Aortic Diastolic Pressure Research Articles

Aortic Hemodynamics and Cognitive Performance in Postmenopausal Women: Impact of Pregnancy History.

BACKGROUNDStudies demonstrate an association between aortic hemodynamics and cognitive function. The impact of pregnancy history on this association is unknown.METHODSPostmenopausal women (age 59 ± 5 years; years since last pregnancy 35 ± 3) with either a history of preeclampsia (PE; n = 34) or a history of a normotensive pregnancy (NP; n = 30) underwent cognitive testing: Letter-Number Sequencing, Digit Span, Trail Making Test, and letter and category fluency. Applanation tonometry was used to derive aortic systolic and diastolic blood pressure and augmentation index.RESULTSDistribution of cognitive scores and aortic hemodynamic measures was similar between the PE and NP groups. Principal component (PC) analysis was used to reduce the 3 aortic hemodynamic measures and the 5 cognitive variables to single summary indices, each representing a weighted average of their respective constituent variables. Using a multivariable linear model based on these PCs that adjusted for pregnancy history and body mass index, the composite index of aortic hemodynamics was associated with the summary cognitive index, whether taking into account a potential interaction with pregnancy history (P = 0.035) or not (P = 0.026) (interaction P = 0.178). Multivariable modeling of individual cognitive tests revealed a differential association for letter fluency by pregnancy history (test for interaction P = 0.023); this score correlated with the aortic hemodynamic index in the PE (partial R2 = 0.20), but not the NP (partial R2 = 0.00) group.CONCLUSIONSElevated aortic hemodynamics may negatively impact cognitive function in postmenopausal women with specific executive functions, such as letter fluency, being impacted more by a pregnancy history of PE.

Acute Effects of Transcatheter Aortic Valve Replacement on Central Aortic Hemodynamics in Patients With Severe Aortic Stenosis.

Severe aortic stenosis induces abnormalities in central aortic pressure, with consequent impaired organ and tissue perfusion. Relief of aortic stenosis by transcatheter aortic valve replacement (TAVR) is associated with both a short- and long-term hypertensive response. Counterintuitively, patients who are long-term normotensive post-TAVR have a worsened prognosis compared with patients with hypertension, yet the underlying mechanisms are not understood. We investigated immediate changes in invasively measured left ventricular and central aortic pressure post-TAVR in patients with severe aortic stenosis using aortic reservoir pressure, wave intensity analysis, and indices of aortic function. Fifty-four patients (mean age 83.6±6.2 years, 50.0% female) undergoing TAVR were included. We performed reservoir pressure and wave intensity analysis on invasively acquired pressure waveforms from the ascending aorta and left ventricle immediately pre- and post-TAVR. Following TAVR, there were increases in systolic, diastolic, mean, and pulse aortic pressures (all P<0.05). Post-TAVR reservoir pressure was unchanged (54.5±12.4 versus 56.6±14.0 mm Hg, P=0.30) whereas excess pressure increased 47% (29.0±10.9 versus 42.6±15.5 mm Hg, P<0.001). Wave intensity analysis (arbitrary units, au) demonstrated increased forward compression wave (64.9±35.5 versus 124.4±58.9, ×103 au, P<0.001), backward compression wave (11.6±5.5 versus 14.4±6.9, ×103 au, P=0.01) and forward expansion wave energies (43.2±27.3 versus 82.8±53.1, ×103 au, P<0.001). Subendocardial viability ratio improved with aortic function effectively unchanged post-TAVR. Increased central aortic pressure following TAVR relates to increased transmitted power and energy to the proximal aorta with increased excess pressure but unchanged reservoir pressure. These changes provide a potential mechanism for the improved prognosis associated with relative hypertension post-TAVR.

Acute Vascular Responses to All‐Extremity Aerobic Exercise

Endothelial function and central arterial stiffness are independent predictors of future cardiovascular events. High‐intensity interval training (HIIT) is a popular and oftentimes superior exercise strategy for decreasing cardiovascular disease risk than moderate‐intensity continuous training (MICT). We have recently adapted HIIT on a non‐weight‐bearing all‐extremity ergometer to reduce impact on the joints and involve muscles in the whole body to activate a larger amount of muscle mass than in lower‐extremity HIIT. However, the acute vascular responses to all‐extremity HIIT and MICT remain unexplored and may be important for optimizing exercise prescription. Therefore, the purpose of this study was to investigate the acute effects of all‐extremity HIIT and MICT on endothelial function, central arterial stiffness and hemodynamics. Sixteen young men (21±1 years of age, means±SE) who were free of clinical disease and did not use tobacco products or medications participated in this study. Vascular measures were assessed at pre‐exercise, at the end of a single session of HIIT and MICT and following recovery. HIIT and MICT were matched for caloric expenditure and were performed on an all‐extremity non‐weight‐bearing ergometer, at least one week apart. HIIT consisted of 4×4‐min intervals at 90% peak heart rate (HRpeak) interspersed by 3‐min intervals at 70% HRpeak for a total of 40 min. MICT consisted of 47 min at 70% HRpeak. Endothelial function was assessed using brachial artery flow‐mediated dilation (FMD) via high resolution ultrasonography in response to 5 min forearm blood flow occlusion. Arterial stiffness (carotid to femoral pulse wave velocity; cfPWV), aortic wave reflection (augmentation index normalized at heart rate 75; AIx75) and aortic systolic and diastolic blood pressure (aoSBP and aoDBP) were assessed using a validated cuff‐based device. HIIT did not result in significant changes in FMD (P=0.08), cfPWV (P=0.3), aoSBP (P=0.1) or aoDBP (P=0.2) within one hour from exercise cessation. AIx75 and heart rate were increased at the end of HIIT and remained elevated following recovery (P≤0.002 vs. pre‐exercise). In response to MICT, FMD remained unchanged (P=0.1). However, cfPWV decreased at the end of MICT (P=0.003) and returned to the pre‐exercise level following recovery (P=0.5). AIx75 increased at the end of MICT (P&lt;0.0001) and returned to the pre‐exercise level following recovery (P=0.3). aoSBP decreased following recovery compared with end of MICT (P=0.04), but was not different than the pre‐exercise level (P=0.3). aoDBP did not significantly change in response to MICT (P=0.09). In conclusion, all‐extremity HIIT and MICT did not attenuate endothelial function or result in adverse changes in aortic blood pressure. MICT, but not HIIT, slightly reduced central arterial stiffness. These findings may have important implications for exercise prescription.

Abstract P525: The Effect of Weight Loss Combined With Aerobic Exercise Training on Arterial Stiffness: Results From the PREVAIL Pilot Study

Objective: The OPTIFAST diet has known effects for weight loss, but little data exists on the effects of the diet on arterial stiffness. Methods: Overweight and obese (BMI: 34.5 + 4.0) adults (N=17) participated in a 10-week OPTIFAST™ weight loss program and supervised aerobic exercise training (50%-75% VO 2 max). The diet consisted of OPTIFAST meal replacement products with a goal of reducing total caloric intake to 800 kcals/day and attending a weekly weight management class. Aerobic exercise was performed 3 times per week and the exercise volume was progressed from 300 to 700 MET mins. per week at an intensity of 50%-75% VO2 max. The goal of study participants was to achieve a 7% weight loss. Carotid-to-femoral pulse wave velocity, blood pressure (aortic and brachial), vascular age, augmentation index and blood samples were measured in the morning after an overnight fast at baseline and follow-up. A paired t-test was performed to evaluate the change in outcomes variables. Results: The mean percent weight loss in the sample was 9.0% (-8.5 kg), with 83.3% of participants achieving 7% weight loss (94.1% achieving ≥5%). The adherence to the exercise program was 94.9% and attendance in the weight loss classes was 81.8%. There was a reduction in pulse wave velocity (-0.44 m/s, p=0.030), aortic systolic blood pressure (-10.5 mmHg, p&lt;0.001), aortic diastolic blood pressure (-7.8 mmHg, p&lt;0.001), brachial systolic blood pressure (-11.2 mmHg , p&lt;0.001), brachial diastolic blood pressure (-7.7 mmHg, p&lt;0.001), vascular age (-13.4 yrs., p=0.008), resting heart rate (-4.7 bpm, p=0.005), and augmentation index (-7.5%, p=0.008) after the intervention. Change in resting heart rate from the intervention was associated with improvements in augmentation index (r=0.60, p=0.010) and approached significance for pulse wave velocity (r=0.45, p=0.07). Weight loss was associated with reduction in augmentation index (r= 0.56, p=0.02), but not change in PWV (r=-0.07, p=0.78). Changes in other cardiometabolic risk factors (e.g. glucose, insulin, lipids, and body fat) were not associated with improvements in arterial stiffness or blood pressure measures (all ps&gt;0.05). Discussion: A hypo-caloric dietary program in combination with aerobic exercise training improves arterial stiffness, aortic blood pressure, and brachial blood pressure in overweight and obese adults An important limitation of the present study is that we cannot separate the health benefits of the diet from the exercise.

Deep learning for prediction of cardiac indices from photoplethysmographic waveform: A virtual database approach.

Deep learning methods combined with large datasets have recently shown significant progress in solving several medical tasks. However, collecting and annotating large datasets can be a very cumbersome and expensive task. We tackle these problems with a virtual database approach where training data is generated using computer simulations of related phenomena. Specifically, we concentrate on the following problem: can cardiovascular indices such as aortic elasticity, diastolic and systolic blood pressures, and blood flow from heart be predicted continuously using wearable photoplethysmographic sensors? We simulate the blood flow using a haemodynamic model consisting of the entire human circulation. Repeated evaluation of the simulator allows us to create a database of "virtual subjects" with size that is only limited by available computational resources. Using this database, we train neural networks to predict the cardiac indices from photoplethysmographic signal waveform. We consider two approaches: neural networks based on predefined input features and deep convolutional neural networks taking waveform directly as the input. The performance of the methods is demonstrated using numerical examples, thus carrying out a preliminary assessment of the approaches. The results show improvements in accuracy compared with the previous methods. The improvements are especially significant with indices related to aortic elasticity and maximum blood flow. The proposed approach would provide new means to measure cardiovascular health continuously, for example, with a simple wrist device.

The Implementation of an Adjustable Afterload Module for Ex Situ Heart Perfusion.

Windkessel impedance analysis has proven to be an effective technique for instituting artificial afterload on ex situ hearts. Traditional fixed parameter afterload modules, however, are unable to handle the changing contractile conditions associated with prolonged ex situ heart perfusion. In this paper, an adjustable afterload module is described comprising of three fully adjustable sub-components: a systemic resistor, a proximal resistor and a compliance chamber. Using a centrifugal pump, the systemic resistor and compliance chamber were subjected to testing across their operating ranges, whereby the predictability of resistance and compliance values was evaluated. The components were then assembled, and the full module tested on three separate porcine hearts perfused for 6h with success defined by the ability to maintain physiological systolic and diastolic aortic pressures across flow rate variability. For both the systemic resistor and compliance chamber, experimental measurements agreed with their theoretical equivalents, with coefficients of determination of 0.99 and 0.97 for the systemic resistor and compliance chamber, respectively. During ex situ perfusion, overall 95% confidence intervals demonstrate that physiological systolic (95-96.21mmHg) and diastolic (26.8-28.8mmHg) pressures were successfully maintained, despite large variability in aortic flow. Left ventricular contractile parameters, were found to be in line with those in previous studies, suggesting the afterload module has no detrimental impact on functional preservation. We conclude that due to the demonstrable control of our afterload module, we can maintain physiological aortic pressures in a passive afterload working mode across prolonged perfusion periods, enabling effective perfusion regardless of contractile performance.

Left Atrial Phasic Function in Patients with Hypertension and Recurrent Atrial Fibrillation: Gender Differences of the Relationship with Diastolic Dysfunction and Central Aortic Pressure

Aim. To evaluate gender-related differences of left atrial (LA) phasic function and structural remodeling in conjunction with the parameters of left ventricular (LV) diastolic dysfunction and central aortic pressure in patients with hypertension and recurrent atrial fibrillation (AF).Material and methods. The comparative study included 30 men and 37 women with non-valvular AF, hypertension and LV hypertrophy. Conventional echocardiographic measures were extended with LA measures, including its volume in three phases, LAemptying fraction (LAEF), passive and active ejection fraction. The parameters of central aortic pressure were estimated by applanation tonometry method.Results. No difference was observed between LA and LV structural parameters in men and women. However, in women LAEF (39 [28;50] vs 50 [42;55]%; p=0.02) and E/E’(9.7 [7.8;12] vs 7.1 [5.6;8.6]; p=0.001) were worse than in men. Active LA ejection fraction was higher in women (31 [21;42] vs 24 [19;31]%; p=0.04), whereas passive one – in men (12 [10;14] vs 33 [23;38]%; p&lt;0.001), respectively. Men and women had comparable heart rate (HR), central and peripheral systolic and diastolic pressure, pulse wave velocity (PWV), but women had higher augmentation index (AI) values [33 [28;39] vs 23 [21;28]%; p&lt;0.001], even adjusted by HR (AI 75) (34 [27;39] vs 26 [20;29]%; p&lt;0.001). Only in men PWV weakly correlated with AI 75 (r=0.44; p=0.02 versus r=-0.11; p=0.51, respectively for men and women; intergroup differences: z=2.26; p=0.012). In a multivariate regression analysis in men LAEF was significantly associated with height, weight, E’, E/E’ and glomerular filtration rate (GFR), whereas in women – with E’ and AI 75.Conclusion. Patients of different genders with recurrent AF and hypertension have comparable LA structuralremodeling. However, women characterized by a more pronounced decrease in LAEF and impaired LV diastolic function than men. In women as distinct from men LV filling is predominantly due to LA systole. In a multivariate regression analysis in men LAEF was significantly associated with height, weight, E’, E/E’ and GFR, whereas in women – with E’ and AI 75.

Liquorice ingestion attenuates vasodilatation via exogenous nitric oxide donor but not via β2-adrenoceptor stimulation.

We examined the effect of liquorice ingestion on haemodynamic responses to exogenous nitric oxide donor (nitroglycerin) and β2-adrenoceptor agonist (salbutamol), and 11β-hydroxysteroid dehydrogenase activity, in 21 volunteers and 21 reference subjects. Haemodynamic data was captured before and after sublingual nitroglycerin (0.25 mg) and inhaled salbutamol (400 μg) during orthostatic challenge utilising radial pulse wave analysis and whole-body impedance cardiography. The recordings were performed at baseline and following two weeks of liquorice intake (290–370 mg/d glycyrrhizin). Urinary cortisone and cortisol metabolites were examined. Liquorice intake elevated aortic systolic and diastolic blood pressure and systemic vascular resistance when compared with the reference group. Following research drug administration the liquorice-induced increase in systemic vascular resistance was observed in the presence of nitroglycerin (p<0.05) but no longer in the presence of salbutamol. Liquorice ingestion decreased cardiac chronotropic response to upright posture (p = 0.032) in unadjusted analysis, but when adjusted for age and sex the difference in the upright change in heart rate was no longer significant. The urinary cortisone to cortisol metabolite ratio decreased from 0.70 to 0.31 (p<0.001) after liquorice intake indicating significant inhibition of the 11β-hydroxysteroid dehydrogenase type 2. In the reference group the haemodynamic variables remained virtually unchanged. These results suggest that liquorice exposure impaired vasodilatation in vivo that was induced by exogenous nitric oxide donor but not that induced by β2-adrenoceptor stimulation.Trial registration: EU Clinical Trials Register 2006-002065-39ClinicalTrials.gov NCT01742702.

Pulse transit time estimation of aortic pulse wave velocity and blood pressure using machine learning and simulated training data.

Recent developments in cardiovascular modelling allow us to simulate blood flow in an entire human body. Such model can also be used to create databases of virtual subjects, with sizes limited only by computational resources. In this work, we study if it is possible to estimate cardiovascular health indices using machine learning approaches. In particular, we carry out theoretical assessment of estimating aortic pulse wave velocity, diastolic and systolic blood pressure and stroke volume using pulse transit/arrival timings derived from photopletyshmography signals. For predictions, we train Gaussian process regression using a database of virtual subjects generated with a cardiovascular simulator. Simulated results provides theoretical assessment of accuracy for predictions of the health indices. For instance, aortic pulse wave velocity can be estimated with a high accuracy (r > 0.9) when photopletyshmography is measured from left carotid artery using a combination of foot-to-foot pulse transmit time and peak location derived for the predictions. Similar accuracy can be reached for diastolic blood pressure, but predictions of systolic blood pressure are less accurate (r > 0.75) and the stroke volume predictions are mostly contributed by heart rate.

Increased central artery stiffness in impaired glucose and type 2 diabetes

—Impaired glucose metabolism (IGM) and type 2 diabetes (DM-2) are associated with high cardiovascular disease risk. Increases in peripheral and central artery stiffness may represent pathophysiologic pathways through which glucose tolerance status leads to cardiovascular disease. Peripheral artery stiffness increases with deteriorating glucose tolerance status, whereas this trend remains unclear for central artery stiffness. Therefore, we investigated the associations between glucose tolerance status and estimates of central arterial stiffness. We performed a population-based study of 619 individuals (normal glucose metabolism, nϭ261; IGM, nϭ170; and DM-2, nϭ188) and assessed central artery stiffness by measuring total systemic arterial compliance, aortic pressure augmentation index, and carotid-femoral transit time. After adjustment for sex, age, heart rate, height, body mass index, and mean arterial pressure, DM-2 was associated with decreased total systemic arterial compliance, increased aortic augmentation index, and decreased carotid-femoral transit time. IGM was borderline significantly associated with decreased total systemic arterial compliance. Respective regression coefficients (95% confidence intervals) for IGM and DM-2 compared with normal glucose metabolism were Ϫ0.05 (Ϫ0.11 to 0.01) and Ϫ0.13 (Ϫ0.19 to Ϫ0.07) mL/mm Hg for total systemic arterial compliance; 1.1 (Ϫ0.2 to 2.5) and 1.6 (0.2 to 3.0) percentage points for aortic augmentation index; and Ϫ0.85 (Ϫ5.20 to 3.49) and Ϫ4.95 (Ϫ9.41 to Ϫ0.48) ms for carotid-femoral transit time. IGM and DM-2 are associated with increased central artery stiffness, which is more pronounced in DM-2. Deteriorating glucose tolerance is associated with increased central and peripheral arterial stiffness, which may partly explain why both DM-2 and IGM are associated with increased cardiovascular risk. (Hypertension. 2004;43:176-181.) Key Words: diabetes mellitus Ⅲ arteries Ⅲ compliance Ⅲ vascular resistance Ⅲ total peripheral resistance B oth impaired glucose metabolism (IGM) and type 2 diabetes mellitus (DM-2) are associated with a high risk of cardiovascular disease and mortality. 1,2 The mechanisms through which these pathologies increase the risk of cardio-vascular disease remain unclear but might involve increased arterial stiffness, 3– 6 which leads to increased systolic blood pressure and left ventricular mass and hampers coronary filling during diastole. 7 Arterial stiffness varies by region and type of artery. It is likely that increased stiffness of both peripheral and central arteries is detrimental. We have previously shown that as compared with individuals with normal glucose metabolism (NGM), stiffness of peripheral arteries is increased in both IGM (femoral and brachial arteries) and DM-2 (femoral, brachial, and carotid arteries). However, it is unknown whether central artery stiffness is increased in IGM and DM-2. In view of these considerations, we investigated, in a population-based cohort of 619 individuals, the associations of glucose tolerance status with arterial stiffness, expressed as total systemic arterial compliance, which reflects the overall buffering capacity of the arterial system, mainly of the proximal aorta; 8,9 the aortic augmentation index; and the height-adjusted carotid-femoral transit time, a surrogate for carotid-femoral pulse wave velocity, 9 which reflects the stiffness of mainly the descending aorta. 8,9 Total systemic arterial compliance was estimated by 2 methods, namely, by the time decay of diastolic aortic pressure and by the ratio of stroke volume to aortic pulse pressure. Carotid-femoral transit time estimates the average

Aortic diastolic pressure decay modulates relation between worsened aortic stiffness and myocardial oxygen supply/demand balance after resistance exercise.

High-intensity resistance exercise (RE) increases aortic stiffness and decreases the index of myocardial oxygen supply/demand balance (Buckberg index, BI); there is a correlation between the changes in these parameters. Central hemodynamics during diastole can explain the correlation. We aimed to investigate whether the aortic diastolic decay index mediates the association between changes in aortic stiffness and BI by high-intensity RE. We evaluated the effect of high-intensity RE on aortic stiffness, BI, aortic decay index, and their associations in 52 young men. Subjects were studied under parallel experimental conditions on two separate days. The order of experiments was randomized between RE (5 sets of 10 repetitions at 75% of 1-repetition maximum) and sham control (seated rest). Aortic pulse wave velocity (PWV; index of aortic stiffness), BI, and aortic decay index were measured in all subjects. Aortic decay index was quantified by fitting an exponential curve: P(t) = P0e-λt (where λ is decay index, P0 is end-systolic pressure and t is time from end-systole). Aortic PWV and decay index increased and BI decreased after RE. RE conditions showed that change in the aortic decay index was associated with changes in aortic PWV and changes in aortic PWV were related to changes in BI, although the PWV-BI relationship was not significant after accounting for decay index change. Mediation analysis revealed the mediating effect of the aortic decay index on the relationship between changes in aortic PWV and BI. The present findings suggest that high-intensity RE-induced aortic stiffening worsens myocardial viability by accelerating aortic diastolic exponential decay.NEW & NOTEWORTHY Aortic pulse wave velocity (PWV) and diastolic decay index increased and Buckberg index (BI) decreased after resistance exercise (RE). Mediation analysis revealed a mediating effect of aortic decay index on the relationship between changes in aortic PWV and BI. The present study provides evidence that high-intensity RE-induced aortic stiffening accelerates aortic decay and aortic decay can account for the relationship between aortic stiffening and a deteriorated surrogate marker of myocardial oxygen supply/demand balance induced by high-intensity RE.

Ambulatory blood pressure and arterial stiffness web-based telemonitoring in patients at cardiovascular risk. First results of the VASOTENS (Vascular health ASsessment Of The hypertENSive patients) Registry.

The VASOTENS Registry is an international telehealth-based repository of 24-hour ambulatory blood pressure monitorings (ABPM) obtained through an oscillometric upper-arm BP monitor allowing combined estimation of some vascular biomarkers. The present paper reports the results obtained in 1200 participants according to different categories of CV risk. Individual readings were averaged for each recording and 24-hour mean of brachial and aortic systolic (SBP) and diastolic blood pressure (DBP), pulse wave velocity (PWV), and augmentation index (AIx) obtained. Peripheral and central BP, PWVand AIx values were increased in older participants (SBP only) and in case of hypertension (SBP and DBP). BP was lower and PWVand AIx higher in females. PWV was increased and BP unchanged in case of metabolic syndrome. Our results suggest that ambulatory pulse wave analysis in a daily life setting may help evaluate vascular health of individuals at risk for CV disease.

IMPACT OF AGGRESSIVE BLOOD PRESSURE REDUCTION ON KIDNEY FUNCTION AFTER RENAL DENERVATION

Objective: Renal denervation (RDN) seems to be safe in patients with true resistant hypertension (RHTN). However long-term effect of significant decrease of blood pressure (BP) level on renal function is lacking. We aimed to investigate renal safety of the procedure depending on the degree of BP reduction. Design and method: A total of 22 patients (age 56,1 ± 10.2 years, 9 males) with true RHTN underwent bilateral RDN procedure (Symplicity RDN System, Medtronic, USA). Office BP, ambulatory BP monitoring, applanation tonometry with the calculation of systolic and diastolic central aortic pressure (sCAP and dCAP), urine levels of NGAL, KIM-1, L-FABP, serum levels of Cystatin C (sCys) and creatinine (sCr) were obtained at baseline, 6-month, 12-month and 24-month follow-up. Renal function was analyzed using CKD-EPI sCr (GFR_CKD-EPI_sCr) and CKD-EPI sCys (GFR_CKD-EPI_sCys) equation. Results: All patients were divided into 3 groups according BP reduction: 1 – BP increase above 0 mmHg; 2 – BP reduction from 0 to −30 mmHg; 3 - BP reduction below 31 mmHg. There were an increased urine KIM-1 level associated with decreased 24-dBP at 12-month follow-up (r = −0,962, p = 0,009). An increased sCr level was registered in a group with decreased dCAP (83,4 ± 8,24; 82,00 ± 7,95; 142,00 ± 9,37; F = 23,476; p = 0,01) and 24-hour sBP (78,3 ± 3,7; 88,2 ± 6,78; 142,00 ± 8,76; F = 61,987; p = 0,004) at 6-month follow-up, also sCr level was associated with decreased 24-hour sBP at 12-month follow-up (r = −0,437, p = 0,04). An increased sCys was registered in a group with decreased sCAP (1,39 ± 0,19; 0,88 ± 0,10; 1,01 ± 0,17; F = 6,156; p = 0,01) and an increased urine L-FABP level – in a group with decreased office dBP (3531,33 ± 1795,04; 997,51 ± 1096,83; 7351,66 ± 3296,97; F = 12,103; p = 0,002) at 6-month follow up. Increased sCys level was registered in a group with decreased 24-hour sBP (0,95 ± 0,16; 0,98 ± 0,12; 1,56 ± 0,15; F = 8,476; p = 0,02) and 24-hour dBP (0,91 ± 0,13; 1,02 ± 0,10; 1,56 ± 0,45; F = 11,121; p = 0,01), decreased GFR_CKD-EPI_sCr was associated with decreased 24-hour dBP (r = 0,691, p = 0,01) at 24-month follow up. Conclusions: Renal function worsening in long-term follow-up may be due to significant decrease of BP as a result of RDN. Therefore, we can suggest the occurrence of the J-curve phenomenon in relation to the kidneys and a further increase of cardiovascular risk.

HIV INFECTION IS AN INDEPENDENT RISK FACTOR OF ARTERIAL STIFFNESS

Objective: The initiation of highly active antiretroviral therapy (HAART) in 1996 dramatically changed the outcome of HIV infection from a fatal disease to a manageable chronic illness. However, HIV infection and/or HAART are associated with accelerated atherosclerosis and increased risk of cardiovascular events. According to 2018 ESH/ESC Guidelines for the management of arterial hypertension, arterial stiffness estimated as carotid-femoral pulse wave velocity (cfPWV) >10m/s is indicative of hypertension-mediated organ damage and increases total cardiovascular risk. The aim of this study is to determine whether HIV infection directly affects arterial stiffness, a hypothesis that remains controversial according to literature. Design and method: We measured cfPWV and other markers of arterial stiffness like augmentation index (AIx) and central aortic blood pressure by applanation tonometry using the Sphygmocor (Atcor, Australia) device in 36 HIV-infected male individuals and 36 age-, body mass index-, pack year- and blood pressure-matched healthy male controls. All subjects were over 48 years of age and had no history of hypertension, diabetes mellitus, moderate or severe renal failure and known cardiovascular disease. Cardiovascular risk was estimated using Hellenic Heart Score, alcohol abuse and physical activity described as metabolic equivalents (METS) were recorded and blood tests were performed for complete blood cell count, fasting plasma glucose, lipid analysis (total, HDL, LDL cholesterol and triglycerides) and the calculation of eGFR using MDRD formula. Time of first positive HIV test and years of antiretroviral therapy were also recorded in HIV-infected group. Results: HIV-infected individuals had higher cfPWV than healthy controls (9.35 ± 1,46m/s vs 8.61 ± 1.18m/s, p = 0.02). AIx (21.6 ± 7,39 vs 18.46 ± 8,17, p = 0.092), central systolic aortic blood pressure (116.75 ± 11.6mmHg vs 116.14 ± 13,34mmHg, p = 0.836) and central diastolic aortic blood pressure (81.61 ± 6.8mmHg vs 79.78 ± 10.12mmHg, P = 0.371) were similar to both groups. In multivariate analysis, age (b = −0.432, p < 0.001) and duration of HIV infection (b = 0.262, p = 0.005) were the two independent determinants of cfPWV. Conclusions: Our study supports that HIV infection is independently associated with cfPWV and, therefore, may increase cardiovascular risk through aortic stiffening.

Salutary Effects of the PULVAD, a Novel Implantable Counterpulsation Assist Device, on Cardiac Mechanoenergetics.

The Pressure Unloading Left Ventricular Assist Vevice (PULVAD) is a novel implantable counterpulsation LVAD, designed to provide ventricular unloading with augmentation of LV performance and retention of pulsatility. We assessed the effects of the PULVAD on hemodynamics and LV mechanoenergetics in seven farm pigs with acute ischemic heart failure. The PULVAD was implanted in the thorax and was connected to the ascending aorta. The PULVAD was pneumatically driven by a standard intra-aortic balloon pump console and was electrocardiogram-synchronized to provide LV pressure unloading along with diastolic aortic pressure augmentation. Hemodynamics, indices of LV mechanoenergetics, and coronary blood flow were measured without and after brief PULVAD support. PULVAD support decreased LV afterload and improved LV mechanical performance (increased ejection fraction, stroke volume, cardiac output and maximum elastance). The PULVAD concurrently reduced LV energy consumption (decreased stroke work and pressure-volume area) and optimized LV energetic performance (improved the ratio of stroke work to pressure-volume area). PULVAD support increased mean coronary blood flow, through dramatic augmentation of diastolic blood flow. In conclusion, the PULVAD unloads the failing LV, optimizes LV mechanoenergetics, and augments coronary blood flow. These salutary effects of short-term PULVAD support provide the foundation for long-term testing.

A Traumatic Pulseless Electrical Activity Model: Mortality Increases With Hypovolemia Time

BackgroundThere currently are no well-defined animal models for traumatic pulseless electrical activity (PEA). Our objective was to develop a swine model of traumatic PEA that would be useful for laboratory research where mortality is an outcome of interest. In this pilot study, we hypothesized that animals that remained in PEA without intervention for a longer period would have increased mortality. Materials and methodsSixteen Yorkshire swine were alternately allocated to either 5 or 10 min of traumatic PEA without intervention. After the nonintervention period, basic life support (BLS) with mechanical cardiopulmonary resuscitation was initiated and performed for 10 min followed by advanced life support (ALS) for an additional 10 min. Hemodynamic and laboratory values are reported for baseline, posthemorrhage, end of BLS, and end of ALS periods. ResultsMortality in the 10-min PEA group (100%) was higher than the 5-min group (38%) (P = 0.03). Animals in the 5-min group had improved aortic diastolic blood pressure, coronary perfusion pressure, and end-tidal CO2 at the end of both the BLS (P = 0.02, 0.002, and 0.02, respectively) and ALS (P = 0.009, 0.005, and 0.008, respectively). The 10-min animals had increased hyperkalemia at the end of the BLS (P = 0.004) and ALS (P = 0.005) periods. All animals in the 10-min group developed ventricular fibrillation (VF) and 38% of the 5-min animals developed VF (P = 0.03). ConclusionsIn our pilot study of traumatic PEA in a swine model, a shorter period of nonintervention resulted in increased survival, improved hemodynamics during resuscitation, decreased hyperkalemia, and less incidence of conversion to VF arrest.

Arterial stiffness in normal pregnancy at 11–13 weeks of gestation and risk of late-onset hypertensive disorders of pregnancy

We evaluated the possible correlation between pulse wave analysis (PWA) parameters measured during the first trimester of pregnancy in normotensive, low-risk women, and the development of hypertensive disorders later in pregnancy. Our hypothesis was that a still asymptomatic increase in arterial stiffness may potentially precede the onset of overt hypertension in pregnancy and that PWA could detect it. The study population (n = 1648) was recruited at the time of prenatal screening for chromosomal abnormalities (11-12 weeks of gestation). The radial pressure waveform was obtained with an applanation tonometer (Sphygmocor, Atcor Medical, West Ryde, Australia) on pregnant women in recumbent position. Arterial stiffness was evaluated using arterial PWA. The aortic systolic pressure (aSp), aortic diastolic pressure, and aortic mean pressure, the aortic pulse pressure, the augmentation pressure, and the augmentation index were calculated. The main outcome measure was the development of hypertensive disorders later in pregnancy. The values of aSp (P < 0.0001), aortic diastolic pressure (P < 0.0001), aortic mean pressure (P < 0.0001), aortic pulse pressure (P = 0.0140), and augmentation index-75 (P < 0.0001) measured in the first trimester of pregnancy were significantly higher in the women who later developed hypertensive disorders of pregnancy than in those who remained normotensive. The aSp (sensitivity 72.6%; specificity 59.6%) was found to be the best predictor for the later development of hypertension. In normotensive, low-risk pregnant women, PWA may be useful for the early detection of risk for the development of hypertensive disorders of pregnancy.

Inflammatory, Serological and Vascular Determinants of Cardiovascular Disease in Systemic Lupus Erythematosus Patients.

Background and aim: Systemic lupus erythematosus (SLE) is associated with increased risk of cardiovascular disease (CVD). Among many mechanisms, accelerated atherosclerosis, endothelial dysfunction, and hypercoagulability play a main role. Here, we investigate whether inflammatory, serological and clinical markers of SLE determine and correlate with arterial stiffness in SLE patients. Materials and methods: Routine blood samples, inflammatory mediators, specific antibodies, and 24 h proteinuria were measured in 43 SLE patients and 43 age and sex-matched controls using routine laboratory assays. We also assessed arterial stiffness by measuring radial artery applanation tonometry-derived augmentation index (AI), normalized AI (AIx@75), aortic pulse pressure, central systolic, diastolic and peripheral blood pressure. Results: SLE patients showed a significantly greater arterial stiffness vs. controls, as demonstrated by the significantly higher AIx@75 and aortic pulse pressure. Interestingly, regression analysis showed that age, systolic pulse pressure, inflammatory markers (erythrocyte sedimentation rate and C-reactive protein), daily dose of glucocorticoids, and cumulative organ damage positively correlated with arterial stiffness. Conclusions: SLE patients show increased arterial stiffness which correlates with markers of inflammation, that is involved in early alterations in arterial walls. Applanation tonometry can be used to screen SLE patients for subclinical vascular damage to implement prevention strategies for CVD.

Intra‐aortic balloon pump counterpulsation in extensive myocardial infarction with persistent ischemia: The SEMPER FI pilot study

This study aimed to prospectively investigate intra-aortic balloon pump counterpulsation (IABP) support in large myocardial infarction complicated by persistent ischemia after primary percutaneous coronary intervention (PCI). Use of IABP is suggested to be effective by increasing diastolic aortic pressure, thereby improving coronary blood flow. This can only be expected with exhausted coronary autoregulation, typical in acute myocardial infarction complicated by persistent ischemia. In this situation, augmented diastolic pressure is expected to increase myocardial oxygenation. One hundred patients with large STEMI complicated by persistent ischemia after primary PCI were randomized to treatment with or without IABP therapy on top of standard care. IABP support was initiated following primary PCI, immediately after inclusion. Primary end point was all-cause mortality, need for (additional) mechanical hemodynamic support, or readmission for heart failure within 6 months. Mean age was 63 ± 10 years, 76% were male. Mean systolic and diastolic blood pressure were 120 ± 25 mmHg and 73 ± 17 mmHg. Mean heart rate was 75 ± 18 mmHg. Before PCI, mean summed ST-deviation was 21 ± 8 mm with only minimal ST-resolution after PCI. One patient in the IABP group reached the primary end point versus four patients in the control group (2% vs. 8%; p = 0.16). After primary PCI, resolution of ST-deviation was significantly more pronounced in the IABP group (73 ± 17%) compared to the control group (56 ± 26%; p < 0.01). In this pilot study, in patients with large STEMI and persistent ischemia after primary PCI, use of IABP showed a nonsignificant decrease in mortality, necessity for (additional) mechanical hemodynamic support or readmission for heart failure at 6 months, and resulted in more rapid ST-resolution.

Abstract P298: Normotensive Habitual Caffeine Consumers Experience No Change in Blood Pressure or Pulse Wave Velocity Following the Combined Consumption of Caffeine and Dietary Nitrate

Intro: Caffeine intake may elevate blood pressure (BP), while habitual consumption leads to developed tolerance, providing conflicting evidence for incurred changes in BP. Dietary nitrate consumption decreases BP and reduces arterial stiffness in patients with atherosclerosis and hypertension due to increased plasma nitrite and enhanced bioavailability of nitric oxide. However, a decline in BP for a healthy cohort could be an unwanted side effect for normotensive individuals. Less is known about the combined effects of dietary nitrate and caffeine on resting hemodynamics in a healthy population. Hypothesis: We hypothesized that caffeine supplementation would increase systolic blood pressure (SBP) and pulse wave velocity (PWV) while combined dietary nitrate consumption would attenuate this rise. Methods: In a randomized, double-blind, counterbalanced study, eight healthy, young adults who typically consumed some but not more than 500 mg caffeine/day completed 4 separate visits to the laboratory, each visit separated by one week. Prior to each visit, participants consumed a 4-day supplementation regimen of either dietary nitrate (12.4 mmol, NIT) or a placebo nitrate (PLN) combined with either caffeine (3 mg/kg, CAF) or placebo caffeine (PLC); this comprised 1 of 4 treatments. The final dose of NIT or PLN was consumed 2.5 hours prior to assessments while CAF or PLC was consumed 1 hour prior. Participants minimized consumption of dietary nitrate rich foods and caffeine during the 4 days leading up to their scheduled visit. Each visit consisted of measurements of peripheral SBP and diastolic blood pressure (DBP) with aortic central systolic and diastolic blood pressure (cSBP and cDBP, respectively) assessed noninvasively using pulse wave analysis. Measurement of arterial stiffness via applanation tonometry determined PWV. A linear mixed effects model analysis was performed to determine if supplementation regimen influenced hemodynamic parameters. Results: SBP of NIT+CAF (115±6 mmHg), PLN+CAF (117±9 mmHg), NIT+PLC (115±6 mmHg) and PLN+PLC (115±6 mmHg)(p=0.591) and PWV of NIT+CAF (5.5±1.1 m/s), PLN+CAF (5.8±0.7 m/s), NIT+PLC (5.8±0.6 m/s) and PLN+PLC (5.6±1.0 m/s) (p=0.353) were not statistically different between treatments. In addition, DBP (p=0.496), cSBP (p=0.656), cDBP (p=0.548), aortic augmentation index (p=0.054), and resting heart rate (p=0.646) were not different between treatments. Conclusion: Following 4 days of caffeine supplementation, habitual caffeine users did not experience any changes in resting hemodynamics when compared to a placebo supplement. In addition, dietary nitrate did not incur any changes in resting metrics whether or not it was consumed alongside caffeine. In this regard, habitual caffeine users are not affected by 3mg/kg doses of caffeine, and dietary nitrate (12.4 mmol/day) does not further reduce the BP of healthy normotensive adults.