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Norton GR, An DW, Aparicio LS, Yu YL, Wei FF, Niiranen TJ, Liu C, Stolarz-Skrzypek K, Wojciechowska W, Jula AM, Rajzer M, Martens DS, Verhamme P, Li Y, Kawecka-Jaszcz K, Nawrot TS, Staessen JA, Woodiwiss AJ. Mortality and Cardiovascular End Points In Relation to the Aortic Pulse Wave Components: An Individual-Participant Meta-Analysis. Hypertension 2024; 81:1065-1075. [PMID: 38390718 DOI: 10.1161/hypertensionaha.123.22036] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Accepted: 02/11/2024] [Indexed: 02/24/2024]
Abstract
BACKGROUND Wave separation analysis enables individualized evaluation of the aortic pulse wave components. Previous studies focused on the pressure height with overall positive but differing results. In the present analysis, we assessed the associations of the pressure of forward and backward (Pfor and Pref) pulse waves with prospective cardiovascular end points, with extended analysis for time to pressure peak (Tfor and Tref). METHODS Participants in 3 IDCARS (International Database of Central Arterial Properties for Risk Stratification) cohorts (Argentina, Belgium, and Finland) aged ≥20 years with valid pulse wave analysis and follow-up data were included. Pulse wave analysis was done using the SphygmoCor device, and pulse wave separation was done using the triangular method. The primary end points consisted of cardiovascular mortality and nonfatal cardiovascular and cerebrovascular events. Multivariable-adjusted Cox regression was used to calculate hazard ratios. RESULTS A total of 2206 participants (mean age, 57.0 years; 55.0% women) were analyzed. Mean±SDs for Pfor, Pref, Tfor, and Tfor/Tref were 31.0±9.1 mm Hg, 20.8±8.4 mm Hg, 130.8±35.5, and 0.51±0.11, respectively. Over a median follow-up of 4.4 years, 146 (6.6%) participants experienced a primary end point. Every 1 SD increment in Pfor, Tfor, and Tfor/Tref was associated with 27% (95% CI, 1.07-1.49), 25% (95% CI, 1.07-1.45), and 32% (95% CI, 1.12-1.56) higher risk, respectively. Adding Tfor and Tfor/Tref to existing risk models improved model prediction (∆Uno's C, 0.020; P<0.01). CONCLUSIONS Pulse wave components were predictive of composite cardiovascular end points, with Tfor/Tref showing significant improvement in risk prediction. Pending further confirmation, the ratio of time to forward and backward pressure peak may be useful to evaluate increased afterload and signify increased cardiovascular risk.
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Affiliation(s)
- Gavin R Norton
- Cardiovascular Pathophysiology and Genomics Research Unit, School of Physiology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa (G.R.N., A.J.W.)
| | - De-Wei An
- Department of Cardiovascular Medicine, Shanghai Key Laboratory of Hypertension, Shanghai Institute of Hypertension, State Key Laboratory of Medical Genomics, National Research Center for Translational Medicine, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, China (D.-W.A., Y.L.)
- Non-Profit Research Association Alliance for the Promotion of Preventive Medicine, Mechelen, Belgium (D.-W.A, Y.-L.Y., K.S.-S., J.A.S.)
- Research Unit Environment and Health, Department of Public Health and Primary Care (D.-W.A, Y.-L.Y., T.S.N.), University of Leuven, Belgium
| | - Lucas S Aparicio
- Servicio de Clínica Médica, Sección Hipertensión Arterial, Hospital Italiano de Buenos Aires, Argentina (L.S.A.)
| | - Yu-Ling Yu
- Non-Profit Research Association Alliance for the Promotion of Preventive Medicine, Mechelen, Belgium (D.-W.A, Y.-L.Y., K.S.-S., J.A.S.)
- Research Unit Environment and Health, Department of Public Health and Primary Care (D.-W.A, Y.-L.Y., T.S.N.), University of Leuven, Belgium
| | - Fang-Fei Wei
- The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China (F.-F.W., C.L.)
| | - Teemu J Niiranen
- Department of Chronic Disease Prevention, Finnish Institute for Health and Welfare, Turku, Finland (T.J.N., A.M.J.)
- Department of Medicine, Turku University Hospital and University of Turku, Finland (T.J.N., A.M.J.)
| | - Chen Liu
- The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China (F.-F.W., C.L.)
| | - Katarzyna Stolarz-Skrzypek
- Non-Profit Research Association Alliance for the Promotion of Preventive Medicine, Mechelen, Belgium (D.-W.A, Y.-L.Y., K.S.-S., J.A.S.)
- First Department of Cardiology, Interventional Electrocardiology and Hypertension, Jagiellonian University Medical College, Kraków, Poland (K.S.-S., W.W., K.K.-J., M.R.)
| | - Wiktoria Wojciechowska
- First Department of Cardiology, Interventional Electrocardiology and Hypertension, Jagiellonian University Medical College, Kraków, Poland (K.S.-S., W.W., K.K.-J., M.R.)
| | - Antti M Jula
- Department of Chronic Disease Prevention, Finnish Institute for Health and Welfare, Turku, Finland (T.J.N., A.M.J.)
- Department of Medicine, Turku University Hospital and University of Turku, Finland (T.J.N., A.M.J.)
| | - Marek Rajzer
- First Department of Cardiology, Interventional Electrocardiology and Hypertension, Jagiellonian University Medical College, Kraków, Poland (K.S.-S., W.W., K.K.-J., M.R.)
| | - Dries S Martens
- Center for Environmental Sciences, Hasselt University, Diepenbeek, Belgium (D.S.M., T.S.N)
| | - Peter Verhamme
- Center for Molecular and Vascular Biology, KU Leuven Department of Cardiovascular Sciences (P.V.), University of Leuven, Belgium
| | - Yan Li
- Department of Cardiovascular Medicine, Shanghai Key Laboratory of Hypertension, Shanghai Institute of Hypertension, State Key Laboratory of Medical Genomics, National Research Center for Translational Medicine, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, China (D.-W.A., Y.L.)
| | - Kalina Kawecka-Jaszcz
- First Department of Cardiology, Interventional Electrocardiology and Hypertension, Jagiellonian University Medical College, Kraków, Poland (K.S.-S., W.W., K.K.-J., M.R.)
| | - Tim S Nawrot
- Research Unit Environment and Health, Department of Public Health and Primary Care (D.-W.A, Y.-L.Y., T.S.N.), University of Leuven, Belgium
- Center for Environmental Sciences, Hasselt University, Diepenbeek, Belgium (D.S.M., T.S.N)
| | - Jan A Staessen
- Non-Profit Research Association Alliance for the Promotion of Preventive Medicine, Mechelen, Belgium (D.-W.A, Y.-L.Y., K.S.-S., J.A.S.)
- Biomedical Science Group, Faculty of Medicine (J.A.S.), University of Leuven, Belgium
| | - Angela J Woodiwiss
- Cardiovascular Pathophysiology and Genomics Research Unit, School of Physiology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa (G.R.N., A.J.W.)
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Hellqvist H, Karlsson M, Hoffman J, Kahan T, Spaak J. Estimation of aortic stiffness by finger photoplethysmography using enhanced pulse wave analysis and machine learning. Front Cardiovasc Med 2024; 11:1350726. [PMID: 38529332 PMCID: PMC10961400 DOI: 10.3389/fcvm.2024.1350726] [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] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Accepted: 02/16/2024] [Indexed: 03/27/2024] Open
Abstract
Introduction Aortic stiffness plays a critical role in the evolution of cardiovascular diseases, but the assessment requires specialized equipment. Photoplethysmography (PPG) and single-lead electrocardiogram (ECG) are readily available in healthcare and wearable devices. We studied whether a brief PPG registration, alone or in combination with single-lead ECG, could be used to reliably estimate aortic stiffness. Methods A proof-of-concept study with simultaneous high-resolution index finger recordings of infrared PPG, single-lead ECG, and finger blood pressure (Finapres) was performed in 33 participants [median age 44 (range 21-66) years, 19 men] and repeated within 2 weeks. Carotid-femoral pulse wave velocity (cfPWV; two-site tonometry with SphygmoCor) was used as a reference. A brachial single-cuff oscillometric device assessed aortic pulse wave velocity (aoPWV; Arteriograph) for further comparisons. We extracted 136 established PPG waveform features and engineered 13 new with improved coupling to the finger blood pressure curve. Height-normalized pulse arrival time (NPAT) was derived using ECG. Machine learning methods were used to develop prediction models. Results The best PPG-based models predicted cfPWV and aoPWV well (root-mean-square errors of 0.70 and 0.52 m/s, respectively), with minor improvements by adding NPAT. Repeatability and agreement were on par with the reference equipment. A new PPG feature, an amplitude ratio from the early phase of the waveform, was most important in modelling, showing strong correlations with cfPWV and aoPWV (r = -0.81 and -0.75, respectively, both P < 0.001). Conclusion Using new features and machine learning methods, a brief finger PPG registration can estimate aortic stiffness without requiring additional information on age, anthropometry, or blood pressure. Repeatability and agreement were comparable to those obtained using non-invasive reference equipment. Provided further validation, this readily available simple method could improve cardiovascular risk evaluation, treatment, and prognosis.
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Affiliation(s)
- Henrik Hellqvist
- Division of Cardiovascular Medicine, Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Mikael Karlsson
- Marcus Wallenberg Laboratory for Sound and Vibration Research, Department of Engineering Mechanics, KTH Royal Institute of Technology, Stockholm, Sweden
| | - Johan Hoffman
- Division of Computational Science and Technology, KTH Royal Institute of Technology, Stockholm, Sweden
| | - Thomas Kahan
- Division of Cardiovascular Medicine, Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Jonas Spaak
- Division of Cardiovascular Medicine, Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden
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Schellinger IN, Dannert A, Hoffmann A, Chodisetti G, Mattern K, Petzold A, Klöting N, Schuster A, Wagenhäuser MU, Emrich F, Stumvoll M, Hasenfuß G, Raaz U. Angiotensin Receptor-Neprilysin Inhibition (Sacubitril/Valsartan) Reduces Structural Arterial Stiffness in Middle-Aged Mice. J Am Heart Assoc 2024; 13:e032641. [PMID: 38348796 PMCID: PMC11010079 DOI: 10.1161/jaha.123.032641] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Accepted: 01/09/2024] [Indexed: 02/21/2024]
Abstract
BACKGROUND Increasing arterial stiffness is a prominent feature of the aging cardiovascular system. Arterial stiffening leads to fundamental alterations in central hemodynamics with widespread detrimental implications for organ function resulting in significant morbidity and death, and specific therapies to address the underlying age-related structural arterial remodeling remain elusive. The present study investigates the potential of the recently clinically available dual angiotensin receptor-neprilysin inhibitor (ARNI) sacubitril/valsartan (LCZ696) to counteract age-related arterial fibrotic remodeling and stiffening in 1-year-old mice. METHODS AND RESULTS Treatment of in 1-year-old mice with ARNI (sacubitril/valsartan), in contrast to angiotensin receptor blocker monotherapy (valsartan) and vehicle treatment (controls), significantly decreases structural aortic stiffness (as measured by in vivo pulse-wave velocity and ex vivo aortic pressure myography). This phenomenon appears, at least partly, independent of (indirect) blood pressure effects and may be related to a direct antifibrotic interference with aortic smooth muscle cell collagen production. Furthermore, we find aortic remodeling and destiffening due to ARNI treatment to be associated with improved parameters of cardiac diastolic function in aged mice. CONCLUSIONS This study provides preclinical mechanistic evidence indicating that ARNI-based interventions may counteract age-related arterial stiffening and may therefore be further investigated as a promising strategy to improve cardiovascular outcomes in the elderly.
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Affiliation(s)
- Isabel N Schellinger
- Department of Cardiology and Pneumology Heart Center at the University Medical Center Göttingen Göttingen Germany
- German Center for Cardiovascular Research (DZHK) e.V. Partner site Göttingen Göttingen Germany
- Department for Endocrinology, Nephrology and Rheumatology University Medical Center Leipzig, University of Leipzig Leipzig Germany
| | - Angelika Dannert
- Department of Cardiology and Pneumology Heart Center at the University Medical Center Göttingen Göttingen Germany
| | - Annet Hoffmann
- Department for Endocrinology, Nephrology and Rheumatology University Medical Center Leipzig, University of Leipzig Leipzig Germany
| | - Giriprakash Chodisetti
- Department of Cardiology and Pneumology Heart Center at the University Medical Center Göttingen Göttingen Germany
| | - Karin Mattern
- Department of Cardiology and Pneumology Heart Center at the University Medical Center Göttingen Göttingen Germany
| | - Anne Petzold
- Department of Cardiology and Pneumology Heart Center at the University Medical Center Göttingen Göttingen Germany
| | - Nora Klöting
- Department for Endocrinology, Nephrology and Rheumatology University Medical Center Leipzig, University of Leipzig Leipzig Germany
| | - Andreas Schuster
- Department of Cardiology and Pneumology Heart Center at the University Medical Center Göttingen Göttingen Germany
- German Center for Cardiovascular Research (DZHK) e.V. Partner site Göttingen Göttingen Germany
| | - Markus U Wagenhäuser
- Department of Vascular and Endovascular Surgery University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf Germany
| | - Fabian Emrich
- Department of Cardiothoracic and Vascular Surgery Goethe University Hospital Frankfurt Frankfurt Germany
| | - Michael Stumvoll
- Department for Endocrinology, Nephrology and Rheumatology University Medical Center Leipzig, University of Leipzig Leipzig Germany
| | - Gerd Hasenfuß
- Department of Cardiology and Pneumology Heart Center at the University Medical Center Göttingen Göttingen Germany
- German Center for Cardiovascular Research (DZHK) e.V. Partner site Göttingen Göttingen Germany
| | - Uwe Raaz
- Department of Cardiology and Pneumology Heart Center at the University Medical Center Göttingen Göttingen Germany
- German Center for Cardiovascular Research (DZHK) e.V. Partner site Göttingen Göttingen Germany
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4
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Chen C, Chen Z, Luo H, Peng B, Hao Y, Xie X, Xie H, Li X. Increasing the sensor channels: a solution for the pressing offsets that cause the physiological parameter inaccuracy in radial artery pulse signal acquisition. Front Bioeng Biotechnol 2024; 12:1359297. [PMID: 38425993 PMCID: PMC10902865 DOI: 10.3389/fbioe.2024.1359297] [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] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Accepted: 01/31/2024] [Indexed: 03/02/2024] Open
Abstract
Introduction: In studies of pulse wave analysis, single-channel sensors only adopt single temporal pulse signals without spatial information to show pulse-feeling patterns. Multi-channel arterial pulse signals, also named as three-dimensional pulse images (3DPIs), provide the spatial and temporal characteristics of radial pulse signals. When involving single or few-channel sensors, pressing offsets have substantial impacts on obtaining inaccurate physiological parameters like tidal peak (P2). Methods: This study discovers the pressing offsets in multi-channel pulse signals and analyzes the relationship between the pressing offsets and time of P2 (T2) by qualifying the pressing offsets. First, we employ a data acquisition system to capture 3DPIs. Subsequently, the errorT2 is developed to qualify the pressing offsets. Results: The outcomes display a central low and peripheral high pattern. Additionally, the errorT2 increase as the distances from the artery increase, particularly at the radial ends of the blood flow direction. For every 1 mm increase in distances between sensing elements and center sensing elements, the errorT2 in the radial direction escalates by 4.87%. When the distance is greater than 3.42 mm, the errorT2 experiences a sudden increase. Discussion: The results show that increasing the sensor channels can overcome the pressing offsets in radial pulse signal acquisition.
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Affiliation(s)
- Chao Chen
- School of Computer Science and Engineering, Sun Yat-Sen University, Guangzhou, China
| | - Zhendong Chen
- School of Computer Science and Engineering, Sun Yat-Sen University, Guangzhou, China
| | - Hongmiin Luo
- Science and Technology Innovation Center, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Bo Peng
- Department of Musical Instrument Engineering, Xinghai Conservatory of Music, Guangzhou, China
- Sniow Research and Development Laboratory, Foshan, China
| | - Yinan Hao
- Department of Musical Instrument Engineering, Xinghai Conservatory of Music, Guangzhou, China
| | - Xiaohua Xie
- School of Computer Science and Engineering, Sun Yat-Sen University, Guangzhou, China
| | - Haiqing Xie
- School of Medical Engineering, Foshan University, Foshan, China
| | - Xinxin Li
- School of Nursing, Sun Yat-Sen University, Guangzhou, China
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5
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Spronck B, Terentes-Printzios D, Avolio AP, Boutouyrie P, Guala A, Jerončić A, Laurent S, Barbosa EC, Baulmann J, Chen CH, Chirinos JA, Daskalopoulou SS, Hughes AD, Mahmud A, Mayer CC, Park JB, Pierce GL, Schutte AE, Urbina EM, Wilkinson IB, Segers P, Sharman JE, Tan I, Vlachopoulos C, Weber T, Bianchini E, Bruno RM. 2024 Recommendations for Validation of Noninvasive Arterial Pulse Wave Velocity Measurement Devices. Hypertension 2024; 81:183-192. [PMID: 37975229 PMCID: PMC10734786 DOI: 10.1161/hypertensionaha.123.21618] [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: 06/21/2023] [Accepted: 10/18/2023] [Indexed: 11/19/2023]
Abstract
BACKGROUND Arterial stiffness, as measured by arterial pulse wave velocity (PWV), is an established biomarker for cardiovascular risk and target-organ damage in individuals with hypertension. With the emergence of new devices for assessing PWV, it has become evident that some of these devices yield results that display significant discrepancies compared with previous devices. This discrepancy underscores the importance of comprehensive validation procedures and the need for international recommendations. METHODS A stepwise approach utilizing the modified Delphi technique, with the involvement of key scientific societies dedicated to arterial stiffness research worldwide, was adopted to formulate, through a multidisciplinary vision, a shared approach to the validation of noninvasive arterial PWV measurement devices. RESULTS A set of recommendations has been developed, which aim to provide guidance to clinicians, researchers, and device manufacturers regarding the validation of new PWV measurement devices. The intention behind these recommendations is to ensure that the validation process can be conducted in a rigorous and consistent manner and to promote standardization and harmonization among PWV devices, thereby facilitating their widespread adoption in clinical practice. CONCLUSIONS It is hoped that these recommendations will encourage both users and developers of PWV measurement devices to critically evaluate and validate their technologies, ultimately leading to improved consistency and comparability of results. This, in turn, will enhance the clinical utility of PWV as a valuable tool for assessing arterial stiffness and informing cardiovascular risk stratification and management in individuals with hypertension.
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Affiliation(s)
- Bart Spronck
- Department of Biomedical Engineering, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Netherlands (B.S.)
- Macquarie Medical School, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, NSW, Australia (B.S., A.P.A., I.T.)
| | - Dimitrios Terentes-Printzios
- 1st Cardiology Department, Hippokration Hospital, National and Kapodistrian University of Athens, Greece (D.T.-P., C.V.)
| | - Alberto P. Avolio
- Macquarie Medical School, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, NSW, Australia (B.S., A.P.A., I.T.)
| | - Pierre Boutouyrie
- Université Paris Cité, Inserm, Paris Cardiovascular Research Center (PARCC), France (P.B., S.L., R.M.B.)
- Service de Pharmacologie et Hypertension, Assistance Publique–Hôpitaux de Paris (AP–HP), Hôpital Européen Georges Pompidou, Paris, France (P.B., S.L., R.M.B.)
| | - Andrea Guala
- Vall d’Hebron Institut de Recerca, Barcelona, Spain (A.G.)
- Centro de Investigación en Red en Enfermedades Cardiovasculares (CIBER-CV), Instituto de Salud Carlos III, Madrid, Spain (A.G.)
| | - Ana Jerončić
- Laboratory of Vascular Aging and Cardiovascular Prevention, Department of Research in Biomedicine and Health, University of Split School of Medicine, Croatia (A.J.)
| | - Stéphane Laurent
- Université Paris Cité, Inserm, Paris Cardiovascular Research Center (PARCC), France (P.B., S.L., R.M.B.)
- Service de Pharmacologie et Hypertension, Assistance Publique–Hôpitaux de Paris (AP–HP), Hôpital Européen Georges Pompidou, Paris, France (P.B., S.L., R.M.B.)
| | | | - Johannes Baulmann
- Praxis Dres. Gille/Baulmann, Rheinbach, Germany (J.B.)
- Division of Cardiology, Medical University of Graz, Austria (J.B.)
| | - Chen-Huan Chen
- College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan (C.-H.C.)
| | - Julio A. Chirinos
- Cardiovascular Division, University of Pennsylvania Perelman School of Medicine and Hospital of the University of Pennsylvania, Philadelphia, PA (J.A.C.)
| | - Stella S. Daskalopoulou
- Department of Medicine, Research Institute McGill University Health Centre, McGill University, Montreal, QC, Canada (S.S.D.)
| | - Alun D. Hughes
- Department of Population Science and Experimental Medicine, Institute of Cardiovascular Science, University College London, United Kingdom (A.D.H.)
| | - Azra Mahmud
- Department of Internal Medicine, Pharmacology, and Clinical Research, Shalamar Medical and Dental College, Lahore, Pakistan (A.M.)
| | - Christopher C. Mayer
- AIT Austrian Institute of Technology, Center for Health & Bioresources, Medical Signal Analysis, Vienna (C.C.M.)
| | - Jeong Bae Park
- JB Lab and Clinic, Department of Precision Medicine and Biostatistics, Wonju College of Medicine, Yonsei University, Seoul, Republic of Korea (J.B.P.)
| | - Gary L. Pierce
- Department of Health and Human Physiology, University of Iowa, IA (G.L.P.)
| | - Aletta E. Schutte
- School of Population Health, University of New South Wales, Sydney, Australia (A.E.S.)
- The George Institute for Global Health, Sydney, NSW, Australia (A.E.S., I.T.)
| | - Elaine M. Urbina
- Cincinnati Children’s Hospital Medical Center, OH (E.M.U.)
- University of Cincinnati, OH (E.M.U.)
| | - Ian B. Wilkinson
- Experimental Medicine and Therapeutics, University of Cambridge, United Kingdom (I.B.W.)
| | | | - James E. Sharman
- Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, Australia (J.E.S.)
| | - Isabella Tan
- Macquarie Medical School, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, NSW, Australia (B.S., A.P.A., I.T.)
- The George Institute for Global Health, Sydney, NSW, Australia (A.E.S., I.T.)
| | - Charalambos Vlachopoulos
- 1st Cardiology Department, Hippokration Hospital, National and Kapodistrian University of Athens, Greece (D.T.-P., C.V.)
| | - Thomas Weber
- Cardiology Department, Klinikum Wels-Grieskirchen, Austria (T.W.)
| | - Elisabetta Bianchini
- Institute of Clinical Physiology, Italian National Research Council, Pisa (E.B.)
| | - Rosa Maria Bruno
- Université Paris Cité, Inserm, Paris Cardiovascular Research Center (PARCC), France (P.B., S.L., R.M.B.)
- Service de Pharmacologie et Hypertension, Assistance Publique–Hôpitaux de Paris (AP–HP), Hôpital Européen Georges Pompidou, Paris, France (P.B., S.L., R.M.B.)
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6
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Taurio J, Koskela J, Sinisalo M, Tikkakoski A, Niemelä O, Hämäläinen M, Moilanen E, Choudhary MK, Mustonen J, Nevalainen P, Pörsti I. Urine sodium excretion is related to extracellular water volume but not to blood pressure in 510 normotensive and never-treated hypertensive subjects. Blood Press 2023; 32:2170869. [PMID: 36708156 DOI: 10.1080/08037051.2023.2170869] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
PURPOSE High sodium intake is an accepted risk factor for hypertension, while low Na+ intake has also been associated with increased risk of cardiovascular events. In this cross-sectional study, we examined the association of 24-h urinary Na+ excretion with haemodynamics and volume status. MATERIALS AND METHODS Haemodynamics were recorded in 510 normotensive and never-treated hypertensive subjects using whole-body impedance cardiography and tonometric radial artery pulse wave analysis. The results were examined in sex-specific tertiles of 24-h Na+ excretion, and comparisons between normotensive and hypertensive participants were also performed. Regression analysis was used to investigate factors associated with volume status. The findings were additionally compared to 28 patients with primary aldosteronism. RESULTS The mean values of 24-h urinary Na+ excretion in tertiles of the 510 participants were 94, 148 and 218 mmol, respectively. Average tertile age (43.4-44.7 years), office blood pressure and pulse wave velocity were corresponding in the tertiles. Plasma electrolytes, lipids, vitamin D metabolites, parathyroid hormone, renin activity, aldosterone, creatinine and insulin sensitivity did not differ in the tertiles. In supine laboratory recordings, there were no differences in aortic systolic and diastolic blood pressure, heart rate, cardiac output and systemic vascular resistance. Extracellular water volume was higher in the highest versus lowest tertile of Na+ excretion. In regression analysis, body surface area and 24-h Na+ excretion were independent explanatory variables for extracellular water volume. No differences in urine Na+ excretion and extracellular water volume were found between normotensive and hypertensive participants. When compared with the 510 participants, patients with primary aldosteronism had 6.0% excess in extracellular water (p = .003), and 24-h Na+ excretion was not related with extracellular water volume. CONCLUSION In the absence of mineralocorticoid excess, Na+ intake, as evaluated from 24-h Na+ excretion, predominantly influences extracellular water volume without a clear effect on blood pressure.
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Affiliation(s)
- Jyrki Taurio
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.,Department of Internal Medicine, Tampere University Hospital, Tampere, Finland
| | - Jenni Koskela
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.,Department of Internal Medicine, Tampere University Hospital, Tampere, Finland
| | - Marjatta Sinisalo
- Department of Internal Medicine, Tampere University Hospital, Tampere, Finland
| | - Antti Tikkakoski
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.,Department of Clinical Physiology, Tampere University Hospital, Tampere, Finland
| | - Onni Niemelä
- Department of Laboratory Medicine and Medical Research Unit, Seinäjoki Central Hospital, Seinäjoki, Finland
| | - Mari Hämäläinen
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.,The Immunopharmacology Research Group, Tampere University and Tampere University Hospital, Tampere, Finland
| | - Eeva Moilanen
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.,The Immunopharmacology Research Group, Tampere University and Tampere University Hospital, Tampere, Finland
| | | | - Jukka Mustonen
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.,Department of Internal Medicine, Tampere University Hospital, Tampere, Finland
| | - Pasi Nevalainen
- Department of Internal Medicine, Tampere University Hospital, Tampere, Finland
| | - Ilkka Pörsti
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.,Department of Internal Medicine, Tampere University Hospital, Tampere, Finland
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7
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Rabow S, Jonsson H, Bro E, Olofsson P. Cardiovascular effects of oxytocin and carbetocin at cesarean section. A prospective double-blind randomized study using noninvasive pulse wave analysis. J Matern Fetal Neonatal Med 2023; 36:2208252. [PMID: 37150593 DOI: 10.1080/14767058.2023.2208252] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/09/2023]
Abstract
BACKGROUND Oxytocin is routinely administered after delivery for prophylaxis and treatment of postpartum hemorrhage, but it is associated with considerable cardiovascular side-effects. Carbetocin, a synthetic oxytocin analogue, has a myometrial contraction effect of 60 min when given IV, compared with 16 min for oxytocin. OBJECTIVE To investigate whether there are differences in cardiovascular effects between oxytocin and carbetocin up to 1 h after treatment. METHODS Sixty-one healthy pregnant women undergoing elective cesarean section in spinal anesthesia were randomized to receive an IV bolus of either five units (8.3 µg) of oxytocin or 100 µg of carbetocin after delivery of the baby. Heart rate (HR), mean arterial blood pressure, ECG ST index, oxygen saturation (SaO2), and photoplethysmographic digital pulse wave analysis variables were recorded before and at 1, 5, 20, and 60 min after drug administration. Vasopressor use, uterine tonus, total bleeding, and need for additional uterotonics were also assessed. Repeated measurement ANOVA was used for statistical analyses. RESULTS The drugs had equal vasodilatory and hypotensive effects. Oxytocin, but not carbetocin, caused a decrease in HR at 1 min and a sustained decrease in cardiac left ventricular ejection time. Aggregate vasopressor use was higher in the carbetocin group. Neither drug caused any change in ST index, SaO2, or subjective cardiac symptoms. Uterine tonus, need for additional uterotonics, or total bleeding did not differ significantly between the groups. CONCLUSION Single doses of oxytocin and carbetocin had similar dilatory effects on vascular tonus, where the difference in aggregate vasopressor use can be attributed to a more persistent hypotensive effect of carbetocin. A transient negative chronotropic and sustained negative inotropic effect occurred after oxytocin. Neither drug showed any alarmingly adverse effects. Differences in drug effects may be attributed to differences in oxytocin and vasopressin receptor signaling pathways.
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Affiliation(s)
- Sofus Rabow
- Department of Anesthesiology and Intensive Care, Institution of Clinical Sciences Lund, Lund University, and Skåne University Hospital, Lund, Sweden
| | - Hanna Jonsson
- Department of Obstetrics and Gynecology, Institution of Clinical Sciences Malmö, Lund University, and Skåne University Hospital, Malmö, Sweden
| | - Emilie Bro
- Department of Obstetrics and Gynecology, Institution of Clinical Sciences Malmö, Lund University, and Skåne University Hospital, Malmö, Sweden
| | - Per Olofsson
- Department of Obstetrics and Gynecology, Institution of Clinical Sciences Malmö, Lund University, and Skåne University Hospital, Malmö, Sweden
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Başaran C, Erfidan G, Özdemir-Şimşek Ö, Arslansoyu-Çamlar S, Alaygut D, Mutlubaş F, Karadeniz C, Dündar BN, Kasap-Demir B. Pulse Wave Analysis in Obese Children with and without Metabolic Syndrome. J Clin Res Pediatr Endocrinol 2023; 15:397-405. [PMID: 37470253 PMCID: PMC10683538 DOI: 10.4274/jcrpe.galenos.2023.2022-10-21] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Accepted: 07/18/2023] [Indexed: 07/21/2023] Open
Abstract
Objective To compare pulse wave analysis (PWA) of obese children with and without metabolic syndrome (MS) with healthy, non-obese children and to evaluate the association between PWA findings and additional risk factors present in children with MS and obesity. Methods From the obese patients examined between June 2019 and June 2021, 41 patients with MS, 36 obese patients without MS, and 34 healthy non-obese children of similar age and gender were evaluated retrospectively. Anthropometric measurements, biochemical evaluation, 24-hour ambulatory blood pressure (BP) measurement (ABPM), left ventricular mass index (LVMI) and PWA measurements were compared. Results When the three groups were compared, weight standard deviation score (SDS), height SDS and body mass index SDS were all significantly higher in the MS group (p<0.05). The following measurements were significantly higher in both MS and non-MS obese patients compared to the control group: from ABPM measures, the systolic and mean arterial pressure BP SDSs load; from PWA, the night central systolic BP, 24-hour, day and night pulse pressure values and 24-hour, day and night pulse wave velocity (PWV) rates; and from cardiac evaluations, the LVMI and relative wall thickness measurements (all p<0.05). Furthermore, the 24-hour and daytime central systolic (cSBP) and diastolic BP (cDBP) values were significantly different between the three groups, being the highest in the MS group (p<0.05). Conclusion Obesity causes higher office, ambulatory and central BP, PWV and LVMI. However our results suggest that additional risk factors associated with MS do not contribute to these parameters, except for 24-hour and daytime cSBP and cDBP values.
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Affiliation(s)
- Cemaliye Başaran
- University Health Sciences Turkey, İzmir Tepecik Training and Research Hospital, Clinic of Pediatrics, Division of Nephrology, İzmir, Turkey
| | - Gökçen Erfidan
- University Health Sciences Turkey, İzmir Tepecik Training and Research Hospital, Clinic of Pediatrics, Division of Nephrology, İzmir, Turkey
| | - Özgür Özdemir-Şimşek
- University Health Sciences Turkey, İzmir Tepecik Training and Research Hospital, Clinic of Pediatrics, Division of Nephrology, İzmir, Turkey
| | - Seçil Arslansoyu-Çamlar
- University Health Sciences Turkey, İzmir Faculty of Medicine, Department of Pediatrics, Division of Nephrology, İzmir, Turkey
| | - Demet Alaygut
- University Health Sciences Turkey, İzmir Faculty of Medicine, Department of Pediatrics, Division of Nephrology, İzmir, Turkey
| | - Fatma Mutlubaş
- University Health Sciences Turkey, İzmir Faculty of Medicine, Department of Pediatrics, Division of Nephrology, İzmir, Turkey
| | - Cem Karadeniz
- İzmir Katip Çelebi University Faculty of Medicine, Department of Pediatrics, Division of Cardiology, İzmir, Turkey
| | - Bumin Nuri Dündar
- İzmir Katip Çelebi University Faculty of Medicine, Department of Pediatrics, Division of Endocrinology, İzmir, Turkey
| | - Belde Kasap-Demir
- University Health Sciences Turkey, İzmir Tepecik Training and Research Hospital, Clinic of Pediatrics, Division of Nephrology, İzmir, Turkey
- İzmir Katip Çelebi University Faculty of Medicine, Department of Pediatrics, Division of Nephrology and Rheumatology, İzmir, Turkey
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González LDM, Romero-Orjuela SP, Rabeya FJ, del Castillo V, Echeverri D. Age and vascular aging: an unexplored frontier. Front Cardiovasc Med 2023; 10:1278795. [PMID: 38028481 PMCID: PMC10665864 DOI: 10.3389/fcvm.2023.1278795] [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] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Accepted: 10/03/2023] [Indexed: 12/01/2023] Open
Abstract
Vascular age is an emerging field in cardiovascular risk assessment. This concept includes multifactorial changes in the arterial wall, with arterial stiffness as its most relevant manifestation, leading to increased arterial pressure and pulsatile flow in the organs. Today, the approved test for measuring vascular age is pulse wave velocity, which has been proven to predict cardiovascular events. Furthermore, vascular phenotypes, such as early vascular aging and "SUPERNOVA," representing phenotypic extremes of vascular aging, have been found. The identification of these phenotypes opens a new field of study in cardiovascular physiology. Lifestyle interventions and pharmacological therapy have positively affected vascular health, reducing arterial stiffness. This review aims to define the concepts related to vascular age, pathophysiology, measurement methods, clinical signs and symptoms, and treatment.
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Affiliation(s)
- Laura del Mar González
- Department of Cardiology, Fundación Cardioinfantil–Instituto de Cardiología, Bogotá, Colombia
| | | | - Fernando J. Rabeya
- School of Medicine and Health Sciences, Universidad del Rosario, Bogotá, Colombia
| | - Valeria del Castillo
- Department of Cardiology, Fundación Cardioinfantil–Instituto de Cardiología, Bogotá, Colombia
| | - Darío Echeverri
- Department of Cardiology, Fundación Cardioinfantil–Instituto de Cardiología, Bogotá, Colombia
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Claessens PJ, Peeters R, Claessens L, Claessens C, Claessens J, Claessens PM. Pulse wave analysis measurements: important, underestimated and undervalued parameters in cardiovascular health problems. Front Cardiovasc Med 2023; 10:1266258. [PMID: 38028442 PMCID: PMC10653328 DOI: 10.3389/fcvm.2023.1266258] [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] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Accepted: 09/25/2023] [Indexed: 12/01/2023] Open
Abstract
Background Central aortic stiffness is established as a reliable measure of cardiovascular disease. While pulse wave velocity (PWV) analysis measures arterial distensibility, risk profile of cardiovascular diseases can be expanded with following pulse wave analysis measurements: central aortic systolic blood pressure (CABPS), central aortic pulse pressure (CAPP), central aortic reflection magnitude (CARM), central aortic augmented pressure (CAAP) and central aortic augmentation index (CAAIx). The aim of this study is to evaluate the clinical usefulness and importance of pulse wave analysis measurements in specific cardiovascular conditions and diseases, both in term of diagnosis and therapeutic monitoring. Methods One thousand sixty-six subjects were included. According to age bracket, four cohorts were investigated-healthy subjects (NL), hypertensive patients (HP), ischemic heart disease (IHD) and valvular heart disease (VHD) patients. Arterial stiffness was analyzed through Sphygmocor XCEL Central Blood Pressure Measurement System and Sphygmocor XCEL PWV Measurement System. Furthermore we observed the pulse wave analysis measurements of 14 patients with diagnose of ADHD who were referred by a child psychiatrist, in order to investigate the initiation of methylphenidate treatment. Results Statistically significant differences were found between NL and HP cohorts, across almost all age brackets, regarding pulse wave analysis measurements. In the risk stratification of arterial stiffness hypertension and especially central aortic blood pressure systolic (CABPS) seems a determining factor. Pulse wave analysis measurements for IHD and VHD cohort comparisons with NL counterparts, revealed non- statistically significant variations. Elevated CAAP, CAAIx and CARM within the youngest age group (0-10 years) in attention-deficit-hyperactivity-disorder (ADHD) patients warrant attention. Conclusions Following such investigations, CABPS appears as a robust predominant factor in problems of arterial stiffness. Pulse wave analysis and PWV are important parameters in the evaluation and monitoring of arterial hypertension and cardiovascular diseases. There is a hypothesis that CAAP could be an important and even decisive parameter in the diagnosis of ADHD. Further investigation needed.
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Affiliation(s)
| | | | | | | | | | - Philip Maria Claessens
- Medical Center “Kloppend Hart Essen-Antwerpen- Schilde”, Antwerp, Belgium
- Department of Cardiology, AZ Monica Deurne, Antwerp, Belgium
- Department of Cardiology, AZ Voorkempen Malle, Antwerp, Belgium
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11
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Campitelli R, Ferrario M, Su F, Creteur J, Herpain A, Carrara M. Pulse wave analysis as a tool for the evaluation of resuscitation therapy in septic shock. Physiol Meas 2023; 44:105002. [PMID: 37738987 DOI: 10.1088/1361-6579/acfc94] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Accepted: 09/22/2023] [Indexed: 09/24/2023]
Abstract
Objective. Pulse wave analysis (PWA) can provide insights into cardiovascular biomechanical properties. The use of PWA in critically ill patients, such as septic shock patients, is still limited, but it can provide complementary information on the cardiovascular effects of treatment when compared to standard indices outlined in international guidelines. Previous works have highlighted how sepsis induces severe cardiovascular derangement with altered arterial blood pressure waveform morphology and how resuscitation according to standard haemodynamic targets is not able to restore the physiological functioning of the cardiovascular system. The aim of this work is to test the effectiveness of PWA in characterizing arterial waveforms obtained from a swine experiment involving polymicrobial septic shock and resuscitation with different drugs.Methods. During the experiment, morphological aortic waveform features, such as indices related to the dicrotic notch and inflection point, were extracted by means of PWA techniques. Finally, all the PWA indices were used to compute a clustering classification (mini batch K-means) of the pigs according to the different phases of the experiment. This analysis aimed to test if PWA features alone could be used to distinguish between the different responses to the administered therapies.Results. The PWA indices highlighted different cardiovascular conditions of the pigs in response to different treatments, despite the mean haemodynamic values typically used to guide therapy administration being similar in all animals. The clustering algorithm was able to distinguish between the different phases of the experiment and the different responses of the animals based on the unique information derived from the aortic PWA.Conclusion. Even when used alone, PWA indices were highly informative when assessing therapy responses in cases of septic shock.Significance. A complex pathological condition like septic shock requires extensive monitoring without neglecting important information from commonly measured signals such as arterial blood pressure. Future studies are needed to understand how individual differences in the response to therapy are associated with different cardiovascular conditions that may become specific therapy targets.
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Affiliation(s)
- Riccardo Campitelli
- Department of Electronics, Information, and Bioengineering, Politecnico di Milano, Milan, Italy
| | - Manuela Ferrario
- Department of Electronics, Information, and Bioengineering, Politecnico di Milano, Milan, Italy
| | - Fuhong Su
- Experimental Laboratory of Intensive Care, Université Libre de Bruxelles, Brussels, Belgium
- Department of Intensive Care, Erasme Hospital, ULB, Brussels, Belgium
| | - Jacques Creteur
- Experimental Laboratory of Intensive Care, Université Libre de Bruxelles, Brussels, Belgium
- Department of Intensive Care, Erasme Hospital, ULB, Brussels, Belgium
| | - Antoine Herpain
- Experimental Laboratory of Intensive Care, Université Libre de Bruxelles, Brussels, Belgium
- Intensive care department, St-Pierre University Hospital, Brussels, Belgium
| | - Marta Carrara
- Department of Electronics, Information, and Bioengineering, Politecnico di Milano, Milan, Italy
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12
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Kim HL, Joh HS, Lim WH, Seo JB, Kim SH, Zo JH, Kim MA. Estimated Pulse Wave Velocity in the Prediction of Clinical Outcomes in Patients Undergoing Drug-Eluting Stent Implantation. J Clin Med 2023; 12:5855. [PMID: 37762796 PMCID: PMC10531714 DOI: 10.3390/jcm12185855] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Revised: 08/28/2023] [Accepted: 09/06/2023] [Indexed: 09/29/2023] Open
Abstract
Background The prognostic value of estimated pulse wave velocity (ePWV) has been infrequently explored in high-risk patient groups. Our study aimed to evaluate the prognostic significance of ePWV among patients undergoing a percutaneous coronary intervention (PCI) with a drug-eluting stent (DES). Methods A total of 4119 consecutive subjects who underwent a PCI with a DES (mean age, 67.1 ± 11.6 years and 33.1% were female) were retrospectively analyzed. ePWV was calculated based on the patient's age and mean blood pressure. Major adverse cardiovascular events (MACE), including cardiac death, non-fatal myocardial infarction, coronary revascularization, and ischemic stroke, were evaluated. Results During a median follow-up duration of 3.51 years (interquartile range, 1.35-6.37 years), there were 746 MACEs (18.1%). A multivariable analysis showed that a higher ePWV was associated with a higher MACE incidence (middle tertile vs. the lowest tertile: hazard ratio [HR], 2.49; 95% confidence interval [CI], 1.81-3.42; p < 0.001; the highest tertile vs. the lowest tertile: HR, 6.18; 95% CI, 4.33-8.80; p < 0.001) The inclusion of ePWV data significantly increased the global chi-square values when added to the clinical information (from 96 to 128; p < 0.001). Conclusion ePWV demonstrated a significant association with MACEs in patients who underwent DES implantation. Given its relative simplicity to calculate, ePWV could potentially serve as a valuable instrument for stratifying cardiovascular risks within this high-risk patient population.
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Affiliation(s)
- Hack-Lyoung Kim
- Division of Cardiology, Department of Internal Medicine, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul National University College of Medicine, Seoul 07061, Republic of Korea; (H.S.J.); (W.-H.L.)
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13
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An DW, Hansen TW, Aparicio LS, Chori B, Huang QF, Wei FF, Cheng YB, Yu YL, Sheng CS, Gilis-Malinowska N, Boggia J, Wojciechowska W, Niiranen TJ, Tikhonoff V, Casiglia E, Narkiewicz K, Stolarz-Skrzypek K, Kawecka-Jaszcz K, Jula AM, Yang WY, Woodiwiss AJ, Filipovský J, Wang JG, Rajzer MW, Verhamme P, Nawrot TS, Staessen JA, Li Y. Derivation of an Outcome-Driven Threshold for Aortic Pulse Wave Velocity: An Individual-Participant Meta-Analysis. Hypertension 2023; 80:1949-1959. [PMID: 37470187 PMCID: PMC10424824 DOI: 10.1161/hypertensionaha.123.21318] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Accepted: 06/08/2023] [Indexed: 07/21/2023]
Abstract
BACKGROUND Aortic pulse wave velocity (PWV) predicts cardiovascular events (CVEs) and total mortality (TM), but previous studies proposing actionable PWV thresholds have limited generalizability. This individual-participant meta-analysis is aimed at defining, testing calibration, and validating an outcome-driven threshold for PWV, using 2 populations studies, respectively, for derivation IDCARS (International Database of Central Arterial Properties for Risk Stratification) and replication MONICA (Monitoring of Trends and Determinants in Cardiovascular Disease Health Survey - Copenhagen). METHODS A risk-carrying PWV threshold for CVE and TM was defined by multivariable Cox regression, using stepwise increasing PWV thresholds and by determining the threshold yielding a 5-year risk equivalent with systolic blood pressure of 140 mm Hg. The predictive performance of the PWV threshold was assessed by computing the integrated discrimination improvement and the net reclassification improvement. RESULTS In well-calibrated models in IDCARS, the risk-carrying PWV thresholds converged at 9 m/s (10 m/s considering the anatomic pulse wave travel distance). With full adjustments applied, the threshold predicted CVE (hazard ratio [CI]: 1.68 [1.15-2.45]) and TM (1.61 [1.01-2.55]) in IDCARS and in MONICA (1.40 [1.09-1.79] and 1.55 [1.23-1.95]). In IDCARS and MONICA, the predictive accuracy of the threshold for both end points was ≈0.75. Integrated discrimination improvement was significant for TM in IDCARS and for both TM and CVE in MONICA, whereas net reclassification improvement was not for any outcome. CONCLUSIONS PWV integrates multiple risk factors into a single variable and might replace a large panel of traditional risk factors. Exceeding the outcome-driven PWV threshold should motivate clinicians to stringent management of risk factors, in particular hypertension, which over a person's lifetime causes stiffening of the elastic arteries as waypoint to CVE and death.
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Affiliation(s)
- De-Wei An
- Department of Cardiovascular Medicine, Shanghai Key Laboratory of Hypertension, Shanghai Institute of Hypertension, State Key Laboratory of Medical Genomics, National Research Centre for Translational Medicine, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, China (D.-W.A., Q.-F.H., Y. B.C., C. S.S., J. G.W., Y.L.)
- Non-Profit Research Association Alliance for the Promotion of Preventive Medicine, Belgium (D.-W.A, T.W.H, B.C., Y.-L.Y., J.A.S.)
- Research Unit Environment and Health, Department of Public Health and Primary Care, University of Leuven, Belgium (D.-W.A, Y.-L.Y., T.S.N.)
| | - Tine W. Hansen
- Non-Profit Research Association Alliance for the Promotion of Preventive Medicine, Belgium (D.-W.A, T.W.H, B.C., Y.-L.Y., J.A.S.)
- The Steno Diabetes Center Copenhagen, Herlev, and Center for Health, Capital Region of Denmark, Copenhagen (T.W.H.)
| | - Lucas S. Aparicio
- Servicio de Clínica Médica, Sección Hipertensión Arterial, Hospital Italiano de Buenos Aires, Argentina (L.S.A.)
| | - Babangida Chori
- Non-Profit Research Association Alliance for the Promotion of Preventive Medicine, Belgium (D.-W.A, T.W.H, B.C., Y.-L.Y., J.A.S.)
- Centre for Environmental Sciences, Hasselt University, Belgium (B.C., T.S.N.)
- Department of Internal Medicine, Faculty of Clinical Sciences, College of Health Sciences, University of Abuja, Nigeria (B.C.)
| | - Qi-Fang Huang
- Department of Cardiovascular Medicine, Shanghai Key Laboratory of Hypertension, Shanghai Institute of Hypertension, State Key Laboratory of Medical Genomics, National Research Centre for Translational Medicine, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, China (D.-W.A., Q.-F.H., Y. B.C., C. S.S., J. G.W., Y.L.)
| | - Fang-Fei Wei
- Department of Cardiology, the First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China (F.-F.W.)
| | - Yi-Bang Cheng
- Department of Cardiovascular Medicine, Shanghai Key Laboratory of Hypertension, Shanghai Institute of Hypertension, State Key Laboratory of Medical Genomics, National Research Centre for Translational Medicine, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, China (D.-W.A., Q.-F.H., Y. B.C., C. S.S., J. G.W., Y.L.)
| | - Yu-Ling Yu
- Non-Profit Research Association Alliance for the Promotion of Preventive Medicine, Belgium (D.-W.A, T.W.H, B.C., Y.-L.Y., J.A.S.)
- Research Unit Environment and Health, Department of Public Health and Primary Care, University of Leuven, Belgium (D.-W.A, Y.-L.Y., T.S.N.)
| | - Chang-Sheng Sheng
- Department of Cardiovascular Medicine, Shanghai Key Laboratory of Hypertension, Shanghai Institute of Hypertension, State Key Laboratory of Medical Genomics, National Research Centre for Translational Medicine, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, China (D.-W.A., Q.-F.H., Y. B.C., C. S.S., J. G.W., Y.L.)
| | - Natasza Gilis-Malinowska
- Hypertension Unit, Department of Hypertension and Diabetology, Medical University of Gdańsk, Poland (N.G.-M., K.N.)
| | - José Boggia
- Centro de Nefrología and Departamento de Fisiopatología, Hospital de Clínicas, Universidad de la República, Montevideo, Uruguay (J.B.)
| | - Wiktoria Wojciechowska
- First Department of Cardiology, Interventional Electrocardiology and Hypertension, Jagiellonian University Medical College, Kraków, Poland (W.W., K.S.-S., M.R., K.K.-J)
| | - Teemu J. Niiranen
- Department of Chronic Disease Prevention, Finnish Institute for Health and Welfare, Turku, Finland (T.J.N., A.M.J.)
- Department of Medicine, Turku University Hospital and University of Turku, Finland (T.J.N., A.M.J.)
| | | | - Edoardo Casiglia
- Department of Medicine, University of Padova, Italy (V.T., E.C.)
| | - Krzysztof Narkiewicz
- Hypertension Unit, Department of Hypertension and Diabetology, Medical University of Gdańsk, Poland (N.G.-M., K.N.)
| | - Katarzyna Stolarz-Skrzypek
- First Department of Cardiology, Interventional Electrocardiology and Hypertension, Jagiellonian University Medical College, Kraków, Poland (W.W., K.S.-S., M.R., K.K.-J)
| | - Kalina Kawecka-Jaszcz
- First Department of Cardiology, Interventional Electrocardiology and Hypertension, Jagiellonian University Medical College, Kraków, Poland (W.W., K.S.-S., M.R., K.K.-J)
| | - Antti M. Jula
- Department of Chronic Disease Prevention, Finnish Institute for Health and Welfare, Turku, Finland (T.J.N., A.M.J.)
- Department of Medicine, Turku University Hospital and University of Turku, Finland (T.J.N., A.M.J.)
| | - Wen-Yi Yang
- Department of Cardiology, Shanghai General Hospital, China (W.-Y.Y.)
| | - Angela J. Woodiwiss
- School of Physiology, University of the Witwatersrand, Johannesburg, South Africa (A.W.)
| | - Jan Filipovský
- Faculty of Medicine, Charles University, Pilsen, Czech Republic (J.F.)
| | - Ji-Guang Wang
- Department of Cardiovascular Medicine, Shanghai Key Laboratory of Hypertension, Shanghai Institute of Hypertension, State Key Laboratory of Medical Genomics, National Research Centre for Translational Medicine, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, China (D.-W.A., Q.-F.H., Y. B.C., C. S.S., J. G.W., Y.L.)
| | - Marek W. Rajzer
- First Department of Cardiology, Interventional Electrocardiology and Hypertension, Jagiellonian University Medical College, Kraków, Poland (W.W., K.S.-S., M.R., K.K.-J)
| | - Peter Verhamme
- Center for Molecular and Vascular Biology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Belgium (P.V.)
| | - Tim S. Nawrot
- Research Unit Environment and Health, Department of Public Health and Primary Care, University of Leuven, Belgium (D.-W.A, Y.-L.Y., T.S.N.)
- Centre for Environmental Sciences, Hasselt University, Belgium (B.C., T.S.N.)
| | - Jan A. Staessen
- Non-Profit Research Association Alliance for the Promotion of Preventive Medicine, Belgium (D.-W.A, T.W.H, B.C., Y.-L.Y., J.A.S.)
- Biomedical Science Group, Faculty of Medicine, University of Leuven, Belgium (J.A.S.)
| | - Yan Li
- Department of Cardiovascular Medicine, Shanghai Key Laboratory of Hypertension, Shanghai Institute of Hypertension, State Key Laboratory of Medical Genomics, National Research Centre for Translational Medicine, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, China (D.-W.A., Q.-F.H., Y. B.C., C. S.S., J. G.W., Y.L.)
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Sigl M, Winter L, Schumacher G, Helmke SC, Shchetynska-Marinova T, Amendt K, Duerschmied D, Hohneck AL. Comparison of Functional and Morphological Estimates of Vascular Age. In Vivo 2023; 37:2178-2187. [PMID: 37652489 PMCID: PMC10500512 DOI: 10.21873/invivo.13317] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Revised: 06/01/2023] [Accepted: 06/02/2023] [Indexed: 09/02/2023]
Abstract
BACKGROUND/AIM Vascular age (VA) is an emerging metric in preventive cardiovascular (CV) medicine. VA can be derived from morphological parameters such as carotid intima-media thickness (CIMT), or functional parameters such as pulse wave analysis (PWA), which celebrates its 100th birthday. This study aimed to investigate whether the results of both approaches are comparable. PATIENTS AND METHODS On the occasion of the double 100th anniversary of PWA and the Mannheim Clinic, 100 volunteers underwent a) bilateral CIMT assessment using high-resolution ultrasound and b) oscillometric PWA at the brachial forearm site. The respective VAs were calculated using previously published equations. RESULTS Median age of the participants was 53.6 years (range=39.8-62.6 years), and 56% were female. Median CIMT was 632.5 μm (range=548.8-730.0 μm). Median PWA-derived VA was 55.3 years (36.5-70.5 years). Different values were obtained for CIMT-derived VA, depending on the reference cohort used as calculation basis, ranging from median 43.7 (26.2-59.5 years) to median 64.0 years (43.5-82.1 years). In 46% of the participants divergent VAs were found, that is, the calculated age was higher according to one method and lower according to the other. Correlation analysis revealed a strong dependence of VA (both PWA- and CIMT-derived) and chronological age, as well as an increase in CV risk factors and the detection of plaques with age. CONCLUSION Different approaches for estimating VA are not comparable and often produce contradictory results. The current methods and their validity must be critically assessed if they are not standardized.
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Affiliation(s)
- Martin Sigl
- Department of Cardiology, Angiology, Haemostaseology and Medical Intensive Care, University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
- European Center for AngioScience (ECAS) and German Center for Cardiovascular Research (DZHK) partner site Heidelberg/Mannheim, Mannheim, Germany
| | - Laura Winter
- Department of Cardiology, Angiology, Haemostaseology and Medical Intensive Care, University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
- European Center for AngioScience (ECAS) and German Center for Cardiovascular Research (DZHK) partner site Heidelberg/Mannheim, Mannheim, Germany
| | | | | | - Tetyana Shchetynska-Marinova
- Department of Cardiology, Angiology, Haemostaseology and Medical Intensive Care, University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
- European Center for AngioScience (ECAS) and German Center for Cardiovascular Research (DZHK) partner site Heidelberg/Mannheim, Mannheim, Germany
| | - Klaus Amendt
- Department of Cardiology, Angiology, Haemostaseology and Medical Intensive Care, University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
- European Center for AngioScience (ECAS) and German Center for Cardiovascular Research (DZHK) partner site Heidelberg/Mannheim, Mannheim, Germany
| | - Daniel Duerschmied
- Department of Cardiology, Angiology, Haemostaseology and Medical Intensive Care, University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
- European Center for AngioScience (ECAS) and German Center for Cardiovascular Research (DZHK) partner site Heidelberg/Mannheim, Mannheim, Germany
| | - Anna Lena Hohneck
- Department of Cardiology, Angiology, Haemostaseology and Medical Intensive Care, University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany;
- European Center for AngioScience (ECAS) and German Center for Cardiovascular Research (DZHK) partner site Heidelberg/Mannheim, Mannheim, Germany
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15
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Bui TV, Picone DS, Schultz MG, Peng X, Black JA, Dwyer N, Roberts-Thomson P, Adams H, Chen CH, Cheng HM, Pucci G, Wang J, Goupil R, Sharman JE. Accuracy of cuff blood pressure and systolic blood pressure amplification. Hypertens Res 2023; 46:1961-1969. [PMID: 37217732 PMCID: PMC10404511 DOI: 10.1038/s41440-023-01311-0] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 03/23/2023] [Accepted: 04/12/2023] [Indexed: 05/24/2023]
Abstract
Automated cuff measured blood pressure (BP) is the global standard used for diagnosing hypertension, but there are concerns regarding the accuracy of the method. Individual variability in systolic BP (SBP) amplification from central (aorta) to peripheral (brachial) arteries could be related to the accuracy of cuff BP, but this has never been determined and was the aim of this study. Automated cuff BP and invasive brachial BP were recorded in 795 participants (74% male, aged 64 ± 11 years) receiving coronary angiography at five independent research sites (using seven different automated cuff BP devices). SBP amplification was recorded invasively by catheter and defined as brachial SBP minus aortic SBP. Compared with invasive brachial SBP, cuff SBP was significantly underestimated (130 ± 18 mmHg vs. 138 ± 22 mmHg, p < 0.001). The level of SBP amplification varied significantly among individuals (mean ± SD, 7.3 ± 9.1 mmHg) and was similar to level of difference between cuff and invasive brachial SBP (mean difference -7.6 ± 11.9 mmHg). SBP amplification explained most of the variance in accuracy of cuff SBP (R2 = 19%). The accuracy of cuff SBP was greatest among participants with the lowest SBP amplification (ptrend < 0.001). After cuff BP values were corrected for SBP amplification, there was a significant improvement in the mean difference from the intra-arterial standard (p < 0.0001) and in the accuracy of hypertension classification according to 2017 ACC/AHA guideline thresholds (p = 0.005). The level of SBP amplification is a critical factor associated with the accuracy of conventional automated cuff measured BP.
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Affiliation(s)
- Tan V Bui
- Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, Australia
| | - Dean S Picone
- Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, Australia
| | - Martin G Schultz
- Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, Australia
| | - Xiaoqing Peng
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - J Andrew Black
- Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, Australia
- Royal Hobart Hospital, Hobart, TAS, Australia
| | - Nathan Dwyer
- Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, Australia
- Royal Hobart Hospital, Hobart, TAS, Australia
| | - Philip Roberts-Thomson
- Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, Australia
- Royal Hobart Hospital, Hobart, TAS, Australia
| | - Heath Adams
- Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, Australia
- Royal Hobart Hospital, Hobart, TAS, Australia
| | - Chen-Huan Chen
- Department of Medicine, National Yang Ming Chiao Tung University, Department of Medical Education, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Hao-Min Cheng
- Department of Medicine, National Yang Ming Chiao Tung University, Department of Medical Education, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Giacomo Pucci
- Unit of Internal Medicine at Terni University Hospital, Department of Medicine, University of Perugia, Perugia, Italy
| | - Jiguang Wang
- Centre for Epidemiological Studies and Clinical Trials, Shanghai Key Laboratory of Hypertension, The Shanghai Institute of Hypertension, Department of Hypertension, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Remi Goupil
- Hopital du Sacre-Coeur de Montreal, Universite de Montreal, Montreal, Canada
| | - James E Sharman
- Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, Australia.
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16
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Jiticovski AFM, Souza DF, Freitas EGB, Ferreira CR, Pereira CDS, Galvão RDV, Santos WDAM, de Oliveira EP, Ferreira SR. Vascular stiffness and healthy arterial aging in older patients with optimal blood pressure. J Bras Nefrol 2023; 45:310-317. [PMID: 36638247 PMCID: PMC10697168 DOI: 10.1590/2175-8239-jbn-2022-0123en] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Accepted: 11/17/2022] [Indexed: 01/15/2023] Open
Abstract
INTRODUCTION Pulse wave velocity is used to diagnose central arterial stiffness (CAS) and quantify healthy vascular aging (HVA). OBJECTIVE To evaluate the CAS and HVA in elderly patients with systemic blood pressure levels classified as optimal/normal. METHODS A total of 102 patients without comorbidities and with systolic pressure (SP) < 120 mmHg and diastolic pressure (DP) < 80 mmHg were selected from the EVOPIU database (Pulse Wave Velocity of Elderly Individuals in an Urban area of Brazil). The carotid-femoral pulse wave velocity (c-fPWV) and the central and peripheral pressures were evaluated in all patients. The patients were divided into four groups: G1: (n = 19, with c-fPWV < 7.6 m/s, without medication), G2 (n = 26, c-fPWV ≥ 7.6 m/s; without medication), G3 (n = 25, c-fPWV < 7.6 m/s with antihypertensive medication), and G4 (n = 32, c-fPWV ≥ 7.6 m/s with antihypertensive medication). RESULTS In our sample, 56.7% of patients had c-fPWV ≥ 7.6 m/s. The central systolic pressure in G1 [99 (10) mmHg] was lower than that found in the other three groups [vs. 112 (14) mmHg, 111 (15), 112 (20) mmHg; P < 0.05)]. CONCLUSION Older people with optimal arterial blood pressure do not necessarily have HVA and could have c-fPWV values close to the limits established for CAS diagnosis.
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Affiliation(s)
| | - Denis Fabiano Souza
- Universidade Federal de Uberlândia, Faculdade de Medicina,
Uberlândia, MG, Brazil
| | | | | | | | | | | | - Erick P. de Oliveira
- Universidade Federal de Uberlândia, Faculdade de Medicina,
Uberlândia, MG, Brazil
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17
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Hotek JC, Chirinos JA, Detwiler TJ, Regan HK, Regan CP. Development and characterization of canine-specific computational models to predict pulsatile arterial hemodynamics and ventricular-arterial coupling. Physiol Rep 2023; 11:e15731. [PMID: 37269177 DOI: 10.14814/phy2.15731] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Revised: 05/12/2023] [Accepted: 05/12/2023] [Indexed: 06/04/2023] Open
Abstract
Pulsatile hemodynamics analyses provide important information about the ventricular-arterial system which cannot be inferred by standard blood pressure measurements. Pulse wave analysis (PWA), wave separation analysis (WSA), and wave power analysis (WPA) characterize arterial hemodynamics with limited preclinical applications. Integrating these tools into preclinical testing may enhance understanding of disease or therapeutic effects on cardiovascular function. We used a canine rapid ventricular pacing (RVP) heart failure model to: (1) Characterize hemodynamics in response to RVP and (2) assess analyses from flow waveforms synthesized from pressure compared to those derived from measured flow. Female canines (n = 7) were instrumented with thoracic aortic pressure transducers, ventricular pacing leads, and an ascending aortic flow probe. Data were collected at baseline, 1 week, and 1 month after RVP onset. RVP progressively reduced stroke volume (SV), the PWA SV estimator, and WSA and WPA pulsatility and wave reflection indices. Indices derived from synthesized flow exhibited similar directional changes and high concordance with measured flow calculations. Our data demonstrate the value of analytical hemodynamic methods to gain deeper insight into cardiovascular function in preclinical models. These approaches can provide complementary value to standard endpoints in evaluating potential effects of pharmaceutical agents intended for human use.
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Affiliation(s)
- Julia C Hotek
- Preclinical Development (PCD), Merck & Co., Inc., West Point, Pennsylvania, USA
| | - Julio A Chirinos
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Theodore J Detwiler
- Preclinical Development (PCD), Merck & Co., Inc., West Point, Pennsylvania, USA
| | - Hillary K Regan
- Preclinical Development (PCD), Merck & Co., Inc., West Point, Pennsylvania, USA
| | - Christopher P Regan
- Preclinical Development (PCD), Merck & Co., Inc., West Point, Pennsylvania, USA
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18
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Pascual J, DeBlois JP, Ray C, Hametner B, Heffernan KS, Voss MA. Central Hemodynamic Response to Activation of the Vestibular Sympathetic Reflex with Head Down Rotation in Healthy Young Adults. J Appl Physiol (1985) 2023. [PMID: 37199782 DOI: 10.1152/japplphysiol.00107.2023] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/19/2023] Open
Abstract
The purpose of this study was to assess the effect of vestibular-sympathetic activation on estimated measures of central (aortic) hemodynamic load in young adults. Methods: 31 participants (n=14 female, 17 male) underwent radial tonometry and popliteal Doppler-ultrasound in the prone position with the head in a neutral position and during 10 minutes of head-down rotation (HDR) as a means of activating the vestibular sympathetic reflex. Subjective orthostatic intolerance was assessed utilizing a 10-item orthostatic hypotension questionnaire. Results: There was a reduction in brachial systolic BP during HDR (111±10 vs. 109±9 mmHg, p<0.05), but there was no change in aortic systolic BP (100±9 vs. 99±8 mmHg, p>0.05). Aortic augmentation index (-5±11 vs. -12±12%, p<0.05) and reservoir pressure (28±8 vs. 26±8mmHg, p<0.05) were reduced with a concomitant reduction in popliteal conductance (5.6±0.7 vs. 4.5±0.7 ml/min∙mmHg, p<0.05). Change in aortic systolic BP was associated with subjective orthostatic intolerance score (r = -0.39, p<0.05). Conclusions: Activation of the vestibular sympathetic reflex via HDR resulted in slight reductions in brachial BP concomitant with preservation of aortic BP. Despite peripheral vascular constriction during HDR, there was a reduction in pressure from wave reflections and reservoir pressure. Finally, there was an association between change in aortic systolic BP during HDR and orthostatic intolerance score suggesting that individuals that cannot defend against drops in aortic BP during vestibular sympathetic reflex activation may be more likely to experience higher subjective symptomatology of orthostatic intolerance.
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Affiliation(s)
- Justin Pascual
- Department of Nutrition, Falk College of Sport and Human Dynamics, Syracuse University, Syracuse, NY, United States
| | - Jacob P DeBlois
- Department of Exercise Science, Falk College of Sport and Human Dynamics, Syracuse University, Syracuse, NY, United States
| | - Chester Ray
- Department of Nutrition and Integrative Physiology, Florida State University, Tallahassee, FL, United States
| | - Bernhard Hametner
- Center for Health & Bioresources, AIT Austrian Institute of Technology, Vienna, Austria
| | - Kevin S Heffernan
- Department of Exercise Science, Falk College of Sport and Human Dynamics, Syracuse University, Syracuse, NY, United States
| | - Margaret A Voss
- Department of Nutrition, Falk College of Sport and Human Dynamics, Syracuse University, Syracuse, NY, United States
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19
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Min S, Kim DH, Joe DJ, Kim BW, Jung YH, Lee JH, Lee BY, Doh I, An J, Youn YN, Joung B, Yoo CD, Ahn HS, Lee KJ. Clinical Validation of a Wearable Piezoelectric Blood-Pressure Sensor for Continuous Health Monitoring. Adv Mater 2023:e2301627. [PMID: 36960816 DOI: 10.1002/adma.202301627] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Revised: 03/16/2023] [Indexed: 05/12/2023]
Abstract
Wearable blood-pressure sensors have recently attracted attention as healthcare devices for continuous non-invasive arterial pressure (CNAP) monitoring. However, the accuracy of wearable blood-pressure (BP) monitoring devices has been controversial due to the low signal quality of sensors, the absence of an accurate transfer function to convert the sensor signals into BP values, and the lack of clinical validation regarding measurement precision. Here, a wearable piezoelectric blood-pressure sensor (WPBPS) is reported, which achieves a high normalized sensitivity (0.062 kPa-1 ), and fast response time (23 ms) for CNAP monitoring. The transfer function of a linear regression model is designed, offering a simple solution to convert the flexible piezoelectric sensor signals into BP values. In order to verify the measurement accuracy of WPBPS, clinical trials are performed on 35 subjects aged from 20 to 80 s after screening. The mean difference between the WPBPS and a commercial sphygmomanometer of 175 BP data pairs is -0.89 ± 6.19 and -0.32 ± 5.28 mmHg for systolic blood pressure (SBP) and diastolic blood pressure (DBP), respectively. By building a WPBPS-embedded wristwatch, the potentially promising use of a convenient, portable, continuous BP monitoring system for cardiovascular disease diagnosis is demonstrated.
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Affiliation(s)
- Seongwook Min
- Department of Materials Science and Engineering, Korea Advanced Institute of Science and Technology (KAIST), 291 Daehak-ro, Yuseong-gu, Daejeon, 34141, Republic of Korea
| | - Dong Hyun Kim
- Department of Materials Science and Engineering, Korea Advanced Institute of Science and Technology (KAIST), 291 Daehak-ro, Yuseong-gu, Daejeon, 34141, Republic of Korea
| | - Daniel J Joe
- Safety Measurement Institute, Korea Research Institute of Standards and Science (KRISS), 267 Gajeong-ro, Yuseong-gu, Daejeon, 34113, Republic of Korea
| | - Byung Woo Kim
- Department of Materials Science and Engineering, Korea Advanced Institute of Science and Technology (KAIST), 291 Daehak-ro, Yuseong-gu, Daejeon, 34141, Republic of Korea
| | - Young Hoon Jung
- Department of Materials Science and Engineering, Korea Advanced Institute of Science and Technology (KAIST), 291 Daehak-ro, Yuseong-gu, Daejeon, 34141, Republic of Korea
| | - Jae Hee Lee
- Department of Materials Science and Engineering, Korea Advanced Institute of Science and Technology (KAIST), 291 Daehak-ro, Yuseong-gu, Daejeon, 34141, Republic of Korea
| | - Bo-Yeon Lee
- Department of Nature-Inspired System and Application, Korea Institute of Machinery and Materials (KIMM), 156 Gajeongbuk-ro, Yuseong-gu, Daejeon, 34103, Republic of Korea
| | - Il Doh
- Safety Measurement Institute, Korea Research Institute of Standards and Science (KRISS), 267 Gajeong-ro, Yuseong-gu, Daejeon, 34113, Republic of Korea
| | - Jaehun An
- Department of Materials Science and Engineering, Korea Advanced Institute of Science and Technology (KAIST), 291 Daehak-ro, Yuseong-gu, Daejeon, 34141, Republic of Korea
| | - Young-Nam Youn
- Division of Cardiovascular Surgery, Severance Cardiovascular Hospital, Yonsei University, College of Medicine, Yonsei University Health System, 50 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea
| | - Boyoung Joung
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea
| | - Chang D Yoo
- Department of Electrical Engineering, Korea Advanced Institute of Science and Technology (KAIST), 291 Daehak-ro, Yuseong-gu, Daejeon, 34141, Republic of Korea
| | - Hyo-Suk Ahn
- Department of Internal Medicine, Division of Cardiology, Uijeongbu St Mary's Hospital, College of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul, 06591, Republic of Korea
| | - Keon Jae Lee
- Department of Materials Science and Engineering, Korea Advanced Institute of Science and Technology (KAIST), 291 Daehak-ro, Yuseong-gu, Daejeon, 34141, Republic of Korea
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20
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Yofoglu LK, Karachalias F, Georgakis MK, Tountas C, Argyris AA, Zhang Y, Papaioannou TG, Blacher J, Weber T, Vlachopoulos C, Safar M, Protogerou AD. Association of Pressure Wave Reflections With Left Ventricular Mass: a Systematic Review and Meta-Analysis. Hypertension 2023; 80:e29-e42. [PMID: 36583390 DOI: 10.1161/hypertensionaha.122.19980] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND Pressure wave reflections (PWRs) within the circulation are assessed at various arterial sites by various noninvasive methods. We aimed at reviewing the conflicting data regarding the hypothesis that higher PWRs are associated with higher left ventricular mass and tested whether this association stands for all available indices of PWRs, all (proximal or distal to the heart) sites of assessment, and is modified by sex, age and heart rate. METHODS Based on a predefined protocol applying the Meta-Analysis of Observational Studies in Epidemiology (MOOSE) guidelines, we identified eligible for meta-analysis data regarding: augmentation index, augmentation pressure, backward pressure (Pb), reflection index, and their association with left ventricular mass index (19 studies, total population n=8686). RESULTS We found statistically significant associations, independent from blood pressure level, for all indices of PWRs at all arterial sites (carotid augmentation index; odds ratio; standardized beta coefficient [β]: 0.14 [95% CI, 0.07% to 0.21%], per SD increase), radial augmentation index (β: 0.21; 0.11 to 0.31), central augmentation pressure (β: 0.15; 0.03 to 0.27), central Pb (β: 0.23; 0.05 to 0.42), and central reflection index (β: 0.14; 0.06 to 0.22), except for aortic augmentation index as estimated by generalized transfer functions. Meta-regression analysis showed that the association between carotid augmentation index and left ventricular mass was higher among populations with higher heart rate (P=0.036, beta: 0.017 [95% CI, 0.001 to 0.033]) and tended to be higher in middle-aged (P=0.07, beta: -0.001; -0.021 to 0.001). CONCLUSIONS A clinically meaningful association between PWRs and left ventricular mass, assessed at either central or peripheral arterial sites by most available methods was shown, suggesting that PWR reduction strategies might be useful. Based on the present evidence, such trials should target middle-aged populations with high normal heart rate.
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Affiliation(s)
- Lazaros K Yofoglu
- Cardiovascular Prevention and Research Unit, Clinic/Laboratory of Pathophysiology, Medical School, National and Kapodistrian University of Athens, Greece (L.K.Y., F.K., C.T., A.A.A., A.D.P.)
| | - Fotios Karachalias
- Cardiovascular Prevention and Research Unit, Clinic/Laboratory of Pathophysiology, Medical School, National and Kapodistrian University of Athens, Greece (L.K.Y., F.K., C.T., A.A.A., A.D.P.)
| | - Marios K Georgakis
- Institute for Stroke and Dementia Research (ISD), University Hospital, LMU Munich, Germany (M.K.G.)
| | - Christos Tountas
- Cardiovascular Prevention and Research Unit, Clinic/Laboratory of Pathophysiology, Medical School, National and Kapodistrian University of Athens, Greece (L.K.Y., F.K., C.T., A.A.A., A.D.P.)
| | - Antonios A Argyris
- Cardiovascular Prevention and Research Unit, Clinic/Laboratory of Pathophysiology, Medical School, National and Kapodistrian University of Athens, Greece (L.K.Y., F.K., C.T., A.A.A., A.D.P.)
| | - Yi Zhang
- Department of Cardiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, China (Y.Z.)
| | - Theodoros G Papaioannou
- Biomedical Engineering Unit, 1st Department of Cardiology, "Hippokration" Hospital, Medical School of the National and Kapodistrian University of Athens, Greece (T.G.P.)
| | - Jacques Blacher
- Paris Descartes University, AP-HP, Diagnosis and Therapeutic Center, Hôtel-Dieu, Paris, France (J.B., M.S.)
| | - Thomas Weber
- Cardiology Department, Klinikum Wels-Grieskirchen, Austria (T.W.)
| | | | - Michel Safar
- Paris Descartes University, AP-HP, Diagnosis and Therapeutic Center, Hôtel-Dieu, Paris, France (J.B., M.S.)
| | - Athanase D Protogerou
- Cardiovascular Prevention and Research Unit, Clinic/Laboratory of Pathophysiology, Medical School, National and Kapodistrian University of Athens, Greece (L.K.Y., F.K., C.T., A.A.A., A.D.P.)
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21
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Zeijen VJ, Feyz L, Kardys I, Geleijnse ML, Van Mieghem NM, Zijlstra F, Lafeber M, Van Der Geest RJ, Hirsch A, Daemen J. Association between renal sympathetic denervation and arterial stiffness: the ASORAS study. J Hypertens 2023; 41:476-485. [PMID: 36655697 PMCID: PMC9894147 DOI: 10.1097/hjh.0000000000003361] [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] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
OBJECTIVES Renal sympathetic denervation (RDN) reduces blood pressure (BP). However, one out of three patients does not exhibit a significant BP response to the therapy. This study investigates the association between noninvasive vascular stiffness indices and RDN-mediated BP reduction. METHODS In this prospective, single-arm pilot study, patients with systolic office BP at least 140 mmHg, mean 24-h systolic ambulatory blood pressure (ABP) at least 130 mmHg and at least three prescribed antihypertensive drugs underwent radiofrequency RDN. The primary efficacy endpoint was temporal evolution of mean 24-h systolic ABP throughout 1-year post RDN (measured at baseline and 3-6-12 months). Effect modification was studied for baseline ultrasound carotid-femoral and magnetic resonance (MR) pulse wave velocity (PWV), MR aortic distensibility, cardiac MR left ventricular parameters and clinical variables. Statistical analyses were performed using linear mixed-effects models, and effect modification was assessed using interaction terms. RESULTS Thirty patients (mean age 62.5 ± 10.7 years, 50% women) with mean 24-h ABP 146.7/80.8 ± 13.7/12.0 mmHg were enrolled. Following RDN, mean 24-h systolic ABP changed with -8.4 (95% CI: -14.5 to -2.3) mmHg/year ( P = 0.007). Independent effect modifiers were CF-PWV [+2.7 (0.3 to 5.1) mmHg/year change in outcome for every m/s increase in CF-PWV; P = 0.03], daytime diastolic ABP [-0.4 (-0.8 to 0.0) mmHg/year per mmHg; P = 0.03], age [+0.6 (0.2 to 1.0) mmHg/year per year of age; P = 0.006], female sex [-14.0 (-23.1 to -5.0) mmHg/year as compared with men; P = 0.003] and BMI [+1.2 (0.1 to 2.2) mmHg/year per kg/m 2 ; P = 0.04]. CONCLUSION Higher CF-PWV at baseline was associated with a smaller reduction in systolic ABP following RDN. These findings could contribute to improve identification of RDN responders.
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Affiliation(s)
| | | | | | | | | | | | - Melvin Lafeber
- Department of Internal and Vascular Medicine, Erasmus University Medical Center, Rotterdam
| | | | - Alexander Hirsch
- Department of Cardiology
- Department of Radiology and Nuclear Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands
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22
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Heinrich T, Bähring R, Larena-Avellaneda A, Querengässer J, Solbrig O, Ehmke H, Schwoerer AP. Bridging vascular physiology to vascular medicine: an integrative laboratory class. Adv Physiol Educ 2023; 47:97-116. [PMID: 36476117 PMCID: PMC9870588 DOI: 10.1152/advan.00170.2022] [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: 07/18/2022] [Revised: 11/08/2022] [Accepted: 11/29/2022] [Indexed: 06/17/2023]
Abstract
Vascular diseases of the legs are highly prevalent and constitute an important part of medical curricula. The understanding of these diseases relies on strongly interwoven aspects of vascular physiology and vascular medicine. We aimed to connect these within a horizontally integrated laboratory class on vascular physiology of the leg that was designed in cooperation between the departments of physiology and vascular surgery. Conceptually, we applied examination techniques of vascular medicine to visualize physiological parameters that are altered by the most frequent diseases. This facilitates integrative discussions on malfunctions, trains diagnostic skills, and bridges to vascular medicine. In four experiments, we use oscillometry and impedance venous occlusion plethysmography to address key aspects of the arterial and venous system of the legs: 1) arterial pulse wave, 2) arterial systolic blood pressure, 3) venous capacitance and venous outflow, and 4) reactive hyperemia. After the experiments, physiological vascular function, the associated diseases, their impact on the recorded parameters, and diagnostic options are discussed. To allow reproduction, we describe the course structure and the experimental setup in detail. We present the experimental data of a cohort of medical students and document learning success and student satisfaction. All experiments were feasible and provided robust data on physiologically and clinically relevant vascular functions. The activity was perceived positively by the students and led to a substantial improvement of knowledge. With this work, we offer a template for reproduction or variation of a proven concept of horizontally integrated teaching of vascular physiology of the leg.NEW & NOTEWORTHY This article presents an integrative laboratory class on vascular physiology bridging to vascular medicine. The four experiments rely on oscillometry and venous occlusion plethysmography. We describe in detail this new class regarding structure, experimental setup, and experimental procedure, and we give insight into the applied materials. Moreover, we present the experimental data of 74 students and a quantitative evaluation of the students' learning success and acceptance.
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Affiliation(s)
- Tobias Heinrich
- Department of Cellular and Integrative Physiology, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Robert Bähring
- Department of Cellular and Integrative Physiology, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Axel Larena-Avellaneda
- Department of Vascular and Endovascular Surgery, Asklepios Hospital Altona, Hamburg, Germany
| | | | - Olaf Solbrig
- medis-Medizinische Messtechnik GmbH, Ilmenau, Germany
| | - Heimo Ehmke
- Department of Cellular and Integrative Physiology, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Alexander P Schwoerer
- Department of Cellular and Integrative Physiology, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
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23
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Mukkamala R, Shroff SG, Landry C, Kyriakoulis KG, Avolio AP, Stergiou GS. The Microsoft Research Aurora Project: Important Findings on Cuffless Blood Pressure Measurement. Hypertension 2023; 80:534-540. [PMID: 36458550 PMCID: PMC9931644 DOI: 10.1161/hypertensionaha.122.20410] [Citation(s) in RCA: 15] [Impact Index Per Article: 15.0] [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] [Indexed: 12/04/2022]
Abstract
Conventional blood pressure (BP) measurement devices based on an inflatable cuff only provide a narrow view of the continuous BP profile. Cuffless BP measuring technologies could permit numerous BP readings throughout daily life and thereby considerably improve the assessment and management of hypertension. Several wearable cuffless BP devices based on pulse wave analysis (applied to a photoplethysmography or tonometry waveform) with or without use of pulse arrival time are now available on the market. The key question is: Can these devices provide accurate measurement of BP? Microsoft Research recently published a complex article describing perhaps the most important and highest resource project to date (Aurora Project) on assessing the accuracy of several pulse wave analysis and pulse wave analysis-pulse arrival time devices. The overall results from 1125 participants were clear-cut negative. The present article motivates and describes emerging cuffless BP devices and then summarizes the Aurora Project. The study methodology and findings are next discussed in the context of regulatory-cleared devices, physiology, and related studies, and the study strengths and limitations are pinpointed thereafter. Finally, the implications of the Aurora Project are briefly stated and recommendations for future work are offered to finally realize the considerable potential of cuffless BP measurement in health care.
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Affiliation(s)
- Ramakrishna Mukkamala
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, USA
- Department of Anesthesiology and Perioperative Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Sanjeev G. Shroff
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, USA
| | - Cederick Landry
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, USA
| | - Konstantinos G. Kyriakoulis
- Hypertension Center STRIDE-7, School of Medicine, Third Department of Medicine, Sotiria Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Alberto P. Avolio
- Macquarie Medical School, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, NSW, Australia
| | - George S. Stergiou
- Hypertension Center STRIDE-7, School of Medicine, Third Department of Medicine, Sotiria Hospital, National and Kapodistrian University of Athens, Athens, Greece
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24
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Phan K, Gomez YH, Gorgui J, El-Messidi A, Gagnon R, Abenhaim HA, Rahme E, Daskalopoulou SS. Arterial stiffness for the early prediction of pre-eclampsia compared with blood pressure, uterine artery Doppler and angiogenic biomarkers: a prospective cohort study. BJOG 2023. [PMID: 36807704 DOI: 10.1111/1471-0528.17430] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [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: 07/08/2022] [Revised: 01/20/2023] [Accepted: 02/07/2023] [Indexed: 02/22/2023]
Abstract
OBJECTIVE Our aim was to evaluate the ability of arterial stiffness parameters to predict pre-eclampsia early compared with peripheral blood pressure, uterine artery Doppler and established angiogenic biomarkers. DESIGN Prospective cohort study. SETTING Tertiary care antenatal clinics in Montreal, Canada. POPULATION Women with singleton high-risk pregnancies. METHODS In the first trimester, arterial stiffness was measured by applanation tonometry, along with peripheral blood pressure and serum/plasma angiogenic biomarkers; uterine artery Doppler was measured in the second trimester. The predictive ability of different metrics was assessed through multivariate logistic regression. MAIN OUTCOME MEASURES Arterial stiffness (carotid-femoral pulse wave velocity, carotid-radial pulse wave velocity) and wave reflection (augmentation index, reflected wave start time), peripheral blood pressure, ultrasound indices of velocimetry and circulating angiogenic biomarker concentrations. RESULTS In this prospective study, among 191 high-risk pregnant women, 14 (7.3%) developed pre-eclampsia. A first-trimester 1 m/s increase in carotid-femoral pulse wave velocity was associated with 64% increased odds (P < 0.05), and a 1-millisecond increase in time to wave reflection with 11% decreased odds for pre-eclampsia (P < 0.01). The area under the curve of arterial stiffness, blood pressure, ultrasound indices and angiogenic biomarkers was 0.83 (95% confidence interval [CI] 0.74-0.92), 0.71 (95% CI 0.57-0.86), 0.58 (95% CI 0.39-0.77), and 0.64 (95% CI 0.44-0.83), respectively. With a 5% false-positive rate, blood pressure had a sensitivity of 14% for pre-eclampsia and arterial stiffness a sensitivity of 36%. CONCLUSIONS Arterial stiffness predicted pre-eclampsia earlier and with greater ability than blood pressure, ultrasound indices or angiogenic biomarkers.
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Affiliation(s)
- K Phan
- Division of Experimental Medicine, Department of Medicine, McGill University, Montreal, Quebec, Canada
| | - Y H Gomez
- Division of Internal Medicine, Department of Medicine, McGill University, Montreal, Quebec, Canada
| | - J Gorgui
- Division of Internal Medicine, Department of Medicine, McGill University, Montreal, Quebec, Canada
| | - A El-Messidi
- Department of Obstetrics and Gynecology, McGill University, Montreal, Quebec, Canada
| | - R Gagnon
- Department of Obstetrics and Gynecology, McGill University, Montreal, Quebec, Canada
| | - H A Abenhaim
- Department of Obstetrics and Gynecology, McGill University, Montreal, Quebec, Canada
| | - E Rahme
- Division of Clinical Epidemiology, Department of Medicine, McGill University, Montreal, Quebec, Canada
| | - S S Daskalopoulou
- Division of Experimental Medicine, Department of Medicine, McGill University, Montreal, Quebec, Canada.,Division of Internal Medicine, Department of Medicine, McGill University, Montreal, Quebec, Canada
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25
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Picone DS, Stoneman E, Cremer A, Schultz MG, Otahal P, Hughes AD, Black JA, Bos WJ, Chen CH, Cheng HM, Dwyer N, Lacy P, Laugesen E, Liang F, Kim HL, Ohte N, Okada S, Omboni S, Ott C, Pereira T, Pucci G, Rajani R, Schmieder R, Sinha MD, Stewart R, Stouffer GA, Takazawa K, Wang J, Weber T, Westerhof BE, Williams B, Yamada H, Sharman JE. Sex Differences in Blood Pressure and Potential Implications for Cardiovascular Risk Management. Hypertension 2023; 80:316-324. [PMID: 35912678 DOI: 10.1161/hypertensionaha.122.19693] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
BACKGROUND Accurate blood pressure (BP) measurement is critical for optimal cardiovascular risk management. Age-related trajectories for cuff-measured BP accelerate faster in women compared with men, but whether cuff BP represents the intraarterial (invasive) aortic BP is unknown. This study aimed to determine the sex differences between cuff BP, invasive aortic BP, and the difference between the 2 measurements. METHODS Upper-arm cuff BP and invasive aortic BP were measured during coronary angiography in 1615 subjects from the Invasive Blood Pressure Consortium Database. This analysis comprised 22 different cuff BP devices from 28 studies. RESULTS Subjects were 64±11 years (range 40-89) and 32% women. For the same cuff systolic BP (SBP), invasive aortic SBP was 4.4 mm Hg higher in women compared with men. Cuff and invasive aortic SBP were higher in women compared with men, but the sex difference was more pronounced from invasive aortic SBP, was the lowest in younger ages, and the highest in older ages. Cuff diastolic blood pressure overestimated invasive diastolic blood pressure in both sexes. For cuff and invasive diastolic blood pressure separately, there were sex*age interactions in which diastolic blood pressure was higher in younger men and lower in older men, compared with women. Cuff pulse pressure underestimated invasive aortic pulse pressure in excess of 10 mm Hg for both sexes in older age. CONCLUSIONS For the same cuff SBP, invasive aortic SBP was higher in women compared with men. How this translates to cardiovascular risk prediction needs to be determined, but women may be at higher BP-related risk than estimated by cuff measurements.
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Affiliation(s)
- Dean S Picone
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia (D.S.P., E.S., M.G.S., P.O., J.A.B., N.D.)
| | - Elif Stoneman
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia (D.S.P., E.S., M.G.S., P.O., J.A.B., N.D.)
| | - Antoine Cremer
- Department of Cardiology/Hypertension, University Hospital of Bordeaux, France (A.C.)
| | - Martin G Schultz
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia (D.S.P., E.S., M.G.S., P.O., J.A.B., N.D.)
| | - Petr Otahal
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia (D.S.P., E.S., M.G.S., P.O., J.A.B., N.D.)
| | - Alun D Hughes
- MRC Unit for Lifelong Health and Ageing at UCL, Institute of Cardiovascular Sciences, University College London, United Kingdom (A.D.H.)
| | - J Andrew Black
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia (D.S.P., E.S., M.G.S., P.O., J.A.B., N.D.).,Royal Hobart Hospital, Hobart, Australia (J.A.B., N.D.)
| | - Willem Jan Bos
- Department of Internal Medicine, St Antonius Hospital, Nieuwegein, The Netherlands (W.J.B.).,Department of Internal Medicine, Leiden University Medical Center, The Netherlands (W.J.B.)
| | - Chen-Huan Chen
- Department of Internal Medicine, National Yang Ming Chiao Tung University College of Medicine (C.-H.C.)
| | - Hao-Min Cheng
- Department of Medicine (H.-M.C.), National Yang Ming Chiao Tung University College of Medicine, Taipei, Taiwan.,Institute of Public Health (H.-M.C.), National Yang Ming Chiao Tung University College of Medicine, Taipei, Taiwan.,Center for Evidence-based Medicine (H.-M.C.), Taipei Veterans General Hospital, Taiwan.,Department of Medical Education (H.-M.C.), Taipei Veterans General Hospital, Taiwan.,Institute of Health and Welfare Policy, National Yang Ming Chiao Tung University College of Medicine, Taipei, Taiwan (H.-M.C.)
| | - Nathan Dwyer
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia (D.S.P., E.S., M.G.S., P.O., J.A.B., N.D.).,Royal Hobart Hospital, Hobart, Australia (J.A.B., N.D.)
| | - Peter Lacy
- Institute of Cardiovascular Sciences University College London (UCL) and National Institute for Health Research (NIHR) UCL/UCL Hospitals Biomedical Research Centre, United Kingdom (P.L., B.W.)
| | - Esben Laugesen
- Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Denmark (E.L.)
| | - Fuyou Liang
- School of Naval Architecture, Ocean and Civil Engineering, Shanghai Jiao Tong University, China (F.L.).,World-Class Research Center "Digital biodesign and personalized healthcare", Sechenov First Moscow State Medical University, Russia (F.L.)
| | - Hack-Lyoung Kim
- Division of Cardiology, Seoul National University Boramae Hospital, Seoul, South Korea (H.-L.K.)
| | - Nobuyuki Ohte
- Department of Cardio-Renal Medicine and Hypertension, Nagoya City University Graduate School of Medical Sciences, Japan (N.O.)
| | - Sho Okada
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, Japan (S.O.)
| | - Stefano Omboni
- Clinical Research Unit, Italian Institute of Telemedicine, Varese, Italy (S.O.).,Department of Cardiology, Sechenov First Moscow State Medical University, Russian Federation (S.O.)
| | - Christian Ott
- Department of Nephrology and Hypertension, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nürnberg, Germany (C.O., R.S.)
| | - Telmo Pereira
- Polytechnic Institute of Coimbra, Coimbra Health School, Coimbra, Portugal (T.P.).,Laboratory for Applied Health Research (LabinSaúde), Coimbra, Portugal (T.P.)
| | - Giacomo Pucci
- Unit of Internal Medicine at Terni University Hospital, Department of Medicine, University of Perugia, Italy (G.P.)
| | - Ronak Rajani
- Cardiology Department, Guy's and St. Thomas' Hospitals, London, United Kingdom (R.R.)
| | - Roland Schmieder
- Department of Nephrology and Hypertension, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nürnberg, Germany (C.O., R.S.)
| | - Manish D Sinha
- Kings College London British Heart Foundation Centre and Department of Clinical Pharmacology and Department of Paediatric Nephrology, Evelina London Children's Hospital, Guy's and St. Thomas' NHS Foundation Trust, United Kingdom (M.D.S)
| | - Ralph Stewart
- Green Lane Cardiovascular Service, Auckland City Hospital, University of Auckland, New Zealand (R.S.)
| | - George A Stouffer
- Division of Cardiology, University of North Carolina at Chapel Hill, Chapel Hill (G.A.S)
| | - Kenji Takazawa
- Center for Health Surveillance and Preventive Medicine, Tokyo Medical University Hospital, Japan (K.T.)
| | - Jiguang Wang
- Centre for Epidemiological Studies and Clinical Trials, Shanghai Key Laboratory of Hypertension, The Shanghai Institute of Hypertension, Department of Hypertension, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, China (J.W.)
| | - Thomas Weber
- Cardiology Department, Klinikum Wels-Grieskirchen, Austria (T.W.)
| | - Berend E Westerhof
- Department of Pulmonary Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences, The Netherlands (B.E.W.)
| | - Bryan Williams
- Institute of Cardiovascular Sciences University College London (UCL) and National Institute for Health Research (NIHR) UCL/UCL Hospitals Biomedical Research Centre, United Kingdom (P.L., B.W.)
| | - Hirotsugu Yamada
- Department of Community Medicine for Cardiology, Tokushima Graduate School of Biomedical Sciences, Japan (H.Y.)
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26
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Jin J, Geng X, Zhang Y, Zhang H, Ye T. Pulse Wave Analysis Method of Cardiovascular Parameters Extraction for Health Monitoring. Int J Environ Res Public Health 2023; 20:2597. [PMID: 36767962 PMCID: PMC9915975 DOI: 10.3390/ijerph20032597] [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] [Figures] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Revised: 01/18/2023] [Accepted: 01/19/2023] [Indexed: 06/18/2023]
Abstract
OBJECTIVE A pulse waveform is regarded as an information carrier of the cardiovascular system, which contains multiple interactive cardiovascular parameters reflecting physio-pathological states of bodies. Hence, multiple parameter analysis is increasingly meaningful to date but still cannot be easily achieved one by one due to the complex mapping between waveforms. This paper describes a new analysis method based on waveform recognition aimed for extracting multiple cardiovascular parameters to monitor public health. The objective of this new method is to deduce multiple cardiovascular parameters for a target pulse waveform based on waveform recognition to a most similar reference waveform in a given database or pattern library. METHODS The first part of the methodology includes building the sub-pattern libraries and training classifier. This provides a trained classifier and the sub-pattern library with reference pulse waveforms and known parameters. The second part is waveform analysis. The target waveform will be classified and output a state category being used to select the corresponding sub-pattern library with the same state. This will reduce subsequent recognition scope and computation costs. The mainstay of this new analysis method is improved dynamic time warping (DTW). This improved DTW and K-Nearest Neighbors (KNN) were applied to recognize the most similar waveform in the pattern library. Hence, cardiovascular parameters can be assigned accordingly from the most similar waveform in the pattern library. RESULTS Four hundred and thirty eight (438) randomly selected pulse waveforms were tested to verify the effectiveness of this method. The results show that the classification accuracy is 96.35%. Using statistical analysis to compare the target sample waveforms and the recognized reference ones from within the pattern library, most correlation coefficients are beyond 0.99. Each set of cardiovascular parameters was assessed using the Bland-Altman plot. The extracted cardiovascular parameters are in strong agreement with the original verifying the effectiveness of this new approach. CONCLUSION This new method using waveform recognition shows promising results that can directly extract multiple cardiovascular parameters from waveforms with high accuracy. This new approach is efficient and effective and is very promising for future continuous monitoring of cardiovascular health.
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Affiliation(s)
- Ji Jin
- The Institute of Microelectronics, Chinese Academy of Sciences, Beijing 100029, China
- University of Chinese Academy of Sciences, Beijing 100049, China
| | - Xingguang Geng
- The Institute of Microelectronics, Chinese Academy of Sciences, Beijing 100029, China
| | - Yitao Zhang
- The Institute of Microelectronics, Chinese Academy of Sciences, Beijing 100029, China
| | - Haiying Zhang
- The Institute of Microelectronics, Chinese Academy of Sciences, Beijing 100029, China
- University of Chinese Academy of Sciences, Beijing 100049, China
| | - Tianchun Ye
- The Institute of Microelectronics, Chinese Academy of Sciences, Beijing 100029, China
- University of Chinese Academy of Sciences, Beijing 100049, China
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27
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Mihuta MS, Stoian D, Borlea A, Roi CM, Velea-Barta OA, Mozos I, Paul C. Evaluating the Arterial Stiffness as a Useful Tool in the Management of Obese Children. Children (Basel) 2023; 10:children10020183. [PMID: 36832311 PMCID: PMC9955158 DOI: 10.3390/children10020183] [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] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Revised: 12/28/2022] [Accepted: 01/15/2023] [Indexed: 01/20/2023]
Abstract
Childhood obesity speeds up the development of arterial stiffness and progressively increases the values of arterial pressure. The purpose of this study is to investigate the value of using pulse wave analysis (PWA) to measure arterial stiffness as a sign of vascular wall impairment in obese children. The research was focused on 60 subjects: 33 obese and 27 normal-weight. Ages ranged from 6 to 18 years old. PWA includes parameters such as pulse wave velocity (PWV), augmentation index (AIx), peripheral and central blood pressure (SBP, DBP, cSBP, cDBP), heart rate, and central pulse pressure (cPP). The device used was a Mobil-O-Graph. Blood parameters were taken from the subject's medical history, not older than 6 months. A high BMI and a large waist circumference are linked to a high PWV. The levels of LDL-c, triglycerides (TG), non-HDL-c, TG/HDL-c ratio, and total cholesterol-HDL-c ratio significantly correlate to PWV, SBP, and cSBP. Alanine aminotransferase is a reliable predictor of PWV, AIx, SBP, DBP, and cDBP, while aspartate aminotransferase is a significant predictor of AIx, mean arterial pressure (MAP), cSBP, and cPP. 25-OH-Vitamin D negatively correlates with PWV, SBP, and MAP and significantly predicts the MAP. Cortisol and TSH levels are not significant to arterial stiffness in obese children without specific comorbidities and neither is fasting glucose in obese children without impaired glucose tolerance. We conclude that PWA contributes valuable data regarding patients' vascular health and should be considered a reliable tool in the management of obese children.
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Affiliation(s)
- Monica Simina Mihuta
- Department of Doctoral Studies, Victor Babes University of Medicine and Pharmacy, 300041 Timisoara, Romania
| | - Dana Stoian
- 2nd Department of Internal Medicine, Victor Babes University of Medicine and Pharmacy, 300041 Timisoara, Romania
- Center of Molecular Research in Nephrology and Vascular Disease, Faculty of Medicine, Victor Babes University of Medicine and Pharmacy, 300041 Timisoara, Romania
- Correspondence:
| | - Andreea Borlea
- 2nd Department of Internal Medicine, Victor Babes University of Medicine and Pharmacy, 300041 Timisoara, Romania
| | - Cristina Mihaela Roi
- Department of Doctoral Studies, Victor Babes University of Medicine and Pharmacy, 300041 Timisoara, Romania
| | - Oana-Alexandra Velea-Barta
- 3rd Department of Odontotherapy and Endodontics, Faculty of Dental Medicine, Victor Babes University of Medicine and Pharmacy, 300041 Timisoara, Romania
| | - Ioana Mozos
- Department of Functional Sciences—Pathophysiology, Center for Translational Research and Systems Medicine, Victor Babes University of Medicine and Pharmacy, 300173 Timisoara, Romania
| | - Corina Paul
- Department of Pediatrics, Victor Babes University of Medicine and Pharmacy, 300041 Timisoara, Romania
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28
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Ragland TJ, Heiston EM, Ballantyne A, Stewart NR, La Salvia S, Musante L, Luse MA, Isakson BE, Erdbrügger U, Malin SK. Extracellular vesicles and insulin-mediated vascular function in metabolic syndrome. Physiol Rep 2023; 11:e15530. [PMID: 36597186 PMCID: PMC9810789 DOI: 10.14814/phy2.15530] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2022] [Accepted: 11/02/2022] [Indexed: 01/05/2023] Open
Abstract
Metabolic Syndrome (MetS) raises cardiovascular disease risk. Extracellular vesicles (EVs) have emerged as important mediators of insulin sensitivity, although few studies on vascular function exist in humans. We determined the effect of insulin on EVs in relation to vascular function. Adults with MetS (n = 51, n = 9 M, 54.8 ± 1.0 years, 36.4 ± 0.7 kg/m2 , ATPIII: 3.5 ± 0.1 a.u., VO2 max: 22.1 ± 0.6 ml/kg/min) were enrolled in this cross-sectional study. Peripheral insulin sensitivity (M-value) was determined during a euglycemic clamp (40 mU/m2 /min, 90 mg/dl), and blood was collected for EVs (CD105+, CD45+, CD41+, TX+, and CD31+; spectral flow cytometry), inflammation, insulin, and substrates. Central hemodynamics (applanation tonometry) was determined at 0 and 120 min via aortic waveforms. Pressure myography was used to assess insulin-induced arterial vasodilation from mouse 3rd order mesenteric arteries (100-200 μm in diameter) at 0.2, 2 and 20 nM of insulin with EVs from healthy and MetS adults. Adults with MetS had low peripheral insulin sensitivity (2.6 ± 0.2 mg/kg/min) and high HOMA-IR (4.7 ± 0.4 a.u.) plus Adipose-IR (13.0 ± 1.3 a.u.). Insulin decreased total/particle counts (p < 0.001), CD45+ EVs (p = 0.002), AIx75 (p = 0.005) and Pb (p = 0.04), FFA (p < 0.001), total adiponectin (p = 0.006), ICAM (p = 0.002), and VCAM (p = 0.03). Higher M-value related to lower fasted total EVs (r = -0.40, p = 0.004) while higher Adipose-IR associated with higher fasted EVs (r = 0.42, p = 0.004) independent of VAT. Fasting CD105+ and CD45+ derived total EVs correlated with fasting AIx75 (r = 0.29, p < 0.05) and Pb (r = 0.30, p < 0.05). EVs from MetS participants blunted insulin-induced vasodilation in mesenteric arteries compared with increases from healthy controls across insulin doses (all p < 0.005). These data highlight EVs as potentially novel mediators of vascular insulin sensitivity and disease risk.
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Affiliation(s)
- Tristan J. Ragland
- Department of Kinesiology & HealthRutgers UniversityNew BrunswickNew JerseyUSA
| | - Emily M. Heiston
- Department of Internal Medicine, Pauley Heart CenterVirginia Commonwealth UniversityRichmondVirginiaUSA
- Department of KinesiologyUniversity of VirginiaCharlottesvilleVirginiaUSA
| | - Anna Ballantyne
- Department of KinesiologyUniversity of VirginiaCharlottesvilleVirginiaUSA
| | - Nathan R. Stewart
- Department of Kinesiology & HealthRutgers UniversityNew BrunswickNew JerseyUSA
- Department of KinesiologyUniversity of VirginiaCharlottesvilleVirginiaUSA
| | | | - Luca Musante
- School of Veterinary MedicineUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Melissa A. Luse
- Robert M Berne Cardiovascular Research CenterUniversity of Virginia School of MedicineCharlottesvilleVirginiaUSA
| | - Brant E. Isakson
- Robert M Berne Cardiovascular Research CenterUniversity of Virginia School of MedicineCharlottesvilleVirginiaUSA
- Department of Molecular Physiology and BiophysicsUniversity of Virginia School of MedicineCharlottesvilleVirginiaUSA
| | - Uta Erdbrügger
- Division of Nephrology, Department of MedicineUniversity of VirginiaCharlottesvilleVirginiaUSA
| | - Steven K. Malin
- Department of Kinesiology & HealthRutgers UniversityNew BrunswickNew JerseyUSA
- Department of KinesiologyUniversity of VirginiaCharlottesvilleVirginiaUSA
- Division of Endocrinology, Metabolism & NutritionDepartment of MedicineNew BrunswickNew JerseyUSA
- The New Jersey Institute for Food, Nutrition and HealthRutgers UniversityNew BrunswickNew JerseyUSA
- Institute of Translational Medicine and ScienceRutgers UniversityNew BrunswickNew JerseyUSA
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29
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Clara FM, Alfie J, Scandurra A, Fita M. The Diastolic Oscillation Amplitude Used as an Arterial Aging Indicator. Vasc Health Risk Manag 2023; 19:193-200. [PMID: 37038502 PMCID: PMC10082575 DOI: 10.2147/vhrm.s381452] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Accepted: 03/27/2023] [Indexed: 04/12/2023] Open
Abstract
Introduction The compliance of the distal arteries depends on their vasoconstrictor tone and distensibility and is sensitive to endothelial function and aging. C2, a component of the Windkessel model, is a measure of distal arterial compliance, and establishes the magnitude of the pressure rise during early diastole. It is calculated from the diastolic portion of the radial pulse wave using sophisticated analyses. C2 is used as a cardiovascular risk indicator since it decreases with aging, high blood pressure, and diabetes. Here, we propose an alternative method to assess the distal arteries distensibility by measuring the amplitude of the oscillation that occurs at the beginning of diastole. Methods Peripheral pulse wave was evaluated noninvasively by applanation tonometry in 511 individuals (264 women) aged between 13 and 70 years. Diastolic amplitude (DA) was measured as the peak-to-peak amplitude of the diastolic oscillation. Radial augmentation index (RAIx) and pulse wave velocity (PWV) were also calculated. Results DA decreased approximately 2% per decade of life between 16 and 70 years from 19% to 7%, and was higher in men than in women (p<0.0001). Linear regression analysis identified RAIx as the strongest predictor of AD (p<0.0001), followed by age and height. Sex modified the age-related decrease in DA (p< 0.001). By applying the method to measure DA from previously published data, we found a strong linear correlation with C2. Conclusion DA decreased linearly with age in a reciprocal manner to the increase in radial augmentation index, was greater in men than women, and was independent of blood pressure and heart rate, as previously reported for C2. We propose that measuring DA could provide an alternative index to evaluate distal arterial compliance and aging.
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Affiliation(s)
- Fernando M Clara
- Instituto de Investigaciones Científicas y Tecnológicas en Electrónica, Universidad Nacional de Mar del Plata/ CONICET, Mar del Plata, Argentina
- Unidad Cardiometabólica, Centro de Especialidades Médicas Ambulatorias, Mar del Plata, Argentina
- Correspondence: Fernando M Clara, ICyTE, UNMDP/CONICET, Av. Juan B. Justo 4302, Mar del Plata, B7600, Argentina, Tel +54 0223 481-0046, Email
| | - José Alfie
- Unidad de Hipertensión Arterial, Servicio de Clínica Médica, Hospital Italiano de Buenos Aires, Ciudad de Buenos Aires, Argentina
| | - Adriana Scandurra
- Instituto de Investigaciones Científicas y Tecnológicas en Electrónica, Universidad Nacional de Mar del Plata/ CONICET, Mar del Plata, Argentina
| | - Mariana Fita
- Unidad Cardiometabólica, Centro de Especialidades Médicas Ambulatorias, Mar del Plata, Argentina
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30
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Lee SC, Lee GH, Lee TY, Park SY. Comparison of parameter types for the calibration of noninvasive continuous cardiac output monitoring of patients undergoing lumbar spinal surgery in the prone position. Technol Health Care 2023; 31:2009-2019. [PMID: 37248925 PMCID: PMC10741371 DOI: 10.3233/thc-220520] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Accepted: 04/12/2023] [Indexed: 05/31/2023]
Abstract
BACKGROUND Cardiac output (CO) decreases on reversing the patient's position to the prone position. Estimated continuous cardiac output (esCCO) systems can noninvasively and continuously monitor CO calibrated by patient information or transesophageal echocardiogram (TEE). OBJECTIVE To compare the accuracy, precision, and trending ability of two calibration methods of CO estimation in patients in prone position. METHODS The CO estimates calibrated by TEE (esT) and patient information (esP) of 26 participants were included. CO was collected at four time points. The accuracy and precision of agreement were evaluated using the Bland-Altman method. A four-quadrant plot was used for trending ability analysis. RESULTS The bias between esP and TEE and between esT and TEE was 0.2594 L/min (95% limits of agreement (LoA): -1.8374 L/min to 2.3562 L/min) and 0.0337 L/min (95% LoA: -0.7381 L/min to 0.8055 L/min), respectively. A strong correlation was found between ΔesP and ΔTEE (p< 0.001, CCC = 0.700) and between ΔesT and ΔTEE (p< 0.001, CCC = 0.794). The concordance rates between ΔesP and ΔTEE and between ΔesT and ΔTEE were 91.9% and 97.1%, respectively. CONCLUSION Despite limited accuracy and precision, esP showed acceptable trending ability. The trending ability of esCCO calibrated by the reference TEE value was comparable with that of TEE.
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Affiliation(s)
- Seung Cheol Lee
- Department of Anesthesiology and Pain Medicine, College of Medicine, Dong-A University, Busan, Korea
| | - Gang Hyun Lee
- Department of Anesthesiology and Pain Medicine, College of Medicine, Dong-A University, Busan, Korea
| | - Tae Young Lee
- Department of Anesthesiology and Pain Medicine, College of Medicine, Dong-A University, Busan, Korea
| | - Sang Yoong Park
- Department of Anesthesiology and Pain Medicine, College of Medicine, Dong-A University, Busan, Korea
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Anthoulakis C, Mamopoulos A. Augmentation index and pulse wave velocity in normotensive versus preeclamptic pregnancies: a prospective case-control study using a new oscillometric method. Ann Med 2022; 54:1-10. [PMID: 34935572 PMCID: PMC8725835 DOI: 10.1080/07853890.2021.2014553] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
OBJECTIVES The objective of this study was to investigate whether oscillometric AS measurements are different in pregnant women with and without preeclampsia (PE). STUDY DESIGN This was a prospective case-control study in singleton pregnancies that had been diagnosed with PE (n = 46) versus normotensive controls (n = 46) between 2014 and 2019. In the case group, pregnancies complicated by PE were classified as either early-onset (<34 weeks of gestation) or late-onset (≥34 weeks of gestation) PE and subgroup analysis was performed. MAIN OUTCOME MEASURES Pulse wave velocity (PWV), augmentation index (Alx), and Alx at a heart rate of 75 beats per minute (Alx-75) were measured using a brachial cuff-based automatic oscillometric device (Mobil-O-Graph 24 h PWA). RESULTS In pregnancies complicated by PE, in comparison with normotensive pregnancies, there were significant differences in PWV (p ˂ .001), and Alx-75 (p ˂ .001). In pregnancies complicated by early-onset PE, in comparison with pregnancies complicated by late-onset PE, there were significant differences in PWV (p = .006), and Alx-75 (p = .009). There was no significant difference in Alx in either of the analyses. CONCLUSIONS PWV and Alx-75 are higher in pregnancies complicated by PE, in comparison with normotensive pregnancies, as well as in early-onset PE, in comparison with late-onset PE.Key messagesPulse wave velocity is higher in pregnancies complicated by preeclampsia.Augmentation index at a heart rate of 75 beats per minute is higher in pregnancies complicated by preeclampsia.Arterial stiffness assessment is a promising risk-stratification tool for future cardiovascular complications but further studies are required.
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Affiliation(s)
- Christos Anthoulakis
- First Department of Obstetrics & Gynecology, "Papageorgiou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Apostolos Mamopoulos
- Third Department of Obstetrics & Gynecology, Hippokration (Ippokrateio) General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
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Kim HL, Jeon WK, Joh HS, Lim WH, Seo JB, Kim SH, Zo JH, Kim MA. Brachial-ankle pulse wave velocity as a predictor of long-term cardiovascular events in 2174 subjects with type 2 diabetes mellitus: A retrospective cohort study. Medicine (Baltimore) 2022; 101:e31758. [PMID: 36397444 PMCID: PMC9666137 DOI: 10.1097/md.0000000000031758] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
The prognostic value of arterial stiffness in patients with diabetes mellitus (DM) remains unclear. The aim of this study was to investigate the association between brachial-ankle pulse wave velocity (baPWV) and the occurrence of cardiovascular events in people with DM. A total of 2714 subjects (mean age, 63.6 years; males, 59.3%) with type 2 DM and without documented cardiovascular disease and stroke were analyzed. The primary end-point of this study was composite cardiovascular events of cardiac death, non-fatal myocardial infarction, coronary revascularization and stroke. There were 118 composite events (4.3%) during a median follow-up period of 3.84 years (interquartile range, 1.60-5.52 years). In multivariable Cox regression analysis, higher baPWV (≥1672 cm/s) was associated with composite events even after controlling for potential confounders (hazard ratio [HR], 2.00; 95% confidence interval [CI], 1.31-3.07; P = .001). Compared to the lowest baPWV tertile, both middle (HR, 1.84; 95% CI, 1.03-3.27; P = .037) and the highest (HR, 2.97; 95% CI, 1.69-5.22; P < .001) tertile of baPWV were associated with increased risk of cardiovascular events in the same multivariable model. In conclusion, the baPWV was associated with cardiovascular events in people with type 2 DM. Considering the simplicity and convenience of baPWV measurement, baPWV may be useful for risk stratification of people with type 2 DM.
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Affiliation(s)
- Hack-Lyoung Kim
- Division of Cardiology, Department of Internal Medicine, Boramae Medical Center, Seoul, National University College of Medicine, Seoul, Republic of Korea
- * Correspondence: Hack-Lyoung Kim, Division of Cardiology, Department of Internal Medicine, Boramae Medical Center, Seoul, National University College of Medicine, 5 Boramae-ro, Dongjak-gu, Seoul 07061, Republic of Korea (e-mail: )
| | - Won Kyeong Jeon
- Division of Cardiology, Department of Internal Medicine, Boramae Medical Center, Seoul, National University College of Medicine, Seoul, Republic of Korea
| | - Hyun Sung Joh
- Division of Cardiology, Department of Internal Medicine, Boramae Medical Center, Seoul, National University College of Medicine, Seoul, Republic of Korea
| | - Woo-Hyun Lim
- Division of Cardiology, Department of Internal Medicine, Boramae Medical Center, Seoul, National University College of Medicine, Seoul, Republic of Korea
| | - Jae-Bin Seo
- Division of Cardiology, Department of Internal Medicine, Boramae Medical Center, Seoul, National University College of Medicine, Seoul, Republic of Korea
| | - Sang-Hyun Kim
- Division of Cardiology, Department of Internal Medicine, Boramae Medical Center, Seoul, National University College of Medicine, Seoul, Republic of Korea
| | - Joo-Hee Zo
- Division of Cardiology, Department of Internal Medicine, Boramae Medical Center, Seoul, National University College of Medicine, Seoul, Republic of Korea
| | - Myung-A Kim
- Division of Cardiology, Department of Internal Medicine, Boramae Medical Center, Seoul, National University College of Medicine, Seoul, Republic of Korea
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Bouwmeester TA, van de Velde L, Galenkamp H, Postema PG, Westerhof BE, van den Born BJH, Collard D. Association between the reflection magnitude and blood pressure in a multiethnic cohort: the Healthy Life in an Urban Setting study. J Hypertens 2022; 40:2263-2270. [PMID: 35950966 PMCID: PMC9553245 DOI: 10.1097/hjh.0000000000003256] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Revised: 07/07/2022] [Accepted: 07/08/2022] [Indexed: 12/02/2022]
Abstract
AIMS Reflection magnitude (RM), the ratio of the amplitudes of the backward and forward central arterial pressure waves, has been shown to predict cardiovascular events. However, the association with blood pressure (BP) and hypertension is unclear. METHODS We assessed RM in 10 195 individuals of Dutch, South-Asian Surinamese, African Surinamese, Ghanaian, Turkish and Moroccan origin aged between 18 and 70 years (54.2% female) participating in the Healthy Life in an Urban Setting study. To determine RM, central arterial pressure and flow were reconstructed from finger BP. Hypertension was defined based on office-BP and medication. Associations with BP, hypertension, and hypertensive organ damage were assessed using linear regression models with correction for relevant covariates. RESULTS Mean RM was 62.5% (standard deviation [SD] 8.0) in men and 63.8% (SD 8.1) in women. RM was lowest in Dutch and highest in South-Asian and African participants. RM increased linearly with 1.35 (95% confidence interval [CI] 1.23-1.46) for every 10 mmHg increase in systolic BP from 120 mmHg onwards, while the relation with diastolic BP was nonlinear. RM was 2.40 (95% CI 2.04-2.76) higher in hypertensive men and 3.82 (95% CI 3.46-4.19) higher in hypertensive women compared to normotensive men and women. In hypertensive men and women with ECG-based left ventricular hypertrophy or albuminuria RM was 1.64 (95% CI 1.09-2.20) and 0.94 (95% CI 0.37-1.52) higher compared to hypertensive participants without hypertensive organ damage. CONCLUSION RM is associated with BP, hypertension and hypertensive organ damage, and may in part explain disparities in hypertension associated cardiovascular risk.
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Affiliation(s)
- Thomas A. Bouwmeester
- Department of Vascular Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam Cardiovascular Sciences, Amsterdam
| | - Lennart van de Velde
- Department of Vascular Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam Cardiovascular Sciences, Amsterdam
- Faculty of Science and Technology, Multi-Modality Medical Imaging Group, Technical Medical Centre, University of Twente, Enschede
| | - Henrike Galenkamp
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam
| | - Pieter G. Postema
- Department of Cardiology, Heart Center, Amsterdam UMC, University of Amsterdam, Amsterdam Cardiovascular Sciences
| | - Berend E. Westerhof
- Department of Pulmonary Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Bert-Jan H. van den Born
- Department of Vascular Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam Cardiovascular Sciences, Amsterdam
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam
| | - Didier Collard
- Department of Vascular Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam Cardiovascular Sciences, Amsterdam
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Pereira MM, Torrado J, Bock J, Sosa C, Diaz A, Bia D, Zócalo Y. Wave separation analysis-derived indexes obtained from radial and carotid tonometry in healthy pregnancy and pregnancy-associated hypertension: Comparison with pulse wave analysis-derived indexes. Front Cardiovasc Med 2022; 9:997452. [PMID: 36386340 PMCID: PMC9664074 DOI: 10.3389/fcvm.2022.997452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Accepted: 10/10/2022] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Increased wave reflections assessed by pulse wave analysis (PWA) was proposed as one of the potential culprits of hypertension seen in women with pregnancy-associated hypertension (PAH). However, this statement has never been confirmed with "Wave Separation Analysis" (WSA), a more sophisticated mathematical approach that analyzes the amplitude and interaction between forward and backward aortic pressure waveform components. OBJECTIVE To characterize potential changes in pressure wave components of PAH compared to healthy non-pregnant (NP) women and women with normal pregnancies (HP) by using WSA and compared these findings with PWA-derived indexes; secondarily, to evaluate differences in WSA-derived indexes between subgroups of PAH (i.e., preeclampsia [PE] and gestational hypertension [GH]). METHODS Using radial and carotid applanation tonometry, we quantified in HP (n = 10), PAH (n = 16), and NP (n = 401): (i) PWA-derived indexes; (ii) WSA-derived indexes: forward (Pf) and backward (Pb) waveform components, backward component arrival time (PbAT), reflection magnitude (RM = Pb/Pf) and index [RIx = Pb/(Pf + Pb)]. RESULTS While PAH was associated with a higher Pf compared to HP and NP, Pb and PbAT were similar between the groups. Both GH and PE showed a higher Pf compared to HP, but only PE had a trend of presenting with higher Pb and lower PbAT compared to the other groups. Finally, PAH showed a trend of having lower RM and RIx compared to NP and HP, with no differences between GH and PE. CONCLUSION PAH was associated with higher Pf, but not higher Pb, compared to NP and HP, although PE also demonstrated a trend of higher Pb.
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Affiliation(s)
- María M. Pereira
- Department of Obstetrics and Gynecology, BronxCare Hospital Center a Clinical Affiliate of Mt Sinai Health Systems and Academic Affiliate of Icahn School of Medicine, Bronx, NY, United States
| | - Juan Torrado
- Department of Internal Medicine, Jacobi Medical Center, Albert Einstein College of Medicine, Bronx, NY, United States
| | - Joshua Bock
- Department of Internal Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, United States
| | - Claudio Sosa
- Department of Obstetrics and Gynecology “C”, Pereira-Rossell Hospital, School of Medicine, Republic University, Montevideo, Uruguay
| | - Alejandro Diaz
- Consejo Nacional de Investigaciones Científicas y Técnicas, Tandil, Argentina
| | - Daniel Bia
- Centro Universitario de Investigación, Innovación y Diagnóstico Arterial (CUiiDARTE), Department of Physiology, School of Medicine, Republic University, Montevideo, Uruguay
| | - Yanina Zócalo
- Centro Universitario de Investigación, Innovación y Diagnóstico Arterial (CUiiDARTE), Department of Physiology, School of Medicine, Republic University, Montevideo, Uruguay,*Correspondence: Yanina Zócalo,
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35
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Remchak ME, Heiston EM, Ballantyne A, Dotson B, Malin SK. Aortic waveform responses to insulin in late versus early chronotype with metabolic syndrome. Physiol Rep 2022; 10:e15473. [PMID: 36301720 PMCID: PMC9612142 DOI: 10.14814/phy2.15473] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Accepted: 08/31/2022] [Indexed: 11/17/2022] Open
Abstract
Late chronotype (LC) correlates with reduced metabolic insulin sensitivity and cardiovascular disease. It is unclear if insulin action on aortic waveforms and inflammation is altered in LC versus early chronotype (EC). Adults with metabolic syndrome (n = 39, MetS) were classified as either EC (Morning-Eveningness Questionnaire [MEQ] = 63.5 ± 1.2) or LC (MEQ = 45.5 ± 1.3). A 120 min euglycemic clamp (40 mU/m<sup>2</sup> /min, 90 mg/dL) with indirect calorimetry was used to determine metabolic insulin sensitivity (glucose infusion rate [GIR]) and nonoxidative glucose disposal (NOGD). Aortic waveforms via applanation tonometry and inflammation by blood biochemistries were assessed at 0 and 120 min of the clamp. LC had higher fat-free mass and lower VO<sub>2</sub> max, GIR, and NOGD (between groups, all p ≤ 0.05) than EC. Despite no difference in 0 min waveforms, both groups had insulin-stimulated elevations in pulse pressure amplification with reduced AIx75 and augmentation pressure (AP; time effect, p ≤ 0.05). However, EC had decreased forward pressure (Pf; interaction effect, p = 0.007) with insulin versus rises in LC. Although LC had higher tumor necrosis factor-α (TNF-α; group effect, p ≤ 0.01) than EC, both LC and EC had insulin-stimulated increases in TNF-α and decreases in hs-CRP (time effect, both p ≤ 0.01). Higher MEQ scores related to greater insulin-stimulated reductions in AP (r = -0.42, p = 0.016) and Pf (r = -0.41, p = 0.02). VO<sub>2</sub> max correlated with insulin-mediated reductions in AIx75 (r = -0.56, p < 0.01) and AP (r = -0.49, p < 0.01). NOGD related to decreased AP (r = -0.44, p = 0.03) and Pf (r = -0.43, p = 0.04) during insulin infusion. LC was depicted by blunted forward pressure waveform responses to insulin and higher TNF-α in MetS. More work is needed to assess endothelial function across chronotypes.
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Affiliation(s)
| | - Emily M. Heiston
- University of VirginiaCharlottesvilleVirginiaUSA,Virginia Commonwealth UniversityRichmondVirginiaUSA
| | | | | | - Steven K. Malin
- Rutgers UniversityNew BrunswickNew JerseyUSA,University of VirginiaCharlottesvilleVirginiaUSA,Division of Endocrinology, Metabolism & NutritionRutgers UniversityNew BrunswickNew JerseyUSA,New Jersey Institute for Food, Nutrition and HealthRutgers UniversityNew BrunswickNew JerseyUSA,Institute of Translational Medicine and ScienceRutgers UniversityNew BrunswickNew JerseyUSA
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36
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Park JS, Shin JH, Park JB, Choi DJ, Youn HJ, Park CG, Kwan J, Ahn Y, Kim DW, Rim SJ, Park SW, Sung J, Bae JH. Central hemodynamics and the discrepancy between central blood pressure and brachial blood pressure. Medicine (Baltimore) 2022; 101:e30484. [PMID: 36221367 PMCID: PMC9542756 DOI: 10.1097/md.0000000000030484] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Despite similar brachial blood pressure, central hemodynamics could be different. The objective of the present study was to investigate the factors, which could influence the discrepancy between central BP (cBP) and brachial blood pressure. Six hundred forty-seven patients (364 males, 48 ± 12 years old) were enrolled. Using applanation tonometry, cBP was noninvasively derived. The median difference between brachial systolic BP (bSBP) and central systolic BP (cSBP) was 8 mm Hg. We defined the discrepancy between bSBP and cSBP as differences >8 mm Hg. For adjustment of cBP, population was divided into 3 groups according to the cBP: group 1, <140 mm Hg of cSBP; group 2, 140 > cSBP < 160 mm Hg; group 3, =160 mm Hg of cSBP. All the central hemodynamic parameters of the patients, including augmentation pressure, augmentation index (AI), heart rate (75 bpm) adjusted augmentation index (AI@HR75), and subendocardial viability ratio, were measured. Using multivariate logistic regression analysis, we evaluated the factors which could influence the discrepancy between bSBP and cSBP. Age, gender, augmentation pressure, AI, and AI@HR75 were correlated with the discrepancy between bSBP and cSBP. AI@HR75 was significantly correlated with the discrepancy between bSBP and cSBP (β-coefficient = -0.376, P < .001 in group 1; β-coefficient = -0.297, P < .001 in group 2; and β-coefficient = -0.545, P < .001 in group 3). In groups 1 and 2, male gender was significantly correlated with the discrepancy between bSBP and cSBP (β-coefficient = -0.857, P = .035 in group 1; β-coefficient = -1.422, P = .039 in group 2). In present study, arterial stiffness might affect the discrepancy between bSBP and cSBP. Also, male gender was closely related to the discrepancy between bSBP and cSBP especially with cSBP <160 mm Hg. Not only cSBP, the discrepancy between cSBP and bSBP should be considered for understanding the central hemodynamics.
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Affiliation(s)
- Jin-Sun Park
- Department of Cardiology, Ajou University School of Medicine, Suwon, Korea
| | - Joon-Han Shin
- Department of Cardiology, Ajou University School of Medicine, Suwon, Korea
- * Correspondence: Joon-Han Shin, MD, Department of Cardiology, Ajou University School of Medicine, 164 Worldcup-ro, Yeongtong-gu, Suwon, Korea 16499. (e-mail: )
| | | | - Dong-Ju Choi
- Cardiovascular Center, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Ho-Joong Youn
- Cardiovascular center and Cardiology Division, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Chang-Gyu Park
- Cardiovascular Center, Korea University Guro Hospital, Seoul, Korea
| | - Jun Kwan
- Department of Cardiology, Inha University College of Medicine, Incheon, Korea
| | - Youngkeun Ahn
- Department of Cardiology, Chonnam National University Hospital, Gwangju, Korea
| | - Dong-Woon Kim
- Division of Cardiology, Department of Internal Medicine, Chungbuk National University Hospital and Chungbuk National University College of Medicine, Cheongju, Korea
| | - Se-Joong Rim
- Division of Cardiology, Department of Internal Medicine, Yonsei University College Medicine, Seoul, Korea
| | - Seung-Woo Park
- Division of Cardiology, Heart Vascular and Stroke Institute, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jidong Sung
- Division of Cardiology, Heart Vascular and Stroke Institute, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jang-Ho Bae
- Department of Cardiology, Heart Center, College of Medicine, Konyang University, Deajeon, Korea
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Rogers SC, Ko YA, Quyyumi AA, Hajjar I. Differential Sex-Specific Effects of Angiotensin-Converting Enzyme Inhibition and Angiotensin Receptor Blocker Therapy on Arterial Function in Hypertension: CALIBREX Trial. Hypertension 2022; 79:2316-2327. [PMID: 35916128 DOI: 10.1161/hypertensionaha.122.19105] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [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] [Indexed: 11/16/2022]
Abstract
BACKGROUND Increased arterial stiffness is associated with adverse cardiovascular outcomes. We studied the sex-specific impact of angiotensin antagonists on vascular function in hypertension with the hypothesis that their effects on arterial stiffness may be variable in men and women. METHODS In 141 hypertensive participants with mild cognitive impairment (age 65.9±7.7, 57% female), candesartan (up to 32 mg, n=77) or lisinopril (up to 40 mg, n=64) were administered to achieve blood pressure <140/90 mm Hg. Pulse wave velocity, central pulse pressure, and central augmentation index were measured using applanation tonometry (SphygmoCor, Australia). Multivariate linear regression and mixed model analyses were performed using intention-to-treat and per protocol analyses for those completing the study. RESULTS Blood pressure reduction was similar among candesartan and lisinopril groups. Compared with candesartan, lisinopril therapy resulted in lower pulse wave velocity (0.5±0.8 versus -0.7±0.4 m/s, respectively; P=0.003) and central pulse pressure (-1±3 versus -7±4 mm Hg; P=0.03) after 1 year. There was a significant interaction by sex whereby the improvements in pulse wave velocity and central pulse pressure with lisinopril compared with candesartan were only observed in women. In contrast, there was greater improvement in augmentation index with candesartan compared with lisinopril (-4±7% versus -1.5±8%; P=0.05), with no sex differences. CONCLUSIONS Despite equipotent antihypertensive effects, lisinopril was more effective than candesartan at lowering arterial stiffness in women. In contrast, candesartan was more effective than lisinopril in improving pulse wave reflections in both sexes. These findings demonstrate differential sex-specific effects of renin-angiotensin system antagonists on arterial function in hypertension that may contribute to long-term cardiovascular and neurocognitive outcomes in this population.
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Affiliation(s)
- Steven C Rogers
- Division of Cardiology, Department of Medicine, Emory Clinical Cardiovascular Research Institute (S.C.R., Y.-A.K., A.A.Q.), Emory University School of Medicine, Atlanta, GA
| | - Yi-An Ko
- Division of Cardiology, Department of Medicine, Emory Clinical Cardiovascular Research Institute (S.C.R., Y.-A.K., A.A.Q.), Emory University School of Medicine, Atlanta, GA
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, GA (Y.-A.K.)
| | - Arshed A Quyyumi
- Division of Cardiology, Department of Medicine, Emory Clinical Cardiovascular Research Institute (S.C.R., Y.-A.K., A.A.Q.), Emory University School of Medicine, Atlanta, GA
| | - Ihab Hajjar
- Department of Neurology (I.H.), Emory University School of Medicine, Atlanta, GA
- Division of General Medicine and Geriatrics, Department of Medicine (I.H.), Emory University School of Medicine, Atlanta, GA
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38
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Bui TV, Picone DS, Schultz MG, Armstrong MK, Peng X, Black JA, Dwyer N, Roberts-Thomson P, Adams H, Hughes AD, Sharman JE. Comparison between cuff-based and invasive systolic blood pressure amplification. J Hypertens 2022; 40:2037-2044. [PMID: 36052526 PMCID: PMC7614121 DOI: 10.1097/hjh.0000000000003228] [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] [Indexed: 02/04/2023]
Abstract
OBJECTIVE Accurate measurement of central blood pressure (BP) using upper arm cuff-based methods is associated with several factors, including determining the level of systolic BP (SBP) amplification. This study aimed to determine the agreement between cuff-based and invasively measured SBP amplification. METHODS Patients undergoing coronary angiography had invasive SBP amplification (brachial SBP - central SBP) measured simultaneously with cuff-based SBP amplification using a commercially available central BP device (device 1: Sphygmocor Xcel; n = 171, 70% men, 60 ± 10 years) and a now superseded model of a central BP device (device 2: Uscom BP+; n = 52, 83% men, 62 ± 10 years). RESULTS Mean difference (±2SD, limits of agreement) between cuff-based and invasive SBP amplification was 4 mmHg (-12, +20 mmHg, P < 0.001) for device 1 and -2 mmHg (-14, +10 mmHg, P = 0.10) for device 2. Both devices systematically overestimated SBP amplification at lower levels and underestimated at higher levels of invasive SBP amplification, but with stronger bias for device 1 (r = -0.68 vs. r = -0.52; Z = 2.72; P = 0.008). Concordance of cuff-based and invasive SBP amplification across quartiles of invasive SBP amplification was low, particularly in the lowest and highest quartiles. The root mean square errors from regression between cuff-based central SBP and brachial SBP were significantly lower (indicating less variability) than from invasive regression models (P < 0.001). CONCLUSIONS Irrespective of the difference from invasive measurements, cuff-based estimates of SBP amplification showed evidence of proportional systematic bias and had less individual variability. These observations could provide insights on how to improve the performance of cuff-based central BP.
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Affiliation(s)
- Tan V Bui
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia
| | - Dean S Picone
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia
| | - Martin G Schultz
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia
| | - Matthew K Armstrong
- Department of Health and Human Physiology, University of Iowa, Iowa City, Iowa, USA
| | - Xiaoqing Peng
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - J Andrew Black
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia
- Royal Hobart Hospital, Hobart, Australia
| | - Nathan Dwyer
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia
- Royal Hobart Hospital, Hobart, Australia
| | - Philip Roberts-Thomson
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia
- Royal Hobart Hospital, Hobart, Australia
| | - Heath Adams
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia
- Royal Hobart Hospital, Hobart, Australia
| | - Alun D Hughes
- MRC Unit for Lifelong Health and Ageing at UCL, Institute of Cardiovascular Sciences, University College London, London, UK
| | - James E Sharman
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia
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Desbiens LC, Fortier C, Nadeau-Fredette AC, Madore F, Hametner B, Wassertheurer S, Agharazii M, Goupil R. Prediction of Cardiovascular Events by Pulse Waveform Parameters: Analysis of CARTaGENE. J Am Heart Assoc 2022; 11:e026603. [PMID: 36056725 PMCID: PMC9496446 DOI: 10.1161/jaha.122.026603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Waveform parameters provide approximate data about aortic wave reflection. However, their association with cardiovascular events remains controversial and their role in cardiovascular prediction is unknown. Methods and Results We analyzed participants aged between 40 and 69 from the population-based CARTaGENE cohort. Baseline pulse wave analysis (central pulse pressure, augmentation index) and wave separation analysis (forward pressure, backward pressure, reflection magnitude) parameters were derived from radial artery tonometry. Associations between each parameter and major adverse atherosclerotic events (MACE; cardiovascular death, stroke, myocardial infarction) were obtained using adjusted Cox models. The incremental predictive value of each parameter compared with the 10-year atherosclerotic cardiovascular disease score alone was assessed using hazard ratios, c-index differences, continuous net reclassification indexes, and integrated discrimination indexes. From 17 561 eligible patients, 2315 patients had a MACE during a median follow-up of 10.1 years. Central pulse pressure, forward pressure, and backward pressure, but not augmentation index and reflection magnitude, were significantly associated with MACE after full adjustment. All parameters except forward pressure statistically improved MACE prediction compared with the atherosclerotic cardiovascular disease score alone. The greatest prediction improvement was seen with augmentation index and reflection magnitude but remained small in magnitude. These 2 parameters enhanced predictive performance more strongly in patients with low baseline atherosclerotic cardiovascular disease scores. Up to 5.7% of individuals were reclassified into a different risk stratum by adding waveform parameters to atherosclerotic cardiovascular disease scores. Conclusions Some waveform parameters are independently associated with MACEs in a population-based cohort. Augmentation index and reflection magnitude slightly improve risk prediction, especially in patients at low cardiovascular risk.
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Affiliation(s)
| | - Catherine Fortier
- Department of Medicine Université de Montréal Montreal Canada.,Hôpital du Sacré-Coeur de Montréal Research Center Montreal Canada
| | - Annie-Claire Nadeau-Fredette
- Department of Medicine Université de Montréal Montreal Canada.,Hôpital Maisonneuve-Rosemont Université de Montréal Montréal Canada
| | - François Madore
- Department of Medicine Université de Montréal Montreal Canada.,Hôpital du Sacré-Coeur de Montréal Research Center Montreal Canada
| | | | | | - Mohsen Agharazii
- Department of Medicine Université Laval Quebec City Canada.,CHU de Quebec Université Laval Quebec City Canada
| | - Rémi Goupil
- Department of Medicine Université de Montréal Montreal Canada.,Hôpital du Sacré-Coeur de Montréal Research Center Montreal Canada
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Haley JE, Woodly SA, Daniels SR, Falkner B, Ferguson MA, Flynn JT, Hanevold CD, Hooper SR, Ingelfinger JR, Khoury PR, Lande MB, Martin LJ, Meyers KE, Mitsnefes M, Becker RC, Rosner BA, Samuels J, Tran AH, Urbina EM. Association of Blood Pressure-Related Increase in Vascular Stiffness on Other Measures of Target Organ Damage in Youth. Hypertension 2022; 79:2042-2050. [PMID: 35762327 PMCID: PMC9378473 DOI: 10.1161/hypertensionaha.121.18765] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [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] [Indexed: 11/16/2022]
Abstract
BACKGROUND Hypertension-related increased arterial stiffness predicts development of target organ damage (TOD) and cardiovascular disease. We hypothesized that blood pressure (BP)-related increased arterial stiffness is present in youth with elevated BP and is associated with TOD. METHODS Participants were stratified by systolic BP into low- (systolic BP <75th percentile, n=155), mid- (systolic BP ≥80th and <90th percentile, n=88), and high-risk BP categories (≥90th percentile, n=139), based on age-, sex- and height-specific pediatric BP cut points. Clinic BP, 24-hour ambulatory BP monitoring, anthropometrics, and laboratory data were obtained. Arterial stiffness measures included carotid-femoral pulse wave velocity and aortic stiffness. Left ventricular mass index, left ventricular systolic and diastolic function, and urine albumin/creatinine were collected. ANOVA with Bonferroni correction was used to evaluate differences in cardiovascular risk factors, pulse wave velocity, and cardiac function across groups. General linear models were used to examine factors associated with arterial stiffness and to determine whether arterial stiffness is associated with TOD after accounting for BP. RESULTS Pulse wave velocity increased across groups. Aortic distensibility, distensibility coefficient, and compliance were greater in low than in the mid or high group. Significant determinants of arterial stiffness were sex, age, adiposity, BP, and LDL (low-density lipoprotein) cholesterol. Pulse wave velocity and aortic compliance were significantly associated with TOD (systolic and diastolic cardiac function and urine albumin/creatinine ratio) after controlling for BP. CONCLUSIONS Higher arterial stiffness is associated with elevated BP and TOD in youth emphasizing the need for primary prevention of cardiovascular disease.
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Affiliation(s)
| | - Shalayna A Woodly
- Cincinnati Children's Hospital Medical Center, University of Cincinnati, OH (S.A.W., P.R.K., L.J.M., M.M., E.M.U.)
| | | | | | | | - Joseph T Flynn
- Department of Pediatrics, University of Washington, Seattle, WA (J.T.F., C.D.H.)
- Division of Nephrology, Seattle Children's Hospital, Seattle, WA (J.T.F., C.D.H.)
| | - Coral D Hanevold
- Department of Pediatrics, University of Washington, Seattle, WA (J.T.F., C.D.H.)
- Division of Nephrology, Seattle Children's Hospital, Seattle, WA (J.T.F., C.D.H.)
| | | | | | - Philip R Khoury
- Rady Children's Hospital San Diego, CA (J.E.H.)
- Cincinnati Children's Hospital Medical Center, University of Cincinnati, OH (S.A.W., P.R.K., L.J.M., M.M., E.M.U.)
| | - Marc B Lande
- University of Rochester Medical Center, Rochester, NY (M.B.L.)
| | - Lisa J Martin
- Rady Children's Hospital San Diego, CA (J.E.H.)
- Cincinnati Children's Hospital Medical Center, University of Cincinnati, OH (S.A.W., P.R.K., L.J.M., M.M., E.M.U.)
| | | | - Mark Mitsnefes
- Cincinnati Children's Hospital Medical Center, University of Cincinnati, OH (S.A.W., P.R.K., L.J.M., M.M., E.M.U.)
| | | | | | - Joshua Samuels
- University of Texas Health Sciences Center, Houston (J.S.)
| | - Andrew H Tran
- Nationwide Children's Hospital, Columbus, OH (A.H.T.)
| | - Elaine M Urbina
- Cincinnati Children's Hospital Medical Center, University of Cincinnati, OH (S.A.W., P.R.K., L.J.M., M.M., E.M.U.)
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41
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ArabiDarrehDor G, Kao YM, Oliver MA, Parajuli B, Carney BC, Keyloun JW, Moffatt LT, Shupp JW, Hahn JO, Burmeister DM. The Potential of Arterial Pulse Wave Analysis in Burn Resuscitation: A Pilot In Vivo Study. J Burn Care Res 2022; 44:599-609. [PMID: 35809084 DOI: 10.1093/jbcr/irac097] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Indexed: 11/13/2022]
Abstract
While urinary output (UOP) remains the primary endpoint for titration of intravenous fluid resuscitation, it is an insufficient indicator of fluid responsiveness. Although advanced hemodynamic monitoring (including arterial pulse wave analysis (PWA)) is of recent interest, the validity of PWA-derived indices in burn resuscitation extremes has not been established. The goal of this paper is to test the hypothesis that PWA-derived cardiac output (CO) and stroke volume (SV) indices as well as pulse pressure variation (PPV) and systolic pressure variation (SPV) can play a complementary role to UOP in burn resuscitation. Swine were instrumented with a Swan-Ganz catheter for reference CO and underwent a 40% total body surface area burns with varying resuscitation paradigms, and were monitored for 24 hours in an ICU setting under mechanical ventilation. The longitudinal changes in PWA-derived indices were investigated, and resuscitation adequacy was compared as determined by UOP versus PWA indices. The results indicated that PWA-derived indices exhibited trends consistent with reference CO and SV measurements: CO and SV indices were proportional to reference CO and SV, respectively (CO: post-calibration limits of agreement (LoA)=+/-24.7 [ml/min/kg], SV: post-calibration LoA=+/-0.30 [ml/kg]) while PPV and SPV were inversely proportional to reference SV (PPV: post-calibration LoA=+/-0.32 [ml/kg], SPV: post-calibration LoA=+/-0.31 [ml/kg]). The results also indicated that PWA-derived indices exhibited notable discrepancies from UOP in determining adequate burn resuscitation. Hence, it was concluded that the PWA-derived indices may have complementary value to UOP in assessing and guiding burn resuscitation.
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Affiliation(s)
- Ghazal ArabiDarrehDor
- Department of Mechanical Engineering, University of Maryland, College Park, MD 20742, USA
| | - Yi-Ming Kao
- Department of Mechanical Engineering, University of Maryland, College Park, MD 20742, USA
| | - Mary A Oliver
- Firefighters' Burn and Surgical Research Laboratory, MedStar Health Research Institute
| | - Babita Parajuli
- Department of Medicine, Uniformed Services University, Bethesda, MD, 20814, USA
| | - Bonnie C Carney
- Firefighters' Burn and Surgical Research Laboratory, MedStar Health Research Institute
| | - John W Keyloun
- Firefighters' Burn and Surgical Research Laboratory, MedStar Health Research Institute.,The Burn Center, MedStar Washington Hospital Center; Washington, DC 20007, USA
| | - Lauren T Moffatt
- Firefighters' Burn and Surgical Research Laboratory, MedStar Health Research Institute
| | - Jeffrey W Shupp
- Firefighters' Burn and Surgical Research Laboratory, MedStar Health Research Institute.,The Burn Center, MedStar Washington Hospital Center; Washington, DC 20007, USA
| | - Jin-Oh Hahn
- Department of Mechanical Engineering, University of Maryland, College Park, MD 20742, USA
| | - David M Burmeister
- Department of Medicine, Uniformed Services University, Bethesda, MD, 20814, USA
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42
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Espersen R, Rejnmark L. The acute effects of milk intake on calcium homeostasis and cardiovascular outcome: A randomized crossover trial in postmenopausal women. Clin Endocrinol (Oxf) 2022; 96:812-818. [PMID: 34755389 PMCID: PMC9299707 DOI: 10.1111/cen.14632] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Revised: 10/18/2021] [Accepted: 10/25/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The importance of calcium intake from dairy in regard to cardiovascular health has been investigated in several studies with discrepant results. Hence, we aim to investigate the immediate effects of milk intake on cardiovascular function. DESIGN A randomized crossover study with at least 10 days for washout between the two interventions, 500 ml of water with 200 µg of cholecalciferol or 500 ml of semi-skimmed milk containing approximately 600 mg of calcium with 200 µg of cholecalciferol. PATIENTS Twenty community-based postmenopausal women aged 60-80 years. MEASUREMENTS Parathyroid hormone and ionized calcium were measured at baseline and after 2 and 4 h on each study day. Pulse wave analysis and velocity were measured at baseline and after 4 h on each study day. RESULTS Compared to water, milk intake increased ionized calcium levels by 0.02 mmol/L (p = .029) and decreased parathyroid hormone levels by 1.78 pmol/L (p < .001). The two interventions caused no changes as measured 4 h after the intervention in the following indices of cardiovascular health; pulse wave velocity, brachial diastolic or systolic blood pressure, central diastolic or systolic blood pressure, mean arterial pressure, pulse pressure, augmentation pressure, augmentation index, heart rate or pulse transit time. CONCLUSIONS Despite significant changes in calcium homeostasis with increased levels of ionized calcium following milk intake, no acute effects seem to occur on measures of cardiovascular health.
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Affiliation(s)
- Rasmus Espersen
- Department of Endocrinology and Internal MedicineAarhus University HospitalAarhusDenmark
- Department of Clinical MedicineAarhus UniversityAarhusDenmark
| | - Lars Rejnmark
- Department of Endocrinology and Internal MedicineAarhus University HospitalAarhusDenmark
- Department of Clinical MedicineAarhus UniversityAarhusDenmark
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43
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Yildirim CS, Kosger P, Akin T, Ucar B. Evaluation of arterial stiffness and central blood pressure by oscillometric method in normotensive offspring of hypertensive parents. Cardiol Young 2022; 32:888-95. [PMID: 34387175 DOI: 10.1017/S1047951121003206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Children with a family history of hypertension have higher blood pressure and hypertensive pathophysiological changes begin before clinical findings. Here, the presence of arterial stiffness was investigated using central blood pressure measurement and pulse wave analysis in normotensive children with at least one parent with essential hypertension. Twenty-four-hour ambulatory pulse wave analysis monitoring was performed by oscillometric method in a study group of 112 normotensive children of hypertensive parents aged between 7 and 18 comparing with a control group of 101 age- and gender-matched normotensive children of normotensive parents. Pulse wave velocity, central systolic and diastolic blood pressure, systolic, diastolic and mean arterial blood pressure values were higher in the study group than the control group (p < 0.001, p = 0.002, p = 0.008, p = 0.001, p = 0.005, p = 0.001, p = 0.001, respectively). In all age groups (7-10, 11-14, and 15-18 years), pulse wave velocity was higher in the study group than the control group (p < 0.001). Pulse wave velocity was higher in children whose both parents are hypertensive compared to the children whose only mothers are hypertensive (p = 0.011). Pulse wave velocity values were positively correlated with age, weight, height, and body mass index (p < 0.05). Higher pulse wave velocity, central systolic and diastolic blood pressure values detected in the study group can be considered as early signs of hypertensive vascular changes. Pulse wave analysis can be a reliable, non-invasive, and reproducible method that can allow taking necessary precautions regarding lifestyle to prevent disease and target organ damage by detecting early hypertensive changes in genetically risky children.
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44
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Lundwall K, Jekell A, Desta L, Jacobson SH, Kahan T, Spaak J. Aortic stiffness and aortic-brachial stiffness mismatch as markers of renal dysfunction in hypertension. Blood Press 2022; 31:91-99. [PMID: 35546095 DOI: 10.1080/08037051.2022.2064266] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
PURPOSE The dismal combination of hypertension and chronic kidney disease potentiates both cardiovascular disease and loss of renal function. Research points to the importance of arterial and left ventricular stiffening in this process but few studies have compared aspects of central and peripheral hemodynamics in relation to renal function in hypertension. MATERIALS AND METHODS We investigated 107 hypertensive individuals with renal function ranging from normal to severe dysfunction with pulse wave analysis to obtain central blood pressures (BP), augmentation index, carotid-femoral and carotid-radial pulse wave velocity (cfPWV, crPWV), aortic-to-brachial stiffness mismatch (cfPWV/crPWV), endothelial function by forearm flow-mediated vasodilation and myocardial microvascular function by subendocardial viability ratio, and indices of left ventricular structure (left ventricular mass index and relative wall thickness, RWT) and diastolic function (left atrial volume index, E/A, and E/é). RESULTS Mean age was 58 years, BP 149/87 mm Hg, 9% had cardiovascular disease, and 31% were on antihypertensive treatment. Mean estimated glomerular filtration rate (eGFR) was 74 (range 130-21) ml/min × 1.73 m2. Whereas cfPWV and cfPWV/crPWV were independently related to eGFR (r = -0.20, p = 0.002, r = -0.16, p = 0.01), central diastolic BP (r = 0.21, p = 0.04), RWT (r = -0.34, p = 0.001), E/é (r = -0.39, p < 0.001) and E/A (r = 0.27, p = 0.01) were related to eGFR in bivariate correlations, but these findings were not retained in multivariate analyses. Remaining markers of hypertensive heart disease and measures of microvascular function were not related to eGFR. CONCLUSION Increased aortic stiffness and aortic-to-brachial stiffness mismatch are independently related to reduced eGFR in hypertensive patients, suggesting an important role for aortic stiffness in the evolution of hypertension-mediated renal dysfunction. Aortic stiffness and aortic-brachial stiffness mismatch may be useful early markers to find hypertensive patients at risk for decline in renal function.
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Affiliation(s)
- Kristina Lundwall
- Division of Cardiovascular Medicine, Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Andreas Jekell
- Division of Cardiovascular Medicine, Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Liyew Desta
- Heart and Vascular Theme, Karolinska University Hospital, Stockholm, Sweden
| | - Stefan H Jacobson
- Division of Nephrology, Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Thomas Kahan
- Division of Cardiovascular Medicine, Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Jonas Spaak
- Division of Cardiovascular Medicine, Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden
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45
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Charlton PH, Pilt K, Kyriacou PA. Establishing best practices in photoplethysmography signal acquisition and processing. Physiol Meas 2022; 43. [PMID: 35508148 PMCID: PMC9136485 DOI: 10.1088/1361-6579/ac6cc4] [Citation(s) in RCA: 1] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Accepted: 05/04/2022] [Indexed: 11/19/2022]
Abstract
Photoplethysmography is now widely utilised by clinical devices such as pulse oximeters, and wearable devices such as smartwatches. It holds great promise for health monitoring in daily life. This editorial considers whether it would be possible and beneficial to establish best practices for photoplethysmography signal acquisition and processing. It reports progress made towards this, balanced with the challenges of working with a diverse range of photoplethysmography device designs and intended applications, each of which could benefit from different approaches to signal acquisition and processing. It concludes that there are several potential benefits to establishing best practices. However, it is not yet clear whether it is possible to establish best practices which hold across the range of photoplethysmography device designs and applications.
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Affiliation(s)
- Peter H Charlton
- Department of Public Health and Primary Care, Cambridge University, Strangeways Research Laboratory, 2 Worts' Causeway, Cambridge, CB1 8RN, UNITED KINGDOM OF GREAT BRITAIN AND NORTHERN IRELAND
| | - Kristjan Pilt
- Department of Health Technologies, Tallinn University of Technology, Ehitajate tee 5, Tallinn, Harjumaa, 19086, ESTONIA
| | - Panayiotis A Kyriacou
- School of Mathematics Computer Science and Engineering, City University of London, Northampton Square, London, EC1V 0HB, UNITED KINGDOM OF GREAT BRITAIN AND NORTHERN IRELAND
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Abstract
Arterial stiffness (AS) is one of the earliest detectable signs of structural and functional alterations of the vessel wall and an independent predictor of cardiovascular events and death. The emerging field of metabolomics can be utilized to detect a wide spectrum of intermediates and products of metabolism in body fluids that can be involved in the pathogenesis of AS. Research over the past decade has reinforced this idea by linking AS to circulating acylcarnitines, glycerophospholipids, sphingolipids, and amino acids, among other metabolite species. Some of these metabolites influence AS through traditional cardiovascular risk factors (e.g., high blood pressure, high blood cholesterol, diabetes, smoking), while others seem to act independently through both known and unknown pathophysiological mechanisms. We propose the term 'arteriometabolomics' to indicate the research that applies metabolomics methods to study AS. The 'arteriometabolomics' approach has the potential to allow more personalized cardiovascular risk stratification, disease monitoring, and treatment selection. One of its major goals is to uncover the causal metabolic pathways of AS. Such pathways could represent valuable treatment targets in vascular ageing.
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Affiliation(s)
- Kaido Paapstel
- Endothelial Research Centre, University of Tartu, 8 Puusepa Street, 51014 Tartu, Estonia;
- Department of Cardiology, Institute of Clinical Medicine, University of Tartu, 8 Puusepa Street, 51014 Tartu, Estonia
- Heart Clinic, Tartu University Hospital, 8 Puusepa Street, 51014 Tartu, Estonia
| | - Jaak Kals
- Endothelial Research Centre, University of Tartu, 8 Puusepa Street, 51014 Tartu, Estonia;
- Department of Surgery, Institute of Clinical Medicine, University of Tartu, 8 Puusepa Street, 51014 Tartu, Estonia
- Surgery Clinic, Tartu University Hospital, 8 Puusepa Street, 51014 Tartu, Estonia
- Department of Biochemistry, Institute of Biomedicine and Translational Medicine, Centre of Excellence for Genomics and Translational Medicine, University of Tartu, 19 Ravila Street, 50411 Tartu, Estonia
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47
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Foti L, Michard F, Villa G, Ricci Z, Romagnoli S. The impact of arterial pressure waveform underdamping and resonance filters on cardiac output measurements with pulse wave analysis. Br J Anaesth 2022; 129:e6-e8. [PMID: 35459533 DOI: 10.1016/j.bja.2022.03.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Revised: 03/13/2022] [Accepted: 03/22/2022] [Indexed: 11/02/2022] Open
Affiliation(s)
- Lorenzo Foti
- Department of Health Science, Section of Anaesthesia and Intensive Care, University of Florence, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | | | - Gianluca Villa
- Department of Health Science, Section of Anaesthesia and Intensive Care, University of Florence, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Zaccaria Ricci
- Department of Health Science, Section of Anaesthesia and Intensive Care, University of Florence, Azienda Ospedaliero-Universitaria Meyer, Florence, Italy
| | - Stefano Romagnoli
- Department of Health Science, Section of Anaesthesia and Intensive Care, University of Florence, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
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48
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Salvi P, Valbusa F, Kearney-Schwartz A, Labat C, Grillo A, Parati G, Benetos A. Non-Invasive Assessment of Arterial Stiffness: Pulse Wave Velocity, Pulse Wave Analysis and Carotid Cross-Sectional Distensibility: Comparison between Methods. J Clin Med 2022; 11. [PMID: 35456316 DOI: 10.3390/jcm11082225] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [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: 03/22/2022] [Revised: 04/08/2022] [Accepted: 04/13/2022] [Indexed: 12/04/2022] Open
Abstract
Background: The stiffening of large elastic arteries is currently estimated in research and clinical practice by propagative and non-propagative models, as well as parameters derived from aortic pulse waveform analysis. Methods: Common carotid compliance and distensibility were measured by simultaneously recording the diameter and pressure changes during the cardiac cycle. The aortic and upper arm arterial distensibility was estimated by measuring carotid−femoral and carotid−radial pulse wave velocity (PWV), respectively. The augmentation index and blood pressure amplification were derived from the analysis of central pulse waveforms, recorded by applanation tonometry directly from the common carotid artery. Results: 75 volunteers were enrolled in this study (50 females, average age 53.5 years). A significant inverse correlation was found between carotid distensibility and carotid−femoral PWV (r = −0.75; p < 0.001), augmentation index (r = −0.63; p < 0.001) and central pulse pressure (r = −0.59; p < 0.001). A strong correlation was found also between the total slope of the diameter/pressure rate carotid curves and aortic distensibility, quantified from the inverse of the square of carotid−femoral PWV (r = 0.67). No correlation was found between carotid distensibility and carotid−radial PWV. Conclusions: This study showed a close correlation between carotid−femoral PWV, evaluating aortic stiffness by using the propagative method, and local carotid cross-sectional distensibility.
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49
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Heimark S, Rindal OMH, Seeberg TM, Stepanov A, Boysen ES, Bøtker-Rasmussen KG, Mobæk NK, Søraas CL, Stenehjem AE, Fadl Elmula FEM, Waldum-Grevbo B. Blood pressure altering method affects correlation with pulse arrival time. Blood Press Monit 2022; 27:139-146. [PMID: 34855653 PMCID: PMC8893131 DOI: 10.1097/mbp.0000000000000577] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Accepted: 11/07/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Pulse arrival time (PAT) is a potential main feature in cuff-less blood pressure (BP) monitoring. However, the precise relationship between BP parameters and PAT under varying conditions lacks a complete understanding. We hypothesize that simple test protocols fail to demonstrate the complex relationship between PAT and both SBP and DBP. Therefore, this study aimed to investigate the correlation between PAT and BP during two exercise modalities with differing BP responses using an unobtrusive wearable device. METHODS Seventy-five subjects, of which 43.7% had a prior diagnosis of hypertension, participated in an isometric and dynamic exercise test also including seated periods of rest prior to, in between and after. PAT was measured using a prototype wearable chest belt with a one-channel electrocardiogram and a photo-plethysmography sensor. Reference BP was measured auscultatory. RESULTS Mean individual correlation between PAT and SBP was -0.82 ± 0.14 in the full protocol, -0.79 ± 0.27 during isometric exercise and -0.77 ± 0.19 during dynamic exercise. Corresponding correlation between PAT and DBP was 0.25 ± 0.35, -0.74 ± 0.23 and 0.39 ± 0.41. CONCLUSION The results confirm PAT as a potential main feature to track changes in SBP. The relationship between DBP and PAT varied between exercise modalities, with the sign of the correlation changing from negative to positive between type of exercise modality. Thus, we hypothesize that simple test protocols fail to demonstrate the complex relationship between PAT and BP with emphasis on DBP.
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Affiliation(s)
- Sondre Heimark
- Department of Nephrology, Oslo University Hospital
- Section for Cardiovascular and Renal Research, Oslo University Hospital
- Institute of Clinical Medicine, University of Oslo
| | | | | | | | | | | | | | - Camilla L. Søraas
- Section for Cardiovascular and Renal Research, Oslo University Hospital
- Section for Environmental and Occupational Medicine, Oslo University Hospital
| | | | - Fadl Elmula M. Fadl Elmula
- Section for Cardiovascular and Renal Research, Oslo University Hospital
- Department of Acute Medicine, Oslo University Hospital, Oslo, Norway
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50
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Zamora-Pasadas M, Marfil-Álvarez R, González-Bustos P, Magán-Fernández A, Mesa F. Periodontitis is associated with higher subclinical atherosclerosis in patients with systemic lupus erythematosus. J Periodontal Res 2022; 57:479-486. [PMID: 35293616 PMCID: PMC9311157 DOI: 10.1111/jre.12977] [Citation(s) in RCA: 1] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Revised: 01/07/2022] [Accepted: 01/26/2022] [Indexed: 12/11/2022]
Abstract
AIM To determine periodontitis prevalence in patients with systemic lupus erythematosus (SLE) and to assess whether periodontitis in SLE patients is associated with a greater subclinical atherosclerosis. METHODS An observational case-control study was conducted in SLE (cases) and patients without any rheumatic diseases (controls), matched for sex. Sociodemographic and cardiometabolic variables were gathered, and SLE activity was assessed through several indexes. Periodontal examination registered probing pocket depth, clinical attachment level, bleeding on probing, plaque index, and tooth loss. Subclinical atherosclerosis was assessed by measuring the carotid-femoral pulse wave velocity (PWV) by Doppler velocimetry, homocysteine levels, C-reactive protein (CRP), and erythrocyte sedimentation rate (ESR). Bivariate analyses and logistic regression were used to assess the association of any of the studied variables with SLE. RESULTS Seventy-one cases and 72 controls were included in the study. Thirty-nine SLE patients (54.9%) were diagnosed with periodontitis, compared with 16 controls (22.2%). High levels of PWV (≥7.7 m/s, 75th percentile) were shown by 44.3% of the cases vs. 22.4% of the controls (p = .011). Among SLE patients, those with periodontitis showed higher PWV values (8.1 ± 1.52 vs. 7.16 ± 1.11 m/s, p = .006) and higher homeostasis model assessment index (indicative of insulin resistance) (1.7 ± 0.73 vs. 2.92 ± 3.05, p = .028) compared to those with periodontal health. Logistic regression showed that waist circumference (OR 1.06, 95% CI 1.01-1.12, p = .015); ESR (OR 1.09, 95% CI 1.03-1.16, p = .003); and bleeding on probing (OR 1.1, 95% CI 1.01-1.19, p = .018) were associated with the risk of SLE. CONCLUSION Systemic lupus erythematosus patients showed a higher periodontitis percentage than controls. Higher PWV values were found in SLE patients with periodontitis, indicating a higher prevalence of subclinical atherosclerosis. Patients with higher gingival bleeding showed a higher risk of SLE.
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Affiliation(s)
- Mónica Zamora-Pasadas
- Systemic Autoimmune Diseases Unit, Department of Internal Medicine, University Hospital Virgen de las Nieves, Granada, Spain
| | - Rafael Marfil-Álvarez
- Periodontology Department, School of Dentistry, University of Granada, Granada, Spain
| | - Pablo González-Bustos
- Systemic Autoimmune Diseases Unit, Department of Internal Medicine, University Hospital Virgen de las Nieves, Granada, Spain
| | | | - Francisco Mesa
- Periodontology Department, School of Dentistry, University of Granada, Granada, Spain
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