Assessment Of Pulse Wave Velocity Research Articles

The association between pulse wave velocity and pregnancy-associated diseases: A systematic review and meta-analysis

BackgroundMaintaining healthy vascular structure and function is important for a healthy pregnancy. Obesity is a well-known predictor for poor postoperative outcomes of vascular surgery. However, the association between pulse wave velocity (PWV), a well-recognized parameter for arterial stiffness assessment, and pregnancy-associated diseases is still unclear. Therefore, we conducted this systematic review, and a meta-analysis was performed to assess the relevant associations. MethodsWe systematically searched the Web of Science and PubMed databases to obtain articles on PWV and pregnancy-associated diseases published before April 2023. The mean with standard deviation was used to assess the differences in PWV in pregnant women with or without relevant diseases. Subgroup analysis was conducted according to specific types of PWV. The Newcastle‒Ottawa Scale was used to evaluate the quality of the enrolled studies. ResultsA total of 6488 individuals from 21 studies were included. All enrolled studies were high-quality. Overall, the PWV was elevated in pregnant women who suffered from preeclampsia (mean difference (MD) = 0.67, 95 % confidence interval (CI): 0.51,0.83, P < 0.00001), hypertension (MD = 1.04, 95 % CI: 1.00,1.08, P < 0.00001), gestational diabetes mellitus (MD = 0.34, 95%CI: 0.19,0.48, P < 0.00001), and diabetes (MD = 0.49, 95%CI: 0.27,0.70, P < 0.00001). Subgroup analysis based on specific types of PWV showed similar results. ConclusionIn our study, PWV is elevated in pregnancy-associated diseases, including preeclampsia, hypertension, and diabetes. The PWV assessment should be regarded as a clinical routine for pregnant women to prevent and manage cardiovascular diseases during pregnancy.

Unattended automatic blood pressure measurements vs conventional office readings in predicting hypertension-mediated organ damage.

Hypertension is a leading cardiovascular risk factor. Accurate blood pressure (BP) measurement is pivotal in hypertension diagnosis and management. Conventional office blood pressure measurements (OBPMs) are error‑prone, exacerbated by the white‑coat effect. Unattended automated office blood pressure measurement (UAOBPM) is emerging as an alternative, mitigating the white‑coat effect. However, its ability to predict hypertension‑mediated organ damage (HMOD) remains disputable. This study compares UAOBPM with OBPM in terms of their association with various types of HMOD, including left ventricular hypertrophy, left atrial enlargement, left ventricular systolic and diastolic dysfunction, intima‑media complex thickening, microalbuminuria, and abnormal pulse wave velocity. A total of 219 hypertensive patients were recruited, interviewed, and examined. Subsequently, BP measurements were conducted in a randomized manner: 1) UAOBPM, after 5 minutes of solitary rest in an examination room, BP was automatically measured 3 times at 1‑minute intervals; 2) OBPM, after 5 minutes of rest, a physician performed 3 consecutive BP measurements at 1‑minute intervals. Subsequent evaluations aimed to detect HMOD and included echocardiography, carotid artery ultrasound, pulse wave velocity assessment, and laboratory tests. UAOBP values were lower than the OBP ones (mean [SD], 124.7 [14.4] vs 128.2 [14.2] mm Hg; P <0.001 for systolic BP, and 73.3 [10.2] vs 75.2 [10.6] mm Hg; P <0.001 for diastolic BP). Correlation and receiver operating characteristic curve analyses revealed no superiority of either method in predicting HMOD. The UAOBPM did not prove superior to OBPM in predicting HMOD. Further research is warranted to determine the role of UAOBPM in clinical practice.

A region-based cross-correlation approach for tonometric carotid–femoral Pulse Wave Velocity Assessment

This work introduces a novel region-based algorithm to determine carotid–femoral Pulse Wave Velocity (cfPWV), decoupling the assessment of this biomarker from point-to-point feature extraction. A dataset of 75 healthy participants, previously recruited to compare the performances of a new instrument, Athos, with the gold standard for non-invasive PWV (SphygmoCor), was used to set up a new algorithm for determining the clinical cfPWV. The proposed approach locates and processes a specific window on the carotid and femoral signals. Cross-correlation is employed to compute the pulse transit time within the pulses. Finally, the cfPWV is assessed. A set of indicators has been defined to quantify the stability and reliability of the window used by the algorithm. The results obtained through the proposed algorithm, the Intersecting Tangent method, and the direct application of the cross-correlation technique on signal epochs have been systematically compared with outcomes derived from the SphygmoCor device. The retrieved results show a Pearson coefficient r = 0.96, P< 0.001, with a mean difference of 0.16m/s for the first case, r = 0.965, P< 0.001, with a mean difference of −0.07m/s for the second, and r = 0.82, P< 0.001, with a mean difference of −1.04m/s for the third. Despite the intersecting tangent method showing slightly better agreement when comparing cfPWV values with those derived from the SphygmoCor, the proposed approach yields significantly lower errors (P< 0.05) in the presence of different levels of added noise, demonstrating greater robustness in this context. This outcome, combined with the excellent accuracy, sustains the suitability of the proposed method for clinical applications.

Arterial Pulse Wave Velocity Signal Reconstruction Using Low Sampling Rates.

Pulse Wave Velocity (PWV) analysis is valuable for assessing arterial stiffness and cardiovascular health and potentially for estimating blood pressure cufflessly. However, conventional PWV analysis from two transducers spaced closely poses challenges in data management, battery life, and developing the device for continuous real-time applications together along an artery, which typically need data to be recorded at high sampling rates. Specifically, although a pulse signal consists of low-frequency components when used for applications such as determining heart rate, the pulse transit time for transducers near each other along an artery takes place in the millisecond range, typically needing a high sampling rate. To overcome this issue, in this study, we present a novel approach that leverages the Nyquist-Shannon sampling theorem and reconstruction techniques for signals produced by bioimpedance transducers closely spaced along a radial artery. Specifically, we recorded bioimpedance artery pulse signals at a low sampling rate, reducing the data size and subsequently algorithmically reconstructing these signals at a higher sampling rate. We were able to retain vital transit time information and achieved enhanced precision that is comparable to the traditional high-rate sampling method. Our research demonstrates the viability of the algorithmic method for enabling PWV analysis from low-sampling-rate data, overcoming the constraints of conventional approaches. This technique has the potential to contribute to the development of cardiovascular health monitoring and diagnosis using closely spaced wearable devices for real-time and low-resource PWV assessment, enhancing patient care and cardiovascular disease management.

Advancing the Local Pulse Wave Velocity Measurement - Wave Confluence Decomposition using a Double Gaussian Propagation Model.

Background Pulse wave velocity (PWV) is a marker of arterial stiffness and local measurements could facilitate its widescale clinical use. However, confluence of incident and early reflected waves leads to biased spatiotemporal PWV estimates. Objective We introduce the Double Gaussian Propagation Model (DGPM) to measure local PWV in consideration of wave confluence (PWVDGPM) and compare it against conventional spatiotemporal PWV (PWVST), with Bramwell-Hill PWV (PWVBH) and blood pressure (BP) as reference measures. Methods Ten subjects ranging from normotension to hypertension were repeatedly measured at rest and with induced PWV changes. Carotid distension waveforms over a 19 mm wide segment were acquired from ultrasonography, simultaneously with noninvasive continuous BP. Per cardiac cycle, the 8-parameter DGPM (amplitude, centroid, width, and velocity, respectively of forward and backward propagating wave) was fitted to the distension waveforms' systolic foot and dicrotic notch complexes. Corresponding PWVST was computed from linear fittings of respective feature timings and distances. Regression analyses were conducted with PWVDGPM and PWVST as predictors, and various PWV and BP measures as response variables. Results Whereas PWVST correlations were insignificant, PWVDGPM estimated the reference PWVBH with a significant reduction in errors (P<0.001), explained up to 65% PWVBH variability at rest, demonstrated higher intra-method consistency and correlated significantly with all BP measures (P<0.001). Conclusion The proposed DGPM measures local carotid PWV in consideration of wave confluence, showing significant correlations with Bramwell-Hill PWV and BP at two distinct waveform complexes. Thereby PWVDGPM outperforms the conventional PWVST in all investigated respects, potentially enabling PWV assessment in routine clinical practice.

Update on the Use of Pulse Wave Velocity to Measure Age-Related Vascular Changes.

Pulse wave velocity (PWV) is an important and well-established measure of arterialstiffness that is strongly associated with aging. Age-related alterations in the elastic properties and integrity ofarterial walls can lead to cardiovascular disease. PWV measurements play an important role in the earlydetection of these changes, as well as other cardiovascular disease risk factors, such as hypertension. Thisreview provides a comprehensive summary of the current knowledge of the effects of aging on arterial stiffness,as measured by PWV. This review highlights recent findings showing the applicability of PWV analysis forinvestigating heart failure, hypertension, and other cardiovascular diseases, as well as cerebrovascular diseasesand Alzheimer's disease. It also discusses the clinical implications of utilizing PWV to monitor treatmentoutcomes, various challenges in implementing PWV assessment in clinical practice, and the development ofnew technologies, including machine learning and artificial intelligence, which may improve the usefulness ofPWV measurements in the future. Measuring arterial stiffness through PWV remains an important technique to study aging, especiallyas the technology continues to evolve. There is a clear need to leverage PWV to identify interventions thatmitigate age-related increases in PWV, potentially improving CVD outcomes and promoting healthy vascularaging.

Abstract 18846: A Noninvasive Smartphone Assessment of Aortic Arch Pulse Wave Velocity and Total Arterial Compliance

Introduction: Several clinical studies including a large multiethnic population (Dallas Heart Study) have shown that total arterial compliance (TAC) and aortic arch pulse wave velocity (PWV aa ) are predictors of cardiovascular disease (CVD) events. Dallas Heart Study also showed that PWV aa predicts brain white matter hyperintensity volume independent of cardiovascular risk factors. Recently, Intrinsic Frequency (IF) analysis of carotid pressure waveform from the Framingham Heart Study was used to predict heart failure (HF) events and CVD (Hypertension, 2021 PMID: 33390053). Aim: Our goal was to show the IF method can determine PWV aa and TAC when applied on carotid pulse waveforms obtained from a standard iPhone camera. Methods: The clinical cohort consisted of 120 individuals (40% women) with ages from 20-92 yrs (mean 53 ± 18), including 54 healthy and 66 patients with CVD (22 HF). Phase-contrast magnetic resonance imaging (PC-MRI) and carotid pressure tonometry data were used to compute TAC. PWV aa values were obtained using PC-MRI flow in ascending and descending aorta (not achieved in 1 patients). A custom Apple iPhone 5S application was used to obtain carotid pulse waves by holding the camera against the neck. IF parameters of iPhone waveforms (calibrated by cuff brachial pressures) were used in machine learning algorithms (IF-iPhone). The models of TAC and PWV aa were developed using 100 participants (99 for PWV aa ) and blindly tested on an additional 20 individuals. Results: In blind tests, iPhone-IF models showed Pearson correlations of r=0.89 and r=0.84 with the measured values of TAC and PWV aa , respectively (Fig.1). Conclusions: Assessment of PWV aa and TAC can be accurately achieved using an unmodified smartphone (iPhone). PWV aa evaluation with an iPhone can be used to identify, predict, and quantify risk of vascular brain damage. A Noninvasive iPhone-based method can be used in a clinical or home setting to routinely assess TAC in the general population or in HF.

Abstract 14589: Impairment of Endothelial Function by Chronic Cannabis Use: An Interim Analysis of the CANDIDE Study

Background: Increasing cannabis legalization has led to a surge in cannabis use. To understand the consequences for cardiovascular health, we have initiated the CANnabis: Does It Damage Endothelium (CANDIDE) study. Here, we report results of an interim analysis. Aims: To investigate the effects of chronic cannabis product use on endothelial function. Approach: We recruited 44 healthy non-tobacco smokers/vapers, 21-50 yrs, in 3 groups based on chronic cannabis use: cannabis smokers, THC edible users, and nonusers. Participants underwent assessment of brachial artery flow-mediated dilation (FMD) and carotid-femoral pulse wave velocity (PWV). Human umbilical vein endothelial cells (ECs) were exposed to sera from each individual with and without VEGF to determine serum effects on endothelial NO production. Human lung microvascular ECs were also exposed to the individual sera and cell permeability was measured by electric cell-substrate impedance sensing. Results: FMD and VEGF-stimulated NO levels were both significantly lower in cannabis smokers than nonusers (5.7±3.3% vs 12.0±8.0%, p=.037, and 1.1±0.3 nM vs 1.5±0.3 nM, p=.018, respectively; figure), comparable effects to what we have reported for tobacco smokers. In contrast, FMD, but not VEGF-stimulated NO levels, was lower in the THC edible users than nonusers (5.0±4.1% vs 12.0±8.0%, p=.031, and 1.6±0.3 nM vs 1.5±0.3 nM, p=.54). There were no significant differences in other functional properties (p&gt;.48). CD31 and IL-1β, which are circulating inflammatory biomarkers that we showed are elevated in tobacco smokers, were not elevated in cannabis smokers. The inflammatory biomarker PTX3 was lower in cannabis smokers than nonusers (p=.038). Conclusion: Chronic cannabis use impairs endothelial function but may reduce inflammation. Our findings suggest that the impairment caused by smoking cannabis vs edible THC use occurs via distinct mechanisms differing in the involvement of endothelial NO production.

Wall Properties of Elastic and Muscular Arteries in Children and Adolescents at Increased Cardiovascular Risk.

Pulse wave velocity (PWV) assessment represents a simple method to estimate arterial distensibility. At present, carotid-femoral PWV (cf-PWV) is considered the gold standard method in the non-invasive evaluation of the elastic properties of the aorta. On the other hand, the mechanical properties of muscular arteries can be evaluated on the axillo-brachial-radia axis by estimating the carotid-radial PWV (cr-PWV). While a number of studies have addressed these issues in adults, limited information is available on the respective features of cf-PWV and cr-PWV and on their modulating factors in children and adolescents at increased cardiovascular risk. The mechanical properties of the predominantly elastic (aorta) and muscular (axillo-brachial-radial axis) arteries were evaluated in a pediatric population characterized by either elevated blood pressure (BP) or excess body weight, and the main factors affecting cf-PWV and cr-PWV values in these individuals were investigated. 443 children and adolescents (median age 11.5 years, 43.3% females) were enrolled; 25% had BP values >90th percentile and 81% were excess weight. The cf-PWV values were significantly lower than the cr-PWV values: median (Q1-Q3) = 4.8 m/s (4.3-5.5) and 5.8 m/s (5.0-6.5), respectively (p < 0.001). The pubertal development (p < 0.03), systolic BP and diastolic BP z-scores (p = 0.002), heart rate (p < 0.001), and waist-to-height ratio (p < 0.005) were significantly associated with cf-PWV values. No significant association was found between BMI z-score and cf-PWV. Predictors of high cf-PWV (>95th percentile) were the heart rate (OR 1.07, 95%CI 1.04-1.10, p < 0.001) and waist-to-height ratio (OR 1.06, 95%CI 1.0-1.13, p = 0.04). The variables significantly related with cr-PWV values were diastolic BP z-score (p = 0.001), heart rate (p < 0.01), and HOMA index (p < 0.02). No significant association was found between the cr-PWV and BMI z-score or waist-to-height ratio. Systolic and diastolic BP values and central obesity are associated with aortic stiffness in a population of children and adolescents at increased cardiovascular risk. In contrast, diastolic BP, heart rate, and levels of insulin resistance appear to be related to distensibility of the upper limb vascular district.

Assessing Automatic Plethysmographic Ankle-Brachial Index Devices in Peripheral Artery Disease Detection: A Comparative Study with Doppler Ankle-Brachial Index Measurements.

BACKGROUND The ankle-brachial index (ABI) is a critical diagnostic test for peripheral artery disease (PAD), albeit requiring technical expertise and dedicated resources. The advent of automatic ABI devices proposes a more accessible approach, necessitating fewer resources and less expertise. This study was conducted to gather data on PAD prevalence and to evaluate the correlation and efficacy of automatic ABI measurements vs traditional Doppler ABI measurements to understand their potential role in primary care settings. MATERIAL AND METHODS ABI measurements were obtained using both the Doppler method and an automatic plethysmographic device (Dopplex ABility, Huntleigh Healthcare). RESULTS Of the 290 participants (mean age 67.6±7.4 years), Doppler ABI method identified 16.8% with abnormal results (<0.9), while the automatic method identified only 5.9%. The mean Doppler ABI was 1.05±0.15, and the mean automatic ABI was 1.12±0.13. The sensitivity of the automatic ABI measurements was 22.2%, and the specificity was 96.8%, with a positive predictive value of 57.1%, and a negative predictive value of 86.9%. Adjustments in the automatic assessment and inclusion of pulse wave velocity enhanced the diagnostic capabilities of the automatic ABI device. CONCLUSIONS While the automatic plethysmographic ABI device may lack the necessary diagnostic capabilities to replace the traditional Doppler ABI device as a standalone test in PAD diagnosis, it could still offer significant value in primary care settings if integrated with adjusted cut-off points and pulse wave velocity analysis.

Alterations in retinal pulse wave velocity under experimental ocular hypertension.

Impairments of blood flow and autoregulation have been implicated in diabetic retinopathy and glaucoma. Thus, identifying biomarkers of retinal vascular compliance and regulatory capacity is of potential value for understanding the pathophysiology and evaluating onset or progression of disease. Pulse wave velocity (PWV) represents the speed of the pulse-propagated pressure wave within blood vessels and has shown promise as a marker of vascular compliance. The purpose of the current study was to report a method for comprehensive assessment of retinal PWV based on spectral analysis of pulsatile intravascular intensity waveforms and determine alterations due to experimental ocular hypertension. Retinal PWV was linearly related to vessel diameter. Increased retinal PWV was associated with elevated intraocular pressure. Retinal PWV has the potential to serve as a vasoregulation biomarker for investigating vascular factors that contribute to the development of retinal diseases in animal models.

Impact of thoracic endovascular aortic repair following blunt traumatic thoracic aortic injury on blood pressure

BackgroundBlunt traumatic thoracic aortic injuries (BTAIs) are associated with a high mortality rate. Thoracic endovascular aortic repair (TEVAR) is the most frequently used surgical strategy in patients with BTAI, as it offers good short- and middle-term results. Previous studies have reported an abnormally high prevalence of hypertension (HT) in these patients. This work aimed to describe the long-term prevalence of HT and provide a comprehensive evaluation of the biomechanical, clinical, and functional factors involved in HT development. MethodsTwenty-six patients treated with TEVAR following BTAI with no history of HT at the time of trauma were enrolled. They were matched with 37 healthy volunteers based on age, sex, and body surface area and underwent a comprehensive follow-up study, including cardiovascular magnetic resonance, 24-hour ambulatory blood pressure monitoring, and assessment of carotid-femoral pulse wave velocity (cfPWV, a measure of aortic stiffness) and flow-mediated vasodilation. ResultsThe mean patient age was 43.5 ± 12.9 years, and the majority were male (23 of 26; 88.5%). At a mean of 120.2 ± 69.7 months after intervention, 17 patients (65%) presented with HT, 14 (54%) had abnormal nighttime blood pressure dipping, and 6 (23%) high cfPWV. New-onset HT was related to a more proximal TEVAR landing zone and greater distal oversizing. Abnormal nighttime blood pressure was related to high cfPWV, which in turn was associated with TEVAR length and premature arterial aging. ConclusionsHT frequently occurs otherwise healthy subjects undergoing TEVAR implantation after BTAI. TEVAR stiffness and length, the proximal landing zone, and distal oversizing are potentially modifiable surgical characteristics related to abnormal blood pressure.

ASSOCIATIONS OF SERUM BIOMARKERS WITH BLOOD PRESSURE IN EX-PRETERM CHILDREN AND ADOLESCENTS

Objective: Preterm birth is considered a risk factor for the development of hypertension throughout life course. The aims of the present study were to assess the levels of serum biomarkers in ex-preterm children and adolescents compared to healthy controls and to examine for associations with office, ambulatory BP parameters, and pulse wave velocity. Design and method: The study population included 52 preterm and 26 term born children and adolescents who underwent office, ambulatory BP monitoring, and assessment of pulse wave velocity. Serum biomarkers including neutrophil gelatinase-associated lipocalin (NGAL), and matrix metalloproteinase-2, -9 (MMP-2, -9) were measured using double-antibody sandwich enzyme-linked Immunosorbent assay. Results: Thirty-five % of the study population presented office hypertension, 38.5% of the ex-preterm and 28% of the term children. Seventeen % of the ex-preterm group presented ABP hypertension. None of the controls had ABP hypertension. Half of the ex-preterm children had white-coat hypertension. Serum NGAL and MMP-2 and -9 levels did not differ between ex-preterm and term groups. NGAL and MMP-9 presented significant correlations with office systolic BP z score (r = 0.33, p&lt;0.005, and r = 0.30, p&lt;0.05, respectively) and day systolic BP z score (r = 0.29, p&lt;0.01, and r = 0.23, p&lt;0.05, respectively). The above associations were also observed in the ex-preterm, but not in the term group. There was no association between any biomarker and PWV. In univariate analysis NGAL presented significant correlations with office (B = 0.009, 95%CI 0.001-0.017, p&lt;0.05) and day systolic BP z-score (B = 0.009, 95%CI 0.001-0.017, p&lt; 0.05) in the ex-preterm group after adjustment for age, sex, birth weight and gestational age. The receiver operating characteristic (ROC) curve analysis showed that NGAL predicted hypertension in ex-preterm children with area under the curve (AUC) 0.713, 95% CI 0.57-0.85, p = 0.010. Conclusions: In ex-preterm children and adolescents NGAL and MMP-9 presented significant associations with systolic BP. The associations for NGAL persisted after adjustment for birth parameters, age and sex suggesting that NGAL should be further investigated as it could serve as early biomarker of hypertension evolution in ex-preterm children and adolescents.

The effect of adverse pregnancy outcomes on vascular aging in young women: the Kailuan study.

Adverse pregnancy outcomes (APOs) are at increased future cardiovascular risk and require effective risk mitigation. However, data regarding appropriate postpartum screening for young women with APOs are lacking. We aimed to investigate the association between APOs and vascular aging by the determination of high pulse wave velocity (PWV) in young women. Women who gave birth from 1990 to 2020 and underwent brachial-ankle pulse wave velocity (baPWV) assessments in the postpartum period were recruited. We excluded women with age ≥50 years at the baPWV assessment or missing postpartum health examinations. The history of APOs including hypertensive disorders of pregnancy, gestational diabetes, preterm delivery, and low birth weight were assessed by medical records. High PWV was defined as baPWV above the 90th percentile for different age group. Multivariable Logistic regression was used to evaluate the association of APOs and high PWV. 3193 participants were included in the analysis, including 912 (28.6%) individuals with APOs. The prevalence of high PWV in the non-APO group and the APOs group were 7.19% (164) and 13.9% (127), respectively (P < 0.05). Compared with non-APO group, the OR (95% CI) of APOs group was 1.67 (1.29-2.16). The risks in the 20-29, 30-39, and 40-49 age groups were 2.51 (1.13-5.59), 1.83 (1.30-2.59), and 1.35 (0.82-2.21) (P for trend <0.05). We conclude that APOs are risk factors of vascular aging for young women and the risk decreased with increasing age. BaPWV should be an important indicator for preventive cardiovascular risk management in young women with APOs. Clinical trial registration: Registration number ChiCTR-TNRC-11001489, http://www.chictr.org.cn/showproj.aspx?proj=8050 .

Arterial stiffness expressed as brachial-ankle pulse wave velocity and gait assessment independent of lower extremity strength: a cross-sectional study in the older men population.

Older men are more vulnerable to fatal falls than women, and gait disturbances contribute to the risk of falls. Studies have assessed the association between arterial stiffness and gait dysfunction, but the results have been inconclusive. This study aimed to conduct a cross-sectional analysis to evaluate the association between brachial-ankle pulse wave velocity (baPWV) and gait assessment in older men. Data from the 2014-2015 Korea Institute of Sport Science Fitness Standards project were used for the analysis. The inclusion criteria were men aged > 65 years with gait assessment [the 30-s chair stand test (30s-CST), the timed up and go (TUG) test, the figure-of-8 walk (F8W) test, the 2-min step test (2MST), and the 6-min walk test (6MWT)] and baPWV measurement data. Generalized linear regression analysis was conducted with multiple confounding factor adjustments, including lower extremity isometric strength. A total of 291 participants were included in the analysis. The mean age was 71.38 ± 4.40 years. The mean values were as follows: (1) 30s-CST, 17.48 ± 5.00; (2) TUG test, 6.01 ± 1.10 s; (3) F8W test, 25.65 ± 4.71 s; (4) 2MST, 102.40 ± 18.83 per 2 min; and (5) 6MWT, 500.02 ± 85.65 m. After multivariable adjustment, baPWV was associated with the 6MWT (β = -0.037, 95% CI: -0.072--0.002), TUG test (β = 0, 95% CI: 0.000-0.001), and F8W test (β = 0.002, 95% CI: 0.000-0.004). baPWV was not associated with the 30s-CST and 2MST. The current study showed a statistically significant association between gait assessments and arterial stiffness, independent of lower extremity strength. However, this association was modest. Future prospective studies are needed to elucidate the complex relationship between arterial stiffness and gait dysfunction.

The significance of central blood pressure for cardiovascular target organ damage in children and adolescents after kidney transplantation

BackgroundCardiovascular (CV) complications are important causes of morbidity and mortality in children after kidney transplantation (KTx). In adults, central blood pressure (cBP) is an accepted predictor of CV sequelae. We aimed to assess the prognostic value of cBP over peripheral blood pressure (pBP) for existing CV damage.MethodsWe measured cBP and pBP in 48 pediatric KTx recipients (mean age: 13.5 ± 4.2 years). Assessment of left ventricular mass index (LVMI) and aortic pulse wave velocity (PWV) allowed detection of CV target organ damage. LVMI and PWV were used as endpoints in multivariable linear regression models, in which cBP and pBP were compared for their predictive value.ResultsUsing cBP z-scores, we identified a larger number of patients with uncontrolled or untreated hypertension compared to pBP (36% vs. 7%). Central systolic blood pressure (cSBP) was a significant independent predictor of LVMI, while peripheral systolic blood pressure (pSBP) was not. Comparing central (cDBP) and peripheral (pDBP) diastolic blood pressure for their predictive value on PWV revealed a greater estimate for cDBP (0.035 vs. 0.026 for pDBP) along with a slightly better model fit for cDBP.ConclusionsOur data in a small group of patients provide first evidence that cBP measurements in pediatric KTx recipients might be helpful in identifying patients at risk for the development of CV sequelae. Investigating a larger patient number, ideally repeatedly, is needed to create further evidence supporting our findings. In light of available devices measuring cBP noninvasively, the implementation of such clinical studies post-KTx care should be feasible.Graphical abstractA higher resolution version of the Graphical abstract is available as Supplementary information

Central blood pressure: nice to know but not yet ready for routine practice

A few years ago, my division bought new 24-hour blood pressure (BP) measurement devices. One sales argument of the manufacturer was that the new devices can also record central blood pressure, and we thought this is a great added feature. Central blood pressure is regarded as an index of aortic stiffness1 and can be calculated from a noninvasive assessment of arterial pulse wave velocity and calculation of the augmentation index.2 At last, the machines arrived, we first tried them on ourselves (of course), received nice printouts, but then the questions started.

The Relationship between Vascular Aging Phenotypes and Renal Damage among Individuals with Type 2 Diabetes

Objective: The aim of this study was to investigate the relationship between vascular aging (VA) phenotypes and renal damage in type 2 diabetic population. Methods: In this cross-sectional study, we included 8,141 individuals with type 2 diabetes who participated in the Kailuan Study during 2010–2018 and completed the brachial-ankle pulse wave velocity (baPWV) assessment for arterial stiffness, an indicator for VA. The age- and sex-specific 10th and 90th percentiles of baPWV based on a reference cohort were used as cutoffs to define supernormal VA (SUPERNOVA, baPWV<10th percentiles), normal VA (NVA, baPWV 10th to 90th percentiles), and early VA (EVA, baPWV>90th percentiles). The estimated glomerular filtration rate (eGFR) and proteinuria levels were used to assess renal damage, including isolated proteinuria, isolated kidney function decline (eGFR<60 mL/min/1.73 m²), and proteinuria combined with kidney function decline. Multivariable logistic regression analysis was used to analyze the relationship between VA phenotypes and diabetic kidney damage. Results: The prevalences of isolated proteinuria, isolated kidney function decline, and proteinuria combined with kidney function decline were 17.0%, 12.2%, and 5.4%, respectively. Compared with NVA, SUPERNOVA was associated with 34% lower odds (95% confidence interval [CI]: 0.46–0.96) of isolated proteinuria after adjusting for age, sex, and other potential confounders. EVA was associated with higher odds of all three types of kidney damage; the adjusted odds ratio (95% CI) was 1.42 (1.20–1.67) for proteinuria, 1.24 (1.01–1.51) for kidney function decline, and 1.56 (1.18–2.06) for proteinuria combined with kidney function decline. Conclusions: VA phenotypes are associated with renal damage, especially isolated proteinuria. SUPERNOVA was associated with lower odds of isolated proteinuria and EVA was associated with higher odds of proteinuria and kidney function decline.

A Heart Rate Step Function Response Method for the Evaluation of Pulse Wave Velocity as a Predictor of Major Adverse Cardio-Vascular Events

Background and Objectives: Cardiovascular diseases are the main cause of death worldwide, and pulse wave velocity (PWV) is considered a predictor of major adverse cardiovascular events. The study intended to be helpful in finding methods for the preliminary assessment of PWV in primary care units. Materials and Methods: The study group consisted of 36 subjects (considered healthy by their own statement) from the medical field (medicine students and residents) aged between 20 and 30 years: 33.3% males and 66.7% females. Two types of measurements were carried out successively: (a) measurements with the arteriograph and (b) measurements on a treadmill effort testing system, where heart rate (HR) was measured over time as a response to step function physical effort (PE). Results: The study allowed for the highlighting of some limits which, if exceeded, can be associated with high PWV values: (i) if after a moderate PE and a resting time of at least 6 min, the HR is larger than 80 b/min; (ii) if the relaxation time in a PE test of moderate intensity is larger than 1 min; (iii) if the HR measured after the subject is raised from the supine to orthostatic position is larger than 100 b/min, and (iv) if the resting HR is larger than 80 b/min. Conclusions: Steady-state HR correlates with PWV and may be used for the preliminary assessment of PWV.

Microcirculatory Pulse Wave Velocity: A Novel Method Utilizing Near-Infrared Spectroscopy

Pulse wave velocity (PWV) is a gold standard assessment for arterial stiffness, which is a well-known marker for cardiovascular diseases. Specifically, PWV is the measurement of the velocity of blood pulse waves traveling across a segment of the arterial network. Although PWV assessment is well-characterized in the conduit arteries with tonometry techniques (TT), PWV to the microcirculation has not been well-studied due to the technical limitations of tonometry. PURPOSE: To measure PWV to the microcirculation using near-infrared spectroscopy (NIRS). METHODS: In 13 healthy-young subjects (23±3.8 years), pulse pressure waveforms were collected from the carotid and radial arteries (with topical force sensors) simultaneously with optical waveforms (measured with NIRS) on the medial forearm. To determine criterion validity, carotid-radial PWV (crPWV) was measured with a well validated TT after 10 minutes of supine rest and after recovery from an arterial occlusion, and the values were compared with a customized algorithm produced in MATLAB for wave detection. To assess construct validity, both macro (crPWV)- and micro (mPWV)- circulatory PWVs were measured before and after 5 minutes of arterial occlusion (250 mmHg). RESULTS: The customized algorithm demonstrated good criterion validity with TT and strongly correlated with TT values (r=0.99, p<0.01), and a t-test revealed no differences between the customized algorithm and TT (p=0.88). Regarding construct validity, the crPWV results aligned well with typical wave patterns reported in previous literature, and demonstrates values reach slower than baseline after 30 seconds of reperfusion (Δ -0.37±0.34 m/s, p=0.029), which represents a reaction to hyperemia. Furthermore, mPWV was slowest immediately after cuff release (Δ -0.63±0.48 m/s, p<0.01), which is well aligned with the vasodilatory response in the microcirculation to ischemia. These findings validate that the novel mPWV method assessed with NIRS measures the correct construct. CONCLUSIONS: Measuring PWV with NIRS represents a feasible assessment of microcirculatory PWV and may be useful for assessing microcirculatory dysfunction in clinical populations, such as individuals with peripheral vascular diseases. Supported by UNO GRACA Grant