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Moazzami K, Mehta A, Young A, Dhindsa DS, Martin G, Mokhtari A, Hesaroieh IG, Shah A, Bremner JD, Vaccarino V, Waller EK, Quyyumi AA. The association between baseline circulating progenitor cells and vascular function: The role of aging and risk factors. Vasc Med 2022; 27:532-541. [PMID: 36062298 PMCID: PMC10150400 DOI: 10.1177/1358863x221116411] [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] [Indexed: 01/24/2023]
Abstract
BACKGROUND To investigate the cross-sectional and longitudinal relationships between vascular function and circulating progenitor cell (CPC) counts with respect to aging and exposure to risk factors. METHODS In 797 adult participants, CPCs were enumerated by flow cytometry as CD45med mononuclear cells expressing CD34 epitope and its subsets co-expressing CD133, and chemokine C-X-C motif receptor 4 (CXCR4+). Arterial stiffness was evaluated by tonometry-derived pulse wave velocity (PWV) and microvascular function was assessed as digital reactive hyperemia index (RHI). RESULTS In cross-sectional analyses, for every doubling in CD34+ cell counts, PWV was 15% higher and RHI was 9% lower, after adjusting for baseline characteristics and risk factors (p for all < 0.01). There were significant CPC-by-age-by-risk factor interactions (p <0.05) for both vascular measures. Among younger subjects (< 48 years), CPC counts were higher in those with risk factors and vascular function was better in those with higher compared to those with lower CPC counts (p for all < 0.0l). In contrast, in older participants, CPCs were not higher in those with risk factors, and vascular function was worse compared to the younger age group. A lower CPC count at baseline was an independent predictor of worsening vascular function during 2-year follow-up. CONCLUSION A higher CPC count in the presence of risk factors is associated with better vascular function among younger individuals. There is no increase in CPC count with risk factors in older individuals who have worse vascular function. Moreover, a higher CPC count is associated with less vascular dysfunction with aging.
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Affiliation(s)
- Kasra Moazzami
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
- Department of Medicine, Division of Cardiology, Emory Clinical Cardiovascular Research Institute, Emory University School of Medicine, Atlanta, GA, USA
| | - Anurag Mehta
- Department of Medicine, Division of Cardiology, Emory Clinical Cardiovascular Research Institute, Emory University School of Medicine, Atlanta, GA, USA
| | - An Young
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
- Department of Medicine, Division of Cardiology, Emory Clinical Cardiovascular Research Institute, Emory University School of Medicine, Atlanta, GA, USA
| | - Devinder Singh Dhindsa
- Department of Medicine, Division of Cardiology, Emory Clinical Cardiovascular Research Institute, Emory University School of Medicine, Atlanta, GA, USA
| | - Greg Martin
- Department of Medicine, Division of Cardiology, Emory Clinical Cardiovascular Research Institute, Emory University School of Medicine, Atlanta, GA, USA
| | - Ali Mokhtari
- Department of Medicine, Division of Cardiology, Emory Clinical Cardiovascular Research Institute, Emory University School of Medicine, Atlanta, GA, USA
| | - Iraj Ghaini Hesaroieh
- Department of Medicine, Division of Cardiology, Emory Clinical Cardiovascular Research Institute, Emory University School of Medicine, Atlanta, GA, USA
| | - Amit Shah
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
- Department of Medicine, Division of Cardiology, Emory Clinical Cardiovascular Research Institute, Emory University School of Medicine, Atlanta, GA, USA
- Atlanta VA Medical Center, Decatur, GA, USA
| | - J Douglas Bremner
- Atlanta VA Medical Center, Decatur, GA, USA
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, GA, USA
| | - Viola Vaccarino
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Edmund K Waller
- Department of Medicine, Division of Cardiology, Emory Clinical Cardiovascular Research Institute, Emory University School of Medicine, Atlanta, GA, USA
| | - Arshed A Quyyumi
- Department of Medicine, Division of Cardiology, Emory Clinical Cardiovascular Research Institute, Emory University School of Medicine, Atlanta, GA, USA
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2
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Desbiens LC, Fortier C, Nadeau-Fredette AC, Madore F, Hametner B, Wassertheurer S, Agharazii M, Goupil R. Prediction of Cardiovascular Events by Pulse Waveform Parameters: Analysis of CARTaGENE. J Am Heart Assoc 2022; 11:e026603. [PMID: 36056725 PMCID: PMC9496446 DOI: 10.1161/jaha.122.026603] [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: 11/16/2022]
Abstract
Background Waveform parameters provide approximate data about aortic wave reflection. However, their association with cardiovascular events remains controversial and their role in cardiovascular prediction is unknown. Methods and Results We analyzed participants aged between 40 and 69 from the population-based CARTaGENE cohort. Baseline pulse wave analysis (central pulse pressure, augmentation index) and wave separation analysis (forward pressure, backward pressure, reflection magnitude) parameters were derived from radial artery tonometry. Associations between each parameter and major adverse atherosclerotic events (MACE; cardiovascular death, stroke, myocardial infarction) were obtained using adjusted Cox models. The incremental predictive value of each parameter compared with the 10-year atherosclerotic cardiovascular disease score alone was assessed using hazard ratios, c-index differences, continuous net reclassification indexes, and integrated discrimination indexes. From 17 561 eligible patients, 2315 patients had a MACE during a median follow-up of 10.1 years. Central pulse pressure, forward pressure, and backward pressure, but not augmentation index and reflection magnitude, were significantly associated with MACE after full adjustment. All parameters except forward pressure statistically improved MACE prediction compared with the atherosclerotic cardiovascular disease score alone. The greatest prediction improvement was seen with augmentation index and reflection magnitude but remained small in magnitude. These 2 parameters enhanced predictive performance more strongly in patients with low baseline atherosclerotic cardiovascular disease scores. Up to 5.7% of individuals were reclassified into a different risk stratum by adding waveform parameters to atherosclerotic cardiovascular disease scores. Conclusions Some waveform parameters are independently associated with MACEs in a population-based cohort. Augmentation index and reflection magnitude slightly improve risk prediction, especially in patients at low cardiovascular risk.
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Affiliation(s)
| | - Catherine Fortier
- Department of Medicine Université de Montréal Montreal Canada.,Hôpital du Sacré-Coeur de Montréal Research Center Montreal Canada
| | - Annie-Claire Nadeau-Fredette
- Department of Medicine Université de Montréal Montreal Canada.,Hôpital Maisonneuve-Rosemont Université de Montréal Montréal Canada
| | - François Madore
- Department of Medicine Université de Montréal Montreal Canada.,Hôpital du Sacré-Coeur de Montréal Research Center Montreal Canada
| | | | | | - Mohsen Agharazii
- Department of Medicine Université Laval Quebec City Canada.,CHU de Quebec Université Laval Quebec City Canada
| | - Rémi Goupil
- Department of Medicine Université de Montréal Montreal Canada.,Hôpital du Sacré-Coeur de Montréal Research Center Montreal Canada
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3
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Schott A, Kluttig A, Mikolajczyk R, Greiser KH, Werdan K, Sedding D, Nuding S. Association of arterial stiffness and heart failure with preserved ejection fraction in the elderly population - results from the CARLA study. J Hum Hypertens 2022:10.1038/s41371-022-00703-y. [PMID: 35581324 DOI: 10.1038/s41371-022-00703-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Revised: 04/05/2022] [Accepted: 04/22/2022] [Indexed: 11/09/2022]
Abstract
Arterial stiffness has been suspected as a cause of left ventricular diastolic dysfunction and may thereby contribute to the development of heart failure with preserved ejection fraction (HFpEF). However, this association is derived from a small number of studies and application of outdated criteria to diagnose HFpEF. This study aimed to investigate the association of arterial stiffness measured by the augmentation index (AIx) and criteria for diagnosing HFpEF according to the recommended HFA-PEFF score. Our analysis based on data from the first follow-up of the CARdiovascular Disease, Living and Ageing in Halle study. The current analysis included participants with available information about comorbidities and risk factors for HFpEF, parameters for calculation of the HFA-PEFF and noninvasive AIx estimated by applanation tonometry. The association of AIx and HFA-PEFF was investigated through descriptive and inductive statistics. A total of 767 participants were included in the analysis. AIx was associated with E/e', left ventricular wall thickness (LVWT), relative wall thickness, left ventricular mass index (LVMI) and NT-proBNP but not with e' or left atrial volume index. However, after adjustment for confounders, only LVMI and LVWT remained associated with AIx. Males with a high AIx had a 3.2-fold higher likelihood of HFpEF than those with a low AIx. In contrast, that association was not present in females. In summary, AIx is associated with the morphological domain of the HFA-PEFF score represented by LVMI and LVWT. Higher values of AIx are associated with a higher likelihood for HFpEF in elderly males but not in females.
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Affiliation(s)
- Artjom Schott
- Department of Internal Medicine III - Cardiology, Angiology and Internal Intensive Care Medicine, Mid-German Heart Center, University Hospital Halle (Saale), Halle (Saale), Germany.
| | - Alexander Kluttig
- Institute of Medical Epidemiology, Biostatistics, and Informatics, Interdisciplinary Center for Health Sciences, Medical Faculty of the Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Rafael Mikolajczyk
- Institute of Medical Epidemiology, Biostatistics, and Informatics, Interdisciplinary Center for Health Sciences, Medical Faculty of the Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Karin Halina Greiser
- Division of Cancer Epidemiology, German Cancer Research Centre, Heidelberg, Germany
| | - Karl Werdan
- Department of Internal Medicine III - Cardiology, Angiology and Internal Intensive Care Medicine, Mid-German Heart Center, University Hospital Halle (Saale), Halle (Saale), Germany
| | - Daniel Sedding
- Department of Internal Medicine III - Cardiology, Angiology and Internal Intensive Care Medicine, Mid-German Heart Center, University Hospital Halle (Saale), Halle (Saale), Germany
| | - Sebastian Nuding
- Department of Internal Medicine III - Cardiology, Angiology and Internal Intensive Care Medicine, Mid-German Heart Center, University Hospital Halle (Saale), Halle (Saale), Germany
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4
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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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5
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Subclinical left ventricular systolic dysfunction by two-dimensional speckle-tracking echocardiography and its relation to ambulatory arterial stiffness index in hypertensive patients. J Hypertens 2021; 38:864-873. [PMID: 31834120 DOI: 10.1097/hjh.0000000000002330] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Increased arterial stiffness is associated with cardiovascular morbidity and mortality among hypertensive patients. OBJECTIVES To assess the relationship between ambulatory arterial stiffness index (AASI) and subclinical left ventricular (LV) systolic dysfunction assessed by 2-D speckle-tracking echocardiography (STE). METHODS We enrolled 70 consecutive patients with hypertension. All patients were evaluated for parameters of ambulatory blood pressure monitoring (ABPM) including AASI. From those patients, 51 underwent conventional echocardiography as well as 2-D STE to assess for subclinical LV systolic dysfunction defined by global longitudinal strain (GLS) and global circumferential strain (GCS). RESULTS The mean age of the patients (n = 51) was 46.3 ± 12.3 years, women represented 59%. Study population were divided into two groups according to blood pressure control as defined by ABPM; controlled (n = 23), and uncontrolled (n = 28). Baseline characteristics were comparable between both groups. There were significant differences in both daytime and night-time mean ABPM (P < 0.05). Posterior wall thickness, as well as LV relative wall thickness were significantly higher in uncontrolled patients (P < 0.05 for each). AASI was significantly, but moderately correlated to GLS. Most ABPM parameters were elevated with the higher AASI values (AASI ≥0.5). Significantly more uncontrolled hypertensive patients were encountered as well. Interestingly, sex and AASI were predictors of impaired GLS by univariate linear regression analysis; however, AASI was the only independent predictor of impaired GLS on multivariate analysis (Beta = 0.3, CI = 0.2--12, and P = 0.04). CONCLUSION AASI might predict subclinical LV systolic dysfunction as assessed by global longitudinal strain. Further wide-scale studies should further explore this intriguing hypothesis.
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6
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Madsen NL, Haley JE, Moore RA, Khoury PR, Urbina EM. Increased Arterial Stiffness Is Associated With Reduced Diastolic Function in Youth With Obesity and Type 2 Diabetes. Front Pediatr 2021; 9:781496. [PMID: 34912763 PMCID: PMC8666894 DOI: 10.3389/fped.2021.781496] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Accepted: 10/29/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Increased arterial stiffness is associated with diastolic dysfunction in adults. Data in youth are lacking, so we examined the impact of arterial stiffness on diastolic function in youth. Methods: We obtained diastolic function and augmentation index, pulse wave velocity, brachial artery distensibility, and carotid stiffness on 612 youth [10-24 years, 65% female, 38% normal weight, 36% obese, and 26% with type 2 diabetes mellitus (T2DM)]. Participants were classified as compliant (C) vs. stiff (S) arteries based on seven arterial stiffness parameters [Global Stiffness Index (GSI), S = GSI > 4). Mean differences in covariates were evaluated by Student's t-tests. A stepwise regression analysis was performed to determine if GSI was an independent predictor of diastolic function. Results: Lower diastolic function and more adverse cardiovascular disease (CVD) risk factors were present in the S group (n = 67) than the C group (n = 545) (p < 0.001). Covariates that were associated with diastolic dysfunction were higher GSI, male sex, higher body mass index (BMI), and systolic blood pressure (SBP) z-score (R 2 = 0.18 to 0.25; p ≤ 0.05). Conclusion: Adverse diastolic function is seen in youth with increased arterial stiffness independent of CVD risk factors. Interventions to improve arterial stiffness prior to clinical onset of diastolic dysfunction are needed to prevent development of heart failure.
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Affiliation(s)
- Nicolas L Madsen
- Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX, United States
| | - Jessica E Haley
- Department of Pediatrics, Rady Children's Hospital, San Diego, CA, United States
| | - Ryan A Moore
- The Heart Institute, Cincinnati Children's Hospital Medical Center and the University of Cincinnati, Cincinnati, OH, United States
| | - Philip R Khoury
- The Heart Institute, Cincinnati Children's Hospital Medical Center and the University of Cincinnati, Cincinnati, OH, United States
| | - Elaine M Urbina
- The Heart Institute, Cincinnati Children's Hospital Medical Center and the University of Cincinnati, Cincinnati, OH, United States
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7
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Early hemodynamic changes after transcatheter aortic valve implantation in patients with severe aortic stenosis measured by invasive pressure volume loop analysis. Cardiovasc Interv Ther 2020; 37:191-201. [PMID: 33313960 PMCID: PMC8789710 DOI: 10.1007/s12928-020-00737-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Accepted: 11/22/2020] [Indexed: 11/20/2022]
Abstract
Replacement of a stenotic aortic valve reduces immediately the ventricular to aortic gradient and is expected to improve diastolic and systolic left ventricular function over the long term. However, the hemodynamic changes immediately after valve implantation are so far poorly understood. Within this pilot study, we performed an invasive pressure volume loop analysis to describe the early hemodynamic changes after transcatheter aortic valve implantation (TAVI) with self-expandable prostheses. Invasive left ventricular pressure volume loop analysis was performed in 8 patients with aortic stenosis (mean 81.3 years) prior and immediately after transfemoral TAVI with a self-expandable valve system (St. Jude Medical Portico Valve). Parameters for global hemodynamics, afterload, contractility and the interaction of the cardiovascular system were analyzed. Left ventricular ejection fraction, (53.9% vs. 44.8%, p = 0.018), preload recruitable stroke work (68.5 vs. 44.8 mmHg, p = 0.012) and end-systolic elastance (3.55 vs. 2.17, p = 0.036) both marker for myocardial contractility declined significantly compared to baseline. As sign of impaired diastolic function, TAU, a preload-independent measure of isovolumic relaxation (37.3 vs. 41.8 ms, p = 0.018) and end-diastolic pressure (13.1 vs. 16.4 mmHg, p = 0.015) raised after valve implantation. Contrarily, a smaller ratio of end-systolic to arterial elastance (ventricular-arterial coupling) indicates an improvement of global cardiovascular energy efficiency (1.40 vs. 0.97 p = 0.036). Arterial elastance had a strong correlation with the number of conducted rapid ventricular pacings (Pearson correlation coefficient, r = 0.772, p = 0.025). Invasive left ventricular pressure volume loop analysis revealed impaired systolic and diastolic function in the early phase after TAVI with self-expandable valve for the treatment of severe aortic stenosis. Contrarily, we found indications for early improvement of global cardiovascular energy efficiency.
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8
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Large-Artery Stiffness in Health and Disease: JACC State-of-the-Art Review. J Am Coll Cardiol 2020; 74:1237-1263. [PMID: 31466622 DOI: 10.1016/j.jacc.2019.07.012] [Citation(s) in RCA: 471] [Impact Index Per Article: 117.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Revised: 06/28/2019] [Accepted: 07/08/2019] [Indexed: 12/27/2022]
Abstract
A healthy aorta exerts a powerful cushioning function, which limits arterial pulsatility and protects the microvasculature from potentially harmful fluctuations in pressure and blood flow. Large-artery (aortic) stiffening, which occurs with aging and various pathologic states, impairs this cushioning function, and has important consequences on cardiovascular health, including isolated systolic hypertension, excessive penetration of pulsatile energy into the microvasculature of target organs that operate at low vascular resistance, and abnormal ventricular-arterial interactions that promote left ventricular remodeling, dysfunction, and failure. Large-artery stiffness independently predicts cardiovascular risk and represents a high-priority therapeutic target to ameliorate the global burden of cardiovascular disease. This paper provides an overview of key physiologic and biophysical principles related to arterial stiffness, the impact of aortic stiffening on target organs, noninvasive methods for the measurement of arterial stiffness, mechanisms leading to aortic stiffening, therapeutic approaches to reduce it, and clinical applications of arterial stiffness measurements.
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9
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Weber T, Chirinos JA. Pulsatile arterial haemodynamics in heart failure. Eur Heart J 2019; 39:3847-3854. [PMID: 29947746 DOI: 10.1093/eurheartj/ehy346] [Citation(s) in RCA: 91] [Impact Index Per Article: 18.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2018] [Accepted: 05/29/2018] [Indexed: 12/15/2022] Open
Abstract
Due to the cyclic function of the human heart, pressure and flow in the circulation are pulsatile rather than continuous. Addressing pulsatile haemodynamics starts with the most convenient measurement, brachial pulse pressure, which is widely available, related to development and treatment of heart failure (HF), but often confounded in patients with established HF. The next level of analysis consists of central (rather than brachial) pressures and, more importantly, of wave reflections. The latter are closely related to left ventricular late systolic afterload, ventricular remodelling, diastolic dysfunction, exercise capacity, and, in the long-term, the risk of new-onset HF. Wave reflection may also represent a suitable therapeutic target. Treatments for HF with preserved and reduced ejection fraction, based on a reduction of wave reflection, are emerging. A full understanding of ventricular-arterial coupling, however, requires dedicated analysis of time-resolved pressure and flow signals, which can be readily accomplished with contemporary non-invasive imaging and modelling techniques. This review provides a summary of our current understanding of pulsatile haemodynamics in HF.
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Affiliation(s)
- Thomas Weber
- Department of Cardiology, Klinikum Wels-Grieskirchen, Austria
| | - Julio A Chirinos
- University of Pennsylvania School of Medicine/Hospital of the University of Pennsylvania, Philadelphia, PA, USA
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10
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Silbiger JJ. Pathophysiology and Echocardiographic Diagnosis of Left Ventricular Diastolic Dysfunction. J Am Soc Echocardiogr 2019; 32:216-232.e2. [DOI: 10.1016/j.echo.2018.11.011] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2018] [Indexed: 12/30/2022]
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11
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Furusawa K, Takeshita K, Suzuki S, Tatami Y, Morimoto R, Okumura T, Yasuda Y, Murohara T. Assessment of abdominal aortic calcification by computed tomography for prediction of latent left ventricular stiffness and future cardiovascular risk in pre-dialysis patients with chronic kidney disease: A single center cross-sectional study. Int J Med Sci 2019; 16:939-948. [PMID: 31341407 PMCID: PMC6643121 DOI: 10.7150/ijms.32629] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2018] [Accepted: 05/11/2019] [Indexed: 02/06/2023] Open
Abstract
Introduction: There is general interest in finding clinical markers for left ventricular diastolic dysfunction (LVDD), a major cause of cardiorenal syndrome leading to heart failure in chronic kidney disease (CKD) patients. The aim was to assess the utility of computed tomography (CT)-based abdominal aortic calcification (AAC) for the prediction of LVDD and prognosis of asymptomatic pre-dialysis CKD patients. Materials and methods: We prospectively evaluated 218 pre-dialysis CKD patients [median estimated glomerular filtration rate (eGFR); 40.9 mL/min/1.73m²]. Non-contrast CT scan and echocardiography were performed to determine the aortic calcification index (ACI) as a semi-quantitative measure of AAC. Results: The median ACI was 11.4. AAC and LVDD were diagnosed in 193 patients (89%) and 75 patients (34%), respectively. Using receiver operating characteristic curve analysis for the estimation of LVDD, ACI of 20 showed optimal sensitivity (52.0%) and specificity (62.8 %) (AUC = 0.664, p < .001). High ACI group included more patients with LVDD-related factors, such as old age, hypertension, diabetes, and more severe CKD. LVDD was significantly more common in patients with high ACI group [39 (50%) and 36 (26%), respectively, p<0.001]. Multivariate analysis showed that ACI correlated significantly with E/A (β=-0.993, p=0.003), E/e' (β=0.077, p<0.001), and cardio-ankle vascular index (β=0.209, p=0.001). Correspondingly, E/e' correlated with logBNP and log(ACI+1), and increased proportionately and significantly with the quartiles of ACI values. Cox proportional hazard models showed that ACI was an independent predictor of CV outcome (hazard ratio 1.03, 95% confidence interval 1.00-1.06, p=0.029). Conclusion: The results would suggest the usefulness of AAC assessment by CT to predict latent LVDD and future CV risk in asymptomatic pre-dialysis CKD patients.
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Affiliation(s)
- Kenji Furusawa
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan.,Department of Clinical Laboratory, Nagoya University Hospital, Nagoya, Japan
| | - Kyosuke Takeshita
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan.,Department of Clinical Laboratory, Nagoya University Hospital, Nagoya, Japan.,Department of Clinical Laboratory, Saitama Medical Centre, Saitama Medical University, Kawagoe, Japan
| | - Susumu Suzuki
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yosuke Tatami
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Ryota Morimoto
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Takahiro Okumura
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yoshinari Yasuda
- Department of CKD Initiatives Internal Medicine, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Toyoaki Murohara
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
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12
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Deep Phenotyping of Systemic Arterial Hemodynamics in HFpEF (Part 2): Clinical and Therapeutic Considerations. J Cardiovasc Transl Res 2017; 10:261-274. [PMID: 28401511 DOI: 10.1007/s12265-017-9736-2] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2016] [Accepted: 01/30/2017] [Indexed: 01/09/2023]
Abstract
Multiple phase III trials over the last few decades have failed to demonstrate a clear benefit of various pharmacologic interventions in heart failure with a preserved left ventricular (LV) ejection fraction (HFpEF). Therefore, a better understanding of its pathophysiology is important. An accompanying review describes key technical and physiologic aspects regarding the deep phenotyping of arterial hemodynamics in HFpEF. This review deals with the potential of this approach to enhance our clinical, translational, and therapeutic approach to HFpEF. Specifically, the role of arterial hemodynamics is discussed in relation to (1) the pathophysiology of left ventricular diastolic dysfunction, remodeling, and fibrosis, (2) impaired oxygen delivery to peripheral skeletal muscle, which affects peripheral oxygen extraction, (3) the frequent presence of comorbidities, such as renal failure and dementia in this population, and (4) the potential to enhance precision medicine approaches. A therapeutic approach to target arterial hemodynamic abnormalities that are prevalent in this population (particularly, with inorganic nitrate/nitrite) is also discussed.
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13
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Deep Phenotyping of Systemic Arterial Hemodynamics in HFpEF (Part 1): Physiologic and Technical Considerations. J Cardiovasc Transl Res 2017; 10:245-259. [PMID: 28210939 DOI: 10.1007/s12265-017-9735-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2016] [Accepted: 01/30/2017] [Indexed: 01/20/2023]
Abstract
A better understanding of the pathophysiology of heart failure with a preserved left ventricular ejection fraction (HFpEF) is important. Detailed phenotyping of pulsatile hemodynamics has provided important insights into the pathophysiology of left ventricular remodeling and fibrosis, diastolic dysfunction, microvascular disease, and impaired oxygen delivery to peripheral skeletal muscle, all of which contribute to exercise intolerance, the cardinal feature of HFpEF. Furthermore, arterial pulsatile hemodynamic mechanisms likely contribute to the frequent presence of comorbidities, such as renal failure and dementia, in this population. Our therapeutic approach to HFpEF can be enhanced by clinical phenotyping tools with the potential to "segment" this population into relevant pathophysiologic categories or to identify individuals exhibiting prominent specific abnormalities that can be targeted by pharmacologic interventions. This review describes relevant technical and physiologic aspects regarding the deep phenotyping of arterial hemodynamics in HFpEF. In an accompanying review, the potential of this approach to enhance our clinical and therapeutic approach to HFpEF is discussed.
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Abstract
Measures of interaction between the left ventricle (LV) and arterial system (ventricular-arterial coupling) are important but under-recognised cardiovascular phenotypes in heart failure. Ventriculo-arterial coupling is commonly assessed in the pressure-volume plane, using the ratio of effective arterial elastance (EA) to LV end-systolic elastance (EES) to provide information on ventricular-arterial system mechanical efficiency and performance when LV ejection fraction is abnormal. These analyses have significant limitations, such as neglecting systolic loading sequence, and are less informative in heart failure with preserved ejection fraction (HFpEF). EA is almost entirely dependent on vascular resistance and heart rate. Assessment of pulsatile arterial haemodynamics and time-resolved myocardial wall stress provide critical incremental physiological information and should be more widely utilised. Pulsatile arterial load represents a promising therapeutic target in HFpEF. Here, we review various approaches to assess ventricular-arterial interactions, and their pathophysiological and clinical implications in heart failure.
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Affiliation(s)
- Julio A Chirinos
- University of Pennsylvania Perelman School of Medicine and Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Nancy Sweitzer
- Tucson and Arizona Sarver Heart Center, University of Arizona College of Medicine, Tucson, AZ, USA
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Chirinos JA, Zamani P. The Nitrate-Nitrite-NO Pathway and Its Implications for Heart Failure and Preserved Ejection Fraction. Curr Heart Fail Rep 2016; 13:47-59. [PMID: 26792295 DOI: 10.1007/s11897-016-0277-9] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
The pathogenesis of exercise intolerance in patients with heart failure and preserved ejection fraction (HFpEF) is likely multifactorial. In addition to cardiac abnormalities (diastolic dysfunction, abnormal contractile reserve, chronotropic incompetence), several peripheral abnormalities are likely to be involved. These include abnormal pulsatile hemodynamics, abnormal arterial vasodilatory responses to exercise, and abnormal peripheral O2 delivery, extraction, and utilization. The nitrate-nitrite-NO pathway is emerging as a potential target to modify key physiologic abnormalities, including late systolic left ventricular (LV) load from arterial wave reflections (which has deleterious short- and long-term consequences for the LV), arterial vasodilatory reserve, muscle O2 delivery, and skeletal muscle mitochondrial function. In a recently completed randomized trial, the administration of a single dose of exogenous inorganic nitrate has been shown to exert various salutary arterial hemodynamic effects, ultimately leading to enhanced aerobic capacity in patients with HFpEF. These effects have the potential for both immediate improvements in exercise tolerance and for long-term "disease-modifying" effects. In this review, we provide an overview of key mechanistic contributors to exercise intolerance in HFpEF, and of the potential therapeutic role of drugs that target the nitrate-nitrite-NO pathway.
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Affiliation(s)
- Julio A Chirinos
- University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA. .,Hospital of the University of Pennsylvania, Philadelphia, PA, USA. .,Ghent University, Ghent, Belgium.
| | - Payman Zamani
- University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA.,Hospital of the University of Pennsylvania, Philadelphia, PA, USA
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Affiliation(s)
- Monica R Shah
- Program in Adult and Pediatric Cardiac Research, Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, MD, USA.
| | - Renee P Wong
- Program in Adult and Pediatric Cardiac Research, Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, MD, USA
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Goto T, Wakami K, Mori K, Kikuchi S, Fukuta H, Ohte N. Vascular Physiology according to Clinical Scenario in Patients with Acute Heart Failure: Evaluation using the Cardio-Ankle Vascular Index. TOHOKU J EXP MED 2016; 240:57-65. [PMID: 27594650 DOI: 10.1620/tjem.240.57] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Increased aortic stiffness may be an important cause of acute heart failure (AHF). Clinical scenario (CS), which classifies the pathophysiology of AHF based on the initial systolic blood pressure (sBP), was proposed to provide the most appropriate therapy for AHF patients. In CS, elevated aortic stiffness, vascular failure, has been considered as a feature of patients categorized as CS1 (sBP > 140 mmHg at initial presentation). However, whether elevated aortic stiffness, vascular failure, is present in such patients has not been fully elucidated. Therefore, we assessed aortic stiffness in AHF patients using the cardio-ankle vascular index (CAVI), which is considered to be independent of instantaneous blood pressure. Sixty-four consecutive AHF patients (mean age, 70.6 ± 12.8 years; 39 men) were classified with CS, based on their initial sBP: CS1: sBP > 140 mmHg (n = 29); CS2: sBP 100-140 mmHg (n = 22); and CS3: sBP < 100 mmHg (n = 13). There were significant group differences in CAVI (CS1 vs. CS2 vs. CS3: 9.7 ± 1.4 vs. 8.4 ± 1.7 vs. 8.3 ± 1.7, p = 0.006, analysis of variance). CAVI was significantly higher in CS1 than in CS2 (p = 0.02) and CS3 (p = 0.04). CAVI did not significantly correlate with sBP at the time of measurement of CAVI (r = 0.24 and p = 0.06). Aortic stiffness assessed using blood pressure-independent methodology apparently increased in CS1 AHF patients. We conclude that vascular failure is a feature of CS1 AHF initiation.
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Affiliation(s)
- Toshihiko Goto
- Department of Cardio-Renal Medicine and Hypertension, Nagoya City University Graduate School of Medical Sciences
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Ilter A, Kiris A, Karkucak M, Sahin M, Serdar OF, Ugan Y. Arterial stiffness is associated with left ventricular dysfunction in patients with rheumatoid arthritis. Clin Rheumatol 2016; 35:2663-2668. [DOI: 10.1007/s10067-015-3163-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2015] [Revised: 11/17/2015] [Accepted: 12/27/2015] [Indexed: 10/22/2022]
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The relationship between arterial stiffness and heart failure with preserved ejection fraction: a systemic meta-analysis. Heart Fail Rev 2015; 20:291-303. [DOI: 10.1007/s10741-015-9471-1] [Citation(s) in RCA: 104] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Kalaycıoğlu E, Gökdeniz T, Aykan AÇ, Hatem E, Gürsoy OM, Çavuşoğlu G, Çetin M, Çelik Ş. Ambulatory arterial stiffness index is associated with impaired left atrial mechanical functions in hypertensive diabetic patients: A speckle tracking study. Anatol J Cardiol 2015; 15:807-13. [PMID: 25592109 PMCID: PMC5336966 DOI: 10.5152/akd.2014.5796] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Objective: The ambulatory arterial stiffness index has been proposed as an indicator of arterial stiffness. The aim of this study was to test the hypothesis that increased ambulatory arterial stiffness index might be related with impaired left atrial function in hypertensive diabetic patients with no previous history of cardiovascular disease. Methods: Inclusion criteria included office systolic BP> 130 mm Hg or diastolic BP> 80 mm Hg and absence of secondary causes of HT, whereas exclusion criteria LV ejection fraction <50%, history of significant coronary artery disease, chronic renal failure, atrial fibrillation/flutter, second or third-degree atrioventricular block, moderate to severe valvular heart disease, history of cerebrovascular disease, non-dipper hypertensive pattern and sleep apnea. The study was composed of 121 hypertensive diabetic patients. Twenty-four-hour ambulatory blood pressure monitoring and echocardiography were performed in each patient. The relationship between ambulatory arterial stiffness index and left atrial functions was analyzed. AASI was calculated as 1 minus the regression slope of diastolic BP plotted against systolic BP obtained through individual 24-h ABPM. Results: The univariate analysis showed that ambulatory arterial stiffness index was positively correlated with age (r=:0.287, p=:0.001), hypertension duration (r=:0.388, p<0.001), fasting plasma glucose (r=:0.224, p=:0.014), HbA1c (r=:0.206, p=:0.023), LDL cholesterol (r=:0.254, p=:0.005), and also overall pulse pressure (r=:0.195, p=:0.002), office-pulse pressure (r=:0.188, p=:0.039), carotid intima-media thickness (r=:0.198, p=:0.029), E/E’ (r=:0.248, p=:0.006), and left atrial volume index (r=:0.237, p=:0.009). Moreover, ambulatory arterial stiffness index was negatively correlated with eGFR (r=:(-) 0.242, p=:0.008), peak left atrial strain during ventricular systole [S-LAs (r=:(-) 0.654, p<0.001)], peak left atrial strain at early diastole [S-LAe (r=:(-)0.215, p=:0.018)], and peak left atrial strain rate during ventricular systole [SR-LAs (r=:(-) 0.607, p<0.001)]. The multiple linear regression analysis showed that ambulatory arterial stiffness index was independently associated with peak left atrial strain rate during ventricular systole (SR-LAs) (p<0.001). Conclusion: In hypertensive diabetic patients, increased ambulatory arterial stiffness index is associated with impaired left atrial functions, independent of left ventricular diastolic dysfunction.
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Affiliation(s)
- Ezgi Kalaycıoğlu
- Department of Cardiology, Ahi Evren Chest and Cardiovascular Surgery Education and Research Hospital; Trabzon-Turkey.
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Zamani P, Bluemke DA, Jacobs DR, Duprez DA, Kronmal R, Lilly SM, Ferrari VA, Townsend RR, Lima JA, Budoff M, Segers P, Hannan P, Chirinos JA. Resistive and pulsatile arterial load as predictors of left ventricular mass and geometry: the multi-ethnic study of atherosclerosis. Hypertension 2015; 65:85-92. [PMID: 25287396 PMCID: PMC4268078 DOI: 10.1161/hypertensionaha.114.04333] [Citation(s) in RCA: 66] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2014] [Accepted: 08/16/2014] [Indexed: 11/16/2022]
Abstract
Arterial load is composed of resistive and various pulsatile components, but their relative contributions to left ventricular (LV) remodeling in the general population are unknown. We studied 4145 participants enrolled in the Multi-Ethnic Study of Atherosclerosis, who underwent cardiac MRI and radial arterial tonometry. We computed systemic vascular resistance (SVR=mean arterial pressure/cardiac output) and indices of pulsatile load including total arterial compliance (TAC, approximated as stroke volume/central pulse pressure), forward wave amplitude (Pf), and reflected wave amplitude (Pb). TAC and SVR were adjusted for body surface area to allow for appropriate sex comparisons. We performed allometric adjustment of LV mass for body size and sex and computed standardized regression coefficients (β) for each measure of arterial load. In multivariable regression models that adjusted for multiple confounders, SVR (β=0.08; P<0.001), TAC (β=0.44; P<0.001), Pb (β=0.73; P<0.001), and Pf (β=-0.23; P=0.001) were significant independent predictors of LV mass. Conversely, TAC (β=-0.43; P<0.001), SVR (β=0.22; P<0.001), and Pf (β=-0.18; P=0.004) were independently associated with the LV wall/LV cavity volume ratio. Women demonstrated greater pulsatile load than men, as evidenced by a lower indexed TAC (0.89 versus 1.04 mL/mm Hg per square meter; P<0.0001), whereas men demonstrated a higher indexed SVR (34.0 versus 32.8 Wood Units×m2; P<0.0001). In conclusion, various components of arterial load differentially associate with LV hypertrophy and concentric remodeling. Women demonstrated greater pulsatile load than men. For both LV mass and the LV wall/LV cavity volume ratio, the loading sequence (ie, early load versus late load) is an important determinant of LV response to arterial load.
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Affiliation(s)
- Payman Zamani
- From the Division of Cardiovascular Medicine, Hospital of the University of Pennsylvania, Perelman School of Medicine and Philadelphia VA Medical Center (P.Z., V.A.F., J.A.C.); National Institute of Biomedical Imaging and Bioengineering, National Institutes of Health, Bethesda, MD (D.A.B.); Departments of Radiology and Medicine, Johns Hopkins University School of Medicine, Baltimore, MD (D.A.B.); Division of Epidemiology and Community Health (D.R.J., P.H.) and Division of Cardiology (D.A.D.), School of Medicine, University of Minnesota, Minneapolis; Department of Biostatistics, School of Public Health, University of Washington, Seattle (R.K.); Division of Cardiovascular Medicine, The Ohio State University Heart and Vascular Center, Columbus (S.M.L.); Division of Nephrology/Hypertension, Perelman School of Medicine, University of Pennsylvania, Philadelphia (R.R.T.); Division of Cardiology, Johns Hopkins Hospital, Baltimore, MD (J.A.L.); Los Angeles Biomedical Research Institute, Torrance, CA (M.B.); and Biofluid, Tissue, and Solid Mechanics for Medical Applications, IBiTech, iMinds Medical IT, Ghent University, Ghent, Belgium (P.S.).
| | - David A Bluemke
- From the Division of Cardiovascular Medicine, Hospital of the University of Pennsylvania, Perelman School of Medicine and Philadelphia VA Medical Center (P.Z., V.A.F., J.A.C.); National Institute of Biomedical Imaging and Bioengineering, National Institutes of Health, Bethesda, MD (D.A.B.); Departments of Radiology and Medicine, Johns Hopkins University School of Medicine, Baltimore, MD (D.A.B.); Division of Epidemiology and Community Health (D.R.J., P.H.) and Division of Cardiology (D.A.D.), School of Medicine, University of Minnesota, Minneapolis; Department of Biostatistics, School of Public Health, University of Washington, Seattle (R.K.); Division of Cardiovascular Medicine, The Ohio State University Heart and Vascular Center, Columbus (S.M.L.); Division of Nephrology/Hypertension, Perelman School of Medicine, University of Pennsylvania, Philadelphia (R.R.T.); Division of Cardiology, Johns Hopkins Hospital, Baltimore, MD (J.A.L.); Los Angeles Biomedical Research Institute, Torrance, CA (M.B.); and Biofluid, Tissue, and Solid Mechanics for Medical Applications, IBiTech, iMinds Medical IT, Ghent University, Ghent, Belgium (P.S.)
| | - David R Jacobs
- From the Division of Cardiovascular Medicine, Hospital of the University of Pennsylvania, Perelman School of Medicine and Philadelphia VA Medical Center (P.Z., V.A.F., J.A.C.); National Institute of Biomedical Imaging and Bioengineering, National Institutes of Health, Bethesda, MD (D.A.B.); Departments of Radiology and Medicine, Johns Hopkins University School of Medicine, Baltimore, MD (D.A.B.); Division of Epidemiology and Community Health (D.R.J., P.H.) and Division of Cardiology (D.A.D.), School of Medicine, University of Minnesota, Minneapolis; Department of Biostatistics, School of Public Health, University of Washington, Seattle (R.K.); Division of Cardiovascular Medicine, The Ohio State University Heart and Vascular Center, Columbus (S.M.L.); Division of Nephrology/Hypertension, Perelman School of Medicine, University of Pennsylvania, Philadelphia (R.R.T.); Division of Cardiology, Johns Hopkins Hospital, Baltimore, MD (J.A.L.); Los Angeles Biomedical Research Institute, Torrance, CA (M.B.); and Biofluid, Tissue, and Solid Mechanics for Medical Applications, IBiTech, iMinds Medical IT, Ghent University, Ghent, Belgium (P.S.)
| | - Daniel A Duprez
- From the Division of Cardiovascular Medicine, Hospital of the University of Pennsylvania, Perelman School of Medicine and Philadelphia VA Medical Center (P.Z., V.A.F., J.A.C.); National Institute of Biomedical Imaging and Bioengineering, National Institutes of Health, Bethesda, MD (D.A.B.); Departments of Radiology and Medicine, Johns Hopkins University School of Medicine, Baltimore, MD (D.A.B.); Division of Epidemiology and Community Health (D.R.J., P.H.) and Division of Cardiology (D.A.D.), School of Medicine, University of Minnesota, Minneapolis; Department of Biostatistics, School of Public Health, University of Washington, Seattle (R.K.); Division of Cardiovascular Medicine, The Ohio State University Heart and Vascular Center, Columbus (S.M.L.); Division of Nephrology/Hypertension, Perelman School of Medicine, University of Pennsylvania, Philadelphia (R.R.T.); Division of Cardiology, Johns Hopkins Hospital, Baltimore, MD (J.A.L.); Los Angeles Biomedical Research Institute, Torrance, CA (M.B.); and Biofluid, Tissue, and Solid Mechanics for Medical Applications, IBiTech, iMinds Medical IT, Ghent University, Ghent, Belgium (P.S.)
| | - Richard Kronmal
- From the Division of Cardiovascular Medicine, Hospital of the University of Pennsylvania, Perelman School of Medicine and Philadelphia VA Medical Center (P.Z., V.A.F., J.A.C.); National Institute of Biomedical Imaging and Bioengineering, National Institutes of Health, Bethesda, MD (D.A.B.); Departments of Radiology and Medicine, Johns Hopkins University School of Medicine, Baltimore, MD (D.A.B.); Division of Epidemiology and Community Health (D.R.J., P.H.) and Division of Cardiology (D.A.D.), School of Medicine, University of Minnesota, Minneapolis; Department of Biostatistics, School of Public Health, University of Washington, Seattle (R.K.); Division of Cardiovascular Medicine, The Ohio State University Heart and Vascular Center, Columbus (S.M.L.); Division of Nephrology/Hypertension, Perelman School of Medicine, University of Pennsylvania, Philadelphia (R.R.T.); Division of Cardiology, Johns Hopkins Hospital, Baltimore, MD (J.A.L.); Los Angeles Biomedical Research Institute, Torrance, CA (M.B.); and Biofluid, Tissue, and Solid Mechanics for Medical Applications, IBiTech, iMinds Medical IT, Ghent University, Ghent, Belgium (P.S.)
| | - Scott M Lilly
- From the Division of Cardiovascular Medicine, Hospital of the University of Pennsylvania, Perelman School of Medicine and Philadelphia VA Medical Center (P.Z., V.A.F., J.A.C.); National Institute of Biomedical Imaging and Bioengineering, National Institutes of Health, Bethesda, MD (D.A.B.); Departments of Radiology and Medicine, Johns Hopkins University School of Medicine, Baltimore, MD (D.A.B.); Division of Epidemiology and Community Health (D.R.J., P.H.) and Division of Cardiology (D.A.D.), School of Medicine, University of Minnesota, Minneapolis; Department of Biostatistics, School of Public Health, University of Washington, Seattle (R.K.); Division of Cardiovascular Medicine, The Ohio State University Heart and Vascular Center, Columbus (S.M.L.); Division of Nephrology/Hypertension, Perelman School of Medicine, University of Pennsylvania, Philadelphia (R.R.T.); Division of Cardiology, Johns Hopkins Hospital, Baltimore, MD (J.A.L.); Los Angeles Biomedical Research Institute, Torrance, CA (M.B.); and Biofluid, Tissue, and Solid Mechanics for Medical Applications, IBiTech, iMinds Medical IT, Ghent University, Ghent, Belgium (P.S.)
| | - Victor A Ferrari
- From the Division of Cardiovascular Medicine, Hospital of the University of Pennsylvania, Perelman School of Medicine and Philadelphia VA Medical Center (P.Z., V.A.F., J.A.C.); National Institute of Biomedical Imaging and Bioengineering, National Institutes of Health, Bethesda, MD (D.A.B.); Departments of Radiology and Medicine, Johns Hopkins University School of Medicine, Baltimore, MD (D.A.B.); Division of Epidemiology and Community Health (D.R.J., P.H.) and Division of Cardiology (D.A.D.), School of Medicine, University of Minnesota, Minneapolis; Department of Biostatistics, School of Public Health, University of Washington, Seattle (R.K.); Division of Cardiovascular Medicine, The Ohio State University Heart and Vascular Center, Columbus (S.M.L.); Division of Nephrology/Hypertension, Perelman School of Medicine, University of Pennsylvania, Philadelphia (R.R.T.); Division of Cardiology, Johns Hopkins Hospital, Baltimore, MD (J.A.L.); Los Angeles Biomedical Research Institute, Torrance, CA (M.B.); and Biofluid, Tissue, and Solid Mechanics for Medical Applications, IBiTech, iMinds Medical IT, Ghent University, Ghent, Belgium (P.S.)
| | - Raymond R Townsend
- From the Division of Cardiovascular Medicine, Hospital of the University of Pennsylvania, Perelman School of Medicine and Philadelphia VA Medical Center (P.Z., V.A.F., J.A.C.); National Institute of Biomedical Imaging and Bioengineering, National Institutes of Health, Bethesda, MD (D.A.B.); Departments of Radiology and Medicine, Johns Hopkins University School of Medicine, Baltimore, MD (D.A.B.); Division of Epidemiology and Community Health (D.R.J., P.H.) and Division of Cardiology (D.A.D.), School of Medicine, University of Minnesota, Minneapolis; Department of Biostatistics, School of Public Health, University of Washington, Seattle (R.K.); Division of Cardiovascular Medicine, The Ohio State University Heart and Vascular Center, Columbus (S.M.L.); Division of Nephrology/Hypertension, Perelman School of Medicine, University of Pennsylvania, Philadelphia (R.R.T.); Division of Cardiology, Johns Hopkins Hospital, Baltimore, MD (J.A.L.); Los Angeles Biomedical Research Institute, Torrance, CA (M.B.); and Biofluid, Tissue, and Solid Mechanics for Medical Applications, IBiTech, iMinds Medical IT, Ghent University, Ghent, Belgium (P.S.)
| | - Joao A Lima
- From the Division of Cardiovascular Medicine, Hospital of the University of Pennsylvania, Perelman School of Medicine and Philadelphia VA Medical Center (P.Z., V.A.F., J.A.C.); National Institute of Biomedical Imaging and Bioengineering, National Institutes of Health, Bethesda, MD (D.A.B.); Departments of Radiology and Medicine, Johns Hopkins University School of Medicine, Baltimore, MD (D.A.B.); Division of Epidemiology and Community Health (D.R.J., P.H.) and Division of Cardiology (D.A.D.), School of Medicine, University of Minnesota, Minneapolis; Department of Biostatistics, School of Public Health, University of Washington, Seattle (R.K.); Division of Cardiovascular Medicine, The Ohio State University Heart and Vascular Center, Columbus (S.M.L.); Division of Nephrology/Hypertension, Perelman School of Medicine, University of Pennsylvania, Philadelphia (R.R.T.); Division of Cardiology, Johns Hopkins Hospital, Baltimore, MD (J.A.L.); Los Angeles Biomedical Research Institute, Torrance, CA (M.B.); and Biofluid, Tissue, and Solid Mechanics for Medical Applications, IBiTech, iMinds Medical IT, Ghent University, Ghent, Belgium (P.S.)
| | - Matthew Budoff
- From the Division of Cardiovascular Medicine, Hospital of the University of Pennsylvania, Perelman School of Medicine and Philadelphia VA Medical Center (P.Z., V.A.F., J.A.C.); National Institute of Biomedical Imaging and Bioengineering, National Institutes of Health, Bethesda, MD (D.A.B.); Departments of Radiology and Medicine, Johns Hopkins University School of Medicine, Baltimore, MD (D.A.B.); Division of Epidemiology and Community Health (D.R.J., P.H.) and Division of Cardiology (D.A.D.), School of Medicine, University of Minnesota, Minneapolis; Department of Biostatistics, School of Public Health, University of Washington, Seattle (R.K.); Division of Cardiovascular Medicine, The Ohio State University Heart and Vascular Center, Columbus (S.M.L.); Division of Nephrology/Hypertension, Perelman School of Medicine, University of Pennsylvania, Philadelphia (R.R.T.); Division of Cardiology, Johns Hopkins Hospital, Baltimore, MD (J.A.L.); Los Angeles Biomedical Research Institute, Torrance, CA (M.B.); and Biofluid, Tissue, and Solid Mechanics for Medical Applications, IBiTech, iMinds Medical IT, Ghent University, Ghent, Belgium (P.S.)
| | - Patrick Segers
- From the Division of Cardiovascular Medicine, Hospital of the University of Pennsylvania, Perelman School of Medicine and Philadelphia VA Medical Center (P.Z., V.A.F., J.A.C.); National Institute of Biomedical Imaging and Bioengineering, National Institutes of Health, Bethesda, MD (D.A.B.); Departments of Radiology and Medicine, Johns Hopkins University School of Medicine, Baltimore, MD (D.A.B.); Division of Epidemiology and Community Health (D.R.J., P.H.) and Division of Cardiology (D.A.D.), School of Medicine, University of Minnesota, Minneapolis; Department of Biostatistics, School of Public Health, University of Washington, Seattle (R.K.); Division of Cardiovascular Medicine, The Ohio State University Heart and Vascular Center, Columbus (S.M.L.); Division of Nephrology/Hypertension, Perelman School of Medicine, University of Pennsylvania, Philadelphia (R.R.T.); Division of Cardiology, Johns Hopkins Hospital, Baltimore, MD (J.A.L.); Los Angeles Biomedical Research Institute, Torrance, CA (M.B.); and Biofluid, Tissue, and Solid Mechanics for Medical Applications, IBiTech, iMinds Medical IT, Ghent University, Ghent, Belgium (P.S.)
| | - Peter Hannan
- From the Division of Cardiovascular Medicine, Hospital of the University of Pennsylvania, Perelman School of Medicine and Philadelphia VA Medical Center (P.Z., V.A.F., J.A.C.); National Institute of Biomedical Imaging and Bioengineering, National Institutes of Health, Bethesda, MD (D.A.B.); Departments of Radiology and Medicine, Johns Hopkins University School of Medicine, Baltimore, MD (D.A.B.); Division of Epidemiology and Community Health (D.R.J., P.H.) and Division of Cardiology (D.A.D.), School of Medicine, University of Minnesota, Minneapolis; Department of Biostatistics, School of Public Health, University of Washington, Seattle (R.K.); Division of Cardiovascular Medicine, The Ohio State University Heart and Vascular Center, Columbus (S.M.L.); Division of Nephrology/Hypertension, Perelman School of Medicine, University of Pennsylvania, Philadelphia (R.R.T.); Division of Cardiology, Johns Hopkins Hospital, Baltimore, MD (J.A.L.); Los Angeles Biomedical Research Institute, Torrance, CA (M.B.); and Biofluid, Tissue, and Solid Mechanics for Medical Applications, IBiTech, iMinds Medical IT, Ghent University, Ghent, Belgium (P.S.)
| | - Julio A Chirinos
- From the Division of Cardiovascular Medicine, Hospital of the University of Pennsylvania, Perelman School of Medicine and Philadelphia VA Medical Center (P.Z., V.A.F., J.A.C.); National Institute of Biomedical Imaging and Bioengineering, National Institutes of Health, Bethesda, MD (D.A.B.); Departments of Radiology and Medicine, Johns Hopkins University School of Medicine, Baltimore, MD (D.A.B.); Division of Epidemiology and Community Health (D.R.J., P.H.) and Division of Cardiology (D.A.D.), School of Medicine, University of Minnesota, Minneapolis; Department of Biostatistics, School of Public Health, University of Washington, Seattle (R.K.); Division of Cardiovascular Medicine, The Ohio State University Heart and Vascular Center, Columbus (S.M.L.); Division of Nephrology/Hypertension, Perelman School of Medicine, University of Pennsylvania, Philadelphia (R.R.T.); Division of Cardiology, Johns Hopkins Hospital, Baltimore, MD (J.A.L.); Los Angeles Biomedical Research Institute, Torrance, CA (M.B.); and Biofluid, Tissue, and Solid Mechanics for Medical Applications, IBiTech, iMinds Medical IT, Ghent University, Ghent, Belgium (P.S.)
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Zamani P, Jacobs DR, Segers P, Duprez DA, Brumback L, Kronmal RA, Lilly SM, Townsend RR, Budoff M, Lima JA, Hannan P, Chirinos JA. Reflection magnitude as a predictor of mortality: the Multi-Ethnic Study of Atherosclerosis. Hypertension 2014; 64:958-64. [PMID: 25259746 PMCID: PMC4192021 DOI: 10.1161/hypertensionaha.114.03855] [Citation(s) in RCA: 71] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2014] [Accepted: 06/24/2014] [Indexed: 11/16/2022]
Abstract
Arterial wave reflections have been associated with mortality in an ethnically homogenous Asian population. It is unknown whether this association is present in a multiethnic population or whether it is independent of subclinical atherosclerosis. We hypothesized that reflection magnitude (defined as the ratio of the amplitude of the backward wave [Pb] to that of the forward wave [Pf]) is associated with all-cause mortality in a large multiethnic adult community-based sample. We studied 5984 participants enrolled in the Multi-Ethnic Study of Atherosclerosis who had analyzable arterial tonometry waveforms. During 9.8±1.7 years of follow-up, 617 deaths occurred, of which 134 (22%) were adjudicated cardiovascular deaths. In Cox proportional hazards models, each 10% increase in reflection magnitude was associated with a 31% increased risk for all-cause mortality (hazard ratio [HR]=1.31; 95% confidence interval [CI]=1.11-1.55; P=0.001). This relationship persisted after adjustment for various confounders and for markers of subclinical atherosclerosis (HR=1.23; 95% CI=1.01-1.51; P=0.04), including the coronary calcium score, ankle-brachial index, common carotid intima-media thickness, and ascending thoracic aortic Agatston score. Pb was independently associated with all-cause mortality in a similarly adjusted model (HR per 10 mm Hg increase in P(b)=2.18; 95% CI=1.21-3.92; P=0.009). Reflection magnitude (HR=1.71; 95% CI=1.06-2.77; P=0.03) and P(b) (HR=5.02; 95% CI=1.29-19.42; P=0.02) were mainly associated with cardiovascular mortality. In conclusion, reflection magnitude is independently associated with all-cause mortality in a multiethnic population initially free of clinically evident cardiovascular disease. This relationship persists after adjustment for a comprehensive set of markers of subclinical atherosclerosis.
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Affiliation(s)
- Payman Zamani
- From the Division of Cardiovascular Medicine, Hospital of the University of Pennsylvania, Perelman School of Medicine and Philadelphia VA Medical Center, Philadelphia (P.Z., J.A.C.); Division of Epidemiology and Community Health, School of Public Health (D.R.J., P.H.) and Division of Cardiology, School of Medicine (D.A.D.), University of Minnesota. Minneapolis; Biofluid, Tissue, and Solid Mechanics for Medical Applications, IBiTech, iMinds Future Health Department, Ghent University, Ghent, Belgium (P.S.); Department of Biostatistics, School of Public Health, University of Washington, Seattle (L.B., R.A.K.); Division of Cardiovascular Medicine, The Ohio State University Heart and Vascular Center, Columbus (S.M.L.); Division of Nephrology/Hypertension, Perelman School of Medicine, University of Pennsylvania, Philadelphia (R.R.T.); Los Angeles Biomedical Research Institute, Torrance, CA (M.B.); and Division of Cardiology, Johns Hopkins Hospital, Baltimore, MD (J.A.L.).
| | - David R Jacobs
- From the Division of Cardiovascular Medicine, Hospital of the University of Pennsylvania, Perelman School of Medicine and Philadelphia VA Medical Center, Philadelphia (P.Z., J.A.C.); Division of Epidemiology and Community Health, School of Public Health (D.R.J., P.H.) and Division of Cardiology, School of Medicine (D.A.D.), University of Minnesota. Minneapolis; Biofluid, Tissue, and Solid Mechanics for Medical Applications, IBiTech, iMinds Future Health Department, Ghent University, Ghent, Belgium (P.S.); Department of Biostatistics, School of Public Health, University of Washington, Seattle (L.B., R.A.K.); Division of Cardiovascular Medicine, The Ohio State University Heart and Vascular Center, Columbus (S.M.L.); Division of Nephrology/Hypertension, Perelman School of Medicine, University of Pennsylvania, Philadelphia (R.R.T.); Los Angeles Biomedical Research Institute, Torrance, CA (M.B.); and Division of Cardiology, Johns Hopkins Hospital, Baltimore, MD (J.A.L.)
| | - Patrick Segers
- From the Division of Cardiovascular Medicine, Hospital of the University of Pennsylvania, Perelman School of Medicine and Philadelphia VA Medical Center, Philadelphia (P.Z., J.A.C.); Division of Epidemiology and Community Health, School of Public Health (D.R.J., P.H.) and Division of Cardiology, School of Medicine (D.A.D.), University of Minnesota. Minneapolis; Biofluid, Tissue, and Solid Mechanics for Medical Applications, IBiTech, iMinds Future Health Department, Ghent University, Ghent, Belgium (P.S.); Department of Biostatistics, School of Public Health, University of Washington, Seattle (L.B., R.A.K.); Division of Cardiovascular Medicine, The Ohio State University Heart and Vascular Center, Columbus (S.M.L.); Division of Nephrology/Hypertension, Perelman School of Medicine, University of Pennsylvania, Philadelphia (R.R.T.); Los Angeles Biomedical Research Institute, Torrance, CA (M.B.); and Division of Cardiology, Johns Hopkins Hospital, Baltimore, MD (J.A.L.)
| | - Daniel A Duprez
- From the Division of Cardiovascular Medicine, Hospital of the University of Pennsylvania, Perelman School of Medicine and Philadelphia VA Medical Center, Philadelphia (P.Z., J.A.C.); Division of Epidemiology and Community Health, School of Public Health (D.R.J., P.H.) and Division of Cardiology, School of Medicine (D.A.D.), University of Minnesota. Minneapolis; Biofluid, Tissue, and Solid Mechanics for Medical Applications, IBiTech, iMinds Future Health Department, Ghent University, Ghent, Belgium (P.S.); Department of Biostatistics, School of Public Health, University of Washington, Seattle (L.B., R.A.K.); Division of Cardiovascular Medicine, The Ohio State University Heart and Vascular Center, Columbus (S.M.L.); Division of Nephrology/Hypertension, Perelman School of Medicine, University of Pennsylvania, Philadelphia (R.R.T.); Los Angeles Biomedical Research Institute, Torrance, CA (M.B.); and Division of Cardiology, Johns Hopkins Hospital, Baltimore, MD (J.A.L.)
| | - Lyndia Brumback
- From the Division of Cardiovascular Medicine, Hospital of the University of Pennsylvania, Perelman School of Medicine and Philadelphia VA Medical Center, Philadelphia (P.Z., J.A.C.); Division of Epidemiology and Community Health, School of Public Health (D.R.J., P.H.) and Division of Cardiology, School of Medicine (D.A.D.), University of Minnesota. Minneapolis; Biofluid, Tissue, and Solid Mechanics for Medical Applications, IBiTech, iMinds Future Health Department, Ghent University, Ghent, Belgium (P.S.); Department of Biostatistics, School of Public Health, University of Washington, Seattle (L.B., R.A.K.); Division of Cardiovascular Medicine, The Ohio State University Heart and Vascular Center, Columbus (S.M.L.); Division of Nephrology/Hypertension, Perelman School of Medicine, University of Pennsylvania, Philadelphia (R.R.T.); Los Angeles Biomedical Research Institute, Torrance, CA (M.B.); and Division of Cardiology, Johns Hopkins Hospital, Baltimore, MD (J.A.L.)
| | - Richard A Kronmal
- From the Division of Cardiovascular Medicine, Hospital of the University of Pennsylvania, Perelman School of Medicine and Philadelphia VA Medical Center, Philadelphia (P.Z., J.A.C.); Division of Epidemiology and Community Health, School of Public Health (D.R.J., P.H.) and Division of Cardiology, School of Medicine (D.A.D.), University of Minnesota. Minneapolis; Biofluid, Tissue, and Solid Mechanics for Medical Applications, IBiTech, iMinds Future Health Department, Ghent University, Ghent, Belgium (P.S.); Department of Biostatistics, School of Public Health, University of Washington, Seattle (L.B., R.A.K.); Division of Cardiovascular Medicine, The Ohio State University Heart and Vascular Center, Columbus (S.M.L.); Division of Nephrology/Hypertension, Perelman School of Medicine, University of Pennsylvania, Philadelphia (R.R.T.); Los Angeles Biomedical Research Institute, Torrance, CA (M.B.); and Division of Cardiology, Johns Hopkins Hospital, Baltimore, MD (J.A.L.)
| | - Scott M Lilly
- From the Division of Cardiovascular Medicine, Hospital of the University of Pennsylvania, Perelman School of Medicine and Philadelphia VA Medical Center, Philadelphia (P.Z., J.A.C.); Division of Epidemiology and Community Health, School of Public Health (D.R.J., P.H.) and Division of Cardiology, School of Medicine (D.A.D.), University of Minnesota. Minneapolis; Biofluid, Tissue, and Solid Mechanics for Medical Applications, IBiTech, iMinds Future Health Department, Ghent University, Ghent, Belgium (P.S.); Department of Biostatistics, School of Public Health, University of Washington, Seattle (L.B., R.A.K.); Division of Cardiovascular Medicine, The Ohio State University Heart and Vascular Center, Columbus (S.M.L.); Division of Nephrology/Hypertension, Perelman School of Medicine, University of Pennsylvania, Philadelphia (R.R.T.); Los Angeles Biomedical Research Institute, Torrance, CA (M.B.); and Division of Cardiology, Johns Hopkins Hospital, Baltimore, MD (J.A.L.)
| | - Raymond R Townsend
- From the Division of Cardiovascular Medicine, Hospital of the University of Pennsylvania, Perelman School of Medicine and Philadelphia VA Medical Center, Philadelphia (P.Z., J.A.C.); Division of Epidemiology and Community Health, School of Public Health (D.R.J., P.H.) and Division of Cardiology, School of Medicine (D.A.D.), University of Minnesota. Minneapolis; Biofluid, Tissue, and Solid Mechanics for Medical Applications, IBiTech, iMinds Future Health Department, Ghent University, Ghent, Belgium (P.S.); Department of Biostatistics, School of Public Health, University of Washington, Seattle (L.B., R.A.K.); Division of Cardiovascular Medicine, The Ohio State University Heart and Vascular Center, Columbus (S.M.L.); Division of Nephrology/Hypertension, Perelman School of Medicine, University of Pennsylvania, Philadelphia (R.R.T.); Los Angeles Biomedical Research Institute, Torrance, CA (M.B.); and Division of Cardiology, Johns Hopkins Hospital, Baltimore, MD (J.A.L.)
| | - Matthew Budoff
- From the Division of Cardiovascular Medicine, Hospital of the University of Pennsylvania, Perelman School of Medicine and Philadelphia VA Medical Center, Philadelphia (P.Z., J.A.C.); Division of Epidemiology and Community Health, School of Public Health (D.R.J., P.H.) and Division of Cardiology, School of Medicine (D.A.D.), University of Minnesota. Minneapolis; Biofluid, Tissue, and Solid Mechanics for Medical Applications, IBiTech, iMinds Future Health Department, Ghent University, Ghent, Belgium (P.S.); Department of Biostatistics, School of Public Health, University of Washington, Seattle (L.B., R.A.K.); Division of Cardiovascular Medicine, The Ohio State University Heart and Vascular Center, Columbus (S.M.L.); Division of Nephrology/Hypertension, Perelman School of Medicine, University of Pennsylvania, Philadelphia (R.R.T.); Los Angeles Biomedical Research Institute, Torrance, CA (M.B.); and Division of Cardiology, Johns Hopkins Hospital, Baltimore, MD (J.A.L.)
| | - Joao A Lima
- From the Division of Cardiovascular Medicine, Hospital of the University of Pennsylvania, Perelman School of Medicine and Philadelphia VA Medical Center, Philadelphia (P.Z., J.A.C.); Division of Epidemiology and Community Health, School of Public Health (D.R.J., P.H.) and Division of Cardiology, School of Medicine (D.A.D.), University of Minnesota. Minneapolis; Biofluid, Tissue, and Solid Mechanics for Medical Applications, IBiTech, iMinds Future Health Department, Ghent University, Ghent, Belgium (P.S.); Department of Biostatistics, School of Public Health, University of Washington, Seattle (L.B., R.A.K.); Division of Cardiovascular Medicine, The Ohio State University Heart and Vascular Center, Columbus (S.M.L.); Division of Nephrology/Hypertension, Perelman School of Medicine, University of Pennsylvania, Philadelphia (R.R.T.); Los Angeles Biomedical Research Institute, Torrance, CA (M.B.); and Division of Cardiology, Johns Hopkins Hospital, Baltimore, MD (J.A.L.)
| | - Peter Hannan
- From the Division of Cardiovascular Medicine, Hospital of the University of Pennsylvania, Perelman School of Medicine and Philadelphia VA Medical Center, Philadelphia (P.Z., J.A.C.); Division of Epidemiology and Community Health, School of Public Health (D.R.J., P.H.) and Division of Cardiology, School of Medicine (D.A.D.), University of Minnesota. Minneapolis; Biofluid, Tissue, and Solid Mechanics for Medical Applications, IBiTech, iMinds Future Health Department, Ghent University, Ghent, Belgium (P.S.); Department of Biostatistics, School of Public Health, University of Washington, Seattle (L.B., R.A.K.); Division of Cardiovascular Medicine, The Ohio State University Heart and Vascular Center, Columbus (S.M.L.); Division of Nephrology/Hypertension, Perelman School of Medicine, University of Pennsylvania, Philadelphia (R.R.T.); Los Angeles Biomedical Research Institute, Torrance, CA (M.B.); and Division of Cardiology, Johns Hopkins Hospital, Baltimore, MD (J.A.L.)
| | - Julio A Chirinos
- From the Division of Cardiovascular Medicine, Hospital of the University of Pennsylvania, Perelman School of Medicine and Philadelphia VA Medical Center, Philadelphia (P.Z., J.A.C.); Division of Epidemiology and Community Health, School of Public Health (D.R.J., P.H.) and Division of Cardiology, School of Medicine (D.A.D.), University of Minnesota. Minneapolis; Biofluid, Tissue, and Solid Mechanics for Medical Applications, IBiTech, iMinds Future Health Department, Ghent University, Ghent, Belgium (P.S.); Department of Biostatistics, School of Public Health, University of Washington, Seattle (L.B., R.A.K.); Division of Cardiovascular Medicine, The Ohio State University Heart and Vascular Center, Columbus (S.M.L.); Division of Nephrology/Hypertension, Perelman School of Medicine, University of Pennsylvania, Philadelphia (R.R.T.); Los Angeles Biomedical Research Institute, Torrance, CA (M.B.); and Division of Cardiology, Johns Hopkins Hospital, Baltimore, MD (J.A.L.)
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Chirinos JA, Rietzschel ER, Shiva-Kumar P, De Buyzere ML, Zamani P, Claessens T, Geraci S, Konda P, De Bacquer D, Akers SR, Gillebert TC, Segers P. Effective arterial elastance is insensitive to pulsatile arterial load. Hypertension 2014; 64:1022-31. [PMID: 25069668 DOI: 10.1161/hypertensionaha.114.03696] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Effective arterial elastance (E(A)) was proposed as a lumped parameter that incorporates pulsatile and resistive afterload and is increasingly being used in clinical studies. Theoretical modeling studies suggest that E(A) is minimally affected by pulsatile load, but little human data are available. We assessed the relationship between E(A) and arterial load determined noninvasively from central pressure-flow analyses among middle-aged adults in the general population (n=2367) and a diverse clinical population of older adults (n=193). In a separate study, we investigated the sensitivity of E(A) to changes in pulsatile load induced by isometric exercise (n=73). The combination of systemic vascular resistance and heart rate predicted 95.6% and 97.8% of the variability in E(A) among middle-aged and older adults, respectively. E(A) demonstrated a quasi-perfect linear relationship with the ratio of systemic vascular resistance/heart period (middle-aged adults, R=0.972; older adults, R=0.99; P<0.0001). Aortic characteristic impedance, total arterial compliance, reflection magnitude, and timing accounted together for <1% of the variability in E(A) in either middle-aged or older adults. Despite pronounced changes in pulsatile load induced by isometric exercise, changes in E(A) were not independently associated with changes pulsatile load but were rather a nearly perfect linear function of the ratio of systemic vascular resistance/heart period (R=0.99; P<0.0001). Our findings demonstrate that E(A) is simply a function of systemic vascular resistance and heart rate and is negligibly influenced by (and insensitive to) changes in pulsatile afterload in humans. Its current interpretation as a lumped parameter of pulsatile and resistive afterload should thus be reassessed.
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Affiliation(s)
- Julio A Chirinos
- From the Department of Medicine, Perelman School of Medicine and Hospital of the University of Pennsylvania, Philadelphia (J.A.C., P.Z.); Department of Medicine, Philadelphia VA Medical Center, PA (J.A.C., P.S.-K., S.R.A., S.G.); Department of Cardiovascular Diseases, Ghent University Hospital, Ghent, Belgium (E.R.R., M.L.D.B., D.D.B.); and Department of Public Health (E.R.R.), Department of Industrial Technology and Construction (T.C.), and Institute Biomedical Technology, iMinds Future Health Department (T.C., P.S.), Ghent University, Ghent, Belgium.
| | - Ernst R Rietzschel
- From the Department of Medicine, Perelman School of Medicine and Hospital of the University of Pennsylvania, Philadelphia (J.A.C., P.Z.); Department of Medicine, Philadelphia VA Medical Center, PA (J.A.C., P.S.-K., S.R.A., S.G.); Department of Cardiovascular Diseases, Ghent University Hospital, Ghent, Belgium (E.R.R., M.L.D.B., D.D.B.); and Department of Public Health (E.R.R.), Department of Industrial Technology and Construction (T.C.), and Institute Biomedical Technology, iMinds Future Health Department (T.C., P.S.), Ghent University, Ghent, Belgium
| | - Prithvi Shiva-Kumar
- From the Department of Medicine, Perelman School of Medicine and Hospital of the University of Pennsylvania, Philadelphia (J.A.C., P.Z.); Department of Medicine, Philadelphia VA Medical Center, PA (J.A.C., P.S.-K., S.R.A., S.G.); Department of Cardiovascular Diseases, Ghent University Hospital, Ghent, Belgium (E.R.R., M.L.D.B., D.D.B.); and Department of Public Health (E.R.R.), Department of Industrial Technology and Construction (T.C.), and Institute Biomedical Technology, iMinds Future Health Department (T.C., P.S.), Ghent University, Ghent, Belgium
| | - Marc L De Buyzere
- From the Department of Medicine, Perelman School of Medicine and Hospital of the University of Pennsylvania, Philadelphia (J.A.C., P.Z.); Department of Medicine, Philadelphia VA Medical Center, PA (J.A.C., P.S.-K., S.R.A., S.G.); Department of Cardiovascular Diseases, Ghent University Hospital, Ghent, Belgium (E.R.R., M.L.D.B., D.D.B.); and Department of Public Health (E.R.R.), Department of Industrial Technology and Construction (T.C.), and Institute Biomedical Technology, iMinds Future Health Department (T.C., P.S.), Ghent University, Ghent, Belgium
| | - Payman Zamani
- From the Department of Medicine, Perelman School of Medicine and Hospital of the University of Pennsylvania, Philadelphia (J.A.C., P.Z.); Department of Medicine, Philadelphia VA Medical Center, PA (J.A.C., P.S.-K., S.R.A., S.G.); Department of Cardiovascular Diseases, Ghent University Hospital, Ghent, Belgium (E.R.R., M.L.D.B., D.D.B.); and Department of Public Health (E.R.R.), Department of Industrial Technology and Construction (T.C.), and Institute Biomedical Technology, iMinds Future Health Department (T.C., P.S.), Ghent University, Ghent, Belgium
| | - Tom Claessens
- From the Department of Medicine, Perelman School of Medicine and Hospital of the University of Pennsylvania, Philadelphia (J.A.C., P.Z.); Department of Medicine, Philadelphia VA Medical Center, PA (J.A.C., P.S.-K., S.R.A., S.G.); Department of Cardiovascular Diseases, Ghent University Hospital, Ghent, Belgium (E.R.R., M.L.D.B., D.D.B.); and Department of Public Health (E.R.R.), Department of Industrial Technology and Construction (T.C.), and Institute Biomedical Technology, iMinds Future Health Department (T.C., P.S.), Ghent University, Ghent, Belgium
| | - Salvatore Geraci
- From the Department of Medicine, Perelman School of Medicine and Hospital of the University of Pennsylvania, Philadelphia (J.A.C., P.Z.); Department of Medicine, Philadelphia VA Medical Center, PA (J.A.C., P.S.-K., S.R.A., S.G.); Department of Cardiovascular Diseases, Ghent University Hospital, Ghent, Belgium (E.R.R., M.L.D.B., D.D.B.); and Department of Public Health (E.R.R.), Department of Industrial Technology and Construction (T.C.), and Institute Biomedical Technology, iMinds Future Health Department (T.C., P.S.), Ghent University, Ghent, Belgium
| | - Prasad Konda
- From the Department of Medicine, Perelman School of Medicine and Hospital of the University of Pennsylvania, Philadelphia (J.A.C., P.Z.); Department of Medicine, Philadelphia VA Medical Center, PA (J.A.C., P.S.-K., S.R.A., S.G.); Department of Cardiovascular Diseases, Ghent University Hospital, Ghent, Belgium (E.R.R., M.L.D.B., D.D.B.); and Department of Public Health (E.R.R.), Department of Industrial Technology and Construction (T.C.), and Institute Biomedical Technology, iMinds Future Health Department (T.C., P.S.), Ghent University, Ghent, Belgium
| | - Dirk De Bacquer
- From the Department of Medicine, Perelman School of Medicine and Hospital of the University of Pennsylvania, Philadelphia (J.A.C., P.Z.); Department of Medicine, Philadelphia VA Medical Center, PA (J.A.C., P.S.-K., S.R.A., S.G.); Department of Cardiovascular Diseases, Ghent University Hospital, Ghent, Belgium (E.R.R., M.L.D.B., D.D.B.); and Department of Public Health (E.R.R.), Department of Industrial Technology and Construction (T.C.), and Institute Biomedical Technology, iMinds Future Health Department (T.C., P.S.), Ghent University, Ghent, Belgium
| | - Scott R Akers
- From the Department of Medicine, Perelman School of Medicine and Hospital of the University of Pennsylvania, Philadelphia (J.A.C., P.Z.); Department of Medicine, Philadelphia VA Medical Center, PA (J.A.C., P.S.-K., S.R.A., S.G.); Department of Cardiovascular Diseases, Ghent University Hospital, Ghent, Belgium (E.R.R., M.L.D.B., D.D.B.); and Department of Public Health (E.R.R.), Department of Industrial Technology and Construction (T.C.), and Institute Biomedical Technology, iMinds Future Health Department (T.C., P.S.), Ghent University, Ghent, Belgium
| | - Thierry C Gillebert
- From the Department of Medicine, Perelman School of Medicine and Hospital of the University of Pennsylvania, Philadelphia (J.A.C., P.Z.); Department of Medicine, Philadelphia VA Medical Center, PA (J.A.C., P.S.-K., S.R.A., S.G.); Department of Cardiovascular Diseases, Ghent University Hospital, Ghent, Belgium (E.R.R., M.L.D.B., D.D.B.); and Department of Public Health (E.R.R.), Department of Industrial Technology and Construction (T.C.), and Institute Biomedical Technology, iMinds Future Health Department (T.C., P.S.), Ghent University, Ghent, Belgium
| | - Patrick Segers
- From the Department of Medicine, Perelman School of Medicine and Hospital of the University of Pennsylvania, Philadelphia (J.A.C., P.Z.); Department of Medicine, Philadelphia VA Medical Center, PA (J.A.C., P.S.-K., S.R.A., S.G.); Department of Cardiovascular Diseases, Ghent University Hospital, Ghent, Belgium (E.R.R., M.L.D.B., D.D.B.); and Department of Public Health (E.R.R.), Department of Industrial Technology and Construction (T.C.), and Institute Biomedical Technology, iMinds Future Health Department (T.C., P.S.), Ghent University, Ghent, Belgium
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24
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Ballo P, Nistri S, Cameli M, Papesso B, Dini FL, Galderisi M, Zuppiroli A, Mondillo S. Association of Left Ventricular Longitudinal and Circumferential Systolic Dysfunction With Diastolic Function in Hypertension: A Nonlinear Analysis Focused on the Interplay With Left Ventricular Geometry. J Card Fail 2014; 20:110-20. [DOI: 10.1016/j.cardfail.2013.12.009] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2012] [Revised: 12/02/2013] [Accepted: 12/11/2013] [Indexed: 10/25/2022]
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Marti CN, Gheorghiade M, Kalogeropoulos AP, Georgiopoulou VV, Quyyumi AA, Butler J. Endothelial dysfunction, arterial stiffness, and heart failure. J Am Coll Cardiol 2012; 60:1455-69. [PMID: 22999723 DOI: 10.1016/j.jacc.2011.11.082] [Citation(s) in RCA: 309] [Impact Index Per Article: 25.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2011] [Revised: 11/26/2011] [Accepted: 11/29/2011] [Indexed: 12/11/2022]
Abstract
Outcomes for heart failure (HF) patients remain suboptimal. No known therapy improves mortality in acute HF and HF with preserved ejection fraction; the most recent HF trial results have been negative or neutral. Improvement in surrogate markers has not necessarily translated into better outcomes. To translate breakthroughs with potential therapies into clinical benefit, a better understanding of the pathophysiology establishing the foundation of benefit is necessary. Vascular function plays a central role in the development and progression of HF. Endothelial function and nitric oxide availability affect myocardial function, systemic and pulmonary hemodynamics, and coronary and renal circulation. Arterial stiffness modulates ventricular loading conditions and diastolic function, key components of HF with preserved ejection. Endothelial function and arterial stiffness may therefore serve as important physiological targets for new HF therapies and facilitate patient selection for improved application of existing agents.
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Affiliation(s)
- Catherine N Marti
- Cardiology Division, Department of Medicine, Emory University, Atlanta, Georgia, USA
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Miyoshi H, Mizuguchi Y, Oishi Y, Iuchi A, Nagase N, Ara N, Oki T. Early detection of abnormal left atrial-left ventricular-arterial coupling in preclinical patients with cardiovascular risk factors: evaluation by two-dimensional speckle-tracking echocardiography. EUROPEAN JOURNAL OF ECHOCARDIOGRAPHY 2011; 12:431-9. [DOI: 10.1093/ejechocard/jer052] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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