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Mynard JP, Kowalski R, Harrington HA, Kondiboyina A, Smolich JJ, Cheung MMH. Superiority of a Representative MRI Flow Waveform over Doppler Ultrasound for Aortic Wave Reflection Assessment in Children and Adolescents With/Without a History of Heart Disease. Ann Biomed Eng 2023; 51:2772-2784. [PMID: 37561232 PMCID: PMC10632254 DOI: 10.1007/s10439-023-03339-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Accepted: 07/29/2023] [Indexed: 08/11/2023]
Abstract
Wave separation analysis (WSA) reveals the impact of forward- and backward-running waves on the arterial pressure pulse, but the calculations require a flow waveform. This study investigated (1) the variability of the ascending aortic flow waveform in children and adolescents with/without a childhood heart disease history (CHD); (2) the accuracy of WSA obtained with a representative flow waveform (RepFlow), compared with the triangulation method and published ultrasound-derived adult representative flow; (3) the impact of limitations in Doppler ultrasound on WSA; and (4) generalizability of results to adults with a history of CHD. Phase contrast MRI was performed in youth without (n = 45, Group 1, 10-19 years) and with CHD (n = 79, Group 2, 7-18 years), and adults with CHD history (n = 29, Group 3, 19-59 years). Segmented aortic cross-sectional area was used as a surrogate for the central pressure waveform in WSA. A subject-specific virtual Doppler ultrasound was performed on MRI data by extracting velocities from a sample volume. Time/amplitude-normalized ascending aortic flow waveforms were highly consistent amongst all groups. WSA with RepFlow therefore yielded errors < 10% in all groups for reflected wave magnitude and return time. Absolute errors were typically 1.5-3 times greater with other methods, including subject-specific (best-case/virtual) Doppler ultrasound, for which velocity profile skewing introduced waveform errors. Our data suggest that RepFlow is the optimal approach for pressure-only WSA in children and adolescents with/without CHD, as well as adults with CHD history, and may even be more accurate than subject-specific Doppler ultrasound in the ascending aorta.
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Affiliation(s)
- Jonathan P Mynard
- Heart Research, Murdoch Children's Research Institute, 50 Flemington Road, Parkville, VIC, 3052, Australia.
- Department of Paediatrics, University of Melbourne, Parkville VIC, Australia.
- Department of Biomedical Engineering, University of Melbourne, Parkville VIC, Australia.
| | - Remi Kowalski
- Heart Research, Murdoch Children's Research Institute, 50 Flemington Road, Parkville, VIC, 3052, Australia
- Department of Paediatrics, University of Melbourne, Parkville VIC, Australia
- Department of Cardiology, Royal Children's Hospital, Parkville VIC, Australia
| | - Hilary A Harrington
- Heart Research, Murdoch Children's Research Institute, 50 Flemington Road, Parkville, VIC, 3052, Australia
| | - Avinash Kondiboyina
- Heart Research, Murdoch Children's Research Institute, 50 Flemington Road, Parkville, VIC, 3052, Australia
- Department of Paediatrics, University of Melbourne, Parkville VIC, Australia
| | - Joseph J Smolich
- Heart Research, Murdoch Children's Research Institute, 50 Flemington Road, Parkville, VIC, 3052, Australia
- Department of Paediatrics, University of Melbourne, Parkville VIC, Australia
| | - Michael M H Cheung
- Heart Research, Murdoch Children's Research Institute, 50 Flemington Road, Parkville, VIC, 3052, Australia
- Department of Paediatrics, University of Melbourne, Parkville VIC, Australia
- Department of Cardiology, Royal Children's Hospital, Parkville VIC, Australia
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Rowland EM, Riemer K, Lichtenstein K, Tang MX, Weinberg PD. Non-invasive Assessment by B-Mode Ultrasound of Arterial Pulse Wave Intensity and Its Reduction During Ventricular Dysfunction. Ultrasound Med Biol 2023; 49:473-488. [PMID: 36335055 DOI: 10.1016/j.ultrasmedbio.2022.09.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Revised: 09/12/2022] [Accepted: 09/24/2022] [Indexed: 06/16/2023]
Abstract
Arterial pulse waves contain clinically useful information about cardiac performance, arterial stiffness and vessel tone. Here we describe a novel method for non-invasively assessing wave properties, based on measuring changes in blood flow velocity and arterial wall diameter during the cardiac cycle. Velocity and diameter were determined by tracking speckles in successive B-mode images acquired with an ultrafast scanner and plane-wave transmission. Blood speckle was separated from tissue by singular value decomposition and processed to correct biases in ultrasound imaging velocimetry. Results obtained in the rabbit aorta were compared with a conventional analysis based on blood velocity and pressure, employing measurements obtained with a clinical intra-arterial catheter system. This system had a poorer frequency response and greater lags but the pattern of net forward-traveling and backward-traveling waves was consistent between the two methods. Errors in wave speed were also similar in magnitude, and comparable reductions in wave intensity and delays in wave arrival were detected during ventricular dysfunction. The non-invasive method was applied to the carotid artery of a healthy human participant and gave a wave speed and patterns of wave intensity consistent with earlier measurements. The new system may have clinical utility in screening for heart failure.
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Affiliation(s)
- Ethan M Rowland
- Department of Bioengineering, Imperial College London, London, UK
| | - Kai Riemer
- Department of Bioengineering, Imperial College London, London, UK
| | | | - Meng-Xing Tang
- Department of Bioengineering, Imperial College London, London, UK
| | - Peter D Weinberg
- Department of Bioengineering, Imperial College London, London, UK.
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Murphy L, Chase JG. Single measurement estimation of central blood pressure using an arterial transfer function. Comput Methods Programs Biomed 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] [What about the content of this article? (0)] [Affiliation(s)] [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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Hahad O, Schmitt VH, Arnold N, Keller K, Prochaska JH, Wild PS, Schulz A, Lackner KJ, Pfeiffer N, Schmidtmann I, Michal M, Schattenberg JM, Tüscher O, Daiber A, Münzel T. Chronic cigarette smoking is associated with increased arterial stiffness in men and women: evidence from a large population-based cohort. Clin Res Cardiol 2023; 112:270-284. [PMID: 36068365 PMCID: PMC9898409 DOI: 10.1007/s00392-022-02092-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Accepted: 08/24/2022] [Indexed: 02/06/2023]
Abstract
BACKGROUND Cigarette smoking is a threat to global human health and a leading cause of the cardiovascular disease (CVD) morbidity and mortality. Importantly, sex-specific differences in smoking-induced arterial stiffness, an early key event in the development of atherosclerotic CVD, remain still elusive. Thus, this study sought out to investigate sex-specific associations between smoking and measures of arterial stiffness. METHODS AND RESULTS Overall, 15,010 participants (7584 men and 7426 women aged 35-74 years) of the Gutenberg Health Study were examined at baseline during 2007-2012. Smoking status, pack-years of smoking, and years since quitting smoking were assessed by a standardized computer-assisted interview. Arterial stiffness and wave reflection were determined by stiffness index (SI) and augmentation index (AI). In the total sample, 45.8% had never smoked, 34.7% were former smokers, and 19.4% were current smokers. Median cumulative smoking exposure was 22.0 pack-years in current male smokers and 16.0 in current female smokers. In general, multivariable linear regression models adjusted for a comprehensive set of confounders revealed that smoking status, pack-years of smoking, and years since quitting smoking were dose-dependently associated with markers of arterial stiffness. In sex-specific analyses, these associations were overall more pronounced in men and SI was stronger related to the male sex, whereas differences between men and women in the case of AI appeared to be less substantial. DISCUSSION The present results indicate that chronic smoking is strongly and dose-dependently associated with increased arterial stiffness in a large population-based cohort regardless of sex but with a stronger association in men.
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Affiliation(s)
- Omar Hahad
- Department of Cardiology-Cardiology I, University Medical Center of the Johannes Gutenberg-University Mainz, Langenbeckstraße 1, 55131, Mainz, Germany. .,German Center for Cardiovascular Research (DZHK), Partner Site Rhine-Main, Mainz, Germany.
| | - Volker H. Schmitt
- Department of Cardiology-Cardiology I, University Medical Center of the Johannes Gutenberg-University Mainz, Langenbeckstraße 1, 55131 Mainz, Germany ,German Center for Cardiovascular Research (DZHK), Partner Site Rhine-Main, Mainz, Germany
| | - Natalie Arnold
- Department of Cardiology-Cardiology I, University Medical Center of the Johannes Gutenberg-University Mainz, Langenbeckstraße 1, 55131 Mainz, Germany ,German Center for Cardiovascular Research (DZHK), Partner Site Rhine-Main, Mainz, Germany ,Department of Cardiology, German Center for Cardiovascular Research (DZHK), partner site Hamburg/Kiel/Luebeck, Hamburg, Germany
| | - Karsten Keller
- Department of Cardiology-Cardiology I, University Medical Center of the Johannes Gutenberg-University Mainz, Langenbeckstraße 1, 55131 Mainz, Germany ,Center for Thrombosis and Hemostasis, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany ,Medical Clinic VII, Department of Sports Medicine, University Hospital Heidelberg, Heidelberg, Germany
| | - Jürgen H. Prochaska
- German Center for Cardiovascular Research (DZHK), Partner Site Rhine-Main, Mainz, Germany ,Center for Thrombosis and Hemostasis, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany ,Preventive Cardiology and Preventive Medicine, Department of Cardiology, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Philipp S. Wild
- German Center for Cardiovascular Research (DZHK), Partner Site Rhine-Main, Mainz, Germany ,Center for Thrombosis and Hemostasis, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany ,Preventive Cardiology and Preventive Medicine, Department of Cardiology, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Andreas Schulz
- Preventive Cardiology and Preventive Medicine, Department of Cardiology, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Karl J. Lackner
- German Center for Cardiovascular Research (DZHK), Partner Site Rhine-Main, Mainz, Germany ,Institute of Clinical Chemistry and Laboratory Medicine, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Norbert Pfeiffer
- Department of Ophthalmology, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Irene Schmidtmann
- Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Matthias Michal
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Jörn M. Schattenberg
- Metabolic Liver Research Program, I. Department of Medicine, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Oliver Tüscher
- Department of Psychiatry and Psychotherapy, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Andreas Daiber
- Department of Cardiology-Cardiology I, University Medical Center of the Johannes Gutenberg-University Mainz, Langenbeckstraße 1, 55131 Mainz, Germany ,German Center for Cardiovascular Research (DZHK), Partner Site Rhine-Main, Mainz, Germany
| | - Thomas Münzel
- Department of Cardiology-Cardiology I, University Medical Center of the Johannes Gutenberg-University Mainz, Langenbeckstraße 1, 55131, Mainz, Germany. .,German Center for Cardiovascular Research (DZHK), Partner Site Rhine-Main, Mainz, Germany.
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Tan J, Xu L, Sun H, Xu B, Li Y, Yao Y. [Quantitative analysis of the effect of contact pressure on the reflection characteristics of radial pressure wave]. Sheng Wu Yi Xue Gong Cheng Xue Za Zhi 2022; 39:1127-1132. [PMID: 36575081 DOI: 10.7507/1001-5515.202203048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
The radial artery pulse wave contains a wealth of physiological and pathological information about the human body, and non-invasive studies of the radial artery pulse wave can assess arterial vascular elasticity in different age groups.The piezoelectric pulse wave transducers were used to non-invasively acquire radial artery pulse waves at different contact pressures in young and middle-aged and elderly populations. The radial artery waveforms were decomposed using a triangular blood flow model fitting method to obtain forward and reflected waves and calculate reflection parameters. Finally a correlation analysis and regression analysis of the contact pressure Psensor with the reflection parameters was carried out. The results showed that the reflection parameters RM, RI and Rd had a strong negative correlation with Psensor in both types of subjects, and the correlation coefficients and slopes of the regression curves were significantly different between the two types of subjects (P<0.05). Based on the results of this study, excessive contact pressure on the transducer should be avoided when detecting radial artery reflection waves in clinical practice. The results also show that the magnitude of the slope of the regression curve between the reflection parameters and the transducer contact pressure may be a potentially useful indicator for quantifying the elastic properties of the vessel.
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Affiliation(s)
- Junyi Tan
- College of MBIE, Northeastern University, Shenyang 110819, P. R. China
| | - Lisheng Xu
- College of MBIE, Northeastern University, Shenyang 110819, P. R. China.,Neusoft Research of Intelligent Healthcare Technology, Co. Ltd., Shenyang 110167, P. R. China
| | - Hongming Sun
- College of MBIE, Northeastern University, Shenyang 110819, P. R. China
| | - Bowen Xu
- College of MBIE, Northeastern University, Shenyang 110819, P. R. China
| | - Yongchun Li
- Shenyang Kangtai Electronic Technology, Co. Ltd., Shenyang 110167, P. R. China
| | - Yudong Yao
- College of MBIE, Northeastern University, Shenyang 110819, P. R. China
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Terentes-Printzios D, Gardikioti V, Vlachopoulos C. Central Over Peripheral Blood Pressure: An Emerging Issue in Hypertension Research. Heart Lung Circ 2021; 30:1667-1674. [PMID: 34426073 DOI: 10.1016/j.hlc.2021.07.019] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 06/13/2021] [Accepted: 07/13/2021] [Indexed: 01/09/2023]
Abstract
Measurement of blood pressure is one of the most important and powerful clinical tools in clinical practice. Physicians use the classical method that was introduced more than 100 years ago with the emergence of the brachial cuff sphygmomanometer. The use of this method, despite its initial setbacks, spread like fire throughout the medical community with the boost by the early adoption by insurance companies to assess risk as well as the ease of use, the availability with the wide variety of devices, the good reproducibility and its predictive role. However, a long-forgotten dispute between measurements of peripheral (brachial) and central (aortic, carotid) blood pressure has resurfaced after the introduction of techniques and devices that can easily and accurately estimate non-invasively the central pressure waveform. Clinicians, until recently, focussed only on the pressure waveform trough (diastole) and peak (systole), ignoring the possible information provided by the rest of the arterial pressure waveform. Several restrictions exist with peripheral blood pressures measured with either an oscillometric or a sphygmomanometer device that blur the existing image of the ideal biomarker to describe the haemodynamic characteristics of the cardiovascular system. On the other hand, central pressures seem to be more pathophysiologically relevant to end-organ damage of the brain, heart and kidneys and on future events. Furthermore, measurement of the central waveform can provide clinically useful information, like the quantification of wave reflections with augmentation index, beyond blood pressure measured in the brachial artery. This article will explain the pathophysiological mechanisms linking central pressures to cardiovascular outcomes, review the evidence for the use of central blood pressure over peripheral pressures, elaborate on the prognostic role of central blood pressures and finally review the latest developments on the pharmacological modulation of central blood pressures.
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Affiliation(s)
- Dimitrios Terentes-Printzios
- First Department of Cardiology, Hippokration Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece.
| | - Vasiliki Gardikioti
- First Department of Cardiology, Hippokration Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Charalambos Vlachopoulos
- First Department of Cardiology, Hippokration Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
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Abstract
Arterial stiffness increases with age, as well as in various pathological states, including obesity, diabetes mellitus, smoking, and dyslipidemia, and it has important consequences for cardiovascular health. Arterial stiffness plays a central role in hemodynamic dysfunction characterized by excess pulsatility; specifically, it leads to heart failure, cerebrovascular disease, and renal failure. Among measures of arterial stiffness, carotid-femoral pulse wave velocity is considered as the reference standard; however, it has not been incorporated into routine clinical practice. Cardio-ankle vascular index (CAVI), which is a marker of arterial stiffness measured from the origin of the aorta to the ankle, was developed in 2004. CAVI is based on stiffness parameter β, which is theoretically independent of blood pressure at the time of measurement. CAVI applies stiffness parameter β to arterial segments between the heart and ankle. The measurement of CAVI is simple and well-standardized, and its reproducibility and accuracy are acceptable. Several studies have demonstrated that CAVI is high in patients with various atherosclerotic risk factors, and treatment of cardiovascular risk factors and lifestyle modifications improve CAVI. Several prospective studies have investigated the association between CAVI and future cardiovascular events in the general population and in patients with cardiovascular risk factors. A cut-off value of 9.0 is proposed for predicting patients at a high risk of cardiovascular events. From this review, it is clear that CAVI may be useful in the prevention of cardiovascular disease.
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Affiliation(s)
- Toru Miyoshi
- Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan.
| | - Hiroshi Ito
- Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
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Phan K, Schiller I, Dendukuri N, Gomez YH, Gorgui J, El-Messidi A, Gagnon R, Daskalopoulou SS. A longitudinal analysis of arterial stiffness and wave reflection in preeclampsia: Identification of changepoints. Metabolism 2021; 120:154794. [PMID: 33971204 DOI: 10.1016/j.metabol.2021.154794] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 04/27/2021] [Accepted: 05/01/2021] [Indexed: 11/19/2022]
Abstract
PURPOSE Preeclampsia (PrE) is a leading complication of pregnancy characterized by vascular dysfunction. Characterizing the longitudinal changes in vascular function prior to PrE onset is critical to the identification of optimal timepoints for vascular assessment and the development of effective early screening strategies. METHODS In this prospective longitudinal study of women with singleton high-risk pregnancies, arterial stiffness and wave reflection parameters were assessed using applanation tonometry at 10-13 weeks' gestation and repeated every 4 weeks throughout pregnancy. Changepoints in carotid-femoral pulse wave velocity (cfPWV), carotid-radial PWV (crPWV), augmentation index (AIx), time to wave reflection (T1R), pulse pressure amplification (PPA), and subendocardial viability ratio (SEVR) were compared between women who did and did not subsequently develop PrE. RESULTS A changepoint in cfPWV and crPWV was detected at 14-17 weeks' gestation. cfPWV then increased in women who went on to develop PrE but decreased in women who did not; a 1.2 m/s difference in cfPWV between the groups was observed at 22-25 weeks' gestation. Conversely, crPWV converged in the two groups from a baseline difference of 1.05 m/s (95% credible interval: 0.37, 1.72). Women who subsequently developed PrE demonstrated an increase in AIx at 18-21 weeks' gestation that was not seen in women who did not develop PrE until 30-33 weeks. No differences in T1R, PPA, or SEVR were observed between the groups. CONCLUSIONS Altered vascular adaptations were detected using measures of arterial stiffness and wave reflection in the early second trimester of pregnant women who developed PrE compared to those who did not. These findings demonstrate the potential clinical utility of arterial stiffness and wave reflection parameters as an early screening tool for PrE, which can be used to inform clinical management of high-risk pregnancies.
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Affiliation(s)
- Kim Phan
- Division of Experimental Medicine, Department of Medicine, McGill University, 1001 Décarie Boulevard, Montreal, Quebec H4A 3J1, Canada.
| | - Ian Schiller
- Division of Clinical Epidemiology, McGill University Health Centre - Research Institute, 1001 Décarie Boulevard, Montreal, Quebec H4A 3J1, Canada.
| | - Nandini Dendukuri
- Division of Clinical Epidemiology, McGill University Health Centre - Research Institute, 1001 Décarie Boulevard, Montreal, Quebec H4A 3J1, Canada.
| | - Yessica-Haydee Gomez
- Division of Internal Medicine, Department of Medicine, McGill University, 1001 Décarie Boulevard, Montreal, Quebec H4A 3J1, Canada
| | - Jessica Gorgui
- Division of Internal Medicine, Department of Medicine, McGill University, 1001 Décarie Boulevard, Montreal, Quebec H4A 3J1, Canada
| | - Amira El-Messidi
- Department of Obstetrics and Gynecology, McGill University, 1001 Décarie Boulevard, Montreal, Quebec H4A 3J1, Canada.
| | - Robert Gagnon
- Department of Obstetrics and Gynecology, McGill University, 1001 Décarie Boulevard, Montreal, Quebec H4A 3J1, Canada.
| | - Stella S Daskalopoulou
- Division of Experimental Medicine, Department of Medicine, McGill University, 1001 Décarie Boulevard, Montreal, Quebec H4A 3J1, Canada; Division of Internal Medicine, Department of Medicine, McGill University, 1001 Décarie Boulevard, Montreal, Quebec H4A 3J1, Canada.
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Cahill LS, Stortz G, Ravi Chandran A, Milligan N, Shinar S, Whitehead CL, Hobson SR, Ayyathurai V, Rahman A, Saghian R, Jobst KJ, McShane C, Block-Abraham D, Seravalli V, Laurie M, Millard S, Delp C, Wolfson D, Baschat AA, Murphy KE, Serghides L, Morgen E, Macgowan CK, Parks WT, Kingdom JC, Sled JG. Wave reflections in the umbilical artery measured by Doppler ultrasound as a novel predictor of placental pathology. EBioMedicine 2021; 67:103326. [PMID: 33965347 DOI: 10.1016/j.ebiom.2021.103326] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2021] [Revised: 03/18/2021] [Accepted: 03/19/2021] [Indexed: 12/14/2022] Open
Abstract
Background The umbilical artery (UA) Doppler pulsatility index is used clinically to detect elevated feto-placental vascular resistance. However, this metric is confounded by variation in fetal cardiac function and is only moderately predictive of placental pathology. Our group developed a novel ultrasound methodology that measures wave reflections in the UA, thereby isolating a component of the Doppler signal that is specific to the placenta. The present study examined whether wave reflections in the UA are predictive of placental vascular pathology. Methods Standard clinical Doppler ultrasound of the UAs was performed in 241 pregnant women. Of these, 40 women met narrowly defined preset criteria for the control group, 36 had maternal vascular malperfusion (MVM) and 16 had fetal vascular malperfusion (FVM). Using a computational procedure, the Doppler waveforms were decomposed into a pair of forward and backward propagating waves. Findings Compared to controls, wave reflections were significantly elevated in women with either MVM (p<0.0001) or FVM pathology (p = 0.02). In contrast, the umbilical and uterine artery pulsatility indices were only elevated in the MVM group (p<0.0001) and there were no differences between women with FVM and the controls. Interpretation The measurement of wave reflections in the UA, combined with standard clinical ultrasound parameters, has the potential to improve the diagnostic performance of UA Doppler to detect placental vascular pathology. Identifying women with FVM pathology is particularly challenging prenatally and future investigations will determine if women at risk of this specific placental disease could benefit from this novel diagnostic technique.
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Abstract
Reflected pressure waves are key to the understanding of vascular ageing, a prominent factor in major cardiovascular events. Several different metrics have been proposed to index the effect of wave reflection on the pressure waveform and thereby serve as an indicator of vascular ageing. The extent to which these indices are influenced by factors other than vascular health remains a matter of concern. In this paper, we use transmission-line theory to derive a mathematical model for the reflection time (Trefl), and the augmentation index (AI), assuming a general extended model of the arterial system. Then, we test the proposed model against values reported in the literature. Finally, we discuss insights from the model to common observations in the literature such as age-related "shift" in the reflection site, the variation of AI with heart rate, and the flattening of Trefl in older participants.
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Affiliation(s)
- Rashid Afkhami
- School of Engineering, The Unviersity of Newcastle, Australia.
| | - Sarah Johnson
- School of Engineering, The Unviersity of Newcastle, Australia.
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11
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Afkhami R, Wong R, Ramadan S, Walker FR, Johnson S. Indexing Cerebrovascular Health Using Transcranial Doppler Ultrasound. Ultrasound Med Biol 2021; 47:919-927. [PMID: 33494950 DOI: 10.1016/j.ultrasmedbio.2020.12.022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 11/26/2020] [Accepted: 12/21/2020] [Indexed: 06/12/2023]
Abstract
Transcranial Doppler (TCD) blood flow velocity has been extensively used in biomedical research as it provides a cost-effective and relatively simple approach to assess changes in cerebral blood flow dynamics and track cerebrovascular health status. In this article we introduce a new TCD-based timing index, TITCD, as an indicator of vascular stiffening and vascular health. We investigate the correlations of the new index and the existing indices, namely the pulsatility index and the augmentation index, with age, cardiorespiratory fitness (CRF) and magnetic resonance imaging (MRI) blood flow pulsatility index (PIMRI). Notably, the new index showed stronger correlations with CRF (r = -0.79) and PIMRI (r = 0.53) compared with the augmentation index (r = -0.65 with CRF and no significant correlation with PIMRI) and the pulsatility index (no significant correlations with CRF or PIMRI), and a similar correlation with age as the augmentation index. The clearer relationship of the proposed timing index with vascular aging factors underlines its utility as an early indicator of vascular stiffening.
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Affiliation(s)
- Rashid Afkhami
- School of Electrical Engineering & Computing, University of Newcastle, Callaghan, New South Wales, Australia.
| | - Rachel Wong
- School of Biomedical Sciences & Pharmacy, University of Newcastle, Callaghan, New South Wales, Australia
| | - Saadallah Ramadan
- School of Health Science, University of Newcastle, Callaghan, New South Wales, Australia
| | - Frederick Rohan Walker
- School of Biomedical Sciences & Pharmacy, University of Newcastle, Callaghan, New South Wales, Australia
| | - Sarah Johnson
- School of Electrical Engineering & Computing, University of Newcastle, Callaghan, New South Wales, Australia
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12
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Harber MP, McCurry A, Carlini N, Kistler B, Fleenor BS. Caffeine ingestion alters central hemodynamics following aerobic exercise in middle-aged men. Eur J Appl Physiol 2020; 121:435-443. [PMID: 33098463 DOI: 10.1007/s00421-020-04521-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Accepted: 10/01/2020] [Indexed: 12/21/2022]
Abstract
PURPOSE To examine the acute influence of caffeine on post-exercise central blood pressures, arterial stiffness, and wave reflection properties. METHODS In a double-blind randomized placebo-controlled crossover study design, ten middle-aged males (55 ± 5 year) completed two exercise trials after ingestion of caffeine (400 mg) or placebo. Measurements were taken before and 30 min post-ingestion via cuff-based pulse wave analysis (PWA) and carotid-femoral pulse wave velocity (PWV). Participants performed a 40-min cycling bout at 70% HRmax with matched workloads between trials. PWA and PWV were reassessed 30 min post-exercise. RESULTS Prior to exercise, compared to placebo, caffeine increased brachial systolic blood pressure (bSBP) (+ 12.3 ± 2.4 mmHg; p = 0.004), brachial diastolic blood pressure (bDBP) (+ 7.7 ± 0.9 mmHg; p = 0.011), central systolic blood pressure (cSBP) (+ 11.1 ± 2.1 mmHg; p = 0.005) and central diastolic blood pressure (cDBP) (+ 7.6 ± 1.0 mmHg; p = 0.012). PWV was higher 30 min after pill ingestion (p = 0.021 for time) with a trend for a greater increase in caffeine (p = 0.074 for interaction). bSBP (p = 0.036) and cSBP (p = 0.007) were lower after exercise but remained higher (both p < 0.001) in caffeine compared to placebo. PWV remained higher (p = 0.023) after exercise in caffeine compared to placebo but was not influenced by exercise. At rest, augmentation pressure (AP) and index (AIx) were not influenced by caffeine ingestion. Conversely, AIx was lower (p = 0.009) after exercise in placebo only. CONCLUSION In healthy and active middle-aged men, pre-exercise caffeine ingestion led to higher central and peripheral systolic blood pressures, PWV and AIx at 30 min post-exercise, indicating an increased left ventricular workload which may have implications for cardiovascular event risk.
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Affiliation(s)
- Matthew P Harber
- Clinical Exercise Physiology, Human Performance Laboratory, Ball State University, Muncie, IN, 47306, USA.
| | - Allison McCurry
- Clinical Exercise Physiology, Human Performance Laboratory, Ball State University, Muncie, IN, 47306, USA
| | - Nicholas Carlini
- Clinical Exercise Physiology, Human Performance Laboratory, Ball State University, Muncie, IN, 47306, USA
| | - Brandon Kistler
- Nutrition and Dietetics, Ball State University, Muncie, IN, USA
| | - Bradley S Fleenor
- Clinical Exercise Physiology, Human Performance Laboratory, Ball State University, Muncie, IN, 47306, USA
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13
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Kim D, Jo J, Kim B, Ryu J, Choi K. Influence of dike-induced morphologic and sedimentologic changes on the benthic ecosystem in the sheltered tidal flats, Saemangeum area, west coast of Korea. Environ Pollut 2020; 257:113507. [PMID: 31706762 DOI: 10.1016/j.envpol.2019.113507] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/31/2018] [Revised: 10/27/2019] [Accepted: 10/27/2019] [Indexed: 06/10/2023]
Abstract
The effects of dike construction on the geomorphology and sedimentary processes of tidal flats were investigated using high-precision topographic profiling, short cores, and unmanned aviation vehicle (UAV)-assisted photogrammetry to understand their adverse consequences on the benthic ecosystem. Tidal flats at the south of Shinsi Island near one of the two sluice gates of the Saemangeum dike, display prominent morphologic features known as shelly sand ridges or cheniers (sensu Otvos, 2000) that have migrated landward about 5 m in a year. The tidal flats were dominated by erosion from winter to spring and by deposition during the remainder of the year except for the periods of heavy precipitation when tidal drainage channels became larger and deeper by headward erosion. With overall coarser-grained surface sediments, the presence of actively migrating wave-built cheniers are in stark contrast to muddy tidal flats with a monotonous morphology before the completion of the Saemangeum dike in 2006. Southeasterly waves reflected from the dike during winter to spring when north to northwesterly winds prevail account for the wave-induced onshore sediment transport and rapid morphologic changes in the tidal flats despite their location protected from offshore waves. The diversity and biomass of major macrofauna species tend to increase during rapid erosion and decrease during rapid deposition, highlighting the anthropogenic effect of dike-induced physical disturbance on the benthic ecosystem in the otherwise sheltered tidal flats.
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Affiliation(s)
- Dohyeong Kim
- School of Earth and Environmental Sciences, Seoul National University, Seoul, South Korea
| | - Joohee Jo
- School of Earth and Environmental Sciences, Seoul National University, Seoul, South Korea
| | - Bora Kim
- Department of Marine Biotechnology, Anyang University, Ganghwa-gun, Incheon, South Korea
| | - Jongseong Ryu
- Department of Marine Biotechnology, Anyang University, Ganghwa-gun, Incheon, South Korea
| | - Kyungsik Choi
- School of Earth and Environmental Sciences, Seoul National University, Seoul, South Korea.
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14
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Cahill LS, Pilmeyer J, Yu LX, Steinman J, Hare GMT, Kassner A, Macgowan CK, Sled JG. Ultrasound Detection of Abnormal Cerebrovascular Morphology in a Mouse Model of Sickle Cell Disease Based on Wave Reflection. Ultrasound Med Biol 2019; 45:3269-3278. [PMID: 31563480 DOI: 10.1016/j.ultrasmedbio.2019.08.017] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Revised: 08/09/2019] [Accepted: 08/23/2019] [Indexed: 06/10/2023]
Abstract
Sickle cell disease (SCD) is associated with a high risk of stroke, and affected individuals often have focal brain lesions termed silent cerebral infarcts. The mechanisms leading to these types of injuries are at present poorly understood. Our group has recently demonstrated a non-invasive measurement of cerebrovascular impedance and wave reflection in mice using high-frequency ultrasound in the common carotid artery. To better understand the pathophysiology in SCD, we used this approach in combination with micro-computed tomography to investigate changes in cerebrovascular morphology in the Townes mouse model of SCD. Relative to controls, the SCD mice demonstrated the following: (i) increased carotid artery diameter, blood flow and vessel wall thickness; (ii) elevated pulse wave velocity; (iii) increased reflection coefficient; and (iv) an increase in the total number of vessel segments in the brain. This study highlights the potential for wave reflection to aid the non-invasive clinical assessment of vascular pathology in SCD.
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Affiliation(s)
- Lindsay S Cahill
- Mouse Imaging Centre, Hospital for Sick Children, Toronto, Ontario, Canada; Translational Medicine, Hospital for Sick Children, Toronto, Ontario, Canada.
| | - Jesper Pilmeyer
- Mouse Imaging Centre, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Lisa X Yu
- Mouse Imaging Centre, Hospital for Sick Children, Toronto, Ontario, Canada; Translational Medicine, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Joe Steinman
- Mouse Imaging Centre, Hospital for Sick Children, Toronto, Ontario, Canada; Department of Medical Biophysics, University of Toronto, Toronto, Ontario, Canada
| | - Gregory M T Hare
- Keenan Research Centre for Biomedical Science and Li Ka Shing Knowledge Institute of St. Michael's Hospital, Department of Anesthesia, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada; Department of Physiology, University of Toronto, Toronto, Ontario, Canada
| | - Andrea Kassner
- Translational Medicine, Hospital for Sick Children, Toronto, Ontario, Canada; Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada
| | - Christopher K Macgowan
- Translational Medicine, Hospital for Sick Children, Toronto, Ontario, Canada; Department of Medical Biophysics, University of Toronto, Toronto, Ontario, Canada
| | - John G Sled
- Mouse Imaging Centre, Hospital for Sick Children, Toronto, Ontario, Canada; Translational Medicine, Hospital for Sick Children, Toronto, Ontario, Canada; Department of Medical Biophysics, University of Toronto, Toronto, Ontario, Canada
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15
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Xiao H, Qi L, Xu L, Li D, Hu B, Zhao P, Ren H, Huang J. Estimation of wave reflection in aorta from radial pulse waveform by artificial neural network: a numerical study. Comput Methods Programs Biomed 2019; 182:105064. [PMID: 31518768 DOI: 10.1016/j.cmpb.2019.105064] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Revised: 08/01/2019] [Accepted: 09/02/2019] [Indexed: 06/10/2023]
Abstract
BACKGROUND AND OBJECTIVE Wave reflection in aorta has been shown to have incremental value for predicting cardiovascular events. However, its estimation by wave separation analysis (WSA) is complex. METHODS In this study, a novel method was proposed based on a cascade artificial neural network (ANN) for wave reflection estimation by the frequency features of radial pressure waveform alone. The simulation database of 4000 samples was generated by a 55-segment transmission line model of human arterial tree and was used for evaluating the ANN with 10-fold cross validation for the estimation of reflection magnitude (RMANN) and reflection index (RIANN) of wave reflection in aorta. RM and RI also were estimated by the WSA with a triangle waveform of aortic flow (RMWSA and RIWSA) and with a real aortic flow waveform (RMRef and RIRef) as reference values. RESULTS The results showed the correlation coefficient and mean difference between RMANN and RMRef (R2 = 0.92, mean ± standard deviation (SD) = 0.0 ± 0.02) and those between RIANN and RIRef (R2 = 0.91, mean ± SD = 0.0 ± 0.01) were better than those between RMWSA and RMRef (R2 = 0.51, mean ± SD = 0.01 ± 0.07) and those between RIWSA and RIRef (R2 = 0.50, mean ± SD = 0.0 ± 0.02). As the sample diversity in the simulation database was increased but the total number of samples keeps constant, the advantage of the ANN, though decreased slightly, became more significant than those of WSA (RMANN VS. RMRef and RIANN VS. RIRef: R2 = 0.88 and 0.88, mean ± SD = 0.0 ± 0.05 and 0.0 ± 0.05; RMWSA VS. RMRef and RIWSA VS. RIRef: R2 = 0.24 and 0.24, mean ± SD = 0.07 ± 0.24 and 0.02 ± 0.08, respectively). In addition, the ANN can achieve better results than the traditional method WSA even only two hidden neurons are used. CONCLUSIONS ANN is a potential method for the estimation of wave reflection in aorta by a single radial pulse waveform, but further validation of this method in clinic trials is needed.
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Affiliation(s)
- Hanguang Xiao
- College of Artificial Intelligent, Chongqing University of Technology, No. 69 Hongguang Rd, Banan, Chongqing 400050, PR China.
| | - Lin Qi
- Sino-Dutch Biomedical and Information Engineering School, Northeastern University, Shenyang, LiaoNing 110167, PR China
| | - Lisheng Xu
- Sino-Dutch Biomedical and Information Engineering School, Northeastern University, Shenyang, LiaoNing 110167, PR China
| | - Decai Li
- Sichuan Mianyang 404 Hospital, No. 56 Yuejing Road, Fucheng District, Mianyang, Sichuan 400050, PR China
| | - Bo Hu
- Sichuan Mianyang 404 Hospital, No. 56 Yuejing Road, Fucheng District, Mianyang, Sichuan 400050, PR China
| | - Pengdong Zhao
- College of Artificial Intelligent, Chongqing University of Technology, No. 69 Hongguang Rd, Banan, Chongqing 400050, PR China
| | - Huijiao Ren
- College of Artificial Intelligent, Chongqing University of Technology, No. 69 Hongguang Rd, Banan, Chongqing 400050, PR China
| | - Jinfeng Huang
- College of Artificial Intelligent, Chongqing University of Technology, No. 69 Hongguang Rd, Banan, Chongqing 400050, PR China
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Bhattacharya S, Iglesias PA. Controlling excitable wave behaviors through the tuning of three parameters. Biol Cybern 2019; 113:61-70. [PMID: 30056608 DOI: 10.1007/s00422-018-0771-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/26/2018] [Accepted: 07/12/2018] [Indexed: 06/08/2023]
Abstract
Excitable systems are a class of dynamical systems that can generate self-sustaining waves of activity. These waves are known to manifest differently under diverse conditions, whereas some travel as planar or radial waves, and others evolve into rotating spirals. Excitable systems can also form stationary stable patterns through standing waves. Under certain conditions, these waves are also known to be reflected at no-flux boundaries. Here, we review the basic characteristics of these four entities: traveling, rotating, standing and reflected waves. By studying their mechanisms of formation, we show how through manipulation of three critical parameters: time-scale separation, space-scale separation and threshold, we can interchangeably control the formation of all the aforementioned wave types.
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Affiliation(s)
- Sayak Bhattacharya
- Department of Electrical and Computer Engineering, The Johns Hopkins University, Baltimore, USA
| | - Pablo A Iglesias
- Department of Electrical and Computer Engineering, The Johns Hopkins University, Baltimore, USA.
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Terenteva N, Chernykh O, Sanchez-Gonzalez MA, Wong A. Acupuncture therapy improves vascular hemodynamics and stiffness in middle-age hypertensive individuals. Complement Ther Clin Pract 2017; 30:14-18. [PMID: 29389472 DOI: 10.1016/j.ctcp.2017.11.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2017] [Accepted: 11/07/2017] [Indexed: 12/20/2022]
Abstract
Acupuncture (ACU) is becoming a more common practice among hypertensive individuals. However, the reported therapeutic effects of ACU in lowering brachial blood pressure (BP) are ambiguous. Therefore, evaluating more sensitive markers of arterial functioning might unveil the protective effects of ACU on hypertension. We examined the effects of an 8-week ACU therapy intervention on vascular hemodynamics and stiffness in middle-age hypertensive individuals. Participants were randomly assigned to either ACU (n = 23) or a control group (n = 22). Brachial and aortic BP, wave reflection (AIx) and arterial stiffness (SI) were measured before and after 8 weeks. There was a significant group x time interaction (P < 0.05) for brachial and aortic BP, AIx and SI which significantly decreased (P < 0.05) following ACU but not after control. ACU led to reductions in brachial and aortic BP, wave reflection and arterial stiffness in middle-age hypertensive individuals. ACU might be effective in the prevention and treatment of hypertension.
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Affiliation(s)
- Nina Terenteva
- Department of Industrial Ecology and Life Safety, Nosov Magnitogorsk State Technical University, Magnitogorsk, Chelyabinsk Region, Russia
| | - Oksana Chernykh
- Department of Economics and Management, Moscow Financial and Law University, Moscow, Russia
| | | | - Alexei Wong
- Department of Health and Human Performance, Marymount University, Arlington, VA, USA.
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18
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Abstract
The description of blood pressure (BP) curve has evolved to include several noninvasively determined parameters, such as aortic stiffness, BP variability, wave reflections, and pulse pressure amplification. These techniques are likely to improve the efficacy of assessing pulsatile arterial hemodynamics and changes in arterial stiffness. The goal for future antihypertensive treatments should not only reduce steady BP, but also control pulsatile pressure and modify the stiffness gradient between central and peripheral arteries, which is frequently elevated. These changes have the potential to reduce residual cardiovascular risk but also to define drug strategies adapted to the needs of individual hypertensive subjects.
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Affiliation(s)
- Michel E Safar
- Centre de Diagnostic et de Thérapeutique, Hôpital Hôtel Dieu, 1 place du Parvis Notre-Dame, Paris 75004, France.
| | - Jacques Blacher
- Centre de Diagnostic et de Thérapeutique, Hôpital Hôtel Dieu, 1 place du Parvis Notre-Dame, Paris 75004, France
| | - Athanase D Protogerou
- Hypertension Center and Cardiovascular Research Laboratory, 1st Department of Propaedeutic Medicine, Laiko Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
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19
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Almeida J, Monteiro J, Silva JA, Bertoquini S, Polónia J. Central pressures and central hemodynamic values in white coat hypertensives are closer to those of normotensives than to those of controlled hypertensives for similar age, gender, and 24-h and nocturnal blood pressures. Rev Port Cardiol 2016; 35:559-567. [PMID: 27717519 DOI: 10.1016/j.repc.2016.05.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2016] [Revised: 05/23/2016] [Accepted: 05/30/2016] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION There is disagreement whether white coat hypertensives (WCH) have different hemodynamic and structural characteristics compared to normotensives (NT) and hypertensives (HT). METHODS We compared cardiovascular prognostic markers (pulse wave velocity [PWV] and aortic stiffness index [ASI]) and data on central hemodynamics and central pressures (augmentation index [AIx], augmentation pressure [AugP] and pulse pressure amplification [PPA]) from aortic pulse wave analysis between NT (n=175), WCH (n=315) and treated HT (n=691), all with 24-h blood pressure (BP) <130/80 and nocturnal BP <120/70 mmHg after matching for age, gender, body mass index (BMI) and and nocturnal BP. The groups were also compared separately in terms of 24-h systolic BP <120 mmHg and 120-129 mmHg. RESULTS The percentage of non-dippers was 40.1% in NT, 34.5% in WCH and 38.3 in HT. For similar 24-h and nocturnal systolic BP (NT 109/64±7/5, WCH 110/66±7/6, HT 109/64±7/5 mmHg), aortic stiffness was greater in HT (n=691, PWV 10.8±2.6 m/s and ASI 0.33±0.16, p<0.01) than in WCH (n=316, PWV 9.7±2.4 m/s and ASI 0.28±0.17) and NT (n=175, PWV 9.5±2.0 m/s and ASI 0.29±0.15); AugP and AIx were higher (p<0.01) in HT (13.9±8.2 and 29.6±12.6 mmHg) than in WCH (11.5±8.5 mmHg and 24.9±15.2) and NT (11.0±6.4 mmHg and 26.6±11.5). PPA was lower (p<0.01) in HT (11.3±5.5 mmHg) than in WCH (13.2±7.1 mmHg) and in NT (12.4±4.9 mmHg). The findings were similar when the 24-h systolic BP <120 mmHg and 120-129 mmHg subgroups were analyzed separately. CONCLUSION Our data suggest that for similar age, gender distribution, BMI, and 24-h and nocturnal BP, aortic stiffness, central aortic pressures and wave reflection in WCH are closer to those of NT than to those with treated HT. This supports the idea that white coat hypertension may be a more benign condition than treated hypertension for similar 24-h and particularly nocturnal BP levels.
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Affiliation(s)
- Joana Almeida
- Departamento de Medicina e Cintesis, Faculdade de Medicina, Universidade do Porto, Porto, Portugal
| | - José Monteiro
- Departamento de Medicina e Cintesis, Faculdade de Medicina, Universidade do Porto, Porto, Portugal
| | - José A Silva
- Unidade de Hipertensão e RCV, Hospital Pedro Hispano, ULS Matosinhos, Matosinhos, Portugal
| | - Susana Bertoquini
- Departamento de Medicina e Cintesis, Faculdade de Medicina, Universidade do Porto, Porto, Portugal
| | - Jorge Polónia
- Departamento de Medicina e Cintesis, Faculdade de Medicina, Universidade do Porto, Porto, Portugal; Unidade de Hipertensão e RCV, Hospital Pedro Hispano, ULS Matosinhos, Matosinhos, Portugal.
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Liu A, Hacker T, Eickhoff JC, Chesler NC. Estrogen Preserves Pulsatile Pulmonary Arterial Hemodynamics in Pulmonary Arterial Hypertension. Ann Biomed Eng 2017; 45:632-43. [PMID: 27557900 DOI: 10.1007/s10439-016-1716-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2016] [Accepted: 08/18/2016] [Indexed: 10/21/2022]
Abstract
Pulmonary arterial hypertension (PAH) is caused by extensive pulmonary vascular remodeling that increases right ventricular (RV) afterload and leads to RV failure. PAH predominantly affects women; paradoxically, female PAH patients have better outcomes than men. The roles of estrogen in PAH remain controversial, which is referred to as "the estrogen paradox". Here, we sought to determine the role of estrogen in pulsatile pulmonary arterial hemodynamic changes and its impact on RV functional adaption to PAH. Female mice were ovariectomized and replenished with estrogen or placebo. PAH was induced with SU5416 and chronic hypoxia. In vivo hemodynamic measurements showed that (1) estrogen prevented loss of pulmonary vascular compliance with limited effects on the increase of pulmonary vascular resistance in PAH; (2) estrogen attenuated increases in wave reflections in PAH and limited its adverse effects on PA systolic and pulse pressures; and (3) estrogen maintained the total hydraulic power and preserved transpulmonary vascular efficiency in PAH. This study demonstrates that estrogen preserves pulmonary vascular compliance independent of pulmonary vascular resistance, which provides a mechanical mechanism for ability of estrogen to delay disease progression without preventing onset. The estrogenic protection of pulsatile pulmonary hemodynamics underscores the therapeutic potential of estrogen in PAH.
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21
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Cheng HM, Chuang SY, Wang JJ, Shih YT, Wang HN, Huang CJ, Huang JT, Sung SH, Lakatta EG, Yin FCP, Chou P, Yeh CJ, Bai CH, Pan WH, Chen CH. Prognostic significance of mechanical biomarkers derived from pulse wave analysis for predicting long-term cardiovascular mortality in two population-based cohorts. Int J Cardiol 2016; 215:388-95. [PMID: 27128568 PMCID: PMC10617614 DOI: 10.1016/j.ijcard.2016.04.070] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2016] [Accepted: 04/11/2016] [Indexed: 11/26/2022]
Abstract
BACKGROUND Numerous mechanical biomarkers derived from pulse wave analysis (PWA) have been proposed to predict cardiovascular outcomes. However, whether these biomarkers carry independent prognostic value and clinical utility beyond traditional cardiovascular risk factors hasn't been systematically evaluated. We aimed to investigate the additive utility of PWA-derived biomarkers in two independent population-based cohorts. METHODS PWA on central arterial pressure waveforms obtained from subjects without a prior history of cardiovascular diseases of two studies was conducted based on the wave transmission and reservoir-wave theory: firstly in the Kinmen study (1272 individuals, a median follow-up of 19.8years); and then in the Cardiovascular Disease Risk Factors Two-Township Study (2221 individuals, median follow-up of 10years). The incremental value of the biomarkers was evaluated by net reclassification index (NRI). RESULTS In multivariate Cox analyses accounting for age, gender, body mass index, systolic blood pressure, fasting glucose, high-density- and low-density-lipoprotein cholesterol, and smoking, only systolic (SC) and diastolic rate constant (DC) of reservoir pressure could independently and consistently predict cardiovascular mortality in both cohorts and the combined cohort (SC: hazard ratio 1.18 [95% confidence interval 1.08-1.28, p<0.001; DC: 1.18 [1.09-1.28], p<0.001]. Risk prediction estimates in traditional risk prediction models were significantly more accurate when incorporating peak of reservoir pressure (NRI=0.049, p=0.0361), SC (NRI=0.043, p=0.0236) and DC (NRI=0.054, p=0.047). CONCLUSIONS Of all PWA-derived biomarkers, SC and DC were consistently identified as valuable parameters for incremental cardiovascular risk prediction in two large prospective cohorts.
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Affiliation(s)
- Hao-Min Cheng
- Department of Medical Education, Taipei Veterans General Hospital, Taipei, Taiwan; Cardiovascular Research Center, National Yang-Ming University, Taipei, Taiwan; Faculty of Medicine, National Yang-Ming University, Taipei, Taiwan; Department of Public Health, National Yang-Ming University, Taipei, Taiwan
| | - Shao-Yuan Chuang
- Division of Preventive Medicine and Health Service, Research Institute of Population Health Sciences, National Health Research Institutes, Miaoli, Taiwan
| | - Jiun-Jr Wang
- School of Medicine, Fu Jen Catholic University, Xinzhuang District, New Taipei City, Taiwan
| | - Yuan-Ta Shih
- Molecular Imaging Center, National Taiwan University, Taipei, Taiwan
| | - Hsin-Ning Wang
- Faculty of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Chi-Jung Huang
- Department of Medical Education, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Jui-Tzu Huang
- Faculty of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Shih-Hsien Sung
- Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Edward G Lakatta
- The Laboratory of Cardiovascular Science in the National Institute on Aging Intramural Research Program in Baltimore, MD, USA
| | - Frank C P Yin
- Department of Biomedical Engineering, Washington University, St Louis, MO, USA
| | - Pesus Chou
- Department of Public Health, National Yang-Ming University, Taipei, Taiwan
| | - Chih-Jung Yeh
- Department of Public Health, Chung-Shan Medical University, Taichung, Taiwan
| | | | - Wen-Harn Pan
- Institute of Biomedical Sciences, Academia Sinica, Taipei, Taiwan
| | - Chen-Huan Chen
- Department of Medical Education, Taipei Veterans General Hospital, Taipei, Taiwan; Cardiovascular Research Center, National Yang-Ming University, Taipei, Taiwan; Faculty of Medicine, National Yang-Ming University, Taipei, Taiwan; Department of Public Health, National Yang-Ming University, Taipei, Taiwan.
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22
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Sluyter JD, Hughes AD, Lowe A, Parker KH, Camargo CA, Hametner B, Wassertheurer S, Scragg RKR. Different associations between beta-blockers and other antihypertensive medication combinations with brachial blood pressure and aortic waveform parameters. Int J Cardiol 2016; 219:257-63. [PMID: 27340919 DOI: 10.1016/j.ijcard.2016.06.051] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2016] [Accepted: 06/12/2016] [Indexed: 01/13/2023]
Abstract
BACKGROUND Comparing the relationships of antihypertensive medications with brachial blood pressure (BP) and aortic waveform parameters may help clinicians to predict the effect on the latter in brachial BP-based antihypertensive therapy. We aimed to make such comparisons with new waveform measures and a wider range of antihypertensive regimens than examined previously. METHODS Cross-sectional analysis of 2933 adults (61% male; aged 50-84years): 1637 on antihypertensive treatment and 1296 untreated hypertensives. Sixteen medicine regimens of up to 4 combinations of drugs from 6 antihypertensive classes were analysed. Aortic systolic BP, augmentation index (AIx), excess pressure integral (EPI), backward pressure amplitude (Pb), reflection index (RI) and pulse wave velocity (PWV) were calculated from aortic pressure waveforms derived from suprasystolic brachial measurement. RESULTS Forest plots of single-drug class comparisons across regimens with the same number of drugs (for between 1- and 3-drug regimens) revealed that AIx, Pb, RI and/or loge(EPI) were higher (maximum difference=5.6%, 2.2mmHg, 0.0192 and 0.13 loge(mmHg⋅s), respectively) with the use of a beta-blocker compared with vasodilators and diuretics, despite no brachial systolic and diastolic BP differences. These differences were reduced (by 34-57%) or eliminated after adjustment for heart rate, and similar effects occurred when controlling for systolic ejection period or diastolic duration. CONCLUSIONS Beta-blocker effects on brachial BP may overestimate effects on aortic waveform parameters. Compared to other antihypertensives, beta-blockers have weaker associations with wave reflection measures and EPI; this is predominantly due to influences on heart rate.
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Affiliation(s)
- John D Sluyter
- School of Population Health, University of Auckland, Auckland, New Zealand.
| | - Alun D Hughes
- Institute of Cardiovascular Sciences, University College London, London, UK
| | - Andrew Lowe
- Institute for Biomedical Technologies, Auckland University of Technology, Auckland, New Zealand
| | - Kim H Parker
- Department of Bioengineering, Imperial College London, London, UK
| | - Carlos A Camargo
- Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, USA
| | - Bernhard Hametner
- Health & Environment Department, AIT Austrian Institute of Technology, Vienna, Austria
| | | | - Robert K R Scragg
- School of Population Health, University of Auckland, Auckland, New Zealand
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23
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Baksi AJ, Davies JE, Hadjiloizou N, Baruah R, Unsworth B, Foale RA, Korolkova O, Siggers JH, Francis DP, Mayet J, Parker KH, Hughes AD. Attenuation of reflected waves in man during retrograde propagation from femoral artery to proximal aorta. Int J Cardiol 2015; 202:441-5. [PMID: 26436672 DOI: 10.1016/j.ijcard.2015.09.064] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2015] [Accepted: 09/21/2015] [Indexed: 01/09/2023]
Abstract
BACKGROUND Wave reflection may be an important influence on blood pressure, but the extent to which reflections undergo attenuation during retrograde propagation has not been studied. We quantified retrograde transmission of a reflected wave created by occlusion of the left femoral artery in man. METHODS 20 subjects (age 31-83 years; 14 male) underwent invasive measurement of pressure and flow velocity with a sensor-tipped intra-arterial wire at multiple locations distal to the proximal aorta before, during and following occlusion of the left femoral artery by thigh cuff inflation. A numerical model of the circulation was also used to predict reflected wave transmission. Wave reflection was measured as the ratio of backward to forward wave energy (WRI) and the ratio of peak backward to forward pressure (Pb/Pf). RESULTS Cuff inflation caused a marked reflection which was largest at 5-10 cm from the cuff (change (Δ) in WRI=0.50 (95% CI 0.38, 0.62); p<0.001, ΔPb/Pf=0.23 (0.18-0.29); p<0.001). The magnitude of the cuff-induced reflection decreased progressively at more proximal locations and was barely discernible at sites>40 cm from the cuff including in the proximal aorta. Numerical modelling gave similar predictions to those observed experimentally. CONCLUSIONS Reflections due to femoral artery occlusion are markedly attenuated by the time they reach the proximal aorta. This is due to impedance mismatches of bifurcations traversed in the backward direction. This degree of attenuation is inconsistent with the idea of a large discrete reflected wave arising from the lower limb and propagating back into the aorta.
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Affiliation(s)
- A John Baksi
- International Centre for Circulatory Health, National Heart and Lung Institute, Imperial College London, & Imperial College Healthcare NHS Trust, UK; Cardiovascular Biomedical Research Unit, Royal Brompton Hospital and Imperial College London, London, UK
| | - Justin E Davies
- International Centre for Circulatory Health, National Heart and Lung Institute, Imperial College London, & Imperial College Healthcare NHS Trust, UK
| | - Nearchos Hadjiloizou
- International Centre for Circulatory Health, National Heart and Lung Institute, Imperial College London, & Imperial College Healthcare NHS Trust, UK
| | - Resham Baruah
- International Centre for Circulatory Health, National Heart and Lung Institute, Imperial College London, & Imperial College Healthcare NHS Trust, UK
| | - Beth Unsworth
- International Centre for Circulatory Health, National Heart and Lung Institute, Imperial College London, & Imperial College Healthcare NHS Trust, UK
| | - Rodney A Foale
- International Centre for Circulatory Health, National Heart and Lung Institute, Imperial College London, & Imperial College Healthcare NHS Trust, UK
| | - Olga Korolkova
- Department of Bioengineering, Imperial College London, UK
| | | | - Darrel P Francis
- International Centre for Circulatory Health, National Heart and Lung Institute, Imperial College London, & Imperial College Healthcare NHS Trust, UK
| | - Jamil Mayet
- International Centre for Circulatory Health, National Heart and Lung Institute, Imperial College London, & Imperial College Healthcare NHS Trust, UK
| | - Kim H Parker
- Department of Bioengineering, Imperial College London, UK
| | - Alun D Hughes
- Institute of Cardiovascular Sciences, University College London, London WC1E 6BT, UK.
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24
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Sera F, Russo C, Iwata S, Jin Z, Rundek T, Elkind MSV, Homma S, Sacco RL, Di Tullio MR. Arterial wave reflection and aortic valve calcification in an elderly community-based cohort. J Am Soc Echocardiogr 2015; 28:430-6. [PMID: 25600036 DOI: 10.1016/j.echo.2014.12.011] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2014] [Indexed: 12/19/2022]
Abstract
BACKGROUND Aortic valve calcification (AVC) without stenosis is common in the elderly, is associated with cardiovascular morbidity and mortality, and may progress to aortic valve stenosis. Arterial stiffness and pulse-wave reflection are important components of proximal aortic hemodynamics, but their relationship with AVC is not established. METHODS To investigate the relationship of arterial wave reflection and stiffness with AVC, pulse wave analysis and AVC evaluation by echocardiography were performed in 867 participants from the Cardiovascular Abnormalities and Brain Lesions study. Participants were divided into four categories on the basis of the severity and extent of AVC: (1) none or mild focal AVC, (2) mild diffuse AVC, (3) moderate to severe focal AVC, and (4) moderate to severe diffuse AVC. Central blood pressures and pulse pressure, total arterial compliance, augmentation index, and time to wave reflection were assessed using applanation tonometry. RESULTS Indicators of arterial stiffness and wave reflection were significantly associated with AVC severity, except for central systolic and diastolic pressures and time to reflection. After adjustment for pertinent covariates (age, sex, race/ethnicity, and estimated glomerular filtration rate), only augmentation pressure (P = .02) and augmentation index (P = .002) were associated with the severity of AVC. Multivariate logistic regression analysis revealed that augmentation pressure (odds ratio per mm Hg, 1.14; 95% confidence interval, 1.02-1.27; P = .02) and augmentation index (odds ratio per percentage point, 1.07; 95% confidence interval, 1.01-1.13; P = .02) were associated with an increased risk for moderate to severe diffuse AVC, even when central blood pressure value was included in the same model. CONCLUSIONS Arterial wave reflection is associated with AVC severity, independent of blood pressure values. Increased contribution of wave reflection to central blood pressure could be involved in the process leading to AVC.
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Affiliation(s)
- Fusako Sera
- Department of Medicine, Columbia University, New York, New York
| | - Cesare Russo
- Department of Medicine, Columbia University, New York, New York
| | - Shinichi Iwata
- Department of Medicine, Columbia University, New York, New York
| | - Zhezhen Jin
- Department of Biostatistics, Columbia University, New York, New York
| | - Tatjana Rundek
- Departments of Neurology and Public Health Sciences, University of Miami, Miami, Florida
| | - Mitchell S V Elkind
- Departments of Neurology and Epidemiology, Columbia University, New York, New York
| | - Shunichi Homma
- Department of Medicine, Columbia University, New York, New York
| | - Ralph L Sacco
- Departments of Neurology and Public Health Sciences, University of Miami, Miami, Florida; Department of Human Genetics, University of Miami, Miami, Florida
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25
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Affiliation(s)
- Jonathan P Mynard
- Heart Research, Clinical Sciences, Murdoch Childrens Research Institute, Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia.
| | - Joseph J Smolich
- Heart Research, Clinical Sciences, Murdoch Childrens Research Institute, Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia
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26
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Lilamand M, Kelaiditi E, Guyonnet S, Antonelli Incalzi R, Raynaud-Simon A, Vellas B, Cesari M. Flavonoids and arterial stiffness: promising perspectives. Nutr Metab Cardiovasc Dis 2014; 24:698-704. [PMID: 24656854 DOI: 10.1016/j.numecd.2014.01.015] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2013] [Revised: 12/20/2013] [Accepted: 01/17/2014] [Indexed: 01/27/2023]
Abstract
BACKGROUND AND AIMS Flavonoids are a group of polyphenol compounds, ubiquitously found in plants. Great emphasis has been given to their possible benefits for cardiovascular health. These beneficial effects may be mediated by a specific action on arterial walls. Arterial stiffness is a marker of vascular aging, increasingly used in the clinical setting and assessed by pulse wave velocity. It has shown to be a robust predictor of cardiovascular events and mortality. This review aims at providing a comprehensive evaluation of available intervention and observational studies examining the relationship between flavonoid consumption and arterial stiffness. DATA SYNTHESIS A Medline(®) literature search was performed using the keywords "arterial stiffness" and "flavonoids". As a result, 2 cross-sectional and 16 intervention studies assessing the relationship between flavonoids intake and arterial stiffness were retained. Four intervention trials reported a significant decrease of arterial stiffness after a flavonoid-based intervention, independently from blood pressure changes. The two observational studies reported significant associations between a higher flavonoid consumption and a lower arterial stiffness. In this review, isoflavones, anthocyanins and to a lesser extent cocoa flavan-3-ols appeared to be the more efficient to improve vascular function. CONCLUSIONS Despite their heterogeneity, preliminary data seem to support an improvement of the arterial stiffness related to flavonoid intake. However, further research on absorption and dose-response effects of the specific flavonoid subclasses on arterial structure is warranted.
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Affiliation(s)
- M Lilamand
- Gérontopôle, Centre Hospitalier Universitaire de Toulouse, France; Service de Gériatrie, Centre Hospitalier Universitaire Bichat, Paris, France.
| | - E Kelaiditi
- Gérontopôle, Centre Hospitalier Universitaire de Toulouse, France
| | - S Guyonnet
- Gérontopôle, Centre Hospitalier Universitaire de Toulouse, France; INSERM UMR 1027, Toulouse, France
| | | | - A Raynaud-Simon
- Service de Gériatrie, Centre Hospitalier Universitaire Bichat, Paris, France
| | - B Vellas
- Gérontopôle, Centre Hospitalier Universitaire de Toulouse, France; INSERM UMR 1027, Toulouse, France; Université de Toulouse III Paul Sabatier, Toulouse, France
| | - M Cesari
- Gérontopôle, Centre Hospitalier Universitaire de Toulouse, France; INSERM UMR 1027, Toulouse, France; Université de Toulouse III Paul Sabatier, Toulouse, France
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27
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Monteiro ER, Campagnol D, Bajotto GC, Simões CR, Rassele AC. Effects of 8 hemodynamic conditions on direct blood pressure values obtained simultaneously from the carotid, femoral and dorsal pedal arteries in dogs. J Vet Cardiol 2013; 15:263-70. [PMID: 24262114 DOI: 10.1016/j.jvc.2013.07.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2012] [Revised: 07/02/2013] [Accepted: 07/25/2013] [Indexed: 11/29/2022]
Abstract
OBJECTIVES This study aimed to evaluate the effect of 8 hemodynamic conditions on blood pressure measurements taken from the carotid, femoral and dorsal pedal arteries of dogs. ANIMALS Six healthy dogs. METHODS During isoflurane anesthesia, catheters were introduced into the carotid, femoral and dorsal pedal arteries of dogs to allow simultaneous monitoring of direct blood pressure in each artery. The dogs were submitted to 8 hemodynamic conditions induced by combining changes in heart rate (bradycardia, normocardia, tachycardia) with changes in blood pressure (hypotension, normotension, hypertension). Values obtained from each arterial catheter were compared and agreement between central (carotid) and peripheral (femoral and dorsal pedal) values were analyzed by the Bland-Altman method. RESULTS During hypotensive conditions, systolic arterial pressure (SAP) was lower in the femoral and dorsal pedal arteries compared to the carotid artery whereas during normotensive and hypertensive conditions, SAP was higher in peripheral arteries. During hypotensive states, increases in heart rate resulted in greater bias between central and peripheral SAP whereas during normotensive states, the bias decreased as heart rate increased. Mean and diastolic arterial pressures were lower in the femoral and dorsal pedal arteries than in the carotid artery during most hemodynamic conditions. CONCLUSIONS In healthy anesthetized dogs, invasive blood pressure measurements in peripheral arteries may differ significantly from measurements in a central artery. The greatest differences were observed in SAP and the magnitude of differences between central and peripheral blood pressure measurements varied according to the dog's hemodynamic condition.
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Affiliation(s)
- Eduardo R Monteiro
- University of Vila Velha, School of Veterinary Medicine, Rua Comissário José Dantas de Melo, 21, Boa Vista, CEP 29102-770 Vila Velha, ES, Brazil.
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Hsu PF, Chuang SY, Cheng HM, Sung SH, Ting CT, Lakatta EG, Yin FCP, Chou P, Chen CH. Associations of serum uric acid levels with arterial wave reflections and central systolic blood pressure. Int J Cardiol 2013; 168:2057-63. [PMID: 23453449 DOI: 10.1016/j.ijcard.2013.01.164] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2012] [Revised: 12/13/2012] [Accepted: 01/13/2013] [Indexed: 02/07/2023]
Abstract
BACKGROUND Uric acid may be involved in the pathogenesis of hypertension. We investigated the roles of four major hemodynamic parameters of blood pressure, including arterial stiffness, wave reflections, cardiac output (CO), and total peripheral resistance (TPR), in the association between uric acid and central systolic blood pressure (SBP-c). METHODS A sample of 1303 normotensive and untreated hypertensive Taiwanese participants (595 women, aged 30-79 years) was drawn from a community-based survey. Study subjects' baseline characteristics, biochemical parameters, carotid-femoral pulse wave velocity (cf-PWV), amplitude of the backward pressure wave decomposed from a calibrated tonometry-derived carotid pressure waveform (Pb), CO, TPR, and SBP-c were analyzed. RESULTS In multi-variate analyses adjusted for age, waist circumference, body mass index, creatinine, total cholesterol, smoking, and heart rate, uric acid significantly correlated with Pb and cf-PWV in men, and Pb and TPR in women. The correlation between uric acid and Pb remained significant in men and women when cf-PWV was further adjusted. In the final multi-variate prediction model (model r(2)=0.839) for SBP-c, the significant independent variables included uric acid (partial r(2)=0.005), Pb (partial r(2)=0.651), cf-PWV (partial r(2)=0.005), CO (partial r(2)=0.062), TPR (partial r(2)=0.021), with adjustment for age, sex, waist circumference, body mass index, creatinine, total cholesterol, smoking, and heart rate. CONCLUSIONS Uric acid was significantly independently associated with wave reflections, which is the dominant determinant of SBP-c. Uric acid was also significantly associated with SBP-c independently of the major hemodynamic parameters.
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Affiliation(s)
- Pai-Feng Hsu
- Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Institute of Public Health, National Yang-Ming University, Taipei, Taiwan; Cardiovascular Research Center, National Yang-Ming University, Taipei, Taiwan
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29
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Bian S, Guo H, Ye P, Luo L, Wu H, Xiao W. Serum uric Acid level and diverse impacts on regional arterial stiffness and wave reflection. Iran J Public Health 2012; 41:33-41. [PMID: 23113222 PMCID: PMC3469023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/10/2012] [Accepted: 06/27/2012] [Indexed: 11/05/2022]
Abstract
BACKGROUND Both increased arterial stiffness and hyperuricaemia are associated with elevated cardiovascular risks. Little is known about the relations of serum uric acid (UA) level to regional arterial stiffness and wave reflection. The aim of the study was to investigate the gender-specific association of serum UA and indices of arterial function in a community-based investigation in China. METHODS Cross-sectional data from 2374 adults (mean age 58.24 years) who underwent routine laboratory tests, regional pulse wave velocity (PWV) and pulse wave analysis measurements were analyzed in a gender-specific manner. None of the participants had atherosclerotic cardiovascular disease, chronic renal failure, systemic inflammatory disease, gout, or were under treatment which would affect serum UA level. RESULTS Men had higher serum UA level than women. Subjects with hyperuricaemia had significantly higher carotid-ankle PWV in both genders (P< 0.05), and the carotid-femoral PWV (PWVc-f) was higher in women (P< 0.001) while the augmentation index was marginally lower in men (P = 0.049). Multiple regression analysis showed that serum UA was an independent determinant only for PWVc-f in women (β = 0.104, P = 0.027) when adjusted for atherogenic confounders. No other independent relationship was found between UA level and other surrogates of arterial stiffness. CONCLUSIONS Serum UA levels are associated with alterations in systemic arterial stiffness that differ in men and women. Women might be more susceptible to large vascular damage associated with hyperuricaemia.
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Affiliation(s)
| | | | - Ping Ye
- Corresponding Author: Tel/Fax: 86-10-66876349. E-mail:
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