Echocardiography assessment of aortic elasticity as a vascular marker in hypertensive vs. healthy individuals

Relationship between Periodontal disease, Porphyromonas gingivalis, peripheral vascular resistance markers and Coronary Artery Disease in Asian Indians

In type-2 diabetes early vascular changes (among others) are hyperperfusion in the retinal circulation (like in the kidney) and increased pulse wave reflection leading to increased aortic pressure. We analyzed whether the DPP4-inhibitor saxagliptin reverses early vascular and haemodynamic changes in type-2 diabetes. In this double-blind randomized controlled clinical cross-over trial 42 patients with type-2 diabetes (age 60.3, 13 were females, BMI 30.6 kg/m2, mean duration of diabetes 4 years, HbA1c 7.0%, blood pressure 132/79 mmHg) were consecutively [PB1] included and randomized to placebo or saxagliptin 5 mg for 6 weeks each. Retinal capillary flow (RCF) was assessed at baseline and after flickerlight exposure (as a vasodilatory test) by scanning laser Doppler flowmetry. Central (aortic) systolic blood pressure (SBP), central pulse pressure (PP), augmentation index and pulse wave velocity were determined with the SphygmoCor device. Following treatment with saxagliptin (as opposed to placebo) saxagliptin effected a better glycemic control, a reduced retinal capillary flow (p=0.033) and, in parallel, reduced central systolic augmentation and pulse pressure (see table). In accordance, Flicker light induced increment of RCF (indicative of vasodilatory capacity of the retinal circulation) was numerically 2-fold greater, although not significant. View this table: Table 1 Our data suggest that treatment with saxagliptin for 6 weeks normalizes retinal capillary flow and improves central haemodynamics in type 2 diabetes.

Objective: Degradation of the glycocalyx (GC), the innermost layer protecting the vascular endothelium, and up-regulation of adhesion molecules is associated with subclinical atherosclerosis and endothelial dysfunction, while aortic stiffness is related to early structural vascular changes and decline in renal function. However, few studies have investigated vascular biomarkers in relation to central and peripheral hemodynamics, and renal function in hypertension. Design and method: 107 patients (58 ± 13 years) with hypertension (mean 149/87 mmHg; 31% on antihypertensive treatment) and a wide range of renal function (eGFR 130 to 21 ml/min x 1.73 m2, mean 74 ml/min), were investigated. Indices of aortic stiffness were central systolic blood pressure (cSBP), central pulse pressure (cPP), carotid/brachial pulse pressure ratio (cPP/brPP), augmentation index (AIx), carotid-femoral pulse wave velocity (PWV), and aortic-brachial PWV ratio, assessed by applanation tonometry (SphygmoCor, AtCor Medical). Endothelial function was studied by forearm post-ischemic flow mediated vasodilatation. The GC glycoproteins hyaluronan (HA) and syndecan-1 (Syn-1), and adhesion molecules (ICAM-1, VCAM-1, and E-selectin), were analysed with ELISA. Results: Median[range] HA, Syn-1, ICAM-1, VCAM-1, and E-selectin were 15 [11–20], 38[27–54], 302[264–345], 347[304–408], and 32[26–41] ng/mL, respectively. HA was related to cPP (r = 0.31; P = 0.002), cPP/brPP (r = 0.21; P = 0.002), AIx (r = 0.21; P = 0.034), PWV (r = 0.31; P = 0.003), and aortic-brachial PWV ratio (r = 0.27; P = 0.011). Syn-1 was inversely related to cSBP (r = –0.17; P = 0.043). E-selectin tended to be inversely related to cSBP (p = 0.10) and to cPP (p = 0.071). HA and VCAM-1 were inversely related to eGFR (r = –0.45 and r = –0.43; both P < 0.001). All vascular biomarkers were unrelated to flow-mediated vasodilation. Conclusions: Vascular biomarkers were associated with indices of aortic stiffness, and impaired renal function, but was unrelated to peripheral endothelial function. HA showed association with increased stiffness, compared to Syn-1 that was unrelated to stiffness, and both HA and VCAM-1 were inversely related to renal function, where elevation of HA and VCAM-1 may reflect endothelial dysfunction of the kidneys. Thus, our results suggest that functional vascular biomarkers may relate to early structural and functional vascular changes in uncomplicated hypertension with impaired renal function.

INTRODUCTION: Attenuated arterial elasticity is one of the earliest markers of atherosclerosis. OBJECTIVE: Our aim was to investigate the relationship of passive smoking and elastic properties of the aorta. METHODS: We studied 11-year-old healthy children (n = 386) from the randomized, prospective atherosclerosis prevention trial (STRIP). Aortic elasticity was analyzed by using M-mode ultrasound imaging on the basis of the measurement of blood pressure and arterial diameter changes during diastole and systole. Aortic compliance (AC) and aortic stiffness index (SI) were calculated. Exposure to tobacco smoke was measured by using serum cotinine concentration, which was analyzed with gas chromatography. RESULTS: Cotinine concentrations ranged from nondetectable (detection limit: 0.16 ng/mL) to 6.8 ng/mL. Cotinine values and aortic elasticity measures were similar between genders. Children were classified into 3 groups according to their cotinine concentration: the top-decile cotinine group (n = 39), the nondetectable cotinine group (n = 220), and the low cotinine group (n = 127). Conventional atherosclerosis risk factors were similar between the 3 cotinine groups. A decreasing trend in AC (P = .041) and an increasing trend in SI (P = .006) was observed across the cotinine groups with an increasing level of tobacco smoke exposure. In addition, systolic and diastolic blood pressure and BMI were independent predictors of the aortic elasticity indices. In multivariable models, cotinine level (P = .020) and systolic blood pressure (P < .001) were inversely associated with AC and directly related to SI (cotinine level, P = .005; systolic blood pressure, P = .0003). CONCLUSIONS: These data suggest that passive smoking is associated with decreased aortic elasticity in children, indicating early arterial changes.

Prognostic value of ventricular-arterial coupling in patients with arterial hypertension and stable heart failure with reduced ejection fraction

Transcutaneous detection of relative changes in artery diameter

Early vascular changes at the molecular level caused by adoption of a sedentary lifestyle are incompletely characterized. Herein, we employed the rodent wheel-lock model to identify mRNAs in the arterial wall that are responsive to the acute transition from higher to lower levels of daily physical activity. Specifically, we evaluated whether short-term cessation of voluntary wheel running alters vascular mRNA levels in rat conduit arteries previously reported to have marked increases (i.e. iliac artery) versus marked decreases (i.e. renal artery) in blood flow during running. We used young female Wistar rats with free access to voluntary running wheels. Following 23 days of voluntary running (average distance of ∼15 km per night; ∼4.4 h per night), rats in one group were rapidly transitioned to a sedentary state by locking the wheels for 7 days (n = 9; wheel-lock 7 day rats) or remained active in a second group for an additional 7 days (n = 9; wheel-lock 0 day rats). Real-time PCR was conducted on total RNA isolated from iliac and renal arteries to evaluate expression of 25 pro-atherogenic and anti-atherogenic genes. Compared with the iliac arteries of wheel-lock 0 day rats, iliac arteries of wheel-lock 7 day rats exhibited increased expression of TNFR1 (+19%), ET1 (+59%) and LOX-1 (+31%; all P < 0.05). Moreover, compared with renal arteries of wheel-lock 0 day rats, renal arteries of wheel-lock 7 day rats exhibited decreased expression of ETb (-23%), p47phox (-32%) and p67phox (-19%; all P < 0.05). These data demonstrate that cessation of voluntary wheel running for 7 days produces modest, but differential changes in mRNA levels between the iliac and renal arteries of healthy rats. This heterogeneous influence of short-term physical inactivity could be attributed to the distinct alteration in haemodynamic forces between arteries.

Age-related changes in aortic elasticity determined by gated radionuclide angiography in patients with systemic hypertension or healed myocardial infarcts and in normal subjects

Abnormal aortic elastic properties in adults with congenital valvular aortic stenosis

Background — Psoriasis vulgaris is a chronic inflammatory disease involving 1-3% of the human population worldwide. Many systemic diseases including cardiovascular disturbances have been described in psoriatic patients. The effect of psoriasis on aortic elasticity parameters has not been well-defined previously. The aim of this study was to determine whether there was any change in aortic elasticity in psoriasis.Methods — Twenty-seven psoriatic patients without cardiovascular involvement and 22 healthy subjects were enrolled into the study. The severity of the disease was evaluated by the “Psoriasis Area and Severity Index (PASI)”. Aortic strain, distensibility and stiffness index were calculated from aortic diameters measured by echocardiography and blood pressures simultaneously measured by sphygmomanometry.Results — The aortic strain and distensibility in the psoriasis group were significantly lower than those in the control group. The aortic stiffness index in the psoriasis group was higher than that in the control group. There was a positive correlation between aortic stiffness index and PASI and longevity of psoriasis disease, whereas a negative correlation between aortic strain and PASI and longevity of psoriasis disease was found.Conclusion — We found that in psoriatic patients without cardiac involvement, aortic elasticity was decreased and this decrease was correlated with the duration and the severity of the disease.

To analyze the clinical value of coronary CT angiography (CCTA) for evaluating aortic stiffness and elasticity in patients with angina and non-obstructive coronary artery (ANOCA). The case data of 120 patients who were diagnosed with ANOCA and underwent CCTA in our hospital were collected and set as the case group, and 86healthy subjects who underwent medical check-up and ANOCA testing in our hospital during the same period were set as the control group. The differences in CCTA indices of ascending aortic stiffness and aortic elasticity, left ventricular function indices of left ventricular ejection fraction (LVEF) and cardiac output (CO) were compared between the two groups. The arterial compliance (AC) and arterial distensibility (AD) values in the case group were significantly lower than those in the control group, while arterial stiffness (β) value was significantly higher in the case group compared to the control group (P<0.05). The LVEF and CO values of patients in the case group were significantly lower than those in the control group (P<0.05). The CCTA indices AC and AD of patients in the case group exhibited a significant positive correlation with their LVEF (r=0.133, r=0.062, P<0.05), while β showed a negative correlation with LVEF (r=-0.092, P=0.005). Aortic stiffness and elasticity in CCTA indices of ANOCA patients exhibited significant alterations, and the correlation analysis suggested a correlation of CCTA aortic stiffness and elasticity indices with left ventricular performance indices.

Obesity is generally accepted as a risk factor for premature atherosclerosis. Subclinical inflammation as quantified by blood levels of C-reactive protein (CRP) contributes to the development and progression of atherosclerosis. We hypothesized that inflammation in obese children is related to functional and early morphological vascular changes. Blood levels of high sensitivity (hs) CRP, hsIL-6, the soluble intercellular adhesion molecule1 (ICAM-1), vascular cell adhesion molecule (VCAM)-1, and E-selectin were measured in 145 severely obese (body mass index [BMI], 32.2+/-5.8 kg/m2) and 54 lean (BMI, 18.9+/-3.2 kg/m2) children 12+/-4 years old. Flow-mediated dilation (FMD) of the brachial artery and carotid intima-media thickness (IMT) measured by high-resolution ultrasound as markers of early vascular changes were assessed in 92 (77 obese and 15 lean) and 59 (50 obese and 9 lean) children, respectively. Obese children had significantly higher levels of hsCRP, hsIL-6, and E-selectin than healthy controls (4.1+/-4.8 versus 0.9+/-1.5 mg/L, P<0.001 for hsCRP; 1.99+/-1.30 versus 1.42+/-1.01 pg/mL, P=0.05 for hsIL-6; and 78+/-38 versus 59+/-29 ng/mL, P=0.01 for E-selectin). There were no differences in the levels of ICAM-1 and VCAM-1 between groups. Obese children had lower peak FMD response (7.70+/-6.14 versus 11.06+/-3.07%, P=0.006) and increased IMT (0.37+/-0.04 versus 0.34+/-0.03 mm, P=0.03) compared with controls. Morbidly obese children (n=14, BMI 44.1+/-3.9 kg/m2) had highest levels of hsCRP (8.7+/-0.7 mg/L), hsIL-6 (3.32+/-1.1 pg/mL), and E-selectin (83+/-40 ng/mL). A proinflammatory state is detectable in obese children, which is accompanied by impaired vascular endothelial function and early structural changes of arteries, even in young subjects at risk. It remains to be determined whether high hsCRP in obese children predicts cardiovascular events.

Introduction: Cardiovascular disease (CVD) is the leading cause of mortality in patients with type 1 diabetes (T1D). There is increasing evidence that maladaptive changes in vascular properties occur early in adolescence. Wall shear stress (WSS) plays crucial role in mechanotransduction and tissue remodeling. However, changes in aortic WSS and vascular properties in T1D adolescents and their associations with T1D biomarkers have yet to be determined. Hypothesis: We hypothesized that non-invasively MRI derived WSS and vascular markers of stiffness will be altered in T1D adolescents. Methods: Fourteen adolescents with T1D and 25 age-matched controls underwent prospective phase-contrast MRI (PC-MRI). Segmented cross sectional planes were selected above the sinotubular junction, transverse to the descending aorta. Maximum WSS values were computed from time specific generated shear fields. Aortic strain (AoS), distensibility (Ds), and stiffness index β (SI) were computed using vessel areas and pulse pressure. All measured hemodynamic and vascular markers were correlated with standard T1D biomarkers: A1C hemoglobin, cholesterol, LDL, HDL, and triglyceride levels. The significance between reported median values was assessed using Wilcoxon Ranked sum method and single linear regression analysis using Spearman rho. Results: Subjects with T1D showed significantly increased maximum WSS (dyne/cm2) in both ascending aorta (11.1 vs. 9.02, p = 0.0065) and descending aorta (13.7 vs. 12.3, p = 0.0166). Furthermore, AoS and Ds (mmHg-1) were both decreased in T1D group in ascending aorta (AoS: 25.1 vs. 29.7, p = 0.0352; Ds: 0.49 vs. 0.71, p = 0.0151) and descending aorta (AoS: 20.1 vs. 26.5, p = 0.0002; Ds: 0.41 vs. 0.66, p = 0.0082). Inversely, SI was higher in T1D group in both vessel segments (0.030 vs. 0.018, p = 0.0021 and 0.034 vs. 0.020, p = 0.0017). There were no significant correlations between PC-MRI derived vascular metrics and collected biomarkers. Conclusions: T1D adolescents show early aortic stiffness and altered WSS. Neither WSS nor stiffness markers correlated with A1C hemoglobin or lipid biomarkers. This suggests that potential therapeutic targets of the early vascular remodeling are beyond standard glycemic and lipid control.

To evaluate macular and peripapillary vascular changes by optical coherence tomography angiography (OCTA) in children with type 1 diabetes mellitus (T1DM) without diabetic retinopathy (DR). This study included 46 patients with T1DM and 46 age-sex matched healthy subjects. All participants were evaluated in terms of macular and optic disk parameters by using AngioVue. Foveal avascular zone (FAZ) area, macular and optic disk vessel density (VD) were analyzed. The correlation of these parameters with metabolic factors such as disease duration, mean hemoglobin A1c (HbA1c), insulin-like growth factor 1 (IGF-1) standard deviation score (SDS), homocysteine (Hcy) level, body mass index (BMI) SDS and daily insulin dose was also investigated in T1DM group. No significant difference was found in FAZ area and optic disk radial peripapillary capillary (RPC) VD comparing diabetic and control groups. In all macular regions, VD was significantly lower in T1DM versus control group both in superficial capillary plexus (SCP) and deep capillary plexus (DCP). None of the metabolic parameters was correlated with FAZ area and optic disk RPC-VD. Vascular density in SCP was negatively correlated with mean HbA1c and positively correlated with IGF-1 SDS. Homocysteine level was negatively correlated with DCP-VD in all areas. In children with T1DM without clinically apparent DR, VD in SCP and DCP was decreased and OCTA is a valuable imaging technique for detecting early vascular changes. The metabolic parameters such as mean HbA1c, IGF-1 SDS and Hcy affect the macular VD in diabetic children. 2011-KAEK-2, 2021/4, Trial registration date: 02.04.2021.

Postoperative tetralogy of Fallot (TOF) patients often develop progressive aortic root dilatation due to an impairment in aortic elastic properties. (1) to assess aortic elasticity at the level of the aortic upper wall by tissue Doppler imaging (TDI); (2) to evaluate the influence of aortic elasticity on left ventricular (LV) diastolic function in TOF patients. Twenty-eight postoperative TOF patients (14 males, 14 females. Mean age: 25.7 ± 1.6 years) and 28 age- and sex-matched normal subjects were examined. Aortic distensibility and stiffness index were calculated. Aortic wall systolic and diastolic velocities, LV systolic and diastolic parameters were assessed by TDI. Aortic distensibility was significantly lower (P = .024), and aortic stiffness index significantly higher (P = .036) in TOF patients compared to controls. E/E' was significantly higher in TOF than in control group (P < .001). Aortic upper wall early diastolic velocity (AWEDV) was significantly correlated with aortic stiffness index (r: -0.42; P < .03), aortic distensibility (r = 0.54; P < .004), left atrial volume (r = -0.62; P = .0004), and E/E' ratio (r = -0.87; P < .0001). The latter relationship remained significant even when excluding the influence of age at surgery (r = -0.60; P < .0007) and of previous palliative surgery (r = -0.53; P < .02). Aortic elastic properties can be directly assessed using TDI to measure AWEDV. Aortic elasticity is significantly lower in postoperative TOF patients, exerting a negative effect also on LV diastolic function, with a potential long-term influence on clinical status.