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Liu H, Zhu S, Xia G, Huang Z, Han W, Li Z, Liu C. Effects of 1,4-dihydropyridine derivatives on cell injury and mTOR of HepG2 and 3D-QSAR study. Comput Biol Chem 2024; 109:108010. [PMID: 38232515 DOI: 10.1016/j.compbiolchem.2023.108010] [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: 08/30/2023] [Revised: 12/26/2023] [Accepted: 12/27/2023] [Indexed: 01/19/2024]
Abstract
1,4-dihydropyridine derivatives (1,4-DHPs) are a class of drugs used to treat cardiovascular diseases, but these drugs can cause liver injury. To reveal the toxicity characteristics of these compounds, we used a series of assays, including cell viability, enzyme activity detection, and western blotting, to investigate the toxicity of seven kinds of 1,4-DHPs (0-100 μM) on HepG2 cells and establish 3D-QSAR model based on relevant toxicity data. After HepG2 cells were treated with 1,4-DHPs for 24 h, high-dose (100 μM) 1,4-DHPs decreased cell viability to varying degrees, while ROS and MDA contents were significantly increased, and ATP content was reduced. Moreover, with the concentration of 100 μM 1,4-DHPs (Nimodipine, Nitrendipine, Cilnidipine, and Manidipine) were markedly inhibited the phosphorylation levels of mTOR protein. The results of the 3D-QSAR model showed that the non-cross validation coefficient (R2) and cross validation coefficient (Q2) of the model were 0.982 and 0.652, respectively. Combined with external validation and the Williams diagram, the model showed good predictability and application domain. Based on the CoMSIA 3D contour map, the introduction of large volume and hydrogen bond receptor groups on the carbonyl oxygen side chains of the 1,4-DHPs ring 3- and 5- was beneficial for reducing the toxicity of 1,4-DHPs. The results of this study could supplement information on the cytotoxicity of 1,4-DHPs, and could provide theoretical support for predicting the toxicity of 1,4-DHPs.
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Affiliation(s)
- Huan Liu
- Guangdong Provincial Key Laboratory of Food Quality and Safety, College of Food Science, South China Agricultural University, Guangzhou 510642, China; Hubei Key Laboratory of Edible Wild Plants Conservation and Utilization, Hubei Normal University, Huangshi 435002, China
| | - Siyu Zhu
- SCAU (Chaozhou) Food Institute Co., Ltd., Chaozhou 521000, China; Guangdong Provincial Key Laboratory of Food Quality and Safety, College of Food Science, South China Agricultural University, Guangzhou 510642, China
| | - Guiqiong Xia
- Guangdong Provincial Key Laboratory of Food Quality and Safety, College of Food Science, South China Agricultural University, Guangzhou 510642, China
| | - Zhuoquan Huang
- SCAU (Chaozhou) Food Institute Co., Ltd., Chaozhou 521000, China; Guangdong Provincial Key Laboratory of Food Quality and Safety, College of Food Science, South China Agricultural University, Guangzhou 510642, China
| | - Wenna Han
- Guangdong Provincial Key Laboratory of Food Quality and Safety, College of Food Science, South China Agricultural University, Guangzhou 510642, China
| | - Zhongyi Li
- Guangdong Provincial Key Laboratory of Food Quality and Safety, College of Food Science, South China Agricultural University, Guangzhou 510642, China
| | - Chunhong Liu
- SCAU (Chaozhou) Food Institute Co., Ltd., Chaozhou 521000, China; Guangdong Provincial Key Laboratory of Food Quality and Safety, College of Food Science, South China Agricultural University, Guangzhou 510642, China.
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Zhao S, Li Y, Su C. Assessment of common risk factors of diabetes and chronic kidney disease: a Mendelian randomization study. Front Endocrinol (Lausanne) 2023; 14:1265719. [PMID: 37780623 PMCID: PMC10535100 DOI: 10.3389/fendo.2023.1265719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2023] [Accepted: 08/25/2023] [Indexed: 10/03/2023] Open
Abstract
Background The increasing prevalence of diabetes and its significant impact on mortality and morbidity rates worldwide has led to a growing interest in understanding its common risk factors, particularly in relation to chronic kidney disease (CKD). This research article aims to investigate the shared risk factors between type 1 diabetes (T1D), type 2 diabetes (T2D), and CKD using a Mendelian randomization (MR) design. Methods The study utilized genome-wide association study (GWAS) datasets for T1D, T2D, and CKD from the FinnGen research project. GWAS summary statistics datasets for 118 exposure traits were obtained from the IEU OpenGWAS database. MR analyses were conducted to examine the causal relationships between exposure traits and each of the three outcomes. Multiple methods, including inverse-variance weighted, weighted median, and MR-Egger, were employed for the MR studies. Results Phenome-wide MR analyses revealed that eosinophil percentage exhibited a significant and suggestive causal association with T1D and CKD, respectively, suggesting its potential as a shared risk factor for T1D and CKD. For T2D, 34 traits demonstrated significant associations. Among these 34 traits, 14 were also significantly associated with CKD, indicating the presence of common risk factors between T2D and CKD, primarily related to obesity, height, blood lipids and sex hormone binding globulin, blood pressure, and walking pace. Conclusion This research has uncovered the eosinophil percentage as a potential common risk factor for both T1D and CKD, while also identifying several traits, such as obesity and blood lipids, as shared risk factors for T2D and CKD. This study contributes to the understanding of the common risk factors between diabetes and CKD, emphasizing the need for targeted interventions to reduce the risk of these diseases.
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Affiliation(s)
- Shuwu Zhao
- Department of Pain, Hunan Cancer Hospital/The Affiliated Cancer Hospital of Xiangya School of Medicine, Changsha, Hunan, China
| | - Yiming Li
- School of Basic Medicine Science, Naval Medical University/Second Military University, Shanghai, China
| | - Chen Su
- Department of Pain, Hunan Cancer Hospital/The Affiliated Cancer Hospital of Xiangya School of Medicine, Changsha, Hunan, China
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3
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Sági B, Vas T, Jakabfi-Csepregi R, Horváth-Szalai Z, Kőszegi T, Csiky B, Nagy J, Kovács TJ. The Role of Two Heart Biomarkers in IgA Nephropathy. Int J Mol Sci 2023; 24:10336. [PMID: 37373483 DOI: 10.3390/ijms241210336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Revised: 06/12/2023] [Accepted: 06/17/2023] [Indexed: 06/29/2023] Open
Abstract
Cardiovascular mortality is a leading cause of death in chronic kidney disease (CKD), as is IgA nephropathy (IgAN). The purpose of this study is to find different biomarkers to estimate the outcome of the disease, which is significantly influenced by the changes in vessels (characterized by arterial stiffness) and the heart. In our cross-sectional study, 90 patients with IgAN were examined. The N-terminal prohormone of brain natriuretic peptide (NT-proBNP) was measured as a heart failure biomarker by an automated immonoassay method, while the carboxy-terminal telopeptide of collagen type I (CITP) as a fibrosis marker was determined using ELISA kits. Arterial stiffness was determined by measuring carotid-femoral pulse wave velocity (cfPWV). Renal function and routine echocardiography examinations were performed as well. Based on eGFR, patients were separated into two categories, CKD 1-2 and CKD 3-5. There were significantly higher NT-proBNP (p = 0.035), cfPWV (p = 0.004), and central aortic systolic pressure (p = 0.037), but not CITP, in the CKD 3-5 group. Both biomarker positivities were significantly higher in the CKD 3-5 group (p = 0.035) compared to the CKD 1-2 group. The central aortic systolic pressure was significantly higher in the diastolic dysfunction group (p = 0.034), while the systolic blood pressure was not. eGFR and hemoglobin levels showed a strong negative correlation, while left ventricular mass index (LVMI), aortic pulse pressure, central aortic systolic pressure, and cfPWV showed a positive correlation with NT-proBNP. cfPWV, aortic pulse pressure, and LVMI showed a strong positive correlation with CITP. Only eGFR was an independent predictor of NT-proBNP by linear regression analysis. NT-proBNP and CITP biomarkers may help to identify IgAN patients at high risk for subclinical heart failure and further atherosclerotic disease.
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Affiliation(s)
- Balázs Sági
- 2nd. Department of Internal Medicine and Nephrology, Diabetes Center, Clinical Center, Medical School, University of Pécs, 7624 Pécs, Hungary
- Fresenius Medical Care Dialysis Center, 7624 Pécs, Hungary
| | - Tibor Vas
- 2nd. Department of Internal Medicine and Nephrology, Diabetes Center, Clinical Center, Medical School, University of Pécs, 7624 Pécs, Hungary
| | - Rita Jakabfi-Csepregi
- Department of Laboratory Medicine, Medical School, University of Pécs, 7624 Pécs, Hungary
- Szentágothai Research Center, University of Pécs, 7624 Pécs, Hungary
| | - Zoltán Horváth-Szalai
- Department of Laboratory Medicine, Medical School, University of Pécs, 7624 Pécs, Hungary
| | - Tamás Kőszegi
- Department of Laboratory Medicine, Medical School, University of Pécs, 7624 Pécs, Hungary
- Szentágothai Research Center, University of Pécs, 7624 Pécs, Hungary
| | - Botond Csiky
- 2nd. Department of Internal Medicine and Nephrology, Diabetes Center, Clinical Center, Medical School, University of Pécs, 7624 Pécs, Hungary
- Fresenius Medical Care Dialysis Center, 7624 Pécs, Hungary
| | - Judit Nagy
- 2nd. Department of Internal Medicine and Nephrology, Diabetes Center, Clinical Center, Medical School, University of Pécs, 7624 Pécs, Hungary
| | - Tibor József Kovács
- 2nd. Department of Internal Medicine and Nephrology, Diabetes Center, Clinical Center, Medical School, University of Pécs, 7624 Pécs, Hungary
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Scalia A, Ghafari C, Navarre W, Delmotte P, Phillips R, Carlier S. High Fidelity Pressure Wires Provide Accurate Validation of Non-Invasive Central Blood Pressure and Pulse Wave Velocity Measurements. Biomedicines 2023; 11:biomedicines11041235. [PMID: 37189852 DOI: 10.3390/biomedicines11041235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 04/12/2023] [Accepted: 04/17/2023] [Indexed: 05/17/2023] Open
Abstract
Central blood pressure (cBP) is known to be a better predictor of the damage caused by hypertension in comparison with peripheral blood pressure. During cardiac catheterization, we measured cBP in the ascending aorta with a fluid-filled guiding catheter (FF) in 75 patients and with a high-fidelity micromanometer tipped wire (FFR) in 20 patients. The wire was withdrawn into the brachial artery and aorto-brachial pulse wave velocity (abPWV) was calculated from the length of the pullback and the time delay between the ascending aorta and the brachial artery pulse waves by gating to the R-wave of the ECG for both measurements. In 23 patients, a cuff was inflated around the calf and an aorta-tibial pulse wave velocity (atPWV) was calculated from the distance between the cuff around the leg and the axillary notch and the time delay between the ascending aorta and the tibial pulse waves. Brachial BP was measured non-invasively and cBP was estimated using a new suprasystolic oscillometric technology. The mean differences between invasively measured cBP by FFR and non-invasive estimation were -0.4 ± 5.7 mmHg and by FF 5.4 ± 9.4 mmHg in 52 patients. Diastolic and mean cBP were both overestimated by oscillometry, with mean differences of -8.9 ± 5.5 mmHg and -6.4 ± 5.1 mmHg compared with the FFR and -10.6 ± 6.3 mmHg and -5.9 ± 6.2 mmHg with the FF. Non-invasive systolic cBP compared accurately with the high-fidelity FFR measurements, demonstrating a low bias (≤5 mmHg) and high precision (SD ≤ 8 mmHg). These criteria were not met when using the FF measurements. Invasively derived average Ao-brachial abPWV was 7.0 ± 1.4 m/s and that of Ao-tibial atPWV was 9.1 ± 1.8 m/s. Non-invasively estimated PWV based on the reflected wave transit time did not correlate with abPWV or with atPWV. In conclusion, we demonstrate the advantages of a novel method of validation for non-invasive cBP monitoring devices using acknowledged gold standard FFR wire transducers and the possibility to easily measure PWV during coronary angiography with the impact of cardiovascular risk factors.
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Affiliation(s)
- Alessandro Scalia
- Department of Cardiology, Centre Hospitalier Universitaire Ambroise Paré, 7000 Mons, Belgium
- Department of Cardiology, UMONS Research Institute for Health Sciences and Technology, University of Mons (UMONS), 7000 Mons, Belgium
| | - Chadi Ghafari
- Department of Cardiology, UMONS Research Institute for Health Sciences and Technology, University of Mons (UMONS), 7000 Mons, Belgium
| | - Wivine Navarre
- Faculty of Medicine, Université Libre de Bruxelles, 1070 Bruxelles, Belgium
| | - Philippe Delmotte
- Department of Cardiology, Centre Hospitalier Universitaire Ambroise Paré, 7000 Mons, Belgium
| | - Rob Phillips
- The School of Medicine, The University of Queensland, Brisbane 4072, Australia
| | - Stéphane Carlier
- Department of Cardiology, Centre Hospitalier Universitaire Ambroise Paré, 7000 Mons, Belgium
- Department of Cardiology, UMONS Research Institute for Health Sciences and Technology, University of Mons (UMONS), 7000 Mons, Belgium
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Murphy L, Chase JG. Single measurement estimation of central blood pressure using an arterial transfer function. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2023; 229:107254. [PMID: 36459818 DOI: 10.1016/j.cmpb.2022.107254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Revised: 11/16/2022] [Accepted: 11/17/2022] [Indexed: 06/17/2023]
Abstract
BACKGROUND Central blood pressure (BP) better reflects the loading conditions on the major organs and is more closely correlated with future cardiovascular events. The increased invasiveness and risk of infection prevents the routine measurement of central BP. Arterial transfer functions can provide central BP estimates from clinically available peripheral measurements. However, current methods are either generalized, potentially lacking the ability to adapt to inter and intra subject variability, or individualized based on additional, clinically unavailable, pulse transit time measurements. This work proposes a novel, self-contained method for individualizing an arterial transfer function from a single peripheral pressure measurement, capable of accurately estimating central BP in a range of hemodynamic conditions. METHODS Pulse wave analysis of femoral BP waves was employed to formulate initial approximations of central BP and arterial inlet flow waveforms, to serve as objective functions for the identification of all model parameters. Root mean squared error (RMSE), and systolic and pulse pressure errors were assessed with respect to invasive aortic BP measurements in a seven (7) porcine endotoxin experiments. Systolic and pulse pressure errors were analysed using Bland-Altman analysis. Method accuracy is also compared with an idealized transfer function, derived using the measured aortic-femoral pulse transit time and minimizing the RMSE of model output pressure with respect to reference aortic pressure, a generalized transfer function model, and invasive femoral pressure measurements. RESULTS Mean bias and limits of agreement (95% CI) for the proposed method were 1.0(-4.6, 6.7)mmHg and -1.0(-6.6, 4.6)mmHg for systolic and pulse pressure, respectively, compared to 3.6(-0.9, 8.2)mmHg and 2.7(-1.8, 7.3)mmHg for the generalized transfer function model. Mean bias and limits of agreement for femoral pressure measurements were -6.4(-15.0, 2.3)mmHg and -9.4(-18.1, -0.8)mmHg, for systolic and pulse pressure, respectively. The pooled mean and standard deviation of the RMSE produced by the single measurement method, relative to reference aortic pressure, was 4.3(1.1)mmHg, consistent with estimates produced by the idealized transfer function, 3.9(1.2)mmHg, and improving of the generalized transfer function, 4.6(1.4)mmHg. CONCLUSIONS The proposed single measurement method provides accurate central BP estimates from routinely available peripheral pressure measurements, and nothing else. The method allows for the individualization of transfer functions on a per patient basis to better capture changes in patient condition during the progression of disease and subsequent treatment, at no additional clinical cost.
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Affiliation(s)
- Liam Murphy
- Department of Mechanical Engineering, University of Canterbury, 20 Kirkwood Avenue, Christchurch, New Zealand.
| | - J Geoffrey Chase
- Department of Mechanical Engineering, University of Canterbury, 20 Kirkwood Avenue, Christchurch, New Zealand
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Circulating fibroblast growth factor 21 links hemodynamics with kidney function in middle-aged and older adults: A mediation analysis. Hypertens Res 2022; 45:125-134. [PMID: 34690353 DOI: 10.1038/s41440-021-00782-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Revised: 09/08/2021] [Accepted: 09/14/2021] [Indexed: 02/08/2023]
Abstract
Altered hemodynamics are commonly observed in individuals with declining renal function; however, the pathophysiological mechanisms linking renal dysfunction and hemodynamics have not been fully elucidated. Fibroblast growth factor 21 (FGF21), which upregulates sympathetic nerve activity, can alter systemic hemodynamics, and its level can increase as renal function declines. This study aimed to determine the associations among circulating FGF21 levels, hemodynamics, and renal function in middle-aged and older adults. In a total of 272 middle-aged and older adults (age range: 46-83 years), estimated glomerular filtration rate (eGFR), hemodynamics (brachial and aortic blood pressure and aortic pulse wave velocity [PWV]), and serum FGF21 levels were measured. For mediation analysis, hemodynamic parameters were entered as outcomes. eGFR or log-transformed urinary albumin and creatinine ratio (UACR) and log-transformed serum FGF21 levels were set as the predictors and mediator, respectively. According to multivariable regression models after adjusting for potential covariates, serum FGF21 levels were significantly associated with brachial systolic blood pressure (β = 0.140), pulse pressure (β = 0.136), and aortic PWV (β = 0.144). Mediation analyses showed that serum FGF21 levels significantly mediated the relationship of eGFR with brachial systolic blood pressure (indirect effect [95% confidence interval]: -0.032 [-0.071, -0.002]), pulse pressure (-0.019 [-0.041, -0.001]), and aortic PWV (-0.457 [-1.053, -0.021]) and the relationship of UACR with aortic PWV (7.600 [0.011, 21.148]). These findings suggest that elevated circulating FGF21 levels partially mediate the association of elevated blood pressure and/or aortic stiffness with renal dysfunction in middle-aged and older adults.
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Khatir DS, Carlsen RK, Ivarsen P, Jespersen B, Pedersen M, Christensen KL, Buus NH. Effects of enhanced versus reduced vasodilating treatment on brachial and central blood pressure in patients with chronic kidney disease: a randomized controlled trial. J Hypertens 2021; 39:2232-2240. [PMID: 34313633 DOI: 10.1097/hjh.0000000000002942] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Blood pressure (BP) control is important in chronic kidney disease (CKD), but a reduction in brachial BP may not mirror changes in central aortic BP (cBP) during antihypertensive medication. We hypothesize that a fall in cBP is better reflected during enhanced vasodilation treatment (EVT) compared with reduced vasodilation treatment (RVT) because of different hemodynamic actions of these interventions. METHODS Eighty-one hypertensive CKD stage 3-4 patients (mean measured glomerular filtration rate 36 ml/min per 1.73 m2) were randomized to either EVT based on renin--angiotensin blockade and/or amlodipine or RVT based on nonvasodilating β-blockade (metoprolol). Before randomization and following 18 months of treatment, we performed 24-h ambulatory BP measurements (ABPM) and radial artery pulse wave analysis for estimation of cBP and augmentation index (AIx). Forearm resistance (Rrest) was determined by venous occlusion plethysmography and arterial stiffness by carotid--femoral pulse wave velocity (PWV). Matched healthy controls were studied once for comparison. RESULTS Compared with controls, CKD patients had elevated ABPM, cBP and PWV. Although ABPM remained unchanged from baseline to follow-up in both treatment groups, cBP decreased 4.7/2.9 mmHg (systolic/diastolic) during EVT and increased 5.1/1.5 mmHg during RVT (Δ=9.8/4.4 mmHg, P=0.02 for SBP, P = 0.05 for DBP). At follow-up, the difference between systolic cBP and 24-h ABPM (ΔBPsyst) was negatively associated with heart rate and positively associated with AIx and Rrest (all P < 0.01) but not PWV (P = 0.32). CONCLUSION In CKD patients, EVT and RVT have opposite effects on cBP and the difference between cBP and ambulatory BP is larger for EVT than RVT.
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Affiliation(s)
| | | | - Per Ivarsen
- Department of Renal Medicine, Aarhus University Hospital
| | | | - Michael Pedersen
- Comparative Medicine Lab, Department of Clinical Medicine, Aarhus University
| | | | - Niels Henrik Buus
- Department of Renal Medicine, Aarhus University Hospital
- Department of Biomedicine, Aarhus University, Aarhus, Denmark
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Flores Gerónimo J, Corvera Poiré E, Chowienczyk P, Alastruey J. Estimating Central Pulse Pressure From Blood Flow by Identifying the Main Physical Determinants of Pulse Pressure Amplification. Front Physiol 2021; 12:608098. [PMID: 33708133 PMCID: PMC7940670 DOI: 10.3389/fphys.2021.608098] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Accepted: 01/18/2021] [Indexed: 12/30/2022] Open
Abstract
Several studies suggest that central (aortic) blood pressure (cBP) is a better marker of cardiovascular disease risk than peripheral blood pressure (pBP). The morphology of the pBP wave, usually assessed non-invasively in the arm, differs significantly from the cBP wave, whose direct measurement is highly invasive. In particular, pulse pressure, PP (the amplitude of the pressure wave), increases from central to peripheral arteries, leading to the so-called pulse pressure amplification (ΔPP). The main purpose of this study was to develop a methodology for estimating central PP (cPP) from non-invasive measurements of aortic flow and peripheral PP. Our novel approach is based on a comprehensive understanding of the main cardiovascular properties that determine ΔPP along the aortic-brachial arterial path, namely brachial flow wave morphology in late systole, and vessel radius and distance along this arterial path. This understanding was achieved by using a blood flow model which allows for workable analytical solutions in the frequency domain that can be decoupled and simplified for each arterial segment. Results show the ability of our methodology to (i) capture changes in cPP and ΔPP produced by variations in cardiovascular properties and (ii) estimate cPP with mean differences smaller than 3.3 ± 2.8 mmHg on in silico data for different age groups (25-75 years old) and 5.1 ± 6.9 mmHg on in vivo data for normotensive and hypertensive subjects. Our approach could improve cardiovascular function assessment in clinical cohorts for which aortic flow wave data is available.
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Affiliation(s)
- Joaquín Flores Gerónimo
- Department of Biomedical Engineering, School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom
- *Correspondence: Joaquín Flores Gerónimo
| | - Eugenia Corvera Poiré
- Departamento de Física y Química Teórica, Facultad de Química, Universidad Nacional Autónoma de México, Ciudad Universitaria, Mexico City, Mexico
- Universitat de Barcelona Institute of Complex Systems (UBICS), Universitat de Barcelona, Barcelona, Spain
| | - Philip Chowienczyk
- Department of Clinical Pharmacology, British Heart Foundation Centre, St Thomas' Hospital, King's College London, London, United Kingdom
| | - Jordi Alastruey
- Department of Biomedical Engineering, School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom
- World-Class Research Center, Digital Biodesign and Personalized Healthcare, Sechenov University, Moscow, Russia
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9
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Mariscal-Harana J, Charlton PH, Vennin S, Aramburu J, Florkow MC, van Engelen A, Schneider T, de Bliek H, Ruijsink B, Valverde I, Beerbaum P, Grotenhuis H, Charakida M, Chowienczyk P, Sherwin SJ, Alastruey J. Estimating central blood pressure from aortic flow: development and assessment of algorithms. Am J Physiol Heart Circ Physiol 2020; 320:H494-H510. [PMID: 33064563 PMCID: PMC7612539 DOI: 10.1152/ajpheart.00241.2020] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Central blood pressure (cBP) is a highly prognostic cardiovascular (CV) risk factor whose accurate, invasive assessment is costly and carries risks to patients. We developed and assessed novel algorithms for estimating cBP from noninvasive aortic hemodynamic data and a peripheral blood pressure measurement. These algorithms were created using three blood flow models: the two- and three-element Windkessel (0-D) models and a one-dimensional (1-D) model of the thoracic aorta. We tested new and existing methods for estimating CV parameters (left ventricular ejection time, outflow BP, arterial resistance and compliance, pulse wave velocity, and characteristic impedance) required for the cBP algorithms, using virtual (simulated) subjects (n = 19,646) for which reference CV parameters were known exactly. We then tested the cBP algorithms using virtual subjects (n = 4,064), for which reference cBP were available free of measurement error, and clinical datasets containing invasive (n = 10) and noninvasive (n = 171) reference cBP waves across a wide range of CV conditions. The 1-D algorithm outperformed the 0-D algorithms when the aortic vascular geometry was available, achieving central systolic blood pressure (cSBP) errors≤2.1 ± 9.7mmHg and root-mean-square errors (RMSEs)≤6.4 ± 2.8mmHg against invasive reference cBP waves (n = 10). When the aortic geometry was unavailable, the three-element 0-D algorithm achieved cSBP errors ≤ 6.0 ± 4.7mmHg and RMSEs ≤ 5.9 ± 2.4mmHg against noninvasive reference cBP waves (n = 171), outperforming the two-element 0-D algorithm. All CV parameters were estimated with mean percentage errors ≤ 8.2%, except for the aortic characteristic impedance (≤13.4%), which affected the three-element 0-D algorithm’s performance. The freely available algorithms developed in this work enable fast and accurate calculation of the cBP wave and CV parameters in datasets containing noninvasive ultrasound or magnetic resonance imaging data.
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Affiliation(s)
- Jorge Mariscal-Harana
- Department of Biomedical Engineering, School of Biomedical Engineering and Imaging Sciences, King's College London, King's Health Partners, London, United Kingdom
| | - Peter H Charlton
- Department of Biomedical Engineering, School of Biomedical Engineering and Imaging Sciences, King's College London, King's Health Partners, London, United Kingdom
| | - Samuel Vennin
- Department of Biomedical Engineering, School of Biomedical Engineering and Imaging Sciences, King's College London, King's Health Partners, London, United Kingdom.,Department of Clinical Pharmacology, King's College London, King's Health Partners, London , United Kingdom
| | - Jorge Aramburu
- TECNUN Escuela de Ingenieros, Universidad de Navarra, Donostia-San Sebastián, Spain
| | - Mateusz Cezary Florkow
- Department of Biomedical Engineering, School of Biomedical Engineering and Imaging Sciences, King's College London, King's Health Partners, London, United Kingdom.,Philips Research, Cambridge, United Kingdom
| | - Arna van Engelen
- Department of Biomedical Engineering, School of Biomedical Engineering and Imaging Sciences, King's College London, King's Health Partners, London, United Kingdom
| | - Torben Schneider
- Philips Healthcare UK, Philips Centre, Guildford Business Park, Guildford, Surrey, United Kingdom
| | - Hubrecht de Bliek
- HSDP Clinical Platforms, Philips Healthcare, Eindhoven, The Netherlands
| | - Bram Ruijsink
- Department of Biomedical Engineering, School of Biomedical Engineering and Imaging Sciences, King's College London, King's Health Partners, London, United Kingdom.,Department of Cardiology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Israel Valverde
- Department of Biomedical Engineering, School of Biomedical Engineering and Imaging Sciences, King's College London, King's Health Partners, London, United Kingdom.,Cardiovascular Pathophysiology, Institute of Biomedicine of Seville, University Hospital of Virgen del Rocío, University of Seville, CIBERCV, CSIC, Seville, Spain
| | - Philipp Beerbaum
- Department of Pediatric Cardiology and Intensive Care, Hannover Medical School, Hannover, Germany
| | - Heynric Grotenhuis
- Department of Pediatric Cardiology, University Medical Center Utrecht/Wilhelmina Children's Hospital, Utrecht, The Netherlands
| | - Marietta Charakida
- Department of Biomedical Engineering, School of Biomedical Engineering and Imaging Sciences, King's College London, King's Health Partners, London, United Kingdom
| | - Phil Chowienczyk
- Department of Clinical Pharmacology, King's College London, King's Health Partners, London , United Kingdom
| | - Spencer J Sherwin
- Department of Aeronautics, South Kensington Campus, Imperial College London, London, United Kingdom
| | - Jordi Alastruey
- Department of Biomedical Engineering, School of Biomedical Engineering and Imaging Sciences, King's College London, King's Health Partners, London, United Kingdom.,Institute of Personalized Medicine, Sechenov University, Moscow, Russia
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Zuo J, Hu Y, Chang G, Chu SL, Tan I, Butlin M, Avolio A. Relationship between arterial stiffness and chronic kidney disease in patients with primary hypertension. J Hum Hypertens 2019; 34:577-585. [PMID: 31664172 DOI: 10.1038/s41371-019-0275-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2019] [Revised: 10/08/2019] [Accepted: 10/10/2019] [Indexed: 11/09/2022]
Abstract
To investigate the association of noninvasive indices of arterial stiffness with chronic kidney disease (CKD) in patients with primary hypertension, 547 (mean age 60 years, 63% males) hypertensive hospital inpatients were recruited, comprising 337 hypertensives without CKD and 210 hypertensives with CKD. Noninvasive arterial stiffness indices were obtained, including central arterial haemodynamics derived from the radial artery waveform using SphygmoCor V8.0 system, carotid-femoral pulse wave velocity (cfPWV), large and small artery elasticity indices (C1, C2 respectively). Intima-media thickness (IMT) was evaluated by ultrasonography. The diagnosis of CKD was assessed by the estimated glomerular filtration rate (eGFR) or urinary albumin creatinine ratio (ACR). Compared with hypertension without CKD, hypertensive patients with CKD were older, had higher central systolic blood pressure, cfPWV, and IMT (all P < 0.01). With decreasing eGFR, cfPWV and augmentation index adjusted to heart rate of 75 bpm increased progressively whereas C2 decreased (P < 0.05) in subjects with CKD. In the overall population, cfPWV showed a significant trend of a negative association with eGFR (P = 0.04) after adjusting for age, gender, and brachial systolic blood pressure. Multiple logistic analysis showed that 1 SD (3 m/s) increase in cfPWV entailed a 1.35 (95% Cl: 1.018-1.790) times higher likelihood of the presence of CKD even after adjustment for confounding factors. The association of arterial stiffness and CKD suggests that cfPWV may be a potential hemodynamic index to evaluate cardiovascular risk in CKD patients with primary hypertension.
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Affiliation(s)
- Junli Zuo
- Department of Hypertension, Ruijin Hospital North, Shanghai Jiao Tong University School of Medicine, Shanghai, China. .,Department of Geriatrics, Ruijin Hospital North, Shanghai Jiao Tong University School of Medicine, Shanghai, China. .,Department of Biomedical Sciences, Faculty of Medicine and Health Sciences, Macquarie University, Sydney, Australia.
| | - Yueliang Hu
- Department of Geriatrics, Ruijin Hospital North, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Guili Chang
- Department of Hypertension, Ruijin Hospital North, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Shao-Li Chu
- Department of Hypertension, Ruijin Hospital North, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Isabella Tan
- Department of Biomedical Sciences, Faculty of Medicine and Health Sciences, Macquarie University, Sydney, Australia
| | - Mark Butlin
- Department of Biomedical Sciences, Faculty of Medicine and Health Sciences, Macquarie University, Sydney, Australia
| | - Alberto Avolio
- Department of Biomedical Sciences, Faculty of Medicine and Health Sciences, Macquarie University, Sydney, Australia
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Kirkham FA, Rankin P, Parekh N, Holt SG, Rajkumar C. Aortic stiffness and central systolic pressure are associated with ambulatory orthostatic BP fall in chronic kidney disease. J Nephrol 2019; 33:317-324. [PMID: 31598911 DOI: 10.1007/s40620-019-00655-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Accepted: 09/24/2019] [Indexed: 10/25/2022]
Abstract
OBJECTIVE Orthostatic hypotension (OH) has a significant association with cardiovascular disease. OH becomes more common in older age, as does arterial stiffness, shown to be independently associated with impaired baroreflex sensitivity and OH. Measurement of arterial compliance and central blood pressures are increasingly important, with evidence that central BP more closely correlates to end-organ damage and mortality than peripheral measurements. Patients with chronic kidney disease (CKD) are high risk for cardiovascular events, which can be predicted through measures of arterial compliance. We hypothesised that OH is associated with arterial stiffness and central blood pressure in CKD patients. DESIGN/SETTING We tested this hypothesis within the arterial compliance and oxidant stress as predictors of loss of renal function, morbidity and mortality in chronic kidney disease (ACADEMIC) study, a single-centre prospective observational study of the progression of arterial stiffness and renal function. PARTICIPANTS One hundred and forty-six patients with CKD 3 or 4. MEASUREMENTS Twenty-four-hour ambulatory BP monitoring with postural sensing (DIASYS Integra 2, Novacor France); central systolic and diastolic BP (cSBP and cDBP) and aortic Augmentation Index using Sphygmocor® (Atcor, Australia); Carotid-femoral pulse wave velocity (cfPWV) using Complior® (ALAM Medical, France). RESULTS Twenty-three patients had a postural SBP fall (prevalence 15.8%), with mean drop 7 mmHg. Patients with OH had higher cfPWV (15.2 m/s vs 12.7 m/s in patients without OH, p < 0.001) and central SBP (147.5 vs 135.7, p = 0.012). Regression analysis gave an odds ratio (OR) of orthostatic SBP fall for cfPWV of 1.46 (95% CI 1.16-1.84, p = 0.001) and 1.03 for cSBP (95% CI 1.004-1.06, p = 0.024) after adjustment for cardiovascular risk factors. CONCLUSION Aortic stiffness and central SBP are independently associated with orthostatic SBP fall in CKD patients. This suggests that enhanced arterial stiffness may be an underlying mechanism in baroreflex dysfunction, and may partly explain the vascular risk in CKD patients.
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Affiliation(s)
- Frances A Kirkham
- Department of Elderly Care and Stroke Medicine, Brighton and Sussex University Hospitals Trust, Brighton, BN2 5BE, UK.
| | - Philip Rankin
- Department of Elderly Care and Stroke Medicine, Brighton and Sussex University Hospitals Trust, Brighton, BN2 5BE, UK
| | - Nikesh Parekh
- Department of Elderly Care and Stroke Medicine, Brighton and Sussex University Hospitals Trust, Brighton, BN2 5BE, UK.,Department of Medicine, Brighton and Sussex Medical School, University of Sussex, Brighton, UK
| | - Stephen G Holt
- Department of Medicine, Brighton and Sussex Medical School, University of Sussex, Brighton, UK.,Department of Nephrology, Brighton and Sussex University Hospitals Trust, Brighton, UK
| | - Chakravarthi Rajkumar
- Department of Elderly Care and Stroke Medicine, Brighton and Sussex University Hospitals Trust, Brighton, BN2 5BE, UK.,Department of Medicine, Brighton and Sussex Medical School, University of Sussex, Brighton, UK
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12
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Determinants of the aortic pulse wave velocity index in hypertensive and diabetic patients. J Hypertens 2018; 36:2324-2332. [DOI: 10.1097/hjh.0000000000001828] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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13
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Rahman M, Hsu JY, Desai N, Hsu CY, Anderson AH, Appel LJ, Chen J, Cohen DL, Drawz PE, He J, Qiang P, Ricardo AC, Steigerwalt S, Weir MR, Wright JT, Zhang X, Townsend RR. Central Blood Pressure and Cardiovascular Outcomes in Chronic Kidney Disease. Clin J Am Soc Nephrol 2018; 13:585-595. [PMID: 29475992 PMCID: PMC5969462 DOI: 10.2215/cjn.08620817] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2017] [Accepted: 01/03/2018] [Indexed: 01/07/2023]
Abstract
BACKGROUND AND OBJECTIVES Central BP measurements provide noninvasive measurement of aortic BP; our objectives were to examine the association of central and brachial BP measurements with risk of cardiovascular outcomes and mortality in patients with CKD and to determine the role of central BP measurement in conjunction with brachial BP in estimating cardiovascular risk. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS In a prospective, longitudinal study (the Chronic Renal Insufficiency Cohort), central BP was measured in participants with CKD using the SphygmoCorPVx System. Cox proportional hazards models were used for analyses. RESULTS Mean age of the participants (n=2875) was 60 years old. After a median follow-up of 5.5 years, participants in the highest quartile of brachial systolic BP (≥138 mm Hg) were at higher risk for the composite cardiovascular outcome (hazard ratio, 1.59; 95% confidence interval, 1.17 to 2.17; c statistic, 0.76) but not all-cause mortality (hazard ratio, 1.28; 95% confidence interval, 0.90 to 1.80) compared with those in the lowest quartile. Participants in the highest quartile of central systolic BP were also at higher risk for the composite cardiovascular outcome (hazard ratio, 1.69; 95% confidence interval, 1.24 to 2.31; c statistic, 0.76) compared with participants in the lowest quartile. CONCLUSIONS We show that elevated brachial and central BP measurements are both associated with higher risk of cardiovascular disease outcomes in patients with CKD. Measurement of central BP does not improve the ability to predict cardiovascular disease outcomes or mortality in patients with CKD compared with brachial BP measurement.
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Affiliation(s)
- Mahboob Rahman
- Due to the number of contributing authors, the affiliations are provided in the Supplemental Material
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14
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Choi HY, Lee CJ, Lee JE, Yang HS, Kim HY, Park HC, Kim HC, Chang HJ, Park SH, Kim BS. Loss of nighttime blood pressure dipping as a risk factor for coronary artery calcification in nondialysis chronic kidney disease. Medicine (Baltimore) 2017; 96:e7380. [PMID: 28658167 PMCID: PMC5500089 DOI: 10.1097/md.0000000000007380] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Diurnal variations in blood pressure (BP) loss are closely associated with target organ damage and cardiovascular events. The quantity of coronary artery calcification (CAC) correlates with the atherosclerotic plaque burden, and an increased quantity indicates a substantially increased risk of cardiovascular events. This study investigated the nighttime diurnal variation in BP loss associated with CAC in patients with chronic kidney disease (CKD).Of the 1958 participants, we enrolled 722 participants with CKD without a history of acute coronary syndrome or symptomatic coronary artery disease. CAC was measured with computed tomography. BP was measured using 24-hour ambulatory BP monitoring. Central BP was measured using a SphygmoCor waveform analysis system.Participants with CAC had significantly higher 24-hour systolic, daytime systolic, and nighttime systolic ambulatory BP and central systolic BP. The percentage of participants with dipping loss was significantly higher among those with CAC. Multivariate logistic regression analysis indicated that dipping loss and dipping ratio were independently associated with CAC after adjusting for traditional and nontraditional cardiovascular risk factors and other BP parameters, including measurements of office-measured BP and central BP. The dipping status improved risk prediction for CAC after considering traditional risk factors and office-measured BP, using the net reclassification improvement and integrated discrimination improvement.Nighttime loss of diurnal variation in BP is an independent risk factor for CAC in CKD patients.
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Affiliation(s)
| | - Chan Joo Lee
- Division of Cardiology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul
| | - Jung Eun Lee
- Department of Internal Medicine, Yong-In Severance Hospital, Yonsei University College of Medicine, Yong-In
| | | | | | | | - Hyeon Chang Kim
- Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Hyuk-Jae Chang
- Division of Cardiology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul
| | - Sung-Ha Park
- Division of Cardiology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul
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Vermorken AJM, Andrès E, Cui Y. Bowel movement frequency, oxidative stress and disease prevention. Mol Clin Oncol 2016; 5:339-342. [PMID: 27703675 DOI: 10.3892/mco.2016.987] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2016] [Accepted: 06/27/2016] [Indexed: 12/13/2022] Open
Abstract
The significance of diet for disease prevention has long been recognised. Dietary recommendations have therefore been integrated in health promotion messages. Gastrointestinal functioning is essential for the digestion of nutrients. Oxidative stress has been observed in patients with constipation, as well as in those with colorectal cancer, cardiovascular disease and other chronic illnesses associated with constipation. The coexistence of colorectal neoplasia and coronary artery disease has been incriminated for exposure to common risk factors associated with increased oxidative stress. It was recently demonstrated that bowel movement frequency is inversely associated with cardiovascular mortality. The aim of the present study was to review the relevant literature in light of these findings. It was concluded that suboptimal functioning of the large bowel may contribute to oxidative stress and, therefore, to increased mortality. Bowel movement frequency may represent a simple quantifiable indicator of adequate colonic function and it is dependent on diet, exercise and other lifestyle factors, but also on individual characteristics, including colonic microbiota. Future health promotion actions may improve the prevention of a number of diseases by advocating lifestyle personalisation for assuring optimal intestinal functioning.
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Affiliation(s)
- Alphons J M Vermorken
- College of Life Sciences, Northwest University, Xi'an, Shaanxi 710069, P.R. China; National Engineering Research Center for Miniaturized Detection Systems, Xi'an, Shaanxi 710069, P.R. China
| | - Emmanuel Andrès
- Department of Internal Medicine, Diabetes and Metabolic Disorders, University Hospital of Strasbourg, 67091 Strasbourg, France
| | - Yali Cui
- College of Life Sciences, Northwest University, Xi'an, Shaanxi 710069, P.R. China; National Engineering Research Center for Miniaturized Detection Systems, Xi'an, Shaanxi 710069, P.R. China
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