Aortic Elasticity In Patients Research Articles

Clinical Research on the Aortic Elasticity in Patients with Type 1 Diabetes Mellitus Complicated with Hypertension.

To investigate the characteristics of aortic elasticity in type 1 diabetes mellitus (DM1) patients with hypertension using dual-source computed tomography (DSCT). Subjects were divided into four groups: 31 with hypertension (EH group), 28 with DM1 (DM1 group), 30 with hypertension and DM1 (DM1 + EH group), and 30 healthy volunteers (control group, CG). ECG-gated DSCT was used to measure the cross-sectional area of the aorta in diastole and systole and calculate the aortic elasticity (D). Analysis of variance and multiple linear regression were used for statistical analysis. Compared with the CG, aortic elasticity (D) in the DM1 group patients was not significantly decreased. Compared with the EH group, the DM1 + EH group showed no significant change. The aortic elasticity (D) in the EH and DM1 + EH groups was significantly lower than that in the CG and DM1 group. DM1 slightly affects the aortic elasticity of the descending aorta, whereas hypertension exerts the main effect.

Evaluation of myocardial strain and aortic elasticity in patients with bicuspid aortic valve.

This study evaluated the myocardial strain and aortic elasticity in patients with bicuspid aortic valve (BAV) and then investigated the relation between them. Thirty-nine patients (30 males; mean age 44±19 years; range 6 to 75 years) with BAV were recruited as BAV group, and 29 age- and sex-matched healthy controls (21 males; mean age 42±11 years; range 20 to 71 years) served as control group. Aortic strain, distensibility and stiffness index were derived using M-mode echocardiography. Left ventricular global myocardial strain was acquired with speckle-tracking echocardiography. Correlation between aortic elasticity and myocardial strain was also analyzed. The results showed that aortic stiffness was higher (17.5±14.0 vs. 5.3±2.7, P<0.001), and aortic strain (4.9±4.7 vs. 11.0±4.1, P<0.001) and distensibility (1.8±2.1 vs. 3.7±1.6, P<0.001) were lower significantly in BAV group than in control group. Global circumferential strain (-19.1±4.2 vs.-22.5±3.7, P<0.001), radial stain (29.8±14.9 vs. 38.0±8.8, P<0.001) and longitudinal stain (-18.4±3.4 vs.-20.8±3.5, P<0.001) were significantly lower in BAV group than in control group. There was weak association between aortic elasticity and myocardial strain. These findings indicated BAV patients manifest reduced myocardial strain which had weak relationship with aortic elastic lesion.

Assessment of myocardial performance index and its association with aortic elasticity in patients with ascending aortic aneurysm.

Ascending aortic aneurysms (AAA) are a leading cause of morbidity and mortality. Nevertheless, their effects on global cardiac functions are yet to be fully understood. Myocardial performance index (MPI) has been widely used to quantitatively assess myocardial functions. The aim of this study was to evaluate left ventricular (LV) functions in patients with AAA using tissue Doppler (TD) echocardiography and MPI in addition to conventional echocardiographic methods. Fifty patients with AAA (33 men, 17 woman; mean age 55.5±7.90 years) were included, and 106 patients without aortic dilatation (mean age 54.1±8.18 years) were included as the control group. LV systolic and diastolic functions were analyzed using 2-dimensional, M-mode, and TD echocardiography. Patients with AAA had significantly higher MPI (0.5±0.04 vs 0.4±0.05, p<0.001), TD-MPI (0.5±0.02 vs 0.4±0.03, p<0.001), and reduced aortic elasticity, as indicated by reduced aortic distensibility (AD) (1.7±1.27 vs 3.1±1.25, p<0.001). Multivariate linear regression analysis showed that TD-MPI was independently correlated with reduced aortic distensibility (B=-0.006, p=0.019, 95% confidence interval,-0.011 to -0.001). MPI and TD-MPI indicated impairment of global cardiac functions in patients with AAA, which may be attributed to reduced aortic elasticity.

Assessment of Aortic Elasticity in Patients with Celiac Disease.

Background and ObjectivesCeliac disease (CD) is a chronic autoimmune disorder induced by dietary gluten intake by individuals who are genetically sensitive. Many studies report an increased risk of cardiovascular diseases in such patients. The aim of this study is to assess aortic elasticity properties in patients with CD that may be associated with an increased risk of cardiovascular disease.Subjects and MethodsEighty-one patients diagnosed with CD by antibody test and biopsy and 63 healthy volunteers were included in this prospective study. Electrocardiographic and echocardiographic examinations were performed.ResultsThe CD group did not have any differences in the conventional echocardiographic parameters compared to the healthy individuals. However, patients in the CD group had an increased aortic stiffness beta index (4.3±2.3 vs. 3.6±1.6, p=0.010), increased pressure strain elastic modulus (33.6±17.0 kPa vs. 28.5±16.7 kPa, p=0.037), decreased aortic distensibility (7.0±3.0×10-6 cm2/dyn vs. 8.2±3.6×10-6 cm2/dyn, p=0.037), and similar aortic strain (17.9±7.7 vs. 16.0±5.5, p=0.070) compared to the control group. Patients with CD were found to have an elevated neutrophil/lymphocyte ratio compared to the control group (2.54±0.63 vs. 2.24±0.63, p=0.012). However, gluten-free diet and neutrophil/lymphocyte ratio were not found to be associated with aortic elasticity.ConclusionPatients with CD had increased aortic stiffness and decreased aortic distensibility. Gluten-free diet enabled the patients with CD to have a reduction in the inflammatory parameters whereas the absence of a significant difference in the elastic properties of the aorta may suggest that the risk of cardiovascular disease persists in this patient group despite a gluten-free diet.

Assessment of Myocardial Performance Index and Aortic Elasticity in Patients With Beta-Thalassemia Major.

BackgroundThis study aimed to assess myocardial performance index (MPI) and arterial elasticity indices in asymptomatic patients with beta-thalassemia major without known heart disease and to determine relationship between these indices and parameters indicating iron load of body.MethodsThe study included 55 asymptomatic beta-thalassemia patients (median age: 20 years (10 - 48 years)) without known history of heart disease and 40 age- and sex-matched healthy controls. MPI and arterial elasticity indices were determined by using standard two-dimensional and Doppler echocardiography. Data were analyzed by SPSS for Windows version 20.0 (SPSS Inc., Chicago, IL, USA).ResultsLeft ventricular mass index (83.917 (50.62 - 144) and 68.37 (41.9 - 113.3)) and MPI (0.464 (0.33 - 0.68) and 0.431 (0.31 - 0.51)) were significantly higher in patients with beta-thalassemia when compared to control group (P < 0.001 and P = 0.006). Aortic elasticity indices were significantly higher while aortic strain and distensibility values were significantly lower in patients with beta-thalassemia compared to controls (all P values < 0.001). Positive correlations were detected between aortic stiffness index and platelet (r = 0.235; P = 0.019) and ferritin values (r = 0.328; P = 0.008). Presence of thalassemia (β = -0.729; P = 0.041) and higher platelet value (β = 0.235; P = 0.019) were significant determinants for increased aortic stiffness in linear regression analysis.ConclusionArterial elasticity indices and MPI are impaired in patients with beta-thalassemia major and these parameters may be used to predict cardiovascular complications in asymptomatic patients with beta-thalassemia major.

Chronic inhibition of tumor necrosis factor-α with infliximab improves myocardial deformation in parallel with aortic elasticity in rheumatoid arthritis.

This study investigated the effects of infliximab, a monoclonal antibody against TNFα, on myocardial deformation and aortic elasticity in patients with rheumatoid arthritis (RA), and the association of aortic elasticity with myocardial deformation. 38 female rheumatoid arthritis (RA) patients and 30 healthy controls were included in the study. Twenty patients received infliximab and 18 patients received prednisolone. Left ventricular (LV) longitudinal, circumferential and radial strain, systolic strain rate and early diastolic strain rate using speckle-tracking echocardiography, and aortic elasticity using M-mode echocardiography were assessed at baseline and post-treatment. LV systolic longitudinal basal-, mid-, and apical strain, systolic mid- and apical strain rate, basal-, mid- and apical early strain rate, circumferential systolic apical strain and systolic strain rate were reduced in RA patients compared to controls. Compared to baseline, infliximab treatment increased aortic strain, aortic distensibility and decreased aortic ß index. No significant aortic elastic changes were observed with prednisolone treatment. Longitudinal basal- and apical strain, basal-, mid- and apical systolic and diastolic strain rates, circumferential basal systolic strain, radial mid- and apical strain and apical strain rate were increased following infliximab treatment. Infliximab treatment improves aortic elasticity in parallel to myocardial deformation, but no significant association was observed following prednisolone treatment. Myocardial deformation is impaired in RA patients and is related to aortic stiffness. Chronic inhibition of TNFα improves LV deformation in association with aortic elasticity.

Evaluation of Carotid Intima‐Media Thickness and Aortic Elasticity in Patients with Nondipper Hypertension

The relationship between cardiovascular diseases and the diurnal blood pressure (BP) rhythm was researched in many studies. It has been demonstrated that the nondipping pattern has been associated with target organ damage and worsened cardiovascular outcomes. The aim of our study was to assess the relationship between aortic elasticity parameters and carotid intima-media thickness (CIMT) and diastolic dysfunction in terms of "dipper" and "nondipper" hypertension subtypes. A total of 60 hypertensive patients without known coronary heart disease were recruited to our study. All patients were classified as "dipper" or "nondipper" after ambulatory BP follow-up. Patients' left ventricular (LV) systolic and diastolic functions were assessed with transthoracic echocardiography. Ascending aorta diameters and CIMT were measured by ultrasonography and the elasticity parameters of aorta were calculated by using relevant formula. There were no significant differences between the groups with respect to demographic, biochemical data, and cardiovascular risk factors. Aortic stiffness was significantly increased in nondippers, whereas aortic strain and distensibility were significantly decreased (P=0.005, P=0.005, and P=0.024, respectively). Carotid artery IMT was significantly increased in nondippers compared to dippers (P=0.013). A significant correlation was noted between CIMT and mean BP. No significant difference was detected between 2 groups in terms of LV hypertrophy and diastolic dysfunction. In our study, we showed that impairment of aortic elasticity parameters and increase in CIMT as a predictor of end organ damage were more often in the nondipper hypertensive patients.

The Effect of Non-dipper and Dipper Blood Pressure Patterns on Aortic Elasticity in Patients with Metabolic Syndrome

The purpose of this study was to evaluate the effect of blood pressure (BP) rhythm on aortic functions in patients with metabolic syndrome. Seventy patients with newly diagnosed hypertension who fulfilled the metabolic syndrome criteria according to the Third Report of the National Cholesterol Education Program Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (NCEP/ATP-III) were evaluated with 24-hour BP holter monitoring. According to BP rhythm, 35 patients with dipper BP pattern and 35 patients with non-dipper BP pattern were enrolled as two groups in our study. Systolic and diastolic diameters of the ascending aorta were measured by M-mode echocardiography and aortic functions (aortic strain, distensibility, and stiffness index) were calculated. The nocturnal systolic and diastolic BPs were significantly higher in non-dipper patients than the dipper group. According to clinical parameters including age, gender, height, weight, body mass index, waist circumference, clinical systolic, and diastolic BPs, we did not find significantly difference between the two groups. Aortic strain was significantly higher (6.63 ± 3.37 vs. 1.81 ± 0.92; P < .0001) and aortic distensibility was lower (2.38 ± 1.18 cm−2/dyn/10−6 and 6.66 ± 3.67 cm−2/dyn/10−6; P < .001) in non-dipper group. These findings suggest that aortic functions were prominently deteriorated in non-dipper hypertensive patients than dippers with metabolic syndrome.

Impaired coronary flow reserve evaluated by echocardiography is associated with increased aortic stiffness in patients with metabolic syndrome: an observational study

Metabolic syndrome (MetS) is a strong predictor of cardiovascular events and coronary flow reserve (CFR), an indicator of microvascular function, has been found to be impaired in MetS. Aortic stiffness (AS) is a simple and effective method for assessing arterial elasticity. The aim of this study was to evaluate whether there is an independent association of impaired coronary flow and aortic elasticity in patients with MetS. Forty-six patients (mean age 47.3 ± 6.6 years) with the diagnosis of MetS according to the ATP III update criteria and 44 age and gender matched controls (mean age 46.0 ± 6.1 years) were included into the cross-sectional observational study. Peak diastolic coronary flow velocities were measured in left anterior descending artery by pulsed wave Doppler at baseline and after adenosine infusion, and CFR was calculated as the ratio of hyperemic to baseline velocities. Aortic strain, distensibility and stiffness were calculated by M-mode echocardiography. Statistical analysis was performed by using Student t-test, Chi-square test, Pearson correlation and linear regression analyses. CFR was significantly lower in patients with MetS than in controls (2.3 ± 0.2 vs 2.7 ± 0.2, p<0.001). In the MetS group, aortic distensibility (10.4 ± 3.5 cm².dyn⁻¹.10⁻⁶ vs. 12.7 ± 3.4 cm2.dyn⁻¹.10⁻⁶, p=0.002) was decreased and AS was significantly increased (6.5 ± 2.0 vs. 3.2 ± 0.8, p<0.001). In multivariate linear regression analysis, AS (β=-0.217, p=0.047), systolic blood pressure (β=-0.215, p=0.050) and waist circumference (β=-0.272, p=0.012) had an independent relationship with impaired CFR. This study demonstrated that coronary flow reserve is impaired in patients with MetS and there is an independent relationship between impaired CFR and increased aortic stiffness, systolic blood pressure or waist circumference.

Intrinsic biventricular dysfunction in Marfan syndrome

BackgroundMarfan syndrome (MFS) is an autosomal, dominantly inherited, connective tissue disorder usually caused by a mutation in the fibrillin-1 gene (FBN1). As fibrillin-1 is a component of the extracellular matrix...

285 – Transposition of the great arteries is associated with increased ascending aorta stiffness

Transposition of the great arteries (TGA) is the consequences of abnormal aorticopulmonary septation. Animal embryonic data indicate that septation and elastogenesis are related events. It was showed that carotid artery is markedly and constitutionally stiffer in patients with TGA. to assess aortic dimensions and aortic elasticity in patients with TGA using magnetic resonance imaging (MRI). MRI was performed in 29 patients with simple TGA operated by an atrial switch procedure (22 male; mean age 29 ± 4 years) and 29 age and gender-matched healthy subjects. TGA patients showed aortic root dilatation (7.7 ± 2.1 vs 6.2 ± 1.2 cm∑, p = 0, 0018, in systole, and 6.8 ± 2.1 vs 5.0 ± 1.2 cm∑, p = 0.0003, in diastole, at tubular level), reduced aortic root distension (13.5 ± 5.9 vs 24.3 ± 11.7, p<0.0001) and reduced aortic root distensibility (3.5 ± 1.6 vs 5.3 ± 2.4 mmHg −1 .10 −3 , p = 0.0009). Biomechanical properties of the descending aorta and pulse wave velocity were similar in TGA patients and in healthy subjects. Body mass index, systolic blood pressure, diastolic blood pressure and pulse pressure were similar between patients and healthy subjects, and had no influence on ascending aorta stiffness. No significant correlation was found between index of aortic stiffness and right ventricle (RV) function (end-diastolic and end systolic volumes, RVEF, RV mass, presence or absence of myocardial fibrosis). It did not change after indexation to body surface area of RV function values. Aortic stiffness in TGA is markedly increased and localized to the ascending aorta. This property could contribute to the dilatation of the ascending aorta part of the new aorta in arterial switch procedure.

The Relationship of Gamma-Glutamyltransferase to Aortic Elastic Properties in Young Patients with Prehypertension

Some cross-sectional studies have demonstrated a positive association between serum gamma-glutamyltransferase (GGT) levels and blood pressure. Accordingly, we aimed to analyze serum GGT levels in patients with prehypertension and examine the relationship with aortic elasticity parameters. The study population consisted of 25 newly diagnosed prehypertensive individuals and 25 healthy control subjects. Aortic strain, distensibility index, and stiffness index beta were calculated from aortic diameters measured by echocardiography and blood pressures simultaneously measured by sphygmomanometry. Prehypertensive patients were detected to have significantly lower aortic distensibility and strain indexes compared to control subjects aortic distensibility. However, aortic stiffness index beta of the prehypertensive group was significantly higher compared to that of the control group (3.73 ± 1.41 vs. 2.97 ± 0.82, p = 0.02). The mean GGT levels were found to be higher in patients with prehypertension compared to those of controls (47.9 ± 15.9 U/L vs. 36.1 ± 9.4 U/L, p = 0.003). When multiple linear regression analysis was done to clarify the contributions of GGT to aortic elasticity adjusting for age, body mass index, uric acid, serum glucose, heart rate, low-density lipoprotein (LDL)-cholesterol, high-density lipoprotein (HDL)-cholesterol, and triglyceride, we observed that only serum GGT levels were significantly associated with aortic elasticity parameters (for aortic strain beta = −0.247, p < 0.001; for aortic distensibility beta = −0.108, p < 0.001; for stiffness index beta = 0.063, p < 0.001). Whatever the mechanism is, young patients with prehypertension have higher serum GGT levels compared to healthy control subjects. More importantly, increased GGT levels are independently associated with impaired aortic elasticity in patients with prehypertension.

Aortic Pressures, Stiffness and Left Ventricular Function in Coronary Slow Flow Phenomenon

Background: Coronary slow flow (CSF) phenomenon is characterized by delayed opacification of coronary vessels in a normal coronary angiogram. Although clinical and pathological features have been previously described, the underlying pathophysiology has not been fully elucidated. In this study, we aimed to evaluate central aortic pressure, aortic stiffness and left ventricular (LV) function in patients with coronary slow flow. Method and Results: The study population consisted of 154 patients who underwent coronary angiography because of typical and quasi-typical symptoms of angina. 81 patients with angiographically proven CSF and 73 cases with normal coronary flow pattern with similar risk profiles were enrolled in the study. Aortic pressures and indexes of elastic properties were evaluated using invasive methods. Aortic pulse pressure (mm Hg) and pulsality index of patients with CSF were found to be significantly higher than those of controls (60.8 ± 13.8 vs. 53.7 ± 14.5, p = 0.002; 0.84 ± 0.22 vs. 0.67 ± 0.18, p = 0.0001, respectively). LV Doppler parameters were deteriorated in patients with CSF. Aortic fractional pulse pressure and pulsality index were significantly correlated with the mean TIMI frame count and LV diastolic parameters in correlation analysis. Conclusion: The present findings allow us to conclude that impaired aortic elasticity in patients with CSF may also be responsible for the impaired LV diastolic parameters.

Change of the aortic elasticity in rheumatoid arthritis: Relationship to associated cardiovascular risk factors

Introduction:Rheumatoid arthritis (RA) is a chronic, systemic, inflammatory disease, which is associated with an excess of cardiovascular events. A decrease in the compliance of the arterial system, termed arterial stiffness, results in increased cardiac workload. Primary prevention of cardiovascular disease (CVD) is a priority for modern medicine. Therefore, further studies are required to explore the mechanisms through which CVD increases in RA.Patients and Methods:This case–control study was performed to detect possible change of aortic elasticity in patients with RA, and to estimate the impact of different cardiovascular and atherogenic risk factors on the severity of arterial stiffness. Sixty-three consecutive adults with RA were enrolled for the study (case group). Forty-one healthy adults matched for age and gender were considered as a control group. All were subjected to assessment of aortic stiffness index and various cardiovascular risk factors. Patients with rheumatoid disease (case group) were divided by their aortic stiffness index status to two groups (A and B, with and without aortic stiffness, respectively).Results:Aortic stiffness was present in 31.7% of the RA patients. Age of the patients, duration of RA, smoking index, waist circumference, triglycerides levels, and CRP were significantly higher in patients with aortic stiffness.Conclusion:RA is associated with decreased elasticity of the aorta in both genders, and such changes seem to be higher in the presence of visceral obesity, smoking, high triglycerides, and extraarticular disease severity.

Abnormal aortic elasticity in patients with liver steatosis

Aim Non-alcoholic fatty liver disease (NAFLD) may be associated with insulin resistance. We aimed to evaluate elastic properties of aorta in patients with NAFLD. Material and method Ninety-two patients with NAFLD and 47 healthy subjects were performed ultrasonographic and echocardiographic examination. Aortic stiffness index (ASI), aortic distensibility (AD) and aortic strain (AS) were compared between healthy subjects and patients and also among grade I and II liver steatosis. Statistical analysis was performed by Independent-Samples t-test, Pearson's correlation test using SPSS 11.0. Results ASI was significantly increased whereas AS and AD were reduced ( p > 0.05) in patients compared to normal ones. ASI was significantly increased while AD and AS slightly increased in patients with grade II liver steatosis compare to grade I. SBP and DBP, cholesterol levels, fasting blood glucose (FBG) were also increased and doppler flow parameters of mitral inflow were abnormally changed in those patients. ASI was positively correlated with FBG, ALT and ALP levels, LDL cholesterol, heart rate and deceleration time of mitral E wave. Conclusion Elastic properties of aorta were abnormally changed in patients with NAFLD. Multiple hemodynamic abnormalities probably associated with insulin resistance may be accountable for abnormal elastic properties of aorta.

Impaired aortic elasticity in patients with psoriasis

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.

The comparative effects of metoprolol and perindopril on aortic elasticity in young patients with prehypertension

It has been recently demonstrated that aortic elasticity is impaired in young patients with prehypertension compared with healthy controls. Accordingly, the purpose of the current study was to analyze the comparative effects of metoprolol and perindopril on aortic elasticity in young patients with prehypertension after 6 months of therapy. Fifty newly diagnosed patients with hypertension, who were in the prehypertension category according to the Joint National Committee seventh report, were enrolled in this blind, randomized, prospective study. After baseline clinical assessment, patients were randomly assigned to 4 mg daily dose of perindopril (group I, n=27, 18 male, median age=35 years) or 100 mg daily dose of metoprolol succinate (group II, n=28, 16 male, median age=33 years) for 6 months. Aortic strain, distensibility, and stiffness indexes were calculated from aortic diameters measured by echocardiography and blood pressures simultaneously measured by sphygmomanometry before and after treatment. When the median aortic distensibility and strain indexes after 6 months of therapy were analyzed, aortic distensibility and strain indexes of both treatment arms were found to be significantly higher than those of the pretreatment period. In contrast, the posttreatment aortic stiffness indexes of both groups were significantly lower compared with those of pretreatment period. No statistical difference was found between pretreatment and posttreatment aortic elasticity parameters of both groups. Importantly, no statistically significant difference was found between the percentage change from baseline of metoprolol and perindopril groups regarding aortic elasticity parameters (aortic distensibility: 38.1 vs. 37.9%, respectively, P=0.86; aortic strain: 37.7 vs. 37.9%, respectively, P=0.44; stiffness index: -20.0 vs. -23.9%). The current study revealed that early pharmacological intervention had strong beneficial effects on aortic elasticity in patients with prehypertension despite the fact that neither metoprolol nor perindopril was superior to the other.

Dialysis-induced hypotension is associated with impaired aortic elasticity in patients undergoing chronic hemodialysis

The pathogenesis of dialysis-induced hypotension (DIH) is multifactorial and may include increased aortic stiffness. This study was undertaken to determine aortic elastic properties in patients undergoing hemodialysis with and without DIH, and to assess the effects of DIH on mortality. Aortic stiffness and left ventricular functions were evaluated in 70 patients undergoing hemodialysis with (n=34) and without DIH (n=36). We also evaluated total mortality at 36 months. Patients with DIH in comparison with patients without DIH, had lower aortic strain (5.0+/-3.8 vs. 7.8+/-3.0%, P<0.005) and distensibility (2.3+/-1.9 vs. 3.2+/-1.7 cm2/dyn/10(3), P<0.01). In univariate analysis, age, aortic stiffness and left ventricular systolic dysfunction, and coronary artery disease were also found to be the main factors associated with DIH. On multivariate logistic regression analysis, aortic distensibility [odds ratio (OR): 0.61; 95% confidence interval (95% CI): 0.40-0.93; P=0.01] and the coronary artery disease (OR: 6.46; 95% CI: 1.62-25.73; P=0.009) remained as significant variables associated with DIH. During follow-up period, 12 out of 34 patients with DIH died compared with 4 out of 36 patients without DIH (log rank, P=0.02). Our data suggest that DIH is strongly associated with increased aortic stiffness and poor outcome. Larger long-term follow-up studies, however, investigating whether the DIH plays a surrogate or causative role on mortality in patients undergoing hemodialysis should be designed.

Ambulatory Blood Pressure for Cardiovascular Risk Stratification

Ambulatory blood pressure (ABP) monitoring is increasingly recognized as a valuable tool to refine prediction of cardiovascular risk related to blood pressure (BP).1 After the first landmark study published by Perloff and colleagues 24 years ago,2 several longitudinal event-based studies provided unequivocal evidence of an independent association between ABP and risk of cardiovascular disease. Although experimental procedures and statistical analyses varied from study to study, ABP generally improved cardiovascular risk stratification over and beyond traditional risk factors, including clinic BP.3 The Table, obtained through an electronic search of literature using the terms “ambulatory blood pressure” and “prognosis,” shows a list of longitudinal event-based studies performed by independent groups. It is worth noting that the list of available studies is longer because each group generally published other analyses of their database. Only the first-appearing or main contribution from each group has been included in the Table. View this table: Longitudinal Event-Based Studies From Independent Groups That Addressed the Prognostic Value of ABP Article p 2145 Three aspects of available investigations deserve special mention. First, the prognostic value of ABP has been examined not only in subjects with clinical diagnosis of hypertension but also in the general population and in a variety of settings, including diabetes mellitus, renal failure, and cerebrovascular disease. Second, subjects could be untreated or treated at the time of ABP monitoring. This point may raise concerns, because drug treatment could exert unpredictable effects on 24-hour ABP profile and, consequently, interpretation and applicability of results. Third, although a continuous relation emerged in most studies between ABP and cardiovascular risk, several investigators tried to define clinical categories based on arbitrary thresholds of ABP. Although such categories are potentially useful to make diagnostic and therapeutic decisions in clinical practice, their prognostic role requires confirmation from large and independent cohort …

Aortic elasticity in patients with ankylosing spondylitis

Objective — Ankylosing spondylitis (AS) is a chronic inflammatory disease which may show cardiac involvement. The effect of AS on aortic elasticity has not been previously defined. The aim of this study was to determine whether there was any change in aortic elasticity in AS.Methods and results — Thirty-five AS patients without cardiovascular involvement and 30 healthy subjects were enrolled into the study. Aortic strain, distensibility index and stiffness index beta were calculated from aortic diameters measured by echocardiography and blood pressures simultaneously measured by sphygmomanometry.The mean aortic strain and distensibility indexes in the AS group were lower than those in the control group.The mean aortic stiffness index in the AS group was higher than that in the control group (p < 0.05). No correlation between the means and the duration was observed in the AS group.Conclusion — We found that in AS patients without cardiac involvement, aortic elasticity was decreased and this decrease was not correlated with the duration of AS.