Β-stiffness Index Research Articles

Abstract MP27: Pregnant Women of Advanced Maternal Age Have Higher Central Artery Stiffness Than Younger Pregnant Women

The frequency of women undergoing pregnancy at advanced maternal age (AMA, ≥35 years) is increasing in developed countries, including the United States. AMA is associated with an increased risk of adverse pregnancy outcomes such as gestational hypertension, preeclampsia, and preterm birth. Increased risk for adverse pregnancy outcomes at AMA may be mediated in part by altered arterial structure and function or inadequate maternal arterial adaptations during pregnancy. Therefore, we examined central artery stiffness and endothelial function across healthy pregnancy (i.e. no comorbid maternal or fetal conditions, born at term) in women who had enrolled in a longitudinal study between March 2015 and January 2020. We hypothesized that women at AMA (age ≥35 years, mean±SE: 36±0 years, n=18) would have higher arterial stiffness and lower endothelial function compared with younger women (age 21-30 years, mean±SE: 27±0 years, n=51) across pregnancy. Hemodynamic and arterial function measures were collected in the first (6-13 weeks), second (18-26 weeks), and third (27-37 weeks) trimesters and postpartum (4-14 weeks after the delivery). Brachial artery blood pressure was assessed in the supine position and central artery stiffness was assessed via carotid-femoral (aortic) pulse wave velocity (cfPWV) and carotid β-stiffness index. Endothelial function was determined via brachial artery flow-mediated dilation (FMD). Brachial artery systolic, diastolic, and mean blood pressures were not different between AMA and younger women across pregnancy or postpartum (all P >0.05). The AMA group had higher cfPWV ( P <0.01) and carotid β-stiffness index ( P <0.01) across pregnancy and postpartum compared to the younger group. cfPWV decreased among younger women at the second and third trimesters compared with the first trimester ( P <0.01), while cfPWV among women of AMA did not change ( P =0.07). There were no differences in FMD between AMA and younger women across pregnancy or postpartum ( P =0.96). These results demonstrate that healthy women of AMA have increased central artery stiffness, but no difference in endothelial function, compared to younger pregnant women across pregnancy, and that the normal decrease in aortic stiffness is blunted in pregnant women of AMA compared to younger women. The sustained higher central artery stiffness throughout pregnancy among women of AMA may contribute to increased risk of pregnancy complications and future CVD risk in these women.

Comparison of Arterial Stiffness and Strain Measured with Speckle Tracking Carotid Strain Ultrasonography after Radiation and Surgical Treatment for Head and Neck Cancer-A Clinical Trial.

This study assessed arterial stiffness in head and neck cancer patients using speckle tracking carotid strain ultrasonography (STCS-US). It investigated the impacts of neck irradiation and neck dissection on the arterial stiffness of these patients by comparing their stiffness parameters with those of healthy controls. A total of 101 participants (67 patients and 34 healthy controls) were enrolled in this study. Fifty-two patients received definitive radiation therapy (TD: 60-72 Gy in 30 days) at least two years ago. Participants were grouped into four according to their states of neck irradiation (IR) and neck dissection (ND): Group (IR+/ND-) had 28 patients, Group (IR+/ND+) had 24 patients, Group (IR-/ND+) had 15 patients, and Group (IR-/ND-) had 34 healthy controls. All the participants underwent STCS-US. Arterial stiffness parameters relating to arterial compliance (AC) and elastic modulus (EM) were significantly changed in Group (IR+/ND-) and Group (IR+/ND+) in the transverse plane (p < 0.001, p < 0.001) and in the longitudinal plane (p < 0.001, p < 0.001); the change in β-stiffness index (β-SI) was more significant in the transverse plane (p = 0.002). Group (IR+/ND+) had significant transverse circumferential (p = 0.001) and radial strain parameters (p = 0.001). The carotid intimal medial thickness (CIMT) significantly changed in Group (IR+/ND+) compared to controls (p = 0.001). Our findings indicate that neck irradiation and neck dissection increase arterial stiffness as single treatments; however, double treatment is associated with a higher increase. Neck irradiation affects strain parameters more than neck dissection alone. The study demonstrated the feasibility and clinical value of the STCS method in assessing arterial stiffness and its potential use in cardiovascular risk assessment for patients with head and neck cancer.

Age-related changes to cerebral artery stiffness and structure in mice

Introduction: With advancing age, there are changes in the structural and material properties of the arterial wall. While the age-related increase in stiffness is well described for large arteries, less is known about the structural changes to cerebral arteries with age. In response to increased blood pressure, as occurs with aging, arteries typically undergo remodeling that includes smooth muscle cell proliferation and collagen accumulation. This remodeling contributes to increased stiffness and reduces pulse pressure dampening, potentially leading to damage to arterioles and capillaries. We hypothesized that old cerebral arteries would display greater stiffness, wall thickness, collagen content, and smooth muscle content compared with young cerebral arteries. Methods: We studied old male (n=10, 24-27 months) and young male (n=9, 4-7 months) C57BL/6 mice. For measures of stiffness, isolated posterior cerebral arteries were exposed to pulsatile pressure (37.5 to 87.5 mmHg, 400 pulses/min) for 30 minutes. Artery diameters during the pulsation were recorded and used to calculate distension, β-stiffness index, and Peterson modulus of elasticity (EP). In sections of the middle cerebral arteries, total wall thickness and total collagen were measured in Masson’s trichrome-stained arteries. Collagen-1 and α-smooth muscle actin content were measured by immunofluorescence in middle cerebral artery sections. Data were analyzed by a Shapiro-Wilks test for normality, and young and old groups were compared by student’s t-test. Group comparisons for β-stiffness, EP, and percent change in diameter were made using a Mann-Whitney test. A p&lt;0.05 was considered statistically significant. Data are mean±SD. Results: Cerebral arteries from young mice, compared with old mice, had a higher distensibility during the application of pulsatile pressure, measured by the percent change in diameter (8.0±4.0% vs. 5.1±2.5%, p=0.03) or absolute change in diameter (12.0±5.4 μm vs. 7.8±3.8 μm, p=0.03). Cerebral artery stiffness, calculated by β-stiffness index (13.1±6.5 AU vs. 21.9±13.8 AU, p=0.03) and EP (777±384 kPa 102 vs.1293±816 kPa 102, p=0.03) was lower in young mice compared with old mice. There was no difference in cerebral artery wall thickness between groups (6.9±3.0 μm vs. 9.6±2.3 μm, p=0.08). Cerebral arteries from old mice had greater amounts of α-smooth muscle actin compared to young mice (1.4±0.2 AU vs. 1.0±0.2 AU, p=0.009). Interestingly, cerebral arteries from old mice had lower collagen-1 compared to young mice (0.8±0.1 vs. 1.0±0.1 AU, p=0.01), but the opposite trend was observed for total collagen (26.3±13.6 AU vs. 17.6±9.6, p=0.06). Conclusion: These results demonstrate that advancing age results in increased functional stiffness of cerebral arteries. An age-related increase in smooth muscle is a potential cause of higher cerebral artery stiffness. This project was funded by NIH R01 AG064016 and the Oregon Medical Research Foundation. This is the full abstract presented at the American Physiology Summit 2023 meeting and is only available in HTML format. There are no additional versions or additional content available for this abstract. Physiology was not involved in the peer review process.

Comparison of Parameters for Assessment of Carotid Stiffness and Their Association with Carotid Atherosclerosis in Rural Australian Adults: A Pilot Study.

Carotid stiffness has been associated with the development and progression of carotid artery disease and is an independent factor for stroke and dementia. There has also been a lack of comparison of different ultrasound-derived carotid stiffness parameters and their association with carotid atherosclerosis. This pilot study aimed to investigate the associations between carotid stiffness parameters (derived via ultrasound echo tracking) and the presence of carotid plaques in Australian rural adults. In cross-sectional analyses, we assessed forty-six subjects (68 ± 9 years; mean ± SD) who underwent carotid ultrasound examinations. Carotid stiffness was assessed by a noninvasive echo-tracking method, measuring and comparing multiple carotid stiffness parameters, including stroke change in diameter (ΔD), stroke change in lumen area (ΔA), β- stiffness index, pulse wave velocity beta (PWV-β), compliance coefficient (CC), distensibility coefficient (DC), Young's elastic modulus (YEM), Peterson elastic modulus (Ep), and strain. Carotid atherosclerosis was assessed bilaterally by the presence of plaques in the common and internal carotid arteries, while carotid stiffness was assessed at the right common carotid artery. β-stiffness index, PWV-β, and Ep were significantly higher (p = 0.006, p = 0.004, p = 0.02, respectively), whilst ΔD, CC, DC, and strain were lower among subjects with carotid plaques (p = 0.036, p = 0.032, p = 0.01, p = 0.02, respectively) comparing to subjects without carotid plaques. YEM and ΔA did not significantly differ among the groups. Carotid plaques were associated with age, history of stroke, coronary artery disease, and previous coronary interventions. These results suggest that unilateral carotid stiffness is associated with the presence of carotid plaques.

Aerobic exercise training reduces central arterial stiffness and improves cerebral blood flow in older adults

Background: Evidence of the benefits of aerobic exercise training (AET) on brain structure, function, and perfusion in older adults is inconclusive.&#x0D; Methods: We conducted two randomized controlled trials (RCT) in sedentary older adults with or without mild cognitive impairment (MCI) to address this question.1-3 The trial’s intervention arm was a progressive moderate-to-vigorous intensity AET, and the active control arm was stretching-and-toning (SAT). Outcome measures included neurocognitive function focused on memory and executive function, global and regional brain volume and cortical thickness measured with structural magnetic resonance imaging (MRI), cerebral blood flow (CBF) and CBF pulsatility measured in the large cerebral arteries (the internal carotid artery, the vertebral artery, and the middle cerebral artery) with 2D duplex ultrasonography and transcranial Doppler, central arterial stiffness measured with arterial applanation tonometry, and cardiorespiratory fitness measured with treadmill peak oxygen consumption (V̇O2peak). The duration of both trials was one year.&#x0D; Results: In both studies, we observed that AET increased V̇O2peak significantly by ∼10% while it did not change with SAT. Cognitive composite scores and domain-specific scores improved in both the AET and SAT groups, although no group differences were observed (likely reflected by cognitive test practice effects). Total brain and hippocampal volume and mean cortical thickness decreased in both groups over one year. Conversely, AET increased CBF, and decreased central arterial stiffness and CBF pulsatility. Increases in V̇O2peak with AET were correlated with increases in CBF and decreases in cerebrovascular resistance (CVR). Further, the improved memory score in the AET group was associated with decreased CVR and central arterial stiffness measured with carotid β-stiffness index.&#x0D; Conclusions: Taken together, these findings demonstrated that one-year moderate-to-vigorous intensity AET increased CBF and decreased central arterial stiffness in older adults with or without MCI. We speculate that improvement in cerebrovascular function with AET may precede its potential effects on brain structure and neurocognitive function in older adults. (The research findings presented herein were supported by the National Institutes of Health R01AG033106 and R01HL102457)

One-year aerobic exercise increases cerebral blood flow in cognitively normal older adults

The impact of aerobic exercise training (AET) on cerebral blood flow (CBF) regulation remains inconclusive. This study investigated the effects of one-year progressive, moderate-to-vigorous AET on CBF, central arterial stiffness, and cognitive performance in cognitively normal older adults. Seventy-three older adults were randomly assigned to AET or stretching-and-toning (SAT, active control) intervention. CBF was measured with 2D duplex ultrasonography. Central arterial stiffness, measured by carotid β-stiffness index, was assessed with the ultrasonography and applanation tonometry. Cerebrovascular resistance (CVR) was calculated as mean arterial pressure divided by CBF. A cognitive battery was administered with a focus on memory and executive function. Cardiorespiratory fitness was measured by peak oxygen consumption (O2peak). One-year AET increased O2peak and CBF and decreased CVR and carotid β-stiffness index. In the AET group, improved O2peak was correlated with increased CBF (r = 0.621, p = 0.001) and decreased CVR (r = −0.412, p = 0.037) and carotid β-stiffness index (r = −0.478, p = 0.011). Further, increased Woodcock-Johnson recall score was associated with decreased CVR (r = −0.483, p = 0.012) and carotid β-stiffness index (r = −0.498, p = 0.008) in AET group (not in SAT group). In conclusion, one-year progressive, moderate-to-vigorous aerobic exercise training increased CBF and decreased carotid arterial stiffness and CVR which were associated with improved memory function in cognitively normal older adults.

Skin microcirculation dynamics are impaired in patients with rheumatoid arthritis and no cardiovascular comorbidities.

Rheumatoid arthritis (RA) is associated with increased cardiovascular disease (CVD) risk. Microvascular endothelial dysfunction contributes to the development of vascular injury and subsequent CVD. We hypothesised that RA patients exhibit blunted microvascular reactivity regardless of CVD risk factors and investigated potential associations with coronary microvascular perfusion and surrogate markers of CVD. This case-control study recruited RA patients and non-RA individuals in the absence of cardiovascular comorbidities. Skin microvascular reactivity was dynamically assessed using laser speckle contrast imaging coupled with post-occlusive reactive hyperaemia protocol. Applanation tonometry was applied to assess subendocardial viability ratio, an index of myocardial microvascular perfusion, and central arterial stiffness [carotid-femoral pulse wave velocity (PWV), augmentation index]. Peripheral arterial stiffness (carotid PWV, β-stiffness index) and carotid atherosclerosis (intima-media thickness) were assessed with carotid ultrasound software. Skin microvascular responses before and following reperfusion [baseline flux, occlusion flux, time-to-peak, peak magnitude, peak-to-baseline magnitude, baseline cutaneous vascular conductance (CVC), and percentage increase in CVC] were significantly impaired in RA patients (n=35) compared to controls (n=35). Presence of RA independently predicted altered microvascular reactivity in multivariate analysis. Skin microcirculation dynamics significantly correlated with coronary microvascular perfusion and peripheral arterial stiffness, yet not carotid atherosclerosis, even after adjustment for CVD risk factors. Patients with RA present impaired microvascular reactivity regardless of CVD risk factors at a preclinical stage preceding CVD. Assessment of skin microvascular dysfunction may reflect a state of generalised vasculopathy, including myocardial microvascular abnormalities, and serve as a non-invasive surrogate indicator of CVD risk in RA.

Mitochondrial-targeted antioxidant supplementation for improving age-related vascular dysfunction in humans: A study protocol.

Background: Cardiovascular disease (CVD) is the leading cause of death worldwide and aging is the primary risk factor for the development of CVD. The increased risk of CVD with aging is largely mediated by the development of vascular dysfunction. Excessive production of mitochondrial reactive oxygen species (mtROS) is a key mechanism of age-related vascular dysfunction. Therefore, establishing the efficacy of therapies to reduce mtROS to improve vascular function with aging is of high biomedical importance. Previously, in a small, randomized, crossover-design pilot clinical trial, our laboratory obtained initial evidence that chronic oral supplementation with the mitochondrial-targeted antioxidant MitoQ improves vascular function in healthy older adults. Here, we describe the protocol for an ongoing R01-funded phase IIa clinical trial to establish the efficacy of MitoQ as a therapy to improve vascular function in older adults (ClinicalTrials.gov Identifier: NCT04851288). Outcomes: The primary outcome of the study is nitric oxide (NO)-mediated endothelium-dependent dilation (EDD) as assessed by brachial artery flow-mediated dilation (FMDBA). Secondary outcomes include mtROS-mediated suppression of EDD, aortic stiffness as measured by carotid-femoral pulse wave velocity, carotid compliance and β-stiffness index, and intima media thickness. Other outcomes include the assessment of endothelial mitochondrial health and oxidative stress in endothelial cells obtained by endovascular biopsy; the effect of altered circulating factors following MitoQ treatment on endothelial cell NO bioavailability and whole cell and mitochondrial reactive oxygen species production ex vivo; and circulating markers of oxidative stress, antioxidant status, and inflammation. Methods: We are conducting a randomized, placebo-controlled, double-blind, parallel group, phase IIa clinical trial in 90 (45/group) healthy older men and women 60 years of age or older. Participants complete baseline testing and are then randomized to either 3 months of oral MitoQ (20 mg; once daily) or placebo supplementation. Outcome measures are assessed at the midpoint of treatment, i.e., 6 weeks, and again at the conclusion of treatment. Discussion: This study is designed to establish the efficacy of chronic supplementation with the mitochondrial-targeted antioxidant MitoQ for improving vascular endothelial function and reducing large elastic artery stiffness in older adults, and to investigate the mechanisms by which MitoQ supplementation improves endothelial function.

Morphology and rheology of pulmonary arteries: A relationship with right ventricular function in patients with pulmonary arterial hypertension associated with atrial septal defect?

Qualitative and quantitative hemodynamic flow indexes have been related to right ventricular (RV) function in pulmonary arterial hypertension (PAH), using 4-dimensional flow cardiac magnetic resonance (4D-flow CMR). Little is known in PAH congenital heart disease population characterized by intracardiac shunting. A prospective bi-centric study was conducted in two French referral centers for PAH to assess RV function and anatomical and rheological parameters in the proximal pulmonary arteries (PA) in PAH associated with atrial septal defect (ASD). A multiparametric evaluation, including a complete hemodynamic catheterization and a 4D flow CMR, was performed in 24 patients (50 years [41–55]) with PAH-ASD, of whom 16 (66%) had a persistent left-to-right shunt. Patients were divided into two groups according to the presence ( n = 14) or absence ( n = 10) of RV dysfunction, defined as RV ejection fraction (RVEF) < 45%. Tricuspid annular excursion (TAPSE) was 21 mm [18–26] and RVEF was 37% [27–52]. Mean pulmonary artery pressure was 50 mmHg [39–59] and pulmonary vascular resistance was 8 Wood units [6–8] and 42% were in WHO/NYHA function class III or VI. RV function was correlated with RV-PA coupling (correlation coefficient = −0.91, P <0.0001), PA compliance (correlation coefficient = −0.40, P = 0.04), and PA stiffness index (correlation coefficient = 0.43, P = 0.03). Helicity and vorticity were correlated with PA area, but there was no significant relationship with RV function. Intrinsic parameters were more alterated in the group without RV dysfunction, characterized by a persistent left to right shunt, with a decreased tight PA compliance ( P = 0.01), decreased distensibility ( P = 0.01), decreased pulsatility index ( P = 0.06), increased β-stiffness index ( P = 0.01), and increased elastance ( P = 0.01). In patients with left-to-right shunt, barometric and volumetric overload aggravates proximal PA remodelling with increased PA dilatation and stiffness. Paradoxically, in patients with RV dysfunction, normally associated with end-stage of PAH and right-to-left shunt, this remodelling is significantly less considerable.

The association between cardiac magnetic resonance-derived aortic stiffness parameters and aortic dilation in young adults with bicuspid aortic valve: With and without coarctation of aorta

BackgroundBicuspid aortic valve (BAV) is associated with progressive aortic dilation. Studies in aortopathies have shown a correlation between increased aortic stiffness and aortic dilation. We aimed to evaluate aortic stiffness measures as predictors of progressive aortic dilation by cardiac magnetic resonance (CMR) in BAV patients. MethodsThis is a retrospective study of 49 patients with BAV (median age 21.1 years at first CMR visit) with ≥2 CMR at the Wisconsin Adult Congenital Heart Disease Program (WAtCH). Circumferential aortic strain, distensibility, and β-stiffness index were obtained from CMR-derived aortic root cine imaging, and aortic dimensions were measured at aortic root and ascending aorta. A linear mixed-model and logistic regression were used to identify important predictors of progressive aortic dilation. ResultsOver a median of 3.8 years follow-up, the annual growth rates of aortic root and ascending aorta dimensions were 0.25 and 0.16 mm/year, respectively. Aortic strain and distensibility decreased while β-stiffness index increased with age. Aortic root strain and distensibility were associated with progressive dilation of the ascending aorta. Baseline aortic root diameter was an independent predictor of >1 mm/year growth rate of the aortic root (adjusted OR 1.34, 95 % CI 1.03–1.74, p = 0.028). Most patients (61 %) had coexisting coarctation of aorta. Despite the higher prevalence of hypertension in patients with aortic coarctation, hypertension or coarctation had no effect on baseline aorta dimensions, stiffness, or progressive aortic dilation. ConclusionSome CMR-derived aortic stiffness parameters correlated with progressive aortic dilation in BAV and should be further investigated in larger and older BAV cohorts.

Body height determines carotid stiffness following resistance exercise in young Japanese men.

Height is inversely associated with an increase in arterial stiffness after habitual resistance exercise (RE). Considering that RE is performed during exercise prescriptions, the association between height and the acute effects of RE on arterial stiffness should be clarified. We investigated the effects of height on arterial stiffness following transient RE. Thirty-nine young Japanese men were studied under parallel experimental conditions [sham control (seated rest) and RE (5 sets of 10 repetitions at 75% of one-repetition maximum)], which were randomly ordered on two separate days. The subjects were divided into tertiles of height (each group, n = 13). The β-stiffness index (index of arterial stiffness), assessed by carotid pulse pressure and distension, was measured in all subjects. A significant interaction between time, height, and RE was found for the β-stiffness index (P = 0.01). RE significantly increased the β-stiffness index in the lower-height group (P < 0.001), but not in the middle- and higher-height groups. Height was negatively associated with an increase in β-stiffness index following RE, even after controlling the confounders, including exercise volume and changes in heart rate and carotid pulse pressure (P = 0.003). The mediation analysis demonstrated a mediating effect of carotid distension on the relationship between height and changes in the β-stiffness index. These results suggest that short height individuals have increased arterial stiffness following RE due to decreased mechanical distension, rather than through the widening of pulsatile pressure.

Arterial stiffness and the risk of heart failure formation in rotational shift workers in the arctic

Abstract Aim To investigate factors associated with arterial hypertension (AH) development, evaluate arterial stiffness (AS) and the risk of heart failure formation in rotational shift workers in the Arctic. Methods Within 6 days of September 2019, in the polar settlement of Yamburg (68 N), on the basis of Yamburggazdobycha LLC medical unit, 183 individuals (48.7±8.3 years), working rotating shifts (16.9±8.7 years) were enrolled via medical examination. Patients were divided into 2 groups according to the level of blood pressure (BP): Group 1 (Gr. 1) included 86 individuals with AH of 1,2 stages; Group 2 (Gr. 2) comprised 97 individuals with BP &amp;lt;140/90 mm Hg. Ultrasound examination of carotid arteries (CA) was performed, Peterson's elastic modulus (Ep), β-stiffness index, cardio-ankle vascular index (CAVI), pulse wave velocity (PWV) were determined; ABPM was performed; EchoCG was conducted using calculation of probability for heart failure with preserved ejection fraction (HFpEF) by the H2FPEF score (Heavy; Hypertensive; Atrial Fibrillation; Pulmonary Hypertension; Elder; Filling Pressure); blood lipid spectrum, inflammatory markers, brain natriuretic peptide were determined. Results In Gr.1 vs Gr.2, elevated levels of left CAVI (7.9 vs 7.4) (p=0.022) and right CAVI (7.9 vs 7.5) (p=0.045) were registered; PWV: 13.8 m/s vs 12.6 m/s (right), (p&amp;lt;0.001) and 13.9 m/s vs 12.6 m/s (left), (p&amp;lt;0.001); triglycerides, (p=0.03); very low density lipoprotein cholesterol, (p=0.054); homocysteine, (p=0.025). Probability of HFpEF by the H2FPEF score was higher in Gr.1 than Gr.2 (p&amp;lt;0.001). According to logistic regression analysis, data of odds ratio (OR) determined the risk of AH developing with increasing of PWV (OR=1.444); 24-hour diastolic blood pressure variability (DBPV24) (OR = 1.164); probability of HFpEF by the H2FPEF score (OR = 1.677). Relationships of Peterson's elastic modulus (Ep) of common carotid artery (CCA) with left ventricular myocardial mass (LVMM) (r=0.39), (p&amp;lt;0.01), LVMMI (r=0.39), (p&amp;lt;0.01), probability HFpEF by H2EPEF score (r=0.27), (p&amp;lt;0.01); β-stiffness index of CCA with LVMM (r=0.25), (p&amp;lt;0.01) were found. Conclusion Interrelation of AH with PWV (OR=1.444), DBPV24 (OR=1.677), probability of HFpEF by the H2FPEF score (OR = 1.677) should be considered for prognostication of the risk of AH with HFpEF formation in rotational shift workers in the Arctic. Associations of AS with LVMM and LVMMI, HFpEF signs may indicate processes of simultaneous interconnected formation of arterial and cardiac stiffness. Funding Acknowledgement Type of funding sources: None.

Effects of aerobic exercise training on mental health and arterial stiffness in middle-aged and older adults.

Aging is associated with deterioration of arterial function and mental health, which are known as cardiovascular risk factors. The present study investigated the effect of aerobic exercise training on mental health and arterial stiffness in middle-aged and older adults. Twenty-nine healthy middle-aged and older adults were assigned to either the aerobic exercise training (N.=14) or the control groups (N.=15). The aerobic exercise training group completed 12 weeks of moderate aerobic exercise training for 3-4 session per week (30-60 minutes). The control group did not change their levels of physical activity. Before and after the 12-week period, the General Health Questionnaire (GHQ) and carotid β-stiffness index, peak oxygen uptake were measured. At the onset of the 12-week period, the GHQ score, Carotid Β-Stiffness Index, and other key variables did not differ significantly between the aerobic exercise and control groups. The 12-week of aerobic exercise training increased peak oxygen uptake. The GHQ score and Carotid Β-Stiffness Index were decreased after the 12-week period in the aerobic exercise training group; however, no significant improvements were observed in the control group. We conclude that 12 weeks of aerobic exercise enhance mental health and decrease arterial stiffness in healthy middle-aged and older adults.

One-day acceptance and commitment therapy (ACT) workshop improves anxiety but not vascular function or inflammation in adults with moderate to high anxiety levels in a randomized controlled trial

ObjectiveAcceptance and Commitment Therapy (ACT) is a behavioral intervention demonstrating sustained improvements in anxiety in individuals with chronic anxiety and psychological distress. Because anxiety disorders are associated with the development of cardiovascular disease (CVD), we hypothesized that a novel 1-day ACT workshop would both lower anxiety and improve vascular function in persons with moderate/high anxiety. MethodsIn a randomized controlled study, 72 adults (age 33.9 ± 8.6 (SD) years) with baseline moderate/high anxiety completed a one-day ACT intervention (n = 44, age 33.9 ± 8.7 years) or control (n = 28, age 37.1 ± 10.1 years). Pre-specified secondary outcomes were measured over 12 weeks: aortic stiffness (carotid-femoral pulse wave velocity [cfPWV]), forearm vascular endothelial function (post-ischemic peak forearm blood flow [FBF] via plethysmography), and brachial artery flow-mediated dilation (FMD). Carotid artery stiffness (β-stiffness index), and inflammatory markers (C-reactive protein and tumor necrosis factor-alpha) were also explored. ResultsAlthough the intervention had a significant and sustained effect on the primary outcome of anxiety as measured by the Beck Anxiety Inventory, the 1-day ACT workshop was not associated with improvement in vascular or inflammatory endpoints. The intervention was unexpectedly associated with increases in β-stiffness index that were also associated with changing trait anxiety. ConclusionAnxiety improvements did not translate into improvements in any of the vascular function outcomes. This may reflect a less-than-robust effect of the intervention on anxiety, failure in design to select those with vascular dysfunction, or not intervening on a relevant causal pathway. (Trial registration NCT02915874 at www.clinicaltrials.gov).

Cognitive performance is lower among individuals with overlap syndrome than in individuals with COPD or obstructive sleep apnea alone: association with carotid artery stiffness.

Chronic obstructive pulmonary disease (COPD) and obstructive sleep apnea (OSA) are both independently associated with increased cardiovascular disease (CVD) risk and impaired cognitive function. It is unknown if individuals with both COPD and OSA (i.e., overlap syndrome) have greater common carotid artery (CCA) stiffness, an independent predictor of CVD risk, and lower cognitive performance than either COPD or OSA alone. Elevated CCA stiffness is associated with cognitive impairment in former smokers with and without COPD in past studies. We compared CCA stiffness and cognitive performance between former smokers with overlap syndrome, COPD only, OSA only and former smoker controls using analysis of covariance (ANCOVA) tests to adjust for age, sex, body mass index (BMI), pack years, and postbronchodilator FEV1/FVC. We also examined the association between CCA stiffness and cognitive performance among each group separately. Individuals with overlap syndrome (n = 12) had greater CCA β-stiffness index (P = 0.015) and lower executive function-processing speed (P = 0.019) than individuals with COPD alone (n = 47), OSA alone (n = 9), and former smoker controls (n = 21), differences that remained significant after adjusting for age, BMI, sex, pack years, and FEV1/FVC. Higher CCA β-stiffness index was associated with lower executive function-processing speed in individuals with overlap syndrome (r = -0.58, P = 0.047). These data suggest that CCA stiffness is greater and cognitive performance is lower among individuals with overlap syndrome compared with individuals with COPD or OSA alone and that CCA stiffening may be an underlying mechanism contributing to the lower cognitive performance observed in patients with overlap syndrome.NEW & NOTEWORTHY Previous studies have demonstrated greater carotid artery stiffness and lower cognitive function among individuals with COPD alone and OSA alone. However, the present study is the first to demonstrate that individuals that have both COPD and OSA (i.e., overlap syndrome) have greater carotid artery stiffness and lower executive function-processing speed than individuals with either disorder alone. Furthermore, among individuals with overlap syndrome greater carotid artery stiffness is associated with lower executive function-processing speed.

Passive Heat Therapy Reduces Aortic and Carotid Artery Stiffness and Intima‐Media Thickness in Middle‐Aged and Older Adults

Aging is accompanied by stiffening of the large elastic arteries and adverse arterial remodeling, which increase risk for cardiovascular diseases (CVD). Passive heat therapy—chronic use of hot baths and saunas—is associated with lower CVD risk. However, it is unknown if a heat therapy intervention affects arterial stiffness and structure in middle-aged and older (MA/O) adults without overt clinical disorders. Purpose To determine if passive heat therapy, via hot water immersion, in healthy MA/O adults: 1) reduces arterial stiffness, as measured by carotid-femoral pulse wave velocity (c-f PWV; i.e., aortic stiffness) and common carotid artery (CCA) and superficial femoral artery (SFA) β-stiffness index; and 2) alters arterial structure, as measured by CCA and SFA intima-media thickness (IMT) and vessel diameter. Methods 23 healthy, minimally active MA/O men and postmenopausal women (57-79 years) were randomized to participate in 30, 60-minute sessions (3-4x/week over 8-10 weeks) of either hot water immersion (40.5°C, N=12, 5M/7F, 68±2 years) or thermoneutral water immersion (36°C, “sham”, N=11, 4M/7F, 66±2 years). Ultrasound- and tonometry-based measures of arterial stiffness and structure were measured at baseline and 24-72 hours after the final water immersion session. Data are mean ± SEM; P-values were determined by 2-way mixed-design ANOVA with Tukey's post-hoc tests. Results In the large elastic arteries (i.e., the arteries that stiffen with aging), heat therapy reduced c-f PWV from 8.7±0.6 to 8.0±0.7 m/s (p=0.03) and CCA β-stiffness index from 10.6±1.6 to 7.8±0.8 (p=0.02); however, heat therapy did not change SFA β-stiffness index (15.0±1.6 vs. 14.6±1.6, p=0.99), a more muscular artery. Heat therapy also improved selective measures of arterial structure. In the CCA, heat therapy decreased IMT from 0.70±0.01 to 0.66±0.02 mm (p<0.01) without affecting diameter (7.4±0.2 vs. 7.2±0.2 mm, p=0.90). Conversely, in the SFA, heat therapy did not alter IMT (0.56±0.02 vs. 0.57±0.02 mm, p>0.99), but tended to increase diameter from 7.6±0.2 to 7.9±0.3 mm (p=0.06), which likely occurred due to repeated increases in vascular shear stress to the lower body during hot water immersion sessions. No changes were observed in any outcome in sham subjects (c-f PWV: 8.5±0.5 vs. 8.4±0.4 m/s, p=0.85; CCA β-stiffness index: 10.0±2.2 vs. 9.9±2.6, p=0.96; CCA IMT: 0.70±0.02 vs. 0.70±0.02 mm, p=0.92; SFA β-stiffness index: 15.2±2.1 vs. 16.0±2.9, p=0.93; CCA diameter: 7.5±0.1 vs. 7.4±0.1 mm, p=0.42; SFA IMT: 0.57±0.03 vs. 0.56 ±0.03 mm, p=0.85; SFA diameter: 7.8±0.4 vs. 7.9±0.3 mm, p=0.98). Conclusion Heat therapy subjects demonstrated clinically relevant reductions in aortic and carotid artery stiffness, and in CCA IMT, all of which are independent predictors of future CVD risk. As such, heat therapy may be a promising lifestyle-based intervention for improving arterial health and thereby reducing CVD risk in MA/O adults.

Stature is negatively associated with increased arterial stiffness after high-intensity bicep curls training in young Japanese men

ABSTRACT Reports have indicated that high-intensity resistance training (RT) increases or does not change arterial stiffness. Meanwhile, higher stature has been suggested to have a protective effect on cardiovascular disease and arterial stiffness. Stature could explain the disagreement in the reported effects of RT on arterial stiffness. This study was aimed at investigating whether stature is related to RT-induced change in arterial stiffness. Thirty-six young Japanese men were assigned to the control (n = 15) and training groups (n = 21). RT programme consisted of supervised bicep curls 3 days per week for 4 weeks (5 sets of 10 repetitions at 75% of 1-repetition maximum). Arterial compliance (AC) and β-stiffness index (via combination of ultrasound and carotid pressure waveforms) were measured in all participants. To verify the effect of stature on RT-induced change in arterial stiffness, the training group was divided into tertiles of stature: lower, middle, and higher stature groups (each group, n = 7). RT significantly decreased AC and increased β-stiffness index in only the lower stature group (both, P < 0.05). Moreover, stature was positively associated with decreased AC and negatively associated with increased β-stiffness index, even after adjusting for confounders including changes in relative strength, pulse pressure, and arterial distension (P < 0.05). The present results suggest that short stature contributes to the increase in arterial stiffness induced by RT in young Japanese men. The present findings suggest that stature should be taken into consideration when designing/engaging in RT programme, due to potential implications for cardiovascular health. Highlights Participants were divided into 3 groups according to tertiles of statures, and arterial stiffness of lower stature group (range of stature: 161.0–169.8 cm) increased after resistance training in young Japanese men, but not middle and higher stature group. Stature was negatively associated with the changed arterial stiffness by resistance training. This study suggests that short stature contributes to the elevation in arterial stiffness elicited by resistance training.

Evaluation of common carotid artery in type 1 diabetes mellitus patients through speckle tracking carotid strain ultrasonography.

We aimed to evaluate the effectiveness of speckle tracking carotid strain (STCS) technique, which enables measurement of arterial stiffness and strain parameters, in the detection of early atherosclerotic findings in type 1 diabetes mellitus (T1DM). We prospectively enrolled 30 T1DM patients and 30 age- and sex-matched control participants with no history of cardiovascular disease. All study population underwent carotid ultrasonography. Radial and circumferential movement of the common carotid artery (CCA) in the transverse plane as the well as the radial movement of the CCA in the longitudinal plane were calculated automatically by using the STCS method. In addition, the strain (%), strain rate (per second), and peak circumferential and radial displacements (mm) were calculated. Arterial stiffness parameters, such as elastic modulus, distensibility, arterial compliance, and β-stiffness index, were calculated using the radial measurements. The mean value of the carotid intima media thickness (CIMT) was calculated semi-automatically for each CCA, in the longitudinal plane. We also analyzed the patients' overall body composition. T1DM and control groups were compared in terms of strain and stiffness parameters and no statistically significant difference was found (p > 0.05). CIMT was higher in diabetic patients than in the control group (p = 0.039). In both groups, age was correlated with all arterial stiffness and strain parameters (p < 0.05). The duration of diabetes was also correlated with β-stiffness index, distensibility, and elastic modulus in the longitudinal plane (p < 0.05). In the diabetic group, abdominal fat ratio, whole body fat ratio, and fat mass were correlated with radial and circumferential displacement and strain parameters in transverse plane, and radial displacement in longitudinal plane (p < 0.05, for each). Diabetic patients were divided into subgroups according to the presence of nephropathy and dyslipidemia. Although no significant difference was found between the groups in terms of CIMT, patients with nephropathy had higher values for transverse and longitudinal elastic modulus, pulse-wave velocity, and longitudinal β-stiffness index, as well as lower values for longitudinal arterial compliance and distensibility, compared with patients without nephropathy (p < 0.05). Also, patients with dyslipidemia had higher longitudinal β-stiffness and elastic modulus values compared with patients without dyslipidemia (p < 0.05). STCS ultrasonography is an effective, easy, and noninvasive method for evaluating the arterial elasticity. It may provide an early assessment of atherosclerosis in patients with T1DM, especially in the presence of nephropathy and dyslipidemia; thus, together with CIMT measurement, it may be used more frequently to detect subclinical damage and stratify atherosclerosis.

One-Year Aerobic Exercise Reduced Carotid Arterial Stiffness and Increased Cerebral Blood Flow in Amnestic Mild Cognitive Impairment.

Central arterial stiffness and brain hypoperfusion are emerging risk factors of Alzheimer's disease (AD). Aerobic exercise training (AET) may improve central arterial stiffness and brain perfusion. To investigate the effects of AET on central arterial stiffness and cerebral blood flow (CBF) in patients with amnestic mild cognitive impairment (MCI), a prodromal stage of AD. This is a proof-of-concept, randomized controlled trial that assigned 70 amnestic MCI patients into a 12-month program of moderate-to-vigorous AET or stretching-and-toning (SAT) intervention. Carotid β-stiffness index and CBF were measured by color-coded duplex ultrasonography and applanation tonometry. Total CBF was measured as the sum of CBF from both the internal carotid and vertebral arteries, and divided by total brain tissue mass assessed with MRI to obtain normalized CBF (nCBF). Episodic memory and executive function were assessed using standard neuropsychological tests (CVLT-II and D-KEFS). Changes in cardiorespiratory fitness were measured by peak oxygen uptake (VO2peak). Total 48 patients (29 in SAT and 19 in AET) were completed one-year training. AET improved VO2peak, decreased carotid β-stiffness index and CBF pulsatility, and increased nCBF. Changes in VO2peak were associated positively with changes in nCBF (r = 0.388, p = 0.034) and negatively with carotid β-stiffness index (r = -0.418, p = 0.007) and CBF pulsatility (r = -0.400, p = 0.014). Decreases in carotid β-stiffness were associated with increases in cerebral perfusion (r = -0.494, p = 0.003). AET effects on cognitive performance were minimal compared with SAT. AET reduced central arterial stiffness and increased CBF which may precede its effects on neurocognitive function in patients with MCI.

Carotid stiffness parameters are earlier markers of subclinical atherosclerosis than central aortic systolic pressure in patients with type 2 diabetes mellitus

Abstract Funding Acknowledgements Type of funding sources: None. Introduction Elevated central aortic systolic pressure (CASP) is a stronger predictor of atherosclerosis than peripherial blood pressure measurement. One-point echo-tracking is a novel noninvasive method for measurement of the local arterial stiffness (AS) of carotid artery (CA). As the cardio-vascular complications of patients with type 2 Diabetes Mellitus (T2DM) are the most clinically significant, establishing early signs of atherosclerosis is of utmost importance for the prognosis Purpose To compare the significance of CASP and of carotid echo-tracking parameters as early signs of atherosclerosis in patients T2DM without cardio-vascular disease Patients and methods 100 patients with T2DM without overt cardio-vascular diseases and 30 healthy age- and sex-matched controls were included in the study and examined for PWVβ, β-stiffness index, arterial compliance (АС), augmentation index (AI), Peterson’s modulus (Ep) of right CA with Aloka Hitachi Prosound α7. CASP was determined with Caspal A-pulse CASP-AL device. Patients with atrial fibrillation and increased blood pressure were excluded from the study. Results: Тhe mean values of CASP in T2DM were 126.4 mmHg vs 125.7 mmHg in controls (p = 0.84). PWVβ was increased in patients compared to controls: 7.42m/s vs 6.4m/s, p = 0.001. The same changes were found in β-stiffness index - 10.4 vs 7.7 (p = 0.001), AI - 13.3 vs 19.8 9 (p = 0.009), and Ep - 151.3 vs 112.1 (p = 0.001). There was no significant difference in АС - 0.77 vs 0.98 (p = 0.11). There was a mild correlation between the CASP and carotid stiffness indices (Table 1). Conclusions Parameters of local arterial stiffness of carotid artery are earlier signs of subclinical atherosclerosis than CASP in patients with T2DM without cardio-vascular disease. One-point echo tracking is a useful non-invasive and easy to perform novel ultrasound method. Table 1 PWV(L) AC(L) PWV(R) Ep(R) AC(R) AI(R) r p r p r p r p r p r p CASP 0.222 0.045 -.295 0.007 .286 0.011 .273 0.015 -0.214 0.05 .256 0.023 L-left CA, R-right CA