden Huang
- Cardiovascular Division, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA
| | - Peter Libby
- Cardiovascular Division, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA
| | - Elena Aikawa
- Center for Molecular Imaging Research, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA
| | - Peter Whittaker
- Department of Emergency Medicine, Wayne State University, Detroit, MI
| | - Jeremy Sylvan
- Cardiovascular Division, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA
| | - Richard T. Lee
- Cardiovascular Division, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA
| | - Masanori Aikawa
- Cardiovascular Division, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA
| |
Collapse
|
27
|
Meijs MFL, Bots ML, Cramer MJM, Vonken EJA, Velthuis BK, van der Graaf Y, Spiering W, Mali WPTM, Doevendans PA. Differences in determinants of left ventricular mass assessed by cardiac magnetic resonance imaging across subjects with and without previous symptomatic atherosclerotic disease. Int J Cardiol 2008; 138:145-50. [PMID: 18804881 DOI: 10.1016/j.ijcard.2008.08.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2008] [Revised: 06/06/2008] [Accepted: 08/08/2008] [Indexed: 10/21/2022]
Abstract
BACKGROUND Most previous studies on determinants of left ventricular (LV) mass have used echocardiography, which is less accurate than cardiac MRI (CMR). Furthermore, studies that used CMR to study the determinants of LV mass were performed in the general population. However, determinants may differ between those with and without previous symptomatic events. We studied the relation between atherosclerotic risk factors and LV mass in subjects free from cardiac disease, yet with and without atherosclerotic disease elsewhere. METHODS A CMR was performed in 531 hypertensive subjects with clinically manifest extra-cardiac atherosclerotic disease or marked risk factors for atherosclerosis. In all subjects information on atherosclerotic risk factors was collected. Multivariable linear regression was used to study the relation of risk factors with LV mass. Interaction was evaluated with multiplicative interaction terms. RESULTS Overall, male gender, weight, height, systolic blood pressure, albuminuria, current smoking, and a history of abdominal aortic aneurysm (AAA) were related to an increased LV mass. In subjects without a history of symptomatic atherosclerotic disease, gender, weight, height and systolic blood pressure were related to LV mass. In addition to these risk factors, albuminuria, current smoking and a history of AAA were related to LV mass in subjects with a history of symptomatic atherosclerotic disease. CONCLUSION Our study points towards differences in risk factor relations across populations with and without symptomatic atherosclerotic disease. The observed relationship between cardiovascular risk factors and LV mass re-emphasizes the importance of adequate treatment of modifiable risk factors in the prevention of cardiovascular disease.
Collapse
Affiliation(s)
- Matthijs F L Meijs
- Department of Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands; Department of Radiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | | | | | | | | | | | | | | | | | | |
Collapse
|
28
|
Kim DH, Kim J, Kim JM, Lee AY. Increased brachial-ankle pulse wave velocity is independently associated with risk of cerebral ischemic small vessel disease in elderly hypertensive patients. Clin Neurol Neurosurg 2008; 110:599-604. [PMID: 18471955 DOI: 10.1016/j.clineuro.2008.03.009] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2007] [Revised: 03/05/2008] [Accepted: 03/06/2008] [Indexed: 10/22/2022]
Abstract
OBJECTIVE Increased arterial stiffness is an independent predictor of cardiovascular diseases in hypertensive patients. Hypertension and aging can cause similar damage to small vessel walls. The objective of this study was to determine relationship between arterial stiffness measured by brachial-ankle pulse wave velocity (baPWV) and the risk of cerebral small vessel disease (SVD) in elderly people with hypertension. METHODS We studied 196 elderly subjects with hypertension (> or =50 years of age) who had neither large vessel stroke nor cardiac embolism. These patients were divided into three groups based on the results of brain MRI: (1) those with first-ever small vessel stroke; (2) those with asymptomatic subcortical ischemia; and (3) a control group with hypertension. RESULTS The baPWV was significantly increased in the patients with first-ever small vessel stroke or asymptomatic subcortical infarction when compared to the control group, after adjusting for systolic blood pressure (SBP), pulse pressure (PP), and hs-CRP (p=0.005). Among subjects with SVD on MRI, the number of lacunar infarcts (LIs)> or =5 was significantly related to a higher baPWV (p=0.02). The relationship between the severity of periventricular white matter hyperintensities (PWMH) and the degree of baPWV became insignificant after adjustment for age. CONCLUSION Increased baPWV was significantly associated with the risk of SVD in elderly persons with hypertension. Therefore, the measurement of baPWV could be used to predict SVD.
Collapse
Affiliation(s)
- Dae-Hyun Kim
- Department of Neurology, College of Medicine, Chungnam National University, 640 Daesa-dong, Joong-ku, Daejeon 301-721, Republic of Korea
| | | | | | | |
Collapse
|
29
|
Cheung N, Islam FMA, Jacobs DR, Sharrett AR, Klein R, Polak JF, Cotch MF, Klein BE, Ouyang P, Wong TY. Arterial compliance and retinal vascular caliber in cerebrovascular disease. Ann Neurol 2007; 62:618-24. [DOI: 10.1002/ana.21236] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
|
30
|
|
31
|
Mizuguchi Y, Tanaka H, Oishi Y, Miyoshi H, Emi S, Ishimoto T, Nagase N, Oki T. Predictive Value of Associations Between Carotid Arterial Sclerosis and Left Ventricular Diastolic Dysfunction in Patients with Cardiovascular Risk Factors. J Am Soc Echocardiogr 2007; 20:806-12. [PMID: 17617306 DOI: 10.1016/j.echo.2007.01.006] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2006] [Indexed: 10/23/2022]
Abstract
It is well known that arterial stiffness affects the morbidity and mortality associated with cardiovascular disease. However, there are limited data addressing the relationship between arterial stiffness and left ventricular (LV) diastolic function in patients with cardiovascular risk factors. Subclinical atherosclerosis was determined by measuring the intima-media thickness and stiffness (beta) of the left and right common carotid arteries using B- and M-mode ultrasonography in 30 patients with one or more cardiovascular risk factors. LV systolic and diastolic function were also determined by measuring transmitral flow velocity, mitral annular motion velocity, and myocardial strain and strain rate profiles using pulsed Doppler, tissue velocity, and ultrasonic strain imaging. The carotid stiffness beta was greater and the peak early diastolic strain rates of the LV posterior and inferior walls were lower in these patients than in the age-matched control group. The carotid intima-media thickness correlated only with body mass index and LV wall thickness. The carotid stiffness beta correlated with age, peak early diastolic velocity and deceleration time of the transmitral flow, peak early diastolic mitral annular motion velocity, and peak early diastolic strain rates of the LV walls. Multiple linear regression analysis revealed that early diastolic strain rates of the LV walls are strongly related to carotid stiffness beta. In conclusion, LV relaxation is significantly associated with carotid arterial atherosclerosis, particularly sclerosis, in patients with cardiovascular risk factors. These results support the importance of screening using ultrasonic strain imaging and early intervention in this patient population.
Collapse
Affiliation(s)
- Yukio Mizuguchi
- Cardiovascular Section, Higashi Tokushima National Hospital, National Hospital Organization, Tokushima, Japan.
| | | | | | | | | | | | | | | |
Collapse
|
32
|
Martens FMAC, van der Graaf Y, Dijk JM, Olijhoek JK, Visseren FLJ. Carotid arterial stiffness is marginally higher in the metabolic syndrome and markedly higher in type 2 diabetes mellitus in patients with manifestations of arterial disease. Atherosclerosis 2007; 197:646-53. [PMID: 17374372 DOI: 10.1016/j.atherosclerosis.2007.02.019] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2006] [Revised: 02/04/2007] [Accepted: 02/19/2007] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Insulin resistance is generally considered to be of major importance in the pathophysiology of the metabolic syndrome and type 2 diabetes mellitus, both high-risk conditions for cardiovascular complications. Carotid artery stiffness is increasingly recognized as an important predictor of cardiovascular morbidity and mortality. Therefore, in the present study we determined whether the metabolic syndrome (MetSyn) and type 2 diabetes mellitus (DM2) are associated with carotid artery stiffness in patients with already clinical manifestations of arterial disease. METHODS AND RESULTS A cross-sectional study in 2105 patients with manifest arterial disease (cerebral, coronary or peripheral artery disease, renal artery stenosis or an aneurysm of the abdominal aorta) was performed. The difference in carotid stiffness between patients with and without MetSyn and with and without DM2 was studied with linear regression analysis. Compared to patients without DM2 (N=1112), patients with DM2 (N=301) had significantly higher arterial stiffness (distension -18.5 (-35.1;-1.9) 95% CI/distensibility -1.8 (-2.2;-1.4) 95% CI). Generally, there was a trend of higher carotid stiffness in patients with MetSyn (N=922) compared to patients without (N=1112) MetSyn (distension -9.6 (-21.5;2.3) 95% CI/distensibility -2.0 (-2.6;-1.4) 95% CI). Excluding the patients with also DM2 (N=230) from the MetSyn-group diminished this relation (distension -5.7 (-18.8;7.4) 95% CI/distensibility -1.1 (-1.6;-0.6) 95% CI). Furthermore, in the population as a whole, carotid artery stiffness increased with increasing number of components of the metabolic syndrome (p=0.08 for distension/p< or =0.001 for distensibility). In addition, this association was not as clear after exclusion of the patients with DM2 from the MetSyn-group (p=0.24 for distension/p<0.001 for distensibility). From all the components of the MetSyn only high blood pressure and high fasting glucose influenced the carotid artery stiffness. CONCLUSIONS We concluded that (increasing number of components of) the metabolic syndrome were associated with marginally higher carotid artery stiffness, while type 2 diabetes was associated with a marked increase in carotid artery stiffness, in patients with already clinical manifestations of arterial disease.
Collapse
Affiliation(s)
- Fabrice M A C Martens
- Department of Internal Medicine, Section of Vascular Medicine, University Medical Center Utrecht, The Netherlands.
| | | | | | | | | |
Collapse
|
33
|
Painter RC, de Rooij SR, Bossuyt PM, de Groot E, Stok WJ, Osmond C, Barker DJ, Bleker OP, Roseboom TJ. Maternal nutrition during gestation and carotid arterial compliance in the adult offspring: the Dutch famine birth cohort. J Hypertens 2007; 25:533-40. [PMID: 17278968 DOI: 10.1097/hjh.0b013e328012135b] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
OBJECTIVE Experimental evidence indicates that maternal undernutrition during gestation may program hypertension in the offspring. We investigated whether maternal undernutrition leads to increased arterial stiffness. METHODS We measured carotid artery lumen diameter (LD), distensibility (DC), stiffness (beta), and compliance (CC) by M-mode ultrasound in 673 individuals, aged 56-61 years, who had been born as term singletons around the time of the 1944-45 Dutch famine. RESULTS Maternal famine exposure had no effect on any of the measures of carotid size or stiffness in the offspring. Low maternal weight at the end of pregnancy and low birth weight were associated with decreased LD (0.01 mm/kg maternal weight, sex-adjusted P < 0.001; 0.1 mm/kg birth weight, sex-adjusted P = 0.08) and CC (0.002 mm2/kPa per kg maternal weight, sex-adjusted P = 0.001; 0.03 mm2/kPa per kg birth weight, sex-adjusted P = 0.03), but neither was associated with increased beta, or decreased DC. These effects were not attenuated by adjusting for maternal protein/carbohydrate ratio in the third trimester. The association of low birth weight with increased CC diminished after adjusting for maternal weight. The association of maternal weight with CC was smaller when adjusted for LD. CONCLUSION Our findings suggest that small maternal size, not poor maternal diet, in late gestation programs decreased arterial compliance in the adult offspring by affecting vessel size rather than vessel wall stiffness.
Collapse
Affiliation(s)
- Rebecca C Painter
- Department of Clinical Epidemiology and Biostatistics, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
| | | | | | | | | | | | | | | | | |
Collapse
|
34
|
Wykretowicz A, Trojnarska O, Guzik P, Katarzyska A. Arterial Stiffness in Adult Patients with Cyanotic Congenital Heart Disease. CONGENIT HEART DIS 2007; 2:134-8. [DOI: 10.1111/j.1747-0803.2007.00087.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
35
|
Alecu C, Gueguen R, Aubry C, Salvi P, Perret-Guillaume C, Ducrocq X, Vespignani H, Benetos A. Determinants of arterial stiffness in an apparently healthy population over 60 years. J Hum Hypertens 2006; 20:749-56. [PMID: 16855622 DOI: 10.1038/sj.jhh.1002072] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Arterial stiffness assessed by the pulse wave velocity (PWV), a non-invasive and reproducible method, predicts cardiovascular morbidity and mortality. The main determinants of arterial stiffness are well established in younger and middle-aged populations, but much less in the elderly. The aim of this study was to describe the determinants of arterial stiffness in elderly apparently healthy subjects. The study included 221 voluntary subjects born before 1944 (mean age 67.4+/-5.0 years), who had a standard health check-up at the 'Centre de Médecine Préventive' of Nancy. Arterial stiffness was evaluated by measuring the carotid-femoral PWV with the PulsePen automatic device. Clinical and biological parameters were evaluated at the same day. Measurements were valid and analysed in 207 subjects (94 women). Mean PWV was 9.39+/-2.64 m/s. Men showed higher PWV values than women (9.99+/-2.56 vs 8.66+/-2.56, P<0.001). In univariate analysis, PWV was correlated with age (r=0.26, P<0.001) and mean arterial pressure (MAP) (r=0.40, P<0.001), and these relationships were similar in men and women. Subjects with hypertension (P<0.001), diabetes mellitus (P<0.001) and obesity (P<0.01) had higher values of PWV. In multiple regression analysis, PWV correlated positively and independently with age, male gender, MAP and diabetes mellitus. In conclusion, in an apparently healthy elderly population, the main determinants of arterial stiffness are the age, MAP, diabetes and gender. Our study also shows that the gender-related differences in arterial stiffness observed in middle-aged subjects are maintained in the elderly.
Collapse
Affiliation(s)
- C Alecu
- Department of Neurology, University of Nancy, Nancy, France
| | | | | | | | | | | | | | | |
Collapse
|
36
|
Tsivgoulis G, Vemmos K, Papamichael C, Spengos K, Daffertshofer M, Cimboneriu A, Zis V, Lekakis J, Zakopoulos N, Mavrikakis M. Common carotid arterial stiffness and the risk of ischaemic stroke. Eur J Neurol 2006; 13:475-81. [PMID: 16722972 DOI: 10.1111/j.1468-1331.2006.01291.x] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
In the present case-control study we aimed to investigate the association of common carotid arterial (CCA) stiffness with ischaemic stroke (IS) and to determine whether this relationship was independent of conventional risk factors including CCA intima-media thickness (CCA-IMT). CCA distensibility, defined as the change of CCA-diameter during the cardiac cycle, and CCA-IMT were evaluated by means of high-resolution B-mode carotid ultrasound examination in consecutive, first-ever IS patients (n=193) and in age- and sex-matched control subjects (n=106). The CCA distensibility (inverse of CCA stiffness) was significantly (P=0.007) lower in IS (0.353 mm, 95% CI: 0.326-0.379) than in control subjects (0.415 mm, 95% CI: 0.378-0.451) even after adjusting for blood pressure values, diastolic CCA-diameter and height. The multivariate logistic regression procedure selected CCA-IMT and CCA distensibility as the only independent predictor variables of IS. Each 1 SD increase in the CCA-IMT and each 1 SD decrease in the CCA distensibility independently increased the likelihood of IS by 167.0% (OR: 2.67, 95% CI: 1.80-3.96, P<0.001) and 59.0% (OR: 1.59, 95% CI: 1.22-2.07, P=0.001) respectively. Increased CCA stiffness is associated with IS independent of conventional risk factors and CCA-IMT. The causal interrelationship between the elastic properties of the CCA and the risk of stroke deserves further investigation by longitudinal studies.
Collapse
Affiliation(s)
- G Tsivgoulis
- Department of Neurology, University of Athens, 'Eginition Hospital', Athens, Greece.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
37
|
Dijk JM, Wangge G, Graaf YVD, Bots ML, Grobbee DE, Algra A. Hemoglobin and atherosclerosis in patients with manifest arterial disease. The SMART-study. Atherosclerosis 2006; 188:444-9. [PMID: 16388808 DOI: 10.1016/j.atherosclerosis.2005.11.010] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2005] [Revised: 10/12/2005] [Accepted: 11/08/2005] [Indexed: 11/22/2022]
Abstract
BACKGROUND Decreased hemoglobin levels are known to be associated with an increased risk of coronary mortality and morbidity. This is largely thought to result from the development of left ventricular hypertrophy. Similar remodeling mechanisms of the vessel wall that may result in atherosclerosis are likely to be present. We studied whether hemoglobin levels are related to different vascular indicators of atherosclerosis. METHODS AND RESULTS This cross-sectional study was performed in the first consecutive 2514 patients with manifest arterial disease enrolled in the SMART-study (Second Manifestations of ARTerial disease). The relation of hemoglobin levels with common carotid IMT (CIMT), presence of a>/=50% internal carotid artery stenosis (ICAS) and prevalent peripheral arterial disease (PAD) was assessed with linear and logistic regression analyses. Each mmol/l increase in hemoglobin was associated with a lower CIMT (-0.03 mm [95% CI: -0.04; -0.01]) and a lower prevalence of >/=50% ICAS (odds ratio: 0.84 [95% CI: 0.73; 0.97]) after adjustment for age, gender and potential confounders. Hemoglobin was not related to prevalence of peripheral arterial disease (1.02 [95% CI: 0.89; 1.16]). CONCLUSIONS This study shows that in patients with manifest arterial disease, increasing hemoglobin levels are associated with reduced severity of atherosclerosis.
Collapse
Affiliation(s)
- J M Dijk
- Julius Center for Health Sciences and Primary Care, University, Medical Center Utrecht (UMCU), Utrecht, The Netherlands
| | | | | | | | | | | |
Collapse
|
38
|
Snowhill PB, Silver FH. A Mechanical Model of Porcine Vascular Tissues-Part II: Stress–Strain and Mechanical Properties of Juvenile Porcine Blood Vessels. ACTA ACUST UNITED AC 2005. [DOI: 10.1007/s10558-005-9070-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
|
39
|
Haro LH, Krajicek M, Lobl JK. Challenges, Controversies, and Advances in Aortic Catastrophes. Emerg Med Clin North Am 2005; 23:1159-77. [PMID: 16199343 DOI: 10.1016/j.emc.2005.07.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Emergency physicians (EPs) are commonly faced with life-threatening entities. Particularly challenging are the aortic catastrophes, such as penetrating aortic ulcers (PAUs), intramural hematomas (IMHs), and atypical presentations of acute aortic dissections and ruptured abdominal aortic aneurysms. Several factors account for this: (1) the rapidly evolving knowledge (particularly in the pathogenesis and precursors of aortic dissection [AD]), (2) the lack of comfort caused by infrequent exposure, (3) the misconceptions about the work up and treatment, (4) the lack of emergent vascular surgery back up in the community, and finally (5) the high short-term mortality and missed rates. Finally, the media has publicized cases of celebrities and other patients who experienced fatal outcomes when their aortic catastrophes went undiagnosed. Practitioners of emergency care should, therefore, understand the challenges, be aware of the recent advances, and help limit the controversies in the evaluation and management of these patients.
Collapse
Affiliation(s)
- Luis H Haro
- Department of Emergency Medicine, Mayo Clinic Rochester, Mayo Clinic College of Medicine, MN 55901, USA.
| | | | | |
Collapse
|
40
|
Matsuoka O, Otsuka K, Murakami S, Hotta N, Yamanaka G, Kubo Y, Yamanaka T, Shinagawa M, Nunoda S, Nishimura Y, Shibata K, Saitoh H, Nishinaga M, Ishine M, Wada T, Okumiya K, Matsubayashi K, Yano S, Ichihara K, Cornélissen G, Halberg F, Ozawa T. Arterial stiffness independently predicts cardiovascular events in an elderly community — Longitudinal Investigation for the Longevity and Aging in Hokkaido County (LILAC) study. Biomed Pharmacother 2005; 59 Suppl 1:S40-4. [PMID: 16275505 PMCID: PMC2836163 DOI: 10.1016/s0753-3322(05)80008-3] [Citation(s) in RCA: 77] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
We investigated the predictive value of arterial stiffness to assess cardiovascular risk in elderly community-dwelling people by means of a multivariate Cox model. In 298 people older than 75 years (120 men and 178 women, average age: 79.6 years), brachial-ankle pulse wave velocity (baPWV) was measured between the right arm and ankle in a supine position. The LILAC study started on July 25, 2000, consultation was repeated yearly, and the last follow-up ended on November 30, 2004. During this follow-up span of 1227 days, there were nine cardiovascular deaths, the cause of death being myocardial infarction for two men and three women or stroke for two men and two women. In Cox proportional hazard models, baPWV as well as age, Mini-Mental State Examination (MMSE), Hasegawa Dementia Scale Revised (HDSR) and the low-frequency/high-frequency (LF/HF) ratio showed a statistically significant association with the occurrence of cardiovascular death. A two-point increase in MMSE and HDSR score significantly protected against cardiovascular death, the relative risk (RR) being 0.776 (P = 0.0369) and 0.753 (P = 0.0029), respectively. The LF/HF ratio also was significant (P = 0.025), but the other indices of HRV were not. After adjustment for age and HDSR, a 200 cm/s increase in baPWV was associated with a 30.2% increase in risk (RR = 1.302, 95% CI: 1.110-1.525), and a 500 cm/s increase in baPWV with a 93.3% increase in risk (RR = 1.933, 95% CI: 1.300-2.874, P = 0.0011), whereas the LF/HF ratio was no longer associated with a statistically significant increase in cardiovascular mortality. In elderly community-dwelling people, arterial stiffness measured by means of baPWV predicted the occurrence of cardiovascular death beyond the prediction provided by age, gender, blood pressure and cognitive functions. baPWV should be added to the cardiovascular assessment in various clinical settings, including field medical surveys and preventive screening. The early detection of risk by chronomics allows the timely institution of prophylactic measures, thereby shifting the focus from rehabilitation to prehabilitation medicine, as a public service to several Japanese towns.
Collapse
Affiliation(s)
- O Matsuoka
- Department of Medicine, Division of Neurocardiology and Chronoecology, Tokyo Women's Medical University, Medical Center East, Nishiogu 2-1-10, Arakawa, Tokyo 116-8567, Japan.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
41
|
Eveson DJ, Robinson TG, Shah NS, Panerai RB, Paul SK, Potter JF. Abnormalities in cardiac baroreceptor sensitivity in acute ischaemic stroke patients are related to aortic stiffness. Clin Sci (Lond) 2005; 108:441-7. [PMID: 15656783 DOI: 10.1042/cs20040264] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Cardiac BRS (baroreceptor reflex sensitivity) is impaired following ischaemic stroke and predicts the risk of subsequent long-term death and disability. Impaired cardiac BRS may be due to impaired central processing of baroreceptor information following stroke or reduced baroreceptor activity due to increased large artery stiffness. We evaluated the relationship between large (aortic) artery stiffness and cardiac BRS during the acute phase of ischaemic stroke and in comparison with a group of stroke-free control subjects. Thirty-one ischaemic stroke patients were studied within 48 h of onset and again on day 14, along with 26 control subjects free of cerebrovascular disease. Cardiac BRS (determined by spectral analyses) and arterial stiffness estimated by PWVcf (carotid–femoral pulse wave velocity) using applanation tonometry were obtained. At baseline, cardiac BRS was lower in the stroke compared with the control group (4.3±2.3 compared with 6.5±4.2 ms/mmHg; P<0.05). Cardiac BRS values were correlated with PWVcf at <48 h (r=−0.51, P<0.01) and on day 14 (r=−0.54, P<0.01), but not in the control group (r=−0.27, P=not significant). In quantile regression models, taking into account the effect of all cardiovascular variables, cardiac BRS was independently related to PWVcf at baseline and on day 14 in the stroke patients, but stroke was not related to cardiac BRS level when other cardiovascular variables were considered. Wall stiffness of the arterial vessels involved in the baroreflex arc may account for, at least in part, the reduced cardiac BRS observed in acute stroke patients.
Collapse
Affiliation(s)
- David J Eveson
- Ageing and Stroke Medicine Group, Department of Cardiovascular Sciences, Leicester Warwick Medical School, Glenfield Hospital, Groby Road, Leicester LE3 9QP, UK.
| | | | | | | | | | | |
Collapse
|
42
|
Dijk JM, Algra A, van der Graaf Y, Grobbee DE, Bots ML. Carotid stiffness and the risk of new vascular events in patients with manifest cardiovascular disease. The SMART study. Eur Heart J 2005; 26:1213-20. [PMID: 15824075 DOI: 10.1093/eurheartj/ehi254] [Citation(s) in RCA: 86] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
AIMS To study whether arterial stiffness is related to risk of new vascular events in patients with manifest arterial disease and to examine whether this relation varies between patients who differ with respect to baseline vascular risk, arterial stiffness, or systolic blood pressure (SBP). METHODS AND RESULTS The study was performed in the first consecutive 2183 patients with manifest arterial disease enrolled in the SMART study (Second Manifestations of ARTerial disease), a cohort study among patients with manifest arterial disease or cardiovascular risk factors. Common carotid distension (i.e. the change in carotid diameter in systole relative to diastole) was measured at baseline by ultrasonography. With the distension, several stiffness parameters were determined. In the entire cohort, none of the carotid artery stiffness parameters was related to the occurrence of vascular events. However, decreased stiffness was related to decreased vascular risk in subjects with low baseline SBP. The relation of carotid stiffness with vascular events did not differ between tertiles of baseline risk and carotid stiffness. CONCLUSION Carotid artery stiffness is no independent risk factor for vascular events in patients with manifest arterial disease. However, in patients with low SBP, decreased carotid stiffness may indicate a decreased risk of vascular events.
Collapse
Affiliation(s)
- Joke M Dijk
- Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Huispostnummer Str. 6.131, PO Box 85060, 3508 BA Utrecht, The Netherlands
| | | | | | | | | |
Collapse
|