Interstitial flow, pressure and residual stress in the aging carotid artery model in FEBio

Vascular smooth muscle cells (VSMCs) are subject to interstitial flow-induced shear stress, which is a critical parameter in cardiovascular disease progression. Transmural pressure loading and residual stresses alter the hydraulic conductivity of the arterial layers and modulate the interstitial fluid flux through the arterial wall. In this paper, a biphasic multilayer model of a common carotid artery (CCA) with anisotropic fiber-reinforced soft tissue and strain-dependent permeability is developed in FEBio software. After the verification of the numerical predictions, age-related arterial thickening and stiffening effects on arterial deformation and interstitial flow are computed under physiological geometry and physical parameters. We found that circumferential residual stress shifts outward in each layer and its gradient increases up to 6 times with aging. Internally pressurized CCA displays nonlinear deformation. In the aged artery, the circumferential stress becomes greater on the media layer (82-158 kPa) and lower on the intima and adventitia (19-23 kPa and 25-28 kPa, respectively). The radial compression of the intima reduces the total hydraulic conductivity by 48% in the young and 16% in the aged arterial walls. Consequently, the average radial interstitial flux increases with pressure by 14% in the young and 91% in the aged arteries. Accordingly, the flow shear stress experienced by the VSMCs becomes more significant for aged arteries, which may accelerate cardiovascular disease progression compared to young arteries.

Multiphoton microscopy observations of 3D elastin and collagen fiber microstructure changes during pressurization in aortic media

Elastin and collagen fibers play important roles in the mechanical properties of aortic media. Because knowledge of local fiber structures is required for detailed analysis of blood vessel wall mechanics, we investigated 3D microstructures of elastin and collagen fibers in thoracic aortas and monitored changes during pressurization. Using multiphoton microscopy, autofluorescence images from elastin and second harmonic generation signals from collagen were acquired in media from rabbit thoracic aortas that were stretched biaxially to restore physiological dimensions. Both elastin and collagen fibers were observed in all longitudinal-circumferential plane images, whereas alternate bright and dark layers were observed along the radial direction and were recognized as elastic laminas (ELs) and smooth muscle-rich layers (SMLs), respectively. Elastin and collagen fibers are mainly oriented in the circumferential direction, and waviness of collagen fibers was significantly higher than that of elastin fibers. Collagen fibers were more undulated in longitudinal than in radial direction, whereas undulation of elastin fibers was equibiaxial. Changes in waviness of collagen fibers during pressurization were then evaluated using 2-dimensional fast Fourier transform in mouse aortas, and indices of waviness of collagen fibers decreased with increases in intraluminal pressure. These indices also showed that collagen fibers in SMLs became straight at lower intraluminal pressures than those in EL, indicating that SMLs stretched more than ELs. These results indicate that deformation of the aorta due to pressurization is complicated because of the heterogeneity of tissue layers and differences in elastic properties of ELs, SMLs, and surrounding collagen and elastin.

[Stiffness of the arterial wall and predicted vascular age as a predictor of cardiovascular disease when stress-induced hypertension in the military personnel]

Stiffness of the arterial wall and predicted vascular age as a predictor of cardiovascular disease when stress-induced hypertension in the military personnel. On the basis of the study of 156 men aged 30-55 years are considered diagnostic methods for stress-induced hypertension in the military personnel. Furthermore, using modern diagnostic methods determined stress effect on the development of stress-induced hypertension, and also the risk of cardiovascular diseases. In order to detect early signs of atherosclerosis used sphygmography, by means of which was determined by cardio ankle vascular index (CA VI), as well as the calculated vascular age. The study proposed a set of organizational, diagnostic and therapeutic measures to reduce the risk of cardiovascular diseases among military personnel exposed to occupational stressful load.

Relation of arterial stiffness and axial motion of the carotid artery wall - a pilot study to test our motion tracking algorithm in practice

Recently researchers have shown growing interest in axial motion of common carotid artery wall. The amplitude of the axial motion of the wall has been initially linked to arterial stiffness and the direction of the axial stretch has been noted to vary, although not highlighted in the studies. In this study, an enhanced block matching algorithm, developed in our earlier study, was used to measure 2D-motion of the human carotid artery wall. A total of 19 healthy subjects were imaged and divided into two groups based on whether their axial motion of intima-media in left common carotid artery was primarily oriented along or against the direction of the blood flow. Statistically significant differences in two independent indices of arterial stiffness, as well as in the size of the artery, were found between the groups, suggesting that retrograde motion of intima-media is associated with smaller carotid arteries and is a possible sign of arterial stiffness.

A nonlinear finite element simulation of balloon expandable stent for assessment of plaque vulnerability inside a stenotic artery

The stresses induced on plaque wall during stent implantation inside a stenotic artery are associated with plaque rupture. The stresses in the plaque-artery-stent structure appear to be distinctly different for different plaque types in terms of both distribution and magnitude. In this study, a nonlinear finite element simulation was executed to analyze the influence of plaque composition (calcified, cellular, and hypocellular) on plaque, artery layers (intima, media, and adventitia), and stent stresses during implantation of a balloon expandable coronary stent into a stenosed artery. The atherosclerotic artery was assumed to consist of a plaque and normal arterial tissues on its outer side. The results revealed a significant influence of plaque types on the maximum stresses induced within plaque wall and artery layers during stenting, but not when calculating maximum stress on stent. The stress on stiffer calcified plaque wall was in the fracture level (2.21 MPa), whereas cellular and hypocellular plaques play a protective role by displaying less stress on their wall. The highest von Mises stresses were observed on less stiff media layer. The findings of this study suggest a lower risk of arterial vascular injury for calcified plaque, while higher risk of plaque ruptures for cellular and hypocellular plaques.

Automatic measurements of diameter, distension and intima media thickness of the aorta in premature rabbit pups using B-mode images

To improve cardiovascular research, there is a growing need for arterial characterization in small animals. We developed a method, ARTIC (arterial characterization) for measuring lumen diameter, distension and intima media thickness (IMT). In this study ARTIC was used to automatically characterize the aorta of premature rabbit pups. Automatic measurements were compared with manual measurements, both performed by three observers. Diameter was 769 ± 140 μm (manual) and 766 ± 142 μm (automatic), distension was 35 ± 15 μm (manual) and 40 ± 12 μm (automatic) and IMT was 84 ± 11 μm (manual) and 88 ± 8 μm (automatic) (mean ± standard deviation). The variation in the measured diameter, distension and IMT ranged from 1.1% to 26.0% (manual) and from 1.0% to 9.0% (automatic). The intra-class correlation coefficient ranged from 33.0% to 99.3% (manual) and from 76.9% to 99.6% (automatic). The evaluation revealed that it is feasible to use ARTIC on B-mode images of arteries with small dimensions, which makes it a useful tool for arterial characterization in small animals.

Arterial stiffness identification of the human carotid artery using the stress-strain relationship in vivo

Arterial stiffness is well accepted as a reliable indicator of arterial disease. Increase in carotid arterial stiffness has been associated with carotid arterial disease, e.g., atherosclerotic plaque, thrombosis, stenosis, etc. Several methods for carotid arterial stiffness assessment have been proposed. In this study, in vivo noninvasive assessment using applanation tonometry and an ultrasound-based motion estimation technique was applied in seven healthy volunteers (age 28±3.6years old) to determine pressure and wall displacement in the left common carotid artery (CCA), respectively. The carotid pressure was obtained using a calibration method by assuming that the mean and diastolic blood pressures remained constant throughout the arterial tree. The regional carotid arterial wall displacement was estimated using a 1D cross-correlation technique on the ultrasound radio frequency (RF) signals acquired at a frame rate of 505-1010Hz. Young's moduli were estimated under two different assumptions: (i) a linear elastic two-parallel spring model and (ii) a two-dimensional, nonlinear, hyperelastic model. The circumferential stress (σ(θ)) and strain (ɛ(θ)) relationship was then established in humans in vivo. A slope change in the circumferential stress-strain curve was observed and defined as the transition point. The Young's moduli of the elastic lamellae (E(1)), elastin-collagen fibers (E(2)) and collagen fibers (E(3)) and the incremental Young's moduli before ( [Formula: see text] ) and after the transition point ( [Formula: see text] ) were determined from the first and second approach, respectively, to describe the contribution of the complex mechanical interaction of the different arterial wall constituents. The average moduli E(1), E(2) and E(3) from seven healthy volunteers were found to be equal to 0.15±0.04, 0.89±0.27 and 0.75±0.29MPa, respectively. The average moduli [Formula: see text] and [Formula: see text] of the intact wall (both the tunica adventitia and tunica media layers) were found to be equal to 0.16±0.04MPa and 0.90±0.25MPa, respectively. The average moduli [Formula: see text] and [Formula: see text] of the tunica adventitia were found to be equal to 0.18±0.05MPa and 0.84±0.22MPa, respectively. The average moduli [Formula: see text] and [Formula: see text] of the tunica media were found to be equal to 0.19±0.05MPa and 0.90±0.25MPa, respectively. The stiffness of the carotid artery increased with strain during the systolic phase. In conclusion, the feasibility of measuring the regional stress-strain relationship and stiffness of the normal human carotid artery was demonstrated noninvasively in vivo.

Assessment of carotid stiffness and intima-media thickness from ultrasound data: comparison between two methods

OBJECTIVE

Increased arterial stiffness and carotid intima-media thickness (IMT) are considered independent predictors of cardiovascular events. The aim of this study was to compare a system recently developed in our laboratory for automatic assessment of these parameters from ultrasound image sequences to a reference radio frequency (RF) echo-tracking system.

METHODS

Common carotid artery scans of 21 patients with cardiovascular risk factors and 12 healthy volunteers were analyzed by both devices for the assessment of diameter (D), IMT, and distension (DeltaD). In the healthy volunteers, analyses were repeated twice to evaluate intraobserver variability. Agreement was evaluated by Bland-Altman analysis, whereas reproducibility was expressed as a coefficient of variation (CV).

RESULTS

Regarding the agreement between the two systems, bias values +/- SD were 0.060 +/- 0.110 mm for D, -0.006 +/- 0.039 mm for IMT, and -0.016 +/- 0.039 mm for DeltaD. Intraobserver CVs were 2% +/- 2% for D, 5% +/- 5% for IMT, and 6% +/- 6% for DeltaD with the RF echo-tracking system and 2% +/- 1% for D, 6% +/- 6% for IMT, and 8% +/- 6% for DeltaD with our automated system.

CONCLUSIONS

Although B-mode-based devices are less precise than RF-based ones, our automated system has good agreement with the reference method and comparable reproducibility, at least when high-quality images are analyzed. Hence, this study suggests that the presented system based on image processing from standard ultrasound scans is a suitable device for measuring IMT and local arterial stiffness parameters in clinical studies.

Neutrophil granulocyte-dependent proteolysis enhances platelet adhesion to the arterial wall under high-shear flow

SUMMARY BACKGROUND

Under high shear stress platelets adhere preferentially to the adventitia layer of the arterial vessel wall in a von Willebrand factor (VWF)-dependent manner.

OBJECTIVE

The present study was undertaken in an attempt to characterize the structural background of the relative thromboresistance of the media and the impact of neutrophil leukocyte-derived proteases (matrix metalloproteinases, neutrophil elastase) on platelet adhesion in this layer of the arteries.

METHODS AND RESULTS

Platelet adhesion to cross-sections of the human iliac artery was monitored by indirect immunofluorescent detection of GpIIb/IIIa antigen. Exposure of the vessel wall to activated neutrophils or neutrophil-derived proteases increased platelet adhesion to the media about tenfold over the control level at 3350 s(-1) surface shear rate. In parallel with this enhanced thrombogenicity morphological changes in the media were evidenced by atomic force microscopy (AFM) and scanning electron microscopy (SEM). The fine proteoglycan meshwork seen with Cupromeronic Blue enhancement of the SEM images was removed by the proteolytic treatment and the typical collagen fiber structure was exposed on the AFM images of the media.

CONCLUSION

Through their proteases activated neutrophils degrade proteoglycans, unmask VWF binding sites and thus abolish the thromboresistance of the media in human arteries.

Vascular abnormalities, paraoxonase activity, and dysfunctional HDL in primary antiphospholipid syndrome

CONTEXT

Accelerated atherosclerosis has been described in antiphospholipid syndrome, but the vascular abnormalities and the underlying mechanisms remain unclear.

OBJECTIVES

To compare vascular structure and function in patients with positive antiphospholipid antibodies (aPL) with controls and to assess their relationship with paraoxonase activity.

DESIGN, SETTING, AND PARTICIPANTS

A cross-sectional study of 77 women with positive antiphospholipid antibodies from a lupus outpatient clinic in London, England (90% of the eligible population) and 77 controls matched on frequency basis for age and cardiovascular risk factors between June 2006 and April 2009. Carotid intima media thickness (CIMT), flow-mediated dilatation, pulse wave velocity, and paraoxonase activity were measured in all patients. Anti-inflammatory and antioxidant properties of high-density lipoprotein (HDL) were examined.

MAIN OUTCOME MEASURES

CIMT, pulse wave velocity, flow-mediated dilatation, and paraoxonase.

RESULTS

Women with aPL had greater CIMT and pulse wave velocity compared with controls (mean [SD], 0.75 [0.16] vs 0.64 [0.09] mm; 95% confidence interval [CI], -0.14 to -0.06; P < .001; and 9.2 [1.6] vs 8.5 [1.8] m/s; 95% CI, -1.14 to -0.06; P = .04) and lower flow-mediated dilatation (6.2% [4.1%] vs 9.6% [4.2%]; 95% CI, 2.02%-4.69%; P < .001). Paraoxonase activity was lower in women with aPL vs controls (median [interquartile range], 91.2 [64.3-105.1] vs 103.0 [80.5-111.5] micromol p-nitrophenol/L/serum/min; 95% CI, 0.004-0.007; P = .005) and was inversely associated with CIMT and pulse wave velocity in women with aPL (standardized beta coefficient = -0.4 and -0.3, respectively; P < .05 for both), but not in the control group. High-density lipoprotein from women with aPL inhibited endothelial nitric oxide production in human aortic endothelial cells, in contrast with controls. The beneficial effects of HDL from women with aPL on vascular cell adhesion molecule 1 expression, superoxide production, and monocyte adhesion following activation of human aortic endothelial cells were largely blunted.

CONCLUSIONS

Compared with controls, women with aPL had greater functional and structural arterial abnormalities, which were associated with lower activity of paraoxonase. In patients with aPL, HDL reduced nitric oxide bioavailability and had impaired anti-inflammatory and antioxidant properties.

Circulating endothelial progenitor cells, endothelial function, carotid intima-media thickness and circulating markers of endothelial dysfunction in people with type 1 diabetes without macrovascular disease or microalbuminuria

AIMS/HYPOTHESIS

Type 1 diabetes is associated with premature arterial disease. Bone-marrow derived, circulating endothelial progenitor cells (EPCs) are believed to contribute to endothelial repair. The hypothesis tested was that circulating EPCs are reduced in young people with type 1 diabetes without vascular injury and that this is associated with impaired endothelial function and increased carotid intima-media thickness (CIMT).

METHODS

We compared 74 people with type 1 diabetes with 80 healthy controls. CD34, CD133, vascular endothelial (VE) growth factor receptor-2 (VEGFR-2) and VE-cadherin antibodies were used to quantify EPCs and progenitor cell subtypes using flow-cytometry. Ultrasound assessment of endothelial function by brachial artery flow-mediated dilatation (FMD) and CIMT was made. Circulating endothelial markers, inflammatory markers and plasma plasminogen activator inhibitor-1 (PAI-1) levels were measured.

RESULTS

CD34+VE-cadherin+, CD133+VE-cadherin+ and CD133+VEGFR-2+ EPC counts were significantly lower in people with diabetes (46-69%; p = 0.004-0.043). In people with type 1 diabetes, FMD was reduced by 45% (p < 0.001) and CIMT increased by 25% (p < 0.001), these being correlated (r = -0.25, p = 0.033). There was a significant relationship between FMD and CD34+VE-cadherin+ (r = 0.39, p = 0.001), CD133+VEGFR-2+ (r = 0.25, p = 0.037) and CD34+ (r = 0.34, p = 0.003) counts. Circulating high-sensitivity C-reactive protein, PAI-1, interleukin-6 and E-selectin were significantly higher in the diabetes group (p < 0.001 to p = 0.049), the last two of these correlating with FMD (r = -0.27, p = 0.028 and r = -0.24, p = 0.048, respectively).

CONCLUSIONS/INTERPRETATION

These findings suggest that abnormalities of endothelial function in addition to pro-inflammatory and pro-thrombotic states are already common in people with type 1 diabetes before development of clinically evident arterial damage. Low EPC counts confirm risk of macrovascular complications and may account for impaired endothelial function and predict future cardiovascular events.

[Clinical implication of assessment of heart rate variability in patients with psoriatic arthritis]

AIM

To evaluate clinical significance of heart rate variability (HRV) in patients with psoriatic arthritis (PsA).

MATERIAL AND METHODS

HRV was investigated by means of time-domain analysis of 24 h ECG ambulatory recording in 113 PsA (70 female) patients < 55-years-old and 65 age-matched healthy subjects. We assessed the presence of standard cardiovascular risk factors, performed carotid and femoral ultrasound with measurement of intima-medial thickness (IMT) in PsA patients. Inflammatory markers (CRP, fibrinogen) were detected in all the patients.

RESULTS

Significantly lower values of HRV parameters adjusted by Mean NN (SDNNn%, SDNNIN%) were detected in PsA men and women when compared to the control group. There was a significant negative correlation between HRV and disease duration, PsA activity (DAS4, Ritchi index), swollen and tender joint counts, femoral IMT, CRP in PsA males (p < 0.05). SDNNin% was lower in PsA male smokers than in non-smokers (p = 0.03). There was a significant negative correlation between HRV and age, systolic blood pressure, dyslipidemia, body mass index, carotid IMT, CRP, fibrinogen in PsA women.

CONCLUSION

Reduced HRV reflects sympatho-vagal imbalance in PsA patients associated with the disease duration and activity, smoking, femoral IMT, markers of inflammation (CRP) in males; with standard cardiovascular risk factors, fibrinogen, CRP, carotid IMT in women, and may be identified as a risk factor for cardiovascular morbidity and mortality in further studies.

Intima-media thickness and carotid resistive index: progression over 6 years and predictive value for cardiovascular events

PURPOSE

Intima-media thickness (IMT) of the common carotid artery and the resistive index (RI) of the internal carotid artery correlate with the degree of atherosclerosis and are predictors of cardiovascular morbidity and mortality. Limited or no data are available about long-term predictive values and the progression of the two markers themselves.

MATERIALS AND METHODS

145 patients with at least one cardiovascular risk factor or clinically manifest atherosclerosis were included. At enrollment and after 36 and 74 months, duplex sonographic measurements of IMT CCA and RI ICA were performed. During follow-up, the occurrence of cardiovascular events (cardiovascular death, myocardial infarction, stroke) was assessed.

RESULTS

At baseline, IMT was 0.79 +/- 0.16 mm and RI 0.66 +/- 0.08. Log-rank analysis showed a continuous increase in the risk of a cardiovascular event with an increasing range of IMT (p = 0.011) and RI (p = 0.006). IMT progression in patients with low versus high atherosclerotic burden (as defined by SMART score < or =7 points and > 7 points) differs significantly (32 +/- 83 microm versus 95 +/- 125 microm; p < 0.002). IMT progression was even more pronounced in patients suffering a cardiovascular event (141 +/- 105 microm versus 54 +/- 111 microm; p < 0.001). No significant RI ICA progression could be detected during follow-up in any group (patients with low vs. high atherosclerotic burden 0.00 +/- 0.06 versus 0.00 +/- 0.04; p = n. s.; patients with vs. without cardiovascular event 0.00 +/- 0.05 versus 0.01 +/- 0.03; p = n. s.).

CONCLUSION

Our results confirm the predictive value for cardiovascular events of RI and IMT in long-term follow-up. In contrast to RI, IMT increases over six years, above all in patients suffering a cardiovascular event. The results suggest that IMT is suitable for cardiovascular risk prediction as well as for progression measurements, while RI cannot be recommended for progression measurements. The effect of drug therapy on RI needs further clarification.

Genetic modifier loci linked to intima formation induced by low flow in the mouse carotid

OBJECTIVE

Previously we found dramatic strain-dependent differences in a low flow model of vascular remodeling. Specifically, intima formation in the left common carotid artery was approximately 30-fold greater in SJL compared to C3HeB/Fe (C3H/F) mice. We hypothesized that a few genes control intima formation in response to low flow. A C3H/F and SJL backcross resulted in broad range of N2 intima phenotypes.

METHODS AND RESULTS

Using genome-wide scan we identified two highly significant quantitative trait loci (QTLs) for intima, Im1 (intima modifier 1 locus) on chromosome 2 (Chr2; 77.6 cM, LOD=6.4), and Im2 on Chr11 (17 cM, LOD=5.3). One significant QTL Im3 was found on Chr18 (6 cM, LOD=3.0), and two suggestive QTLs (LOD=1.5 and 1.8) were identified on Chr7 and Chr17, respectively. Interestingly, the intima/media ratio trait mapped to the same QTLs as the intima trait. Haplotype mapping predicted 40 candidate genes. Six of these genes contained SNPs that differed between C3H/F and SJL.

CONCLUSIONS

We have successfully mapped 3 QTLs (Im1, Im2, and Im3) that are associated with carotid intima formation in response to low blood flow. These results may be important in identifying genes that influence carotid intima-media thickening and predict cardiovascular disease in humans.

Automated edge detection versus manual edge measurement in analysis of brachial artery reactivity: a comparison study

High resolution ultrasound, combined with computer imaging technology, is commonly used to measure changes in brachial artery diameter for the determination of endothelial-dependent vasodilation (EDD) and endothelial independent-vasodilation (EID). Currently, two methods of computerized edge-detection systems are in use to measure changes in artery diameter. One system involves the sonographer manually tracking the artery walls while the second system involves a computer automated edge-detection system that automatically tracks the artery wall. The purpose of this study was to compare the two types of computerized edge-detection systems for measuring vascular function and structure. One hundred fifty (female = 70, male = 80) participants agreed to participate. Baseline brachial diameter, carotid intima-medial thickness (cIMT), EDD and EID were measured by the two computerized edge-detection systems utilizing the same ultrasound B-mode image. Mean values (+/-standard error) for baseline diameter, cIMT, EDD and EID were 3.53 (+/-0.10) mm, 0.43 (+/-0.01) mm, 5.72 (+/-0.20)% and 22.17 (+/-0.60)%, respectively for the manual edge-detection software system. Mean values for baseline diameter, cIMT, EDD and EID were 3.59 (+/-0.10) mm, 0.44 (+/-0.01) mm, 7.33 (+/-0.30)% and 25.77 (+/-0.60)%, respectively for the automated edge-detection software system. Bland-Altman plots displayed large variations between the two edge-detection methods for assessing cIMT and changes in artery diameter following brachial EDD and EID. The results of the study demonstrate that manual and automated computerized edge-detection systems track dynamic changes in brachial artery diameter and cIMT measures differently. Therefore, caution should be used when comparing research utilizing different computerized edge-detection systems for measuring vascular function and structure.

Brachial artery pulsatility index change 1 minute after 5-minute forearm compression: comparison with flow-mediated dilatation

OBJECTIVE

Endothelial impairment evaluation by sonographic measurement of flow-mediated dilatation (FMD) has become broadly used. However, this method has 2 main caveats: the dilatation depends on the baseline arterial diameter, and a high precision level is required. Vasodilatation leads to an amplified fall in impedance. We hypothesized that assessment of the pulsatility index change (PI-C) 1 minute after 5-minute forearm compression might evaluate that fall in impedance. The aim of this study was to compare the PI-C with FMD.

METHODS

Flow-mediated dilatation and the PI-C were assessed in 51 healthy women aged between 35.1 and 67.1 years. We correlated both FMD and the PI-C with age, body mass index, waist circumference, cholesterol level, high-density lipoprotein level, glucose level, systolic and diastolic blood pressure, pulse pressure, brachial artery diameter, simplified Framingham score, intima-media thickness, and carotid stiffness index. Intraclass correlation coefficients between 2 FMD and PI-C measurements were also examined.

RESULTS

Only FMD correlated with baseline brachial diameter (r = -0.53). The PI-C had a high correlation with age, body mass index, waist circumference, cholesterol level, systolic blood pressure, pulse pressure, simplified Framingham score, and intima-media thickness. The correlation between FMD and the PI-C was high (r = -0.66). The PI-C had a higher intraclass correlation coefficient (0.991) than FMD (0.836) but not brachial artery diameter (0.989).

CONCLUSIONS

The PI-C had a large correlation with various markers of cardiovascular risk. Additionally, PI-C measurement does not require offline analysis, extra software, or electrocardiography. We think that the PI-C could be considered a marker of endothelial function. However, more studies are required before further conclusions.

Association of Carotid Intima-Medial Thickness and Indices of Arterial Stiffness With Cardiovascular Disease Outcomes in CKD

BACKGROUND

Indices of arterial structure and stiffness are proposed as surrogate markers of cardiovascular disease in patients with chronic kidney disease (CKD), but no study examined multiple markers in the same population.

STUDY DESIGN

Prospective observational study.

SETTING & PARTICIPANTS

315 subjects with stages 4 to 5 CKD, aged 24 to 79 years (mean age, 56.6 +/- 13.6 [SD] years), enrolled in the Atherosclerosis and Folic Acid Supplementation Trial.

PREDICTORS

Carotid arterial intima-medial thickness (IMT; n = 315) and indices of arterial stiffness (n = 207), including aortofemoral pulse wave velocity (PWV[a-f]), systemic arterial compliance (SAC), and carotid-derived augmentation index.

OUTCOMES

The primary outcome was a composite of all fatal and nonfatal cardiovascular events.

RESULTS

During follow-up (median, 3.6 years), 95 cardiovascular events occurred. On Cox proportional-hazard modeling, mean maximum IMT, PWV(a-f), and SAC were predictive of the composite clinical end point of all cardiovascular events, but carotid-derived augmentation index was not (hazard ratio [HR] for every 0.01-mm increase in IMT, 1.09; P = 0.001; 95% confidence interval [CI], 1.03 to 1.14; HR for every 1-m/s increase in PWV(a-f), 1.18; P < 0.001; 95% CI, 1.12 to 1.25; HR for every 0.01-U/mm Hg decrease in SAC, 0.98; P = 0.01; 95% CI, 0.97 to 0.99). After adjustment for age, sex, blood pressure, diabetes, past cardiovascular disease, cholesterol level, and smoking, PWV(a-f) remained a significant independent predictor of cardiovascular events (adjusted HR, 1.12; P = 0.001; 95% CI, 1.05 to 1.20), but IMT and SAC did not.

LIMITATIONS

Study power to analyze differences between predialysis and dialysis stages of CKD.

CONCLUSIONS

PWV(a-f) is the only arterial index independently associated with cardiovascular outcome in patients with CKD.

Polyphenols modulate calcium-independent mechanisms in human arterial tissue-engineered vascular media

BACKGROUND

In the present study, an arterial tissue-engineered vascular media (TEVM) was produced from cultured human smooth muscle cells of the umbilical artery and we took advantage of this model to evaluate the regulation of contraction and the signalling pathways of polyphenols in arteries.

METHODS

Cultured human smooth muscle cells of the umbilical artery were used to produce arterial TEVMs. Contraction experiments were performed to determine intracellular targets involved in the modulation of contraction by polyphenols extract from red wine, Provinols (SEPPIC Groupe Air Liquide, Paris, France).

RESULTS

Smooth muscle cells in arterial TEVM displayed a differentiated phenotype as demonstrated by the expression of alpha-smooth muscle actin, a vascular smooth muscle-specific marker, and tissue contraction in response to vasoconstrictor and vasodilator agents. Contractions caused by histamine were associated with an increase in [Ca(2+)](i) and a Ca(2+)-independent signalling pathway. The latter pathway involved mechanisms sensitive to protein kinase C, myosin light chain kinase, and Rho-associated protein kinase inhibitors. The regulation of contraction induced by Provinols shows that treatment of arterial TEVM with this compound significantly decreased histamine-induced contraction. This effect was associated with the inhibition of the Rho-associated protein kinase pathway and the decrease in alpha-smooth muscle actin expression.

CONCLUSION

The use of arterial TEVM, brings new insights into the mechanisms by which polyphenols regulate vascular contraction in the human artery.

Sex hormones and aortic wall remodeling in an arteriovenous fistula

BACKGROUND

An arteriovenous fistula (AVF) creates high blood flow through the artery and fistula. With this high flow, there is flow-induced remodeling and an increase in diameter, but no intimal hyperplasia. Estrogen has been shown to modify vascular remodeling, decreasing intimal hyperplasia after endothelial injury.

OBJECTIVE

These experiments tested the hypothesis that estrogen administration would decrease wall thickness in an AVF model. Because estrogen may decrease wall thickness, we also tested the hypothesis that testosterone would increase wall thickness.

METHODS

A fistula was created between the abdominal aorta and the inferior vena cava in Sprague-Dawley rats to generate high blood flow conditions in the aorta. Four groups of female animals were examined: sham, control with AVF ovariectomized (OVX) with AVF and OVX plus testosterone with AVF Four groups of male animals were also examined: sham, control with AVF castrated with AVF and castrated plus estrogen with AVF Five weeks after creation of the AVF, the aortas were collected and fixed; wall thickness was measured both proximal and distal to the AVF.

RESULTS

Ovariectomy resulted in a significant decrease in estrogen levels (P < 0.01). Testosterone administration tended to increase testosterone levels in the OVX females, but values did not approach levels observed in the control males. No difference was noted in the proximal wall thickness between the control and the OVX animals. The OVX females receiving testosterone exhibited a significant increase in both proximal and distal wall thickness compared with control females (P < 0.001). In the male animals, there was no significant change in aortic wall thickness in the castrated rats compared with the controls. Estrogen administration in the castrated males resulted in a significant decrease in wall thickness in the proximal and distal aorta (P < 0.05).

CONCLUSION

These studies suggest that, in a model of vascular remodeling, estrogen administration decreases wall thickness, and testosterone administration increases wall thickness.

Increased diameter and enhanced myogenic response of saphenous vein induced by two-week experimental orthostasis are reversible

Previously, increased diameter and enhanced myogenic tone were seen after 2-week 45o head-up (HUT2) in the rat. We studied the reversibility and the effect of extended tilt on this phenomenon using two experimental groups: HUT2 plus 2-week horizontal (HUT2HOR2), and 4-week tilting (HUT4). 4-weeks in normal cages (NC4) served as control. Diameter of saphenous vein (SV) in 2-20 mm Hg pressure range, wall and media thickness, endothelial and smooth muscle cell densities, and cell proliferation were measured. The diameter of SV from HUT4 was significantly larger compared with HUT2HOR2 or NC4 within the whole pressure range both in Krebs-Ringer (870.4+/-21.3 vs. 778.2+/-24.9 and 771.6+/-28.1 microm at 10 mm Hg, respectively) and in Ca(2+)-free solution. Myogenic and norepinephrine-induced vascular tone, wall and media thickness did not differ among the three groups. Endothelial cell density decreased in HUT4 (10.7+/-1.2) vs. HUT2HOR2 (15.1+/-1.0) and NC4 (15.3+/-0.6), while that of smooth muscle was unchanged. No cell proliferation marker was seen. In conclusion, both increased diameter and enhanced myogenic tone of SV seen in HUT2 proved to be reversible. HUT4 resulted in increased SV diameter, similarly to HUT2, however, vascular tone was not amplified. This suggests that a prolonged orthostatic load may readjust the function of smooth muscle.

Multiphysics Simulation of Blood Flow and LDL Transport in a Porohyperelastic Arterial Wall Model

Atherosclerosis localizes at a bend and∕or bifurcation of an artery, and low density lipoproteins (LDL) accumulate in the intima. Hemodynamic factors are known to affect this localization and LDL accumulation, but the details of the process remain unknown. It is thought that the LDL concentration will be affected by the filtration flow, and that the velocity of this flow will be affected by deformation of the arterial wall. Thus, a coupled model of a blood flow and a deformable arterial wall with filtration flow would be invaluable for simulation of the flow field and concentration field in sequence. However, this type of highly coupled interaction analysis has not yet been attempted. Therefore, we performed a coupled analysis of an artery with multiple bends in sequence. First, based on the theory of porous media, we modeled a deformable arterial wall using a porohyperelastic model (PHEM) that was able to express both the filtration flow and the viscoelastic behavior of the living tissue, and simulated a blood flow field in the arterial lumen, a filtration flow field and a displacement field in the arterial wall using a fluid-structure interaction (FSI) program code by the finite element method (FEM). Next, based on the obtained results, we further simulated LDL transport using a mass transfer analysis code by the FEM. We analyzed the PHEM in comparison with a rigid model. For the blood flow, stagnation was observed downward of the bends. The direction of the filtration flow was only from the lumen to the wall for the rigid model, while filtration flows from both the wall to the lumen and the lumen to the wall were observed for the PHEM. The LDL concentration was high at the lumen∕wall interface for both the PHEM and rigid model, and reached its maximum value at the stagnation area. For the PHEM, the maximum LDL concentration in the wall in the radial direction was observed at the position of 3% wall thickness from the lumen∕wall interface, while for the rigid model, it was observed just at the lumen∕wall interface. In addition, the peak LDL accumulation area of the PHEM moved about according to the pulsatile flow. These results demonstrate that the blood flow, arterial wall deformation, and filtration flow all affect the LDL concentration, and that LDL accumulation is due to stagnation and the presence of filtration flow. Thus, FSI analysis is indispensable.

Tensile Residual Strains on the Elastic Lamellae along the Porcine Thoracic Aorta

AIMS

This study determines the residual strains on the elastic lamellae in the porcine thoracic aorta to understand the distribution of strains amongst the components of the vascular wall.

METHODS

Residual strains in aortic rings were released by cutting and purifying the elastin. Strains were calculated from lamellar contour lengths based on lamellar waviness and from mechanical tests.

RESULTS

On the release of residual strains, waviness decreased 2-7%, the inner lamellae shortened 2.1 +/- 0.6% and the outer lamellae shortened 7.1 +/- 0.4% (p < 0.001), indicating that all lamellar elastin was under tension in fresh aortic tissue. Lamellar shortening was 3% greater in the distal than in the proximal tissue. Mechanical tests confirmed the morphological results and showed that the residual strains in fresh tissue required both the elastic tissue and the vascular smooth muscle. Tensile residual strains averaging 1.0% remained in the uncut elastin rings.

CONCLUSION

When waviness is considered, the residual strains on the individual wall components can differ from the surface residual strains based only on the ring perimeter. The residual strains on the inner elastic lamellae are tensile, not compressive. The strain distribution amongst the individual components is non-uniform and not adequately understood to determine the physiological strains in the aortic wall.

Three-dimensional mechanical properties of porcine coronary arteries: a validated two-layer model

The normal coronary artery consists of two mechanically distinct layers: intima-media and adventitia. The objective of this study is to establish a two-layer three-dimensional (3-D) stress-strain relation of porcine coronary arteries. Experimental measurements were made by a series of biaxial tests (inflation and axial extension) of intact coronary arteries and, subsequently, their corresponding intima-media or adventitia layer. The Fung-type exponential strain energy function was used to describe the 3-D strain-stress relation for each layer and the intact wall. A genetic algorithm was used to determine the material constants in the Fung-type constitutive equation by curve fitting the experimental data. Because one layer must be sacrificed before the other layer can be tested, the material property of the missing layer was computed from the material constants of the intact vessel and the tested layer. A total of 20 porcine hearts were used: one group of 10 hearts for the left anterior descending artery and another group of 10 hearts for the right coronary artery. Each group was further divided into two subgroups of five specimens tested for the intact wall and the intima-media layer and for the intact wall and the adventitia layer. Our results show statistically significant differences in the material properties of the two layers. The mathematical model was validated by experimental stress-strain data for individual layers. The validated 3-D constitutive model will serve as a foundation for formulation of layer-specific boundary value problems in coronary physiology and cardiology.

Axl, a receptor tyrosine kinase, mediates flow-induced vascular remodeling

Intima-media thickening (IMT) in response to hemodynamic stress is a physiological process that requires coordinated signaling among endothelial, inflammatory, and vascular smooth muscle cells (VSMC). Axl, a receptor tyrosine kinase, whose ligand is Gas6, is highly induced in VSMC after carotid injury. Because Axl regulates cell migration, phagocytosis and apoptosis, we hypothesized that Axl would play a role in IMT. Vascular remodeling in mice deficient in Axl (Axl(-/-)) and wild-type littermates (Axl(+/+)) was induced by ligation of the left carotid artery (LCA) branches maintaining flow via the left occipital artery. Both genotypes had similar baseline hemodynamic parameters and carotid artery structure. Partial ligation altered blood flow equally in both genotypes: increased by 60% in the right carotid artery (RCA) and decreased by 80% in the LCA. There were no significant differences in RCA remodeling between genotypes. However, in the LCA Axl(-/-) developed significantly smaller intima+media compared with Axl(+/+) (31+/-4 versus 42+/-6x10(-6) microm3, respectively). Quantitative immunohistochemistry of Axl(-/-) LCA showed increased apoptosis compared with Axl(+/+) (5-fold). As expected, p-Akt was decreased in Axl(-/-), whereas there was no difference in Gas6 expression. Cell composition also changed significantly, with increases in CD45+ cells and decreases in VSMC, macrophages, and neutrophils in Axl(-/-) compared with Axl(+/+). These data demonstrate an important role for Axl in flow-dependent remodeling by regulating vascular apoptosis and vascular inflammation.

Adventitia contribution in vascular tone: insights from adventitia‐derived cells in a tissue‐engineered human blood vessel

Whether the adventitia component of blood vessels directly participates in the regulation of vascular tone remains to be demonstrated. We have recently developed a human tissue-engineered blood vessel comprising the three tunicae of a native blood vessel using the self-assembly approach. To investigate the role of the adventitia in the modulation of vascular tone, this tissue-engineering method was used to produce three vascular constructs from cells explanted and proliferated from donor vessel tunicae 1) an adventitia + a media, or only 2) an adventitia, or 3) a media. The vasoconstriction responses of these 3 constructs to endothelin, the most potent vasopressor known up-to-date, as well as to nonselective and selective agonists and antagonists, were compared. The adventitia contracted to endothelin-1, -2, whereas the media and the media+adventitia contracted to all three endothelins. Endothelin-induced contraction of the adventitia was dependent on ET(A) receptors, whereas that of the media and the adventitia+media was ET(A) and ET(B) receptor-dependent. RT-PCR studies corroborated these results. SNP induced a dose-dependent relaxation of the three tissue constructs. We also demonstrated that the endothelin-converting enzyme, responsible for the formation of the active endothelin peptides, was present and functional in the adventitia. In conclusion, this is the first direct demonstration that the adventitia has the capacity to contract and relax in response to vasoactive factors. The present study suggests that the adventitia of a blood vessel could play a greater role than expected in the modulation of blood vessel tone.

Uremia-Specific Effects in the Arterial Media During Development of Uremic Atherosclerosis in Apolipoprotein E–Deficient Mice

OBJECTIVE

Uremia accelerates formation of atherosclerosis-like lesions in apolipoprotein E-deficient (apoE(-/-)) mice. In this study, we compared gene expression patterns in classical and uremic atherosclerosis.

METHODS AND RESULTS

High-density oligonucleotide microarray analyses were performed with aortic RNA from 5/6 nephrectomized (NX) and sham-operated mice. After 12 weeks, NX apoE(-/-) mice had more atherosclerosis and 24 genes were differentially expressed as compared with sham apoE(-/-) mice. Nine genes expressed in muscle cells displayed reduced expression (3.3- to 142-fold, P<0.05), whereas osteopontin gene expression was increased 8.7-fold (P<0.05) in NX mice. Studies of NX wild-type mice suggested that the changes in NX apoE(-/-) mice were dependent on hypercholesterolemia. Nevertheless, lesioned versus nonlesioned areas of aortas from nonuremic apoE(-/-) mice with classical atherosclerosis displayed less pronounced reductions in expression of the muscle cell related genes than seen in NX apoE(-/-) mice even though the osteopontin gene expression was increased approximately 15-fold. Electron microscopy showed more vacuolized and necrotic smooth muscle cells within the media underneath both nonlesioned and lesioned intima in NX than in sham apoE(-/-) mice.

CONCLUSIONS

The results suggest that uremic vasculopathy in apoE(-/-) mice, in addition to intimal atherosclerosis, is characterized by a uremia-specific medial smooth muscle cell degeneration, which appears to be accentuated by hypercholesterolemia.

Expression profiling identifies smooth muscle cell diversity within human intima and plaque fibrous cap: loss of RGS5 distinguishes the cap

BACKGROUND

The fibrous cap of the atherosclerotic lesion is believed to be critical to stability because disruption of the cap is the final event leading to plaque rupture. We have, therefore, used expression arrays to define the phenotype of the cap and other plaque components.

METHODS AND RESULTS

To identify unique expression programs able to distinguish the smooth muscle of the cap from other plaque smooth muscle cells, RNA profiles were determined in human carotid artery media, nonatherosclerotic adjacent intima, fibrous cap of advanced atherosclerotic plaques, and whole advanced plaque with cDNA arrays covering 21,000 or 26,000 Unigene clusters. The molecular signature of each tissue was dominated by a core gene-set with differential expression of <1% of clusters assayed.

CONCLUSIONS

Both intima and cap expressed novel genes not previously associated with SMC pathology. If the cap is derived from a unique subpopulation, this pattern is the signature of that particular set of cells. The loss of RGS5 in the fibrous cap is of particular interest because of its role in vessel development and physiology.

Common carotid artery stiffness, cardiovascular function and lipid metabolism after menopause

While cardiovascular disease is a major cause of death in elderly women, relatively little is known regarding the influence of menopause on atherogenesis. We tried to characterize postmenopausal changes in the arterial properties. A group of 72 postmenopausal women were classified into subgroups based on duration of the postmenopausal period (PMP): Group PM1 (1-2 years; n = 16), PM4 (2-6 years; n = 16), PM8 (6-10 years; n = 25), and PM12 (10-15 years; n = 15). The control group consisted of 24 volunteers with regular menstruation (PM0). The diameter pulse waveform and intima-media thickness (IMT) of the common carotid artery (CCA) was measured using a phase-locked echo tracking system coupled with B-mode ultrasonography. The stiffness index was calculated from the waveform and the systemic blood pressure. The cardiac contractile force and the cerebral perfusion were also estimated using the maximum incremental velocity (MIV) and the calculated blood flow, as well as the fasting lipid profile. When compared to control, significant and progressive increases were noted in total cholesterol and low density lipoprotein (PM1, PM4, PM8, PM12), IMT (PM8, PM12), and SI (PM1, PM4, PM8, PM12). Further significant and progressive reductions were noted in pulse amplitude of CCA diameter (PM1, PM4, PM8, PM12) and MIV and cerebral perfusion (PM8, PM12). The postmenopausal increase in CCA stiffness as well as lipid profile occurs earlier than the increase in IMT and may be a more sensitive predictor of disorder on arterial property.

Macromolecular Transport in the Arterial Wall: Alternative Models for Estimating Barriers

Early atherosclerosis, or atherogenesis, is characterized by the abnormal accumulation of plasma-borne macromolecules (e.g., LDL) in the arterial intima. The change of barrier characteristics of tissue in the arterial wall requires evaluation of macromolecular transport across the endothelial cell layer (ECL) and internal elastic lamina (IEL), the luminal and abluminal boundaries of the arterial intima, respectively. In this study, alternative mathematical models are derived from dynamic mass balances to describe macromolecular transport across the arterial wall. One model considers each medial layer as a spatially lumped compartment, whereas another model consists of a spatially lumped intima and spatially distributed media. Model simulations of a tracer concentration distribution in the arterial wall are compared with concentration distributions of horseradish peroxidase (HRP) after i.v. injection in mice. For each model, optimal parameter values are obtained that yield model outputs matching the data well for two different HRP circulation times. The model parameter estimates show that the ECL is the major barrier for macromolecular transport across the normal arterial wall. Sensitivity analysis indicates that the parameter estimates of the transport coefficients of the ECL and IEL are well determined. Optimal circulation times are determined and expected to yield improved precision of parameter estimates in future experiments to reflect disease progression.

Tissue-engineered human vascular media with a functional endothelin system

BACKGROUND

Cardiovascular diseases remain a major cause of death and disability in the Western world. Among the various approaches adopted to counteract the morbidity associated with these diseases, surgical procedures and cardiac and vascular xenotransplantations or allotransplantations are routinely performed. The suitable vascular graft would be as close as possible to the native and healthy vessel composed exclusively of human components provided by the patient and would adapt to the donor's hemodynamics. We have developed such a tissue-engineered human blood vessel reconstructed with human cells. Because endothelin is the most potent vasopressor known to date, we were interested in investigating the functionality of the endothelinergic system in our reconstructed human blood vessel.

METHODS AND RESULTS

Vasoconstriction studies were performed with nonselective and selective agonists and antagonists to demonstrate that ET(A) receptors were present and functional in tissue-engineered human vascular media constructed with the self-assembly method. Reverse-transcriptase polymerase chain reaction studies demonstrated that mRNA of the ET(A) but not the ET(B) receptor was present in these human tissue-engineered blood vessels. Furthermore, we demonstrated that the endothelin-converting enzyme, the main enzyme responsible for the formation of the biologically active endothelin peptides, was present and functional in these same bioengineered vascular media.

CONCLUSIONS

Our results suggest that the media component of our tissue-engineered blood vessel has the potential of controlling vascular resistance via the presence of functional endothelin ET(A) receptors and endothelin-converting enzyme.

Biaxial elastic material properties of porcine coronary media and adventitia

The importance of mechanical stresses and strains has become well recognized in vascular physiology and pathology. To compute the stress and strain on the various components of the vessel wall, we must know the constitutive equations for the different layers of the vessel wall. The objective of the present study is to determine the constitutive equation of the coronary artery treated as a two-layer composite: intima-media and adventitial layers. Twelve hearts were obtained from a local slaughterhouse, and the right coronary artery and left anterior descending artery were dissected free from the myocardium. The vessel wall was initially mechanically tested biaxially (inflation and axial extension) as a whole (intact wall) and subsequently as intima-media or adventitial layer. A Fung-type exponential strain energy function was used to curve fit the experimental data for the intact wall and individual layers for the right coronary artery and left anterior descending artery. Two methods were used for the determination of material constants, including the Marquardt-Levenberg nonlinear least squares method and the genetic algorithm method. Our results show that there were no statistically significant differences in the material constants obtained from the two methods and that either set of elastic constants results in good fit of the data. Furthermore, at an in vivo value of axial stretch ratio, we find that the stiffness is as follows: intima-media > intact > adventitia. These results underscore the composite nature of coronary arteries with different material properties in each layer. The present results are necessary for analysis of coronary artery mechanics and to provide a fundamental understanding of vessel physiology.

Transmural strain distribution in the blood vessel wall

The transmural distributions of stress and strain at the in vivo state have important implications for the physiology and pathology of the vessel wall. The uniform transmural strain hypothesis was proposed by Takamyzawa and Hayashi (Takamizawa K and Hayashi K. J Biomech 20: 7–17, 1987; Biorheology 25: 555–565, 1988) as describing the state of arteries in vivo. From this hypothesis, they derived the residual stress and strain at the no-load condition and the opening angle at the zero-stress state. However, the experimental evidence cited by Takamyzawa and Hayashi ( J Biomech 20: 7–17, 1987; and Biorheology 25: 555–565, 1988) to support this hypothesis was limited to arteries whose opening angles (θ) are <180°. It is well known, however, that θ > 180° do exist in the cardiovascular system. Our hypothesis is that the transmural strain distribution cannot be uniform when θ is >180°. We present both theoretical and experimental evidence for this hypothesis. Theoretically, we show that the circumferential stretch ratio cannot physically be uniform across the vessel wall when θ exceeds 180° and the deviation from uniformity will increase with an increase in θ beyond 180°. Experimentally, we present data on the transmural strain distribution in segments of the porcine aorta and coronary arterial tree. Our data validate the theoretical prediction that the outer strain will exceed the inner strain when θ > 180°. This is the converse of the gradient observed when the residual strain is not taken into account. Although the strain distribution may not be uniform when θ exceeds 180°, the uniformity of stress distribution is still possible because of the composite nature of the blood vessel wall, i.e., the intima-medial layer is stiffer than the adventitial layer. Hence, the larger strain at the adventitia can result in a smaller stress because the adventitia is softer at physiological loading.

Biaxial incremental homeostatic elastic moduli of coronary artery: two-layer model

The detailed mechanical properties of various layers of the coronary artery are important for understanding the function of the vessel. The present article is focused on the determination of the incremental modulus in different layers and directions in the neighborhood of the in vivo state. The incremental modulus can be defined for any material subjected to a large deformation if small perturbations in strain lead to small perturbations of stresses in a linear fashion. This analysis was applied to the porcine coronary artery, which was treated as a two-layered structure consisting of an inner intima-media layer and an outer adventitia layer. We adopted a theory based on small-perturbation experiments at homeostatic conditions for determination of incremental moduli in circumferential, axial, and cross directions in the two layers. The experiments were based on inflation and axial stretch. We demonstrate that under homeostatic conditions the incremental moduli are layer- and direction dependent. The incremental modulus is highest in the circumferential direction. Furthermore, in the circumferential direction, the media is stiffer than the whole wall, which is stiffer than the adventitia. In the axial direction, the adventitia is stiffer than the intact wall, which is stiffer than the media. Hence, the coronary artery must be treated as a composite, nonisotropic body. The data acquire physiological relevance in relation to coronary artery health and disease.

Metformin attenuates progression of carotid arterial wall thickness in patients with type 2 diabetes

To investigate the anti-atherogenic effect of metformin, we prospectively evaluated the effect of metformin treatment on common carotid intima-media thickness (CCA-IMT) in patients with type 2 diabetes. A 2-year open prospective study was performed. Thirty-six patients were treated with metformin (500-750 mg per day). CCA-IMT was measured after 1- and 2-year treatment. Changes in CCA-IMT were compared with control patients. After 2-year metformin therapy, the progression of CCA-IMT was significantly less than 56 control patients (0.02+/-0.08 mm versus 0.07+/-0.08 mm, P<0.01). Metformin therapy did not alter body weight, blood pressure, HbA1c, and serum lipids relative to the control. Thus, metformin attenuates the progression of CCA-IMT. This anti-atherogenic effect is not mediated through changes in classical cardiovascular risk factors.

A new method to denude the endothelium without damage to media: structural, functional, and biomechanical validation

The intimial thickening that occurs in human and animal atherogenesis can be induced by mechanical injury to the endothelium. The objective of the present study was to develop a new method to induce arterial endothelial injury without damage to the media for future investigations of mechanisms of intimal thickening and atherogenesis. A specifically designed catheter was inserted into the common femoral artery of Wistar rats (n = 9) through an arteriotomic mouth. After application of Tyrode solution containing 0.14 M KCl on the surface of the vessel, the vessel contracted onto the catheter. The catheter was then moved back and forth to scrape away the endothelium. The left common femoral artery of the same rat was subjected to the standard balloon injury model. The two models were evaluated structurally, functionally, and biomechanically. Structurally, we verified that both techniques remove the endothelium, but the balloon method damages the media. Functionally, we examined the contractile response of the artery to [K+] and norepinephrine 2 days after the denudation. We found that the right femoral artery underwent contraction in response to [K+], whereas the left artery did not. Furthermore, neither artery responded to norepinephrine. Biomechanically, we measured the pressure-diameter relationship and the zero-stress state of the vessel and computed the stress-strain relation. The circumferential stretch ratios at 120 mmHg were 1.38 +/- 0.08 for the control, 1.41 +/- 0.08 (P > 0.05) for the new method, and 1.56 +/- 0.09 for the balloon injury (P < 0.05). The opening angles at the zero-stress state were 113 +/- 21 degrees for the control, 102 +/- 18 degrees for the new method (P > 0.05), and 8 +/- 13 degrees for the balloon injury (P < 0.001). In conclusion, the new method removes the endothelium while maintaining the structure, contractile function, and biomechanical properties of the vessel.

Improved analysis of the vascular response to arterial ligation using a multivariate approach

Ligation of the murine common carotid artery induces a reproducible remodeling response. The contribution of individual genes can be determined by comparison of the phenotypes of genetically modified mice. Although studies have shown the response to carotid artery ligation is influenced by many factors, individual analyses typically only consider a single factor, the presence of a gene of interest. Because of this limitation, measurements of the response to ligation show large variation, making the determination of significant difference between test groups difficult. In this study, we examine the hypothesis that the variation in the response to ligation is due to non-genetic factors in addition to genetic factors. Distance from the ligature, a variable common to all arterial ligation experiments, is an important source of variation and a significant predictor of the remodeling response. We find that the use of statistical regression is an improved analysis technique, as it allows the simultaneous consideration of multiple variables. We demonstrate this by showing improved sensitivity and novel findings in the analysis of the remodeling response in mice genetically mutant for the osteopontin gene. We conclude regression analysis provides a simple way to improve both comparative power and description of vascular remodeling.

Relationship Between the Dynamic Geometry and Wall Thickness of a Human Coronary Artery

Objective— It is widely recognized that hemodynamic and wall mechanical forces are involved in the initiation and development of atherosclerosis. In the coronary vasculature, these forces are likely mediated by arterial dynamics and geometry. This research examines the hypothesis that coronary artery motion and geometry affect the local predisposition to disease, presumably through their influence on the stresses at and in the artery wall.

Methods and Results— The dynamics of a human right coronary artery and the variation of wall thickness along its length were characterized from biplane cineangiograms and intravascular ultrasound records, respectively. The dynamic geometry parameters were distance along the vessel, cyclic displacement, axial strain, curvature, and torsion. Multiple regression analyses using principal components show that (1) no single dynamic geometry parameter has a dominant influence on wall thickness, (2) linear combinations of such parameters predict wall thickness measures with high confidence ( P <0.001; R 2 between 0.17 and 0.44), and (3) both the time-average values of curvature and torsion and their excursion during the cardiac cycle are positively correlated with maximum wall thickness and cross-sectional asymmetry.

Conclusions— The relationships seen here support the hypothesis that dynamic geometry plays a role in the localization of early coronary artery thickening.

Shear modulus of porcine coronary artery: contributions of media and adventitia

The epicardial coronary arteries experience significant torsion in the axial direction due to changes in the shape of the heart during the cardiac cycle. The objective of this study was to determine the torsional mechanical properties of the coronary arteries under various circumferential and longitudinal loadings. The coronary artery was treated as a two-layer composite vessel consisting of intima-medial and adventitial layers, and the shear modulus of each layer was determined. Eight porcine hearts were obtained at a local abattoir, and their right coronary and left anterior descending arteries were isolated and tested in vitro with a triaxial torsion machine (inflation, longitudinal stretch, and circumferential twist). After the intact vessel was tested, the adventitia was dissected away, leaving an intact media that was then tested under identical triaxial loading conditions. We proposed a biomechanical analysis to compute the shear modulus of the adventitia from the measured shear moduli of the intact vessel and the media. To validate our predictions, we used four additional hearts in which the shear modulus of the adventitia was measured after dissection of media. Our results show that the shear modulus does not depend on the shear stress or strain but varies linearly with circumferential and longitudinal stresses and in a nonlinear way with the corresponding strains. Furthermore, we found that the shear modulus of the adventitia is larger than that of the intact vessel, which is larger than the vessel media. These results may have important implications for baroreceptor sensitivity, circulation of the vasa vasorum, and coronary dissection.

Carotid and femoral arterial wall mechanics in scleroderma

OBJECTIVE

Large-vessel arterial disease is increasingly recognized as a major cause of morbidity in autoimmune rheumatic disorders. Recent evidence suggests that scleroderma (systemic sclerosis, SSc) may be linked to altered fibrillin-1 metabolism associated with a defect in chromosome 15q. If this is the case, we may expect to see changes in the arterial wall mechanics of large vessels not clinically involved in the disease process. We undertook a study to determine whether the biomechanical properties and intima-media thickness (IMT) of the elastic carotid artery and the muscular femoral artery are altered in subjects with limited (lcSSc) and diffuse (dcSSc) cutaneous SSc.

METHODS

Measurements of carotid and femoral wall mechanics were made in 33 patients with lcSSc, 19 patients with dcSSc and 21 control subjects, using a duplex scanner coupled to a Wall Track system. Their age, gender, body mass index, heart rate, systolic and diastolic blood pressures, presumed cardiovascular load, and plasma creatinine, fasting cholesterol, triglyceride and glucose concentrations were also measured.

RESULTS

There was a progressive and significant reduction (P < 0.001) in the elastic properties of the carotid artery from the control group (compliance, 16.24 +/- 4.39 %mmHg(-1) x 10(-2)) to the lcSSc group (10.89 +/- 2.43 %mmHg(-1) x 10(-2)) to the dcSSc group (7.65 +/- 2.08 %mmHg(-1) x 10(-2)), even after adjustment for the systemic physiological and biochemical variables studied, which are known to influence the mechanics of arterial walls. There was no apparent difference between the groups in the mean elastic indices of the femoral artery and the IMT of the carotid and femoral arteries.

CONCLUSION

The elastic properties of the carotid artery are significantly altered in SSc, and the two major subsets of SSc may be distinguished by their carotid artery biomechanics. This suggests that connective tissue abnormality occurs at sites not previously assessed.

Bovine distal pulmonary arterial media is composed of a uniform population of well-differentiated smooth muscle cells with low proliferative capabilities

The media of the normal bovine main pulmonary artery (MPA) is composed of phenotypically heterogeneous smooth muscle cells (SMC) with markedly different proliferative capabilities in response to serum, mitogens, and hypoxia. Little, however, is known of the SMC phenotype in distal pulmonary arteries (PA), particularly in arterioles, which regulate the pulmonary circulation. With a panel of muscle-specific antibodies against alpha-smooth muscle (SM)-actin, SM-myosin heavy chains (SM-MHC), SM-MHC-B isoform, desmin, and meta-vinculin, we demonstrate a progressive increase in phenotypic uniformity and level of differentiation of SMC along the proximal-to-distal axis of normal adult bovine pulmonary circulation so that the media of distal PA (1,500- to 100-microm diameter) is composed of a phenotypically uniform population of "well-differentiated" SMC. Similarly, when isolated and assessed in vitro, distal PA-SMC is composed of a single, uniform population of differentiated SMC that exhibited minimal growth responses to a variety of mitogens while their cell size increased substantially in response to serum. Their growth was inhibited by hypoxic exposure under all conditions tested. Distal PA-SMC also differed from MPA-SMC by exhibiting a distinct pattern of DNA synthesis in response to serum and mitogens. Thus, in contrast to the MPA, distal PA media is composed of an apparently uniform population of well-differentiated SMC that are proliferation resistant and have a substantial capacity to hypertrophy in response to growth-promoting stimuli. We thus speculate that distinct SMC phenotypes present in distal vs. proximal PA may confer different response mechanisms during remodeling in conditions such as hypertension.

The association of Pro12Ala polymorphism in PPARgamma2 with lower carotid artery IMT in Japanese

In this study, the association of the Pro12Ala peroxisome proliferator-activated receptor gamma2 (PPARgamma2) polymorphism with atherosclerosis was examined in a Japanese Type 2 diabetic population. PPARgamma has been identified as a key regulator of adipogenesis. Recently, some studies reported that the Pro12Ala polymorphism was associated with resistance to Type 2 diabetes. It is well-known that Type 2 diabetes is closely related with disorder of lipid metabolism as well as impaired glucose homeostasis, resulting in atherosclerosis. We aimed to evaluate the association between carriers of the Pro12Ala PPARgamma2 mutation and clinical profiles concerning atherosclerosis besides plasma glucose and lipid concentrations. Screening for the mutation was performed using the polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) method among 154 Type 2 diabetic patients. The homozygotes of the Pro12 allele were 143 (93%), the heterozygotes of the Pro12 and Ala12 allele were 11 (7%) and the homozygote of the Ala12 allele was not detected. The group with the Ala12 allele had a significantly lower value of carotid artery intima-media thickness (IMT) than that without it, although there was no difference between two groups in sex, age or other clinical variables we examined. The Pro12Ala PPARgamma2 polymorphism may be associated with carotid artery IMT values in Type 2 diabetes mellitus.

A new non-invasive ultrasonic method for simultaneous measurements of longitudinal and radial arterial wall movements: first in vivo trial

During recent years, the radial movement of the arterial wall has been extensively studied, and measurements of the radial movement are now an important tool in cardiovascular research for characterizing the mechanical properties of the arterial wall. In contrast, the longitudinal movement of vessels has gained little or no attention as it has been presumed that this movement is negligible. With modern high-resolution ultrasound, it can, however, be seen that the intima-media complex of the arterial wall moves not only in the radial direction, but also in the longitudinal direction during pulse-wave propagation. This paper describes a new non-invasive ultrasonic method that is able to measure simultaneously two dimensionally arterial vessel wall movements. The method is demonstrated in a limited in vivo trial. Results from the in vivo trial show that, apart from the well-known radial movement, there is a distinct longitudinal movement in the human common carotid artery with, in this case, the intima-media complex moving substantially as compared with the region of the tunica adventitia. Two-dimensional evaluation of the vessel-wall movements, taking not only the radial movement, but also the longitudinal movement into account, may provide novel information of importance in the evaluation of vessel-wall function.

Collagen biomechanics in cerebral arteries and bifurcations assessed by polarizing microscopy

Collagen is the main matrix protein of the artery wall. We have used the known correlation between collagen birefringence and its mechanical properties to assess the wall structural integrity in brain arteries and their bifurcation regions, which are the sites of formation of saccular aneurysms. Segments of 28 brain arteries, including bifurcations, were pressure fixed and sectioned in one of three orthogonal planes. Measurements were taken by polarizing microscopy of the birefringence of collagen fibers at the apex of bifurcations and in the main layers of the artery wall - adventitia, media and intima. Dimensional data were obtained of the layers in order to estimate wall properties. Along the apex of the flow divider we measured a narrow band of collagen (birefringence 30% higher than the adjacent adventitia) providing strength and stiffness in that region. There is a thin cell-free outer layer of the tunica media (mean thickness 11 microm) comprised of densely packed coaligned collagen with high birefringence. From the fiber birefringence and directional alignment of the individual layers we calculated that the adventitia contributes about one third of circumferential and almost all of longitudinal strength of intracranial arteries.

Plasminogen activator inhibitor contributes to the coronary wall thickening in patients with angiographically normal coronary

INTRODUCTION

Angiographically normal coronary arteries have concealed intimal thickening that importantly contribute to coronary arterial disease activity. Increased plasma levels of plasminogen activator inhibitor (PAI) are associated with myocardial infarction and atherosclerosis. However, it remains unclear whether the PAI contributes to vascular wall thickening detected by intravascular ultrasound (IVUS) in normal coronary angiogram. The aim of this study was to evaluate if the PAI activity contributes to the extent of atherosclerotic changes in angiographically normal coronary arteries using IVUS technique.

MATERIALS AND METHODS

We studied 33 consecutive patients with normal coronary angiograms. These patients were divided into a high level of plasma PAI activity group (H-PAI; n=12) and a normal range of PAI activity group (N-PAI; n=21), according to the plasma PAI activity levels.

RESULTS

The average of "percent intima+media area (%I+M area)" and "maximal intima+media (I+M) thickness" were significantly greater in the H-PAI group as compared with those in the N-PAI group (p<0.05). Minimal lumen diameter and lumen area were comparable between these groups. The plasma PAI activity level was the independent predictor of increase in maximal I+M thickness, in multiple regression analysis with the traditional risk factors as covariates.

CONCLUSIONS

Thickened intima+media of angiographically normal coronary arteries were associated with high plasma level of PAI activity, independently of other traditional risk factors. PAI may contribute to the pathogenesis of coronary intimal thickening that might increase coronary arterial tone.

[MRI characterization of atherosclerotic arteries: diagnosis of plaque rupture]

Plaque stability and its counterpart, vulnerability, depend on the relative amount and morphology of its principal components: lipid core and fibrous cap. Lipids are mainly made of cholesterol esters and cholesterol monohydrates, but phospholipids and triglycerides are also present. Major chemokines, cytokines, enzymes and markers of inflammation are locally produced, which interact and degrade the arterial matrix, but also stimulate smooth muscle cells and osteopontine production. Due to these differences in composition, the lipid cores have various chemical and biophysical properties (with solid, liquid or liquid-crystalline phases), and so has the collagenous cap, which influence imaging parameters. MRI has improved its capacity to characterize arterial tissue. This technique can now discriminate the different components of normal and pathological arterial walls through various endogenous or exogenous contrast: intima, media, adventitia, perivascular fat, lipid core, collagenous cap and calcifications of atheromatous plaques, but also precise the elements of plaque resistance to radial stress, or the various factors of inflammation. In the next years, improvement of resolution, new contrast sequences (diffusion or magnetization transfer) or spectroscopy, will compete to allow for the best discrimination of these usual suspects: "the unstable plaques".

Two-dimensional maps of short-term albumin uptake by the immature and mature rabbit aortic wall around branch points

In children, aortic lipid deposition develops in triangular regions of the wall downstream of branch points, whilst in adults these regions are particularly free of disease. Comparable age-related patterns occur in rabbit aortas. They may be explained by patterns of wall permeability to circulating macromolecules: along the longitudinal midline through branches, permeability is greater downstream than upstream in immature rabbits, but is greater upstream at later ages. Here we have mapped permeability in detail around such branches, not just along the midline. Short-term uptake of rhodamine-labeled albumin, measured using digital imaging fluorescence microscopy of serial sections, was greatest in an approximately triangular region downstream of immature branches, but in mature animals it was greater upstream, particularly away from the midline, and in streaks to the side of branches. Hence the maps are consistent with earlier permeability data and closely resemble the patterns of disease.

Vascular smooth muscle cell stress as a determinant of cerebral artery myogenic tone

Although the level of myogenic tone (MT) varies considerably from vessel to vessel, the regulatory mechanisms through which the actual diameter set point is determined are not known. We hypothesized that a unifying principle may be the equalization of active force at the contractile filament level, which would be reflected in a normalization of wall stress or, more specifically, media stress. Branched segments of rat cerebral arteries ranging from <50 microm to >200 microm in diameter were cannulated and held at 60 mmHg with the objectives of: 1) evaluating the relationship between arterial diameter and the extent of myogenic tone, 2) determining whether differences in MT correlate with changes in cytosolic calcium ([Ca(2+)](i)), and 3) testing the hypothesis that a normalization of wall or media stress occurs during the process of tone development. The level of MT increased significantly as vessel size decreased. At 60 mmHg, vascular smooth muscle [Ca(2+)](i) concentrations were similar in all vessels studied (averaging 230 +/- 9.2 nM) and not correlated with vessel size or the extent of tone. Wall tension increased with increasing arterial size, but wall stress and media stress were similar in large versus small arteries. Media stress, in particular, was quite uniform in all vessels studied. Both morphological and calcium data support the concept of equalization of media stress (and, hence, vascular smooth muscle cell stress and force) as an underlying mechanism in determining the level of tone present in any particular vessel. The equalization of active (vascular smooth muscle cell) stress may thus explain differences in MT observed in the different-sized vessels constituting the arterial network and provide a link between arterial structure and function, in both short- and long-term (hypertension) pressure adaptation.

Arterial intimal-medial permeability and coevolving structural responses to defined shear-stress exposures

The purpose of this research was to examine the evolution of arterial shear stress-induced intimal albumin permeability and coevolving structural responses in swine arteries. Uniform laminar shear-stress responses were compared with those of a simulated "flow separation" stress field. These fields were created using specially designed flow-configuring devices in an experimentally controlled, metabolically supported, ex vivo thoracoabdominal aorta preparation. The Evans blue dye-albumin complex (EBD-alb) permeability patterns that evolved were measured by a reflectometric method. The corresponding tissue structural responses were evaluated by histological, immunostaining, and ultrastructural microscopic techniques. It was shown that when a previously in vivo-adapted artery is challenged by a new mechanochemical environment, it undergoes a sequence of adaptive processes over the ensuing 95 h. Intimal regions of laminar shear-stress exposure ( approximately 16 dyn/cm(2)) responded initially (23 h) with an increase in permeability. With continued stress exposure, intimal-medial structural changes ensued that restored the artery to a physiologically normal permeability. Over this same period, adjacent endothelial regions exposed to simulated flow separation stress fields ( approximately 0.03-0.27 dyn/cm(2)) developed early and progressively increasing permeability. This was associated with formation of local intimal edema, loss of intimal matrix material, and development of distinctively raised, gelatinous-appearing intimal lesions having a potentially preatheromatous architecture.

Age related constitutive laws and stress distribution in human main coronary arteries with reference to residual strain

An analytical model has been used to simulate the effects of tissue aging on residual strain, constitutive relations and stiffness parameter in the main right and left (ramus circumflexus) human coronary arteries, based on experimental data. The experimental opening angle theta scatters considerably with age. The optimum angle theta(op) approximately equals 70 degrees, which makes the circumferential stress uniform in the arterial wall at a normal blood pressure, is approximately constant throughout aging. Above age of the 15 years the estimated and experimental values of theta are greater than theta(op) and therefore the mechanical load of the inner layers of the media and the intima decreases and the adventitia is overloaded. On the basis of nonlinear regression analysis, age-related constitutive laws of arterial wall circumferential stiffness have been determined. Above the age of 30, arterial wall hardening increases rapidly. The left coronary artery is stiffer than the right artery for groups from 35 to 45 years of age. Hyperelasticity theory has been used to identify age-related multiaxial stress through wall thickness. A theoretical model based on the reduced Green strain provides a very good representation of the coronary artery circumferential mechanical response and predicts its nearly isotropic behavior. Bio-composite material forms non-homogeneous stresses and, in the course of aging, it increases the adventitia loading. In groups aged from 10 to 15 years, whose coronary artery residual strains are low, the circumferential stress distribution has a classic form. Stiffness parameter beta gradually increases with age and this increase is significant above the age of 60. Parameter beta tends to decrease when the opening angle theta increases.

Physical and enzymatic perturbation of the architecture of the Tunica media destroys its inherent thromboresistance

The media layer of the arterial cryo-cross sections, is defective for vWf-dependent platelet adhesion. Exposure of the same layer by stripping off the most inner portions of the vessel wall results in a highly thrombogenic surface. Stripping or balloon dilation was applied to porcine arteries prior to functional assays. Cryosections of treated or untreated arteries were perfused with porcine blood at 3,350 s(-1) and platelet deposition was detected by indirect immunofluorescence. Following balloon dilation, vWf-dependent platelet deposition increased; covering 9.08 +/- 1.36% of the total media surface area, this value for untreated vessels was 0.88 +/- 0.14%. A 10-fold increase was also found in the binding of vWf-coated fluorescent beads to the media. In addition to mechanical procedures, treatment by serine-proteases like trypsin, chymotrypsin and proteinase 3, or by chondroitinase ABC, but not by heparitinase also resulted in a 7-10-fold increase in platelet coverage over the media. Collagen in the media may be complexed with another vessel wall component shielding the vWf-binding sites. Mechanical or biochemical processes unmask these sites, and increase the thrombogenicity of the vessel wall.