1
|
Rezaeian P, Shufelt C, Wei J, Pacheco C, Cook-Wiens G, Berman D, Tamarappoo B, Thomson L, Nelson M, Anderson R, Petersen J, Handberg E, Pepine C, Merz CB. Arterial stiffness assessment in coronary microvascular dysfunction and heart failure with preserved ejection fraction: An initial report from the WISE-CVD continuation study. AMERICAN HEART JOURNAL PLUS : CARDIOLOGY RESEARCH AND PRACTICE 2024; 41:100390. [PMID: 38600957 PMCID: PMC11004063 DOI: 10.1016/j.ahjo.2024.100390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/27/2024] [Accepted: 03/29/2024] [Indexed: 04/12/2024]
Abstract
Background Heart failure with preserved ejection fraction (HFpEF) is the most common cardiac complication in patients with coronary microvascular dysfunction (CMD), yet its underlying pathways remain unclear. Aortic pulse-wave velocity (aPWV) is an indicator of large artery stiffness and a predictor for cardiovascular disease. However, aPWV in CMD and HFpEF is not well characterized and may provide understanding of disease progression. Methods Among participants without obstructive coronary artery disease, we evaluated 51 women with suspected CMD and 20 women and men with evidence of HFpEF. All participants underwent aPWV measurement (SphygmoCor, Atcor Medical) with higher aPWV indicating greater vascular stiffness. Cardiac magnetic resonance imaging (CMRI) assessed left ventricular (LV) ejection fraction, CMD via myocardial perfusion reserve index (MPRI), and ventricular remodeling via LV mass-volume ratio. . Statistical analysis was performed using Wilcoxon rank sum tests, Pearson correlations and linear regression analysis. Results Compared to the suspected CMD group, the HFpEF participants were older (65 ± 12 vs 56 ± 11 yrs., p = 0.002) had higher BMI (31.0 ± 4.3 vs 27.8 ± 6.7 kg/m2, p = 0.013), higher aPWV (10.5 ± 2.0 vs 8.0 ± 1.6 m/s, p = 0.05) and lower MPRI (1.5 ± 0.3 vs1.8 ± 0.3, p = 0.02), but not remodeling. In a model adjusted for cardiovascular risk factors, the HFpEF group had a lower LVEF (estimate -4.78, p = 0.0437) than the suspected CMD group. Conclusions HFpEF participants exhibit greater arterial stiffness and lower myocardial perfusion reserve, with lower LVEF albeit not remodeling, compared to suspected CMD participants. These findings suggest arterial stiffness may contribute to progression from CMD to HFpEF. Prospective work is needed and ongoing.
Collapse
Affiliation(s)
- P. Rezaeian
- Torrance Memorial Medical Center-A Cedars-Sinai Affiliate, Torrance, CA, USA
| | - C.L. Shufelt
- Division of General Internal Medicine, Mayo Clinic, Jacksonville, FL, USA
| | - J. Wei
- Barbra Streisand Women's Heart Center, Cedars-Sinai Smidt Heart Institute, Los Angeles, CA, USA
| | - C. Pacheco
- Hôspital Pierre-Boucher, Centre Hospitalier de l'Université de Montréal, Université de Montreal, QC, Canada
| | - G. Cook-Wiens
- Torrance Memorial Medical Center-A Cedars-Sinai Affiliate, Torrance, CA, USA
| | - D. Berman
- Taper Imaging, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - B. Tamarappoo
- Taper Imaging, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - L.E. Thomson
- Taper Imaging, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - M.D. Nelson
- The University of Texas at Arlington, Arlington, TX, USA
| | - R.D. Anderson
- Division of Cardiology, Department of Medicine, University of Florida, Gainesville, FL, USA
| | - J. Petersen
- Division of Cardiology, Department of Medicine, University of Florida, Gainesville, FL, USA
| | - E.M. Handberg
- Division of Cardiology, Department of Medicine, University of Florida, Gainesville, FL, USA
| | - C.J. Pepine
- Division of Cardiology, Department of Medicine, University of Florida, Gainesville, FL, USA
| | - C.N. Bairey Merz
- Barbra Streisand Women's Heart Center, Cedars-Sinai Smidt Heart Institute, Los Angeles, CA, USA
| |
Collapse
|
2
|
Xie H, Gao L, Fan F, Gong Y, Zhang Y. Research Progress and Clinical Value of Subendocardial Viability Ratio. J Am Heart Assoc 2024; 13:e032614. [PMID: 38471822 PMCID: PMC11009993 DOI: 10.1161/jaha.123.032614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/14/2024]
Abstract
Cardiovascular disease remains the leading cause of morbidity and mortality worldwide, with ischemic heart disease being a major contributor, either through coronary atherosclerotic plaque-related major vascular disease or coronary microvascular dysfunction. Obstruction of coronary blood flow impairs myocardial perfusion, which may lead to acute myocardial infarction in severe cases. The subendocardial viability ratio, also known as the Buckberg index, is a valuable tool for evaluation of myocardial perfusion because it reflects the balance between myocardial oxygen supply and oxygen demand. The subendocardial viability ratio can effectively evaluate the function of the coronary microcirculation and is associated with arterial stiffness. This ratio also has potential value in predicting adverse cardiovascular events and mortality in various populations. Moreover, the subendocardial viability ratio has demonstrated clinical significance in a range of diseases, including hypertension, aortic stenosis, peripheral arterial disease, chronic kidney disease, diabetes, and rheumatoid arthritis. This review summarizes the applications of the subendocardial viability ratio, its particular progress in the relevant research, and its clinical significance in cardiovascular diseases.
Collapse
Affiliation(s)
- Haotai Xie
- Department of CardiologyPeking University First HospitalBeijingChina
| | - Lan Gao
- Department of CardiologyPeking University First HospitalBeijingChina
- Institute of Cardiovascular DiseasePeking University First HospitalBeijingChina
| | - Fangfang Fan
- Department of CardiologyPeking University First HospitalBeijingChina
- Institute of Cardiovascular DiseasePeking University First HospitalBeijingChina
| | - Yanjun Gong
- Department of CardiologyPeking University First HospitalBeijingChina
- Institute of Cardiovascular DiseasePeking University First HospitalBeijingChina
| | - Yan Zhang
- Department of CardiologyPeking University First HospitalBeijingChina
- Institute of Cardiovascular DiseasePeking University First HospitalBeijingChina
| |
Collapse
|
3
|
Onishi H, Izumo M, Nishikawa H, Suzuki T, Sato Y, Watanabe M, Kuwata S, Kamijima R, Naganuma T, Nakamura S, Akashi YJ. Prognostic value of transvalvular flow rate in patients with low-gradient severe aortic stenosis: A dobutamine stress echocardiography study. Echocardiography 2024; 41:e15712. [PMID: 37937359 DOI: 10.1111/echo.15712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Revised: 10/06/2023] [Accepted: 10/29/2023] [Indexed: 11/09/2023] Open
Abstract
BACKGROUNDS There are limited data on the clinical relevance of transvalvular flow rate (Qmean ) at rest (Qrest) and at peak stress (Qstress ) during dobutamine stress echocardiography (DSE) in patients with low-gradient severe aortic stenosis (LG-SAS). METHODS We retrospectively analyzed the clinical data of patients with LG-SAS who underwent DSE. LG-SAS was defined as an aortic valve (AV) area index of < .6 cm2 /m2 and a mean AV pressure gradient (AVPG) of < 40 mm Hg. The primary endpoint included all-cause death and heart failure hospitalization. RESULTS Of 100 patients (mean age 79.5 ± 7.3 years; men, 45.0%; resting left ventricular ejection fraction [LVEF] 52.1% ± 15.9%; resting stroke volume index 35.8 ± 7.7 mL/m2 ; Qrest 171.8 ± 34.9 mL/s), the primary endpoint occurred in 51 patients during a median follow-up of 2.84 (interquartile range 1.01-5.21) years. When the study patients were divided into three subgroups based on Qrest and Qstress , the multivariate analysis showed that Qrest < 200 mL/s and Qstress ≥200 mL/s (hazard ratio 3.844; 95% confidence interval 1.143-12.930; p = .030), as well as Qrest and Qstress < 200 mL/s (hazard ratio 9.444; 95% confidence interval 2.420-36.850; p = .001), were significantly associated with unfavorable outcomes with Qrest and Qstress ≥200 mL/s as a reference after adjusting for resting LVEF, resting mean AVPG, chronic kidney disease, New York Heart Association functional class III/IV, and AV replacement. CONCLUSIONS Flow conditions based on the combination of Qrest and Qstress are helpful for risk stratification in LG-SAS patients.
Collapse
Affiliation(s)
- Hirokazu Onishi
- Department of Cardiology, St. Marianna University School of Medicine, Kanagawa, Japan
- Department of Cardiology, New Tokyo Hospital, Chiba, Japan
| | - Masaki Izumo
- Department of Cardiology, St. Marianna University School of Medicine, Kanagawa, Japan
| | - Haruka Nishikawa
- Department of Cardiology, St. Marianna University School of Medicine, Kanagawa, Japan
| | - Tomomi Suzuki
- Department of Cardiology, St. Marianna University School of Medicine, Kanagawa, Japan
| | - Yukio Sato
- Department of Cardiology, St. Marianna University School of Medicine, Kanagawa, Japan
| | - Mika Watanabe
- Department of Cardiology, St. Marianna University School of Medicine, Kanagawa, Japan
| | - Shingo Kuwata
- Department of Cardiology, St. Marianna University School of Medicine, Kanagawa, Japan
| | - Ryo Kamijima
- Department of Cardiology, St. Marianna University School of Medicine, Kanagawa, Japan
| | - Toru Naganuma
- Department of Cardiology, New Tokyo Hospital, Chiba, Japan
| | - Sunao Nakamura
- Department of Cardiology, New Tokyo Hospital, Chiba, Japan
| | - Yoshihiro J Akashi
- Department of Cardiology, St. Marianna University School of Medicine, Kanagawa, Japan
| |
Collapse
|
4
|
Li Q, Cai W, Li Y, Zhang R, Zeng C, Ma X, Barka CK, Zhang C, Sun T, Xie H. Effects of a theory-based exercise intervention on physical activity levels and health-related outcomes in older people with chronic diseases. Geriatr Gerontol Int 2023; 23:78-84. [PMID: 36573456 DOI: 10.1111/ggi.14520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Revised: 10/31/2022] [Accepted: 11/18/2022] [Indexed: 12/28/2022]
Abstract
BACKGROUND The benefits of physical activity are well-documented, and the prevalence of physical inactivity is high in older patients with chronic diseases. This study aimed to investigate the impact of an aerobic exercise intervention based on the capacity, opportunity, motivation-behavior (COM-B) model on physical activity and health-related outcomes in this population. METHODS Thirty-five participants were randomly assigned to the intervention group (IG) for an exercise intervention based on the COM-B model, and 33 were assigned to the control group (CG) for usual care. Physical activity levels, daily steps and bone mineral density T-value, body mass index, waist-hip ratio, subendocardial myocardial viability rate, central arterial pressure, growth index, brachial-ankle pulse wave velocity, ankle-arm index were measured at baseline, during the 12-week intervention, and after the 12-week follow-up. RESULTS Compared with the CG and pre-intervention, total physical activity in the IG increased significantly (P < 0.05); however, after the 12-week follow-up, total physical activity decreased. At the same time, the average daily steps of the elderly in both groups increased. Compared with the CG, at the 12-week follow-up, the bone mineral density T-value in the IG was significantly improved (P < 0.05). Compared with the pre-intervention values, during the 12-week intervention, bone mineral density T-value, body mass index, waist-hip ratio, subendocardial myocardial viability rate and central arterial pressure were significantly improved (P < 0.05); after the 12-week follow-up, brachial-ankle pulse wave velocity and ankle-arm index were significantly improved (P < 0.05). No statistically significant changes in the growth index were detected, independent of the group and time. CONCLUSION Theory-based exercise interventions can change the physical inactivity behavior of older people with chronic diseases, effectively promoting physical activity and improves bone mineral density T-value, controls body weight, and reduces cardiovascular risk and physiological indicators related to atherosclerosis. Geriatr Gerontol Int 2023; 23: 78-84.
Collapse
Affiliation(s)
- Qiyu Li
- School of Nursing, Bengbu Medical College, Bengbu, China
| | - Weiwei Cai
- Department of Nursing, Bengbu Third People's Hospital, Bengbu, China
| | - Yanling Li
- School of Nursing, Bengbu Medical College, Bengbu, China
| | - Ruixin Zhang
- Thyroid and mammary disease area of general surgery department, Fuyang People's Hospital, Fuyang, China
| | - Chunlu Zeng
- School of Nursing, Bengbu Medical College, Bengbu, China
| | - Xiaoqing Ma
- School of Nursing, Bengbu Medical College, Bengbu, China
| | | | - Chu Zhang
- School of Nursing, Bengbu Medical College, Bengbu, China
| | - Ting Sun
- School of Nursing, Bengbu Medical College, Bengbu, China
| | - Hui Xie
- School of Nursing, Bengbu Medical College, Bengbu, China
| |
Collapse
|
5
|
Aursulesei Onofrei V, Ceasovschih A, Anghel RC, Roca M, Marcu DTM, Adam CA, Mitu O, Cumpat C, Mitu F, Crisan A, Haba CMS, Artene B. Subendocardial Viability Ratio Predictive Value for Cardiovascular Risk in Hypertensive Patients. MEDICINA (KAUNAS, LITHUANIA) 2022; 59:medicina59010024. [PMID: 36676648 PMCID: PMC9862049 DOI: 10.3390/medicina59010024] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 12/14/2022] [Accepted: 12/19/2022] [Indexed: 12/24/2022]
Abstract
Background: The subendocardial viability ratio (SEVR), also known as the Buckberg index, is a parameter of arterial stiffness with indirect prognostic value in assessing long-term cardiovascular risk. Materials and Methods: We conducted a prospective cohort study on 70 patients with uncomplicated hypertension admitted to a county medical reference hospital. We analyzed demographics, laboratory data, arterial stiffness parameters and cardiovascular risk scores (SCORE and Framingham risk scores) and aimed to identify paraclinical parameters associated with increased cardiovascular risk. Results: Of the arterial stiffness parameters, SEVR correlates statistically significantly with age, central and peripheral systolic blood pressure, as well as with heart rate. SEVR seems to have prognostic value among hypertensive patients by increasing the risk of major cardiovascular events assessed by SCORE and Framingham risk scores. SEVR correlates statistically significantly with serum fibrinogen (p = 0.02) and hemoglobin (p = 0.046). Between pulse wave velocity and lipid parameters (p = 0.021 for low-density lipoprotein cholesterol <LDL> and p = 0.030 for triglycerides) a statistically significant relationship was found for the study group. The augmentation index of the aorta also correlated with serum LDL-cholesterol (p = 0.032) and the hemoglobin levels (p = 0.040) of hypertensive patients. Conclusions: Age, abdominal circumference and Framingham score are independent predictors for SEVR in our study group, further highlighting the need for early therapeutic measures to control risk factors in this category of patients.
Collapse
Affiliation(s)
- Viviana Aursulesei Onofrei
- “St. Spiridon” Clinical Emergency Hospital, Independence Boulevard No. 1, 700111 Iasi, Romania
- Department of Medical Specialties I, “Grigore T. Popa” University of Medicine and Pharmacy, University Street No. 16, 700115 Iasi, Romania
| | - Alexandr Ceasovschih
- “St. Spiridon” Clinical Emergency Hospital, Independence Boulevard No. 1, 700111 Iasi, Romania
- Department of Medical Specialties I, “Grigore T. Popa” University of Medicine and Pharmacy, University Street No. 16, 700115 Iasi, Romania
| | - Razvan Constantin Anghel
- “St. Spiridon” Clinical Emergency Hospital, Independence Boulevard No. 1, 700111 Iasi, Romania
- Department of Medical Specialties I, “Grigore T. Popa” University of Medicine and Pharmacy, University Street No. 16, 700115 Iasi, Romania
| | - Mihai Roca
- Department of Medical Specialties I, “Grigore T. Popa” University of Medicine and Pharmacy, University Street No. 16, 700115 Iasi, Romania
- Clinical Rehabilitation Hospital, Cardiovascular Rehabilitation Clinic, Pantelimon Halipa Street No. 14, 700661 Iasi, Romania
| | - Dragos Traian Marius Marcu
- Department of Medical Specialties I, “Grigore T. Popa” University of Medicine and Pharmacy, University Street No. 16, 700115 Iasi, Romania
| | - Cristina Andreea Adam
- Department of Medical Specialties I, “Grigore T. Popa” University of Medicine and Pharmacy, University Street No. 16, 700115 Iasi, Romania
- Clinical Rehabilitation Hospital, Cardiovascular Rehabilitation Clinic, Pantelimon Halipa Street No. 14, 700661 Iasi, Romania
| | - Ovidiu Mitu
- “St. Spiridon” Clinical Emergency Hospital, Independence Boulevard No. 1, 700111 Iasi, Romania
- Department of Medical Specialties I, “Grigore T. Popa” University of Medicine and Pharmacy, University Street No. 16, 700115 Iasi, Romania
| | - Carmen Cumpat
- Clinical Rehabilitation Hospital, Cardiovascular Rehabilitation Clinic, Pantelimon Halipa Street No. 14, 700661 Iasi, Romania
- Department of Management, “Alexandru Ioan Cuza” University, Blv. Carol I, 700506 Iasi, Romania
| | - Florin Mitu
- Department of Medical Specialties I, “Grigore T. Popa” University of Medicine and Pharmacy, University Street No. 16, 700115 Iasi, Romania
- Clinical Rehabilitation Hospital, Cardiovascular Rehabilitation Clinic, Pantelimon Halipa Street No. 14, 700661 Iasi, Romania
| | - Adrian Crisan
- “St. Spiridon” Clinical Emergency Hospital, Independence Boulevard No. 1, 700111 Iasi, Romania
| | - Cristian Mihai Stefan Haba
- “St. Spiridon” Clinical Emergency Hospital, Independence Boulevard No. 1, 700111 Iasi, Romania
- Department of Medical Specialties I, “Grigore T. Popa” University of Medicine and Pharmacy, University Street No. 16, 700115 Iasi, Romania
| | - Bogdan Artene
- “St. Spiridon” Clinical Emergency Hospital, Independence Boulevard No. 1, 700111 Iasi, Romania
- Correspondence:
| |
Collapse
|
6
|
Namasivayam M, He W, Churchill TW, Capoulade R, Liu S, Lee H, Danik JS, Picard MH, Pibarot P, Levine RA, Hung J. Transvalvular Flow Rate Determines Prognostic Value of Aortic Valve Area in Aortic Stenosis. J Am Coll Cardiol 2020; 75:1758-1769. [PMID: 32299587 DOI: 10.1016/j.jacc.2020.02.046] [Citation(s) in RCA: 55] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Revised: 02/01/2020] [Accepted: 02/14/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Aortic valve area (AVA) ≤1.0 cm2 is a defining characteristic of severe aortic stenosis (AS). AVA can be underestimated at low transvalvular flow rate. Yet, the impact of flow rate on prognostic value of AVA ≤1.0 cm2 is unknown and is not incorporated into AS assessment. OBJECTIVES This study aimed to evaluate the effect of flow rate on prognostic value of AVA in AS. METHODS In total, 1,131 patients with moderate or severe AS and complete clinical follow-up were included as part of a longitudinal database. The effect of flow rate (ratio of stroke volume to ejection time) on prognostic value of AVA ≤1.0 cm2 for time to death was evaluated, adjusting for confounders. Sensitivity analysis was performed to identify the optimal cutoff for prognostic threshold of AVA. The findings were validated in a separate external longitudinal cohort of 939 patients. RESULTS Flow rate had a significant effect on prognostic value of AVA. AVA ≤1.0 cm2 was not prognostic for mortality (p = 0.15) if AVA was measured at flow rates below median (≤242 ml/s). In contrast, AVA ≤1.0 cm2 was highly prognostic for mortality (p = 0.003) if AVA was measured at flow rates above median (>242 ml/s). Findings were irrespective of multivariable adjustment for age, sex, and surgical/transcatheter aortic valve replacement (as time-dependent covariates); comorbidities; medications; and echocardiographic features. AVA ≤1.0 cm2 was also not an independent predictor of mortality below median flow rate in the validation cohort. The optimal flow rate cutoff for prognostic threshold was 210 ml/s. CONCLUSIONS Transvalvular flow rate determines prognostic value of AVA in AS. AVA measured at low flow rate is not a good prognostic marker and therefore not a good diagnostic marker for truly severe AS. Flow rate assessment should be incorporated into clinical diagnosis, classification, and prognosis of AS.
Collapse
Affiliation(s)
- Mayooran Namasivayam
- Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts. https://twitter.com/MayoNamasivayam
| | - Wei He
- Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Timothy W Churchill
- Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Romain Capoulade
- Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts; Université de Nantes, CHU Nantes, CNRS, INSERM, l'institut du thorax, F-44000, Nantes, France; Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada
| | - Shiying Liu
- Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Hang Lee
- Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Jacqueline S Danik
- Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Michael H Picard
- Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Philippe Pibarot
- Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada
| | - Robert A Levine
- Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Judy Hung
- Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.
| |
Collapse
|
7
|
Namasivayam M, Picard MH. Flow Rate in Aortic Stenosis: Clinical Tool, Hemodynamic Insight, or Both? J Am Soc Echocardiogr 2020; 33:449-451. [DOI: 10.1016/j.echo.2020.01.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Accepted: 01/28/2020] [Indexed: 12/11/2022]
|
8
|
Schroeder EC, Lefferts WK, Hilgenkamp TIM, Fernhall B. Acute systemic inflammation reduces both carotid and aortic wave reflection in healthy adults. Physiol Rep 2019; 7:e14203. [PMID: 31402635 PMCID: PMC6689683 DOI: 10.14814/phy2.14203] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Accepted: 07/26/2019] [Indexed: 01/15/2023] Open
Abstract
Acute inflammation increases the risk of cardiac and cerebrovascular events, possibly related to alterations in the hemodynamic load. Wave reflection at the aorta and carotid provides insight into downstream vascular changes and hemodynamic load at the heart and brain. Acute inflammation has been suggested to reduce wave reflection via downstream vasodilation; however, this is not firmly established and has only been investigated at the aorta. We sought to explore the effect of acute inflammation on aortic and carotid hemodynamics in healthy, young adults. Pressure waveforms were collected via radial and carotid applanation tonometry in 23 adults (26 ± 4 years) before and 24 h after a typhoid vaccination. Waveforms were calibrated to brachial mean and diastolic pressure, and waveform separation analyses (WSA) were performed, yielding augmentation index, reflection index, time to reflection (Tr), forward (Pf) and reflected (Pb) wave magnitude, and pulse wave velocity. Arterial diameters and carotid stiffness were measured via ultrasonography. Acute inflammation reduced wave reflection at 24 h in both the aorta and carotid (P < 0.05) without changes in mean pressure. WSA did not reveal independent changes in Pf, Pb, or Tr (P > 0.05). Arterial stiffness did not change; however, brachial and carotid artery diameters increased. Acute inflammation reduces wave reflection in the aorta and carotid artery in young adults, potentially due to downstream/peripheral vasodilation. Reduced aortic wave reflection did not disturb the cardiac workload; however, reductions in carotid wave reflection may render the brain vulnerable to pulsatile hemodynamics. These findings may have implications for cardiac and cerebrovascular risk during acute inflammation.
Collapse
Affiliation(s)
- Elizabeth C. Schroeder
- Integrative Physiology Laboratory, College of Applied Health SciencesUniversity of Illinois at ChicagoChicagoIllinois
| | - Wesley K. Lefferts
- Integrative Physiology Laboratory, College of Applied Health SciencesUniversity of Illinois at ChicagoChicagoIllinois
| | - Thessa I. M. Hilgenkamp
- Integrative Physiology Laboratory, College of Applied Health SciencesUniversity of Illinois at ChicagoChicagoIllinois
| | - Bo Fernhall
- Integrative Physiology Laboratory, College of Applied Health SciencesUniversity of Illinois at ChicagoChicagoIllinois
| |
Collapse
|
9
|
Wu Q, Zhang X, Xu Y, Wang M, Wang Y, Yang X, Ma Z, Sun Y. A cross-section study of main determinants of arterial stiffness in Hefei area, China. INT ANGIOL 2019; 38:150-156. [PMID: 30938496 DOI: 10.23736/s0392-9590.19.04078-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Arterial stiffness has emerged as an independent risk factor for adverse cardiovascular disease events and is the consequence of multiple risk factors. The aim of the present study is to explore the main determinants of arterial stiffness in a Chinese population and to study how the arterial stiffness levels affected by different number of risk factors. METHODS This study included 358 subjects in Hefei area of China. Anthropometric indexes, biochemical indexes, cardiovascular function indexes and lifestyle were achieved. Brachial-ankle pulse wave velocity (baPWV) was used to assess arterial stiffness. Multivariate linear regression model was performed to identify the main determinants of arterial stiffness levels. RESULTS baPWV was correlated with age, sex, hypertension, various blood pressure components (systolic blood pressure [SPB], diastolic blood pressure, pulse pressure, and central arterial pressure), serum lipids, fasting blood-glucose and body mass index, subendocardial viability ratio (SEVR) and ejection duration (ED) in bivariate correlation analysis. Moreover, baPWV was only positively correlated with age, hypertension and SBP and inversely correlated with SEVR and ED in multivariable regression model. These five variables explained about 74.8% variances of baPWV and age was the strongest determinant of arterial stiffness. In addition, the levels of arterial stiffness increased with the augmented number of risk factors when the total number of factors was no more than 4. CONCLUSIONS The main determinants of arterial stiffness were age, hypertension, SBP, SEVR and ED. Furthermore, the number of risk factors had an independent influence on arterial stiffness, it is of great importance to consider the number of risk factors when it comes to cardiovascular risk assessment.
Collapse
Affiliation(s)
- Qingyuan Wu
- AnHui Province Key Laboratory of Medical Physics and Technology, Institute of Intelligent Machines, Hefei Institutes of Physical Sciences, Chinese Academy of Sciences, Hefei, China.,Department of Automation, University of Science and Technology of China, Hefei, China
| | - Xiaoyu Zhang
- AnHui Province Key Laboratory of Medical Physics and Technology, Institute of Intelligent Machines, Hefei Institutes of Physical Sciences, Chinese Academy of Sciences, Hefei, China.,Department of Automation, University of Science and Technology of China, Hefei, China
| | - Yang Xu
- AnHui Province Key Laboratory of Medical Physics and Technology, Institute of Intelligent Machines, Hefei Institutes of Physical Sciences, Chinese Academy of Sciences, Hefei, China
| | - Mu Wang
- AnHui Province Key Laboratory of Medical Physics and Technology, Institute of Intelligent Machines, Hefei Institutes of Physical Sciences, Chinese Academy of Sciences, Hefei, China
| | - Yu Wang
- AnHui Province Key Laboratory of Medical Physics and Technology, Institute of Intelligent Machines, Hefei Institutes of Physical Sciences, Chinese Academy of Sciences, Hefei, China.,Department of Automation, University of Science and Technology of China, Hefei, China
| | - Xiaoyue Yang
- AnHui Province Key Laboratory of Medical Physics and Technology, Institute of Intelligent Machines, Hefei Institutes of Physical Sciences, Chinese Academy of Sciences, Hefei, China.,Department of Automation, University of Science and Technology of China, Hefei, China
| | - Zuchang Ma
- Department of Automation, University of Science and Technology of China, Hefei, China -
| | - Yining Sun
- AnHui Province Key Laboratory of Medical Physics and Technology, Institute of Intelligent Machines, Hefei Institutes of Physical Sciences, Chinese Academy of Sciences, Hefei, China
| |
Collapse
|
10
|
Kozan M, Ozan ZT, Demir V, Ede H. The relation of novel cardiovascular risk parameters in patients with familial Mediterranean fever. JRSM Cardiovasc Dis 2019; 8:2048004018823856. [PMID: 30643639 PMCID: PMC6322093 DOI: 10.1177/2048004018823856] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2018] [Revised: 06/27/2018] [Accepted: 09/26/2018] [Indexed: 11/17/2022] Open
Abstract
Objective In this study, we aimed at correlating the thickness of epicardial adipose tissue and levels of Vitamin D with cardiac risk in patients with familial Mediterranean fever. Methods Sixty-five patients with familial Mediterranean fever and 38 healthy controls with matching age and sex were included in the study. The patients with a history of familial Mediterranean fever attacks within the previous two weeks or with any history of inflammatory or cardiovascular disease were excluded. Data regarding age, gender, weight, height, waist circumference, body mass index (calculated as weight/height2), pulse wave velocity, serum Vitamin D levels from fasting blood samples, and Homeostatic Model Assessment for insulin resistance were obtained for the patients and controls. The epicardial adipose tissue was visualized as an echo-free space between the outer surface of myocardium and visceral pericardium using two-dimensional echocardiography, and the thickness of epicardial adipose tissue was measured in parasternal long-axis view at the end of diastole. Results The patients with familial Mediterranean fever had significantly higher levels of C-reactive protein, epicardial adipose tissue, and pulse wave velocity (p < 0.001, <0.05, <0.005, respectively) as compared with the control group. However, the serum Vitamin D levels in the two groups were observed to be similar (p = 0.486). Weak but significant positive correlations were observed between epicardial adipose tissue thickness and C-reactive protein (r = 0.302, p < 0.005), epicardial adipose tissue thickness and pulse wave velocity (r = 0.263, p < 0.01), and C-reactive protein and pulse wave velocity (r = 0.235, p < 0.05). Conclusion Thickness of epicardial adipose tissue and pulse wave velocity were observed to increase in patients with familial Mediterranean fever.
Collapse
Affiliation(s)
- Mustafa Kozan
- Department of Internal Medicine, Faculty of Medicine, Bozok University, Yozgat, Turkey
| | - Zeynep Tugba Ozan
- Department of Internal Medicine, Faculty of Medicine, Bozok University, Yozgat, Turkey
| | - Vahit Demir
- Department of Cardiology, Faculty of Medicine, Bozok University, Yozgat, Turkey
| | - Hüseyin Ede
- Department of Cardiology, Faculty of Medicine, Bozok University, Yozgat, Turkey
| |
Collapse
|
11
|
Namasivayam M, McEniery CM, Wilkinson IB, Yasmin, Cockroft JR, McDonnell BJ, Adji A, O’Rourke MF. Different Effects of Vascular Aging on Ischemic Predisposition in Healthy Men and Women. Hypertension 2018; 72:1294-1300. [DOI: 10.1161/hypertensionaha.118.11642] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Affiliation(s)
- Mayooran Namasivayam
- From the Faculty of Medicine, University of New South Wales, Sydney, Australia (M.N., M.F.O.)
| | - Carmel M. McEniery
- Division of Experimental Medicine and Immunotherapeutics, University of Cambridge, United Kingdom (C.M.M., I.B.W., Y.)
| | - Ian B. Wilkinson
- Division of Experimental Medicine and Immunotherapeutics, University of Cambridge, United Kingdom (C.M.M., I.B.W., Y.)
| | - Yasmin
- Division of Experimental Medicine and Immunotherapeutics, University of Cambridge, United Kingdom (C.M.M., I.B.W., Y.)
| | - John R. Cockroft
- School of Health Sciences, Cardiff Metropolitan University, United Kingdom (J.R.C., B.J.M.)
| | - Barry J. McDonnell
- School of Health Sciences, Cardiff Metropolitan University, United Kingdom (J.R.C., B.J.M.)
| | - Audrey Adji
- Faculty of Medical and Health Sciences, Macquarie University, Sydney, Australia (A.A.)
| | - Michael F. O’Rourke
- From the Faculty of Medicine, University of New South Wales, Sydney, Australia (M.N., M.F.O.)
| | | |
Collapse
|
12
|
Bu Z, Ma J, Fan Y, Qiao Z, Kang Y, Zheng Y, Wang W, Du Y, Zheng Z, Shen X, He B, Pu J. Ascending Aortic Strain Analysis Using 2-Dimensional Speckle Tracking Echocardiography Improves the Diagnostics for Coronary Artery Stenosis in Patients With Suspected Stable Angina Pectoris. J Am Heart Assoc 2018; 7:JAHA.118.008802. [PMID: 29982229 PMCID: PMC6064841 DOI: 10.1161/jaha.118.008802] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Background Arterial stiffening and atherosclerosis tend to coexist. Strain imaging, using a 2‐dimensional speckle tracking (2D‐ST) method, has been used for arterial stiffness assessment and early identification of atherosclerosis. We investigated whether the ascending aortic strain assessed by 2D‐ST echocardiography at rest can predict the presence of coronary artery disease (CAD). Methods and Results Two hundred seventy‐one consecutive patients with suspected stable angina pectoris sequentially underwent exercise treadmill testing, 2‐dimensional echocardiography, M‐mode echocardiography, 2D‐ST echocardiography, and coronary angiography. Circumferential ascending aortic strain (CAAS) and radial ascending aortic strain were assessed by 2D‐ST echocardiography. Ninety‐two patients with coronary lumen area stenosis ≥70% were categorized as having significant CAD. Global CAAS was significantly lower in patients with significant CAD (7.41±2.30% versus 11.54±4.03%; P<0.001) and remained an independent predictor of significant CAD (odds ratio, 0.64 [0.54–0.75]; P<0.001) after multivariate regression. Based on the receiver operating characteristic curve for diagnosing significant CAD, the optimal cut‐off value of global CAAS was ≤9.22% (sensitivity, 86%; specificity, 70%; area under curve=0.82; P<0.001). Global CAAS decreased with increasing severity of CAD and was significantly associated with 3‐vessel disease (odds ratio, 0.58 [0.42–0.79]; P<0.001). Diagnostics for significant CAD were remarkably better for global CAAS combined with exercise treadmill testing than for exercise treadmill testing alone (area under curve=0.88 versus 0.78; P<0.001). Conclusions Global CAAS assessed by 2D‐ST echocardiography at rest was able to predict the presence of significant CAD and identify multivessel disease. In addition, global CAAS combined with exercise treadmill testing remarkably improved the diagnostics for significant CAD.
Collapse
Affiliation(s)
- Zhaohui Bu
- Institute of Biomedical Engineering, University of Shanghai for Science and Technology, Shanghai, China.,Department of Cardiology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Jun Ma
- Department of Cardiology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Yibo Fan
- Department of Cardiology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Zhiqing Qiao
- Department of Cardiology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Yu Kang
- Department of Cardiology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Ying Zheng
- Department of Cardiology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Wei Wang
- Department of Cardiology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Yongping Du
- Department of Cardiology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Zheng Zheng
- Institute of Biomedical Engineering, University of Shanghai for Science and Technology, Shanghai, China
| | - Xuedong Shen
- Department of Cardiology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Ben He
- Department of Cardiology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China .,Department of Cardiology, Shanghai Chest Hospital Shanghai Jiao Tong University, Shanghai, China
| | - Jun Pu
- Department of Cardiology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| |
Collapse
|
13
|
Avolio AP, Kuznetsova T, Heyndrickx GR, Kerkhof PLM, Li JKJ. Arterial Flow, Pulse Pressure and Pulse Wave Velocity in Men and Women at Various Ages. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2018; 1065:153-168. [PMID: 30051383 DOI: 10.1007/978-3-319-77932-4_10] [Citation(s) in RCA: 55] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
The increase in pulse pressure (PP) that occurs with advancing age is predominantly due to reduced arterial distensibility leading to decreased aortic compliance, particularly in the elderly, in whom high blood pressure mainly manifests as isolated systolic hypertension. Since age-related changes in stroke volume are minimal compared with changes in PP, PP is often considered a surrogate measure of arterial stiffness. However, since PP is determined by both cardiac and arterial function, a more precise and reliable means of assessment of arterial stiffness is arterial pulse wave velocity (PWV), a parameter that is only dependent on arterial properties. Arterial stiffness as measured by PWV has been found to be a powerful pressure-related indicator for cardiovascular morbidity and mortality. We analyzed PP and PWV in men and women of various age groups in healthy volunteers as well as cardiac patients with different types of diseases. The findings identified several striking sex-specific differences which demand consideration in guidelines for diagnostic procedures, for epidemiological analysis, and in evaluation of therapeutic interventions.
Collapse
Affiliation(s)
- Alberto P Avolio
- Department of Biomedical Sciences, Faculty of Medicine and Health Sciences, Macquarie University, Sydney, NSW, Australia.
| | - Tatiana Kuznetsova
- Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium
| | | | - Peter L M Kerkhof
- Department of Radiology and Nuclear Medicine, Amsterdam Cardiovascular Sciences, VU University Medical Center, Amsterdam, The Netherlands
| | - John K-J Li
- Department of Biomedical Engineering, Rutgers University, Piscataway, NJ, USA
| |
Collapse
|
14
|
Abbott T, Pearse R, Archbold R, Wragg A, Kam E, Ahmad T, Khan A, Niebrzegowska E, Rodseth R, Devereaux P, Ackland G. Association between preoperative pulse pressure and perioperative myocardial injury: an international observational cohort study of patients undergoing non-cardiac surgery. Br J Anaesth 2017; 119:78-86. [DOI: 10.1093/bja/aex165] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/04/2017] [Indexed: 01/23/2023] Open
|
15
|
Namugowa A, Iputo J, Wandabwa J, Meeme A, Buga GAB. Comparison of arterial stiffness in preeclamptic and normotensive pregnant women from a semi-rural region of South Africa. Clin Exp Hypertens 2017; 39:277-283. [DOI: 10.1080/10641963.2016.1254227] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
|
16
|
Namasivayam M, McCready M, Adji A, O'Rourke MF. The Role of Heart Rate in Diastolic Coronary Perfusion and Subclinical Myocardial Ischemia. J Am Coll Cardiol 2017; 69:1647. [PMID: 28335851 DOI: 10.1016/j.jacc.2016.11.087] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2016] [Accepted: 11/17/2016] [Indexed: 11/28/2022]
|
17
|
Shafique E, Torina A, Reichert K, Colantuono B, Nur N, Zeeshan K, Ravichandran V, Liu Y, Feng J, Zeeshan K, Benjamin LE, Irani K, Harrington EO, Sellke FW, Abid MR. Mitochondrial redox plays a critical role in the paradoxical effects of NAPDH oxidase-derived ROS on coronary endothelium. Cardiovasc Res 2017; 113:234-246. [PMID: 28088753 DOI: 10.1093/cvr/cvw249] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2016] [Revised: 12/25/2016] [Accepted: 12/07/2016] [Indexed: 12/31/2022] Open
Abstract
AIMS There are conflicting reports on the role of reactive oxygen species (ROS) i.e. beneficial vs. harmful, in vascular endothelium. Here, we aim to examine whether duration of exposure to ROS and/or subcellular ROS levels are responsible for the apparently paradoxical effects of oxidants on endothelium. METHODS AND RESULTS We have recently generated binary (Tet-ON/OFF) conditional transgenic mice (Tet-Nox2:VE-Cad-tTA) that can induce 1.8 ± 0.42-fold increase in NADPH oxidase (NOX)-derived ROS specifically in vascular endothelium upon withdrawal of tetracycline from the drinking water. Animals were divided in two groups: one exposed to high endogenous ROS levels for 8 weeks (short-term) and the other for 20 weeks (long-term). Using endothelial cells (EC) isolated from mouse hearts (MHEC), we demonstrate that both short-term and long-term increase in NOX-ROS induced AMPK-mediated activation of eNOS. Interestingly, although endothelium-dependent nitric oxide (NO)-mediated coronary vasodilation was significantly increased after short-term increase in NOX-ROS, coronary vasodilation was drastically reduced after long-term increase in ROS. We also show that short-term ROS increase induced proliferation in EC and angiogenic sprouting in the aorta. In contrast, long-term increase in cytosolic ROS resulted in nitrotyrosine-mediated inactivation of mitochondrial (mito) antioxidant MnSOD, increase in mito-ROS, loss of mitochondrial membrane potential (Δψm), decreased EC proliferation and angiogenesis. CONCLUSION The findings suggest that NOX-derived ROS results in increased mito-ROS. Whereas short-term increase in mito-ROS was counteracted by MnSOD, long-term increase in ROS resulted in nitrotyrosine-mediated inactivation of MnSOD, leading to unchecked increase in mito-ROS and loss of Δψm followed by inhibition of endothelial function and proliferation.
Collapse
Affiliation(s)
- Ehtesham Shafique
- Cardiovascular Research Center, Division of Cardiothoracic Surgery, Department of Surgery, Rhode Island Hospital, 1 Hoppin St, Providence, RI 02903, USA
| | - Anali Torina
- Cardiovascular Research Center, Division of Cardiothoracic Surgery, Department of Surgery, Rhode Island Hospital, 1 Hoppin St, Providence, RI 02903, USA
| | - Karla Reichert
- Cardiovascular Research Center, Division of Cardiothoracic Surgery, Department of Surgery, Rhode Island Hospital, 1 Hoppin St, Providence, RI 02903, USA
| | - Bonnie Colantuono
- Cardiovascular Research Center, Division of Cardiothoracic Surgery, Department of Surgery, Rhode Island Hospital, 1 Hoppin St, Providence, RI 02903, USA
| | - Nasifa Nur
- Cardiovascular Research Center, Division of Cardiothoracic Surgery, Department of Surgery, Rhode Island Hospital, 1 Hoppin St, Providence, RI 02903, USA
| | - Khawaja Zeeshan
- Cardiovascular Research Center, Division of Cardiothoracic Surgery, Department of Surgery, Rhode Island Hospital, 1 Hoppin St, Providence, RI 02903, USA
| | - Vani Ravichandran
- Cardiovascular Research Center, Division of Cardiothoracic Surgery, Department of Surgery, Rhode Island Hospital, 1 Hoppin St, Providence, RI 02903, USA
| | - Yuhong Liu
- Cardiovascular Research Center, Division of Cardiothoracic Surgery, Department of Surgery, Rhode Island Hospital, 1 Hoppin St, Providence, RI 02903, USA.,Warren Alpert Medical School of Brown University, 593 Eddy St, Providence, RI 02903, USA
| | - Jun Feng
- Cardiovascular Research Center, Division of Cardiothoracic Surgery, Department of Surgery, Rhode Island Hospital, 1 Hoppin St, Providence, RI 02903, USA.,Warren Alpert Medical School of Brown University, 593 Eddy St, Providence, RI 02903, USA
| | - Khawaja Zeeshan
- Cardiovascular Research Center, Division of Cardiothoracic Surgery, Department of Surgery, Rhode Island Hospital, 1 Hoppin St, Providence, RI 02903, USA
| | | | - Kaikobad Irani
- University of Iowa Carver School of Medicine, Iowa, IA, USA
| | - Elizabeth O Harrington
- Providence VA Medical Center, Providence, RI, USA.,Brown University, Providence, RI, USA
| | - Frank W Sellke
- Cardiovascular Research Center, Division of Cardiothoracic Surgery, Department of Surgery, Rhode Island Hospital, 1 Hoppin St, Providence, RI 02903, USA.,Warren Alpert Medical School of Brown University, 593 Eddy St, Providence, RI 02903, USA
| | - Md Ruhul Abid
- Cardiovascular Research Center, Division of Cardiothoracic Surgery, Department of Surgery, Rhode Island Hospital, 1 Hoppin St, Providence, RI 02903, USA; .,Warren Alpert Medical School of Brown University, 593 Eddy St, Providence, RI 02903, USA.,Brown University, Providence, RI, USA
| |
Collapse
|
18
|
Namasivayam M, Adji A, O'Rourke MF. Evaluating the Hemodynamic Basis of Age-Related Central Blood Pressure Change Using Aortic Flow Triangulation. Am J Hypertens 2016; 29:178-84. [PMID: 26045532 DOI: 10.1093/ajh/hpv080] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2014] [Accepted: 05/05/2015] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Pulsatile blood pressure rises with age, especially in the aorta. The comparative role of forward and reflected pressure waves (FW and RW, respectively), determined by aortic flow triangulation has not previously been explored in a large clinical cohort. This study aimed to identify the role of FW and RW in the rise in aortic pulse pressure with age. METHODS For 879 outpatients, aortic pressure waveforms were generated using a validated generalized transfer function applied to radial pressure waves recorded using applanation tonometry. FW and RW were subsequently determined using aortic flow triangulation. Contributions of FW and RW to rise in aortic pulse pressure with age were determined using multivariate linear regression and product of coefficient mediation analysis, with adjustment for height, weight, heart rate, and mean arterial pressure. Comparisons were made by gender and before and after age 60. RESULTS In subjects aged 60 and below, RW was an important contributor to pulsatile pressure elevation with age, but FW was non-contributory in either gender after multivariate correction. In subjects aged above 60, both FW and RW were significant and equal contributors in both genders. CONCLUSIONS In a clinical setting, both FW and RW are important to pulsatile aortic blood pressure across the lifespan, but RW appears to have a more pronounced effect across all ages, whereas FW has less effect in younger persons.
Collapse
Affiliation(s)
- Mayooran Namasivayam
- Department of Cardiology, St. Vincent's Hospital and Clinic, Sydney, Australia; Faculty of Medicine, University of New South Wales, Sydney Australia; Vascular-Ventricular Interactions Laboratory, Cardiac Physiology and Transplantation Division, Victor Chang Cardiac Research Institute, Sydney, Australia
| | - Audrey Adji
- Department of Cardiology, St. Vincent's Hospital and Clinic, Sydney, Australia; Vascular-Ventricular Interactions Laboratory, Cardiac Physiology and Transplantation Division, Victor Chang Cardiac Research Institute, Sydney, Australia; Australian School of Advanced Medicine, Macquarie University, Sydney, Australia
| | - Michael F O'Rourke
- Department of Cardiology, St. Vincent's Hospital and Clinic, Sydney, Australia; Faculty of Medicine, University of New South Wales, Sydney Australia; Vascular-Ventricular Interactions Laboratory, Cardiac Physiology and Transplantation Division, Victor Chang Cardiac Research Institute, Sydney, Australia;
| |
Collapse
|
19
|
Lefferts WK, Hughes WE, Heffernan KS. Effect of acute nitrate ingestion on central hemodynamic load in hypoxia. Nitric Oxide 2016; 52:49-55. [DOI: 10.1016/j.niox.2015.12.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2015] [Revised: 11/03/2015] [Accepted: 12/01/2015] [Indexed: 12/20/2022]
|
20
|
Nichols WW, Denardo SJ, Davidson JB, Huo T, Bairey Merz CN, Pepine CJ. Association of aortic stiffness and wave reflections with coronary flow reserve in women without obstructive coronary artery disease: An ancillary study from the National Heart, Lung, and Blood Institute-sponsored Women's Ischemia Syndrome Evaluation (WISE). Am Heart J 2015; 170:1243-54. [PMID: 26678647 PMCID: PMC4685957 DOI: 10.1016/j.ahj.2015.08.019] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2015] [Accepted: 08/25/2015] [Indexed: 01/03/2023]
Abstract
BACKGROUND Increased aortic stiffness and reduced coronary flow reserve (CFR) independently predict adverse outcomes. But information about relationships between arterial properties and CFR in subjects without obstructive coronary artery disease (CAD) is limited. METHODS CFR was measured (Doppler flow wire and intracoronary adenosine) in 50 women (age 53 ± 11 years) with symptoms and signs of myocardial ischemia without obstructive CAD. Aortic pulse wave velocity (aPWV), a measure of aortic stiffness, was obtained via catheter pullback; radial artery pressure waves were measured by applanation tonometry and central aortic pressure synthesized. RESULTS Overall, CFR (mean 2.61 ± 0.47) was significantly correlated with aPWV (r = -0.51), pulse wave amplification (r = 0.45), augmented pressure (r = -0.48), augmentation index (AIx, r = -0.44), aortic systolic pressure (r = -0.49), left ventricular wasted energy (LVEw, r = -0.47) (all P < .001), systolic pressure time index (r = -0.37, P < .008), and rate pressure product (r = -0.29, P < .04). In the multiple regression model including aPWV, CFR was still significantly correlated with aPWV (P < .008) and aortic systolic pressure (P < .01). No other measures contributed significant additional information. Women with CFR ≤2.5 versus those with CFR >2.5 had greater aPWV (894 ± 117 vs 747 ± 93 cm/s, P < .001), augmented pressure (14 ± 4.9 vs 11 ± 4.1 mmHg, P < .008), AIx (32 ± 6.6 vs 27 ± 6.6%, P < .003), LVEw (30 ± 12 vs 21 ± 10 dyne-s/cm(2) × 10(2), P < .02) and reduced pulse pressure amplification (1.20 ± .07 vs 1.26 ± .10, P < .008) and pressure wave travel time (133 ± 7.3 vs 138 ± 6.9 milliseconds, P < .04). CONCLUSIONS Among symptomatic women without obstructive CAD, CFR was inversely related to aortic systolic pressure and indices of aortic stiffness. These changes in arterial properties increase left ventricular afterload requiring the ventricle to generate additional, but wasted, energy that increases indices of myocardial oxygen demand, reduces CFR and increases vulnerability to ischemia.
Collapse
Affiliation(s)
- Wilmer W Nichols
- Division of Cardiovascular Medicine, University of Florida, Gainesville, FL
| | - Scott J Denardo
- Division of Cardiovascular Medicine, Duke University Medical Center, Durham, NC
| | | | - Tianyao Huo
- Division of Cardiovascular Medicine, University of Florida, Gainesville, FL
| | - C Noel Bairey Merz
- Barbra Streisand Women's Heart Center, Cedars-Sinai Heart Institute, Los Angeles, CA
| | - Carl J Pepine
- Division of Cardiovascular Medicine, University of Florida, Gainesville, FL.
| |
Collapse
|
21
|
Teixeira R, Vieira MJ, Gonçalves A, Cardim N, Gonçalves L. Ultrasonographic vascular mechanics to assess arterial stiffness: a review. Eur Heart J Cardiovasc Imaging 2015; 17:233-46. [DOI: 10.1093/ehjci/jev287] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2015] [Accepted: 10/04/2015] [Indexed: 12/21/2022] Open
|
22
|
Townsend RR, Rosendorff C, Nichols WW, Edwards DG, Chirinos JA, Fernhall B, Cushman WC. American Society of Hypertension position paper: central blood pressure waveforms in health and disease. ACTA ACUST UNITED AC 2015; 10:22-33. [PMID: 26612106 DOI: 10.1016/j.jash.2015.10.012] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2015] [Revised: 10/14/2015] [Accepted: 10/28/2015] [Indexed: 01/07/2023]
Abstract
A number of devices are available which noninvasively estimate central aortic blood pressure using a variety of approaches such as tonometry or oscillometry. In this position paper, we discuss how the central pressure waveform is generated and measured, how central pressure waveforms appear in health and disease, the predictive value of central blood pressure measurements, the effects of interventions on waveforms, and areas of future need in this field of clinical and research endeavor.
Collapse
Affiliation(s)
- Raymond R Townsend
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
| | - Clive Rosendorff
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA; Department of Medicine, James J. Peters VA Medical Center, Bronx, NY, USA
| | - Wilmer W Nichols
- Division of Medicine, Department of Medicine, College of Medicine, University of Florida, Gainesville, FL, USA; Division of Cardiovascular Medicine, Department of Medicine, University of Florida, Gainesville, FL, USA
| | - David G Edwards
- Department of Kinesiology and Applied Physiology, College of Health Sciences, University of Delaware, Newark, DE, USA
| | - Julio A Chirinos
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Bo Fernhall
- Department of Kinesiology and Nutrition, College of Applied Health Sciences, University of Illinois Chicago, Chicago, IL, USA
| | - William C Cushman
- Department of Medicine Service, Veterans Affairs Medical Center, University of Tennessee College of Medicine, Memphis, TN, USA
| |
Collapse
|
23
|
Impact of age on aortic wave reflection responses to metaboreflex activation and its relationship with leg lean mass in post-menopausal women. Exp Gerontol 2015; 70:119-24. [DOI: 10.1016/j.exger.2015.07.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2015] [Revised: 06/24/2015] [Accepted: 07/13/2015] [Indexed: 12/23/2022]
|
24
|
Townsend RR, Wilkinson IB, Schiffrin EL, Avolio AP, Chirinos JA, Cockcroft JR, Heffernan KS, Lakatta EG, McEniery CM, Mitchell GF, Najjar SS, Nichols WW, Urbina EM, Weber T. Recommendations for Improving and Standardizing Vascular Research on Arterial Stiffness: A Scientific Statement From the American Heart Association. Hypertension 2015; 66:698-722. [PMID: 26160955 DOI: 10.1161/hyp.0000000000000033] [Citation(s) in RCA: 938] [Impact Index Per Article: 104.2] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
|
25
|
Lefferts WK, Heffernan KS, Hultquist EM, Fehling PC, Smith DL. Vascular and central hemodynamic changes following exercise-induced heat stress. Vasc Med 2015; 20:222-9. [PMID: 25939655 DOI: 10.1177/1358863x14566430] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
This study examined the effects of moderate exercise-induced heat stress (EIHS) on vascular function, central hemodynamic load and indices of coronary perfusion. Vascular-hemodynamic measures were collected in 12 healthy men (aged 22±3 years) pre and post 100 minutes of moderate, intermittent exercise in two randomized conditions: heat stress (HS; wearing firefighter personal protective equipment (PPE)), and no heat stress (NHS; wearing a cooling shirt and equivalent PPE weight). Aortic blood pressure, reflected wave pressure (Pb), systolic (SPTI) and diastolic pressure time-integral (DPTI), and aortic stiffness were assessed before and after each condition. SPTI was significantly greater, and DPTI and Pb were significantly lower for HS-post compared to NHS-post (p<0.05). Pulse wave velocity was not different between conditions. In conclusion, EIHS does not affect aortic stiffness, but increases indices of myocardial work and reduces indices of coronary perfusion which may be related to chronotropic responses to EIHS. The mismatch between oxygen demand and oxygen supply may increase cardiac vulnerability to ischemia during strenuous work in the heat.
Collapse
Affiliation(s)
- Wesley K Lefferts
- Skidmore College, Saratoga Springs, NY, USA Syracuse University, Syracuse, NY, USA
| | | | | | | | | |
Collapse
|
26
|
Roush GC, Fagard RH, Salles GF, Pierdomenico SD, Reboldi G, Verdecchia P, Eguchi K, Kario K, Hoshide S, Polonia J, de la Sierra A, Hermida RC, Dolan E, Fapohunda J. Prognostic impact of sex–ambulatory blood pressure interactions in 10 cohorts of 17 312 patients diagnosed with hypertension. J Hypertens 2015; 33:212-20. [DOI: 10.1097/hjh.0000000000000435] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
|
27
|
Tan W, Madhavan K, Hunter KS, Park D, Stenmark KR. Vascular stiffening in pulmonary hypertension: cause or consequence? (2013 Grover Conference series). Pulm Circ 2014; 4:560-80. [PMID: 25610594 PMCID: PMC4278618 DOI: 10.1086/677370] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2014] [Accepted: 05/27/2014] [Indexed: 12/24/2022] Open
Abstract
Recent studies have indicated that systemic arterial stiffening is a precursor to hypertension and that hypertension, in turn, can perpetuate arterial stiffening. Pulmonary artery (PA) stiffening is also well documented to occur in pulmonary hypertension (PH), and there is evidence that pulmonary vascular stiffness (PVS) may be a better predictor of outcome than pulmonary vascular resistance (PVR). We have hypothesized that the decreased flow-damping function of elastic PAs in PH likely initiates and/or perpetuates dysfunction of pulmonary microvasculature. Recent studies have shown that large-vessel stiffening increases flow pulsatility in the distal pulmonary vasculature, leading to endothelial dysfunction within a proinflammatory, vasoconstricting, and profibrogenic environment. The intricate role of stiffening-stimulated high pulsatile flow in endothelial cell dysfunction includes stepwise molecular events underlying PA hypertrophy, inflammation, endothelial-mesenchymal transition, and fibrosis. In addition to contributing to microenvironmental alterations of the distal vasculature, disordered proximal-distal PA coupling likely also plays a role in increasing ventricular afterload, ultimately causing right ventricle (RV) dysfunction and death. Current therapeutic treatments do not provide a realistic approach to destiffening arteries and, thus, to potentially abrogating the effects of high pulsatile flow on the distal pulmonary vasculature or the increased work imposed by stiffening on the RV. Scrutinizing the effect of PA stiffening on high pulsatile flow-induced cellular and molecular changes, and vice versa, might lead to important new therapeutic options that abrogate PA remodeling and PH development. With a clear understanding that PA stiffening may contribute to the progression of PH to an irreversible state by contributing to chronic microvascular damage in lungs, future studies should be aimed first at defining the underlying mechanisms leading to PA stiffening and then at improved treatment approaches based on these findings.
Collapse
Affiliation(s)
- Wei Tan
- Department of Pediatrics, University of Colorado Denver, Aurora, Colorado, USA
- Cardiovascular Pulmonary Research Laboratories, University of Colorado Denver, Aurora, Colorado, USA
- Department of Mechanical Engineering, University of Colorado Boulder, Boulder, Colorado, USA
| | - Krishna Madhavan
- Department of Pediatrics, University of Colorado Denver, Aurora, Colorado, USA
- Department of Bioengineering, University of Colorado Denver, Aurora, Colorado, USA
| | - Kendall S. Hunter
- Department of Pediatrics, University of Colorado Denver, Aurora, Colorado, USA
- Department of Bioengineering, University of Colorado Denver, Aurora, Colorado, USA
| | - Daewon Park
- Department of Bioengineering, University of Colorado Denver, Aurora, Colorado, USA
| | - Kurt R. Stenmark
- Department of Pediatrics, University of Colorado Denver, Aurora, Colorado, USA
- Cardiovascular Pulmonary Research Laboratories, University of Colorado Denver, Aurora, Colorado, USA
| |
Collapse
|
28
|
Wang JZ, Zhang YL, Hu FS, He ZJ, Yang XJ, Ma ZC, Sun YN. A new tonometric device for radial augmentation index and subendocardial viability ratio: potential use in health screening. J Clin Hypertens (Greenwich) 2014; 16:707-12. [PMID: 25203355 DOI: 10.1111/jch.12396] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2014] [Revised: 07/13/2014] [Accepted: 07/20/2014] [Indexed: 11/29/2022]
Abstract
Augmentation index (AIx) and subendocardial viability ratio (SEVR) are widely accepted indices of wave reflection and myocardial oxygen demand relative to supply. This study aimed to validate a new tonometric device (IIM-2010A) for obtaining AIx and SEVR from radial artery. A total of 68 outpatients (32 men and 36 women) aged 20 to 76 years (44.7±16.6 years) recruited from a health screening center participated in the study. AIx was obtained from radial pressure using the HEM-9000AI and IIM-2010A devices, while SEVR was measured from carotid pressure with the tonometric method and from radial pressure by the IIM-2010A device. In a subgroup of 24 patients, the measurements of AIx and SEVR were repeated after an interval of 10 minutes. The correlation of radial AIx between the IIM-2010A and HEM-9000AI devices was highly significant (r=0.956, P<.01). Radial SEVR determined from IIM-2010A was also highly related to carotid SEVR (r=0.864, P<.01), although the value was about 13.1% lower. There was no statistically significant difference between the repeated measurements of both indices. The lower coefficient of variation (2.9% vs 4.3% for AIx, 3.3% vs 4.1% for SEVR) and higher intraclass correlation coefficient (0.96 vs 0.91 for AIx, 0.93 vs 0.86 for SEVR) of IIM-2010A confirmed better short-term reproducibility, compared with the HEM-9000AI device and carotid tonometry. The new tonometric device IIM-2010A is effective and reproducible in calculating radial AIx and SEVR and has potential use in health screening.
Collapse
Affiliation(s)
- Jing-Zhi Wang
- Department of Automation, University of Science and Technology of China, Hefei, China; Research Center for Information Technology of Sports and Health, Institute of Intelligent Machines, Chinese Academy of Sciences, Hefei, China
| | | | | | | | | | | | | |
Collapse
|
29
|
Effects of hypocaloric diet, low-intensity resistance exercise with slow movement, or both on aortic hemodynamics and muscle mass in obese postmenopausal women. Menopause 2014; 20:967-72. [PMID: 23511706 DOI: 10.1097/gme.0b013e3182831ee4] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
OBJECTIVE This study aims to examine the independent and combined impact of hypocaloric diet and low-intensity resistance exercise training (LIRET) on aortic hemodynamics and appendicular skeletal muscle mass (ASM) in obese postmenopausal women. METHODS Forty-one obese postmenopausal women (mean [SD] age, 54 [1] y) were randomly assigned to LIRET (n = 13), diet (n = 14), or diet + LIRET (n = 14). Body weight, waist circumference, aortic systolic blood pressure, aortic pulse pressure, augmentation index, subendocardial viability ratio (SEVR; myocardial perfusion), and heart rate (HR) were measured before and after 12 weeks. ASM was assessed by dual-energy x-ray absorptiometry. RESULTS Body weight (P < 0.001) and waist circumference (P < 0.01) decreased similarly after diet and diet + LIRET compared with no changes after LIRET. ASM did not change after diet + LIRET, and the decrease observed after diet (P < 0.001) was significant compared with LIRET. Aortic systolic blood pressure decreased similarly after LIRET (P < 0.05), diet (P < 0.01), and diet + LIRET (P < 0.01). Aortic pulse pressure (P < 0.05) decreased similarly after diet and diet + LIRET, but not after LIRET. SEVR (P < 0.01) increased similarly in both diet groups, whereas HR (P < 0.01) decreased only after diet. Changes in SEVR (P < 0.05) and HR (P< 0.01) with diet were different compared with LIRET. The augmentation index did not change in any group. CONCLUSIONS Our findings suggest that diet-induced weight loss may reduce cardiovascular risk by improving SEVR via HR and aortic pulse pressure reductions in obese postmenopausal women. LIRET prevents ASM loss associated with hypocaloric diet but has no additive effects on aortic hemodynamics.
Collapse
|
30
|
Sex differences in noninvasive estimates of left ventricular pressure energetics but not myocardial oxygen demand in young adults. Artery Res 2014. [DOI: 10.1016/j.artres.2014.07.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
|
31
|
Eight weeks of stretching training reduces aortic wave reflection magnitude and blood pressure in obese postmenopausal women. J Hum Hypertens 2013; 28:246-50. [PMID: 24132138 DOI: 10.1038/jhh.2013.98] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2013] [Revised: 08/07/2013] [Accepted: 09/03/2013] [Indexed: 11/08/2022]
Abstract
The augmentation index (AIx, a marker of wave reflection) is reduced and peripheral artery vasodilation increased following acute stretching exercise. We examined the effects of stretching training (ST) on arterial function, blood pressure (BP) and sympathetic vasomotor modulation. Twenty-eight obese postmenopausal women (57±1 years) were randomized to a ST (n=14) or no-exercise control (CON) group ( n=14). ST included stretching exercises 3 days week(-1) for 8 weeks. Brachial (b) and aortic (a) systolic BP (SBP), diastolic BP (DBP), mean arterial pressure (MAP), heart rate (HR), brachial-ankle pulse wave velocity (baPWV), carotid-femoral PWV (aPWV), femoral-ankle PWV (faPWV), AIx, low-frequency component of SBP (LFSBP) and sit/reach score (SRS) were measured before and after interventions. There were significant decreases in bSBP (P<0.05), aSBP (P<0.01), aDBP (P<0.05), aMAP (P<0.01), aAIx (P<0.05) and LFSBP (P<0.05) after ST compared with CON. SRS significantly (P<0.01) increased after ST but not after CON. There were no significant effects (P>0.05) on HR, baPWV, aPWV and faPWV after ST or CON. Eight weeks of ST decreases BP, AIx and LFSBP in obese postmenopausal women. Our findings show that ST reduces peripheral and central BP, wave reflection magnitude and vascular sympathetic activity in obese postmenopausal women with prehypertension and hypertension.
Collapse
|
32
|
Effects of resistance training on central blood pressure and wave reflection in obese adults with prehypertension. J Hum Hypertens 2013; 28:143-4. [DOI: 10.1038/jhh.2013.83] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
|
33
|
MA ZUCHANG, ZHANG YONGLIANG, NI CHAOMING, HE ZIJUN, CAO QINGQING, SUN YINING. A NEW METHOD FOR DETERMINING SUBENDOCARDIAL VIABILITY RATIO FROM RADIAL ARTERY PRESSURE WAVES. J MECH MED BIOL 2013. [DOI: 10.1142/s0219519413500607] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Aortic subendocardial viability ratio (SEVR), an index of myocardial oxygen demand relative to supply, has been used for the early detection of hemodynamic changes. We aimed to validate a new method for determining SEVR directly from radial pressures. Hemodynamic parameters were measured in 231 outpatients (108 males and 123 females) for physical examination, aged from 20–77 years (45.9 ± 17.3 years), including 210 healthy and 21 hypertensive subjects. Aortic SEVR was obtained using a validated device (SphygmoCor; AtCor Medical, Sydney, Australia), and radial SEVR was obtained using a portable vascular testing device (IIM-2010A; Institute and Intelligent of Machines, Hefei, China). Radial SEVR was strongly related to aortic SEVR (r = 0.824, p < 0.01), with approximately 15.7% lower value. Aortic and radial SEVR had similar independent predictors, including diastolic time fraction (DTF), systolic blood pressure, diastolic blood pressure, age, and height. DTF exerted the most influence on both of them. In healthy subjects, there were significant changes in aortic and radial SEVR between age groups in both males and females (p < 0.05 for both ). Changes in aortic and radial SEVR with aging were parallel though the differences between them increased. These results suggested that the simple and easily obtainable radial SEVR could provide equivalent information to aortic SEVR, and has potential for the primary prevention of cardiovascular disease in health screening.
Collapse
Affiliation(s)
- ZU-CHANG MA
- Jiangsu Institute of Sports Science, Nanjing 210033, Jiangsu, P. R. China
- Beijing Sport University, Beijing 100084, P. R. China
- Institute and Intelligent of Machines, Chinese Academy of Sciences, Hefei 230031, Anhui, P. R. China
| | - YONG-LIANG ZHANG
- Institute and Intelligent of Machines, Chinese Academy of Sciences, Hefei 230031, Anhui, P. R. China
- Department of Automation, University of Science and Technology of China, Hefei 230027, Anhui, P. R. China
| | - CHAO-MING NI
- Department of Rehabilitation Medicine, The Affiliated Provincial Hospital of Anhui Medical University, Hefei 230001 Anhui, P. R. China
| | - ZI-JUN HE
- Institute and Intelligent of Machines, Chinese Academy of Sciences, Hefei 230031, Anhui, P. R. China
- Department of Automation, University of Science and Technology of China, Hefei 230027, Anhui, P. R. China
| | - QING-QING CAO
- Institute and Intelligent of Machines, Chinese Academy of Sciences, Hefei 230031, Anhui, P. R. China
| | - YI-NING SUN
- Institute and Intelligent of Machines, Chinese Academy of Sciences, Hefei 230031, Anhui, P. R. China
| |
Collapse
|
34
|
Figueroa A, Kalfon R, Madzima TA, Wong A. Effects of whole-body vibration exercise training on aortic wave reflection and muscle strength in postmenopausal women with prehypertension and hypertension. J Hum Hypertens 2013; 28:118-22. [DOI: 10.1038/jhh.2013.59] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2013] [Revised: 05/24/2013] [Accepted: 06/03/2013] [Indexed: 12/21/2022]
|
35
|
Nichols WW, Denardo SJ, Johnson BD, Sharaf BL, Bairey Merz CN, Pepine CJ. Increased wave reflection and ejection duration in women with chest pain and nonobstructive coronary artery disease: ancillary study from the Women's Ischemia Syndrome Evaluation. J Hypertens 2013; 31:1447-54; discussion 1454-5. [PMID: 23615325 PMCID: PMC3766396 DOI: 10.1097/hjh.0b013e3283611bac] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Wave reflections augment central aortic SBP and increase systolic pressure time integral (SPTI) thereby increasing left ventricular (LV) afterload and myocardial oxygen (MVO2) demand. When increased, such changes may contribute to myocardial ischemia and angina pectoris, especially when aortic diastolic time is decreased and myocardial perfusion pressure jeopardized. Accordingly, we examined pulse wave reflection characteristics and diastolic timing in a subgroup of women with chest pain (Women's Ischemia Syndrome Evaluation, WISE) and no obstructive coronary artery disease (CAD). METHODS Radial artery BP waveforms were recorded by applanation tonometry, and aortic BP waveforms derived. Data from WISE participants were compared with data from asymptomatic women (reference group) without chest pain matched for age, height, BMI, mean arterial BP, and heart rate. RESULTS Compared with the reference group, WISE participants had higher aortic SBP and pulse BP and ejection duration. These differences were associated with increased augmentation index and reflected pressure wave systolic duration. These modifications in wave reflection characteristics were associated with increased SPTI and wasted LV energy (Ew) and a decrease in pulse pressure amplification, myocardial viability ratio, and diastolic pressure time fraction. CONCLUSION WISE participants with no obstructive CAD have changes in systolic wave reflections and diastolic timing that increase LV afterload, MVO2 demand, and Ew with the potential to reduce coronary artery perfusion. These alterations in cardiovascular function contribute to an undesirable mismatch in the MVO2 supply/demand that promotes ischemia and chest pain and may contribute to, or increase the severity of, future adverse cardiovascular events.
Collapse
Affiliation(s)
- Wilmer W Nichols
- Division of Cardiovascular Medicine, University of Florida College of Medicine, Gainesville, Florida 32601, USA
| | | | | | | | | | | |
Collapse
|
36
|
Markus MRP, Stritzke J, Baumeister SE, Siewert U, Baulmann J, Hannemann A, Schipf S, Meisinger C, Dörr M, Felix SB, Keil U, Völzke H, Hense HW, Schunkert H. Effects of smoking on arterial distensibility, central aortic pressures and left ventricular mass. Int J Cardiol 2013; 168:2593-601. [PMID: 23597572 DOI: 10.1016/j.ijcard.2013.03.045] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2012] [Revised: 01/21/2013] [Accepted: 03/17/2013] [Indexed: 10/27/2022]
Abstract
BACKGROUND The effects of smoking on central aortic pressures and the age-related increase in left ventricular mass (LVM) are largely unknown. We studied the relationship between smoking, arterial distensibility, central aortic pressures and left ventricular mass in two population-based studies. METHODS Data was obtained from two German population-based studies (KORA and SHIP, participants' ages 25-84 years). We identified 114 normotensive current smokers and 185 normotensive all-time non-smokers in KORA as well as 400 and 588 such individuals in SHIP. Echocardiographic LVM was obtained at baseline (T0) and follow-up after ten years (T1) in KORA and at follow-up (T1) in SHIP. Additionally, pulse-wave analysis-based central aortic pressure and augmentation index (AIx) were measured at T1 in KORA. RESULTS Cross-sectional analysis, using KORA T0 and SHIP T1, revealed in both studies a higher covariate-adjusted LVM and left ventricular mass index (LVMI) in smokers as compared with non-smokers. Moreover, in the KORA T1 examination, the smokers demonstrated a more pronounced increase, relative to baseline, of LVM (+13.5%) and LVMI (+13.4%) compared to non-smokers (+8.59% and +8.65%; p=0.036 and 0.042, respectively). Additionally, at KORA T1 smokers had a higher central systolic blood pressure and higher AIx than non-smokers (p=0.012 and p=0.001, respectively). CONCLUSIONS The difference in central aortic pressure due to enhanced and more prolonged wave reflection may explain our finding of a further pronounced increase in left ventricular wall thickness and mass over time in smokers.
Collapse
Affiliation(s)
- Marcello Ricardo Paulista Markus
- Department Study of Health in Pomerania/Clinical-Epidemiological Research, Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
37
|
Cecelja M, Chowienczyk P. Role of arterial stiffness in cardiovascular disease. JRSM Cardiovasc Dis 2012; 1:10.1258_cvd.2012.012016. [PMID: 24175067 PMCID: PMC3738327 DOI: 10.1258/cvd.2012.012016] [Citation(s) in RCA: 189] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Propagation of the pressure wave along the arterial tree (pulse wave velocity [PWV]) is related to the intrinsic elasticity of the arterial wall. PWV is increased in stiffer arteries and, when measured over the aorta, is an independent predictor of cardiovascular morbidity and mortality. Given the predictive power of PWV, identifying strategies that prevent or reduce stiffening may be important in prevention of cardiovascular events. One view is that aortic stiffness occurs as a result of atherosclerosis along the aorta. However, there is little or no association between PWV and classical risk factors for atherosclerosis, other than age and blood pressure. Furthermore, PWV does not increase during early stages of atherosclerosis, as measured by intima-media thickness and non-calcified atheroma, but it does increase in the presence of aortic calcification that occurs within advanced atherosclerotic plaque. Age-related widening of pulse pressure is the major cause of age-related increase in prevalence of hypertension and has been attributed to arterial stiffening. This review summarizes the methods of measuring aortic stiffness in humans, the pathophysiological mechanisms leading to aortic stiffness, including its association with atherosclerosis, and the haemodynamic consequences of increased aortic stiffness.
Collapse
Affiliation(s)
- Marina Cecelja
- King's College London British Heart Foundation Centre, Department of Clinical Pharmacology, St Thomas' Hospital , London , UK
| | | |
Collapse
|
38
|
Botden IPG, Draijer R, Westerhof BE, Rutten JHW, Langendonk JG, Sijbrands EJG, Danser AHJ, Zock PL, van den Meiracker AH. Red wine polyphenols do not lower peripheral or central blood pressure in high normal blood pressure and hypertension. Am J Hypertens 2012; 25:718-23. [PMID: 22421906 DOI: 10.1038/ajh.2012.25] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Epidemiological data suggest that modest red wine consumption may reduce cardiovascular disease risk. Red wine polyphenols improved human endothelial vascular function and reduced blood pressure (BP) in animal studies, but the results of human intervention studies investigating the effect of red wine polyphenols on BP are inconsistent. The objective was to investigate whether polyphenols extracted from red wine reduce peripheral and central BP in subjects with high-normal BP or grade 1 hypertension. METHODS In a double-blind, placebo-controlled three-period crossover trial, we assigned 61 subjects (mean age 61.4 ± 8.4 years) with office systolic BP 135 ± 9 mm Hg and diastolic BP 82 ± 8 mm Hg to dairy drinks containing either placebo, 280 mg red wine polyphenols, or 560 mg red wine polyphenols. After each 4-week intervention period, office and 24-h ambulatory BP measurements, and central hemodynamic measurements derived from continuous finger BP recordings were assessed. RESULTS Polyphenol treatment did not significantly affect 24-h BP: systolic/diastolic BP was 143 ± 2/84 ± 1 mm Hg after placebo, 143 ± 2/84 ± 1 mm Hg after 280 mg/day of red wine polyphenols, and 142 ± 2/83 ± 1 mm Hg after 560 mg/day. Neither dose of polyphenol treatment changed office or central BP, aortic augmentation index (AIx) or pulse wave reflection index. CONCLUSIONS Intake of red wine polyphenols in two different dosages for 4 weeks did not decrease peripheral or central BP in subjects with a high normal or grade 1 hypertension. Our findings do not support the hypothesis that polyphenols account for the suggested cardiovascular benefits of red wine consumption by lowering BP.
Collapse
|
39
|
Lane AD, Heffernan KS, Rossow LM, Fahs CA, Ranadive SM, Yan H, Baynard T, Wilund K, Fernhall B. Aortic reservoir function, estimated myocardial demand and coronary perfusion pressure following steady-state and interval exercise. Clin Physiol Funct Imaging 2012; 32:353-60. [DOI: 10.1111/j.1475-097x.2012.01136.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2011] [Accepted: 03/13/2012] [Indexed: 01/09/2023]
Affiliation(s)
- A. D. Lane
- Exercise and Cardiovascular Research Laboratory, Department of Kinesiology and Community Health; University of Illinois at Urbana-Champaign; Champaign; IL
| | - K. S. Heffernan
- Department of Exercise Science; Syracuse University; Syracuse; NY
| | - L. M. Rossow
- Department of Health and Exercise Science, Neuromuscular Research Laboratory; University of Oklahoma; Norman; OK; USA
| | - C. A. Fahs
- Department of Health and Exercise Science, Neuromuscular Research Laboratory; University of Oklahoma; Norman; OK; USA
| | - S. M. Ranadive
- Exercise and Cardiovascular Research Laboratory, Department of Kinesiology and Community Health; University of Illinois at Urbana-Champaign; Champaign; IL
| | - H. Yan
- Exercise and Cardiovascular Research Laboratory, Department of Kinesiology and Community Health; University of Illinois at Urbana-Champaign; Champaign; IL
| | - T. Baynard
- Exercise and Cardiovascular Research Laboratory, Department of Kinesiology and Community Health; University of Illinois at Urbana-Champaign; Champaign; IL
| | - K. Wilund
- Exercise and Cardiovascular Research Laboratory, Department of Kinesiology and Community Health; University of Illinois at Urbana-Champaign; Champaign; IL
| | - B. Fernhall
- Exercise and Cardiovascular Research Laboratory, Department of Kinesiology and Community Health; University of Illinois at Urbana-Champaign; Champaign; IL
| |
Collapse
|
40
|
Cecelja M, Jiang B, Spector TD, Chowienczyk P. Progression of central pulse pressure over 1 decade of aging and its reversal by nitroglycerin a twin study. J Am Coll Cardiol 2012; 59:475-83. [PMID: 22281250 DOI: 10.1016/j.jacc.2011.10.871] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2011] [Revised: 09/12/2011] [Accepted: 10/04/2011] [Indexed: 01/09/2023]
Abstract
OBJECTIVES The goal of this study was to examine the progression of central arterial pulse pressure (cPP) in women and the degree to which this can be reversed by nitrovasodilation. BACKGROUND cPP can be partitioned into height of the first systolic shoulder (P1), generated by a forward pressure wave and related to arterial stiffness, and augmentation pressure (AP), thought to be influenced by pressure wave reflection from muscular arteries and/or aortic reservoir. METHODS Using a longitudinal cohort design, cPP, P1, and AP were estimated (using the SphygmoCor System [AtCor Medical Pty Ltd., West Ryde, Australia]) in 411 female twins over a mean follow-up of 10.8 years. In a subsample (n = 42), cPP, arterial stiffness (using pulse wave velocity [PWV]) and arterial diameters (using ultrasonography) were measured before and after nitroglycerin administration (400 μg s/l). RESULTS cPP increased more than peripheral pulse pressure (10.3 and 9.2 mm Hg, respectively; p < 0.0001). In women <60 years of age at follow-up, AP contributed more to the increase in cPP than did P1 (increases of 6.5 ± 6.4 mm Hg and 4.2 ± 7.8 mm Hg, respectively). P1 was significantly positively correlated to PWV (p < 0.0001); AP was correlated to aorto-femoral tapering (p < 0.0001) but not PWV. Nitroglycerin reduced cPP by 10.0 ± 6.0 mm Hg (p < 0.0001), equivalent to a decade of aging. The reduction in cPP was entirely explained by a decrease in AP, with no significant change in P1 or PWV but an increase in large artery diameters of 4% to 18% (p < 0.0001). CONCLUSIONS Age-related widening of cPP is driven in large part by an increase in AP, which can be reversed by selective dilation of muscular arteries, independent of PWV.
Collapse
Affiliation(s)
- Marina Cecelja
- King's College London, British Heart Foundation Centre, Cardiovascular Division, Department of Clinical Pharmacology, St. Thomas' Hospital, London, United Kingdom
| | | | | | | |
Collapse
|
41
|
Cardiac oxygen supply is compromised during the night in hypertensive patients. Med Biol Eng Comput 2011; 49:1073-81. [PMID: 21786015 PMCID: PMC3158337 DOI: 10.1007/s11517-011-0810-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2011] [Accepted: 07/07/2011] [Indexed: 01/26/2023]
Abstract
The enhanced heart rate and blood pressure soon after awaking increases cardiac oxygen demand, and has been associated with the high incidence of acute myocardial infarction in the morning. The behavior of cardiac oxygen supply is unknown. We hypothesized that oxygen supply decreases in the morning and to that purpose investigated cardiac oxygen demand and oxygen supply at night and after awaking. We compared hypertensive to normotensive subjects and furthermore assessed whether pressures measured non-invasively and intra-arterially give similar results. Aortic pressure was reconstructed from 24-h intra-brachial and simultaneously obtained non-invasive finger pressure in 14 hypertensives and 8 normotensives. Supply was assessed by Diastolic Time Fraction (DTF, ratio of diastolic and heart period), demand by Rate-Pressure Product (RPP, systolic pressure times heart rate, HR) and supply/demand ratio by Adia/Asys, with Adia and Asys diastolic and systolic areas under the aortic pressure curve. Hypertensives had lower supply by DTF and higher demand by RPP than normotensives during the night. DTF decreased and RPP increased in both groups after awaking. The DTF of hypertensives decreased less becoming similar to the DTF of normotensives in the morning; the RPP remained higher. Adia/Asys followed the pattern of DTF. Findings from invasively and non-invasively determined pressure were similar. The cardiac oxygen supply/demand ratio in hypertensive patients is lower than in normotensives at night. With a smaller night-day differences, the hypertensives’ risk for cardiovascular events may be more evenly spread over the 24 h. This information can be obtained noninvasively.
Collapse
|