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Otero-Luis I, Saz-Lara A, Moreno-Herráiz N, Lever-Megina CG, Bizzozero-Peroni B, Martínez-Ortega IA, Varga-Cirila R, Cavero-Redondo I. Exploring the Association between Mediterranean Diet Adherence and Arterial Stiffness in Healthy Adults: Findings from the EvasCu Study. Nutrients 2024; 16:2158. [PMID: 38999905 PMCID: PMC11242985 DOI: 10.3390/nu16132158] [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: 06/10/2024] [Revised: 07/01/2024] [Accepted: 07/03/2024] [Indexed: 07/14/2024] Open
Abstract
(1) Background: Previous evidence has indicated a connection between a Mediterranean diet and cardiovascular disease. However, evidence for subclinical markers of cardiovascular disease, such as arterial stiffness, is limited. Therefore, the aim of this study was to assess the associations between adherence to the Mediterranean diet (MD), as assessed by the MEDAS-14 questionnaire, and arterial stiffness, as assessed by aortic pulse wave velocity, in healthy adults and according to sex. (2) A cross-sectional study including 386 healthy participants was performed in the EVasCu study. Adjusted and unadjusted differences in adherence to the MD and arterial stiffness were determined using Student's t test and ANCOVA for the total sample and according to sex. (3) Results: Our results showed that individuals with a high adherence to the MD had a greater arterial stiffness, both in the total sample and in females, although this difference was not significant after adjusting for possible confounding variables, such as age. (4) Conclusions: Our findings indicated that, in the unadjusted analyses, healthy subjects with a high adherence to the MD showed a greater arterial stiffness. When these analyses were adjusted, no significant differences were shown in a-PWv according to the categories of MD adherence.
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Affiliation(s)
- Iris Otero-Luis
- CarVasCare Research Group (2023-GRIN-34459), Facultad de Enfermería de Cuenca, Universidad de Castilla-La Mancha, 16002 Cuenca, Spain
| | - Alicia Saz-Lara
- CarVasCare Research Group (2023-GRIN-34459), Facultad de Enfermería de Cuenca, Universidad de Castilla-La Mancha, 16002 Cuenca, Spain
| | - Nerea Moreno-Herráiz
- CarVasCare Research Group (2023-GRIN-34459), Facultad de Enfermería de Cuenca, Universidad de Castilla-La Mancha, 16002 Cuenca, Spain
| | - Carla Geovanna Lever-Megina
- CarVasCare Research Group (2023-GRIN-34459), Facultad de Enfermería de Cuenca, Universidad de Castilla-La Mancha, 16002 Cuenca, Spain
| | - Bruno Bizzozero-Peroni
- Instituto Superior de Educación Física, Universidad de la República, Rivera 40000, Uruguay
- Health and Social Research Center, Universidad de Castilla La-Mancha, 16002 Cuenca, Spain
| | | | - Rebeca Varga-Cirila
- CarVasCare Research Group (2023-GRIN-34459), Facultad de Enfermería de Cuenca, Universidad de Castilla-La Mancha, 16002 Cuenca, Spain
| | - Iván Cavero-Redondo
- CarVasCare Research Group (2023-GRIN-34459), Facultad de Enfermería de Cuenca, Universidad de Castilla-La Mancha, 16002 Cuenca, Spain
- Facultad de Ciencias de la Salud, Universidad Autónoma de Chile, Talca 3460000, Chile
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Verpalen VA, Ververs FA, Slieker M, Nuboer R, Swart JF, van der Ent CK, Fejzic Z, Westenberg JJ, Leiner T, Grotenhuis HB, Schipper HS. Enhanced aortic stiffness in adolescents with chronic disease is associated with decreased left ventricular global longitudinal strain. IJC HEART & VASCULATURE 2024; 52:101385. [PMID: 38694268 PMCID: PMC11061239 DOI: 10.1016/j.ijcha.2024.101385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Revised: 03/03/2024] [Accepted: 03/07/2024] [Indexed: 05/04/2024]
Abstract
Background The recent Cardiovascular Disease in Adolescents with Chronic Disease (CDACD) study showed enhanced aortic stiffness and wall thickness in adolescents with various chronic disorders. Enhanced aortic stiffness can increase left ventricular (LV) afterload and trigger a cascade of adverse arterioventricular interaction. Here, we investigate the relation between aortic changes and LV function in the CDACD study participants. Methods This cross-sectional study included 114 adolescents 12-18 years old with cystic fibrosis (CF, n = 24), corrected coarctation of the aorta (CoA, n = 25), juvenile idiopathic arthritis (JIA, n = 20), obesity (n = 20), and healthy controls (n = 25). Aortic pulse wave velocity (PWV), which reflects aortic stiffness, and aortic wall thickness (AWT) were assessed with cardiovascular magnetic resonance imaging (CMR). Echocardiography was employed to study conventional markers of LV function, as well as LV global longitudinal strain (LVGLS), which is an established (pre)clinical marker of LV dysfunction. Results First, aortic PWV and AWT were increased in all chronic disease groups, compared to controls. Second, in adolescents with CoA, JIA, and obesity, echocardiography showed a decreased LVGLS, while LV dimensions and conventional LV function markers were similar to controls. Third, multivariable linear regression identified aortic PWV as the most important determinant of their decreased LVGLS (standardized β -0.522, p < 0.001). Conclusions The decreased LVGLS in several adolescent chronic disease groups was associated with enhanced aortic PWV, which might reflect adverse arterioventricular interaction. Whether the decreased LVGLS in the chronic disease groups could negatively impact their long-term cardiovascular outcomes requires further study.
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Affiliation(s)
- Victor A. Verpalen
- Department of Pediatric Cardiology, Wilhelmina Children’s Hospital, University Medical Center Utrecht, the Netherlands
- Department of Radiology and Nuclear Medicine, Amsterdam University Medical Center, Amsterdam Cardiovascular Sciences, the Netherlands
| | - Francesca A. Ververs
- Center for Translational Immunology, University Medical Center Utrecht, the Netherlands
| | - Martijn Slieker
- Department of Pediatric Cardiology, Wilhelmina Children’s Hospital, University Medical Center Utrecht, the Netherlands
| | - Roos Nuboer
- Department of Pediatrics, Meander Medical Center Amersfoort, the Netherlands
| | - Joost F. Swart
- Department of Pediatric Immunology, Wilhelmina Children’s Hospital, University Medical Center Utrecht, the Netherlands
| | - Cornelis K. van der Ent
- Department of Pediatric Pulmonology, Wilhelmina Children’s Hospital, University Medical Center Utrecht, the Netherlands
| | - Zina Fejzic
- Department of Pediatric Cardiology, Amalia Children’s Hospital Radboud University Medical Center Nijmegen, the Netherlands
| | | | - Tim Leiner
- Department of Radiology, Mayo Clinics, United States of America
| | - Heynric B. Grotenhuis
- Department of Pediatric Cardiology, Wilhelmina Children’s Hospital, University Medical Center Utrecht, the Netherlands
| | - Henk S. Schipper
- Department of Pediatric Cardiology, Wilhelmina Children’s Hospital, University Medical Center Utrecht, the Netherlands
- Center for Translational Immunology, University Medical Center Utrecht, the Netherlands
- Department of Pediatric Cardiology, Sophia Children’s Hospital, Erasmus Medical Center, Rotterdam, the Netherlands
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Bia D, Salazar F, Cinca L, Gutierrez M, Facta Á, Diaz A, Zócalo Y. Impact of a cuff-based device calibration method on the agreement between invasive and noninvasive aortic and brachial pressure. Clin Physiol Funct Imaging 2024; 44:228-239. [PMID: 38014525 DOI: 10.1111/cpf.12869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Revised: 11/03/2023] [Accepted: 11/20/2023] [Indexed: 11/29/2023]
Abstract
INTRODUCTION Brachial cuff-based methods are increasingly used to estimate aortic systolic blood pressure (aoSBP). However, there are several unresolved issues. AIMS to determine to what extent the scheme used to calibrate brachial records (1) can affect noninvasive obtained aoSBP levels, and consequently, the level of agreement with the aoSBP recorded invasively, and (2) how different ways of calibrating ultimately impact the relationship between aoSBP and cardiac properties. METHODS brachial and aortic blood pressure (BP) was simultaneously obtained by invasive (catheterisation) and noninvasive (brachial oscillometric-device) methods (89 subjects). aoSBP was noninvasive obtained using three calibration schemes: 'SD': diastolic and systolic brachial BP, 'C': diastolic and calculated brachial mean BP (bMBP), 'Osc': diastolic and oscillometry-derived bMBP. Agreement between invasive and noninvasive aoSBP, and associations between BP and echocardiographic-derived parameters were analysed. CONCLUSIONS 'C' and 'SD' schemes generated aoSBP levels lower than those recorded invasively (mean errors: 6.9 and 10.1 mmHg); the opposite was found when considering 'Osc'(mean error: -11.4 mmHg). As individuals had higher invasive aoSBP, the three calibration schemes increasingly underestimated aoSBP levels; and viceversa. The 'range' of invasive aoSBP in which the calibration schemes reach the lowest error level (-5-5 mmHg) is different: 'C': 103-131 mmHg; 'Osc': 159-201 mmHg; 'SD':101-124 mmHg. The calibration methods allowed reaching levels of association between aoSBP and cardiac characteristics, somewhat lower, but very similar to those obtained when considering invasive aoSBP. There is no evidence of a clear superiority of one calibration method over another when considering the association between aoSBP and cardiac characteristics.
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Affiliation(s)
- Daniel Bia
- Departamento de Fisiología, Centro Universitario de Investigación, Innovación y Diagnóstico Arterial (CUiiDARTE), Facultad de Medicina, Universidad de la República, Montevideo, Uruguay
| | - Federico Salazar
- Sección Hipertensión Arterial, Departamento de Cardiología, Hospital Privado de Comunidad, Mar del Plata, Argentina
| | - Luis Cinca
- Sección Hipertensión Arterial, Departamento de Cardiología, Hospital Privado de Comunidad, Mar del Plata, Argentina
| | - Marcos Gutierrez
- Sección Hipertensión Arterial, Departamento de Cardiología, Hospital Privado de Comunidad, Mar del Plata, Argentina
| | - Álvaro Facta
- Sección Hipertensión Arterial, Departamento de Cardiología, Hospital Privado de Comunidad, Mar del Plata, Argentina
| | - Alejandro Diaz
- Instituto de Investigación en Ciencias de la Salud, UNICEN-CCT CONICET, Tandil, Provincia de Buenos Aires, Argentina
| | - Yanina Zócalo
- Departamento de Fisiología, Centro Universitario de Investigación, Innovación y Diagnóstico Arterial (CUiiDARTE), Facultad de Medicina, Universidad de la República, Montevideo, Uruguay
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Marshall AG, Neikirk K, Afolabi J, Mwesigwa N, Shao B, Kirabo A, Reddy AK, Hinton A. Update on the Use of Pulse Wave Velocity to Measure Age-Related Vascular Changes. Curr Hypertens Rep 2024; 26:131-140. [PMID: 38159167 PMCID: PMC10955453 DOI: 10.1007/s11906-023-01285-x] [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] [Accepted: 11/08/2023] [Indexed: 01/03/2024]
Abstract
PURPOSE OF REVIEW Pulse wave velocity (PWV) is an important and well-established measure of arterial stiffness that is strongly associated with aging. Age-related alterations in the elastic properties and integrity of arterial walls can lead to cardiovascular disease. PWV measurements play an important role in the early detection of these changes, as well as other cardiovascular disease risk factors, such as hypertension. This review provides a comprehensive summary of the current knowledge of the effects of aging on arterial stiffness, as measured by PWV. RECENT FINDINGS This review highlights recent findings showing the applicability of PWV analysis for investigating heart failure, hypertension, and other cardiovascular diseases, as well as cerebrovascular diseases and Alzheimer's disease. It also discusses the clinical implications of utilizing PWV to monitor treatment outcomes, various challenges in implementing PWV assessment in clinical practice, and the development of new technologies, including machine learning and artificial intelligence, which may improve the usefulness of PWV measurements in the future. Measuring arterial stiffness through PWV remains an important technique to study aging, especially as the technology continues to evolve. There is a clear need to leverage PWV to identify interventions that mitigate age-related increases in PWV, potentially improving CVD outcomes and promoting healthy vascular aging.
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Affiliation(s)
- Andrea G Marshall
- Department of Molecular Physiology and Biophysics, Vanderbilt University, Nashville, TN, USA
| | - Kit Neikirk
- Department of Molecular Physiology and Biophysics, Vanderbilt University, Nashville, TN, USA
| | - Jeremiah Afolabi
- Department of Medicine, Vanderbilt University Medical Center, 750 Robinson Research Building, 2200 Pierce Ave, Nashville, TN, 37232-0615, USA
| | - Naome Mwesigwa
- Department of Medicine, Vanderbilt University Medical Center, 750 Robinson Research Building, 2200 Pierce Ave, Nashville, TN, 37232-0615, USA
| | - Bryanna Shao
- Department of Molecular Physiology and Biophysics, Vanderbilt University, Nashville, TN, USA
| | - Annet Kirabo
- Department of Medicine, Vanderbilt University Medical Center, 750 Robinson Research Building, 2200 Pierce Ave, Nashville, TN, 37232-0615, USA
| | - Anilkumar K Reddy
- Department of Medicine, Baylor College of Medicine, One Baylor Plaza, Houston, TX, 77030, USA
| | - Antentor Hinton
- Department of Molecular Physiology and Biophysics, Vanderbilt University, Nashville, TN, USA.
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Hong J, Nandi M, Charlton PH, Alastruey J. Noninvasive hemodynamic indices of vascular aging: an in silico assessment. Am J Physiol Heart Circ Physiol 2023; 325:H1290-H1303. [PMID: 37737734 PMCID: PMC10908403 DOI: 10.1152/ajpheart.00454.2023] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 09/12/2023] [Accepted: 09/12/2023] [Indexed: 09/23/2023]
Abstract
Vascular aging (VA) involves structural and functional changes in blood vessels that contribute to cardiovascular disease. Several noninvasive pulse wave (PW) indices have been proposed to assess the arterial stiffness component of VA in the clinic and daily life. This study investigated 19 of these indices, identified in recent review articles on VA, by using a database comprising 3,837 virtual healthy subjects aged 25-75 yr, each with unique PW signals simulated under various levels of artificial noise to mimic real measurement errors. For each subject, VA indices were calculated from filtered PW signals and compared with the precise theoretical value of aortic Young's modulus (EAo). In silico PW indices showed age-related changes that align with in vivo population studies. The cardio-ankle vascular index (CAVI) and all pulse wave velocity (PWV) indices showed strong linear correlations with EAo (Pearson's rp > 0.95). Carotid distensibility showed a strong negative nonlinear correlation (Spearman's rs < -0.99). CAVI and distensibility exhibited greater resilience to noise compared with PWV indices. Blood pressure-related indices and photoplethysmography (PPG)-based indices showed weaker correlations with EAo (rp and rs < 0.89, |rp| and |rs| < 0.84, respectively). Overall, blood pressure-related indices were confounded by more cardiovascular properties (heart rate, stroke volume, duration of systole, large artery diameter, and/or peripheral vascular resistance) compared with other studied indices, and PPG-based indices were most affected by noise. In conclusion, carotid-femoral PWV, CAVI and carotid distensibility emerged as the superior clinical VA indicators, with a strong EAo correlation and noise resilience. PPG-based indices showed potential for daily VA monitoring under minimized noise disturbances.NEW & NOTEWORTHY For the first time, 19 noninvasive pulse wave indices for assessing vascular aging were examined together in a single database of nearly 4,000 subjects aged 25-75 yr. The dataset contained precise values of the aortic Young's modulus and other hemodynamic measures for each subject, which enabled us to test each index's ability to measure changes in aortic stiffness while accounting for confounding factors and measurement errors. The study provides freely available tools for analyzing these and additional indices.
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Affiliation(s)
- Jingyuan Hong
- Division of Imaging Sciences and Biomedical Engineering, King's College London, St. Thomas' Hospital, London, United Kingdom
| | - Manasi Nandi
- School of Cancer and Pharmaceutical Science, King's College London, London, United Kingdom
| | - Peter H Charlton
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom
| | - Jordi Alastruey
- Division of Imaging Sciences and Biomedical Engineering, King's College London, St. Thomas' Hospital, London, United Kingdom
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Wang J, Jing C, Hu X, Cui J, Tang Q, Tu L, Zhao S, Huang J, Guo D, Li Y, Xu J. Assessment of aortic to peripheral vascular stiffness and gradient by segmented upper limb PWV in healthy and hypertensive individuals. Sci Rep 2023; 13:19859. [PMID: 37963909 PMCID: PMC10645764 DOI: 10.1038/s41598-023-46932-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Accepted: 11/07/2023] [Indexed: 11/16/2023] Open
Abstract
Theoretically pulse wave velocity (PWV) is obtained by calculating the distance between two waveform probes divided by the time difference, and PWV ratio is used to assess the arterial stiffness gradient (SG) from proximal to distal. The aim was to investigate segmental upper-limb PWV (ulPWV) differences and the effects of hypertension and or aging on each ulPWV and SG. The study collected multi-waveform signals and conduction distances from 167 healthy individuals and 92 hypertensive patients. The results showed significant differences between ulPWVs (P < 0.001), with increased and then decreased vascular stiffness along the proximal transmission to the distal peripheral artery and then to the finger. Adjusted for age and sex, ulPWVs in hypertension exceeded that of healthy individuals, with significant differences between groups aged ≥ 50 years (P < 0.05). The hrPWV/rfPWV (heart-radial/radial-finger) was reduced in hypertension and differed significantly between the aged ≥ 50 years (P = 0.015); the ratio of baPWV (brachial-ankle) to ulPWV differed significantly between groups (P < 0.05). Hypertension affected the consistency of rfPWV with hfPWV (heart-finger). The findings suggest that segmented ulPWV is instrumental in providing stiffness corresponding to the physiological structure of the vessel. The superimposition of hypertension and or aging exacerbates peripheral arterial stiffness, as well as alteration in stiffness gradient.
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Affiliation(s)
- Jue Wang
- School of Traditional Chinese Medicine, Shanghai University of Traditional Chinese Medicine, No. 1200, Cailun Road, Pudong New District, Shanghai, 201203, China
| | - Congcong Jing
- Department of Endocrinology, Seventh People's Hospital of Shanghai, Shanghai, China
| | - Xiaojuan Hu
- Shanghai Collaborative Innovation Center of TCM Health Services, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Ji Cui
- School of Traditional Chinese Medicine, Shanghai University of Traditional Chinese Medicine, No. 1200, Cailun Road, Pudong New District, Shanghai, 201203, China
| | - Qingfeng Tang
- The University Key Laboratory of Intelligent Perception and Computing of Anhui Province, Anqing Normal University, Anqing, China
| | - Liping Tu
- School of Traditional Chinese Medicine, Shanghai University of Traditional Chinese Medicine, No. 1200, Cailun Road, Pudong New District, Shanghai, 201203, China
| | - Shiju Zhao
- School of Traditional Chinese Medicine, Shanghai University of Traditional Chinese Medicine, No. 1200, Cailun Road, Pudong New District, Shanghai, 201203, China
| | - Jinlian Huang
- School of Traditional Chinese Medicine, Shanghai University of Traditional Chinese Medicine, No. 1200, Cailun Road, Pudong New District, Shanghai, 201203, China
| | - Dandan Guo
- School of Traditional Chinese Medicine, Shanghai University of Traditional Chinese Medicine, No. 1200, Cailun Road, Pudong New District, Shanghai, 201203, China
| | - Yongzhi Li
- School of Traditional Chinese Medicine, Shanghai University of Traditional Chinese Medicine, No. 1200, Cailun Road, Pudong New District, Shanghai, 201203, China.
- China Astronaut Research and Training Center, Astronaut Health Center Laboratory, No. 26, Beiqing Road, Haidian District, Beijing, 100094, China.
| | - Jiatuo Xu
- School of Traditional Chinese Medicine, Shanghai University of Traditional Chinese Medicine, No. 1200, Cailun Road, Pudong New District, Shanghai, 201203, China.
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Zócalo Y, Bia D, Sánchez R, Lev G, Mendiz O, Ramirez A, Cabrera-Fischer EI. Central-to-peripheral blood pressure amplification: role of the recording site, technology, analysis approach, and calibration scheme in invasive and non-invasive data agreement. Front Cardiovasc Med 2023; 10:1256221. [PMID: 37886732 PMCID: PMC10598655 DOI: 10.3389/fcvm.2023.1256221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Accepted: 09/18/2023] [Indexed: 10/28/2023] Open
Abstract
Background Systolic blood pressure amplification (SBPA) and pulse pressure amplification (PPA) can independently predict cardiovascular damage and mortality. A wide range of methods are used for the non-invasive estimation of SBPA and PPA. The most accurate non-invasive method for obtaining SBPA and/or PPA remains unknown. Aim This study aims to evaluate the agreement between the SBPA and PPA values that are invasively and non-invasively obtained using different (1) measurement sites (radial, brachial, carotid), (2) measuring techniques (tonometry, oscillometry/plethysmography, ultrasound), (3) pulse waveform analysis approaches, and (4) calibration methods [systo-diastolic vs. approaches using brachial diastolic and mean blood pressure (BP)], with the latter calculated using different equations or measured by oscillometry. Methods Invasive aortic and brachial pressure (catheterism) and non-invasive aortic and peripheral (brachial, radial) BP were simultaneously obtained from 34 subjects using different methodologies, analysis methods, measuring sites, and calibration methods. SBPA and PPA were quantified. Concordance correlation and the Bland-Altman analysis were performed. Results (1) In general, SBPA and PPA levels obtained with non-invasive approaches were not associated with those recorded invasively. (2) The different non-invasive approaches led to (extremely) dissimilar results. In general, non-invasive measurements underestimated SBPA and PPA; the higher the invasive SBPA (or PPA), the greater the underestimation. (3) None of the calibration schemes, which considered non-invasive brachial BP to estimate SBPA or PPA, were better than the others. (4) SBPA and PPA levels obtained from radial artery waveform analysis (tonometry) (5) and common carotid artery ultrasound recordings and brachial artery waveform analysis, respectively, minimized the mean errors. Conclusions Overall, the findings showed that (i) SBPA and PPA indices are not "synonymous" and (ii) non-invasive approaches would fail to accurately determine invasive SBPA or PPA levels, regardless of the recording site, analysis, and calibration methods. Non-invasive measurements generally underestimated SBPA and PPA, and the higher the invasive SBPA or PPA, the higher the underestimation. There was not a calibration scheme better than the others. Consequently, our study emphasizes the strong need to be critical of measurement techniques, to have methodological transparency, and to have expert consensus for non-invasive assessment of SBPA and PPA.
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Affiliation(s)
- Yanina Zócalo
- Departamento de Fisiología, Centro Universitario de Investigación, Innovación y Diagnóstico Arterial (CUiiDARTE), Facultad de Medicina, Universidad de la República, Montevideo, Uruguay
| | - Daniel Bia
- Departamento de Fisiología, Centro Universitario de Investigación, Innovación y Diagnóstico Arterial (CUiiDARTE), Facultad de Medicina, Universidad de la República, Montevideo, Uruguay
| | - Ramiro Sánchez
- Metabolic Unit and Hypertension Unit, University Hospital, Favaloro Foundation, Buenos Aires, Argentina
| | - Gustavo Lev
- Department of Interventional Cardiology, University Hospital, Favaloro Foundation, Buenos Aires, Argentina
| | - Oscar Mendiz
- Department of Interventional Cardiology, University Hospital, Favaloro Foundation, Buenos Aires, Argentina
| | - Agustín Ramirez
- Instituto de Medicina Traslacional, Trasplante y Bioingeniería (IMETTYB), Favaloro University—CONICET, Buenos Aires, Argentina
| | - Edmundo I. Cabrera-Fischer
- Instituto de Medicina Traslacional, Trasplante y Bioingeniería (IMETTYB), Favaloro University—CONICET, Buenos Aires, Argentina
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Bia D, Salazar F, Cinca L, Gutierrez M, Facta A, Zócalo Y, Diaz A. Direct estimation of central aortic pressure from measured or quantified mean and diastolic brachial blood pressure: agreement with invasive records. Front Cardiovasc Med 2023; 10:1207069. [PMID: 37560119 PMCID: PMC10409477 DOI: 10.3389/fcvm.2023.1207069] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Accepted: 07/03/2023] [Indexed: 08/11/2023] Open
Abstract
Background Recently it has been proposed a new approach to estimate aortic systolic blood pressure (aoSBP) without the need for specific devices, operator-dependent techniques and/or complex wave propagation models/algorithms. The approach proposes aoSBP can be quantified from brachial diastolic and mean blood pressure (bDBP, bMBP) as: aoSBP = bMBP2/bDBP. It remains to be assessed to what extent the method and/or equation used to obtain the bMBP levels considered in aoSBP calculation may affect the estimated aoSBP, and consequently the agreement with aoSBP invasively recorded. Methods Brachial and aortic pressure were simultaneously obtained invasively (catheterization) and non-invasively (brachial oscillometry) in 89 subjects. aoSBP was quantified in seven different ways, using measured (oscillometry-derived) and calculated (six equations) mean blood pressure (MBP) levels. The agreement between invasive and estimated aoSBP was analyzed (Concordance correlation coefficient; Bland-Altman Test). Conclusions The ability of the equation "aoSBP = MBP2/DBP" to (accurately) estimate (error <5 mmHg) invasive aoSBP depends on the method and equation considered to determine bMBP, and on the aoSBP levels (proportional error). Oscillometric bMBP and/or approaches that consider adjustments for heart rate or a form factor ∼40% (instead of the usual 33%) would be the best way to obtain the bMBP levels to be used to calculate aoSBP.
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Affiliation(s)
- Daniel Bia
- Departamento de Fisiología, Centro Universitario de Investigación, Innovación y Diagnóstico Arterial (CUiiDARTE), Facultad de Medicina, Universidad de la República, Montevideo, Uruguay
| | - Federico Salazar
- Sección Hipertensión Arterial, Departamento de Cardiología, Hospital Privado de Comunidad, Mar del Plata, Argentina
| | - Luis Cinca
- Sección Hipertensión Arterial, Departamento de Cardiología, Hospital Privado de Comunidad, Mar del Plata, Argentina
| | - Marcos Gutierrez
- Sección Hipertensión Arterial, Departamento de Cardiología, Hospital Privado de Comunidad, Mar del Plata, Argentina
| | - Alvaro Facta
- Sección Hipertensión Arterial, Departamento de Cardiología, Hospital Privado de Comunidad, Mar del Plata, Argentina
| | - Yanina Zócalo
- Departamento de Fisiología, Centro Universitario de Investigación, Innovación y Diagnóstico Arterial (CUiiDARTE), Facultad de Medicina, Universidad de la República, Montevideo, Uruguay
| | - Alejandro Diaz
- Instituto de Investigación en Ciencias de la Salud, UNICEN-CCT CONICET, Tandil, Argentina
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Deng X, Song Y, Han X, Chen X, Yang W, Wu S, Zhou Y. Brachial-ankle pulse wave velocity trajectories in a middle-aged population. Front Cardiovasc Med 2023; 10:1092525. [PMID: 37051065 PMCID: PMC10083284 DOI: 10.3389/fcvm.2023.1092525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Accepted: 03/06/2023] [Indexed: 03/28/2023] Open
Abstract
ObjectiveThe “trajectory” phenotype was observed in several cardiovascular risk factors with aging. We aim to identify multiple brachial-ankle Pulse Wave Velocity (baPWV) trajectory phenotypes and assess their determinants.MethodsAmong 5,182 participants with baPWV measurements (2010–2016) at no less than three time points in Kailuan Study, we derived baPWV trajectory pattern using SAS Proc Traj program. We applied the lowest Bayesian information criterion to identify the best typing model, related the identified trajectory pattern to baseline and changes in characteristics.ResultsAmong 5.3 ± 1.7 years follow-up, four distinct baPWV trajectories were identified as low (1,961,37.8%), medium-low (1,846,35.6%), medium-high (1,024,19.8%), and high (351,6.8%) groups. In the stepwise models, mean arterial pressure and age were the main determinators of the trajectory patterns, with a Δpseudo-R2 of 0.335 and 0.164, respectively. With the low trajectory group as reference and multivariable adjustment, odd ratios of medium low, medium high and high associated with 1 mmHg increment of mean arterial pressure were 1.08(95%CI: 1.07–1.09), 1.13(1.12–1.14), and 1.16(1.15–1.18). The estimates for age were 1.08(1.07–1.10), 1.20(1.18–1.21) and 1.28(1.26–1.31). Additionally, baseline resting heart rate, low-density lipoprotein cholesterol, fasting blood glucose, hypersensitive C-reaction protein and uric acid, and changes in mean arterial pressure, resting heart rate, fasting blood glucose, and uric acid were positively associated with the trajectory, while BMI was negatively associated.ConclusionsThe changes in baPWV overtime followed a “trajectory” pattern, mainly determined by mean arterial pressure and age.
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10
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Bia D, Zócalo Y, Sánchez R, Torrado JF, Lev G, Mendiz O, Pessana F, Ramírez A, Cabrera-Fischer EI. Brachial Blood Pressure Invasively and Non-Invasively Obtained Using Oscillometry and Applanation Tonometry: Impact of Mean Blood Pressure Equations and Calibration Schemes on Agreement Levels. J Cardiovasc Dev Dis 2023; 10:jcdd10020045. [PMID: 36826541 PMCID: PMC9959257 DOI: 10.3390/jcdd10020045] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Revised: 11/28/2022] [Accepted: 12/06/2022] [Indexed: 01/27/2023] Open
Abstract
The use of oscillometric methods to determine brachial blood pressure (bBP) can lead to a systematic underestimation of the invasively measured systolic (bSBP) and pulse (bPP) pressure levels, together with a significant overestimation of diastolic pressure (bDBP). Similarly, the agreement between brachial mean blood pressure (bMBP), invasively and non-invasively measured, can be affected by inaccurate estimations/assumptions. Despite several methodologies that can be applied to estimate bMBP non-invasively, there is no consensus on which approach leads to the most accurate estimation. Aims: to evaluate the association and agreement between: (1) non-invasive (oscillometry) and invasive bBP; (2) invasive bMBP, and bMBP (i) measured by oscillometry and (ii) calculated using six different equations; and (3) bSBP and bPP invasively and non-invasively obtained by applanation tonometry and employing different calibration methods. To this end, invasive aortic blood pressure and bBP (catheterization), and non-invasive bBP (oscillometry [Mobil-O-Graph] and brachial artery applanation tonometry [SphygmoCor]) were simultaneously obtained (34 subjects, 193 records). bMBP was calculated using different approaches. Results: (i) the agreement between invasive bBP and their respective non-invasive measurements (oscillometry) showed dependence on bBP levels (proportional error); (ii) among the different approaches used to obtain bMBP, the equation that includes a form factor equal to 33% (bMBP = bDBP + bPP/3) showed the best association with the invasive bMBP; (iii) the best approach to estimate invasive bSBP and bPP from tonometry recordings is based on the calibration scheme that employs oscillometric bMBP. On the contrary, the worst association between invasive and applanation tonometry-derived bBP levels was observed when the brachial pulse waveform was calibrated to bMBP quantified as bMBP = bDBP + bPP/3. Our study strongly emphasizes the need for methodological transparency and consensus for non-invasive bMBP assessment.
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Affiliation(s)
- Daniel Bia
- Departamento de Fisiología, Facultad de Medicina, Centro Universitario de Investigación, Innovación y Diagnóstico Arterial (CUiiDARTE), Universidad de la República, Montevideo 11800, Uruguay
- Correspondence: or (D.B.); (Y.Z.)
| | - Yanina Zócalo
- Departamento de Fisiología, Facultad de Medicina, Centro Universitario de Investigación, Innovación y Diagnóstico Arterial (CUiiDARTE), Universidad de la República, Montevideo 11800, Uruguay
- Correspondence: or (D.B.); (Y.Z.)
| | - Ramiro Sánchez
- Metabolic Unit and Hypertension Unit, University Hospital, Favaloro Foundation, Buenos Aires 1093, Argentina
| | - Juan F. Torrado
- Departamento de Fisiología, Facultad de Medicina, Centro Universitario de Investigación, Innovación y Diagnóstico Arterial (CUiiDARTE), Universidad de la República, Montevideo 11800, Uruguay
| | - Gustavo Lev
- Department of Interventional Cardiology, University Hospital, Favaloro Foundation, Buenos Aires 1093, Argentina
| | - Oscar Mendiz
- Department of Interventional Cardiology, University Hospital, Favaloro Foundation, Buenos Aires 1093, Argentina
| | - Franco Pessana
- Department of Information Technology, Engineering and Exact Sciences Faculty, Favaloro University, Buenos Aires 1746, Argentina
| | - Agustín Ramírez
- IMETTYB, Favaloro University—CONICET, Buenos Aires 1746, Argentina
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11
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Bia D, Zócalo Y, Sánchez R, Lev G, Mendiz O, Pessana F, Ramirez A, Cabrera-Fischer EI. Aortic systolic and pulse pressure invasively and non-invasively obtained: Comparative analysis of recording techniques, arterial sites of measurement, waveform analysis algorithms and calibration methods. Front Physiol 2023; 14:1113972. [PMID: 36726850 PMCID: PMC9885133 DOI: 10.3389/fphys.2023.1113972] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Accepted: 01/05/2023] [Indexed: 01/18/2023] Open
Abstract
Background: The non-invasive estimation of aortic systolic (aoSBP) and pulse pressure (aoPP) is achieved by a great variety of devices, which differ markedly in the: 1) principles of recording (applied technology), 2) arterial recording site, 3) model and mathematical analysis applied to signals, and/or 4) calibration scheme. The most reliable non-invasive procedure to obtain aoSBP and aoPP is not well established. Aim: To evaluate the agreement between aoSBP and aoPP values invasively and non-invasively obtained using different: 1) recording techniques (tonometry, oscilometry/plethysmography, ultrasound), 2) recording sites [radial, brachial (BA) and carotid artery (CCA)], 3) waveform analysis algorithms (e.g., direct analysis of the CCA pulse waveform vs. peripheral waveform analysis using general transfer functions, N-point moving average filters, etc.), 4) calibration schemes (systolic-diastolic calibration vs. methods using BA diastolic and mean blood pressure (bMBP); the latter calculated using different equations vs. measured directly by oscillometry, and 5) different equations to estimate bMBP (i.e., using a form factor of 33% ("033"), 41.2% ("0412") or 33% corrected for heart rate ("033HR"). Methods: The invasive aortic (aoBP) and brachial pressure (bBP) (catheterization), and the non-invasive aoBP and bBP were simultaneously obtained in 34 subjects. Non-invasive aoBP levels were obtained using different techniques, analysis methods, recording sites, and calibration schemes. Results: 1) Overall, non-invasive approaches yielded lower aoSBP and aoPP levels than those recorded invasively. 2) aoSBP and aoPP determinations based on CCA recordings, followed by BA recordings, were those that yielded values closest to those recorded invasively. 3) The "033HR" and "0412" calibration schemes ensured the lowest mean error, and the "033" method determined aoBP levels furthest from those recorded invasively. 4) Most of the non-invasive approaches considered overestimated and underestimated aoSBP at low (i.e., 80 mmHg) and high (i.e., 180 mmHg) invasive aoSBP values, respectively. 5) The higher the invasively measured aoPP, the higher the level of underestimation provided by the non-invasive methods. Conclusion: The recording method and site, the mathematical method/model used to quantify aoSBP and aoPP, and to calibrate waveforms, are essential when estimating aoBP. Our study strongly emphasizes the need for methodological transparency and consensus for the non-invasive aoBP assessment.
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Affiliation(s)
- Daniel Bia
- Departamento de Fisiología, Centro Universitario de Investigación, Innovación y Diagnóstico Arterial (CUiiDARTE), Facultad de Medicina, Universidad de la República, Montevideo, Uruguay,*Correspondence: Daniel Bia, ; Yanina Zócalo,
| | - Yanina Zócalo
- Departamento de Fisiología, Centro Universitario de Investigación, Innovación y Diagnóstico Arterial (CUiiDARTE), Facultad de Medicina, Universidad de la República, Montevideo, Uruguay,*Correspondence: Daniel Bia, ; Yanina Zócalo,
| | - Ramiro Sánchez
- Metabolic Unit and Hypertension Unit, University Hospital, Favaloro Foundation, Buenos Aires, Argentina
| | - Gustavo Lev
- Department of Interventional Cardiology, University Hospital, Favaloro Foundation, Buenos Aires, Argentina
| | - Oscar Mendiz
- Department of Interventional Cardiology, University Hospital, Favaloro Foundation, Buenos Aires, Argentina
| | - Franco Pessana
- Department of Information Technology, Engineering and Exact Sciences Faculty, Favaloro University, Buenos Aires, Argentina
| | - Agustín Ramirez
- IMETTYB Favaloro University—CONICET, Buenos Aires, Argentina
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12
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du Plessis JP, Lammertyn L, Schutte AE, Nienaber-Rousseau C. H-Type Hypertension among Black South Africans and the Relationship between Homocysteine, Its Genetic Determinants and Estimates of Vascular Function. J Cardiovasc Dev Dis 2022; 9:jcdd9120447. [PMID: 36547444 PMCID: PMC9783379 DOI: 10.3390/jcdd9120447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Revised: 11/29/2022] [Accepted: 12/07/2022] [Indexed: 12/14/2022] Open
Abstract
Elevated homocysteine (Hcy) increases cardiovascular disease (CVD) risk. Our objective was to emphasize Hcy’s contribution in hypertension and CVD management by determining H-type hypertension (hypertension with Hcy ≥ 10 µmol/L) and associations between Hcy, blood pressure (BP) and estimates of vascular function among Black South Africans. We included 1995 adults (63% female). Plasma Hcy and cardiovascular measures (systolic and diastolic BP (SBP, DBP), pulse pressure, heart rate (HR), carotid-radialis pulse wave velocity (cr-PWV), intercellular adhesion molecule-1 (ICAM-1) and vascular cell adhesion molecule-1) were quantified. Five Hcy-related polymorphisms (cystathionine β-synthase (CBS 844ins68, T833C, G9276A); methylenetetrahydrofolate reductase (MTHFR C677T) and methionine synthase (MTR A2756G)) were genotyped. Hcy was >10 µmol/L in 41% (n = 762), and of the 47% (n = 951) hypertensives, 45% (n = 425) presented with H-type. Hcy was higher in hypertensives vs. normotensives (9.86 vs. 8.78 µmol/L, p < 0.0001, effect size 0.56) and correlated positively with SBP, DBP, cr-PWV and ICAM-1 (r > 0.19, p < 0.0001). Over Hcy quartiles, SBP, DBP, HR, cr-PWV and ICAM-1 increased progressively (all p-trends ≤ 0.001). In multiple regression models, Hcy contributed to the variance of SBP, DBP, HR, cr-PWV and ICAM-1. H-type hypertensives also had the lowest MTHFR 677 CC frequency (p = 0.03). Hcy is positively and independently associated with markers of vascular function and raised BP.
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Affiliation(s)
- Jacomina P. du Plessis
- Centre of Excellence for Nutrition, North-West University, Potchefstroom 2520, South Africa
| | - Leandi Lammertyn
- Hypertension in Africa Research Team, North-West University, Potchefstroom 2520, South Africa
- Medical Research Council Unit for Hypertension and Cardiovascular Disease, North-West University, Potchefstroom Campus, Potchefstroom 2520, South Africa
| | - Aletta E. Schutte
- Hypertension in Africa Research Team, North-West University, Potchefstroom 2520, South Africa
- Medical Research Council Unit for Hypertension and Cardiovascular Disease, North-West University, Potchefstroom Campus, Potchefstroom 2520, South Africa
- School of Population Health, University of New South Wales, The George Institute of Global Health, Sydney, NSW 2000, Australia
| | - Cornelie Nienaber-Rousseau
- Centre of Excellence for Nutrition, North-West University, Potchefstroom 2520, South Africa
- Medical Research Council Unit for Hypertension and Cardiovascular Disease, North-West University, Potchefstroom Campus, Potchefstroom 2520, South Africa
- Correspondence:
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13
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Chou CH, Yin JH, Lin YK, Yang FC, Chu TW, Chuang YC, Lin CW, Peng GS, Sung YF. The optimal pulse pressures for healthy adults with different ages and sexes correlate with cardiovascular health metrics. Front Cardiovasc Med 2022; 9:930443. [PMID: 36545016 PMCID: PMC9760735 DOI: 10.3389/fcvm.2022.930443] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Accepted: 11/10/2022] [Indexed: 12/07/2022] Open
Abstract
Background Pulse pressure (PP) may play a role in the development of cardiovascular disease, and the optimal PP for different ages and sexes is unknown. In a prospective cohort, we studied subjects with favorable cardiovascular health (CVH), proposed the mean PP as the optimal PP values, and demonstrated its relationship with healthy lifestyles. Methods and results Between 1996 and 2016, a total of 162,636 participants (aged 20 years or above; mean age 34.9 years; 26.4% male subjects; meeting criteria for favorable health) were recruited for a medical examination program. PP in male subjects was 45.6 ± 9.4 mmHg and increased after the age of 50 years. PP in female subjects was 41.8 ± 9.5 mmHg and increased after the age of 40 years, exceeding that of male subjects after the age of 50 years. Except for female subjects with a PP of 40-70 mmHg, PP increase correlates with both systolic blood pressure (BP) increase and diastolic BP decrease. Individuals with mean PP values are more likely to meet health metrics, including body mass index (BMI) <25 kg/m2 (chi-squared = 9.35, p<0.01 in male subjects; chi-squared = 208.79, p < 0.001 in female subjects) and BP <120/80 mmHg (chi-squared =1,300, p < 0.001 in male subjects; chi-squared =11,000, p < 0.001 in female subjects). We propose a health score (Hscore) based on the sum of five metrics (BP, BMI, being physically active, non-smoking, and healthy diet), which significantly correlates with the optimal PP. Conclusion The mean PP (within ±1 standard deviation) could be proposed as the optimal PP in the adult population with favorable CVH. The relationship between health metrics and the optimal PP based on age and sex was further demonstrated to validate the Hscore.
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Affiliation(s)
- Chung-Hsing Chou
- Department of Neurology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan,Graduate Institute of Medical Sciences, National Defense Medical Center, Taipei, Taiwan
| | - Jiu-Haw Yin
- Department of Neurology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan,Division of Neurology, Department of Internal Medicine, Taipei Veterans General Hospital, Hsinchu, Taiwan
| | - Yu-Kai Lin
- Department of Neurology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan,Graduate Institute of Medical Sciences, National Defense Medical Center, Taipei, Taiwan
| | - Fu-Chi Yang
- Department of Neurology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Ta-Wei Chu
- Department of Obstetrics and Gynecology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan,MJ Health Screening Center, Taipei, Taiwan
| | | | - Chia Wen Lin
- MJ Health Research Foundation, MJ Group, Taipei, Taiwan
| | - Giia-Sheun Peng
- Department of Neurology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan,Division of Neurology, Department of Internal Medicine, Taipei Veterans General Hospital, Hsinchu, Taiwan
| | - Yueh-Feng Sung
- Department of Neurology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan,*Correspondence: Yueh-Feng Sung
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14
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Park JB, Sharman JE, Li Y, Munakata M, Shirai K, Chen CH, Jae SY, Tomiyama H, Kosuge H, Bruno RM, Spronck B, Kario K, Lee HY, Cheng HM, Wang J, Budoff M, Townsend R, Avolio AP. Expert Consensus on the Clinical Use of Pulse Wave Velocity in Asia. Pulse (Basel) 2022; 10:1-18. [PMID: 36660436 PMCID: PMC9843646 DOI: 10.1159/000528208] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Accepted: 11/10/2022] [Indexed: 11/23/2022] Open
Abstract
Arterial stiffness is a progressive aging process that predicts cardiovascular disease. Pulse wave velocity (PWV) has emerged as a noninvasive, valid, and reliable measure of arterial stiffness and an independent risk predictor for adverse outcomes. However, up to now, PWV measurement has mostly been used as a tool for risk prediction and has not been widely used in clinical practice. This consensus paper aims to discuss multiple PWV measurements currently available in Asia and to provide evidence-based assessment together with recommendations on the clinical use of PWV. For the methodology, PWV measurement including the central elastic artery is essential and measurements including both the central elastic and peripheral muscular arteries, such as brachial-ankle PWV and cardio-ankle vascular index, can be a good alternative. As Asian populations are rapidly aging, timely detection and intervention of "early vascular aging" in terms of abnormally high PWV values are recommended. More evidence is needed to determine if a PWV-guided therapeutic approach will be beneficial to the prevention of cardiovascular diseases beyond current strategies. Large-scale randomized controlled intervention studies are needed to guide clinicians.
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Affiliation(s)
- Jeong Bae Park
- JB Lab and Clinic, And Department of Precision Medicine and Biostatistics, Yonsei University, Wonju College of Medicine, Seoul, Republic of Korea
| | - James E. Sharman
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
| | - Yan Li
- Shanghai Institute of Hypertension, Ruijin Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Masanori Munakata
- Research Center for Lifestyle-related Disease, Tohoku Rosai Hospital, Sendai, Japan
| | - Kohji Shirai
- Research Center, Seijinkai, Mihama Hospital, Chiba, Japan
| | - Chen-Huan Chen
- Department of Medicine, National Yang Ming Chiao Tung University College of Medicine, Taipei, Taiwan
| | - Sae Young Jae
- Department of Sport Science, University of Seoul, Seoul, Republic of Korea
| | | | - Hisanori Kosuge
- Department of Cardiology, Tokyo Medical University, Tokyo, Japan
| | - Rosa Maria Bruno
- Université Paris Cité, INSERM, PARCC, Paris, France
- Pharmacology Unit, AP-HP, Hôpital Européen Georges Pompidou, Paris, France
| | - Bart Spronck
- Department of Biomedical Engineering, CARIM School for Cardiovascular Diseases, Maastricht University, Maastricht, The Netherlands
- Macquarie Medical School, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, New South Wales, Australia
| | - Kazuomi Kario
- Department of Medicine, Jichi Medical University School of Medicine (JMU), Shimotsuke, Japan
| | - Hae Young Lee
- Department of Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Hao-Min Cheng
- Division of Faculty Development, Taipei Veterans General Hospital, Ph.D. Program of Interdisciplinary Medicine (PIM), National Yang Ming Chiao Tung University, College of Medicine, Taipei, Taiwan
| | - Jiguang Wang
- Shanghai Institute of Hypertension, Ruijin Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Matthew Budoff
- Department of Medicine, Lundquist Institute at Harbor-UCLA, Torrance, California, USA
| | - Raymond Townsend
- Department of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Alberto P. Avolio
- Macquarie Medical School, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, New South Wales, Australia
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15
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Pereira MM, Torrado J, Bock J, Sosa C, Diaz A, Bia D, Zócalo Y. Wave separation analysis-derived indexes obtained from radial and carotid tonometry in healthy pregnancy and pregnancy-associated hypertension: Comparison with pulse wave analysis-derived indexes. Front Cardiovasc Med 2022; 9:997452. [PMID: 36386340 PMCID: PMC9664074 DOI: 10.3389/fcvm.2022.997452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Accepted: 10/10/2022] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Increased wave reflections assessed by pulse wave analysis (PWA) was proposed as one of the potential culprits of hypertension seen in women with pregnancy-associated hypertension (PAH). However, this statement has never been confirmed with "Wave Separation Analysis" (WSA), a more sophisticated mathematical approach that analyzes the amplitude and interaction between forward and backward aortic pressure waveform components. OBJECTIVE To characterize potential changes in pressure wave components of PAH compared to healthy non-pregnant (NP) women and women with normal pregnancies (HP) by using WSA and compared these findings with PWA-derived indexes; secondarily, to evaluate differences in WSA-derived indexes between subgroups of PAH (i.e., preeclampsia [PE] and gestational hypertension [GH]). METHODS Using radial and carotid applanation tonometry, we quantified in HP (n = 10), PAH (n = 16), and NP (n = 401): (i) PWA-derived indexes; (ii) WSA-derived indexes: forward (Pf) and backward (Pb) waveform components, backward component arrival time (PbAT), reflection magnitude (RM = Pb/Pf) and index [RIx = Pb/(Pf + Pb)]. RESULTS While PAH was associated with a higher Pf compared to HP and NP, Pb and PbAT were similar between the groups. Both GH and PE showed a higher Pf compared to HP, but only PE had a trend of presenting with higher Pb and lower PbAT compared to the other groups. Finally, PAH showed a trend of having lower RM and RIx compared to NP and HP, with no differences between GH and PE. CONCLUSION PAH was associated with higher Pf, but not higher Pb, compared to NP and HP, although PE also demonstrated a trend of higher Pb.
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Affiliation(s)
- María M. Pereira
- Department of Obstetrics and Gynecology, BronxCare Hospital Center a Clinical Affiliate of Mt Sinai Health Systems and Academic Affiliate of Icahn School of Medicine, Bronx, NY, United States
| | - Juan Torrado
- Department of Internal Medicine, Jacobi Medical Center, Albert Einstein College of Medicine, Bronx, NY, United States
| | - Joshua Bock
- Department of Internal Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, United States
| | - Claudio Sosa
- Department of Obstetrics and Gynecology “C”, Pereira-Rossell Hospital, School of Medicine, Republic University, Montevideo, Uruguay
| | - Alejandro Diaz
- Consejo Nacional de Investigaciones Científicas y Técnicas, Tandil, Argentina
| | - Daniel Bia
- Centro Universitario de Investigación, Innovación y Diagnóstico Arterial (CUiiDARTE), Department of Physiology, School of Medicine, Republic University, Montevideo, Uruguay
| | - Yanina Zócalo
- Centro Universitario de Investigación, Innovación y Diagnóstico Arterial (CUiiDARTE), Department of Physiology, School of Medicine, Republic University, Montevideo, Uruguay,*Correspondence: Yanina Zócalo,
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16
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Pulse Wave Velocity for Risk Stratification of Patients with Aortic Aneurysm. J Clin Med 2022; 11:jcm11144026. [PMID: 35887789 PMCID: PMC9316234 DOI: 10.3390/jcm11144026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2022] [Revised: 07/04/2022] [Accepted: 07/11/2022] [Indexed: 11/16/2022] Open
Abstract
Background: Patients with an aortic aneurysm are at high cardiovascular risk. Pulse wave velocity (PWV) is used as a parameter for risk stratification but may be affected by aortic disease (AoD). This study aimed to investigate the dependence of PWV on treated or untreated AoD and to identify modifiable factors of PWV. Methods: The measurement of PWV with the Mobil-O-Graph was performed fully automatically in a collective of 381 patients (75.6% male and 24.4% female). Of all patients, 53.8% had nonaortic atherosclerotic vascular disease (AVD), 28.9% had treated AoD, and 17.3% had untreated AoD. Results: There was a statistically significant effect of age (R2 = 0.838) and current systolic blood pressure (SBP) on PWV (page corrected < 0.05). After correction for age, no statistically significant difference was found between the PWV of men and women, patients with different body weights or degrees of chronic kidney disease, diabetics and nondiabetics, and smokers and nonsmokers. Comparison between patients with nonaortic AVD and treated or untreated AoD revealed no statistically significant differences (PWVnonaortic AVD 10.0 ± 1.8 m/s, PWVtreated AoD 10.0 ± 1.5 m/s, PWVuntreated AoD 9.8 ± 1.6 m/s; page corrected > 0.05). Conclusions: PWV determined with the Mobil-O-Graph correlated with age and current SBP. Neither aortic disease versus nonaortic AVD, its treatment, nor other cardiovascular risk factors had a significant effect on PWV. Successful blood pressure control is crucial to avoid high PWV and thus an increase in cardiovascular events.
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17
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Gómez-García M, Torrado J, Pereira M, Bia D, Zócalo Y. Fat-Free Mass Index, Visceral Fat Level, and Muscle Mass Percentage Better Explain Deviations From the Expected Value of Aortic Pressure and Structural and Functional Arterial Properties Than Body Fat Indexes. Front Nutr 2022; 9:856198. [PMID: 35571946 PMCID: PMC9099434 DOI: 10.3389/fnut.2022.856198] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Accepted: 03/21/2022] [Indexed: 12/15/2022] Open
Abstract
Bioelectrical impedance analysis (BIA)-derived indexes [e.g., fat (FMI) and fat-free mass indexes (FFMI), visceral fat level (VFL)] are used to characterize obesity as a cardiovascular risk factor (CRF). The BIA-derived index that better predicts arterial variability is still discussed.
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Affiliation(s)
- Mariana Gómez-García
- Departamento de Educación Física y Salud, Instituto Superior de Educación Física, Universidad de la República, Montevideo, Uruguay
- CUiiDARTE-Movimiento, Actividad, Salud (CUiiDARTE-MAS), Comisión Sectorial de Investigación Científica, Universidad de la República, Montevideo, Uruguay
| | - Juan Torrado
- CUiiDARTE-Movimiento, Actividad, Salud (CUiiDARTE-MAS), Comisión Sectorial de Investigación Científica, Universidad de la República, Montevideo, Uruguay
- Department of Internal Medicine, Jacobi Medical Center, Albert Einstein College of Medicine, New York, NY, United States
| | - María Pereira
- Department of Obstetrics and Gynecology, BronxCare Hospital Center a Clinical Affiliate of Mt Sinai Health Systems and Academic Affiliate of Icahn School of Medicine, New York, NY, United States
| | - Daniel Bia
- CUiiDARTE-Movimiento, Actividad, Salud (CUiiDARTE-MAS), Comisión Sectorial de Investigación Científica, Universidad de la República, Montevideo, Uruguay
- Departamento de Fisiología, Facultad de Medicina, Centro Universitario de Investigación, Innovación y Diagnóstico Arterial (CUiiDARTE), Universidad de la República, Montevideo, Uruguay
| | - Yanina Zócalo
- CUiiDARTE-Movimiento, Actividad, Salud (CUiiDARTE-MAS), Comisión Sectorial de Investigación Científica, Universidad de la República, Montevideo, Uruguay
- Departamento de Fisiología, Facultad de Medicina, Centro Universitario de Investigación, Innovación y Diagnóstico Arterial (CUiiDARTE), Universidad de la República, Montevideo, Uruguay
- *Correspondence: Yanina Zócalo
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Bai Y, Wang Q, Cheng D, Hu Y, Chao H, Avolio A, Tang B, Zuo J. Comparison of Risk of Target Organ Damage in Different Phenotypes of Arterial Stiffness and Central Aortic Blood Pressure. Front Cardiovasc Med 2022; 9:839875. [PMID: 35497999 PMCID: PMC9046870 DOI: 10.3389/fcvm.2022.839875] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Accepted: 03/14/2022] [Indexed: 11/18/2022] Open
Abstract
Objectives The aim of this study was to explore the risk of target organ damage (TOD) in different groups based on carotid-femoral pulse wave velocity (cfPWV) and central aortic blood pressure (CBP) in different populations. Methods The study cohort was divided into four groups according to the status of cfPWV and CBP [Group (cfPWV/CBP): high cfPWV and high CBP; Group (cfPWV): high cfPWV and normal CBP; Group (CBP): normal cfPWV and high CBP; Group (control): normal cfPWV and normal CBP]. TOD was determined by the assessment of carotid intima-media thickness (CIMT) abnormality, chronic kidney disease (CKD), microalbuminuria, and left ventricular hypertrophy (LVH). Results A total of 1,280 patients (mean age 53.14 ± 12.76 years, 64.1% male patients) were recruited in this study. Regarding Group (control) as reference, LVH was significantly higher in Group (cfPWV) and Group (CBP) [OR 2.406, 95% CI (1.301–4.452), P < 0.05; OR 2.007, 95% CI (1.335–3.017), P < 0.05]; microalbuminuria was significantly higher in Group (cfPWV/CBP) and Group (CBP) [OR 3.219, 95% CI (1.630–6.359), P < 0.05; OR 3.156, 95% CI (1.961–5.079), P < 0.05]. With age stratified by 60 years, the risk of CKD was significantly higher in Group (cfPWV/CBP) [OR 4.019, 95% CI (1.439–11.229), P < 0.05]. Conclusion Different phenotypes based on the status of cfPWV and CBP were associated with different TOD. Individuals with both cfPWV and CBP elevated have a higher risk of microalbuminuria.
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Affiliation(s)
- Yaya Bai
- Department of Geriatrics, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Qian Wang
- Department of Geriatrics, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Di Cheng
- Department of Geriatrics, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yueliang Hu
- Department of Geriatrics, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Huijuan Chao
- Department of Geriatrics, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Alberto Avolio
- Department of Biomedical Sciences, Faculty of Medicine, Health and Human Sciences, Macquarie (University) Medical School, Sydney, NSW, Australia
| | - Biwen Tang
- Department of Geriatrics, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- *Correspondence: Biwen Tang
| | - Junli Zuo
- Department of Geriatrics, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Department of Biomedical Sciences, Faculty of Medicine, Health and Human Sciences, Macquarie (University) Medical School, Sydney, NSW, Australia
- Junli Zuo
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Gómez-García M, Torrado J, Bia D, Zócalo Y. Influence of Epoch Length and Recording Site on the Relationship Between Tri-Axial Accelerometry-Derived Physical Activity Levels and Structural, Functional, and Hemodynamic Properties of Central and Peripheral Arteries. Front Sports Act Living 2022; 4:799659. [PMID: 35280222 PMCID: PMC8909126 DOI: 10.3389/fspor.2022.799659] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Accepted: 01/17/2022] [Indexed: 12/11/2022] Open
Abstract
BackgroundIt remains to be established to what extent physical activity (PA) levels among individuals are independently associated with deviations from the “optimal” state of the arterial system. Accelerometers have been proposed as means to obtain reliable, objective, and more comprehensive data of PA. Decisions at the time of data collection/processing could influence the association between accelerometry-derived indices and arterial properties.Objectives(i) To identify to what extent the strength of association between arterial properties and accelerometer-derived indices depend on the recording site and/or the epoch length; (ii) to determine whether some arterial characteristics (hemodynamic vs. structural vs. functional) or regions (elastic vs. transitional vs. muscular arteries; central vs. peripheral) have higher levels of association with accelerometry-derived indices.MethodsPhysical activity (PA), cardiovascular risk factors (CRFs), and cardiovascular properties were evaluated in 60 volunteers (general population; age: 23–62 years; women: 43%). PA was measured daily for 7 days (free-living situation; triaxial-accelerometers ActiGraph-GT3X+; hip and wrist; “Worn-to-wrist” option) and raw data was converted at epoch lengths of 1, 5, 10, 30, and 60-s. PA-related energy expenditure, daily time in moderate-to-vigorous PA, steps/minute, and counts-per-minute for vector magnitude were calculated. The cardiovascular evaluation included hemodynamic (central and peripheral pressure), structural (diameters and intima-media thickness), and functional (local and regional stiffness) parameters of carotids, femoral, and brachial arteries, and carotid-femoral and carotid-radial pathways. Arterial z-scores were obtained using age-related equations derived from healthy participants not exposed to CRFs (n = 1,688; age: 2–84 years; female: 51.2%) to evaluate at which degree each parameter deviates from the “optimal” value.MethodsIn general, hip recordings outperformed those obtained on the wrist regarding the strength of association with arterial parameters. Accelerometer-derived indices and their association with arterial properties vary depending on the recording site and epoch length. PA indices are stronger associated with functional (local) than structural variables and with central than peripheral arteries.ConclusionsRegardless of the PA index, there were independent associations with central artery characteristics, which reinforces that these territories would be the most related to PA levels. Differences in data acquisition and processing could lead to differences in conclusions when addressing the association between accelerometer-derived indices and the cardiovascular system.
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Affiliation(s)
- Mariana Gómez-García
- Departamento de Educación Física y Salud, Instituto Superior de Educación Física, Universidad de la República, Montevideo, Uruguay
- Grupo “Centro Universitario de Investigación, Innovación y Diagnóstico Arterial – Movimiento, Actividad, Salud” (CUiiDARTE-MAS), Comisión Sectorial de Investigación Científica (CSIC), Universidad de la República, Montevideo, Uruguay
| | - Juan Torrado
- Grupo “Centro Universitario de Investigación, Innovación y Diagnóstico Arterial – Movimiento, Actividad, Salud” (CUiiDARTE-MAS), Comisión Sectorial de Investigación Científica (CSIC), Universidad de la República, Montevideo, Uruguay
- Department of Internal Medicine, Jacobi Medical Center, Albert Einstein College of Medicine, New York, NY, United States
- Departamento de Fisiología, Facultad de Medicina, Centro Universitario de Investigación, Innovación y Diagnóstico Arterial (CUiiDARTE), Universidad de la República, Montevideo, Uruguay
| | - Daniel Bia
- Grupo “Centro Universitario de Investigación, Innovación y Diagnóstico Arterial – Movimiento, Actividad, Salud” (CUiiDARTE-MAS), Comisión Sectorial de Investigación Científica (CSIC), Universidad de la República, Montevideo, Uruguay
- Departamento de Fisiología, Facultad de Medicina, Centro Universitario de Investigación, Innovación y Diagnóstico Arterial (CUiiDARTE), Universidad de la República, Montevideo, Uruguay
| | - Yanina Zócalo
- Grupo “Centro Universitario de Investigación, Innovación y Diagnóstico Arterial – Movimiento, Actividad, Salud” (CUiiDARTE-MAS), Comisión Sectorial de Investigación Científica (CSIC), Universidad de la República, Montevideo, Uruguay
- Departamento de Fisiología, Facultad de Medicina, Centro Universitario de Investigación, Innovación y Diagnóstico Arterial (CUiiDARTE), Universidad de la República, Montevideo, Uruguay
- *Correspondence: Yanina Zócalo
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Zócalo Y, Gómez-García M, Torrado J, Bia D. Aging-Related Moderation of the Link Between Compliance With International Physical Activity Recommendations and the Hemodynamic, Structural, and Functional Arterial Status of 3,619 Subjects Aged 3–90 Years. Front Sports Act Living 2022; 4:800249. [PMID: 35265833 PMCID: PMC8899126 DOI: 10.3389/fspor.2022.800249] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Accepted: 01/11/2022] [Indexed: 12/16/2022] Open
Abstract
Background Compliance with physical activity recommendations (CPARs) is associated with better health indicators. However, there are only few studies to date that have comprehensively analyzed the association between CPARs and cardiovascular status “as a whole” (e.g., analyzing hemodynamic, structural, and functional properties, and different arterial territories). The relationship between CPARs and cardiovascular properties could be strongly influenced by the growth and aging process. Aim The goal of the study is to investigate the association between CPAR and cardiovascular properties by placing special emphasis on: (i) identifying if there is an independent association, (ii) if the association is “moderated” by age, and (iii) to what extent the association depends on the arterial parameter (hemodynamic vs. structural vs. functional) and/or the arterial segment (e.g., central vs. peripheral; elastic vs. transitional vs. muscular arteries). Methods A total of 3,619 subjects (3–90 years of age) were studied. Extensive cardiovascular evaluations were performed. Cardiovascular risk factors (CRFs) and physical activity (PA) levels were determined. The subjects were categorized as compliant (n = 1, 969) or non-compliant (n = 1,650) with World Health Organization-related PA recommendations. Correlation and multiple regression models (including CPAR*Age interaction) were obtained, and Johnson-Neyman technique was used to produce regions of significance. Results The independent association between CPARs and cardiovascular characteristics were strongly moderated by age. The moderation was observed on a wide range of age but particularly notorious on the extremes of life. Certain arterial characteristics demonstrated opposite effects in relation to CPAR status depending on the range of age considered. The association between CPAR and cardiovascular characteristics was independent of CRFs and moderated by age. In subjects younger than 45–55 years, CPAR status was associated with lower central and peripheral blood pressure (i.e., the younger the subject, the higher the reduction). During adult life, as age increases in the subjects, CPARs was associated with a beneficial hemodynamic profile, which is not related with variations in pressure but strongly related with lower levels of waveform-derived indexes and ventricular afterload determinants. Conclusions The independent associations between CPARs and arterial properties were strongly moderated by age. Data provided by blood pressure levels and waveform-derived indexes would be enough to evaluate the independent association between CPARs and the vascular system in the general population.
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Affiliation(s)
- Yanina Zócalo
- Departamento de Fisiología, Facultad de Medicina, Centro Universitario de Investigación, Innovación y Diagnóstico Arterial, Universidad de la República, Montevideo, Uruguay
- CUiiDARTE - Movimiento, Actividad, Salud (CUiiDARTE-MAS), Comisión Sectorial de Investigación Científica, Universidad de la República, Montevideo, Uruguay
- *Correspondence: Yanina Zócalo
| | - Mariana Gómez-García
- CUiiDARTE - Movimiento, Actividad, Salud (CUiiDARTE-MAS), Comisión Sectorial de Investigación Científica, Universidad de la República, Montevideo, Uruguay
- Departamento de Educación Física y Salud, Instituto Superior de Educación Física, Universidad de la República, Montevideo, Uruguay
| | - Juan Torrado
- CUiiDARTE - Movimiento, Actividad, Salud (CUiiDARTE-MAS), Comisión Sectorial de Investigación Científica, Universidad de la República, Montevideo, Uruguay
- Department of Internal Medicine, Jacobi Medical Center, Albert Einstein College of Medicine, New York, NY, United States
| | - Daniel Bia
- Departamento de Fisiología, Facultad de Medicina, Centro Universitario de Investigación, Innovación y Diagnóstico Arterial, Universidad de la República, Montevideo, Uruguay
- CUiiDARTE - Movimiento, Actividad, Salud (CUiiDARTE-MAS), Comisión Sectorial de Investigación Científica, Universidad de la República, Montevideo, Uruguay
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Zócalo Y, Bia D. Central Pressure Waveform-Derived Indexes Obtained From Carotid and Radial Tonometry and Brachial Oscillometry in Healthy Subjects (2–84 Y): Age-, Height-, and Sex-Related Profiles and Analysis of Indexes Agreement. Front Physiol 2022; 12:774390. [PMID: 35126173 PMCID: PMC8811372 DOI: 10.3389/fphys.2021.774390] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2021] [Accepted: 12/22/2021] [Indexed: 12/11/2022] Open
Abstract
Aortic blood pressure (aoBP) waveform-derived indexes could provide valuable (prognostic) information over and above cardiovascular risk factors (CRFs). To obtain aoBP waveform-characteristics, several (i) techniques, (ii) recording sites, (iii) pressure-only waveform analysis mathematical approaches [e.g., pulse wave analysis (PWA), wave separation analysis (WSA)], and (iv) indexes [augmentation pressure and index (AP and AIx), forward (Pf) and backward (Pb) components of aoBP, reflection magnitude (RM), and reflection index (Rix)], were proposed. An accurate clinical use of these indexes requires knowing their physiological age-related profiles and the expected values for a specific subject. There are no works that have characterized waveform-derived indexes profiles in large populations considering: (i) as a continuous, data from different age stages (childhood, adolescence, and adulthood), (ii) complementary indexes, (iii) data obtained from different techniques and approaches, and (iv) analyzing potential sex- and body height (BH)-related differences. In addition, (v) there is a lack of normative data (reference intervals, RIs) for waveform-derived indexes.
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Diaz A, Grand M, Torrado J, Salazar F, Zócalo Y, Bia D. Aortic Pressure Levels and Waveform Indexes in People Living With Human Immunodeficiency Virus: Impact of Calibration Method on the Differences With Respect to Non-HIV Subjects and Optimal Values. Front Cardiovasc Med 2022; 8:772912. [PMID: 35004887 PMCID: PMC8733318 DOI: 10.3389/fcvm.2021.772912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Accepted: 11/30/2021] [Indexed: 12/03/2022] Open
Abstract
Background: There are scarce and controversial data on whether human immunodeficiency virus (HIV) infection is associated with changes in aortic pressure (aoBP) and waveform-derived indexes. Moreover, it remains unknown whether potential differences in aoBP and waveform indexes between people living with HIV (PLWHIV) and subjects without HIV (HIV-) would be affected by the calibration method of the pressure waveform. Aims: To determine: (i) whether PLWHIV present differences in aoBP and waveform-derived indexes compared to HIV- subjects; (ii) the relative impact of both HIV infection and cardiovascular risk factors (CRFs) on aoBP and waveform-derived indexes; (iii) whether the results of the first and second aims are affected by the calibration method. Methods: Three groups were included: (i) PLWHIV (n = 86), (ii) HIV- subjects (general population; n = 1,000) and (iii) a Reference Group (healthy, non-exposed to CRFs; n = 398). Haemodynamic parameters, brachial pressure (baBP; systolic: baSBP; diastolic: baDBP; mean oscillometric: baMBPosc) and aoBP and waveform-derived indexes were obtained. Brachial mean calculated (baMBPcalc=baDBP+[baSBP-baDBP]/3) pressure was quantified. Three waveform calibration schemes were used: systolic-diastolic, calculated (baMBPcalc/baDBP) and oscillometric mean (baMBPosc/baDBP). Results: Regardless of CRFs and baBP, PLWHIV presented a tendency of having lower aoBP and waveform-derived indexes which clearly reached statistical significance when using the baMBPosc/baDBP or baMBPcalc/baDBP calibration. HIV status exceeded the relative weight of other CRFs as explanatory variables, being the main explanatory variable for variations in central hemodynamics when using the baMBPosc/baDBP, followed by the baMBPcalc/baDBP calibration. Conclusions: The peripheral waveform calibration approach is an important determinant to reveal differences in central hemodynamics in PLWHIV.
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Affiliation(s)
- Alejandro Diaz
- Consejo Nacional de Investigaciones Científicas y Técnicas, Instituto de Investigación en Ciencias de la Salud (IICS), Universidad Nacional del Centro de la Provincia de Buenos Aires (UNICEN), Tandil, Argentina
| | - Marina Grand
- Instituto de Investigación en Ciencias de la Salud, Facultad de Ciencias de la Salud, Universidad Nacional del Centro de la Provincia de Buenos Aires, Tandil, Argentina.,Hospital Dr. Héctor M. Cura, Olavarría, Argentina
| | - Juan Torrado
- Department of Internal Medicine, Jacobi Medical Center, Albert Einstein College of Medicine, New York, NY, United States
| | - Federico Salazar
- Servicio de Cardiología, Hospital Privado de Comunidad, Mar del Plata, Argentina
| | - Yanina Zócalo
- Departamento de Fisiología, Facultad de Medicina, Centro Universitario de Investigación, Innovación y Diagnóstico Arterial, Universidad de la República, Montevideo, Uruguay
| | - Daniel Bia
- Departamento de Fisiología, Facultad de Medicina, Centro Universitario de Investigación, Innovación y Diagnóstico Arterial, Universidad de la República, Montevideo, Uruguay
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Pereira MM, Torrado J, Sosa C, Diaz A, Bia D, Zócalo Y. Center-To-Periphery Arterial Stiffness Gradient Is Attenuated and/or Reversed in Pregnancy-Associated Hypertension. Front Cardiovasc Med 2022; 8:766723. [PMID: 35004884 PMCID: PMC8739768 DOI: 10.3389/fcvm.2021.766723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Accepted: 11/22/2021] [Indexed: 11/17/2022] Open
Abstract
Background: Non-pregnant (NP) women have a progressive increase in arterial stiffness from central-to-peripheral arteries [“stiffness gradient” (SG)], which is of physiologic importance since excessive pulsatility is filtered by the creation of wave reflections. If the aorta gets stiff with minimal or no change in the periphery, the SG is dissipated transmitting pressure disturbances to the microcirculation. It remains unknown the status of the SG in both women with healthy pregnancies (HP) and complicated by pregnancy-associated hypertension (PAH). Objective: To determine whether HP and PAH are associated with changes in SG. Secondarily, we aim at identifying potential differences between the subgroups of PAH (pre-eclampsia and gestational hypertension). Methods: HP (n = 10), PAH (n = 16), and healthy NP women (n = 401, to be matched for age, and cardiovascular risk with the pregnant women) were included. Carotid-to-femoral (cfPWV) and carotid-to-radial pulse wave velocity (crPWV), common carotid artery (CCA) and brachial artery (BA) diameters and elastic modulus (EM), and regional (cfPWV/crPWV or “PWV ratio”) and local (CCA EM/BA EM or “EM ratio”) SG were quantified. Results: HP showed no changes in PWV ratio compared with NP, in the presence of significantly lower cfPWV and crPWV. HP exhibited higher arterial diameters and lower CCA EM/BA EM compared to NP, without differences with PAH. PAH was associated with a significant increase in the PWV ratio that exceeded the levels of both NP and HP, explained by a lower (although significant) reduction of cfPWV with respect to that observed in HP with respect to NP, and a higher reduction in crPWV with respect to that observed between HP and NP. The blunted reduction in cfPWV observed in PAH coincided with an increase in the CCA EM. Conclusions: Compared with NP, HP was associated with unchanged PWV ratio but with a reduction in CCA EM/BA EM, in the setting of a generalized drop in arterial stiffness. Compared with NP and HP, PAH was associated with an “exaggerated rise” in the PWV ratio without changes in CCA EM/BA EM, in the setting of a blunt reduction in cfPWV but exaggerated crPWV drop. The SG attenuation/reversal in PAH was mainly driven by pre-eclampsia.
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Affiliation(s)
- María M Pereira
- Department of Obstetrics and Gynecology, BronxCare Hospital Center a Clinical Affiliate of Mt Sinai Health Systems and Academic Affiliate of Icahn School of Medicine, Bronx, NY, United States
| | - Juan Torrado
- Department of Internal Medicine, Jacobi Medical Center, Albert Einstein College of Medicine, Bronx, NY, United States
| | - Claudio Sosa
- Department of Obstetrics and Gynecology "C", Pereira-Rossell Hospital, School of Medicine, Republic University, Montevideo, Uruguay
| | - Alejandro Diaz
- Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Tandil, Argentina
| | - Daniel Bia
- Department of Physiology, Centro Universitario de Investigación, Innovación y Diagnóstico Arterial (CUiiDARTE), School of Medicine, Republic University, Montevideo, Uruguay
| | - Yanina Zócalo
- Department of Physiology, Centro Universitario de Investigación, Innovación y Diagnóstico Arterial (CUiiDARTE), School of Medicine, Republic University, Montevideo, Uruguay
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Validation of a new device for photoplethysmographic measurement of multi-site arterial pulse wave velocity. Biocybern Biomed Eng 2021. [DOI: 10.1016/j.bbe.2021.11.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Zócalo Y, Bia D. Sex- and Age-Related Physiological Profiles for Brachial, Vertebral, Carotid, and Femoral Arteries Blood Flow Velocity Parameters During Growth and Aging (4-76 Years): Comparison With Clinical Cut-Off Levels. Front Physiol 2021; 12:729309. [PMID: 34512398 PMCID: PMC8427671 DOI: 10.3389/fphys.2021.729309] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Accepted: 07/26/2021] [Indexed: 02/04/2023] Open
Abstract
Ultrasound-derived blood flow velocity (BFV) levels [e.g., peak systolic velocity (PSV)], intrabeat indexes (e.g., resistive), and intersegment ratios [e.g., internal/common carotid artery (ICA/CCA) PSV ratio] are assessed to describe cardiovascular physiology and health status (e.g., disease severity evaluation and/or risk stratification). In this respect, fixed cut-off values (disregard of age or sex) have been proposed to define “significant” vascular disease from BFV-derived data (parameters). However, the use of single fixed cut-off values has limitations. Accurate use of BFV-derived parameters requires knowing their physiological age-related profiles and the expected values for a specific subject. To our knowledge, there are no studies that have characterized BFV profiles in large populations taking into account: (i) data from different age-stages (as a continuous) and transitions (childhood–adolescence–adulthood), (ii) complementary parameters, (iii) data from different arteries, and (iv) potential sex- and hemibody-related differences. Furthermore, (v) there is little information regarding normative data [reference intervals (RIs)] for BFV indexes. Aims: The aims of this study are the following: (a) to determine the need for age-, body side-, and sex-specific profiles for BFV levels and derived parameters (intrabeat indexes and intersegment ratios), and (b) to define RIs for BFV levels and parameters, obtained from CCA, ICA, external carotid, vertebral, femoral, and brachial arteries records. Methods: A total of 3,619 subjects (3–90 years) were included; 1,152 were healthy (without cardiovascular disease and atheroma plaques) and non-exposed to cardiovascular risk factors. BFV data were acquired. The agreement between left and right data was analyzed (Concordance correlation, Bland–Altman). Mean and SD equations and age-related profiles were obtained for BFV levels and parameters (regression methods; fractional polynomials). Results: Left and right body-side derived data were not always equivalent. The need for sex-specific RIs was dependent on the parameter and/or age considered. RIs were defined for each studied artery and parameter. Percentile curves were compared with recommended fixed cut-off points. The equations for sex, body-side, and age-specific BFV physiological profiles obtained in the large population (of children, adolescents, and adults) studied were included (spreadsheet formats), enabling to determine for a particular subject, the expected values and potential data deviations.
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Affiliation(s)
- Yanina Zócalo
- Physiology Department, School of Medicine, CUiiDARTE, Republic University, Montevideo, Uruguay
| | - Daniel Bia
- Physiology Department, School of Medicine, CUiiDARTE, Republic University, Montevideo, Uruguay
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Age- and sex-related profiles for macro, macro/micro and microvascular reactivity indexes: Association between indexes and normative data from 2609 healthy subjects (3-85 years). PLoS One 2021; 16:e0254869. [PMID: 34280235 PMCID: PMC8289111 DOI: 10.1371/journal.pone.0254869] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Accepted: 07/05/2021] [Indexed: 02/07/2023] Open
Abstract
Vascular reactivity (VR), defined as blood vessels’ capability to actively modify the diameter and flow resistances can be non-invasively assessed analyzing vascular response to forearm occlusion. Several VR indexes can be quantified: (i) ´microvascular´, which consider variables that depend almost exclusively on changes in distal resistances, (ii)´ macrovascular´, that evaluate the changes in brachial artery (BA) diameter, adjusting for blood flow stimulus, and (iii) ´macro/micro´, whose values depend on the micro and macrovascular response without discriminating each one´s contribution. VR indexes could not be associated. Many VR indexes have been used without availability of adequate normative data (reference intervals, RIs). Aims: (1) to evaluate macro, macro/micro and micro VR indexes obtained in a cohort of healthy children, adolescents and adults, (2) to evaluate the association between VR indexes, (3) to determine the need for age and/or sex-specific RIs, and (4) to define RIs for VR indexes. Methods: Ultrasound (B-mode/Doppler) and automatic computerized analysis were used to assess BA diameter, blood flow velocity and distal resistances, at rest and in conditions of decreased and increased blood flow. Macro, macro/micro and micro VR indexes were quantified (n = 3619). RIs-subgroups were defined according to European Reference Values for Arterial Measurements Collaboration Group (n = 1688, 3–84 years) and HUNT3-Fitness Study Group (n = 2609, 3–85 years) criteria. Mean value and standard deviation equations were obtained for VR indexes. The need for age or sex-specific RIs was analyzed. Percentile curves were defined and data were compared with those obtained in other populations. Conclusion: Macro and macro/micro VR indexes showed no association (or it was very weak) with microvascular indexes. Age- and sex-related profiles and RIs for macro, macro/micro and micro VR indexes were defined in a large population of healthy subjects (3–85 y). Equations for mean, standard deviation and percentiles values (year-to-year) were included in text and spreadsheet formats.
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Physical Activity, Sedentary Behavior and Sleep Time:Association with Cardiovascular Hemodynamic Parameters, Blood Pressure and Structural and Functional Arterial Properties in Childhood. J Cardiovasc Dev Dis 2021; 8:jcdd8060062. [PMID: 34072999 PMCID: PMC8227229 DOI: 10.3390/jcdd8060062] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Revised: 05/10/2021] [Accepted: 05/21/2021] [Indexed: 12/14/2022] Open
Abstract
An association between movement behavior (MB) components (sleep time (ST), physical activity (PA) and sedentary behavior (SB)) and the state of the cardiovascular (CV) system in children has been postulated. However, it is still controversial whether MB components and/or sub-components (domains) during childhood are independently associated with aortic and peripheral blood pressure (BP), and structural or functional arterial properties. Aims: (1) to evaluate MB components and subcomponents associations with CV characteristics, (2) to analyze the explanatory capacity of interindividual variations in MB on CV properties inter-individual variations at the beginning of school age. Methods: Anthropometric, aortic and peripheral BP, hemodynamic levels (cardiac output, systemic vascular resistances), wave reflection indexes, and arterial structural (diameter, intima–media thickness) and functional (blood flow velocities, Doppler-indexes, local and regional arterial stiffness) parameters of elastic (carotids), transitional (brachial) and muscular (femoral) arteries and time spent in MB (PA questionnaires) were assessed in 816 children (5–6 years). Cardiovascular variables were standardized (z-scores), using age- and sex-related mean values and standard deviations obtained from subjects non-exposed to CV risk factors (CRFs) and who complied with 24 h MB recommendations (reference subgroup). Multiple linear regression models were constructed considering the CV z-scores as dependent variables and CRFs and MB components and subcomponents as independent variables. Results: CV variables showed independent association with MB variations. However, their explanatory capacity on CV characteristics was lesser than that of anthropometric indexes, sex and/or high BP. Conclusions: MB components and sub-components were associated with CV characteristics regardless of other factors, but their capacity to explain variations was lesser than that of anthropometric data, sex or high BP state. MB subcomponents (e.g., sedentary play and screen time in case of SB) showed different (even opposite) associations with CV parameters. ST was associated mainly with indexes of the ventricle ejective function, rather than with CV structural characteristics. SB component and subcomponents were associated with BP, but not with structural parameters. PA component and subcomponents were associated with both BP and structural parameters. The different arterial types, as well central and peripheral parameters showed independent associations with MB components and subcomponents. None of these were independently associated with arterial stiffness.
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