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Cooper LL, Prescott BR, Xanthakis V, Benjamin EJ, Vasan RS, Hamburg NM, Long MT, Mitchell GF. Association of Aortic Stiffness and Pressure Pulsatility With Noninvasive Estimates of Hepatic Steatosis and Fibrosis: The Framingham Heart Study. Arterioscler Thromb Vasc Biol 2024; 44:1704-1715. [PMID: 38752348 PMCID: PMC11209780 DOI: 10.1161/atvbaha.123.320553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2023] [Accepted: 04/29/2024] [Indexed: 06/28/2024]
Abstract
BACKGROUND Arterial stiffening may contribute to the pathogenesis of metabolic dysfunction-associated steatotic liver disease. We aimed to assess relations of vascular hemodynamic measures with measures of hepatic steatosis and fibrosis in the community. METHODS Our sample was drawn from the Framingham Offspring, New Offspring Spouse, Third Generation, Omni-1, and Omni-2 cohorts (N=3875; mean age, 56 years; 54% women). We used vibration-controlled transient elastography to assess controlled attenuation parameter and liver stiffness measurements as measures of liver steatosis and liver fibrosis, respectively. We assessed noninvasive vascular hemodynamics using arterial tonometry. We assessed cross-sectional relations of vascular hemodynamic measures with continuous and dichotomous measures of hepatic steatosis and fibrosis using multivariable linear and logistic regression. RESULTS In multivariable models adjusting for cardiometabolic risk factors, higher carotid-femoral pulse wave velocity (estimated β per SD, 0.05 [95% CI, 0.01-0.09]; P=0.003), but not forward pressure wave amplitude and central pulse pressure, was associated with more liver steatosis (higher controlled attenuation parameter). Additionally, higher carotid-femoral pulse wave velocity (β=0.11 [95% CI, 0.07-0.15]; P<0.001), forward pressure wave amplitude (β=0.05 [95% CI, 0.01-0.09]; P=0.01), and central pulse pressure (β=0.05 [95% CI, 0.01-0.09]; P=0.01) were associated with more hepatic fibrosis (higher liver stiffness measurement). Associations were more prominent among men and among participants with obesity, diabetes, and metabolic syndrome (interaction P values, <0.001-0.04). Higher carotid-femoral pulse wave velocity, but not forward pressure wave amplitude and central pulse pressure, was associated with higher odds of hepatic steatosis (odds ratio, 1.16 [95% CI, 1.02-1.31]; P=0.02) and fibrosis (odds ratio, 1.40 [95% CI, 1.19-1.64]; P<0.001). CONCLUSIONS Elevated aortic stiffness and pressure pulsatility may contribute to hepatic steatosis and fibrosis.
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Affiliation(s)
| | - Brenton R. Prescott
- Section of Preventive Medicine and Epidemiology, Department of Medicine, Boston University Chobanian and Avedisian School of Medicine, Boston, MA, USA
| | - Vanessa Xanthakis
- Section of Preventive Medicine and Epidemiology, Department of Medicine, Boston University Chobanian and Avedisian School of Medicine, Boston, MA, USA
- Boston University and NHLBI’s Framingham Study, Framingham, MA, USA
- Department of Biostatistics, Boston University School of Public Heath, Boston, MA, USA
| | - Emelia J. Benjamin
- Boston University and NHLBI’s Framingham Study, Framingham, MA, USA
- Evans Department of Medicine, Boston Medical Center, Boston, MA, USA
- Whitaker Cardiovascular Institute, Boston University Chobanian and Avedisian School of Medicine, Boston, MA, USA
- Cardiology and Preventive Medicine Sections, Department of Medicine, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA
| | - Ramachandran S. Vasan
- Boston University and NHLBI’s Framingham Study, Framingham, MA, USA
- The University of Texas School of Public Health San Antonio, San Antonio, TX, USA
- The University of Texas Health Science Center, San Antonio, TX, USA
| | - Naomi M. Hamburg
- Evans Department of Medicine, Boston Medical Center, Boston, MA, USA
- Whitaker Cardiovascular Institute, Boston University Chobanian and Avedisian School of Medicine, Boston, MA, USA
| | - Michelle T. Long
- Department of Medicine, Section of Gastroenterology, Boston University Chobanian and Avedisian School of Medicine, Boston, MA, USA
- Novo Nordisk A/S, Søborg, Denmark
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Jha M, Musani S, McCarthy I, Hundley WG, Carr JJ, Terry JG, Oshunbade A, Vasan RS, Butler J, Hall M, Mitchell GF, Fox E, Tsao CW. Subclinical association of aortic stiffness with cardiac structure and function in African-Americans: The Jackson Heart Study. THE INTERNATIONAL JOURNAL OF CARDIOVASCULAR IMAGING 2024:10.1007/s10554-024-03159-y. [PMID: 38909092 DOI: 10.1007/s10554-024-03159-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/29/2024] [Accepted: 06/03/2024] [Indexed: 06/24/2024]
Abstract
Cardiovascular disease (CVD) morbidity and mortality are high among black adults. We aimed to study the granular subclinical relations of aortic stiffness and left ventricular (LV) function and remodeling in blacks, in whom limited data are available. In the Jackson Heart Study, 1050 U.S. community-dwelling black adults without CVD underwent 1.5 T cardiovascular magnetic resonance. We assessed regional and global aortic stiffness and LV structure and function, including LV mass indexed to body surface area (LVMI), end-diastolic volume (LVEDV), ejection fraction (EF), and global and regional circumferential strain (Ecc). Phase contrast images of the cross-sectional aorta at the pulmonary artery bifurcation and abdominal aorta bifurcation were acquired to measure pulse wave velocity of the aortic arch (AA-PWV) and thoracic aorta (T-PWV). Results of multivariable-adjusted analyses are presented as SD unit change in LV variables per SD change in PWV variables. Participants were 62% women with mean age of 59 ± 10 years. Higher AA-PWV and T-PWV were associated with greater LVMI: for T-PWV, β = 0.10, 95% CI = 0.03-0.16, p = 0.002. Higher AA-PWV and T-PWV were associated with worse (more positive) Ecc at the LV base (for AA-PWV, β = 0.13, 95% CI = 0.05-0.20, p = 0.0007), but not mid-LV or apex. AA-PWV and T-PWV were not associated with LV mass/LVEDV or EF. In this cross-sectional study of blacks without CVD in the U.S., aortic stiffness is associated with subclinical adverse LV function in basal segments. Future studies may elucidate the temporal relationships of aortic stiffness on the pattern and progression of LV remodeling, dysfunction, and associated prognosis in blacks.
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Affiliation(s)
- Mawra Jha
- Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Avenue, RW-453, Boston, MA, 02215, USA
| | - Solomon Musani
- Division of Cardiovascular Disease, University of Mississippi Medical Center, Jackson, MS, USA
- Jackson Heart Study, Jackson, MS, USA
| | | | - W Gregory Hundley
- Pauley Heart Center, Virginia Commonwealth University Medical Center, Richmond, VA, USA
| | - John Jeffrey Carr
- Department of Radiology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - James G Terry
- Pauley Heart Center, Virginia Commonwealth University Medical Center, Richmond, VA, USA
| | - Adebamike Oshunbade
- Division of Cardiovascular Disease, University of Mississippi Medical Center, Jackson, MS, USA
| | - Ramachandran S Vasan
- Sections of Preventive Medicine and Epidemiology and Cardiology, Department of Medicine, Department of Epidemiology, Boston University School of Medicine, Boston University School of Public Health, Boston, MA, USA
| | - Javed Butler
- Division of Cardiovascular Disease, University of Mississippi Medical Center, Jackson, MS, USA
| | - Michael Hall
- Division of Cardiovascular Disease, University of Mississippi Medical Center, Jackson, MS, USA
| | | | - Ervin Fox
- Division of Cardiovascular Disease, University of Mississippi Medical Center, Jackson, MS, USA
- Jackson Heart Study, Jackson, MS, USA
| | - Connie W Tsao
- Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Avenue, RW-453, Boston, MA, 02215, USA.
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Maimaitiaili R, Zhao S, Teliewubai J, Yu S, Meng W, Zhao Y, Xu Y, Zhang Y. Vasculopathy Augments Cardiovascular Risk in Community-Dwelling Elderly with Left Ventricular Hypertrophy. J Pers Med 2024; 14:558. [PMID: 38929779 PMCID: PMC11204535 DOI: 10.3390/jpm14060558] [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: 04/01/2024] [Revised: 05/13/2024] [Accepted: 05/21/2024] [Indexed: 06/28/2024] Open
Abstract
This study aimed to investigate the impact of various vasculopathies alongside left ventricular hypertrophy (LVH) on cardiovascular risk in the elderly. This prospective cohort study included 3339 older adults from the Northern Shanghai Study, classified into four mutually exclusive left ventricular (LV) geometry groups based on echocardiographic data: normal geometry, concentric remodeling, eccentric hypertrophy, and concentric hypertrophy. Vasculopathy was categorized into three primary types: arteriosclerosis, atherosclerosis, and renal senescence. Major adverse cardiovascular events (MACEs) were defined as non-fatal acute myocardial infarction, non-fatal stroke, and cardiovascular deaths according to ICD-10 codes. Over a median follow-up period of 5.7 years, 221 incident cases of MACEs were identified. Concentric hypertrophy exhibited the highest prevalence of hypertension, the most significant increase in vascular stiffness, and the highest rate of MACEs. The adjusted Cox regression analysis showed that eccentric hypertrophy is associated with an increased risk of MACEs (HR: 1.638 [95% CI: 1.151-2.331], p = 0.006), while concentric hypertrophy shows an even higher risk (HR: 1.751 [95% CI: 1.127-2.721], p = 0.013). Conversely, concentric remodeling was not significantly associated with an increased risk of MACEs. Renal senescence presents a moderate but significant risk for MACEs, with an HR of 1.361 (95% CI: 1.019-1.819; p = 0.037) when adjusted for LVH. The Kaplan-Meier analysis showed that patients with LVH and multiple vasculopathies experience the most significant decrease in survival probability (log-rank p < 0.001). The subgroup analysis revealed that LVH significantly raises the risk of MACEs, especially in older males with hypertension, diabetes, or vasculopathy. This study reinforces the importance of LVH as a predictor of adverse cardiovascular outcomes and underscores the compounded risk associated with the presence of multiple vasculopathies. Additionally, it highlights renal senescence as a distinct and independent risk factor for MACEs, separate from LVH.
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Affiliation(s)
| | | | | | | | | | | | | | - Yi Zhang
- Department of Cardiology, Shanghai Tenth People’s Hospital, Tongji University School of Medicine, 301 Middle Yanchang Road, Shanghai 200072, China
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Yu L, Xu G, Zhou Q, Ouyang M, Gao L, Zeng S. Biomechanical properties of the ascending aorta in patients with arterial hypertension by velocity vector imaging. THE INTERNATIONAL JOURNAL OF CARDIOVASCULAR IMAGING 2024; 40:397-405. [PMID: 37991691 DOI: 10.1007/s10554-023-03003-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Accepted: 10/31/2023] [Indexed: 11/23/2023]
Abstract
Aortic stiffness is an important risk factor for cardiovascular events and morbidity. Increased aortic stiffness is associated with an increase in cardiac and vascular hypertension-related organ damage. To evaluate the biomechanical properties of the ascending aorta (AA) in patients with arterial hypertension (AH) by velocity vector imaging (VVI). Ninety-five patients with AH and 53 normal healthy control participants were prospectively enrolled. AA biomechanical properties, i.e., ascending aortic global longitudinal strain (ALS), ascending aortic global circumferential strain (ACS), and fractional area change (FAC), were evaluated by VVI. Relative wall thickness (RWT) and left ventricular mass (LVM) were calculated. Pulsed Doppler early transmitral peak flow velocity (E), early diastolic mitral annular velocity (e'), left ventricular global longitudinal strain (GLS), distensibility (D) and stiffness index (SI) of AA were also obtained. The ALS, ACS and FAC were significantly lower in the AH patients, especially in those with ascending aorta dilatation (AAD), than in the normal healthy control subjects. The patients with AAD had a higher E/e' ratio, RWT, LVM and SI and a lower GLS and D than patients without AAD and normal healthy volunteers (p < 0.05). There were significant associations between biomechanical properties and D, SI, E/e' and GLS (ALS and D: r = 0.606, ALS and SI: r = - 0.645, ALS and E/e': r = - 0.489, ALS and GLS: r = 0.466, ACS and D: r = 0.564, ACS and SI: r = - 0.567, ACS and E/e': r = - 0.313, ACS and GLS: r = 0.320, FAC and D: r = 0.649, FAC and SI: r = - 0.601, FAC and E/e': r = - 0.504, FAC and GLS: r = 0.524, respectively, p < 0.05). The biomechanical properties of AA were impaired in patients with AH, especially patients with ascending aorta dilatation. Hypertension is associated with a high prevalence of diastolic and systolic dysfunction and increased arterial stiffness. Further study is needed to evaluate the clinical application of AA biomechanical properties by VVI.
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Affiliation(s)
- Li Yu
- Department of Ultrasound Diagnosis, Second Xiangya Hospital of Central South University, Changsha, 410000, China
| | - Ganqiong Xu
- Department of Ultrasound Diagnosis, Second Xiangya Hospital of Central South University, Changsha, 410000, China
| | - Qichang Zhou
- Department of Ultrasound Diagnosis, Second Xiangya Hospital of Central South University, Changsha, 410000, China
| | - Mingzhi Ouyang
- Department of Ultrasound Diagnosis, Second Xiangya Hospital of Central South University, Changsha, 410000, China
| | - Lei Gao
- Department of Ultrasound Diagnosis, Second Xiangya Hospital of Central South University, Changsha, 410000, China
| | - Shi Zeng
- Department of Ultrasound Diagnosis, Second Xiangya Hospital of Central South University, Changsha, 410000, China.
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Spetko N, Rong J, Larson MG, Haidar M, Raber I, Peters K, Benjamin EJ, O'Donnell CJ, Manning WJ, Vasan RS, Mitchell GF, Tsao CW. Cross-Sectional Relationships of Proximal Aortic Stiffness and Left Ventricular Diastolic Function in Adults in the Community. J Am Heart Assoc 2022; 11:e027230. [PMID: 36533620 PMCID: PMC9798804 DOI: 10.1161/jaha.122.027230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Background Stiffness of the proximal aorta may play a critical role in adverse left ventricular (LV)-vascular interactions and associated LV diastolic dysfunction. In a community-based sample, we sought to determine the association between proximal aortic stiffness measured by cardiovascular magnetic resonance (CMR) and several clinical measures of LV diastolic mechanics. Methods and Results Framingham Heart Study Offspring adults (n=1502 participants, mean 67±9 years, 54% women) with available 1.5T CMR and transthoracic echocardiographic measures were included. Measures included proximal descending aortic strain and aortic arch pulse wave velocity by CMR (2002-2006) and diastolic function (mitral Doppler E and A wave velocity, E wave area, and LV tissue Doppler e' velocity) by echocardiography (2005-2008). Multivariable linear regression analysis was used to relate CMR aortic stiffness measures to measures of echocardiographic LV diastolic function. All continuous variables were standardized. In multivariable-adjusted regression analyses, aortic strain was inversely associated with E wave deceleration time (estimated β=-0.10±0.032, P=0.001), whereas aortic arch pulse wave velocity was inversely associated with E/A ratio (estimated β=-0.094±0.027, P=0.0006), E wave area (estimated β=-0.070±0.027, P=0.010), and e' (estimated β=-0.061±0.027, P=0.022), all indicating associations of higher aortic stiffness by CMR with less favorable LV diastolic function. Compared with men, women had a larger inverse relationship between pulse wave velocity and E/A ratio (interaction β=-0.085±0.031, P=0.0064). There was no significant effect modification by age or a U-shaped (quadratic) relation between aortic stiffness and LV diastolic function measures. Conclusions Higher proximal aortic stiffness is associated with less favorable LV diastolic function. Future studies may clarify temporal relations of aortic stiffness with varying patterns and progression of LV diastolic dysfunction.
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Affiliation(s)
- Nicholas Spetko
- Department of Medicine, Cardiovascular Division, Beth Israel Deaconess Medical CenterHarvard Medical SchoolBostonMA
| | - Jian Rong
- Boston University and National Heart, Blood and Lung Institute’s Framingham Heart StudyFraminghamMA
| | - Martin G. Larson
- Boston University and National Heart, Blood and Lung Institute’s Framingham Heart StudyFraminghamMA,Department of Mathematics and StatisticsBoston UniversityBostonMA
| | | | - Inbar Raber
- Department of Medicine, Cardiovascular Division, Beth Israel Deaconess Medical CenterHarvard Medical SchoolBostonMA
| | - Kevin Peters
- Department of Medicine, Cardiovascular Division, Beth Israel Deaconess Medical CenterHarvard Medical SchoolBostonMA
| | - Emelia J. Benjamin
- Boston University and National Heart, Blood and Lung Institute’s Framingham Heart StudyFraminghamMA,Sections of Preventive Medicine and Epidemiology and Cardiology, Department of MedicineBoston University School of Medicine, Department of Epidemiology, Boston University School of Public HealthBostonMA
| | - Christopher J. O'Donnell
- Department of Medicine, Cardiology Section, VA Boston Healthcare System, and Division of Cardiovascular Medicine, Brigham and Women’s HospitalHarvard Medical SchoolWest RoxburyMA
| | - Warren J. Manning
- Department of Medicine, Cardiovascular Division, Beth Israel Deaconess Medical CenterHarvard Medical SchoolBostonMA,Department of Radiology, Beth Israel Deaconess Medical CenterHarvard Medical SchoolBostonMA
| | - Ramachandran S. Vasan
- Boston University and National Heart, Blood and Lung Institute’s Framingham Heart StudyFraminghamMA,Sections of Preventive Medicine and Epidemiology and Cardiology, Department of MedicineBoston University School of Medicine, Department of Epidemiology, Boston University School of Public HealthBostonMA
| | | | - Connie W. Tsao
- Department of Medicine, Cardiovascular Division, Beth Israel Deaconess Medical CenterHarvard Medical SchoolBostonMA
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Pierce GL, Coutinho TA, DuBose LE, Donato AJ. Is It Good to Have a Stiff Aorta with Aging? Causes and Consequences. Physiology (Bethesda) 2022; 37:154-173. [PMID: 34779281 PMCID: PMC8977146 DOI: 10.1152/physiol.00035.2021] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Revised: 10/28/2021] [Accepted: 11/08/2021] [Indexed: 01/09/2023] Open
Abstract
Aortic stiffness increases with advancing age, more than doubling during the human life span, and is a robust predictor of cardiovascular disease (CVD) clinical events independent of traditional risk factors. The aorta increases in diameter and length to accommodate growing body size and cardiac output in youth, but in middle and older age the aorta continues to remodel to a larger diameter, thinning the pool of permanent elastin fibers, increasing intramural wall stress and resulting in the transfer of load bearing onto stiffer collagen fibers. Whereas aortic stiffening in early middle age may be a compensatory mechanism to normalize intramural wall stress and therefore theoretically "good" early in the life span, the negative clinical consequences of accelerated aortic stiffening beyond middle age far outweigh any earlier physiological benefit. Indeed, aortic stiffness and the loss of the "windkessel effect" with advancing age result in elevated pulsatile pressure and flow in downstream microvasculature that is associated with subclinical damage to high-flow, low-resistance organs such as brain, kidney, retina, and heart. The mechanisms of aortic stiffness include alterations in extracellular matrix proteins (collagen deposition, elastin fragmentation), increased arterial tone (oxidative stress and inflammation-related reduced vasodilators and augmented vasoconstrictors; enhanced sympathetic activity), arterial calcification, vascular smooth muscle cell stiffness, and extracellular matrix glycosaminoglycans. Given the rapidly aging population of the United States, aortic stiffening will likely contribute to substantial CVD burden over the next 2-3 decades unless new therapeutic targets and interventions are identified to prevent the potential avalanche of clinical sequelae related to age-related aortic stiffness.
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Affiliation(s)
- Gary L Pierce
- Department of Health and Human Physiology, University of Iowa, Iowa City, Iowa
- Department of Internal Medicine, University of Iowa, Iowa City, Iowa
- Abboud Cardiovascular Research Center, University of Iowa, Iowa City, Iowa
- Fraternal Order of Eagles Diabetes Research Center, University of Iowa, Iowa City, Iowa
| | - Thais A Coutinho
- Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
- Divisions of Cardiology and Cardiac Prevention and Rehabilitation, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Lyndsey E DuBose
- Division of Geriatrics, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Anthony J Donato
- Department of Internal Medicine, University of Utah, Salt Lake City, Utah
- Department of Nutrition and Integrative Physiology, University of Utah, Salt Lake City, Utah
- Department of Biochemistry, University of Utah, Salt Lake City, Utah
- Geriatric Research Education and Clinical Center, VA Salt Lake City, Salt Lake City, Utah
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Hsu HC, Tade G, Norton GR, Peters F, Robinson C, Dlongolo N, Teckie G, Woodiwiss AJ, Dessein PH. Aortic Stiffness and Pulsatile Pressures as Potential Mediators of Chronic Kidney Disease Induced Impaired Diastolic Function. Int J Nephrol Renovasc Dis 2022; 15:27-40. [PMID: 35210818 PMCID: PMC8858013 DOI: 10.2147/ijnrd.s346074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Accepted: 01/22/2022] [Indexed: 11/23/2022] Open
Abstract
Purpose We assessed whether aortic stiffness and pulsatile pressures can mediate chronic kidney disease (CKD)-associated impaired diastolic function. Participants and Methods In 276 black Africans including 46 CKD (19 non-dialysis; 27 dialysis) and 230 control subjects, pulse wave velocity (PWV) estimated aortic stiffness and pulsatile pressures (forward and backward wave pressure, central systolic blood pressure (CSBP) and pulse pressure (CPP)) were determined by applanation tonometry; e’ as an index of left ventricular active relaxation and E/e’ as a measure of left ventricular filling pressure or passive relaxation were evaluated by echocardiography. Results In age, sex, traditional cardiovascular risk factor and mean arterial pressure (MAP) adjusted regression models, CKD was inversely associated with e’ (p = 0.03) and directly with E/e’ (p < 0.01). The CKD-e’ relationship was attenuated and no longer significant (p = 0.31) upon additional adjustment for aortic PWV but not pulsatile pressures (p = 0.03–0.05). In product of coefficient mediation analysis, PWV accounted for 47.6% of the CKD-e’ association. CSBP (22.9%) and CPP (18.6%) but not PWV (11.3%) accounted for a significant and relevant proportion of the CKD-E/e’ relationship. However, CKD remained strongly associated with E/e’ independent of aortic function measures (p < 0.01). Treatable covariates that were or tended to be consistently associated with diastolic function included MAP (p < 0.01) and diabetes (p = 0.02–0.07) for the CKD-e’ and CKD-E/e’ relations, respectively. Conclusion Aortic stiffness rather than pulsatile pressures mediates CKD-related impaired left ventricular active relaxation. By contrast, aortic pulsatile pressures (and not stiffness) contribute to CKD-related left ventricular filling pressures but do not fully account for the respective association.
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Affiliation(s)
- Hon-Chun Hsu
- Cardiovascular Pathophysiology and Genomics Research Unit, School of Physiology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Nephrology Unit, Milpark Hospital, Johannesburg, South Africa
| | - Grace Tade
- Cardiovascular Pathophysiology and Genomics Research Unit, School of Physiology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Gavin R Norton
- Cardiovascular Pathophysiology and Genomics Research Unit, School of Physiology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Ferande Peters
- Cardiovascular Pathophysiology and Genomics Research Unit, School of Physiology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Chanel Robinson
- Cardiovascular Pathophysiology and Genomics Research Unit, School of Physiology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Noluntu Dlongolo
- Rheumatology Unit, Rosebank Hospital, Johannesburg, South Africa
| | - Gloria Teckie
- Division of Nephrology, Department of Medicine, Chris Hani Baragwanath Hospital and Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa
| | - Angela J Woodiwiss
- Cardiovascular Pathophysiology and Genomics Research Unit, School of Physiology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Patrick H Dessein
- Cardiovascular Pathophysiology and Genomics Research Unit, School of Physiology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Internal Medicine Department, University of the Witwatersrand, Johannesburg, South Africa
- Correspondence: Patrick H Dessein, Tel +27 662491468, Email
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Obayashi M, Kobayashi S, Nanno T, Hamada Y, Yano M. Relation between Oscillometric Measurement of Central Hemodynamics and Left Ventricular Hypertrophy in Hypertensive Patients. Pulse (Basel) 2022; 9:116-124. [PMID: 35083178 DOI: 10.1159/000520006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Accepted: 09/28/2021] [Indexed: 12/20/2022] Open
Abstract
Introduction The augmentation index (AIx) or central systolic blood pressure (SBP), measured by radial applanation tonometry, has been reported to be independently associated with left ventricular hypertrophy (LVH) in Japanese hypertensive patients. Cuff-based oscillometric measurement of the AIx using Mobil-O-Graph® showed a low or moderate agreement with the AIx measurement with other devices. Methods The AIx measured using the Mobil-O-Graph was validated against the tonometric measurements of the radial AIx measured using HEM-9000AI in 110 normotensive healthy individuals (age, 21-76 years; 50 men). We investigated the relationship between the central hemodynamics assessed using the Mobil-O-Graph and LVH in 100 hypertensive patients (age, 54-75 years; 48 men), presenting a wall thickness of ≥11 mm and ≥10 mm in men and women, respectively. Results Although the Mobil-O-Graph-measured central AIx showed no negative values, it correlated moderately with the HEM-9000AI-measured radial AIx (r = 0.602, p < 0.001) in the normotensive individuals. The hypertensive patients did not show a significant difference in the central SBP between the sexes, but the central AIx was lower in men than in women. The independent determinants influencing left ventricle (LV) mass index (LVMI) (R2 = 0.362; adjusted R2 = 0.329, p < 0.001) were heart rate (β = -0.568 ± 0.149, p < 0.001), central SBP (β = 0.290 ± 0.100, p = 0.005), and aortic root diameter (β = 1.355 ± 0.344, p = 0.001). Age (β = -0.025 ± 0.124, p = 0.841) and the central AIx (β = 0.120 ± 0.131, p = 0.361) were not independently associated with the LVMI. The area under the receiver operator characteristic curve to evaluate the diagnostic performance of the central AIx for the presence of LVH (LVMI >118 g/m2 in men or >108 g/m2 in women) was statistically significant in men (0.875, p < 0.001) but not in women (0.622, p = 0.132). In men, a central AIx of 28.06% had a sensitivity of 83.3% and specificity of 80.0% for detecting LVH. Conclusions AIx measurement in men provided useful prognostic information for the presence of LVH. Pulse-wave analysis assessed using the Mobil-O-Graph may be a valuable tool for detecting LVH in hypertensive patients.
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Affiliation(s)
- Masakazu Obayashi
- Department of Cardiovascular Medicine, Sanyo-Onoda City Hospital, Sanyo-Onoda, Japan
| | - Shigeki Kobayashi
- Division of Cardiology, Department of Medicine and Clinical Science, Yamaguchi University Graduate School of Medicine, Ube, Japan
| | - Takuma Nanno
- Department of Cardiovascular Medicine, Sanyo-Onoda City Hospital, Sanyo-Onoda, Japan
| | - Yoriomi Hamada
- Department of Cardiovascular Medicine, Sanyo-Onoda City Hospital, Sanyo-Onoda, Japan
| | - Masafumi Yano
- Division of Cardiology, Department of Medicine and Clinical Science, Yamaguchi University Graduate School of Medicine, Ube, Japan
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Kumai K, Tomiyama H, Takahashi T, Nakano H, Fujii M, Matsumoto C, Shiina K, Yamashina A, Chikamori T. Longitudinal Association of Arterial Stiffness and Pressure Wave Reflection with Decline of the Cardiac Systolic Performance in Healthy Men. J Atheroscler Thromb 2021; 29:1342-1351. [PMID: 34629372 PMCID: PMC9444689 DOI: 10.5551/jat.63099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
AIMS This prospective observational study aimed to examine the individual longitudinal associations of the increases in the arterial stiffness and pressure wave reflection with the decline in the cardiac systolic performance during the study period in healthy middle-aged Japanese men. METHODS In 4016 middle-aged Japanese healthy men (43±9 years), the brachial-ankle pulse wave velocity (baPWV), radial augmentation index (rAI), and pre-ejection period/ejection time (pre-ejection period (PEP)/ET) were measured annually during a 9-year study period. RESULTS The baPWV, rAI, and PEP/ET showed steady annual increases during the study period. According to the results of multivariate linear regression analyses, both the baPWV and rAI measured at the baseline showed significant independent associations with the PEP/ET measured at the baseline (baPWV: beta=0.17, p<0.01 and rAI: beta=0.11, p<0.01), whereas neither showed any association with the PEP/ET measured at the end of the study period. The results of the mixed-model linear regression analysis of the repeated-measures data collected over the 9-year study period revealed that the baPWV, but not the rAI, showed a significant longitudinal association with the PEP/ET (estimate=0.69 x 10-4, p<0.01). CONCLUSION In apparently healthy middle-aged Japanese men, the annual increase of the arterial stiffness, rather than the annual increase of the pressure wave reflection, appears to be more closely associated with the annual decline of the cardiac systolic performance as assessed by the systolic time interval.
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Affiliation(s)
- Kento Kumai
- Department of Cardiology, Tokyo Medical University
| | - Hirofumi Tomiyama
- Department of Cardiology, Tokyo Medical University.,Division of Preemptive Medicine for Vascular Damage, Tokyo Medical University
| | | | | | | | | | - Kazuki Shiina
- Department of Cardiology, Tokyo Medical University.,Division of Preemptive Medicine for Vascular Damage, Tokyo Medical University
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10
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Shirakawa T, Kuratani T, Yoshitatsu M, Shimamura K, Fukui S, Kurata A, Koyama Y, Toda K, Fukuda I, Sawa Y. Towards a Clinical Implementation of Measuring the Elastic Modulus of the Aorta from Cardiac Computed Tomography Images. IEEE Trans Biomed Eng 2021; 68:3543-3553. [PMID: 33945468 DOI: 10.1109/tbme.2021.3077362] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE The elasticity of the aortic wall varies depending on age, vessel location, and the presence of aortic diseases. Noninvasive measurement will be a powerful tool to understand the mechanical state of the aorta in a living human body. This study aimed to determine the elastic modulus of the aorta using computed tomography images. METHODS We constructed our original formulae based on mechanics of materials. Then, we performed computed tomography scans of a silicon rubber tube by applying four pressure conditions to the lumen. The segment elastic modulus was calculated from the scanned images using our formulae. The actual modulus was measured using a tensile loading test for comparison. RESULTS The segment moduli of elasticity from the images were 0.525 [0.524, 0.527], 0.524 [0.520, 0.524], 0.520 [0.515, 0.523], and 0.522 [0.516, 0.532] (unit: MPa, median [25%, 75% quantiles]) for the four pressure conditions, respectively. The corresponding measurements in the tensile test were 0.548 [0.539, 0.566], 0.535 [0.528, 0.553], 0.526 [0.513, 0.543], and 0.523 [0.508, 0.530], respectively. These results indicated errors of 4.2%, 2.1%, 1.1%, and 0.2%, respectively. CONCLUSION Our formulae provided good estimations of the segment elastic moduli of a silicon rubber tube under physiological pressure conditions using the computed tomography images. SIGNIFICANCE In addition to the elasticity, the formulae provide the strain energy as well. These properties can be better predictors of aortic diseases. The formulae consist of clinical parameters commonly used in medical settings (pressure, diameter, and wall thickness).
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11
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Abstract
Arterial stiffness, a leading marker of risk in hypertension, can be measured at material or structural levels, with the latter combining effects of the geometry and composition of the wall, including intramural organization. Numerous studies have shown that structural stiffness predicts outcomes in models that adjust for conventional risk factors. Elastic arteries, nearer to the heart, are most sensitive to effects of blood pressure and age, major determinants of stiffness. Stiffness is usually considered as an index of vascular aging, wherein individuals excessively affected by risk factor exposure represent early vascular aging, whereas those resistant to risk factors represent supernormal vascular aging. Stiffness affects the function of the brain and kidneys by increasing pulsatile loads within their microvascular beds, and the heart by increasing left ventricular systolic load; excessive pressure pulsatility also decreases diastolic pressure, necessary for coronary perfusion. Stiffness promotes inward remodeling of small arteries, which increases resistance, blood pressure, and in turn, central artery stiffness, thus creating an insidious feedback loop. Chronic antihypertensive treatments can reduce stiffness beyond passive reductions due to decreased blood pressure. Preventive drugs, such as lipid-lowering drugs and antidiabetic drugs, have additional effects on stiffness, independent of pressure. Newer anti-inflammatory drugs also have blood pressure independent effects. Reduction of stiffness is expected to confer benefit beyond the lowering of pressure, although this hypothesis is not yet proven. We summarize different steps for making arterial stiffness measurement a keystone in hypertension management and cardiovascular prevention as a whole.
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Affiliation(s)
- Pierre Boutouyrie
- Faculté de Médecine, Université de Paris, INSERM U970, Hôpital Européen Georges Pompidou, Assistance Publique Hôpitaux de Paris, France (P.B.)
| | - Phil Chowienczyk
- King's College London British Heart Foundation Centre, Department of Clinical Pharmacology, St Thomas' Hospital, London, United Kingdom (P.C.)
| | - Jay D Humphrey
- Department of Biomedical Engineering and Vascular Biology and Therapeutics Program, Yale University, New Haven, CT (J.D.H.)
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12
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Karwat P, Klimonda Z, Styczyński G, Szmigielski C, Litniewski J. Aortic root movement correlation with the function of the left ventricle. Sci Rep 2021; 11:4473. [PMID: 33627700 PMCID: PMC7904934 DOI: 10.1038/s41598-021-83278-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Accepted: 02/01/2021] [Indexed: 12/12/2022] Open
Abstract
Echocardiographic assessment of systolic and diastolic function of the heart is often limited by image quality. However, the aortic root is well visualized in most patients. We hypothesize that the aortic root motion may correlate with the systolic and diastolic function of the left ventricle of the heart. Data obtained from 101 healthy volunteers (mean age 46.6 ± 12.4) was used in the study. The data contained sequences of standard two-dimensional (2D) echocardiographic B-mode (brightness mode, classical ultrasound grayscale presentation) images corresponding to single cardiac cycles. They also included sets of standard echocardiographic Doppler parameters of the left ventricular systolic and diastolic function. For each B-mode image sequence, the aortic root was tracked with use of a correlation tracking algorithm and systolic and diastolic values of traveled distances and velocities were determined. The aortic root motion parameters were correlated with the standard Doppler parameters used for the assessment of LV function. The aortic root diastolic distance (ARDD) mean value was 1.66 ± 0.26 cm and showed significant, moderate correlation (r up to 0.59, p < 0.0001) with selected left ventricular diastolic Doppler parameters. The aortic root maximal diastolic velocity (ARDV) was 10.8 ± 2.4 cm/s and also correlated (r up to 0.51, p < 0.0001) with some left ventricular diastolic Doppler parameters. The aortic root systolic distance (ARSD) was 1.63 ± 0.19 cm and showed no significant moderate correlation (all r values < 0.40). The aortic root maximal systolic velocity (ARSV) was 9.2 ± 1.6 cm/s and correlated in moderate range only with peak systolic velocity of medial mitral annulus (r = 0.44, p < 0.0001). Based on these results, we conclude, that in healthy subjects, aortic root motion parameters correlate significantly with established measurements of left ventricular function. Aortic root motion parameters can be especially useful in patients with low ultrasound image quality precluding usage of typical LV function parameters.
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Affiliation(s)
- Piotr Karwat
- Institute of Fundamental Technological Research, Polish Academy of Sciences, Pawińskiego 5B, 02-106, Warsaw, Poland.
| | - Ziemowit Klimonda
- Institute of Fundamental Technological Research, Polish Academy of Sciences, Pawińskiego 5B, 02-106, Warsaw, Poland
| | - Grzegorz Styczyński
- Department of Internal Medicine, Hypertension and Angiology, Medical University of Warsaw, Banacha 1A, 02-097, Warsaw, Poland
| | - Cezary Szmigielski
- Department of Internal Medicine, Hypertension and Angiology, Medical University of Warsaw, Banacha 1A, 02-097, Warsaw, Poland
| | - Jerzy Litniewski
- Institute of Fundamental Technological Research, Polish Academy of Sciences, Pawińskiego 5B, 02-106, Warsaw, Poland
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13
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Mitchell GF. Arterial Stiffness in Aging: Does It Have a Place in Clinical Practice?: Recent Advances in Hypertension. Hypertension 2021; 77:768-780. [PMID: 33517682 DOI: 10.1161/hypertensionaha.120.14515] [Citation(s) in RCA: 38] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Aortic stiffness increases markedly with age and is associated with excess risk for various adverse clinical outcomes, including heart disease, dementia, and kidney disease. Although evidence for adverse effects of aortic stiffening is overwhelming, integration of direct and indirect measures of aortic stiffness into routine clinical assessment has lagged behind the science. This brief review will examine recent evidence supporting the value of stiffness as an important new risk factor for hypertension and cardiovascular disease and will offer suggestions for incorporating stiffness measures into routine clinical practice.
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14
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Guala A, Teixidó-Tura G, Rodríguez-Palomares J, Ruiz-Muñoz A, Dux-Santoy L, Villalva N, Granato C, Galian L, Gutiérrez L, González-Alujas T, Sanchez V, Forteza A, García-Dorado D, Evangelista A. Proximal aorta longitudinal strain predicts aortic root dilation rate and aortic events in Marfan syndrome. Eur Heart J 2020; 40:2047-2055. [PMID: 30977783 DOI: 10.1093/eurheartj/ehz191] [Citation(s) in RCA: 50] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2018] [Revised: 10/15/2018] [Accepted: 03/22/2019] [Indexed: 12/31/2022] Open
Abstract
AIMS Life expectancy in Marfan syndrome patients has improved thanks to the early detection of aortic dilation and prophylactic aortic root surgery. Current international clinical guidelines support the use of aortic root diameter as a predictor of complications. However, other imaging markers are needed to improve risk stratification. This study aim to ascertain whether proximal aorta longitudinal and circumferential strain and distensibility assessed by cardiac magnetic resonance (CMR) predict the aortic root dilation rate and aortic events in Marfan syndrome. METHODS AND RESULTS One hundred and seventeen Marfan patients with no previous aortic dissection, cardiac/aortic surgery, or moderate/severe aortic regurgitation were prospectively included in a multicentre protocol of clinical and imaging follow-up. At baseline, CMR was performed and proximal aorta longitudinal strain and ascending aorta circumferential strain and distensibility were obtained. During follow-up (85.7 [75.0-93.2] months), the annual growth rate of aortic root diameter was 0.62 ± 0.65 mm/year. Fifteen patients underwent elective surgical aortic root replacement and four presented aortic dissection. Once corrected for baseline clinical and demographic characteristics and aortic root diameter, proximal aorta longitudinal strain, but not circumferential strain and distensibility, was an independent predictor of the aortic root diameter growth rate (P = 0.001, P = 0.823, and P = 0.997, respectively), z-score growth rate (P = 0.013, P = 0.672, and P = 0.680, respectively), and aortic events (P = 0.023, P = 0.096, and P = 0.237, respectively). CONCLUSION Proximal aorta longitudinal strain is independently related to the aortic root dilation rate and aortic events in addition to aortic root diameter, clinical risk factors, and demographic characteristics in Marfan syndrome patients.
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Affiliation(s)
- Andrea Guala
- Department of Cardiology, Hospital Universitari Vall d'Hebron, CIBER-CV, Vall d'Hebron institut de Recerca, Universitat Autònoma de Barcelona, Paseo Vall d'Hebron 119-129, Barcelona, Spain
| | - Gisela Teixidó-Tura
- Department of Cardiology, Hospital Universitari Vall d'Hebron, CIBER-CV, Vall d'Hebron institut de Recerca, Universitat Autònoma de Barcelona, Paseo Vall d'Hebron 119-129, Barcelona, Spain
| | - Jose Rodríguez-Palomares
- Department of Cardiology, Hospital Universitari Vall d'Hebron, CIBER-CV, Vall d'Hebron institut de Recerca, Universitat Autònoma de Barcelona, Paseo Vall d'Hebron 119-129, Barcelona, Spain
| | - Aroa Ruiz-Muñoz
- Department of Cardiology, Hospital Universitari Vall d'Hebron, CIBER-CV, Vall d'Hebron institut de Recerca, Universitat Autònoma de Barcelona, Paseo Vall d'Hebron 119-129, Barcelona, Spain
| | - Lydia Dux-Santoy
- Department of Cardiology, Hospital Universitari Vall d'Hebron, CIBER-CV, Vall d'Hebron institut de Recerca, Universitat Autònoma de Barcelona, Paseo Vall d'Hebron 119-129, Barcelona, Spain
| | - Nicolas Villalva
- Department of Cardiology, Hospital Universitari Vall d'Hebron, CIBER-CV, Vall d'Hebron institut de Recerca, Universitat Autònoma de Barcelona, Paseo Vall d'Hebron 119-129, Barcelona, Spain
| | - Chiara Granato
- Department of Cardiology, Hospital Universitari Vall d'Hebron, CIBER-CV, Vall d'Hebron institut de Recerca, Universitat Autònoma de Barcelona, Paseo Vall d'Hebron 119-129, Barcelona, Spain
| | - Laura Galian
- Department of Cardiology, Hospital Universitari Vall d'Hebron, CIBER-CV, Vall d'Hebron institut de Recerca, Universitat Autònoma de Barcelona, Paseo Vall d'Hebron 119-129, Barcelona, Spain
| | - Laura Gutiérrez
- Department of Cardiology, Hospital Universitari Vall d'Hebron, CIBER-CV, Vall d'Hebron institut de Recerca, Universitat Autònoma de Barcelona, Paseo Vall d'Hebron 119-129, Barcelona, Spain
| | - Teresa González-Alujas
- Department of Cardiology, Hospital Universitari Vall d'Hebron, CIBER-CV, Vall d'Hebron institut de Recerca, Universitat Autònoma de Barcelona, Paseo Vall d'Hebron 119-129, Barcelona, Spain
| | - Violeta Sanchez
- Department of Cardiology, Hospital doce de Octubre, Avenida Cordoba, Madrid, Spain
| | - Alberto Forteza
- Department of Cardiac Surgery, Hospital Puerta de Hierro. Calle Manuel de Falla, 1, Majadahonda, Spain
| | - David García-Dorado
- Department of Cardiology, Hospital Universitari Vall d'Hebron, CIBER-CV, Vall d'Hebron institut de Recerca, Universitat Autònoma de Barcelona, Paseo Vall d'Hebron 119-129, Barcelona, Spain
| | - Artur Evangelista
- Department of Cardiology, Hospital Universitari Vall d'Hebron, CIBER-CV, Vall d'Hebron institut de Recerca, Universitat Autònoma de Barcelona, Paseo Vall d'Hebron 119-129, Barcelona, Spain
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15
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Alem MM, Alshehri AM. Inter-relationships between left ventricular mass, geometry and arterial stiffness. J Int Med Res 2020; 48:300060520903623. [PMID: 32237948 PMCID: PMC7132812 DOI: 10.1177/0300060520903623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Objective To investigate the inter-relationships between left ventricular mass (LVM), left ventricular (LV) geometry and arterial stiffness parameters (aortic pulse wave velocity [Ao-PWV] and heart rate-corrected augmentation index [c-AIx]) in patients with chronic heart failure (CHF). Methods This study was a secondary analysis of existing data that were collected from patients with CHF New York Heart Association class I–III with reduced ejection fraction (HFrEF) or preserved ejection fraction (HFpEF). Transthoracic echocardiography was performed on all patients, along with measurement of arterial stiffness parameters (Ao-PWV and c-AIx) using sphygmocardiography. Results A total of 73 patients (58 males) with a mean ± SD age of 55.9 ± 11.6 years were enrolled in this study. Of these, 20 patients (27.4%) had systemic hypertension, 46 (63.0%) had type 2 diabetes mellitus. Ischaemic heart disease was the main aetiology of CHF (63 of 73 patients; 86.3%). In multiple linear regression, the left ventricular mass index (LVMI) was significantly associated with c-AIx (β = –1.59) and EF (β = –1.51). Comparison of Ao-PWV among the four LV geometric patterns revealed significant differences. Conclusion In this cohort of CHF patients, LVMI was predicted by c-AIx and EF. The corresponding values of Ao-PWV were parallel in different LV geometric patterns and confirmed their adverse prognostic values.
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Affiliation(s)
- Manal M. Alem
- Department of Pharmacology, College of Clinical Pharmacy, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
- Manal M. Alem, Department of Pharmacology, College of Clinical Pharmacy, Imam Abdulrahman Bin Faisal University, PO Box 1982, Building A76 King Faisal Road, Dammam 31441, Saudi Arabia.
| | - Abdullah M. Alshehri
- Department of Internal Medicine, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
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16
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Norman G, Norton GR, Peterson V, Gomes M, Libhaber CD, Sareli P, Woodiwiss AJ. Associations between circulating resistin concentrations and left ventricular mass are not accounted for by effects on aortic stiffness or renal dysfunction. BMC Cardiovasc Disord 2020; 20:35. [PMID: 32000666 PMCID: PMC6993505 DOI: 10.1186/s12872-019-01319-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Accepted: 12/24/2019] [Indexed: 01/20/2023] Open
Abstract
Background Although, in-part through an impact on left ventricular mass (LVM), resistin (an adipokine) may contribute to heart failure, whether this is explained by the adverse effects of resistin on aortic stiffness and renal function is unknown. Methods Relationships between circulating resistin concentrations and LVM index (LVMI), and LVM beyond that predicted by stroke work (inappropriate LVM [LVMinappr]) (echocardiography) were determined in 647 randomly selected community participants, and in regression analysis, the extent to which these relations could be explained by aortic pulse wave velocity (PWV) or estimated glomerular filtration rate (eGFR) was evaluated. Results Independent of confounders, resistin concentrations were independently associated with LVMI, LVMinappr, LV hypertrophy (LVH), PWV and eGFR. Furthermore, independent of confounders, LVMI, LVMinappr and LVH were independently associated with PWV and eGFR. However, adjustments for either PWV or eGFR failed to modify the relationships between resistin concentrations and LVMI, LVMinappr or LVH. Moreover, in multivariate regression analysis neither PWV nor eGFR significantly modified the contribution of resistin to LVMinappr or LVMI. Conclusions Independent relationships between circulating concentrations of the adipocytokine resistin and LVM are not explained by the impact of resistin on ventricular-vascular coupling or renal dysfunction. Resistin’s effects on LVM are therefore likely to be through direct actions on the myocardium.
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Affiliation(s)
- Glenda Norman
- Cardiovascular Pathophysiology and Genomics Research Unit, School of Physiology, Faculty of Health Sciences, University of the Witwatersrand Medical School, 7 York Road, Parktown, Johannesburg, 2193, South Africa
| | - Gavin R Norton
- Cardiovascular Pathophysiology and Genomics Research Unit, School of Physiology, Faculty of Health Sciences, University of the Witwatersrand Medical School, 7 York Road, Parktown, Johannesburg, 2193, South Africa.
| | - Vernice Peterson
- Cardiovascular Pathophysiology and Genomics Research Unit, School of Physiology, Faculty of Health Sciences, University of the Witwatersrand Medical School, 7 York Road, Parktown, Johannesburg, 2193, South Africa
| | - Monica Gomes
- Cardiovascular Pathophysiology and Genomics Research Unit, School of Physiology, Faculty of Health Sciences, University of the Witwatersrand Medical School, 7 York Road, Parktown, Johannesburg, 2193, South Africa
| | - Carlos D Libhaber
- Cardiovascular Pathophysiology and Genomics Research Unit, School of Physiology, Faculty of Health Sciences, University of the Witwatersrand Medical School, 7 York Road, Parktown, Johannesburg, 2193, South Africa
| | - Pinhas Sareli
- Cardiovascular Pathophysiology and Genomics Research Unit, School of Physiology, Faculty of Health Sciences, University of the Witwatersrand Medical School, 7 York Road, Parktown, Johannesburg, 2193, South Africa
| | - Angela J Woodiwiss
- Cardiovascular Pathophysiology and Genomics Research Unit, School of Physiology, Faculty of Health Sciences, University of the Witwatersrand Medical School, 7 York Road, Parktown, Johannesburg, 2193, South Africa.
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17
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Prakash A, Gordon LB, Kleinman ME, Gurary EB, Massaro J, D'Agostino R, Kieran MW, Gerhard-Herman M, Smoot L. Cardiac Abnormalities in Patients With Hutchinson-Gilford Progeria Syndrome. JAMA Cardiol 2019; 3:326-334. [PMID: 29466530 DOI: 10.1001/jamacardio.2017.5235] [Citation(s) in RCA: 57] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Importance Hutchinson-Gilford progeria syndrome (HGPS) is an ultrarare disorder associated with premature death due to cardiovascular events during the second decade of life. However, because of its rarity (107 identified living patients), the natural history of cardiac disease remains uncharacterized. Therefore, meaningful cardiac end points for clinical trials have been difficult to establish. Objective To examine the course of appearance of cardiac abnormalities in patients with HGPS to identify meaningful cardiac end points for use in future clinical trials. Design, Setting, and Participants In this prospective, cross-sectional, observational study, 27 consecutive patients with clinically and genetically confirmed classic HGPS were evaluated at a single center for 1 visit from July 1, 2014, through February 29, 2016, before initiation of treatment. Exposure Classic HGPS. Main Outcomes and Measures Echocardiography was used to assess ventricular and valve function using standard techniques. Diastolic left ventricular (LV) function was assessed using tissue Doppler imaging. Previously published normative data were used to adjust findings to age and body size. Results This study included 27 patients (median age, 5.6 years; age range, 2-17 years; 15 [56%] male). Among echocardiographic indicators, LV diastolic dysfunction, defined as a tissue Doppler septal or lateral early velocity z score less than -2, was the most prevalent abnormality, seen in 16 patients (59%). Diastolic dysfunction was seen in all age groups, and its prevalence increased with age, mirroring findings seen during normal aging. Indicators of LV diastolic function were more abnormal in older patients. The z scores for lateral and septal early velocities were lower (r = -0.77, P < .001; and r = -0.66, P < .001, respectively), whereas those for the ratio of early mitral inflow velocity to early diastolic tissue Doppler myocardial velocity were higher (r = 0.80, P < .001; and r = 0.72, P < .001, respectively) in older patients. Other echocardiographic findings, including LV hypertrophy, LV systolic dysfunction, and valve disease, were less prevalent in the first decade and were seen more frequently in the second decade. Conclusions and Relevance In this largest-to-date cohort of patients with HGPS, LV diastolic dysfunction was the most prevalent echocardiographic abnormality and its prevalence increased with aging. Echocardiographic indicators of LV diastolic function may be useful end points in future clinical trials in this patient population.
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Affiliation(s)
- Ashwin Prakash
- Department of Cardiology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts.,Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
| | - Leslie B Gordon
- Department of Anesthesiology, Preoperative and Pain Medicine, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts.,Department of Pediatrics, Hasbro Children's Hospital, Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Monica E Kleinman
- Department of Anesthesiology, Preoperative and Pain Medicine, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts.,Department of Critical Care Medicine, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Ellen B Gurary
- Department of Mathematics and Statistics, Boston University, Harvard Clinical Research Institute, Boston, Massachusetts
| | - Joseph Massaro
- Department of Mathematics and Statistics, Boston University, Harvard Clinical Research Institute, Boston, Massachusetts
| | - Ralph D'Agostino
- Department of Mathematics and Statistics, Boston University, Harvard Clinical Research Institute, Boston, Massachusetts
| | - Mark W Kieran
- Division of Hematology/Oncology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Marie Gerhard-Herman
- Department of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| | - Leslie Smoot
- Department of Cardiology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts.,Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
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Heusinkveld MHG, Delhaas T, Lumens J, Huberts W, Spronck B, Hughes AD, Reesink KD. Augmentation index is not a proxy for wave reflection magnitude: mechanistic analysis using a computational model. J Appl Physiol (1985) 2019; 127:491-500. [PMID: 31161882 PMCID: PMC6711407 DOI: 10.1152/japplphysiol.00769.2018] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
The augmentation index (AIx) is deemed to capture the deleterious effect on left ventricular (LV) work of increased wave reflection associated with stiffer arteries. However, its validity as a proxy for wave reflection magnitude has been questioned. We hypothesized that, in addition to increased wave reflection due to increased pulse wave velocity, LV myocardial shortening velocity influences AIx. Using a computational model of the circulation, we investigated the isolated and combined influences of myocardial shortening velocity vs,LV and arterial stiffness on AIx. Aortic blood pressure waveforms were characterized using AIx and the reflected wave pressure amplitude (p^bw, obtained using wave separation analysis). Our reference simulation (normal vs,LV and arterial stiffness) was characterized by an AIx of 21%. A realistic reduction in vs,LV caused AIx to increase from 21 to 42%. An arterial stiffness increase, characterized by a relevant 1.0 m/s increase in carotid-femoral pulse wave velocity, caused AIx to increase from 21 to 41%. Combining the reduced vs,LV and increased arterial stiffness resulted in an AIx of 54%. In a multistep parametric analysis, both vs,LV and arterial stiffness were about equal determinants of AIx, whereas p^bw was only determined by arterial stiffness. Furthermore, the relation between increased AIx and LV stroke work was only ≈50% explained by an increase in arterial stiffness, the other factor being vs,LV. The p^bw, on the other hand, related less ambiguously to LV stroke work. We conclude that the AIx reflects both cardiac and vascular properties and should not be considered an exclusively vascular parameter. NEW & NOTEWORTHY We used a state-of-the-art computational model to mechanistically investigate the validity of the augmentation index (AIx) as a proxy for (changes in) wave reflection. In contrary to current belief, we found that LV contraction velocity influences AIx as much as increased arterial stiffness, and increased AIx does not necessarily relate to an increase in LV stroke work. Wave reflection magnitude derived from considering pressure, as well as flow, does qualify as a determinant of LV stroke work.
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Affiliation(s)
| | - Tammo Delhaas
- CARIM School for Cardiovascular Diseases, Maastricht University, The Netherlands
| | - Joost Lumens
- CARIM School for Cardiovascular Diseases, Maastricht University, The Netherlands
| | - Wouter Huberts
- CARIM School for Cardiovascular Diseases, Maastricht University, The Netherlands
| | - Bart Spronck
- Department of Biomedical Engineering, Yale University, New Haven, Connecticut
| | - Alun D Hughes
- Institute of Cardiovascular Science, University College London, United Kingdom
| | - Koen D Reesink
- CARIM School for Cardiovascular Diseases, Maastricht University, The Netherlands
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19
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Mokotedi L, Gunter S, Robinson C, Michel F, Solomon A, Norton GR, Woodiwiss AJ, Tsang L, Dessein PH, Millen AME. Early Wave Reflection and Pulse Wave Velocity Are Associated with Diastolic Dysfunction in Rheumatoid Arthritis. J Cardiovasc Transl Res 2019; 12:580-590. [PMID: 31119564 DOI: 10.1007/s12265-019-09892-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Accepted: 05/06/2019] [Indexed: 12/13/2022]
Abstract
Rheumatoid arthritis (RA) impacts arterial and diastolic function. This study examined whether arterial properties can determine diastolic function in RA. In 173 RA patients, arterial function measures including carotid femoral pulse wave velocity (PWV), central systolic and pulse pressure, pulse pressure amplification, and the magnitude and timing of the forward and reflected waves were measured using applanation tonometry. Diastolic function parameters including the ratio of early-to-late transmitral velocity (E/A) and ratio of E to the mean of the lateral and septal wall myocardial tissue lengthening (e') were measured using echocardiography. The timing of the reflected wave was associated with E/A; PWV was related to E/e'. The timing of the reflected wave, forward wave magnitude, and pulse pressure amplification were associated with impaired relaxation; PWV was related to increased left ventricular (LV) filling pressure. Early wave reflection and PWV are associated with LV-impaired relaxation and increased filling pressure, respectively, in RA.
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Affiliation(s)
- Lebogang Mokotedi
- Cardiovascular Pathophysiology and Genomics Research Unit, School of Physiology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Sulé Gunter
- Cardiovascular Pathophysiology and Genomics Research Unit, School of Physiology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Chanel Robinson
- Cardiovascular Pathophysiology and Genomics Research Unit, School of Physiology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Frederic Michel
- Cardiovascular Pathophysiology and Genomics Research Unit, School of Physiology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Ahmed Solomon
- Department of Rheumatology, Charlotte Maxeke Johannesburg Academic Hospital, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Gavin R Norton
- Cardiovascular Pathophysiology and Genomics Research Unit, School of Physiology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Angela J Woodiwiss
- Cardiovascular Pathophysiology and Genomics Research Unit, School of Physiology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Linda Tsang
- Cardiovascular Pathophysiology and Genomics Research Unit, School of Physiology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Patrick H Dessein
- Cardiovascular Pathophysiology and Genomics Research Unit, School of Physiology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.,Free University and University Hospital, Brussels, Belgium
| | - Aletta M E Millen
- Cardiovascular Pathophysiology and Genomics Research Unit, School of Physiology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
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20
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Kolkenbeck-Ruh A, Motau TH, Naran R, Libhaber CD, Sareli P, Norton GR, Woodiwiss AJ. Organ-Specific, Age-Dependent Associations of Steady-State Pressures and Pulsatile Pressure Wave Components With End-Organ Measures. Am J Hypertens 2019; 32:272-281. [PMID: 30481263 DOI: 10.1093/ajh/hpy171] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2018] [Accepted: 11/08/2018] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND The contribution of steady-state pressures and the forward (Pf) and backward (reflected) (Pb) wave pressure components of pulse pressure to risk prediction have produced contrasting results. We hypothesized that the independent contribution of steady-state pressures (mean arterial pressure [MAP]), Pf and Pb, to cardiovascular damage is organ specific and age dependent. METHODS In 1,384 black South Africans from a community sample, we identified independent relations between MAP, Pf, or Pb (applanation tonometry and SphygmoCor software) and left ventricular mass index (LVMI) (n = 997) (echocardiography), carotid intima-media thickness (IMT) (n = 804) (B-mode ultrasound), or aortic pulse wave velocity (PWV) (n = 1,217). RESULTS Independent of risk factors, relations between Pf and IMT were noted in those over 50 years (P < 0.02), whereas in those less than 50 years, MAP (P < 0.005) was independently associated with IMT. Pb failed to show independent relations with IMT at any age (P > 0.37) In contrast, independent relations between Pb and LVMI were noted in those less than (P < 0.0001), and greater than (P < 0.02) 50 years, whereas MAP was not independently associated with LVMI at any age (P > 0.07) and Pf tended to show significant relations only in the elderly (P = 0.05). Moreover, although MAP (P < 0.005) and Pb (P < 0.01) showed independent relations with PWV at any age, Pf failed to show independent relations (P > 0.10). CONCLUSION Independent of confounders, steady-state and aortic Pf and Pb show associations with end-organ measures that are organ specific and age dependent.
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Affiliation(s)
- Andrea Kolkenbeck-Ruh
- Cardiovascular Pathophysiology and Genomics Research Unit, School of Physiology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Tshegofatso H Motau
- Cardiovascular Pathophysiology and Genomics Research Unit, School of Physiology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Ravi Naran
- Cardiovascular Pathophysiology and Genomics Research Unit, School of Physiology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Carlos D Libhaber
- Cardiovascular Pathophysiology and Genomics Research Unit, School of Physiology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Pinhas Sareli
- Cardiovascular Pathophysiology and Genomics Research Unit, School of Physiology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Gavin R Norton
- Cardiovascular Pathophysiology and Genomics Research Unit, School of Physiology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Angela J Woodiwiss
- Cardiovascular Pathophysiology and Genomics Research Unit, School of Physiology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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21
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Ahmed MK, Adam KF, El-Shafey WE. Assessment of Aortic Root Mechanics in Hypertensive Patients by Speckle Tracking Echocardiography. ACTA ACUST UNITED AC 2019. [DOI: 10.4236/wjcd.2019.93019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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22
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Groban L, Tran QK, Ferrario CM, Sun X, Cheng CP, Kitzman DW, Wang H, Lindsey SH. Female Heart Health: Is GPER the Missing Link? Front Endocrinol (Lausanne) 2019; 10:919. [PMID: 31993020 PMCID: PMC6970950 DOI: 10.3389/fendo.2019.00919] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2019] [Accepted: 12/17/2019] [Indexed: 12/20/2022] Open
Abstract
The G Protein-Coupled Estrogen Receptor (GPER) is a novel membrane-bound receptor that mediates non-genomic actions of the primary female sex hormone 17β-estradiol. Studies over the past two decades have elucidated the beneficial actions of this receptor in a number of cardiometabolic diseases. This review will focus specifically on the cardiac actions of GPER, since this receptor is expressed in cardiomyocytes as well as other cells within the heart and most likely contributes to estrogen-induced cardioprotection. Studies outlining the impact of GPER on diastolic function, mitochondrial function, left ventricular stiffness, calcium dynamics, cardiac inflammation, and aortic distensibility are discussed. In addition, recent data using genetic mouse models with global or cardiomyocyte-specific GPER gene deletion are highlighted. Since estrogen loss due to menopause in combination with chronological aging contributes to unique aspects of cardiac dysfunction in women, this receptor may provide novel therapeutic effects. While clinical studies are still required to fully understand the potential for pharmacological targeting of this receptor in postmenopausal women, this review will summarize the evidence gathered thus far on its likely beneficial effects.
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Affiliation(s)
- Leanne Groban
- Department of Anesthesiology, Wake Forest School of Medicine, Winston Salem, NC, United States
- Department of Internal Medicine-Molecular Medicine, Wake Forest School of Medicine, Winston Salem, NC, United States
- *Correspondence: Leanne Groban
| | - Quang-Kim Tran
- Department of Physiology & Pharmacology, Des Moines University College of Osteopathic Medicine, Des Moines, IA, United States
| | - Carlos M. Ferrario
- Department of Surgery, Wake Forest School of Medicine, Winston Salem, NC, United States
- Department of Physiology-Pharmacology, Wake Forest School of Medicine, Winston Salem, NC, United States
| | - Xuming Sun
- Department of Anesthesiology, Wake Forest School of Medicine, Winston Salem, NC, United States
| | - Che Ping Cheng
- Department of Internal Medicine, Cardiovascular Medicine Section, Wake Forest School of Medicine, Winston Salem, NC, United States
| | - Dalane W. Kitzman
- Department of Internal Medicine, Cardiovascular Medicine Section, Wake Forest School of Medicine, Winston Salem, NC, United States
| | - Hao Wang
- Department of Anesthesiology, Wake Forest School of Medicine, Winston Salem, NC, United States
- Department of Internal Medicine-Molecular Medicine, Wake Forest School of Medicine, Winston Salem, NC, United States
| | - Sarah H. Lindsey
- Department of Pharmacology, Tulane University, New Orleans, LA, United States
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23
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Mitchell GF. Aortic stiffness, pressure and flow pulsatility, and target organ damage. J Appl Physiol (1985) 2018; 125:1871-1880. [PMID: 30359540 PMCID: PMC6842890 DOI: 10.1152/japplphysiol.00108.2018] [Citation(s) in RCA: 77] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Revised: 09/17/2018] [Accepted: 10/24/2018] [Indexed: 01/19/2023] Open
Abstract
Measures of aortic stiffness and pressure and flow pulsatility have emerged as correlates of and potential contributors to cardiovascular disease, dementia, and kidney disease. Higher aortic stiffness and greater pressure and flow pulsatility are associated with excessive pulsatile load on the heart, which increases mass and reduces global longitudinal strain of the left ventricle. Excessive stiffness and pulsatility are also associated with microvascular lesions in high-flow organs, such as the brain and kidney, suggesting that small vessels in these organs are damaged by pulsatility. This brief review will summarize evidence relating aortic stiffness to cardiovascular, brain, and kidney disease.
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Affiliation(s)
- Gary F Mitchell
- Cardiovascular Engineering, Incorporated, Norwood, Massachusetts
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24
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Coutinho T, Mielniczuk LM, Srivaratharajah K, deKemp R, Wells GA, Beanlands RS. Coronary artery microvascular dysfunction: Role of sex and arterial load. Int J Cardiol 2018; 270:42-47. [DOI: 10.1016/j.ijcard.2018.06.072] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2017] [Revised: 05/27/2018] [Accepted: 06/18/2018] [Indexed: 01/09/2023]
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25
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Vascular aging and target organ damage: is it predictable? J Hypertens 2018; 36:1269-1271. [PMID: 29697479 DOI: 10.1097/hjh.0000000000001705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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26
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Abstract
The aorta has 2 main functions, conduit and cushion, and is designed to transmit blood to the periphery and buffer pulsatile stress from ventricular contraction. In the interaction between the structural and functional changes of the aorta, aging and disease processes impact on aortic material properties and hemodynamics. For a comprehensive assessment of changes in aortic structure and function associated with aging and disease, noninvasive cardiovascular imaging techniques, especially magnetic resonance imaging, have recently been developed. Magnetic resonance imaging allows for direct and accurate measurement of different aortic characteristics including structural measures such as aortic area or volume, aortic length, curvature, and aortic wall thickness and functional measures such as aortic strain, distensibility, and pulse wave velocity. Excellent reproducibility of magnetic resonance imaging methods allows us to assess the response of the whole aorta to both pharmacological and nonpharmacological therapies. Aortic flow and functional assessment could be added to clinical routine cardiac magnetic resonance as a comprehensive imaging modality primarily performed for the noninvasive evaluation of left ventricular function, left ventricular load, and vascular/ventricular coupling. New techniques such as 4-dimensional flow could provide and further elucidate the combined age-related effects of altered aortic geometry and function. This following review will describe the pathophysiological aspects of the aorta and the ability, value, and prospects of cardiovascular imaging, especially magnetic resonance imaging, to study age-related changes in aortic structure and function and assess the relationship between these alterations and cardiovascular disease.
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Affiliation(s)
- Yoshiaki Ohyama
- Departments of Cardiology/Medicine and Radiology, Johns Hopkins University, Baltimore, MD (Y.O., B.A.V., J.A.C.L.). Sorbonne Universités, UPMC University Paris 06, INSERM 1146, CNRS 7371, Laboratoire d'Imagerie Biomédicale, Paris, France (A.R., N.K.). Department of Cardiovascular Imaging and Interventional Radiology, Institute of Cardiology, Hôpital Pitié-Salpêtrière (AP-HP), Paris, France (A.R.). Clinical Investigation and Research Unit, Gunma University Hospital, Maebashi, Japan (Y.O.)
| | - Alban Redheuil
- Departments of Cardiology/Medicine and Radiology, Johns Hopkins University, Baltimore, MD (Y.O., B.A.V., J.A.C.L.). Sorbonne Universités, UPMC University Paris 06, INSERM 1146, CNRS 7371, Laboratoire d'Imagerie Biomédicale, Paris, France (A.R., N.K.). Department of Cardiovascular Imaging and Interventional Radiology, Institute of Cardiology, Hôpital Pitié-Salpêtrière (AP-HP), Paris, France (A.R.). Clinical Investigation and Research Unit, Gunma University Hospital, Maebashi, Japan (Y.O.)
| | - Nadjia Kachenoura
- Departments of Cardiology/Medicine and Radiology, Johns Hopkins University, Baltimore, MD (Y.O., B.A.V., J.A.C.L.). Sorbonne Universités, UPMC University Paris 06, INSERM 1146, CNRS 7371, Laboratoire d'Imagerie Biomédicale, Paris, France (A.R., N.K.). Department of Cardiovascular Imaging and Interventional Radiology, Institute of Cardiology, Hôpital Pitié-Salpêtrière (AP-HP), Paris, France (A.R.). Clinical Investigation and Research Unit, Gunma University Hospital, Maebashi, Japan (Y.O.)
| | - Bharath Ambale Venkatesh
- Departments of Cardiology/Medicine and Radiology, Johns Hopkins University, Baltimore, MD (Y.O., B.A.V., J.A.C.L.). Sorbonne Universités, UPMC University Paris 06, INSERM 1146, CNRS 7371, Laboratoire d'Imagerie Biomédicale, Paris, France (A.R., N.K.). Department of Cardiovascular Imaging and Interventional Radiology, Institute of Cardiology, Hôpital Pitié-Salpêtrière (AP-HP), Paris, France (A.R.). Clinical Investigation and Research Unit, Gunma University Hospital, Maebashi, Japan (Y.O.)
| | - Joao A C Lima
- Departments of Cardiology/Medicine and Radiology, Johns Hopkins University, Baltimore, MD (Y.O., B.A.V., J.A.C.L.). Sorbonne Universités, UPMC University Paris 06, INSERM 1146, CNRS 7371, Laboratoire d'Imagerie Biomédicale, Paris, France (A.R., N.K.). Department of Cardiovascular Imaging and Interventional Radiology, Institute of Cardiology, Hôpital Pitié-Salpêtrière (AP-HP), Paris, France (A.R.). Clinical Investigation and Research Unit, Gunma University Hospital, Maebashi, Japan (Y.O.).
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27
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Plonek T, Zak M, Burzynska K, Rylski B, Gozdzik A, Kustrzycki W, Beyersdorf F, Jasinski M, Filipiak J. The combined impact of mechanical factors on the wall stress of the human ascending aorta - a finite elements study. BMC Cardiovasc Disord 2017; 17:297. [PMID: 29262774 PMCID: PMC5738844 DOI: 10.1186/s12872-017-0733-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Accepted: 12/11/2017] [Indexed: 01/16/2023] Open
Affiliation(s)
- Tomasz Plonek
- Department of Cardiac and Thoracic Surgery, Wroclaw Medical University, Borowska 213, 50-556, Wroclaw, Poland.
| | - Malgorzata Zak
- Department of Biomedical Engineering, Mechatronics and Theory of Mechanisms, Wroclaw University of Science and Technology, Wroclaw, Poland
| | - Karolina Burzynska
- Department of Biomedical Engineering, Mechatronics and Theory of Mechanisms, Wroclaw University of Science and Technology, Wroclaw, Poland
| | - Bartosz Rylski
- Department of Cardio-vascular Surgery, Heart Centre Freiburg University, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Anna Gozdzik
- Department of Cardiac and Thoracic Surgery, Wroclaw Medical University, Borowska 213, 50-556, Wroclaw, Poland
| | - Wojciech Kustrzycki
- Department of Cardiac and Thoracic Surgery, Wroclaw Medical University, Borowska 213, 50-556, Wroclaw, Poland
| | - Friedhelm Beyersdorf
- Department of Cardio-vascular Surgery, Heart Centre Freiburg University, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Marek Jasinski
- Department of Cardiac and Thoracic Surgery, Wroclaw Medical University, Borowska 213, 50-556, Wroclaw, Poland
| | - Jaroslaw Filipiak
- Department of Biomedical Engineering, Mechatronics and Theory of Mechanisms, Wroclaw University of Science and Technology, Wroclaw, Poland
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28
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Ye Z, Pellikka PA, Kullo IJ. Sex differences in associations of cardio-ankle vascular index with left ventricular function and geometry. Vasc Med 2017; 22:465-472. [PMID: 28931350 DOI: 10.1177/1358863x17725810] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
The cardio-ankle vascular index (CAVI) is a measure of global arterial stiffness. We hypothesized that CAVI is associated with left ventricular (LV) function and geometry in individuals without structural heart disease. We measured CAVI in 600 participants (mean age 60.3±14.6 years, 54% men) without history of atherosclerotic cardiovascular disease who were referred for transthoracic echocardiography. Linear regression analysis was used to assess the association of CAVI with LV function (peak mitral annular systolic s' and early diastolic velocity e') and structure (LV mass index (LVMI) and relative wall thickness (RWT)). Older age, male sex, lower body mass index, history of hypertension, diabetes and chronic kidney disease were each associated with a higher CAVI (adjusted R2 = 0.56, all p < 0.01). A higher CAVI was associated with lower s' and e', and greater RWT, independent of age, sex, systolic BP and other conventional cardiovascular risk factors (all p < 0.05); a borderline association of higher CAVI with greater LVMI ( p = 0.05) was present. Associations with e', s' and RWT were similar in women and men but the association with LVMI was stronger in women than in men ( p for interaction = 0.02, multivariable-adjusted β = 6.92, p < 0.001 in women; p > 0.1 in men). In conclusion, a higher CAVI, a measure of global arterial stiffness, is associated with worse LV systolic function, worse diastolic relaxation, and greater LV RWT in both men and women, and with LVMI in women.
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Affiliation(s)
- Zi Ye
- Department of Cardiovascular Diseases and the Gonda Vascular Center, Mayo Clinic, Rochester, MN, USA
| | - Patricia A Pellikka
- Department of Cardiovascular Diseases and the Gonda Vascular Center, Mayo Clinic, Rochester, MN, USA
| | - Iftikhar J Kullo
- Department of Cardiovascular Diseases and the Gonda Vascular Center, Mayo Clinic, Rochester, MN, USA
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29
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Elattar MA, Vink LW, van Mourik MS, Baan J, vanBavel ET, Planken RN, Marquering HA. Dynamics of the aortic annulus in 4D CT angiography for transcatheter aortic valve implantation patients. PLoS One 2017; 12:e0184133. [PMID: 28886071 PMCID: PMC5590871 DOI: 10.1371/journal.pone.0184133] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2016] [Accepted: 08/18/2017] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND Transcatheter aortic valve implantation (TAVI) is a well-established treatment for patients with severe aortic valve stenosis. This procedure requires pre-operative planning by assessment of aortic dimensions on CT Angiography (CTA). It is well-known that the aortic root dimensions vary over the heart cycle. However, sizing is commonly performed at either mid-systole or end-diastole only, which has resulted in an inadequate understanding of its full dynamic behavior. STUDY GOAL We studied the variation in annulus measurements during the cardiac cycle and determined if this variation is dependent on the amount of calcification at the annulus. METHODS We measured and compared aortic root annular dimensions and calcium volume in CTA acquisitions at 10 cardiac cycle phases in 51 aortic stenosis patients. Sub-group analysis was performed based on the volume of calcium by splitting the population into mildly and severely calcified valves subgroups. RESULTS For most annulus measurements, the largest differences were found between 10% and 70 to 80% cardiac cycle phases. Mean difference (±standard deviation) in annular minimum diameter, maximum diameter, area, and aspect ratio between mid-systole and end-diastole phases were 1.0 ± 0.29 mm (p = 0.065), 0.30 ± 0.24 mm (p = 0.7), 24.1 ± 7.6 mm2 (p < 0.001), and 0.041 ± 0.012 (p = 0.039) respectively. Calcium volume measurements varied strongly during the cardiac cycle. The dynamic annulus area was behaving differently between mildly and severely calcified subgroups (p = 0.02). Furthermore, patients with severe aortic calcification were associated with larger annulus diameters. CONCLUSION There is a significant variation of annulus area and calcium volume measurement during the cardiac cycle. In our measurements, only the dynamic variation of the annulus area is dependent on the severity of the aortic calcification. For TAVI candidates, the annulus area is significantly larger in mid-systole compared to end-diastole.
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Affiliation(s)
- Mustafa A. Elattar
- Department of Biomedical Engineering and Physics, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Leon W. Vink
- Department of Biomedical Engineering and Physics, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Martijn S. van Mourik
- Department of Heart Center, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Jan Baan
- Department of Heart Center, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Ed T. vanBavel
- Department of Biomedical Engineering and Physics, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - R. Nils Planken
- Department of Radiology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Henk A. Marquering
- Department of Biomedical Engineering and Physics, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
- Department of Radiology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
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30
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de Roos A, van der Grond J, Mitchell G, Westenberg J. Magnetic Resonance Imaging of Cardiovascular Function and the Brain: Is Dementia a Cardiovascular-Driven Disease? Circulation 2017; 135:2178-2195. [PMID: 28559496 DOI: 10.1161/circulationaha.116.021978] [Citation(s) in RCA: 83] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
The proximal aorta acts as a coupling device between heart and brain perfusion, modulating the amount of pressure and flow pulsatility transmitted into the cerebral microcirculation. Stiffening of the proximal aorta is strongly associated with age and hypertension. The detrimental effects of aortic stiffening may result in brain damage as well as heart failure. The resulting cerebral small vessel disease and heart failure may contribute to early cognitive decline and (vascular) dementia. This pathophysiological sequence of events underscores the role of cardiovascular disease as a contributory mechanism in causing cognitive decline and dementia and potentially may provide a starting point for prevention and treatment. Magnetic resonance imaging is well suited to assess the function of the proximal aorta and the left ventricle (eg, aortic arch pulse wave velocity and distensibility) as well as the various early and late manifestations of cerebral small vessel disease (eg, microbleeds and white matter hyperintensities in strategically important regions of the brain). Specialized magnetic resonance imaging techniques are explored for diagnosing preclinical changes in white matter integrity or brain microvascular pulsatility.
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Affiliation(s)
- Albert de Roos
- From Leiden University Medical Center, Department of Radiology, The Netherlands (A.d.R., J.v.d.G., J.W.); and Cardiovascular Engineering, Inc, Norwood, MA (G.M.).
| | - Jeroen van der Grond
- From Leiden University Medical Center, Department of Radiology, The Netherlands (A.d.R., J.v.d.G., J.W.); and Cardiovascular Engineering, Inc, Norwood, MA (G.M.)
| | - Gary Mitchell
- From Leiden University Medical Center, Department of Radiology, The Netherlands (A.d.R., J.v.d.G., J.W.); and Cardiovascular Engineering, Inc, Norwood, MA (G.M.)
| | - Jos Westenberg
- From Leiden University Medical Center, Department of Radiology, The Netherlands (A.d.R., J.v.d.G., J.W.); and Cardiovascular Engineering, Inc, Norwood, MA (G.M.)
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31
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Zhou T, Huang X, Cai X, Xie L. Combined treatment of irbesartan and diltiazem ameliorates endothelium dependent vasodilatation in hypertensives. Clin Exp Hypertens 2017; 39:612-618. [PMID: 28613098 DOI: 10.1080/10641963.2017.1306537] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Tingting Zhou
- Fujian Medical University, Fujian Hypertension Research Institute, Fuzhou, P.R. China
| | - Xiaodong Huang
- Fujian Hypertension Research Institute, First Affiliated Hospital of Fujian Medical University, Fuzhou, PR China
| | - Xiaoqi Cai
- Fujian Hypertension Research Institute, First Affiliated Hospital of Fujian Medical University, Fuzhou, PR China
| | - Liangdi Xie
- Fujian Hypertension Research Institute, First Affiliated Hospital of Fujian Medical University, Fuzhou, PR China
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32
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Imga NN, Elalmıs OU, Tuna MM, Dogan BA, Sahın D, Gursoy T, Yalcın Y, Berker D, Guler S. Comparison of echocardiographic findings in patients with nonfunctioning adrenal incidentalomas. Kaohsiung J Med Sci 2017; 33:295-301. [PMID: 28601234 DOI: 10.1016/j.kjms.2017.04.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2016] [Revised: 03/05/2017] [Accepted: 03/08/2017] [Indexed: 10/19/2022] Open
Abstract
Adrenal incidentalomas (AIs) are usually discovered incidentally after imaging unrelated to adrenal glands. We aimed to evaluate standard risk factors for systemic atherosclerosis and echocardiographic changes in patients with nonfunctioning AIs and compare them with normal subjects. We evaluated 70 patients diagnosed with AIs and 51 healthy controls. Mean levels were determined for HbA1c, LDL, uric acid, fasting plasma insulin, HOMA, and neutrophil-to-lymphocyte ratio (NLR), and these values were found to be significantly higher in the patients than the controls. The mean left atrial diameter, interventricular septum thickness, posterior wall thickness, left ventricular mass, E-wave deceleration time, isovolumetric relaxation time, and the median ratio of the early transmittal flow velocity to the early diastolic tissue velocity (E/Em) were higher in patients with AIs compared to controls. The mitral annular early diastolic velocity was lower in patients with AIs. The mean aortic diastolic diameter, stiffness index (SI), and aortic strain were higher, and aortic distensibility was lower in the patients. The mean right ventricular diameter, right atrial major-axis diameter, and right atrial minor-axis diameter were statistically higher in the patient group than the controls. A negative correlation was found between the NLR and aortic strain and aortic distensibility, while a positive correction was found between the NLR and SI. We found altered left ventricular (LV) and right ventricular (RV) echocardiographic findings in patients with AIs without known cardiovascular disease. Aortic stiffness was also increased. These changes may be related to an increase in cardiovascular risk factors in AI patients.
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Affiliation(s)
- Narin Nasıroglu Imga
- Department of Endocrinology, Ankara Numune Education and Research Hospital, Ankara, Turkey.
| | - Ozgul Ucar Elalmıs
- Department of Cardiology, Ankara Numune Education and Research Hospital, Ankara, Turkey
| | - Mazhar Muslum Tuna
- Department of Endocrinology, Ankara Numune Education and Research Hospital, Ankara, Turkey
| | - Bercem Aycıcek Dogan
- Department of Endocrinology, Ankara Numune Education and Research Hospital, Ankara, Turkey
| | - Deniz Sahın
- Department of Cardiology, Ankara Numune Education and Research Hospital, Ankara, Turkey
| | - Tugba Gursoy
- Department of Cardiology, Ankara Numune Education and Research Hospital, Ankara, Turkey
| | - Yavuz Yalcın
- Department of Endocrinology, Ankara Numune Education and Research Hospital, Ankara, Turkey
| | - Dilek Berker
- Department of Endocrinology, Ankara Numune Education and Research Hospital, Ankara, Turkey
| | - Serdar Guler
- Department of Endocrinology, Ankara Numune Education and Research Hospital, Ankara, Turkey
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Ohyama Y, Ambale-Venkatesh B, Noda C, Chugh AR, Teixido-Tura G, Kim JY, Donekal S, Yoneyama K, Gjesdal O, Redheuil A, Liu CY, Nakamura T, Wu CO, Hundley WG, Bluemke DA, Lima JAC. Association of Aortic Stiffness With Left Ventricular Remodeling and Reduced Left Ventricular Function Measured by Magnetic Resonance Imaging: The Multi-Ethnic Study of Atherosclerosis. Circ Cardiovasc Imaging 2017; 9:CIRCIMAGING.115.004426. [PMID: 27353852 DOI: 10.1161/circimaging.115.004426] [Citation(s) in RCA: 62] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2015] [Accepted: 05/18/2016] [Indexed: 12/28/2022]
Abstract
BACKGROUND This study sought to assess cross-sectional associations of aortic stiffness assessed by magnetic resonance imaging with left ventricular (LV) remodeling and myocardial deformation in the Multi-Ethnic Study of Atherosclerosis (MESA). METHODS AND RESULTS Aortic arch pulse wave velocity (PWV) was measured with phase contrast cine magnetic resonance imaging. LV circumferential strain (Ecc), torsion, and early diastolic strain rate were determined by tagged magnetic resonance imaging. Multivariable linear regression models were used to adjust for demographics and cardiovascular risk factors. Of 2093 participants, multivariable linear regression models demonstrated that higher arch PWV was associated with higher LV mass index (B=0.53 per 1 SD increase for log-transformed PWV, P<0.05) and LV mass to volume ratio (B=0.015, P<0.01), impaired LV ejection fraction (LVEF; B=-0.84; P<0.001), Ecc (B=0.55; P<0.001), torsion (B=-0.11; P<0.001), and early diastolic strain rate (B=-0.003; P<0.05). In sex stratified analysis, higher arch PWV was associated with higher MVR (B=0.02; P<0.05), impaired Ecc (B=0.60; P<0.001), and LVEF (B=-0.45; P<0.05), but with maintained torsion in women. Higher PWV was associated with impaired Ecc (B=0.49; P<0.001) and LVEF (B=-1.21; P<0.001), with lower torsion (B=-0.17; P<0.001) in men. CONCLUSIONS Higher arch PWV is associated with LV remodeling, and reduced LV systolic and diastolic function in a large multiethnic population. Greater aortic arch stiffness is associated with concentric LV remodeling and relatively preserved LVEF with maintained torsion in women, whereas greater aortic arch stiffness is associated with greater LV dysfunction demonstrated as impaired Ecc, torsion, and LVEF, with less concentric LV remodeling in men.
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Affiliation(s)
- Yoshiaki Ohyama
- From the Department of Cardiology (Y.O., C.N., A.R.C., G.T.-T., J.-Y.K., S.D., K.Y., O.G., J.A.C.L.), Department of Radiology (B.A.-V.), Johns Hopkins University, Baltimore, MD; Department of Cardiology, Hospital General Universitari Vall d'Herbron, Barcelona, Spain (G.T.-T.); Department of Cardiology, Oslo University Hospital, Norway (O.G.); Imagerie Cardiovasculaire/Cardiovascular Imaging DICVRI, Institut de Cardiologie, Groupe Hospitalier Pitié Salpêtrière, Paris, France (A.R.); National Institutes of Health Clinical Center, National Institute of Biomedical Imaging and Bioengineering, Bethesda, MD (C.-Y.L., D.A.B.); Clinical Investigation and Research Unit, Gunma University, Maebashi, Japan (T.N.); Office of Biostatistics Research, National Heart, Lung and Blood Institute, Bethesda, MD (C.O.W.); and Department of Epidemiology and Prevention, Wake Forest School of Medicine, Winston-Salem, NC (W.G.H.)
| | - Bharath Ambale-Venkatesh
- From the Department of Cardiology (Y.O., C.N., A.R.C., G.T.-T., J.-Y.K., S.D., K.Y., O.G., J.A.C.L.), Department of Radiology (B.A.-V.), Johns Hopkins University, Baltimore, MD; Department of Cardiology, Hospital General Universitari Vall d'Herbron, Barcelona, Spain (G.T.-T.); Department of Cardiology, Oslo University Hospital, Norway (O.G.); Imagerie Cardiovasculaire/Cardiovascular Imaging DICVRI, Institut de Cardiologie, Groupe Hospitalier Pitié Salpêtrière, Paris, France (A.R.); National Institutes of Health Clinical Center, National Institute of Biomedical Imaging and Bioengineering, Bethesda, MD (C.-Y.L., D.A.B.); Clinical Investigation and Research Unit, Gunma University, Maebashi, Japan (T.N.); Office of Biostatistics Research, National Heart, Lung and Blood Institute, Bethesda, MD (C.O.W.); and Department of Epidemiology and Prevention, Wake Forest School of Medicine, Winston-Salem, NC (W.G.H.)
| | - Chikara Noda
- From the Department of Cardiology (Y.O., C.N., A.R.C., G.T.-T., J.-Y.K., S.D., K.Y., O.G., J.A.C.L.), Department of Radiology (B.A.-V.), Johns Hopkins University, Baltimore, MD; Department of Cardiology, Hospital General Universitari Vall d'Herbron, Barcelona, Spain (G.T.-T.); Department of Cardiology, Oslo University Hospital, Norway (O.G.); Imagerie Cardiovasculaire/Cardiovascular Imaging DICVRI, Institut de Cardiologie, Groupe Hospitalier Pitié Salpêtrière, Paris, France (A.R.); National Institutes of Health Clinical Center, National Institute of Biomedical Imaging and Bioengineering, Bethesda, MD (C.-Y.L., D.A.B.); Clinical Investigation and Research Unit, Gunma University, Maebashi, Japan (T.N.); Office of Biostatistics Research, National Heart, Lung and Blood Institute, Bethesda, MD (C.O.W.); and Department of Epidemiology and Prevention, Wake Forest School of Medicine, Winston-Salem, NC (W.G.H.)
| | - Atul R Chugh
- From the Department of Cardiology (Y.O., C.N., A.R.C., G.T.-T., J.-Y.K., S.D., K.Y., O.G., J.A.C.L.), Department of Radiology (B.A.-V.), Johns Hopkins University, Baltimore, MD; Department of Cardiology, Hospital General Universitari Vall d'Herbron, Barcelona, Spain (G.T.-T.); Department of Cardiology, Oslo University Hospital, Norway (O.G.); Imagerie Cardiovasculaire/Cardiovascular Imaging DICVRI, Institut de Cardiologie, Groupe Hospitalier Pitié Salpêtrière, Paris, France (A.R.); National Institutes of Health Clinical Center, National Institute of Biomedical Imaging and Bioengineering, Bethesda, MD (C.-Y.L., D.A.B.); Clinical Investigation and Research Unit, Gunma University, Maebashi, Japan (T.N.); Office of Biostatistics Research, National Heart, Lung and Blood Institute, Bethesda, MD (C.O.W.); and Department of Epidemiology and Prevention, Wake Forest School of Medicine, Winston-Salem, NC (W.G.H.)
| | - Gisela Teixido-Tura
- From the Department of Cardiology (Y.O., C.N., A.R.C., G.T.-T., J.-Y.K., S.D., K.Y., O.G., J.A.C.L.), Department of Radiology (B.A.-V.), Johns Hopkins University, Baltimore, MD; Department of Cardiology, Hospital General Universitari Vall d'Herbron, Barcelona, Spain (G.T.-T.); Department of Cardiology, Oslo University Hospital, Norway (O.G.); Imagerie Cardiovasculaire/Cardiovascular Imaging DICVRI, Institut de Cardiologie, Groupe Hospitalier Pitié Salpêtrière, Paris, France (A.R.); National Institutes of Health Clinical Center, National Institute of Biomedical Imaging and Bioengineering, Bethesda, MD (C.-Y.L., D.A.B.); Clinical Investigation and Research Unit, Gunma University, Maebashi, Japan (T.N.); Office of Biostatistics Research, National Heart, Lung and Blood Institute, Bethesda, MD (C.O.W.); and Department of Epidemiology and Prevention, Wake Forest School of Medicine, Winston-Salem, NC (W.G.H.)
| | - Jang-Young Kim
- From the Department of Cardiology (Y.O., C.N., A.R.C., G.T.-T., J.-Y.K., S.D., K.Y., O.G., J.A.C.L.), Department of Radiology (B.A.-V.), Johns Hopkins University, Baltimore, MD; Department of Cardiology, Hospital General Universitari Vall d'Herbron, Barcelona, Spain (G.T.-T.); Department of Cardiology, Oslo University Hospital, Norway (O.G.); Imagerie Cardiovasculaire/Cardiovascular Imaging DICVRI, Institut de Cardiologie, Groupe Hospitalier Pitié Salpêtrière, Paris, France (A.R.); National Institutes of Health Clinical Center, National Institute of Biomedical Imaging and Bioengineering, Bethesda, MD (C.-Y.L., D.A.B.); Clinical Investigation and Research Unit, Gunma University, Maebashi, Japan (T.N.); Office of Biostatistics Research, National Heart, Lung and Blood Institute, Bethesda, MD (C.O.W.); and Department of Epidemiology and Prevention, Wake Forest School of Medicine, Winston-Salem, NC (W.G.H.)
| | - Sirisha Donekal
- From the Department of Cardiology (Y.O., C.N., A.R.C., G.T.-T., J.-Y.K., S.D., K.Y., O.G., J.A.C.L.), Department of Radiology (B.A.-V.), Johns Hopkins University, Baltimore, MD; Department of Cardiology, Hospital General Universitari Vall d'Herbron, Barcelona, Spain (G.T.-T.); Department of Cardiology, Oslo University Hospital, Norway (O.G.); Imagerie Cardiovasculaire/Cardiovascular Imaging DICVRI, Institut de Cardiologie, Groupe Hospitalier Pitié Salpêtrière, Paris, France (A.R.); National Institutes of Health Clinical Center, National Institute of Biomedical Imaging and Bioengineering, Bethesda, MD (C.-Y.L., D.A.B.); Clinical Investigation and Research Unit, Gunma University, Maebashi, Japan (T.N.); Office of Biostatistics Research, National Heart, Lung and Blood Institute, Bethesda, MD (C.O.W.); and Department of Epidemiology and Prevention, Wake Forest School of Medicine, Winston-Salem, NC (W.G.H.)
| | - Kihei Yoneyama
- From the Department of Cardiology (Y.O., C.N., A.R.C., G.T.-T., J.-Y.K., S.D., K.Y., O.G., J.A.C.L.), Department of Radiology (B.A.-V.), Johns Hopkins University, Baltimore, MD; Department of Cardiology, Hospital General Universitari Vall d'Herbron, Barcelona, Spain (G.T.-T.); Department of Cardiology, Oslo University Hospital, Norway (O.G.); Imagerie Cardiovasculaire/Cardiovascular Imaging DICVRI, Institut de Cardiologie, Groupe Hospitalier Pitié Salpêtrière, Paris, France (A.R.); National Institutes of Health Clinical Center, National Institute of Biomedical Imaging and Bioengineering, Bethesda, MD (C.-Y.L., D.A.B.); Clinical Investigation and Research Unit, Gunma University, Maebashi, Japan (T.N.); Office of Biostatistics Research, National Heart, Lung and Blood Institute, Bethesda, MD (C.O.W.); and Department of Epidemiology and Prevention, Wake Forest School of Medicine, Winston-Salem, NC (W.G.H.)
| | - Ola Gjesdal
- From the Department of Cardiology (Y.O., C.N., A.R.C., G.T.-T., J.-Y.K., S.D., K.Y., O.G., J.A.C.L.), Department of Radiology (B.A.-V.), Johns Hopkins University, Baltimore, MD; Department of Cardiology, Hospital General Universitari Vall d'Herbron, Barcelona, Spain (G.T.-T.); Department of Cardiology, Oslo University Hospital, Norway (O.G.); Imagerie Cardiovasculaire/Cardiovascular Imaging DICVRI, Institut de Cardiologie, Groupe Hospitalier Pitié Salpêtrière, Paris, France (A.R.); National Institutes of Health Clinical Center, National Institute of Biomedical Imaging and Bioengineering, Bethesda, MD (C.-Y.L., D.A.B.); Clinical Investigation and Research Unit, Gunma University, Maebashi, Japan (T.N.); Office of Biostatistics Research, National Heart, Lung and Blood Institute, Bethesda, MD (C.O.W.); and Department of Epidemiology and Prevention, Wake Forest School of Medicine, Winston-Salem, NC (W.G.H.)
| | - Alban Redheuil
- From the Department of Cardiology (Y.O., C.N., A.R.C., G.T.-T., J.-Y.K., S.D., K.Y., O.G., J.A.C.L.), Department of Radiology (B.A.-V.), Johns Hopkins University, Baltimore, MD; Department of Cardiology, Hospital General Universitari Vall d'Herbron, Barcelona, Spain (G.T.-T.); Department of Cardiology, Oslo University Hospital, Norway (O.G.); Imagerie Cardiovasculaire/Cardiovascular Imaging DICVRI, Institut de Cardiologie, Groupe Hospitalier Pitié Salpêtrière, Paris, France (A.R.); National Institutes of Health Clinical Center, National Institute of Biomedical Imaging and Bioengineering, Bethesda, MD (C.-Y.L., D.A.B.); Clinical Investigation and Research Unit, Gunma University, Maebashi, Japan (T.N.); Office of Biostatistics Research, National Heart, Lung and Blood Institute, Bethesda, MD (C.O.W.); and Department of Epidemiology and Prevention, Wake Forest School of Medicine, Winston-Salem, NC (W.G.H.)
| | - Chia-Ying Liu
- From the Department of Cardiology (Y.O., C.N., A.R.C., G.T.-T., J.-Y.K., S.D., K.Y., O.G., J.A.C.L.), Department of Radiology (B.A.-V.), Johns Hopkins University, Baltimore, MD; Department of Cardiology, Hospital General Universitari Vall d'Herbron, Barcelona, Spain (G.T.-T.); Department of Cardiology, Oslo University Hospital, Norway (O.G.); Imagerie Cardiovasculaire/Cardiovascular Imaging DICVRI, Institut de Cardiologie, Groupe Hospitalier Pitié Salpêtrière, Paris, France (A.R.); National Institutes of Health Clinical Center, National Institute of Biomedical Imaging and Bioengineering, Bethesda, MD (C.-Y.L., D.A.B.); Clinical Investigation and Research Unit, Gunma University, Maebashi, Japan (T.N.); Office of Biostatistics Research, National Heart, Lung and Blood Institute, Bethesda, MD (C.O.W.); and Department of Epidemiology and Prevention, Wake Forest School of Medicine, Winston-Salem, NC (W.G.H.)
| | - Tetsuya Nakamura
- From the Department of Cardiology (Y.O., C.N., A.R.C., G.T.-T., J.-Y.K., S.D., K.Y., O.G., J.A.C.L.), Department of Radiology (B.A.-V.), Johns Hopkins University, Baltimore, MD; Department of Cardiology, Hospital General Universitari Vall d'Herbron, Barcelona, Spain (G.T.-T.); Department of Cardiology, Oslo University Hospital, Norway (O.G.); Imagerie Cardiovasculaire/Cardiovascular Imaging DICVRI, Institut de Cardiologie, Groupe Hospitalier Pitié Salpêtrière, Paris, France (A.R.); National Institutes of Health Clinical Center, National Institute of Biomedical Imaging and Bioengineering, Bethesda, MD (C.-Y.L., D.A.B.); Clinical Investigation and Research Unit, Gunma University, Maebashi, Japan (T.N.); Office of Biostatistics Research, National Heart, Lung and Blood Institute, Bethesda, MD (C.O.W.); and Department of Epidemiology and Prevention, Wake Forest School of Medicine, Winston-Salem, NC (W.G.H.)
| | - Colin O Wu
- From the Department of Cardiology (Y.O., C.N., A.R.C., G.T.-T., J.-Y.K., S.D., K.Y., O.G., J.A.C.L.), Department of Radiology (B.A.-V.), Johns Hopkins University, Baltimore, MD; Department of Cardiology, Hospital General Universitari Vall d'Herbron, Barcelona, Spain (G.T.-T.); Department of Cardiology, Oslo University Hospital, Norway (O.G.); Imagerie Cardiovasculaire/Cardiovascular Imaging DICVRI, Institut de Cardiologie, Groupe Hospitalier Pitié Salpêtrière, Paris, France (A.R.); National Institutes of Health Clinical Center, National Institute of Biomedical Imaging and Bioengineering, Bethesda, MD (C.-Y.L., D.A.B.); Clinical Investigation and Research Unit, Gunma University, Maebashi, Japan (T.N.); Office of Biostatistics Research, National Heart, Lung and Blood Institute, Bethesda, MD (C.O.W.); and Department of Epidemiology and Prevention, Wake Forest School of Medicine, Winston-Salem, NC (W.G.H.)
| | - W Gregory Hundley
- From the Department of Cardiology (Y.O., C.N., A.R.C., G.T.-T., J.-Y.K., S.D., K.Y., O.G., J.A.C.L.), Department of Radiology (B.A.-V.), Johns Hopkins University, Baltimore, MD; Department of Cardiology, Hospital General Universitari Vall d'Herbron, Barcelona, Spain (G.T.-T.); Department of Cardiology, Oslo University Hospital, Norway (O.G.); Imagerie Cardiovasculaire/Cardiovascular Imaging DICVRI, Institut de Cardiologie, Groupe Hospitalier Pitié Salpêtrière, Paris, France (A.R.); National Institutes of Health Clinical Center, National Institute of Biomedical Imaging and Bioengineering, Bethesda, MD (C.-Y.L., D.A.B.); Clinical Investigation and Research Unit, Gunma University, Maebashi, Japan (T.N.); Office of Biostatistics Research, National Heart, Lung and Blood Institute, Bethesda, MD (C.O.W.); and Department of Epidemiology and Prevention, Wake Forest School of Medicine, Winston-Salem, NC (W.G.H.)
| | - David A Bluemke
- From the Department of Cardiology (Y.O., C.N., A.R.C., G.T.-T., J.-Y.K., S.D., K.Y., O.G., J.A.C.L.), Department of Radiology (B.A.-V.), Johns Hopkins University, Baltimore, MD; Department of Cardiology, Hospital General Universitari Vall d'Herbron, Barcelona, Spain (G.T.-T.); Department of Cardiology, Oslo University Hospital, Norway (O.G.); Imagerie Cardiovasculaire/Cardiovascular Imaging DICVRI, Institut de Cardiologie, Groupe Hospitalier Pitié Salpêtrière, Paris, France (A.R.); National Institutes of Health Clinical Center, National Institute of Biomedical Imaging and Bioengineering, Bethesda, MD (C.-Y.L., D.A.B.); Clinical Investigation and Research Unit, Gunma University, Maebashi, Japan (T.N.); Office of Biostatistics Research, National Heart, Lung and Blood Institute, Bethesda, MD (C.O.W.); and Department of Epidemiology and Prevention, Wake Forest School of Medicine, Winston-Salem, NC (W.G.H.)
| | - Joao A C Lima
- From the Department of Cardiology (Y.O., C.N., A.R.C., G.T.-T., J.-Y.K., S.D., K.Y., O.G., J.A.C.L.), Department of Radiology (B.A.-V.), Johns Hopkins University, Baltimore, MD; Department of Cardiology, Hospital General Universitari Vall d'Herbron, Barcelona, Spain (G.T.-T.); Department of Cardiology, Oslo University Hospital, Norway (O.G.); Imagerie Cardiovasculaire/Cardiovascular Imaging DICVRI, Institut de Cardiologie, Groupe Hospitalier Pitié Salpêtrière, Paris, France (A.R.); National Institutes of Health Clinical Center, National Institute of Biomedical Imaging and Bioengineering, Bethesda, MD (C.-Y.L., D.A.B.); Clinical Investigation and Research Unit, Gunma University, Maebashi, Japan (T.N.); Office of Biostatistics Research, National Heart, Lung and Blood Institute, Bethesda, MD (C.O.W.); and Department of Epidemiology and Prevention, Wake Forest School of Medicine, Winston-Salem, NC (W.G.H.).
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The association of endothelial function and tone by digital arterial tonometry with MRI left ventricular mass in African Americans: the Jackson Heart Study. ACTA ACUST UNITED AC 2017; 11:258-264. [DOI: 10.1016/j.jash.2017.03.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2016] [Revised: 02/12/2017] [Accepted: 03/18/2017] [Indexed: 11/20/2022]
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Bello H, Norton GR, Ballim I, Libhaber CD, Sareli P, Woodiwiss AJ. Contributions of aortic pulse wave velocity and backward wave pressure to variations in left ventricular mass are independent of each other. ACTA ACUST UNITED AC 2017; 11:265-274.e2. [PMID: 28365237 DOI: 10.1016/j.jash.2017.03.001] [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: 10/07/2016] [Revised: 02/27/2017] [Accepted: 03/02/2017] [Indexed: 01/15/2023]
Abstract
Aortic pulse wave velocity (PWV) and backward waves, as determined from wave separation analysis, predict cardiovascular events beyond brachial blood pressure. However, the extent to which these aortic hemodynamic variables contribute independent of each other is uncertain. In 749 randomly selected participants of African ancestry, we therefore assessed the extent to which relationships between aortic PWV or backward wave pressures (Pb) (and hence central aortic pulse pressure [PPc]) and left ventricular mass index (LVMI) occur independent of each other. Aortic PWV, PPc, forward wave pressure (Pf), and Pb were determined using radial applanation tonometry and SphygmoCor software and LVMI using echocardiography; 44.5% of participants had an increased left ventricular mass indexed to height1.7. With adjustments for age, brachial systolic blood pressure or PP, and additional confounders, PPc and Pb, but not Pf, were independently related to LVMI and left ventricular hypertrophy (LVH) in both men and women. However, PWV was independently associated with LVMI in women (partial r = 0.16, P < .001), but not in men (partial r = 0.03), and PWV was independently associated with LVH in women (P < .05), but not in men (P = .07). With PWV and Pb included in the same multivariate regression models, PWV (partial r = 0.14, P < .005) and Pb (partial r = 0.10, P < .05) contributed to a similar extent to variations in LVMI in women. In addition, with PWV and Pb included in the same multivariate regression models, PWV (P < .05) and Pb (P < .02) contributed to LVH in women. In conclusion, aortic PWV and Pb (and hence pulse pressure) although both associated with LVMI and LVH produce effects which are independent of each other.
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Affiliation(s)
- Hamza Bello
- Cardiovascular Pathophysiology and Genomics Research Unit, School of Physiology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Gavin R Norton
- Cardiovascular Pathophysiology and Genomics Research Unit, School of Physiology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Imraan Ballim
- Cardiovascular Pathophysiology and Genomics Research Unit, School of Physiology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Carlos D Libhaber
- School of Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Pinhas Sareli
- Cardiovascular Pathophysiology and Genomics Research Unit, School of Physiology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Angela J Woodiwiss
- Cardiovascular Pathophysiology and Genomics Research Unit, School of Physiology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
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Bell V, McCabe EL, Larson MG, Rong J, Merz AA, Osypiuk E, Lehman BT, Stantchev P, Aragam J, Benjamin EJ, Hamburg NM, Vasan RS, Mitchell GF, Cheng S. Relations Between Aortic Stiffness and Left Ventricular Mechanical Function in the Community. J Am Heart Assoc 2017; 6:JAHA.116.004903. [PMID: 28069573 PMCID: PMC5523643 DOI: 10.1161/jaha.116.004903] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background Aortic stiffness impairs optimal ventricular–vascular coupling and left ventricular systolic function, particularly in the long axis. Left ventricular global longitudinal strain (GLS) has recently emerged as a sensitive measure of early cardiac dysfunction. In this study, we investigated the relation between aortic stiffness and GLS in a large community‐based sample. Methods and Results In 2495 participants (age 39–90 years, 57% women) of the Framingham Offspring and Omni cohorts, free of cardiovascular disease, we performed tonometry to measure arterial hemodynamics and echocardiography to assess cardiac function. Aortic stiffness was evaluated as carotid–femoral pulse wave velocity and as characteristic impedance, and GLS was calculated using speckle tracking–based measurements. In multivariable analyses adjusting for age, sex, height, systolic blood pressure, augmentation index, left ventricular structure, and additional cardiovascular risk factors, increased carotid–femoral pulse wave velocity (B±SE: 0.122±0.030% strain per SD, P<0.0001) and characteristic impedance (0.090±0.029, P=0.002) were both associated with worse GLS. We observed effect modification by sex on the relation between characteristic impedance and GLS (P=0.004); in sex‐stratified multivariable analyses, the relation between greater characteristic impedance and worse GLS persisted in women (0.145±0.039, P=0.0003) but not in men (P=0.73). Conclusions Multiple measures of increased aortic stiffness were cross‐sectionally associated with worse GLS after adjusting for hemodynamic variables. Parallel reductions in left ventricular long axis shortening and proximal aortic longitudinal strain in individuals with a stiffened proximal aorta, from direct mechanical ventricular‐vascular coupling, offers an alternative explanation for the observed relations.
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Affiliation(s)
| | - Elizabeth L McCabe
- Department of Biostatistics, Boston University School of Public Health, Boston, MA
| | - Martin G Larson
- Department of Biostatistics, Boston University School of Public Health, Boston, MA.,Framingham Heart Study, Framingham, MA
| | - Jian Rong
- Framingham Heart Study, Framingham, MA
| | - Allison A Merz
- Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, MA
| | | | | | | | | | - Emelia J Benjamin
- Department of Epidemiology, Boston University School of Public Health, Boston, MA.,Framingham Heart Study, Framingham, MA.,Preventive Medicine and Cardiology Sections, Whitaker Cardiovascular Institute, Boston University School of Medicine, Boston, MA
| | - Naomi M Hamburg
- Preventive Medicine and Cardiology Sections, Whitaker Cardiovascular Institute, Boston University School of Medicine, Boston, MA.,Evans Department of Medicine, Boston University School of Medicine, Boston, MA
| | - Ramachandran S Vasan
- Department of Epidemiology, Boston University School of Public Health, Boston, MA.,Framingham Heart Study, Framingham, MA.,Preventive Medicine and Cardiology Sections, Whitaker Cardiovascular Institute, Boston University School of Medicine, Boston, MA
| | | | - Susan Cheng
- Framingham Heart Study, Framingham, MA .,Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, MA
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37
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Pandey A, Khan H, Newman AB, Lakatta EG, Forman DE, Butler J, Berry JD. Arterial Stiffness and Risk of Overall Heart Failure, Heart Failure With Preserved Ejection Fraction, and Heart Failure With Reduced Ejection Fraction: The Health ABC Study (Health, Aging, and Body Composition). Hypertension 2016; 69:267-274. [PMID: 27993954 DOI: 10.1161/hypertensionaha.116.08327] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2016] [Revised: 10/09/2016] [Accepted: 11/17/2016] [Indexed: 01/08/2023]
Abstract
Higher arterial stiffness is associated with increased risk of atherosclerotic events. However, its contribution toward risk of heart failure (HF) and its subtypes, HF with preserved ejection fraction (HFpEF) and HF with reduced ejection fraction (HFrEF), independent of other risk factors is not well established. In this study, we included Health ABC study (Health, Aging, and Body Composition) participants without prevalent HF who had arterial stiffness measured as carotid-femoral pulse wave velocity (cf-PWV) at baseline (n=2290). Adjusted Cox-proportional hazards models were constructed to determine the association between continuous and data-derived categorical measures (tertiles) of cf-PWV and incidence of HF and its subtypes (HFpEF [ejection fraction >45%] and HFrEF [ejection fraction ≤45%]). We observed 390 HF events (162 HFpEF and 145 HFrEF events) over 11.4 years of follow-up. In adjusted analysis, higher cf-PWV was associated with greater risk of HF after adjustment for age, sex, ethnicity, mean arterial pressure, and heart rate (hazard ratio [95% confidence interval] for cf-PWV tertile 3 versus tertile 1 [ref] =1.35 [1.05-1.73]). However, this association was not significant after additional adjustment for other cardiovascular risk factors (hazard ratio [95% confidence interval], 1.14 [0.88-1.47]). cf-PWV velocity was also not associated with risk of HFpEF and HFrEF after adjustment for potential confounders (most adjusted hazard ratio [95% confidence interval] for cf-PWV tertile 3 versus tertile 1 [ref]: HFpEF, 1.06 [0.72-1.56]; HFrEF, 1.28 [0.83-1.97]). In conclusion, arterial stiffness, as measured by cf-PWV, is not independently associated with risk of HF or its subtypes after adjustment for traditional cardiovascular risk factors.
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Affiliation(s)
- Ambarish Pandey
- From the Division of Cardiology, Department of Internal Medicine (A.P., J.D.B.) and Department of Clinical Sciences (J.D.B.), University of Texas Southwestern Medical Center, Dallas; Department of Internal Medicine, Emory University School of Medicine, Atlanta, GA (H.K.); Department of Epidemiology, Graduate School of Public Health at University of Pittsburgh, PA (A.B.N.); Laboratory of Cardiovascular Science, Biomedical Research Center, National Institutes of Heath, National Institute of Aging, Baltimore, MD (E.G.L.); Section of Geriatric Cardiology, Divisions of Geriatrics and Cardiology, University of Pittsburgh School of Medicine, VA Pittsburgh Healthcare System, PA (D.E.F.); and Division of Cardiology, Department of Internal Medicine, Stony Brook University School of Medicine, New York, NY (J.B.)
| | - Hassan Khan
- From the Division of Cardiology, Department of Internal Medicine (A.P., J.D.B.) and Department of Clinical Sciences (J.D.B.), University of Texas Southwestern Medical Center, Dallas; Department of Internal Medicine, Emory University School of Medicine, Atlanta, GA (H.K.); Department of Epidemiology, Graduate School of Public Health at University of Pittsburgh, PA (A.B.N.); Laboratory of Cardiovascular Science, Biomedical Research Center, National Institutes of Heath, National Institute of Aging, Baltimore, MD (E.G.L.); Section of Geriatric Cardiology, Divisions of Geriatrics and Cardiology, University of Pittsburgh School of Medicine, VA Pittsburgh Healthcare System, PA (D.E.F.); and Division of Cardiology, Department of Internal Medicine, Stony Brook University School of Medicine, New York, NY (J.B.)
| | - Anne B Newman
- From the Division of Cardiology, Department of Internal Medicine (A.P., J.D.B.) and Department of Clinical Sciences (J.D.B.), University of Texas Southwestern Medical Center, Dallas; Department of Internal Medicine, Emory University School of Medicine, Atlanta, GA (H.K.); Department of Epidemiology, Graduate School of Public Health at University of Pittsburgh, PA (A.B.N.); Laboratory of Cardiovascular Science, Biomedical Research Center, National Institutes of Heath, National Institute of Aging, Baltimore, MD (E.G.L.); Section of Geriatric Cardiology, Divisions of Geriatrics and Cardiology, University of Pittsburgh School of Medicine, VA Pittsburgh Healthcare System, PA (D.E.F.); and Division of Cardiology, Department of Internal Medicine, Stony Brook University School of Medicine, New York, NY (J.B.)
| | - Edward G Lakatta
- From the Division of Cardiology, Department of Internal Medicine (A.P., J.D.B.) and Department of Clinical Sciences (J.D.B.), University of Texas Southwestern Medical Center, Dallas; Department of Internal Medicine, Emory University School of Medicine, Atlanta, GA (H.K.); Department of Epidemiology, Graduate School of Public Health at University of Pittsburgh, PA (A.B.N.); Laboratory of Cardiovascular Science, Biomedical Research Center, National Institutes of Heath, National Institute of Aging, Baltimore, MD (E.G.L.); Section of Geriatric Cardiology, Divisions of Geriatrics and Cardiology, University of Pittsburgh School of Medicine, VA Pittsburgh Healthcare System, PA (D.E.F.); and Division of Cardiology, Department of Internal Medicine, Stony Brook University School of Medicine, New York, NY (J.B.)
| | - Daniel E Forman
- From the Division of Cardiology, Department of Internal Medicine (A.P., J.D.B.) and Department of Clinical Sciences (J.D.B.), University of Texas Southwestern Medical Center, Dallas; Department of Internal Medicine, Emory University School of Medicine, Atlanta, GA (H.K.); Department of Epidemiology, Graduate School of Public Health at University of Pittsburgh, PA (A.B.N.); Laboratory of Cardiovascular Science, Biomedical Research Center, National Institutes of Heath, National Institute of Aging, Baltimore, MD (E.G.L.); Section of Geriatric Cardiology, Divisions of Geriatrics and Cardiology, University of Pittsburgh School of Medicine, VA Pittsburgh Healthcare System, PA (D.E.F.); and Division of Cardiology, Department of Internal Medicine, Stony Brook University School of Medicine, New York, NY (J.B.)
| | - Javed Butler
- From the Division of Cardiology, Department of Internal Medicine (A.P., J.D.B.) and Department of Clinical Sciences (J.D.B.), University of Texas Southwestern Medical Center, Dallas; Department of Internal Medicine, Emory University School of Medicine, Atlanta, GA (H.K.); Department of Epidemiology, Graduate School of Public Health at University of Pittsburgh, PA (A.B.N.); Laboratory of Cardiovascular Science, Biomedical Research Center, National Institutes of Heath, National Institute of Aging, Baltimore, MD (E.G.L.); Section of Geriatric Cardiology, Divisions of Geriatrics and Cardiology, University of Pittsburgh School of Medicine, VA Pittsburgh Healthcare System, PA (D.E.F.); and Division of Cardiology, Department of Internal Medicine, Stony Brook University School of Medicine, New York, NY (J.B.)
| | - Jarett D Berry
- From the Division of Cardiology, Department of Internal Medicine (A.P., J.D.B.) and Department of Clinical Sciences (J.D.B.), University of Texas Southwestern Medical Center, Dallas; Department of Internal Medicine, Emory University School of Medicine, Atlanta, GA (H.K.); Department of Epidemiology, Graduate School of Public Health at University of Pittsburgh, PA (A.B.N.); Laboratory of Cardiovascular Science, Biomedical Research Center, National Institutes of Heath, National Institute of Aging, Baltimore, MD (E.G.L.); Section of Geriatric Cardiology, Divisions of Geriatrics and Cardiology, University of Pittsburgh School of Medicine, VA Pittsburgh Healthcare System, PA (D.E.F.); and Division of Cardiology, Department of Internal Medicine, Stony Brook University School of Medicine, New York, NY (J.B.).
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38
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Kaess BM, Rong J, Larson MG, Hamburg NM, Vita JA, Cheng S, Aragam J, Levy D, Benjamin EJ, Vasan RS, Mitchell GF. Relations of Central Hemodynamics and Aortic Stiffness with Left Ventricular Structure and Function: The Framingham Heart Study. J Am Heart Assoc 2016; 5:e002693. [PMID: 27016574 PMCID: PMC4943246 DOI: 10.1161/jaha.115.002693] [Citation(s) in RCA: 68] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Background The differing relations of steady and pulsatile components of central hemodynamics and aortic stiffness with cardiac dimensions and function have not been fully elucidated. Methods and Results Central hemodynamics and carotid‐femoral pulse wave velocity (CFPWV, a measure of aortic stiffness) were measured by arterial tonometry in 5799 participants of the Framingham Heart Study (mean age 51 years, 54% women) and related to echocardiographic left ventricular (LV) dimensions and systolic and diastolic function using multivariable‐adjusted partial Pearson correlations. Mean arterial pressure (MAP, steady component of central blood pressure) was associated positively with LV wall thickness (r=0.168; P<0.0001) but showed only a weak direct association with LV diastolic dimension (r=0.035, P=0.006). Central pulse pressure (pulsatile component of central blood pressure) showed a direct correlation with both LV diastolic dimension and LV wall thickness (r=0.08 and 0.044, both P<0.0001 in multivariable models that included MAP). CFPWV was not associated with LV structure (all P≥0.27) in MAP‐adjusted models). Both MAP and CFPWV were associated inversely with LV diastolic function (E′; r=−0.140 and −0.153, respectively; both P<0.0001), and these associations persisted after additional adjustment for LV mass and central pulse pressure (r=−0.142 and −0.108, both P<0.0001). MAP and CFPWV were not associated with LV fractional shortening (P≥0.10), whereas central pulse pressure was positively related (r=0.064, P<0.0001). Conclusions Pulsatile and steady components of central pressure are conjointly yet variably related to LV structure. CFPWV is related to LV diastolic function but not to systolic function. Additional studies are warranted to confirm these observations.
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Affiliation(s)
- Bernhard M Kaess
- National Heart, Blood and Lung Institute's Framingham Heart Study, Framingham, MA Deutsches Herzzentrum, Munich, Germany
| | - Jian Rong
- National Heart, Blood and Lung Institute's Framingham Heart Study, Framingham, MA
| | - Martin G Larson
- National Heart, Blood and Lung Institute's Framingham Heart Study, Framingham, MA Department of Mathematics and Statistics, Boston University, Boston, MA Department of Biostatistics, Boston University School of Public Health, Boston, MA
| | - Naomi M Hamburg
- Evans Department of Medicine, Boston University School of Medicine, Boston, MA Whitaker Cardiovascular Institute, Boston University School of Medicine, Boston, MA
| | - Joseph A Vita
- Evans Department of Medicine, Boston University School of Medicine, Boston, MA Whitaker Cardiovascular Institute, Boston University School of Medicine, Boston, MA
| | - Susan Cheng
- Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Jayashree Aragam
- Veterans Administration Hospital, West Roxbury, MA Harvard Medical School, Boston, MA
| | - Daniel Levy
- National Heart, Blood and Lung Institute's Framingham Heart Study, Framingham, MA Sections of Preventive Medicine and Epidemiology and Cardiology, Department of Medicine, Boston University School of Medicine, Boston, MA
| | - Emelia J Benjamin
- National Heart, Blood and Lung Institute's Framingham Heart Study, Framingham, MA Evans Department of Medicine, Boston University School of Medicine, Boston, MA Whitaker Cardiovascular Institute, Boston University School of Medicine, Boston, MA Sections of Preventive Medicine and Epidemiology and Cardiology, Department of Medicine, Boston University School of Medicine, Boston, MA
| | - Ramachandran S Vasan
- National Heart, Blood and Lung Institute's Framingham Heart Study, Framingham, MA Evans Department of Medicine, Boston University School of Medicine, Boston, MA Whitaker Cardiovascular Institute, Boston University School of Medicine, Boston, MA Sections of Preventive Medicine and Epidemiology and Cardiology, Department of Medicine, Boston University School of Medicine, Boston, MA
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Dawes TJW, Gandhi A, de Marvao A, Buzaco R, Tokarczuk P, Quinlan M, Durighel G, Diamond T, Monje Garcia L, de Cesare A, Cook SA, O'Regan DP. Pulmonary Artery Stiffness Is Independently Associated with Right Ventricular Mass and Function: A Cardiac MR Imaging Study. Radiology 2016; 280:398-404. [PMID: 26909648 DOI: 10.1148/radiol.2016151527] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Purpose To determine the relationship between pulmonary artery (PA) stiffness and both right ventricular (RV) mass and function with cardiac magnetic resonance (MR) imaging. Materials and Methods The study was approved by the local research ethics committee, and all participants gave written informed consent. Cardiac MR imaging was performed at 1.5 T in 156 healthy volunteers (63% women; age range, 19-61 years; mean age, 36.1 years). High-temporal-resolution phase-contrast imaging was performed in the main and right PAs. Pulmonary pulse wave velocity (PWV) was determined by the interval between arterial systolic upslopes. RV function was assessed with feature tracking to derive peak systolic strain and strain rate, as well as peak early-diastolic strain rate. RV volumes, ejection fraction (RVEF), and mass were measured from the cine images. The association of pulmonary PWV with RV function and mass was quantified with univariate linear regression. Interstudy repeatability was assessed with intraclass correlation. Results The repeatability coefficient for pulmonary PWV was 0.96. Increases in pulmonary PWV and RVEF were associated with increases in age (r = 0.32, P < .001 and r = 0.18, P = .025, respectively). After adjusting for age (P = .090), body surface area (P = .073), and sex (P = .005), pulmonary PWV demonstrated an independent positive association with RVEF (r = 0.34, P = .026). Significant associations were also seen with RV mass (r = 0.41, P = .004), RV radial strain (r = 0.38, P = .022), and strain rate (r = 0.35, P = .002), and independent negative associations were seen with radial (r = 0.27, P = .003), longitudinal (r = 0.40, P = .007), and circumferential (r = 0.31, P = .005) peak early-diastolic strain rate with the same covariates. Conclusion Pulmonary PWV is reliably assessed with cardiac MR imaging. In subjects with no known cardiovascular disease, increasing PA stiffness is associated with increasing age and is also moderately associated with both RV mass and function after controlling for age, body surface area, and sex. (©) RSNA, 2016 Online supplemental material is available for this article.
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Affiliation(s)
- Timothy J W Dawes
- From the Medical Research Council Clinical Sciences Centre, Faculty of Medicine, Imperial College London, Hammersmith Hospital Campus, Du Cane Road, London, W12 0HS, England (T.J.W.D., A.d.M., R.B., P.T., M.Q., G.D., T.D., L.M.G., S.A.C., D.P.O'R.); Department of Cardiology, Imperial College NHS Healthcare Trust, London, England (A.G.); and Sorbonne Universités, UPMC Univ Paris 06, INSERM UMR_S 1146, CNRS UMR 7371, Lib, Paris, France (A.d.C.)
| | - Ajay Gandhi
- From the Medical Research Council Clinical Sciences Centre, Faculty of Medicine, Imperial College London, Hammersmith Hospital Campus, Du Cane Road, London, W12 0HS, England (T.J.W.D., A.d.M., R.B., P.T., M.Q., G.D., T.D., L.M.G., S.A.C., D.P.O'R.); Department of Cardiology, Imperial College NHS Healthcare Trust, London, England (A.G.); and Sorbonne Universités, UPMC Univ Paris 06, INSERM UMR_S 1146, CNRS UMR 7371, Lib, Paris, France (A.d.C.)
| | - Antonio de Marvao
- From the Medical Research Council Clinical Sciences Centre, Faculty of Medicine, Imperial College London, Hammersmith Hospital Campus, Du Cane Road, London, W12 0HS, England (T.J.W.D., A.d.M., R.B., P.T., M.Q., G.D., T.D., L.M.G., S.A.C., D.P.O'R.); Department of Cardiology, Imperial College NHS Healthcare Trust, London, England (A.G.); and Sorbonne Universités, UPMC Univ Paris 06, INSERM UMR_S 1146, CNRS UMR 7371, Lib, Paris, France (A.d.C.)
| | - Rui Buzaco
- From the Medical Research Council Clinical Sciences Centre, Faculty of Medicine, Imperial College London, Hammersmith Hospital Campus, Du Cane Road, London, W12 0HS, England (T.J.W.D., A.d.M., R.B., P.T., M.Q., G.D., T.D., L.M.G., S.A.C., D.P.O'R.); Department of Cardiology, Imperial College NHS Healthcare Trust, London, England (A.G.); and Sorbonne Universités, UPMC Univ Paris 06, INSERM UMR_S 1146, CNRS UMR 7371, Lib, Paris, France (A.d.C.)
| | - Paweł Tokarczuk
- From the Medical Research Council Clinical Sciences Centre, Faculty of Medicine, Imperial College London, Hammersmith Hospital Campus, Du Cane Road, London, W12 0HS, England (T.J.W.D., A.d.M., R.B., P.T., M.Q., G.D., T.D., L.M.G., S.A.C., D.P.O'R.); Department of Cardiology, Imperial College NHS Healthcare Trust, London, England (A.G.); and Sorbonne Universités, UPMC Univ Paris 06, INSERM UMR_S 1146, CNRS UMR 7371, Lib, Paris, France (A.d.C.)
| | - Marina Quinlan
- From the Medical Research Council Clinical Sciences Centre, Faculty of Medicine, Imperial College London, Hammersmith Hospital Campus, Du Cane Road, London, W12 0HS, England (T.J.W.D., A.d.M., R.B., P.T., M.Q., G.D., T.D., L.M.G., S.A.C., D.P.O'R.); Department of Cardiology, Imperial College NHS Healthcare Trust, London, England (A.G.); and Sorbonne Universités, UPMC Univ Paris 06, INSERM UMR_S 1146, CNRS UMR 7371, Lib, Paris, France (A.d.C.)
| | - Giuliana Durighel
- From the Medical Research Council Clinical Sciences Centre, Faculty of Medicine, Imperial College London, Hammersmith Hospital Campus, Du Cane Road, London, W12 0HS, England (T.J.W.D., A.d.M., R.B., P.T., M.Q., G.D., T.D., L.M.G., S.A.C., D.P.O'R.); Department of Cardiology, Imperial College NHS Healthcare Trust, London, England (A.G.); and Sorbonne Universités, UPMC Univ Paris 06, INSERM UMR_S 1146, CNRS UMR 7371, Lib, Paris, France (A.d.C.)
| | - Tamara Diamond
- From the Medical Research Council Clinical Sciences Centre, Faculty of Medicine, Imperial College London, Hammersmith Hospital Campus, Du Cane Road, London, W12 0HS, England (T.J.W.D., A.d.M., R.B., P.T., M.Q., G.D., T.D., L.M.G., S.A.C., D.P.O'R.); Department of Cardiology, Imperial College NHS Healthcare Trust, London, England (A.G.); and Sorbonne Universités, UPMC Univ Paris 06, INSERM UMR_S 1146, CNRS UMR 7371, Lib, Paris, France (A.d.C.)
| | - Laura Monje Garcia
- From the Medical Research Council Clinical Sciences Centre, Faculty of Medicine, Imperial College London, Hammersmith Hospital Campus, Du Cane Road, London, W12 0HS, England (T.J.W.D., A.d.M., R.B., P.T., M.Q., G.D., T.D., L.M.G., S.A.C., D.P.O'R.); Department of Cardiology, Imperial College NHS Healthcare Trust, London, England (A.G.); and Sorbonne Universités, UPMC Univ Paris 06, INSERM UMR_S 1146, CNRS UMR 7371, Lib, Paris, France (A.d.C.)
| | - Alain de Cesare
- From the Medical Research Council Clinical Sciences Centre, Faculty of Medicine, Imperial College London, Hammersmith Hospital Campus, Du Cane Road, London, W12 0HS, England (T.J.W.D., A.d.M., R.B., P.T., M.Q., G.D., T.D., L.M.G., S.A.C., D.P.O'R.); Department of Cardiology, Imperial College NHS Healthcare Trust, London, England (A.G.); and Sorbonne Universités, UPMC Univ Paris 06, INSERM UMR_S 1146, CNRS UMR 7371, Lib, Paris, France (A.d.C.)
| | - Stuart A Cook
- From the Medical Research Council Clinical Sciences Centre, Faculty of Medicine, Imperial College London, Hammersmith Hospital Campus, Du Cane Road, London, W12 0HS, England (T.J.W.D., A.d.M., R.B., P.T., M.Q., G.D., T.D., L.M.G., S.A.C., D.P.O'R.); Department of Cardiology, Imperial College NHS Healthcare Trust, London, England (A.G.); and Sorbonne Universités, UPMC Univ Paris 06, INSERM UMR_S 1146, CNRS UMR 7371, Lib, Paris, France (A.d.C.)
| | - Declan P O'Regan
- From the Medical Research Council Clinical Sciences Centre, Faculty of Medicine, Imperial College London, Hammersmith Hospital Campus, Du Cane Road, London, W12 0HS, England (T.J.W.D., A.d.M., R.B., P.T., M.Q., G.D., T.D., L.M.G., S.A.C., D.P.O'R.); Department of Cardiology, Imperial College NHS Healthcare Trust, London, England (A.G.); and Sorbonne Universités, UPMC Univ Paris 06, INSERM UMR_S 1146, CNRS UMR 7371, Lib, Paris, France (A.d.C.)
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Wittek A, Karatolios K, Fritzen CP, Bereiter-Hahn J, Schieffer B, Moosdorf R, Vogt S, Blase C. Cyclic three-dimensional wall motion of the human ascending and abdominal aorta characterized by time-resolved three-dimensional ultrasound speckle tracking. Biomech Model Mechanobiol 2016; 15:1375-88. [PMID: 26897533 DOI: 10.1007/s10237-016-0769-2] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2015] [Accepted: 02/03/2016] [Indexed: 01/22/2023]
Abstract
The aim of this study was to measure, characterize, and compare the time-resolved three-dimensional wall kinematics of the ascending and the abdominal aorta. Comprehensive description of aortic wall kinematics is an important issue for understanding its physiological functioning and early detection of adverse changes. Data on the three-dimensional, dynamic cyclic deformation of the aorta in vivo are scarce. Either most imaging techniques available are too slow to capture aortic wall motion (CT, MRI) or they do not provide three-dimensional geometry data. Three-dimensional volume data sets of ascending and abdominal aortae of male healthy subjects (25.5 [24.5, 27.5] years) were acquired by use of a commercial echocardiography system with a temporal resolution of 11-25 Hz. Longitudinal and circumferential strain, twist, and relative volume change were determined by use of a commercial speckle tracking algorithm and in-house software. The kinematics of the abdominal aorta is characterized by diameter change, almost constant length and unidirectional, either clockwise or counter clockwise twist. In contrast, the ascending aorta undergoes a complex deformation with alternating clockwise and counterclockwise twist. Length and diameter changes were in the same order of magnitude with a phase shift between both. Longitudinal strain and its phase shift to circumferential strain contribute to the proximal aorta's Windkessel function. Complex cyclic deformations are known to be highly fatiguing. This may account for increased degradation of components of the aortic wall and therefore promote aortic dissection or aneurysm formation.
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Affiliation(s)
- Andreas Wittek
- Department of Biological Sciences, Goethe University, Max-von-Laue-Str. 13, 60438, Frankfurt am Main, Germany
- Department of Mechanical Engineering, University Siegen, Siegen, Germany
| | | | | | - Jürgen Bereiter-Hahn
- Department of Biological Sciences, Goethe University, Max-von-Laue-Str. 13, 60438, Frankfurt am Main, Germany
| | | | - Rainer Moosdorf
- University Heart Center, Philipps University Marburg, Marburg, Germany
| | - Sebastian Vogt
- University Heart Center, Philipps University Marburg, Marburg, Germany
| | - Christopher Blase
- Department of Biological Sciences, Goethe University, Max-von-Laue-Str. 13, 60438, Frankfurt am Main, Germany.
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Mileto A, Heye TJ, Makar RA, Hurwitz LM, Marin D, Boll DT. Regional Mapping of Aortic Wall Stress by Using Deformable, Motion-coherent Modeling based on Electrocardiography-gated Multidetector CT Angiography: Feasibility Study. Radiology 2016; 280:230-6. [PMID: 26780540 DOI: 10.1148/radiol.2015151078] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Purpose To investigate the feasibility of deformable, motion-coherent modeling based on electrocardiography-gated multidetector computed tomographic (CT) angiography of the thoracic aorta and to evaluate whether quantifiable information on aortic wall stress as a function of patient-specific cardiovascular parameters can be gained. Materials and Methods For this institutional review board-approved, HIPAA-compliant study, thoracic electrocardiography-gated dual-source multidetector CT angiographic images were used from 250 prospectively enrolled patients (150 men, 100 women; mean age, 79 years). On reconstructed 50-phase CT angiographic images, aortic strain and deformation were determined at seven cardiac and aortic locations. One-way analysis of variance was used by assessing the magnitude for longitudinal and axial strain and axial deformation, as well as time-resolved peak and maxima count for longitudinal strain and axial deformation. Interdependencies between aortic strain and deformation with extracted hemodynamic parameters were evaluated. Results With increasing heart rates, there was a significant decrease in longitudinal strain (P = .009, R(2) = 0.95) and a decrease in the number of longitudinal strain peaks (P < .001, R(2) = 0.79); however, a significant increase in axial deformation (P < .001, R(2) = 0.31) and axial strain (P = .009, R(2) = 0.61) was observed. Increasing aortic blood velocity led to increased longitudinal strain (P = .018, R(2) = 0.42) and longitudinal strain peak counts (P = .011, R(2) = 0.48). Pronounced motion in the longitudinal direction limited motion in the axial plane (P < .019, R(2) = 0.29-0.31). Conclusion The results of this study render a clinical basis and provide proof of principle for the use of deformable, motion-coherent modeling to provide quantitative information on physiological motion of the aorta under various hemodynamic circumstances. (©) RSNA, 2016 Online supplemental material is available for this article.
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Affiliation(s)
- Achille Mileto
- From the Department of Radiology, Duke University Medical Center, Durham, NC (A.M., R.A.M., L.M.H., D.M., D.T.B.); and Department of Radiology, University Hospital of Basel, 4048 Basel, Switzerland (T.J.H., D.T.B.)
| | - Tobias J Heye
- From the Department of Radiology, Duke University Medical Center, Durham, NC (A.M., R.A.M., L.M.H., D.M., D.T.B.); and Department of Radiology, University Hospital of Basel, 4048 Basel, Switzerland (T.J.H., D.T.B.)
| | - Ryan A Makar
- From the Department of Radiology, Duke University Medical Center, Durham, NC (A.M., R.A.M., L.M.H., D.M., D.T.B.); and Department of Radiology, University Hospital of Basel, 4048 Basel, Switzerland (T.J.H., D.T.B.)
| | - Lynne M Hurwitz
- From the Department of Radiology, Duke University Medical Center, Durham, NC (A.M., R.A.M., L.M.H., D.M., D.T.B.); and Department of Radiology, University Hospital of Basel, 4048 Basel, Switzerland (T.J.H., D.T.B.)
| | - Daniele Marin
- From the Department of Radiology, Duke University Medical Center, Durham, NC (A.M., R.A.M., L.M.H., D.M., D.T.B.); and Department of Radiology, University Hospital of Basel, 4048 Basel, Switzerland (T.J.H., D.T.B.)
| | - Daniel T Boll
- From the Department of Radiology, Duke University Medical Center, Durham, NC (A.M., R.A.M., L.M.H., D.M., D.T.B.); and Department of Radiology, University Hospital of Basel, 4048 Basel, Switzerland (T.J.H., D.T.B.)
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