Evaluation Of Aortic Stiffness Research Articles

Intravascular ultrasound imaging in evaluation of aortic stiffness: A proof-of-concept study.

Aortic stiffness is a well-known cardio-vascular risk factor. For years, different methods have been studied in the assessment of aortic elastic properties and large arterial stiffness for risk stratification. Herein is an assessment of the role of intravascular ultrasound (IVUS) imaging for the evaluation of aortic elastic properties. Intravascular ultrasound imaging of the aorta was performed in 12 patients with transthoracic echocardiography (TTE) and computed tomography (CT) evidence for enlargement of the ascending aorta - diameter ≥ 40.0 mm. Mechanical properties of the aorta were derived from the measured diameters and intra-aortic pressure. Paired samples T-test analyses were performed to determine differences between measurements derived by TTE, CT and IVUS. Mean values of the calculated elastic properties via IVUS of the ascending aorta were as follows: compliance 0.021 ± 0.02; strain 205 ± 4.3; aortic stiffness index 4.3 ± 0.75; elastic modulus 0.31 ± 0.05. On paired T-test analysis maximum ascending aortic diameter measured by CT aortography and IVUS did not differ significantly (t = -0.19, p = 0.985), but a significant difference between IVUS measurements and TTE derived diameters was found (t = 13.118, p = 0.034). On average, IVUS diameters were 2.3 mm larger than the results acquired by TTE (95% confidence interval: 14.21-17.13). Intravascular ultrasound examination of the ascending aorta provided larger diameters than the ones collected by means of TTE. However, IVUS measurements did not differ significantly from diameters derived by CT aortography.

Evaluation of aortic stiffness by echocardiography in tympanosclerosis patients

Tympanosclerosis (TS) is a scarring process that may occur during otitis media. Aortic stiffness (AS) is a significant predictor for the development of heart diseases due to its close relationship with atherosclerosis. Similar pathophysiological processes based on inflammation may explain both TS and AS formation. We hypothesized that aortic elasticity, an indicator of AS, might be impaired in patients suffering from TS. The present study aimed to evaluate echocardiographically the aortic elasticity properties and measure blood inflammatory parameters in TS-detected patients.Ninety-eight participants diagnosed with chronic otitis media were enrolled in the study. TS-detected 42 participants were subjected to the study group, while 56 without TS constituted the control group. The two groups' demographic, clinical, echocardiographic, and laboratory characteristics were compared.Demographic, clinical, and laboratory parameter differences were found insignificant. Hs-CRP, neutrophil-to-lymphocyte ratio, and systemic immune-inflammation index were significantly higher in the study group than the control group (p=0.018, p=0.003, p=0.019, respectively).The study group had significantly lower aortic strain (11.80 ± 4.84 vs. 16.30 ± 3.91; p<0.001) and distensibility (5.23 ± 2.68 vs. 7.24 ± 2.89; p=0.001) values than the control group. The AS index was meaningfully higher in the study group than in the control group (4.81 ± 2.41 vs. 3.12 ± 1.02; p<0.001). Other echocardiographic parameters between the two groups were found to be insignificant.In TS-detected patients, AS parameters were found to be impaired. Aortic elasticity parameters measured by echocardiography, a non-invasive and easily accessible method, can help predict the risk of atherosclerosis and related diseases in TS-developed patients.

Aortic Pulse Wave Velocity Evaluated by 4D Flow MRI Across the Adult Lifespan.

Evaluation of aortic stiffness by pulse wave velocity (PWV) across the adult lifespan is needed to better understand normal aging in women and men. To characterize PWV in the thoracic aorta using 4D flow MRI in an age- and sex-stratified cohort of healthy adults. Retrospective. Ninety nine healthy participants (age: 46 ± 15 [19-79] years, 50% female), divided into young adults (<45 years) (N=48), midlife (45-65 years) (N=37), and later life (>65 years) (N=14) groups. 1.5 T or 3T, 2D cine bSSFP, 4D flow MRI. Cardiac functional parameters of end-diastolic volume (EDV), end-systolic volume (ESV), stroke volume (SV) and myocardial mass were assessed by 2D cine bSSFP. PWV and aortic blood flow velocity were assessed by 4D flow MRI. Reproducibility of PWV was evaluated in a subset of nine participants. Analysis of variance, Pearson's correlation coefficient (r), linear regression, intraclass correlation coefficient (ICC). A P value < 0.05 was considered statistically significant. PWV increased significantly with age (young adults: 5.4 ± 0.9m/sec, midlife: 7.2 ± 1.1m/sec, and later life: 9.4 ± 1.8m/sec) (r=0.79, slope=0.09 m/sec/year). PWV did not differ in women and men in entire sample (P=0.40) or within age groups (young adults: P=0.83, midlife: P=0.17, and later life: P=0.96). PWV was significantly correlated with EDV (r=-0.29), ESV (r=-0.23), SV (r=-0.28), myocardial mass (r=0.21), and mean aortic blood flow velocity (r=-0.62). In the test-retest subgroup (N=9), PWV was 6.7 ± 1.5 [4.4-9.3] m/sec and ICC=0.75. 4D flow MRI quantified higher aortic PWV with age, by approximately 1m/sec per decade, and significant differences between young adults, midlife and later life. Reproducibility analysis showed good test-retest agreement. Increased PWV was associated with decline in cardiac function and reduced aortic blood flow velocity. This study demonstrates the utility of 4D flow MRI-derived aortic PWV for studying aging. 2 TECHNICAL EFFICACY: Stage 2.

Inductive Plethysmography for aortic Pulse Wave Velocity.

Aortic stiffening is a process that is linked to cardiovascular risk factor increase. Then, aortic stiffness evaluation is considered as a good index of the evolution of pathophysiological situations, including myocardial infarction, heart failure, atherosclerosis or stroke. Today, pulse wave velocity (PWV) measurement is considered as the gold standard for evaluation of arterial stiffness. However, most of the current measurement techniques of PWV consider the time for the blood pressure pulse to propagate through a combined length of arteries and give access to arterial PWV. Therefore, none of the available techniques focuses only on the aorta. In the present context of smart clothes development, Inductive Plethsymography (IP) can be an interesting alternative for aortic PWV measure, since it has recently been shown that combination of thoracic and abdominal IP recordings can give cardiac information. We therefore investigate the potential of IP for aortic PWV measurement. In this preliminary study, a comparative analysis of PWV estimated from IP and PWV evaluated from the arm has been carried out on 11 healthy volunteers. Results show a significant linear correlation between both measures (r = 0.86, p<0.001), promising for future investigations on pathological populations.

Premenapozal migren hastalarında aort sertliği parametrelerinin değerlendirilmesi

Purpose: Migraine is an episodic primary headache disorder, which affects approximately 10% of the adult population, predominantly females. Based on the changes detected in migraine and previous findings, arterial stiffness can be considered to be an important contributor to vascular events in patients with migraine. The aim of this study was to investigate the associations between atherosclerosis and migraine through the evaluation of aortic stiffness in premenopausal migraine patients.Materials and Methods: The study included 68 female patients with migraine, and a control group of 39 healthy females. To reveal the association between migraine and arterial stiffness, echocardiography was applied and aortic stiffness was evaluated. Blood pressure measurements, basic biochemical tests and the 12 derivation-ECG recordings of each patient were taken simultaneously. Results: Basic echocardiographic findings were similar in patients and the control group. Systolic and diastolic diameters of the aorta, and the change in aortic diameter were also similar in both groups. Aortic distensibility, aortic strain and beta indices were also similar in both groups. No significant differences were determined between patients with and without aura migraine and the control group in respect of systolic blood pressure, diastolic blood pressure and pulse pressure. Conclusion: As a marker of atherosclerosis, the aortic stiffness parameters didn’t differ between migraine and control group.

Evaluation of aortic stiffness in a tertiary care centre - Echocardiographic correlation with angiography

Evaluation of aortic stiffness in a tertiary care centre - Echocardiographic correlation with angiography

P1823Aortic walls elastic properties assessment with ultrafast ultrasound imaging in case of bicuspid aortic valve

Abstract Background Magnetic resonance imaging allows evaluation of aortic stiffness by the maximum rate of systolic distension (MRSD) a new prognosis factor of aortic dilatation in patients with bicuspid aortic valve (BAV). MRSD requires a continuous monitoring of the aortic diameter during the cardiac cycle, not accessible to conventional echocardiography contrary to ultrafast ultrasound imaging (UF). Purpose To develop specific aortic sequences in ultrafast ultrasound imaging (UF) to provide access to the aortic MRSD Methods Tissue Doppler allowed a precise estimation of the movement of each wall and the fine variation of the aortic diameter. To automatically track the anterior and posterior aortic walls during the cardiac cycle, we developed in the laboratory a specific interface (Figure). MRSD was the maximum of the derivative of the diameter chande over time. To assess this new technique, 24 patients (10 BAV patients and 14 controls, mean age 45.8 vs. 40.7 years, p=0.464, respectively) were consecutively included at a reference center for BAV. The ascending aorta was evaluated at the sinus of Valsalva, the tubular aorta and the aortic arch with a phased array probe (Supersonic Imagine) and dedicated sequences at 2000 frames/s. Results The lab-made interface allowed to track the aortic diameter and to calculate the MRSD from the UF acquisitions for each patient. We found lower MRSD at the sinus of Valsalva in case of BAV in accordance with previously demonstrated higher stiffness at this segment by our team (Table). Table 1. UF Aortic parameters for BAV patients and controls BAV patients Controls p (Mann Whitney) Sinus of Valsalva Diameter (mm) 26.2 [22.4–32.5] 27.09 [23.5–29.5] 0.796 MRSD (s–1) 1.05 [0.73–1.19] 1.51 [1.28–1.99] 0.023 Tubular ascending aorta Diameter 31.4 [29.4–32.2] 28.9 [22.6–31.5] 0.328 MRSD 0.94 [0.59–1.27] 1.09 [0.87–1.41] 0.353 Aortic arch Diameter 24.2 [23.7–24.8] 24.2 [18.9–24.5] 0.673 MRSD 0.57 [0.35–1.07] 0.85 [0.76–1.02] 0.257 Results are median [25th–75th percentile]. Figure 1 Conclusion UF allows evaluation of aortic stiffness by MRSD using dedicated sequence and interface. As echocardiography, UF is easily accessible and therefore deserves attention from cardiologists taking care of BAV patients to evaluate the segmental aortic remodeling associated with BAV.

Investigation of elastic features of aorta and color M-mode flow propagation velocity (APV) of descending aorta in the patients with ischemic and non-ischemic dilated cardiomyopathy.

Aortic flow propagation velocity (APV) is a novel echocardiographic parameter used in coronary artery disease. It has also been used for the evaluation of aortic stiffness. In the present study, APV was measured in patients with ischemic and non-ischemic dilated cardiomyopathy (DCM) and was compared with the parameters of aortic stiffness such as aortic distensibility (AD) and aortic strain (AS). A total of 140 patients who had undergone coronary angiographic imaging were included in the study. Out of these patients, 44 had ischemic DCM, 46 had non-ischemic DCM, and 50 had normal coronary angiography (control group). AS, AD, and APV were calculated echocardiographically. One-way analysis of variance (ANOVA) and the Kruskal-Wallis test were used to compare continuous variables between the groups, while the categorical variables were compared using Pearson's Chi square test. Pearson's correlation test was used to investigate the parameters associated with APV, AS, and AD. Ischemic DCM and non-ischemic DCM groups differed significantly. The comparison of these groups with the control group, in terms of AS, AD, and APV values (ANOVA p < 0.001 for all) also showed a significant difference. APV was found to be significantly correlated with AS (r = 0.645, p < 0.001) and AD (r = 0.604, p < 0.001). In ROC analysis, the area under the curve (AUC) value for APV was 0.999 (p = 0.000) for detection of patients ischemic DCM and non-ischemic DCM. APV may be considered to be a novel and a simple echocardiographic marker, for both, distinguishing ischemic from non-ischemic DCM as well as for the presence of dilated cardiomyopathy with or without critical coronary artery disease.

Autoantibodies against AT1 and α1-adrenergic receptors predict arterial stiffness progression in normotensive subjects over a 5-year period.

Arterial stiffness is an independent indicator of cardiovascular risk. Autoantibodies (AAs) against angiotensin AT1 receptor (AT1-AAs) and α1-adrenergic receptor (α1-AAs) are important in the pathogenesis of hypertension. We identified the types of AT1-AAs and α1-AAs in normotensive subjects, with the aim of determining whether these antibodies predict aortic stiffness progression. Carotid-femoral pulse wave velocity (cf-PWV) was used to measure aortic stiffness. Overall, 816 subjects (71% of those invited) underwent a medical examination and evaluation of aortic stiffness. The types of AT1-AAs and α1-AAs were measured at baseline. Meanwhile, plasma renin, angiotensin II (Ang II), and norepinephrine (NE) concentrations were measured at baseline and follow-up. Baseline mean cf-PWV was 9.90 ± 0.84 m/s and follow-up was 10.51 ± 1.12 m/s. The annualized ΔPWV was 0.12 ± 0.08 m/s/year. At the end of follow-up, 129 normotensive subjects developed hypertension and 144 subjects had PWV progression. After adjustment for covariates, AA type was independently associated with ΔPWV, annualized ΔPWV, and abnormal PWV. In our study, the risk of developing hypertension (RR =2.028, 95% CI: 1.227-3.351, P=0.006) and PWV progression (RR =2.910, 95% CI: 1.612-5.253, P<0.001) in AA-positive subjects was significantly higher than that in AA-negative subjects. Receiver operating characteristic (ROC) curve showed AA had an identify power to discriminate subjects with or without PWV and hypertension progression. We have shown for the first time that the types of A1-AAs and α1-AAs are independent predictors for aortic stiffness progression in normotensive subjects. Our data collectively support the utility of these AAs as potential markers of aortic stiffness.

Evaluation of aortic stiffness in Gilbert syndrome patients: a protective effect of elevated bilirubin levels.

Gilbert's syndrome (GS) is an autosomal recessive disease that is characterized by an increase in indirect bilirubin (IB). The incidence of atherosclerotic heart disease is decreased in GS. This study aimed to investigate the relation between pulse wave velocity (PWV) and the presence of GS. The study included 58 GS patients (32 females, age; 27.12 ± 7.27 years, 26 males, age; 26.63 ± 5.84 years) admitted to the internal medicine clinic of the hospital. The control group included 58 healthy individuals (35 females [27.33 ± 8.06 years old, p=0.716] and 23 males [27.38 ± 6.91 years old, p=0.923]). PWV of both groups was measured from the right carotid and femoral arteries. Mean age of the GS group was 26.03 ± 8.22 years, while that of the healthy group was 26.60 ± 5.84 years. The GS group's diastolic blood pressure and PWV were significantly lower than those of the control group: 67.76 ± 8.59 mmHg vs 71.72 ± 7.28 mmHg; p=0.008, and 5.63 ± 1.12 m/s vs 6.18 ± 1.22 m/s; p=0.014 respectively. The GS group's high density lipoprotein (HDL) level was significantly higher than that of the control group: 1.4 ± 0.3 mmol/L vs 1.2 ± 0.3 mmol/L, p=0.029. This study found PWV among GS patients to be lower than that among non-smoking and aged-matched healthy controls.

Carotid Artery and Aortic Stiffness Evaluation in Aortic Stenosis

In aortic stenosis (AS), the combination of risk factors can progressively lead to an increased arterial rigidity, which can be evaluated by the carotid artery and aortic stiffness (β index). The aim of this study was to investigate the relationship between carotid and aortic β index, left ventricular (LV) function, plasma brain natriuretic peptide (BNP) level, and symptoms in patients with AS. Comprehensive echocardiography including Doppler tissue imaging of the mitral annulus was performed in 53 patients with AS (aortic valve area < 1.2 cm(2)) and preserved LV ejection fractions (≥ 50%). Carotid β index was automatically derived from ultrasound wall tracking of the right carotid artery. The mitral E/e' ratio was used to estimate LV filling pressures. Carotid β index was higher in women than in men and was significantly correlated with age (P < .0001), diastolic arterial pressure (P = .046), pulse pressure (P = .006), and systemic arterial compliance (P = .001). Interestingly, carotid β index was significantly correlated with E/e' ratio (P < .0001) and plasma BNP level (P = .011). In multivariate regression analysis, carotid β index was an independent predictor of E/e' ratio (P < .0001) and of BNP level (P = .02). Moreover, carotid β index was significantly higher in symptomatic patients (P = .009). Aortic β index was significantly correlated with carotid β index (P < .0001), E/e' ratio (P = .004), and BNP (P < .001) and was significantly higher in symptomatic patients (P = .037). In patients with moderate to severe AS and preserved LV ejection fractions, the presence of increased carotid artery and aortic stiffness, assessed using carotid and aortic β index, is independently associated with elevated LV filling pressures, BNP level, and symptoms.

Pulse wave velocity in real-time cardiac magnetic resonance

Background Atherosclerosis and its associated diseases are constantly increasing in developed countries. Aortic stiffness is an indicator for atherosclerosis and is associated with mortality and morbidity especially in aortic abdominal aneurysms. For further evaluation of aortic stiffness, we examined n = 13 healthy volunteers using real-time magnetic-resonance imaging (RT-MRI) with highly undersampled radial fast low-angle shot (FLASH) acquisitions, phase-sensitive image reconstructions and regularized nonlinear inversion (NLINV). We hypothesized that RT-MRI is able to determine pulse wave velocity (PWV) and flow data using just one transverse view of the ascending and descending aorta. This method could be superior to complex known MRI methods using velocity projection today. Methods We assessed PWV as surrogate parameter for aortic stiffness by velocity-encoded RT-MRI. Time lag between the ascending and descending aortic pulse wave was calculated and divided by the mean length of the aortic arch for each individual in detail. RT-MRI can determine PWV during normal breathing, physical strain and recovery from strain using the Valsalva (VM) and Mueller maneuvers (MM). During strain/maneuvers volunteers had visual feedback of intra-thoracic pressure via a mouthpiece to ensure adequate strain performance. We calculated PWV in normal breathing, at the end of strain and at the end of the recovery phase. Due to the advantage of a single heart beat-to-beat variability with

Atrial Functions in Prediabetic Patients

Significant correlation was determined between aortic strain and fasting blood glucose, HbA1c level and DM duration (respectively r1⁄4-0,265; p:0,008, r1⁄40,279; p:0,005 ve r1⁄4-0,14; p:0,03) (Table 3 and Figure 2). Conclusion: In this study, we showed that aortic stiffness was increased in newly diagnosis diabetes mellitus. Echocardiographically noninvasive evaluation of aortic stiffness may be helpful in estimation of cardiovascular risk in patients with diabetes mellitus.

The Relation of Aortic Stiffness and In‐Stent Restenosis in Patients Undergoing Percutaneous Coronary Stenting

There is a suggestion that increased aortic stiffness can be the early manifestations of the atherosclerosis process and is related to decrease coronary flow after coronary stenting. We aimed to evaluate whether aortic stiffness could predict occurrence of in-stent restenosis (ISR) and its relation to coronary flow reserve (CFR) after coronary artery stenting. The study population included 126 patients with single vessel coronary artery disease (CAD) undergoing percutaneous coronary intervention (PCI) with bare-metal stenting and at least 12 months of follow-up. All patients underwent noninvasive aortic stiffness index (ASI) assessment before stenting and coronary flow assessment 1 month after stenting. Clinical ISR was observed in 29 (23%) patients, whereas 97 patients remained free of signs or symptoms of recurrent ischemia. ASI was significantly higher in patients with coronary artery disease versus control subjects, and it is significantly increased in patients with restenosis versus those without restenosis (P < 0.0001 and P < 0.001, respectively). There was a significant negative correlation between ASI and CFR (P = 0.0001). The ASI was significantly correlated with C-reactive protein (r = 0.395, P < 0.03). On univariate and multivariate analysis, ASI was the strongest predictor of restenosis (OR 6.8, 95% CI 2.6-13.5). Increased aortic stiffness was an independent predictor of poststenting impaired coronary flow and occurrence of ISR in patients undergoing PCI. Evaluation of aortic stiffness may represent a useful screening tool to stratify patients according to future risk of restenosis.

ASSOCIATIONS OF OBSTRUCTIVE SLEEP APNEA WITH VASCULAR DAMAGE AND ENDOTHELIAL DYSFUNCTION IN HYPERTENSIVES: PP.32.270

Objectives: Incriminating evidence of an adverse effect of obstructive sleep apnea (OSA) on the vasculature is increasing. We investigated the degree of vascular impairment in the high risk population of hypertensives with OSA by diverse atherosclerotic surrogates. Design and Methods: We studied 62 consecutive patients [49 men, aged 48 ± 7 years, 31 smokers, body mass index (BMI) 32 ± 4 kg/m2) with untreated hypertension and OSA diagnosed by polysomnography (PSG) [apnea/hypopnea index (AHI)>or=5], and a control group of 70 untreated hypertensives without OSA (AHI<5) matched for age, sex, body mass index, smoking status and 24 h systolic blood pressure (BP). All subjects underwent 24 h ambulatory BP monitoring, echocardiography and aortic stiffness evaluation by means of carotid – femoral pulse wave velocity (PWV) using an automatic device (Complior SP). Metabolic profile, serum creatinine levels (sCr), glomerular filtration rate (eGFR), and asymmetric dimethyl-arginine (ADMA) were assessed from a morning blood sample. The albumin/creatinine excretion ratio (ACR) was calculated from two non consecutive urine morning samples. Results: Hypertensives with OSA had similar 24 h systolic BP (140 ± 9 vs. 138 ± 6 mmHg, p = NS) but higher 24 h diastolic BP levels (87 ± 6 vs. 84 ± 7 mmHg, p = 0.03) compared to the control group. Left ventricle mass index was greater in the OSA group (109 ± 23 vs. 100 ± 25 gr/m2, p = 0.04), while relative wall thickness (0.43 ± 0.07 vs. 0.43 ± 0.08) and metabolic profile did not differ (p = NS for all). Although sCr and eGFR were similar between the two groups (0.96 ± 0.18 vs. 0.94 ± 0.18 mg/dl and 114 ± 30 vs. 116 ± 27 ml/min/1.73m2, p = NS for both), patients with OSA exhibited higher levels of logACR and logADMA compared to those without (1.07 ± 0.31 vs. 0.66 ± 0.38 mg/g, -0.25 ± 0.1 vs.-0.31 ± 0.1 ìmol/l, respectively, p < 0.0001 for both) even after adjustment for confounders. Furthermore, PWV was elevated in OSA patients compared to the control group. (8.2 ± 0.7vs.7.2 ± 0.9m/sec,p < 0.001). In the entire study population logAHI was correlated with PWV (r = 0.35, p < 0.001), logADMA (r = 0.30, p = 0.001) and logACR (r = 0.34, p < 0.0001). Conclusion: Elevated values of ADMA, PWV and ACR in hypertensives with OSA reveal an atherosclerotic state enhanced by sleep disordered breathing.

Evaluation of Aortic Stiffness (Aortic Pulse–Wave Velocity) Before and After Elective Abdominal Aortic Aneurysm Repair Procedures: A Pilot Study#

Background:The main clinical criterion for abdominal aortic aneurysm (AAA) repair operations is an AAA diameter ≥5.5 cm. When AAAs increase in size, specific changes occur in the mechanical properties of the aortic wall. Pulse-wave velocity (PWV) has been used as an indicator of vascular stiffness. A low PWV may predict AAA rupture risk and is an early predictor of cardiovascular mortality.Methods:We investigated the prognostic value of PWV before and after elective AAA repair procedures. Twenty four patients scheduled for an open AAA repair underwent a preoperative carotid-femoral aortic PWV measurement. A second aortic PWV measurement was carried out 6 months postoperatively.Results:The mean aortic PWV increased from 7.84 ± 1.85 preoperatively to 10.08 ± 1.57 m/sec 6 months postoperatively (mean change: 2.25; 95% confidence interval 1.4 to 3.1 m/sec; p<0.0001). The preprocedural PWV measurement did not correlate with AAA diameter (Spearman’s rank correlation coefficient ρ=0.12; p=0.59).Conclusions:Whether the increase in aortic PWV postoperatively suggests a decreased cardiovascular risk following AAA repair remains to be established. Aortic PWV should also be investigated as an adjunct tool for assessing AAA rupture risk.

Abstract 4875: Obstructive Sleep Apnea is Associated With Increased Aortic Stiffening, Microalbuminuria and Endothelial Dysfunction in Hypertensives: A Double Enemy to the Vasculature

Introduction: Incriminating evidence of an adverse effect of obstructive sleep apnea (OSA) on the vasculature is increasing. We investigated the degree of vascular impairment in the high risk population of hypertensives with OSA by diverse atherosclerotic surrogates. Methods : We studied 62 consecutive patients [49 men, aged 48±7 years, 31 smokers, body mass index (BMI) 32±4kg/m 2 ) with untreated hypertension and OSA diagnosed by polysomnography (PSG) [apnea/hypopnea index (AHI)≥5], and a control group of 70 untreated hypertensives without OSA (AHI&lt;5) matched for age, sex, body mass index, smoking status and 24h systolic blood pressure (BP). All subjects underwent 24h ambulatory BP monitoring, echocardiography and aortic stiffness evaluation by means of carotid - femoral pulse wave velocity (PWV) using an automatic device (Complior SP). Metabolic profile, serum creatinine levels (sCr), glomerular filtration rate (eGFR), and asymmetric dimethyl-arginine (ADMA) were assessed from a morning blood sample. The albumin/creatinine excretion ratio (ACR) was calculated from two non consecutive urine morning samples. Results : Hypertensives with OSA had similar 24h systolic BP (140±9 vs. 138±6 mmHg, p=NS) but higher 24h diastolic BP levels (87±6 vs. 84±7 mmHg, p=0.03) compared to the control group. Left ventricle mass index was greater in the OSA group (109±23 vs. 100±25 gr/m 2 , p=0.04), while relative wall thickness (0.43±0.07 vs. 0.43±0.08) and metabolic profile did not differ (p=NS for all). Although sCr and eGFR were similar between the two groups (0.96±0.18 vs. 0.94±0.18mg/dl and 114±30 vs. 116±27 ml/min/1.73m 2 , p=NS for both), patients with OSA exhibited higher levels of logACR and logADMA compared to those without (1.07±0.31 vs. 0.66±0.38 mg/g, −0.25±0.1 vs. −0.31±0.1 μ mol/l, respectively, p&lt;0.0001 for both) even after adjustment for confounders. Furthermore, PWV was elevated in OSA patients compared to the control group. (8.2±0.7vs.7.2±0.9m/sec, p&lt;0.001). In the entire study population logAHI was correlated with PWV (r=0.35, p&lt;0.001), logADMA (r=0.30, p=0.001) and logACR (r=0.34, p&lt;0.0001). Conclusions : Elevated values of ADMA, PWV and ACR in hypertensives with OSA reveal an atherosclerotic state enhanced by sleep disordered breathing.

Evaluation of aortic stiffness in children with chronic renal failure

The measurement of aortic stiffness (As) [aortic strain (S), pressure strain elastic modulus (Ep) and pressure strain normalized by diastolic pressure (Ep*)] is suggested as an excellent marker of subclinical arterial sclerosis. We aimed to investigate the presence of As and to determine the relationship between As and some risk factors in children with chronic renal failure (CRF). Twenty-six pre-dialysis (PreD) [female/male (F/M) 7/19] patients and 23 chronic peritoneal dialysis (CPD) (F/M 13/10) patients were assessed. Twenty-nine healthy children were selected as a control group (F/M 14/15). We determined anemia, abnormal calcium/phosphate metabolism, hypertension, diastolic dysfunction, increased left ventricular mass (LVM), hypertriglyceridemia, increased stiffness (Ep, Ep*), and decreased strain (S) in the CRF (PreD and CPD) group compared with the controls (P < 0.05). Presence of renal disease, LVM and usage of angiotensin-converting enzyme inhibitor (ACE-I) in all groups; female gender, duration of disease and the usage of anti-hypertensive drug therapy in CRF patients; and LVM and LVM index in healthy children were found to be independent predictors for aortic stiffness and/or strain. In conclusion, CRF is associated with significant arterial functional abnormalities in uremic children and not controlled by dialysis treatment. These results suggest that, even in young children, uremia has a profound impact on arterial function.

The incremental effect of obstructive sleep apnoea syndrome on arterial stiffness in newly diagnosed essential hypertensive subjects

Although obstructive sleep apnoea syndrome (OSAS) is accompanied by an increased atherosclerotic cardiovascular disease burden, its relationship with arterial stiffness is not yet well determined. We investigated whether essential hypertensive individuals with OSAS are characterized by increased arterial stiffness. Our study population consisted of 46 consecutive patients with newly diagnosed untreated stage I-II essential hypertension suffering from OSAS (35 men, aged 49 +/- 8 years) and 53 hypertensive individuals without OSAS, matched for age, sex, and smoking status. All subjects underwent polysomnography, echocardiography and aortic stiffness evaluation by means of carotid-femoral pulse wave velocity (c-fPWV) measurements. Hypertensive subjects with OSAS [apnoea/hypopnoea index (AHI)>or =5] compared with hypertensive subjects without OSAS (AHI < 5) demonstrated increased levels of body mass index (31.4 +/- 4 versus 29.3 +/- 4 kg/m2, P = 0.015), office systolic/diastolic blood pressure (151/99 versus 145/94 mmHg, respectively, P < 0.05, for both cases) and relative wall thickness (RWT; 0.46 +/- 0.06 versus 0.42 +/- 0.07, P=0.010). Hypertensive subjects with OSAS compared with those without OSAS had significantly increased c-fPWV by 9% (8.56 +/- 0.49 versus 7.85 +/- 0.93 m/s, P=0.001) and this difference remained significant even after adjustment for confounders (P=0.04). In the total study population, c-fPWV was correlated with age (r=0.35, P=0.015), office systolic blood pressure (r=0.30, P=0.007), RWT (r=0.30, P=0.03), logAHI (r=0.389, P=0.0001) and minimum oxygen saturation (r=-0.418, P=0.0001). OSAS has a significant incremental effect on aortic stiffening in the setting of middle-aged essential hypertensive subjects. This finding suggests that the presence of OSAS in a hypertensive patient accelerates vascular damage, increasing cardiovascular risk.

Evaluation of aortic stiffness in tobacco-smoking adolescents

Purpose To measure the aortic stiffness in tobacco-smoking adolescents and to investigate its relationship to tobacco smoke. Methods Aortic strain (S), pressure strain elastic modulus (Ep), and normalized Ep (Ep*) in tobacco-smoking adolescents and the healthy control group were measured by a sphygmomanometer with cuff and transthoracic echocardiography. The study group consisted of 30 healthy cases (M/F: 27/3) as a control group and 30 tobacco-smoking volunteer adolescents (M/F: 28/2). Unpaired Student's t-test was used for comparison of these groups. Results The mean ages were 16.1 ± 1.8 years and 16.2 ± 1.4 years, respectively. The number of cigarettes smoked per day was 31 ± 7.1 and the duration of smoking was 3.4 ± 1.1 years. S, Ep and Ep* measurements of tobacco smokers were different than the control groups' and this difference was statistically significant. S values were significantly higher in nonsmokers than in smokers; whereas Ep and Ep* values were significantly higher in smoker group. Conclusions This study demonstrated that measurement of aortic stiffness with S, Ep, and Ep* can be used as an early indicator of atherosclerosis in tobacco-smoking adolescents.