Aortic AIx Research Articles

Acute Alterations To Arterial Stiffness In Young Adults With SARS-CoV-2

INTRODUCTION: Contracting SARS-CoV-2 has been implicated in systemic vascular alterations. While our group has recently observed decrements to vascular function among young adults who have recently contracted SARS-CoV-2, much less is known regarding the impact of SARS-CoV-2 to the vascular architecture. PURPOSE: The purpose of this study was to determine if SARS-CoV-2 alters carotid-femoral pulse wave velocity (PWVcf), pulse wave analysis (PWA), and carotid stiffness following a positive test result. Using a cross-sectional study design, we hypothesized that PWVcf, PWA, and carotid stiffness would be higher among individuals who recently contracted SARS-CoV-2 compared to healthy controls. METHODS: We tested 14 young adults (8F/6M, 21 ± 1y, 24 ± 3 kg·m-1) 3-4 weeks following a positive SARS-CoV-2 test result compared to young healthy adults who had not tested positive for SARS-CoV-2. Doppler ultrasound was used to determine carotid stiffness, distensibility, compliance, and carotid-femoral PWV (PWVcf); Sphygmocor was utilized for assessing aortic AIx, aortic augmentation (AP), and aortic AIx standardized at 75 bpm ([email protected]). RESULTS: Differences were observed between groups in PWVcf (Control: 5.02 ± 0.49m·s-1; SARS-CoV-2: 5.77 ± 0.99m·s-1), carotid stiffness (Control: 4.96 ± 0.71 m/s; SARS-CoV-2: 5.88 ± 0.93 m/s), Young’s Modulus (Control: 396 ± 120 kPa; SARS-CoV-2: 576 ± 224 kPa), and [email protected] (Control: -2.8 ± 15.5%; SARS-CoV-2: 9.5 ± 6.9%) (p < 0.05). However, carotid distension (Control: 0.58 ± 0.16 mm; SARS-CoV-2: 0.62 ± .18 mm) was not different between groups (p > 0.05). CONCLUSION: These data suggest decrements to vascular architecture as indicated by increased measures for arterial stiffness and augmentation index in young adults following contraction of SARS-CoV-2. These vascular alterations may have implications for cardiovascular disease risk among those recovering from SARS-CoV-2. Support or Funding Information: Funding was provided by the Appalachian State University Office of Research (COVID-19 Research Clusters Program Award).

Impaired pulse pressure amplification, augmentation index, and arterial stiffness are associated with reduced limb lean mass in overweight and obese postmenopausal women.

The age-related muscle mass loss has been associated with increased arterial stiffness (brachial-ankle pulse wave velocity, baPWV) and wave reflection (augmentation index, AIx). In healthy individuals, pulse pressure (PP) is lower in the aorta compared to the brachial artery (PP amplification, PPA). Postmenopausal women experience elevated aortic stiffness leading to increased AIx and aortic PP causing reduced PPA, an independent predictor of cardiovascular mortality. It is unknown whether appendicular skeletal muscle index (ASMI), arm (ArmLM) or leg lean mass (LegLM) are negatively associated with PPA. The purpose of this study was to investigate the associations between vascular function (PPA, AIx, and baPWV) and lean mass (ASMI, ArmLM, and LegLM) in postmenopausal women. The study was performed in 93 postmenopausal women (48-71years; BMI: 30±7kg/m2). PPA (brachial/aortic PP), aortic AIx, and baPWV were measured. ArmLM and LegLM were measured by dual-energy X-ray absorptiometry. ASMI was calculated as (ArmLM+LegLM)/Ht2. Associations between vascular and lean mass measures were analyzed by multiple linear regression. PPA was associated with ASMI (β=0.29, p=.016) and LegLM (β=0.25, p=.028) after adjustment for age, height, systolic pressure, strength, and heart rate. AIx was associated with ASMI (β=-0.27, p=.011), ArmLM (β=-0.25, p=.023), and LegLM (β=-0.22, p=.026), while baPWV was associated with reduced ASMI (β=-0.23, p=.043) and ArmLM (β=-0.23, p=.045), but not with LegLM (β=-0.19, p=.074) after full adjustment. Our findings indicate that impaired pulsatile hemodynamics (PPA and AIx) are negatively associated with ASMI and LegLM, while arterial stiffness is negatively associated with ASMI and ArmLM. Thus, vascular dysfunction may be implicated in muscle mass loss in overweight and obese postmenopausal women.

Brain arterial dilatation modifies the association between extracranial pulsatile hemodynamics and brain perivascular spaces: the Northern Manhattan Study.

Pulsatile hemodynamics are associated with brain small perivascular spaces (SPVS). It is unknown whether the stiffness of intermediary arteries connecting the aorta and brain modifies this association. Participants from the Northern Manhattan Study were assessed for SPVS (defined as ≤3 mm T1 voids) and white matter hyperintensity volume (WMH) using MRI. Middle (MCA) and anterior cerebral arterial (ACA) diameters (measured on time-of-flight MRA) and CCA strain (assessed by ultrasound) were used as surrogates of stiffness. Brachial and aortic pulse pressure (PP) and aortic augmentation index (Aix, assessed by applanation tonometry) were used as markers of pulsatility. We tested whether stiffness in intermediary arteries modifies the association between extracranial pulsatility with SPVS and WMH. We found that among 941 participants (mean age 71 ± 9 years, 60% women, 66% Hispanic), the right MCA/ACA diameter was associated with right anterior SPVS (B = 0.177, P = 0.002). Brachial PP was associated with right anterior SPVS (B = 0.003, P = 0.02), and the effect size was bigger with right MCA/ACA diameter in the upper tertile (P = 0.001 for the interaction). The association between right CCA strain and ipsilateral SPVS was modified by MCA/ACA diameter, with the largest effect size in those with ipsilateral MCA/ACA diameter in the upper tertile (P = 0.001 for the interaction). Similar dose-effects and statistical interactions were replicated using aortic AIx or aortic PP. We found no evidence of effect modification between pulsatile measures and WMH by stiffness measures. In summary, pulsatile hemodynamics relate to brain SPVS, and the association is the strongest among individuals with dilated brain arteries.

Total Sleep Deprivation Does Not Adversely Affect Arterial Stiffness, Wave Reflection and Aortic Pressure in Young Healthy Men

Sleep deprivation is a common problem and may contribute to increased risk for development of cardiovascular disease. The influence of sleep deprivation on arterial stiffness, wave reflection and aortic pressure, independent predictors of cardiovascular disease, has not been fully elucidated. Therefore, the purpose of this study was to investigate the acute effects of total sleep deprivation (TSD) on arterial stiffness, wave reflection and aortic pressure in young healthy men. Twelve participants (22 ± 1 yrs, means ± SE) completed this study. Participants were free of clinical disease and sleep disorders, and did not use tobacco products, or take medications. Arterial stiffness (carotid to femoral pulse wave velocity; cfPWV), wave reflection (aortic augmentation index; AIx), and aortic blood pressures (systolic and diastolic blood pressure; aoSBP and aoDBP, and pulse pressure aoPP) were assessed using a validated cuff‐based device (SphygmoCor XCEL, AtCor Medical). Measures were obtained at the same time in the morning following a night of regular sleep (CON) and a night of TSD. During TSD, participants rested quietly under supervision and abstained from caffeine for ≥20 hrs. The average duration of sleep deprivation was 26.3 ± 1.3 hrs. In response to TSD, cfPWV did not significantly change (6.6 ± 0.2 vs. 6.4 ± 0.2 m·s−1; CON vs. TSD; P = 0.1). Aortic pressures (aoSBP: 104 ± 2 vs. 105 ± 2 mmHg; aoDBP: 69 ± 2 vs. 71 ± 3 mmHg; and aoPP: 34 ± 2 vs. 34 ± 1 mmHg; P≥0.5) and AIx also remained unchanged in response to TSD (9 ± 3 vs. 5 ± 2 %; P = 0.1). In conclusion, TSD does not adversely affect arterial stiffness, wave reflection or aortic pressure in young healthy men. Future investigations should explore the influence of TSD in populations at high risk for developing cardiovascular disease.Support or Funding InformationThis work was supported by the Gatorade Trust through funds distributed by the University of Florida, Department of Medicine.This abstract is from the Experimental Biology 2019 Meeting. There is no full text article associated with this abstract published in The FASEB Journal.

Retinal micro-vascular and aortic macro-vascular changes in postmenopausal women with primary hyperparathyroidism

Aim of the study was to evaluate the micro and macro-vascular changes in patients with primary hyperparathyroidism (PHPT) compared to controls. 30 postmenopausal PHPT women (15 hypertensive and 15 normotensive) and 30 normotensive controls underwent biochemical evaluation of mineral metabolism and measurements of arterial stiffness by 24 hour ambulatory blood pressure monitoring. Retinal microcirculation was imaged by a Retinal Vessel Analyzer. PHPT patients also underwent bone mineral density measurements and kidney ultrasound. PHPT patients had higher mean calcium and parathyroid hormone values compared to controls. Evaluating macro-vascular compartment, we found higher values of 24 hours-systolic, diastolic blood pressure, aortic pulse wave velocity (aPWV) and aortic augmentation index (Aix) in hypertensive PHPT, but not in normotensive PHPT compared to controls. The eye examination showed narrowing arterial and venular diameters of retinal vessels in both hypertensive and normotensive PHPT compared to controls. In hypertensive PHPT, 24 hours systolic blood pressure was associated only with parathyroid hormone (PTH) levels (beta = 0.36, p = 0.04). aPWV was associated with retinal diameter (beta = −0.69, p = 0.003), but not with PTH. Retinal artery diameter was associated with PTH (beta = −0.6, p = 0.008). In the normotensive PHPT, only PTH was associated with retinal artery diameter (beta = −0.60, p = 0.01) and aortic AIx (beta = 0.65, p = 0.02). In conclusion, we found macro-vascular impairment in PHPT and that micro-vascular impairment is negatively associated with PTH, regardless of hypertension in PHPT.

Diabetes Retinopathy (DR) Relates to Complication Risk in Young Persons with T1D

Young persons who develop DR may represent a high-risk group for early development of other complications. In young persons with youth-onset T1D, we evaluated associations between DR status and markers of other T1D complication risk. Youth (N=127), mean age 21.7 y (range 10.7-31.9), mean T1D onset 6.3 y (range 0.5-17.6) underwent DR assessment (ETDRS-protocol 7 field fundus photos); renal, neuropathic, and CVD risk screenings; and risk screening by blood/urine studies. DR was classified as none (No DR, 37%), mild nonproliferative (Mild DR, 46%), and more than mild NPDR (Advanced DR, 17%). More severe DR was associated with greater age, T1D duration, A1c, and weight status (Table). DR severity was associated with neuropathy, vascular stiffness by pulse wave (aortic AIx), and inflammatory, oxidative stress, and endothelial activation markers (CRP, isoprostane, e-selectin). Paradoxically, greater DR was associated with less PAI-1. After adjustment for age, T1D duration, weight, and A1c by ANCOVA, DR status was associated with differences in cooling threshold (7.6, 8.6, 12.3, p=.0003) and e-selectin (39.8, 34.0, 46.0, p=.02). Young persons with DR have high risk for neuropathic, renal, and CVD complications. While PAI-1 is lower, markers of inflammation and oxidative stress are higher in this group. Optimal glycemic control must be prioritized to prevent or delay DR progression and other complications in young persons with DR. Unadjusted Associations Between Clinical Factors and DR Status, *indicates ln transformed p valueClinical FactorNo DR (n=47) Mean or Median or %Mild DR (n=59) Mean or Median or %Advanced DR (n=21) Mean or Median or %P value ANOVA or Chi-squareAge (yrs)/T1D Duration (yrs)/A1c (%)18.9/13.2/8.022.6/15.8/8.625.8/19.6/9.1&amp;lt;.0001/&amp;lt;.0001/.03Sex (% male)/Overweight/obese (%)60/3236/6148/57.05/.009Urinary Albumin Excretion* /eGFR per 1.73m27.3/128.26.4/141.29.3/140.6.04/.02Neuropathy (MNSI)/Warm Threshold/Cold Threshold1.3/14.6/7.11.9/15.3/8.63.0/18.2/13.4.004/.005/&amp;lt;.001Mean SBP/Mean DBP/Aortic AIx110/68/2.0112/71/9.0115/74/11.1.2/.008/.003PAI1* (ng/ml)/CRP* (mg/l)/IGF1 (ng/ml)36.8/0.8/207.526.2/2.5/160.614.4/2.7/138.8&amp;lt;.001/.002/.002E-selectin(ng/ml)/Urine isoprostane* (ng/ml)40.8/0.2034.5/0.3441.8/0.40.1/.002 Disclosure M. Katz: None. G.L. King: Research Support; Self; Sanofi-Aventis. J. Sun: Other Relationship; Self; Novartis Pharmaceuticals Corporation. Research Support; Self; Genentech, Inc., Optovue, Incorporated, Boston Micromachines Corporation, Adaptive Sensory Technology, Kalvista Pharmaceuticals, Inc.. Other Relationship; Self; Novo Nordisk Inc. L.M. Laffel: Consultant; Self; Eli Lilly and Company, Novo Nordisk Inc., Sanofi US, MannKind Corporation, Roche Diagnostics Corporation, Dexcom, Inc., Insulet Corporation, AstraZeneca, Boehringer Ingelheim Pharmaceuticals, Inc., Johnson &amp; Johnson Diabetes Institute, LLC..

ACUTE EFFECTS OF SURGICAL AORTIC VALVE REPLACEMENT ON AORTIC HEMODYNAMICS AND WAVE REFLECTIONS

Objective: Aortic hemodynamics and wave reflections are independent predictors of adverse cardiovascular events. Surgical aortic valve replacement (SAVR) is still the first choice for treatment of patients with aortic stenosis. We sought to investigate in this pilot study the effect of SAVR upon aortic vascular function and hemodynamics. Design and method: Twenty-five patients (mean age 71.0 ± 7.1 years, 11 female) with severe aortic stenosis undergoing SAVR were included. Aortic hemodynamics and wave reflections (aortic pressures, aortic augmentation index [[email protected]], augmented pressure) and subendocardial viability ratio (SEVR) were measured with Sphygmocor. Measurements were conducted prior to the surgery and at discharge. Results: There was a statistically significant decrease in aortic systolic blood pressure (SBP) (134 ± 24 vs 118 ± 17mmHg with p = 0.002, respectively). that was not apparent in peripheral SBP. Diastolic blood pressure (both peripheral and aortic) did not change significantly, while heart rate was increased after the surgery (67 ± 11 vs 88 ± 15 bpm with p < 0.001, respectively). We observed a marginally significant decrease in aortic [email protected] (29 ± 13 vs 22 ± 12% with p = 0.05, respectively) and a decrease in aortic AIx (p < 0.001, Figure) and augmented pressure (20 ± 10 vs 8 ± 7 mmHg with p < 0.001, respectively). Moreover, there was a marginally non-significant trend for an increase in SEVR (137 ± 30 vs 149 ± 35%, p = 0.095). Conclusions: Our study shows that shortly after SAVR subjects show a decrease in aortic wave reflections with a small improvement of myocardial perfusion. These findings further elucidate the short-term hemodynamic consequences of SAVR.

PULSE WAVE VELOCITY NON-DIPPING PATTERN IS ASSOCIATED WITH CARDIOVASCULAR MORTALITY IN HYPERTENSIVE PATIENTS UNDERGOING CHRONIC HEMODIALYISIS

Objective: Increased arterial stiffness is established as an independent cardiovascular (CV) risk factor. Although this association was found also in patients undergoing hemodialysis (HD), reports are frequently contradictory largely because measurements were obtained shortly before or after HD. The aim of our study was to analyze circadian variations of aortic stiffness using ABPM device which provides valid measures in ambulatory conditions and association with CV mortality. Design and method: A total of 31 hypertensive patients (19 M, 12 F; averaged age 59.4) who had been on intermittent HD treatment for more than 6 months were enrolled in this study (22.6% diabetic, 16.1% smokers) and followed up for average 18.6 months. Patients received HD treatment 4 hr/session three times a week during the study period. TensioMed Arteriograph which records oscillometric BP and pulse waveforms at the brachial artery and provides valid measures of aortic BP, AIx, and PWV in ambulatory conditions was applied on non-dialysis midweek day. Control group consist of 25 healthy subjects without prior diabetes, CKD, hypertension and hyperlipidemia. Results: Systolic BP, PWV and AIx non-dipping patterns were found in 74.2%, 64.5% and 61.3% of patients. We failed to find difference in AIx dipping pattern between patients and control subjects (38.7% vs. 28.0%; p = 0.4) while PWV non-dipping pattern was significantly more frequently found in HD patients (64.5% vs. 16.0%, p < 0.001). At the end of follow-up period 13 (41.9%) patient died from CV deaths. We have not found any differences in age, dialysis parameters, comorbidity, HD therapy and laboratory parameters between survived and deceased HD patients. Differences in basal systolic and diastolic BP, PWV, AIx between survived and deceased were not statistically significant. There were no differences in number of BP and AIx non-dippers between survived and deceased patients while significantly higher number of deceased patients had PWV nocturnal non-dipping pattern (84.5% vs.50.0%, p = 0.04). Conclusions: A newly introduced ABPM devices for ambulatory recordings provide new insights on importance of arterial stiffnes for CV moratlity in patients undergoing HD. Our results showed that PWV non-dipping pattern is independently associated with CV moratily.

Acupuncture therapy improves vascular hemodynamics and stiffness in middle-age hypertensive individuals

Acupuncture (ACU) is becoming a more common practice among hypertensive individuals. However, the reported therapeutic effects of ACU in lowering brachial blood pressure (BP) are ambiguous. Therefore, evaluating more sensitive markers of arterial functioning might unveil the protective effects of ACU on hypertension. We examined the effects of an 8-week ACU therapy intervention on vascular hemodynamics and stiffness in middle-age hypertensive individuals. Participants were randomly assigned to either ACU (n = 23) or a control group (n = 22). Brachial and aortic BP, wave reflection (AIx) and arterial stiffness (SI) were measured before and after 8 weeks. There was a significant group x time interaction (P < 0.05) for brachial and aortic BP, AIx and SI which significantly decreased (P < 0.05) following ACU but not after control. ACU led to reductions in brachial and aortic BP, wave reflection and arterial stiffness in middle-age hypertensive individuals. ACU might be effective in the prevention and treatment of hypertension.

Acute and chronic effects on central hemodynamics and arterial stiffness in professional rowers

Controversial data exist on acute and chronic effects of competitive sports on central hemodynamics and arterial stiffness. We investigated chronic as well as acute training effects in professional rowers. The trial was planned as a non-randomized, controlled pilot-study comparing athletes and controls. 13 German national team rowers (24.1 ± 1.5 years) and 12 controls (23.8 ± 0.8 years) participated. Aortic, brachial hemodynamics and arterial stiffness were measured (Arteriograph, TensioMed®, Hungary) before and after a standardized exercise test. Chronic heart rate (49 2 bpm versus 70 2 bpm, p < 0.05) as well as brachial diastolic pressure (65 2 mmHg versus 74 2 mmHg, p < 0.05) was significantly lower in rowers. Physical power (305 63 versus 158 60 W, p < 0.001) was better. Chronic aortic pulse pressure (41.6 6.0 versus 35.2 3.8 mmHg; p < 0.01) and AIx (9.1 5.4 versus 7.0 10.2; p < 0.01) were significantly higher in athletes. After the all-out test (acute effects) pulse wave velocity (rowers: 6.6 1.2 m s−1 versus 7.8 1.6 m s−1, p < 0.001; control group 6.0 0.4 m s−1 versus 8.0 1.4 m s−1, p = 0.005) and heart rate (rowers: 49 2 bpm versus 91 3 bpm, p < 0.001; control group 70 2 bpm versus 92 4 bpm, p < 0.001) increased significantly in both groups. The controls’ aortic AIx (7.0 10.2 versus 2.0 6.0; p < 0.01) decreased significantly after exercise. Professional rowers showed higher chronic aortic pulse pressure and arterial stiffness. Given the risk associated with elevated aortic pulse pressure and AIx for development of cardiovascular diseases, longterm observations of professional rowers are needed with respect to arterial stiffness and prognosis. Furthermore the acute effects need additional research.

Hemodialysis patients with intradialytic rise in blood pressure display higher baseline aortic stiffness and negligible drop in augmentation index with dialysis.

In hemodialysis patients, the intradialytic rise in blood pressure (BP) is associated with increased mortality risk. However, the mechanisms of this adverse effect are not yet elucidated. This study examined whether intradialytic rise in BP is associated with increased arterial stiffness and wave reflections, which are powerful cardiovascular risk predictors in hemodialysis. The pattern of intradialytic hemodynamic response was evaluated in 70 prevalent hemodialysis patients, by measuring seated brachial BP before and after the mid-week dialysis session. All patients had pre- and post-dialysis determination of aortic pulse wave velocity (PWV) and heart rate-adjusted augmentation index [AIx(75)], as measures of arterial stiffness and wave reflections, with the Sphygmocor device. Intradialytic rise in brachial systolic BP (SBP) was evident in 17 patients, whereas intradialytic change in SBP (ΔSBP) of -10 to 0 mmHg was observed in 23 and ΔSBP greater than -10 mmHg in 30 patients. Participants with intradialytic SBP rise had significantly higher pre-dialysis aortic PWV (10.4 ± 1.6 vs 8.3 ± 1.9 vs 9.4 ± 2.4 m/s, P < 0.01) and AIx(75) (28.1 ± 7.3 vs 21.7 ± 8.6 vs 25.8 ± 8.2%, P < 0.05) than those experiencing intradialytic ΔSBP of -10 to 0 and greater than -10 mmHg, respectively. Patients with rise in SBP during dialysis exhibited also lower intradialytic reduction in AIx(75) (-1.5 ± 4.9 vs -5.4 ± 5.9 vs -6.7 ± 5.3%, P < 0.001). This study shows that aortic stiffness and wave reflections are higher and not affected by dialysis procedure in patients with intradialytic SBP rise, suggesting that accelerated arteriosclerosis may be one possible explanation for the heightened cardiovascular risk associated with intradialytic hypertension.

Changes in Vascular Tone Occur Early During Hemodialysis Treatments Independently of Volume Reduction

Hypotension commonly occurs during hemodialysis (HD). Hypotension can result from an absolute reduction in plasma volume following excessive ultrafiltration or from a reduction in vascular tone. We hypothesized that changes in vascular tone could occur during dialysis. Aortic pulse wave velocity (aPWV) was measured in 197 HD patients, mean age 63.3 ± 16.6 years, 62% male, 49% diabetic, during a single HD session. aPWV did not change (9.6 ± 2.2 vs. 9.6 ± 2.2 m/s) with HD. Systolic blood pressure (SBP) declined from 151 ± 31 to 147 ± 32 after 20 min and to 140 ± 36 mm Hg on completion of HD (P < 0.05), with an ultrafiltration volume of 2.2 ± 0.9 L over a 3.9 ± 0.4 h HD session. Aortic SBP declined from 154 ± 32 to 146 ± 29 after 20 min and 143 ± 35 at the end of HD, P < 0.001. Aortic augmentation index (Aortic Aix) decreased from 65% (52-79%) to 36.7% (23.3-52.9%) by 20 min and to 34.3 (15.1-49.1%) on completion of HD (P < 0.05), and brachial augmentation index (brachial Aix) from 5.7% (-25.2 to 27.5%) to -1.9% (-2.2 to 30.1%) and -6.6% (-44 to 22.7%), respectively, P < 0.05. Diastolic reflection area (DRA) increased from 36.7 (27.9-46.3) to 40.4 (32.2-51) after 20 min and 47.1 (34.2-60.5) on completion of HD, P < 0.05. We report changes in arterial tone within 20 min of starting HD, when minimal ultrafiltration has occurred, suggesting that volume changes may not be the only predisposing cause of intradialytic hypotension. The combination of a fall in SBP and a rise in DRA would suggest a reduction in coronary blood flow in keeping with reports of "myocardial stunning" during HD.

Impact of age on aortic wave reflection responses to metaboreflex activation and its relationship with leg lean mass in post-menopausal women

Wave reflection (augmentation pressure [AP] and index [AIx]) is greater in older women than men. Resting AP is a better wave reflection index than AIx in older adults. The negative relationship between wave reflection and lean mass (LM) has been inconsistent. We investigated the impact of age and LM on aortic hemodynamic responses to metaboreflex activation in post-menopausal women. Post-menopausal women, younger and older (n=20 per group) than 60years, performed 2-min isometric handgrip at 30% of maximal force followed by 3-min post-exercise muscle ischemia (PEMI). We measured carotid–femoral pulse wave velocity (cfPWV) and femoral-ankle PWV (faPWV) at rest, and aortic systolic blood pressure (aSBP), pulse pressure (aPP), AP, AIx, and AIx-adjusted for heart rate (AIx@75) at rest and during PEMI using tonometry. Arm and leg LM were measured by DEXA. Resting cfPWV, aSBP, and aPP were higher, while AIx@75 and leg LM were lower in older than younger women. aSBP and aPP increased similarly during PEMI in both groups. Increases in AP (P<0.05), AIx (P<0.05), and AIx@75 (P<0.01) during PEMI were greater in older than younger women. From these responses, only AP during PEMI was correlated (P<0.05) positively with aSBP and aPP responses, and negatively with leg LM. Resting faPWV, but not cfPWV, was correlated (P<0.01) with AP, aSBP, and aPP during PEMI. Therefore, PEMI induces greater wave reflection responses in older than younger post-menopausal women. Our findings suggest that the increased AP response to PEMI is related to leg arterial stiffness and muscle loss in older women.

5B.03

Objective: The present study was designed to investigate the relationship between left ventricular elastance (ELV), arterial elastance (EA), parameters of vascular stiffness and the influence of gender in a population of hypertensive individuals at high cardiovascular (CV) risk. Design and method: Seventy eight subjects participated in the study. Trans-thoracic cardiac ultrasound exam and parameters of aortic stiffness (carotid-femoral pulse wave velocity, PWV) wave reflection (augmentation index, AIx), aortic and carotid pulse pressure (PP) were obtained. Ultrasound images of the common carotid artery were acquired for the assessment of intima-media thickness (IMT) as well as carotid compliance (CC) and distensibility coefficient (DC). Results: The mean age of subjects was 62,5 years old, 37,2% had diabetes, 48,7% dyslipidemia, 7,7% previous CV events. Women (43%) and men were superimposable for CV risk factors except for older age (63.3 ± 9.2 vs 57.5 ± 10.4 years, p < 0.001) and greater prevalence of dyslipidemia (66% vs 35%, p = 0.04). In the overall population ELV was significantly correlated with EA (r = 0.79,p < 0.001), age, gender and BMI (r = 0.30,p = 0.07,r = -0.64,p < 0.001,r = -0.32,p = 0.004 respectively), AIx (r = 0.53,p < 0.001), aortic PP (r = 0.39,p < 0.001) CC (r = -0.44, p < 0.001) and DC (r = -0.27, p = 0.02), but not with PWV (r = 0.13,p = 0.28). In the multiple regression model including EA, ELV was still significantly correlated with EA, BMI, gender (all p < 0.001) and aortic PP (p = 0.004). Conversely, DC and PWV were not. DC, CC, PWV and IMT were similar in men and women. ELV (p < 0.0001) and EA (p = 0.0002) were higher in women than in men, while EA/ELV was lower (p = 0.0003). While EA and BMI were significantly correlated with ELV both in men (r = 0.74,p < 0.0001) and women (r = 0.77,p < 0.0001), DC was correlated with ELV only in women (women r = 0.04,p = 0.03, men r = -0.21,p = 0.17), and aortic PP (men r = 0.44,p = 0.002, women r = 0.44, p = 0.01) and AIX (men r = 0.37,p = 0.002, women r = 0.33, p = 0.06) only in men. Conclusions: In hypertensive individuals, main determinants of ventricular elastance are arterial elastance as an integrated index of arterial vascular load, central PP, gender and BMI. However, large artery stiffness in women and pressure augmentation in men might play an additional role.

L-Citrulline Supplementation Attenuates Cardiovascular Responses to Metaboreflex Activation with Cold Exposure in Young Overweight Men

Cold-induced increases in left ventricular afterload may increase the risk for cardiac events in individuals with high cardiovascular risk. Obese individuals have higher blood pressure (BP) and sympathetic responses to post-exercise muscle ischemia (PEMI) than lean counterparts. L-citrulline supplementation attenuates systolic BP (SBP) and pressure wave reflection (augmentation index, AIx) responses to the cold pressor test (CPT), but the capacity of L-citrulline to reduce aortic hemodynamics and arterial stiffness responses during PEMI with and without cold exposure is unknown. PURPOSE: To examine if L-citrulline supplementation would attenuate hemodynamic responses to PEMI with and without CPT (PEMI+CPT). METHODS: Fourteen healthy overweight/obese men (age 24 ± 6 y; BMI 29.3 ± 4.0 kg/m2) were randomly assigned to placebo (maltodextrin) or L-citrulline (6 g/day) supplementation for 14 days and cross-over after 14 days of wash-out. Brachial SBP, aortic SBP, aortic AIx, brachial-ankle pulse wave velocity (baPWV, a marker of arterial stiffness), and heart rate were evaluated at baseline, during PEMI, and during PEMI+CPT. RESULTS: During PEMI, L-citrulline significantly decreased aortic AIx (-8.6 ± 2.0%; P < 0.01) compared with placebo, but did not affect brachial SBP, aortic SBP, and baPWV. During PEMI+CPT, L-citrulline decreased brachial SBP (-11 ± 3 mmHg, P < 0.01), aortic SBP (-13 ± 3 mmHg, P < 0.01), aortic AIx (-13.8 ± 2.2%, P < 0.01), and baPWV (-0.9 ± 0.4 m/s, P < 0.05) compared with placebo. CONCLUSIONS: L-citrulline supplementation attenuated the increases in peripheral and central SBP, wave reflection, and arterial stiffness during metaboreflex activation in the cold, a condition with greater vascular responses than PEMI without CPT.

The effect of physical exercise on arterial stiffness parameters in young sportsmen

Objective This study aimed to determine the eff ect of single-bout exercise on aortic stiff ness parameters in young basketball players.Method and results A total of 108 young male subjects (mean age 14.2 ± 3.4 years) were enrolled into the study. Simultaneous measurement of aortic pulse wave velocity (PWVao) and augmentation index (AIxao) were performed with the oscillometric, occlusive device. Echocardiographic parameters of left ventricular systolic and diastolic function at rest were also measured in sportsmen. We did not fi nd signifi cant diff erences of restin PWVao in comparison with young sportsmen (S) and age-matched healthy volunteers (V): 5.82 ± 0.14 m/s vs 5.83 ± 0.12 m/s for S and V groups, respectively. The values of PWVao measured after dynamic exercise, isometric exercise, and rest were 8.0 ± 0.5 m/s, 5.86 ± 0.1 m/s and 5.82 ± 0.1 m/s, respectively. We confi rmed that values after dynamic exercise are signifi cantly diff erent from those after isometric exercise ( P <0.01) and those after rest ( P <0.01). The AIxao values exhibited a considerable, but statistically non-signifi cant, decrease during dynamic exercise in the three groups (11.7 ± 7% vs 3.8 ± 3% vs- 0.9 ± 0.9% for groups 1, 2, and 3, respectively)Conclusion We applied a feasible, clinically useful method which allowed us to measure changes in aortic PWV and AIx during acute, single-bout exercise on the basketball court in young sportsmen.

Su1295 Expression of Surrogate Markers for Early Atherosclerosis (ATS) in Young Patients With Inflammatory Bowel Disease (IBD) Compared With Healthy Controls (HC)

BACKGROUND AND AIM: recent studies have documented an increased rate of cardiovascular events in IBD patients. Studies on surrogate markers for early ATS have led to conflicting results. Our aim was to investigate the prevalence of increased intima-media thickness (IMT) of the carotid arteries and of arterial stiffness in a homogeneous cohort of young patients with IBD. METHODS: we recruited 68 consecutive IBD patients (35 males), and 38 sex and age matched HC. Median age was 31.6 ± 8.1 years. Data on clinical and demographic features, cardiovascular risk factors, personal and familial history of cardiovascular events, concomitant therapies were registered on a dedicated database. Forty-five out of IBD patients had Crohn disease (CD) and 23 had Ulcerative Colitis (UC). Twenty-two CD patients had a disease duration greater than 5 years and 9 showed a clinically active disease. In the UC group 8 patients had a disease duration greater than 5 years and 3 clinically active disease. Sixteen out of 68 IBD patients were smokers, 9 ex-smokers; 29 had a family history of cardiovascular events, 3 were hypertensive and 2 patients had diabetes mellitus, 21 had a BMI greater than 25. Left and right carotid IMT was evaluated using high resolution Bmode ultrasonography. Arterial stiffness was assessed by measurement of carotid-femoral Pulse Wave Velocity (PWV) and Augmentation Index (AI). RESULTS: there was a statistically significant difference between IBD patients and HC for total cholesterol values (P <0.013) and LDL-cholesterol (P <0.019). There was no difference in lipid profile between CD and UC. There was a trend toward significance in the distribution of BMI values between patients and HC (P 0.082). Right carotid IMT was higher in IBD group than in controls (P <0.047), but there was no statistically significant difference between subjects with CD and UC. Moreover, PWV average and AORTIC AIX (AIx) were significantly higher in patients than in controls (P <0.006 and P <0.004 respectively). CONCLUSION: in our study we have found increased expression of surrogate markers for early onset ATS in young Mediterranean patients with IBD. This seems not to be related to traditional risk factors for ATS. Clinical follow-up of IBD patients should include assessment at diagnosis and monitoring of IMT of the carotid arteries and of arterial elastic properties, in order to reduce the risk of cardiovascular events.

Su1296 Diagnostic Benefit of MRE Following CT

BACKGROUND AND AIM: recent studies have documented an increased rate of cardiovascular events in IBD patients. Studies on surrogate markers for early ATS have led to conflicting results. Our aim was to investigate the prevalence of increased intima-media thickness (IMT) of the carotid arteries and of arterial stiffness in a homogeneous cohort of young patients with IBD. METHODS: we recruited 68 consecutive IBD patients (35 males), and 38 sex and age matched HC. Median age was 31.6 ± 8.1 years. Data on clinical and demographic features, cardiovascular risk factors, personal and familial history of cardiovascular events, concomitant therapies were registered on a dedicated database. Forty-five out of IBD patients had Crohn disease (CD) and 23 had Ulcerative Colitis (UC). Twenty-two CD patients had a disease duration greater than 5 years and 9 showed a clinically active disease. In the UC group 8 patients had a disease duration greater than 5 years and 3 clinically active disease. Sixteen out of 68 IBD patients were smokers, 9 ex-smokers; 29 had a family history of cardiovascular events, 3 were hypertensive and 2 patients had diabetes mellitus, 21 had a BMI greater than 25. Left and right carotid IMT was evaluated using high resolution Bmode ultrasonography. Arterial stiffness was assessed by measurement of carotid-femoral Pulse Wave Velocity (PWV) and Augmentation Index (AI). RESULTS: there was a statistically significant difference between IBD patients and HC for total cholesterol values (P <0.013) and LDL-cholesterol (P <0.019). There was no difference in lipid profile between CD and UC. There was a trend toward significance in the distribution of BMI values between patients and HC (P 0.082). Right carotid IMT was higher in IBD group than in controls (P <0.047), but there was no statistically significant difference between subjects with CD and UC. Moreover, PWV average and AORTIC AIX (AIx) were significantly higher in patients than in controls (P <0.006 and P <0.004 respectively). CONCLUSION: in our study we have found increased expression of surrogate markers for early onset ATS in young Mediterranean patients with IBD. This seems not to be related to traditional risk factors for ATS. Clinical follow-up of IBD patients should include assessment at diagnosis and monitoring of IMT of the carotid arteries and of arterial elastic properties, in order to reduce the risk of cardiovascular events.

The Effects of Magnesium-EDTA Chelation Therapy on Arterial Stiffness

Traditional risk factors for cardiovascular disease can only assess risks for groups of people. New parameters of arterial stiffness are more reliable for predicting cardiovascular outcomes for individuals with and without a cardiovascular history. The objective of this study was to assess the effects of Magnesium-EDTA chelation therapy using new methods and parameters such as pulse wave velocity (PWV), central blood pressure (SBPao) and endothelial function (Aix). We followed 43 patients with an abnormal PWV and SBPao, setting them up in two groups. The 21 patients in Group A had already been diagnosed with cardiovascular disease. The other 22 patients in Group B also showed abnormal PWV, SBPao and Aix, but showed no cardiovascular symptoms. Each patient in Groups A and B received one Mg-EDTA treatment per week. The total treatment plan consisted of 25 Mg-EDTA chelation treatments according to the standard protocol of IBCMT. After 25 Mg-EDTA chelation sessions, PWV and SBPao improved significantly in all patients of Groups A and B. In addition, Aix improved significantly in these patients, but remained abnormal. Group C included 18 asymptomatic patients with normal PWV or SBPao. Aix was abnormal in this group, but to a much lesser extent than Groups A and B. The 18 asymptomatic patients of Group C did not receive Mg-EDTA treatment. Observation showed no significant changes in all three parameters of arterial stiffness. The results of this study indicate that a course of treatment with Magnesium-EDTA chelation therapy significantly lowers cardiovascular risks. We conclude that Mg-EDTA chelation therapy improves PWV as an indicator of arterial stiffness, SBPao (central blood pressure) as an indicator of aortic elasticity and Aix (augmented aortic index) as an indicator of endothelial functioning. These improvements in PWV, SBPao and Aix demonstrate that atherosclerosis is a dynamic and (partially) reversible process.

Heritability of arterial stiffness and carotid intima-media thickness: An Italian twin study

Carotid intima-media thickness (IMT) and arterial stiffness parameters, including aortic augmentation index (AIx) and pulse wave velocity (PWV), are independent predictors of stroke and cardiovascular disease. Genetic effects on these traits were never explored in a Mediterranean country. The present study aims to quantify the contribution of genes, environment and age to carotid IMT and aortic Aix and PWV. The twin design was used. A total of 348 adult twins from the Italian Twin Register underwent measurements of carotid IMT and aortic PWV and AIx in three university hospitals located in Rome, Padua and Perugia. Carotid IMT was measured by B-mode ultrasound, aortic PWV and AIx by Arteriograph. Genetic modelling was performed to decompose total variance of traits into genetic, shared and unshared environmental and age components. For each phenotype, the best-fitting model included additive genetic, unshared environmental and age effects. For IMT, heritability was 0.32 (95% confidence interval (CI): 0.25-0.38), unshared environmental component was 0.25 (0.18-0.32) and age contribution was 0.44 (0.39-0.49). For AIx and PWV, heritabilities were 0.42 (0.29-0.55) and 0.49 (0.35-0.62), unshared environmental components were 0.31 (0.22-0.44) and 0.37 (0.26-0.51) and age contributions were 0.27 (0.16-0.39) and 0.14 (0.06-0.24), respectively. This study shows substantial genetic and unshared environmental influences on carotid intima-media thickness and arterial stiffness and confirms the relevant role of age in the aetiology of these traits. Further support is provided for prevention and health promotion strategies based on modifiable factors.