Cardio-ankle Vascular Index In Patients Research Articles

Association between the Serum Soluble Urokinase Plasminogen Activator Receptor and Peripheral Arterial Stiffness According to the Cardio-Ankle Vascular Index in Patients Undergoing Kidney Transplantation.

High soluble urokinase plasminogen activator receptor (suPAR) levels are correlated with cardiovascular (CV) disease. Arterial stiffness is associated with aging-related vascular diseases and is an independent risk factor for CV morbidity and mortality. It can be measured by the cardio-ankle vascular index (CAVI). We evaluated the association between serum suPAR levels and arterial stiffness according to the CAVI in kidney transplantation (KT) recipients. In this study, 82 patients undergoing KT were enrolled. Serum suPAR levels were analyzed using an enzyme immunoassay. The CAVI was measured using a plethysmograph waveform device, and patients with a CAVI of 9.0 were assigned to the peripheral arterial stiffness (PAS) group. Twenty KT patients (24.4%) had PAS, were of older age (p = 0.042), and had higher serum triglyceride (p = 0.023) and suPAR levels (p 0.001) than the normal group. After adjusting for factors significantly associated with PAS by multivariate logistic regression analysis, serum suPAR levels (odds ratio [OR] 1.072, 95% confidence interval (CI) 1.023-1.123; p = 0.004) were independently associated with PAS in KT patients. The logarithmically transformed suPAR level (log-suPAR) was also positively correlated with the left or right CAVI values (all p 0.001) from the results of the Spearman correlation analysis in KT patients. Serum suPAR levels are positively associated with left or right CAVI values and are independently associated with PAS in KT patients.

Relationship between Lipoprotein Lipase Derived from Subcutaneous Adipose Tissue and Cardio-Ankle Vascular Index in Japanese Patients with Severe Obesity

Introduction: Cardio-ankle vascular index (CAVI) is an arterial stiffness index that correlates inversely with body mass index (BMI) and subcutaneous fat area. Lipoprotein lipase (LPL) that catalyzes the hydrolysis of serum triglycerides is produced mainly in adipocytes. Serum LPL mass reflects LPL expression in adipose tissue, and its changes correlate inversely with changes in CAVI. We hypothesized that LPL derived from subcutaneous adipose tissue (SAT) suppresses the progression of arteriosclerosis and examined the relationship of LPL gene expression in different adipose tissues and serum LPL mass with CAVI in Japanese patients with severe obesity undergoing laparoscopic sleeve gastrectomy (LSG). Methods: This study was a single-center retrospective database analysis. Fifty Japanese patients who underwent LSG and had 1-year postoperative follow-up data were enrolled (mean age 47.5 years, baseline BMI 46.6 kg/m2, baseline HbA1c 6.7%). SAT and visceral adipose tissue (VAT) samples were obtained during LSG surgery. LPL gene expression was analyzed by real-time PCR. Serum LPL mass was measured by ELISA using a specific monoclonal antibody against LPL. Results: At baseline, LPL mRNA expression in SAT correlated positively with serum LPL mass, but LPL mRNA expression in VAT did not. LPL mRNA expression in SAT was correlated, and serum LPL mass tended to correlate inversely with the number of metabolic syndrome symptoms, but LPL mRNA expression in VAT did not. LPL mRNA expression in SAT and CAVI tended to correlate inversely in the group with visceral-to-subcutaneous fat ratio of 0.4 or higher, which is considered metabolically severe. Serum LPL mass increased 1 year after LSG. Change in serum LPL mass at 1 year after LSG tended to be an independent factor inversely associated with change in CAVI. Conclusions: Serum LPL mass reflected LPL mRNA expression in SAT in Japanese patients with severe obesity, and LPL mRNA expression in SAT was associated with CAVI in patients with visceral obesity. The change in serum LPL mass after LSG tended to independently contribute inversely to the change in CAVI. This study suggests that LPL derived from SAT may suppress the progression of arteriosclerosis.

Elevated Lipoprotein(a) Levels are Associated with Arterial Stiffness Measured by Cardio-Ankle Vascular Index in Patients Undergoing Peritoneal Dialysis.

Arterial stiffness (AS) can be used to predict future cardiovascular diseases. High lipoprotein(a) (Lp(a)) levels were independently correlated with cardiovascular (CV) morbidity and death in patients with chronic renal insufficiency. The cardio-ankle vascular index (CAVI) is a useful biomarker of arteriosclerotic disorders and has a close relationship with a variety of CV events. This study aimed to investigate the correlation between serum Lp(a) levels and AS in patients on peritoneal dialysis (PD) using the CAVI. A total of 86 adult patients who were on regular PD for at least 3 months were recruited in this study. The CAVI values were determined using the waveform device (VaSera VS-1000). A CAVI value of 9.0 on either side was defined as high. Serum Lp(a) levels were measured by an enzyme-linked immunosorbent assay. Among these participants, 35 of 86 (40.7%) belonged to the high CAVI group. In contrast to those with a normal CAVI, PD recipients in the high CAVI group had higher serum levels of total cholesterol (p = 0.003), triglycerides (p = 0.044), C-reactive protein (p 0.001), and Lp(a) (p 0.001), whereas their albumin levels were significantly lower (p = 0.026). Based on multivariable logistic regression analysis, serum Lp(a) (odds ratio [OR] 1.025, 95% confidence interval [CI] 1.010-1.040, p = 0.001), total cholesterol (OR 1.042, 95% CI 1.005-1.081, p = 0.027), and C-reactive protein (each increase 0.1 mg/dL, OR 1.217, 95% CI 1.008-1.469, p = 0.041) levels were found as the parameters that could independently predict AS in patients on PD. Further, using Spearman's correlation analysis, both the left and right CAVIs revealed a significantly positive correlation with log-transformed Lp(a) levels (r = 0.588, p 0.001; r = 0.639, p 0.001, respectively). Serum Lp(a) levels were postulated to participate in the pathogenic processes of AS in adult patients undergoing PD.

Changes in Arterial Stiffness Monitored Using the Cardio-Ankle Vascular Index in Patients with Rheumatic Disease Receiving Initial Glucocorticoid Therapy: A Clinical Pilot Study.

Systemic inflammatory rheumatic diseases predispose to premature birth, accelerated atherosclerosis, and increased cardiovascular disease (CVD). While glucocorticoids (GCs) are used in various rheumatic diseases, and the associations between GC excess and increased prevalence of CVD complications are well established, the mechanisms underlying GCs' role in atheroma development are unclear. We conducted an observational study to address GC therapy's effect on arterial stiffness using the cardio-ankle vascular index (CAVI) in patients with rheumatic diseases. Twenty-eight patients with rheumatic disease received initial GC therapy with prednisolone at doses ranging from 20 to 60 mg/d. CAVI was examined at baseline and 3 and 6 months after GC therapy. Changes in CAVI and inflammatory parameters were evaluated. GC therapy increased the mean CAVI after 3 months but decreased it to pretreatment levels after 6 months. The mean CAVI substantially decreased with GC treatment in patients <65 years but increased in patients ≥65 years. Alterations in CAVI during the 6-month GC treatment negatively correlated with the lymphocyte-to-monocyte ratio (LMR) at baseline. Conversely, no correlation was observed between alterations in CAVI values and conventional inflammatory markers (C-reactive protein and erythrocyte sedimentation rate). Multivariate analysis of factors related to changes in CAVI highlighted young age, high prednisolone dosage, and LMR at baseline. GC temporarily exacerbates but eventually improves arterial stiffness in rheumatic diseases. Particularly in young patients, GC may improve arterial stiffness by reducing inflammation. Therefore, the LMR before GC therapy in rheumatic diseases may be a potential predictor of arterial stiffness.

The effects of severe periodontitis on arterial stiffness using cardio-ankle vascular index in patients with type 2 diabetes.

Arterial stiffness, which is a measure of the elasticity of the arteries, is also a risk factor for the development of cardiovascular diseases and its measurement is important for evaluating the atherosclerosis process. The purpose of this cross-sectional study to investigate whether severe periodontitis in short-term type 2 diabetes may be associated with increased cardio-ankle vascular index (CAVI) values specified for subclinical atherosclerosis risk. A total of 136 subjects, including 69 subjects with short-term type 2 diabetes (35 with severe periodontitis and 34 with periodontally healthy) and 67 systemically healthy subjects (32 with severe periodontitis and 35 with periodontally healthy) were enrolled to this study. Assessment of all participants included in this study in terms of arterial stiffness was determined by CAVI. Serum fasting plasma glucose (FPG), glycated haemoglobin (HbA1c), triglyceride (TRG), high-density lipoprotein (HDL), low-density lipoprotein (LDL), total cholesterol (TC) and C-reactive protein (CRP) levels were calculated using standard methods. Full mouth periodontal measurements were recorded. Multiple linear regression analysis was performed to evaluate the relationship between periodontal parameters and mean CAVI values of the groups. Mean CAVI levels were significantly higher in diabetic and periodontitis group compared to the other study groups (p < .05). In diabetes and periodontitis group, CAVI was showed positive correlations with CRP (r = .337, p = .048) and HbA1c (r = .442, p = .008). Also, positive significant correlations were found with probing depth (PD) and clinical attachment level (CAL) in the periodontitis groups. Multiple regression analysis revealed that CAL independently predicted CAVI levels in periodontitis groups (β = .433, p = .019 in diabetes and periodontitis groups and β = .57, p = .001 in systemically healthy and periodontitis group respectively). This is the first study investigating the association between severe periodontitis and CAVI in patients with short-term diabetes. Our findings suggest that severe periodontitis may be an intermediate factor in the pathway between type 2 diabetes and cardiovascular disease by increasing the arterial stiffness.

Characteristics of Preoperative Arteriosclerosis Evaluated by Cardio-Ankle Vascular Index in Patients with Osteoarthritis before Total Knee Arthroplasty.

Cardiovascular disease (CVD) is a major risk factor for mortality in patients with osteoarthritis, and comorbidities increase postoperative complications after total knee arthroplasty (TKA). Arteriosclerosis plays a main role in hemodynamic dysfunction and CVD; however, arteriosclerosis has not been preoperatively evaluated before TKA using the cardio-ankle vascular index (CAVI). In this study, we evaluated the degree of preoperative arteriosclerosis using the CAVI in patients undergoing TKA, as well as its correlations with several preoperative patient factors. Arteriosclerosis was evaluated in 209 consecutive patients (251 knees) with osteoarthritis who underwent TKA at our institution between May 2011 and June 2022. The CAVI was measured in the supine position 1 day before TKA, and the correlations between the CAVI and several clinical factors were analyzed. The CAVI was normal in 62 knees (25%), borderline in 71 knees (28%), and abnormal in 118 knees (47%). Univariate analysis revealed a moderate positive correlation between preoperative CAVI and age (r = 0.451, p < 0.001) and a weak negative correlation between preoperative CAVI and body weight (r = -0.306, p < 0.001) and body mass index (BMI) (r = -0.319, p < 0.001). Multivariate analysis showed that age (β = 0.349, p < 0.001) and BMI (β = -0.235, p < 0.001) were significantly correlated with preoperative CAVI. Arteriosclerosis should be carefully managed intraoperatively and postoperatively in patients with osteoarthritis undergoing TKA, particularly in older patients and patients with a low BMI.

Serum Malondialdehyde-Oxidized Low-Density Lipoprotein Level Is Associated with Arterial Stiffness by Cardio-Ankle Vascular Index in Coronary Artery Bypass Graft Patients.

A high malondialdehyde-oxidized low-density lipoprotein (MDA-oxLDL) level is associated with atherosclerotic cardiovascular diseases and major adverse cardiovascular events. A higher cardio-ankle vascular index (CAVI) is independently associated with an increased risk of cardiovascular events, cardiovascular mortality, myocardial infarction, and stroke in patients with cardiovascular risk. Thus, this study aimed to evaluate the relationship between serum MDA-oxLDL levels and CAVI in patients with triple-vessel coronary artery disease who underwent coronary artery bypass graft (CABG) surgery. Fasting blood samples and baseline characteristics were obtained from 88 patients who had undergone CABG. A commercialized enzyme-linked immunosorbent assay was used to measure MDA-oxLDL levels. An automatic pulse wave analyzer was used to measure CAVI values, and each side of CAVI values of ≥9 was designated as arterial stiffness. In total, 47 participants were assigned to the arterial stiffness group. More patients had diabetes mellitus, were older, and had higher serum MDA-oxLDL levels in the arterial stiffness group than in the control group. A multivariate logistic regression analysis disclosed that MDA-oxLDL and diabetes mellitus were independent predictors of arterial stiffness. Moreover, according to the Spearman's correlation analysis, the serum MDA-oxLDL level was positively associated with both left and right CAVI. Serum MDA-oxLDL levels were positively associated with arterial stiffness in patients who had undergone CABG.

Eotaxin and cardio-ankle vascular index in patients with high and very high cardiovascular risk

Eotaxin is a chemokine, which is a chemoattractant mainly to eosinophils, as well as basophils and Th2 lymphocytes. According to studies, overexpression of eotaxin is found in endothelial and smooth muscle cells of blood vessels in the area of atherosclerotic plaque. In clinical medicine, cardio-ankle vascular index (CAVI) is widely used as an indicator of arteriosclerosis and a predictor of cardiovascular events. Few studies have shown the relationship of eotaxin with coronary atherosclerosis; in other studies, the relationship of eotaxin with atherosclerosis, myocardial infarction and pulse wave velocity was not revealed. The aim of the present study was to assess blood level of eotaxin and cardio-ankle vascular index and their association with major cardiovascular risk factors in patients with high and very high cardiovascular risk. We examined 65 patients with high and very high cardiovascular risk, due to documented coronary artery disease, type 2 diabetes mellitus, or combination of cardiovascular risk factors and who were undergoing generally accepted cardioactive, hypoglycemic therapy and lipid-lowering therapy. All patients were examined for the elastic properties of the vascular wall by volumetric sphygmography with assessment of CAVI. In the blood, the concentrations of eotaxin, high-sensitivity C-reactive protein, glycosylated hemoglobin and lipid spectrum indicators were determined. All examined were divided into two groups: with a normal value of CAVI (less than 8) and elevated. Patients with elevated CAVI had higher concentrations of eotaxin (p = 0.013), total cholesterol (p = 0.009), low-density lipoprotein cholesterol (p = 0.016), were older (p &lt; 0.0001) and less likely to take statins (p = 0.002). In all those examined, correlations were found between serum eotaxin concentration and CAVI (rs = 0.34; p = 0.005), as well as age (rs = 0.32; p = 0.006). The age of the patients correlated with CAVI (rs = 0.35; p = 0.007). Thus, in our study, we for the first time showed the relationship between higher concentrations of eotaxin and an increased cardio-ankle vascular index in patients with high and very high cardiovascular risk. Cardio-ankle vascular index was associated with age, lipid metabolism and lipid-lowering therapy. The obtained results allow us to consider eotaxin as a factor associated with atherogenesis and arterial stiffness.

Ventricular Function and Cardio-Ankle Vascular Index in Patients With Pulmonary Artery Hypertension.

This study aims to evaluate the left ventricle (LV) systolic and diastolic function in patients with idiopathic pulmonary arterial hypertension (IPAH) and its correlation with systemic arterial stiffness assessed by cardio-ankle vascular index (CAVI). We included 37 patients with IPAH and 20 healthy people matched by age. All patients were assessed: vital signs, 6-minute walk test, NT-proBNP level, the CAVI, the right ventricular (RV) and LV function parameters, including ejection time (ET), tissue speckle-tracking values - global longitudinal strain (GLS) and strain rate (SR). The groups were matched by age, gender, BMI, office SBP and DBP. Patients with IPAH had higher heart rate, NT-proBNP level and lower ferritin level, GFR (CKD-EPI), SaO2 than healthy people. The mean CAVIleft was higher in IPAH patients than in the control group- 8.7±1.1 vs 7.5±0.9, P=0.007. Healthy people had significantly less E/e' and lower IVRT. LVET and RVET were shorter in IPAH patients. Patients with IPAH had mean LVGLS -(-17.6±4.8%) and 35.1% of them were with LVGLS ≤16% compared to healthy people -(-21.8±1.4%) and 0%, respectively. LVSR was significant less in IPAH patients, but in the normal range. We found significant correlations of CAVI with age, history of syncope, bilirubin, uric acid, total cholesterol, cardiac output, cardiac index, RVET, LVET and E/A. Multiple linear regression confirmed the independent significance for age (β=0.083±0.023, CI 0.033-0.133) and RVET (β=-0.018±0.005, CI -0.029 to -0.008) only. The risk to have CAVI ≥8 increased in 5.8 times in IPAH patients with RVET <248 ms (P=0.046). CAVI did not correlate with LVGLS and LVSR. Significant worse systolic and diastolic LV functions were stated in pulmonary hypertensive patients compared to the control group. No LV GLS, no LV SR had significant associations with arterial stiffness evaluated by CAVI.

Association of Cardio-Ankle Vascular Index (CAVI) and Duration of Diabetes Mellitus in the STOP (Semaglutide Treatment on Coronary Plaque Progression) Randomized Control Trial

IntroductionCardio‐ankle vascular index(CAVI) is a novel index that measures arterial stiffness noninvasively. Recent studies demonstrated CAVI to be a predictor for coronary artery disease(CAD). Patients with Type-2 diabetes mellitus(DM) develop arterial stiffening which contributes to the CAD complications associated with DM. However, a comprehensive assessment of the association of CAVI and DM has not been reported. MethodsThe STOP trial randomized patients with DM and presence of coronary plaque on CCTA to Semaglutide 1mg once weekly or placebo. CAVI was measured using the VaSera(Fukuda Denshi, Tokyo, Japan). Non-invasive blood pressure, Pulse Wave Velocity and Heart Sound Measuring were integrated to compute CAVI. Multivariate linear regression was used to examine the association of baseline CAVI and duration of diabetes. ResultsIn 98 randomized STOP subjects, mean age was 56.8±8.3 yrs and 60 (61%) were male. Of these, 81 (83%) had hyperlipidemia, 81 (83%) had hypertension, 13 (13%) were current-smokers, and 31 (32%) were former-smokers. The mean duration of DM was 16.3±7.5 yrs. In an unadjusted linear regression analysis, there was a positive linear relationship between duration of DM and CAVI (p=0.036). However, upon further analysis with adjustment for age, gender, body mass index, HLD, HTN, and past smoking, the association was no longer significant (p=0.189). ConclusionCAVI has a linear association with the duration of Diabetes. The lack of statistical significance on multivariate adjusted analysis could be due to the small sample size. Future studies should assess the prognostic role of CAVI in patients with DM.

Association of monocyte-to-high density lipoprotein ratio with arterial stiffness in patients with diabetes

BackgroundPrevious studies proposed that chronic inflammation in diabetes has a role in abnormal collagen production and elastin degradation, which promotes arterial stiffness. Monocyte-to-High Density Lipoprotein cholesterol ratio (MHR) is a simple measurement associated with inflammation and oxidative stress. However, little is known about the relationship of MHR with arterial stiffness. This study aimed to determine the association of MHR with arterial stiffness in patients with diabetes.MethodsA total of 81 patients with type 2 diabetes mellitus were enrolled in a cross-sectional study. Arterial stiffness factor in this study was Cardio Ankle Vascular Index (CAVI). We analyzed complete blood count and lipid profile in all participants, then performed statistical analysis to determine the relationship between MHR and CAVI. Receiver operating characteristic (ROC) analysis was used to estimate the cut-off values of MHR to predict CAVI ≥ 9.ResultsMedian of MHR in this study was 11.91 with the mean of CAVI was 8.13 ± 0.93. Spearman correlation analysis revealed a significant positive correlation between MHR and CAVI (ρ = 0.239, p = 0.031). Multivariate analysis showed the independent association of MHR to arterial stiffness (β = 0.361, 95% CI 0.023–0.093) and to CAVI ≥ 9 (OR 1.181, 95% CI 1.047–1.332). The cut-off values of MHR for predicting CAVI ≥ 9 were identified as ≥ 13 (OR 3.289, 95% CI 1.036–10.441).ConclusionMHR is associated with CAVI in patients with diabetes, irrespective of various potential confounders.

Low lung diffusing capacity is associated with high cardio-ankle vascular index in patients with chronic obstructive pulmonary disease

Low lung diffusing capacity is associated with high cardio-ankle vascular index in patients with chronic obstructive pulmonary disease

Elevation of Cardio-Ankle Vascular Index in Patients with Malignant Lymphoma Treated with R-CHOP Regimen

Introduction: An increased risk of arteriosclerosis and cardiovascular disease has been noted in cancer survivors. However, there are only a few reports available that consider the risk of arteriosclerosis in patients treated with chemotherapy. R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisolone) regimen is a standard treatment for patients with B-cell malignant lymphoma. In this regimen, prednisolone has a potential risk of diabetes mellitus (DM), hyperlipidemia (HL), and osteoporosis and doxorubicin has cardiotoxicity. However, there are no studies that have investigated the effect of R-CHOP therapy on arteriosclerosis. An arterial stiffness parameter, the cardio-ankle vascular index (CAVI), was developed as a marker evaluating arteriosclerosis of aorta, femoral and tibial arteries. The principle of CAVI is based on the stiffness parameter ß theory proposed by Hayashi et al, and it is based on the variance of the arterial pressure that is required to change the vascular diameter. So, CAVI does not depend on blood pressure changes during the measurement. As previously demonstrated, CAVI is significantly elevated in arteriosclerotic diseases such as coronary artery disease and cerebral infarction. We reported the first report evaluating the changes of CAVI during R-CHOP therapy in a patient with follicular lymphoma (2017, J Clin Med Res.). The patients had an elevated CAVI in combination with plaque formation after 8 cycles of R-CHOP. In this study, we evaluated CAVI in patients with malignant lymphoma treated with R-CHOP therapy. In addition, we investigated the change of von Willebrand factor (vWF) as a vascular endothelial damage during the treatment.Materials and methods:Patients with B cell malignant lymphoma who received R-CHOP therapy were enrolled from April 2014 to January 2017. The changes in CAVI before and after the first and the final courses of R-CHOP were evaluated. Some recent patients who did not complete R-CHOP therapy were also evaluated the change of vWF in the course of treatment.Results: CAVI was evaluated in 8 patients (4 men and 4 women, with a median age of 69 years old). Three patients had DM, one had hypertension and 3 patients had HL in their medical histories. Their primary diseases were; 5 with diffuse large B cell lymphoma, 2 with follicular lymphoma and I with mucosa-associated lymphoid tissue lymphoma. The clinical stages of patients were IIA to IVB. All eight patients achieved complete remission after 4 to 8 courses of chemotherapy. Figure 1 shows the changes of CAVI at pretreatment, just before the second R-CHOP treatment and just before the final treatment. The median value of CAVI was significantly elevated from 8.7±0.64 to 9.2±0.64 after the first course (p=0.012), and was elevated to 9.2±0.91) before the final treatment although not statistically significant (p=0.067). Figure 2 shows the change of vWF during the course of treatment in 5 patients. vWF show a tendency to elevate with following the treatment.Conclusions: We report that patients with B-cell malignant lymphoma showed the elevated CAVI after R-CHOP even after the first course. We also confirmed an elevation of vWF following the course of treatment. These data suggest that R-CHOP therapy might be a risk factor for the progression of arteriosclerosis in patients with malignant lymphoma.Figure 1. The change of CAVI pretreatment, just before the second course and before the final treatment in patients with malignant lymphoma treated with R-CHOP.Figure 2. The increment of vWF in patients with malignant lymphoma treated with R-CHOP therapy. [Display omitted] DisclosuresNo relevant conflicts of interest to declare.

Arterial Stiffness Assessed by Cardio-Ankle Vascular Index in Patients With Abdominal Aortic Aneurysm and Its Alterations After Treatment.

The aim of the present study was to investigate a potential difference on the arterial stiffness among aneurysm patients and non-aneurysm controls, as well as to explore potential changes between patients treated either with endovascular or open repair. A 110 patients with an infrarenal AAA were prospectively enrolled in this study. Fifty-six patients received an EVAR, whereas 54 patients received an open surgical repair. Moreover, 103 gender and age-matched subjects without AAA served as controls. The cardio-ankle vascular index (CAVI) was applied for measurement of the arterial stiffness. CAVI values were statistically higher in the AAA patients when compared with control subjects. Although at 48 hours postoperatively the CAVI values were increased in both groups when compared to baseline values, the difference in CAVI had a tendency to be higher in the open group compared to the endovascular group. At 6 months of follow up the CAVI values returned to the baseline for the patients of the open repair group. However, in the endovascular group CAVI values remained higher when compared with the baseline values. Patients with AAAs demonstrated a higher value of CAVI compared to healthy controls. A significant increase of arterial stiffness in both groups during the immediate postoperative period was documented. The increase in arterial stiffness remained significant at 6 months in EVAR patients. Further studies are needed to elucidate the impact of a decreased aortic compliance after stentgraft implantation on the cardiac function of patients with AAA.

Assessment of Arterial Stiffness with Cardio-Ankle Vascular Index in Patients with Mitral Annular Calcification.

Arterial stiffness is related to arteriolosclerotic diseases and is a marker of adverse cardiovascular events. Mitral annular calcification (MAC) is progressive calcium deposition on the posterior and inferior mitral annulus and is associated with atherosclerotic cardiovascular diseases. Cardio-ankle vascular index (CAVI) is a measurement technique used to estimate the degree of arterial stiffness without effect from blood pressure. The aim of this study is to research arterial stiffness using CAVI in patients with MAC. The study was cross-sectional and observational and included 98 patients with MAC confirmed by echocardiography who referred to the cardiology clinics and met study inclusion criteria and 38 controls without MAC. CAVI measurements were obtained by using the Vascular Screening System VaSera VS-1000 (Fukuda Denshi, Tokyo, Japan) device. The two groups were similar in terms of demographic characteristics, including age, sex, hypertension, coronary artery disease, body surface area, and smoking (P > .05). Left atrial volume index was significantly higher in patients with MAC compared with the control group (P < .001). Right arm CAVI, left arm CAVI, and mean CAVI were significantly higher in the MAC group than the control group (P = .037, P = .005, and P = .014, respectively) and increased with MAC severity. There was a significant positive correlation between mean CAVI and MAC grade (r = 0.278, P = .001). Also, when ankle-brachial index (ABI) was measured with CAVI, left and right extremity ABI values were significantly lower in patients with MAC (P = .017 and P = .005, respectively). CAVI increased in all patients with MAC and associated with increasing grade of calcification.

Clinical Significance of the Cardio-Ankle Vascular Index in Postmenopausal Women With Hypercholesterolemia

Background: The cardio-ankle vascular index (CAVI) is a physiological indicator of arterial elasticity. However, limited information regarding the clinical significance of the CAVI in patients with hypercholesterolemia is available. This cross-sectional study aimed to elucidate the clinical significance of the CAVI for the primary prevention of cardiovascular disease (CVD) among postmenopausal women with hypercholesterolemia. Methods: A total of 168 untreated postmenopausal hypercholesterolemic women (low-density lipoprotein cholesterol levels ≥ 140 mg/dL, mean age ± standard deviation, 63 ± 10 years) with no history of CVD events were enrolled. The CAVI was measured using commercial devices, after which, its relationships with various clinical parameters, such as carotid artery ultrasonography findings and CVD biomarkers, were examined. Results: A significant positive correlation was observed between the CAVI and maximum intima-media thickness of the common carotid artery (max-C-IMT), which was evaluated using carotid artery ultrasonography (r = 0.49, P < 0.001). Regarding CVD biomarkers, the CAVI was significantly correlated with estimated glomerular filtration rate (r = -0.18, P < 0.001), high-sensitivity C-reactive protein (r = 0.36, P < 0.001), whole blood passage time as a marker of blood rheology (r = 0.41, P < 0.001), and skin autofluorescence as a marker of advanced glycation end products in tissues (r = 0.46, P < 0.001), although no significant correlation was noted between serum lipid parameters and the CAVI. Multiple regression analysis identified max-C-IMT (β = 0.35, P < 0.001), whole blood passage time (β = 0.18, P = 0.007), skin autofluorescence (β = 0.17, P = 0.011), and age (β = 0.16, P = 0.018) as variables independently associated with CAVI. Conclusion: The present study indicated that the CAVI is an essential CVD risk factor among postmenopausal women with hypercholesterolemia. Moreover, impaired blood rheology and increase of skin autofluorescence were associated with elevated CAVI in such patients. J Clin Med Res. 2021;13(5):276-282 doi: https://doi.org/10.14740/jocmr4509

Clinical Significance of the Cardio-Ankle Vascular Index in Postmenopausal Women With Hypercholesterolemia.

BackgroundThe cardio-ankle vascular index (CAVI) is a physiological indicator of arterial elasticity. However, limited information regarding the clinical significance of the CAVI in patients with hypercholesterolemia is available. This cross-sectional study aimed to elucidate the clinical significance of the CAVI for the primary prevention of cardiovascular disease (CVD) among postmenopausal women with hypercholesterolemia.MethodsA total of 168 untreated postmenopausal hypercholesterolemic women (low-density lipoprotein cholesterol levels ≥ 140 mg/dL, mean age ± standard deviation, 63 ± 10 years) with no history of CVD events were enrolled. The CAVI was measured using commercial devices, after which, its relationships with various clinical parameters, such as carotid artery ultrasonography findings and CVD biomarkers, were examined.ResultsA significant positive correlation was observed between the CAVI and maximum intima-media thickness of the common carotid artery (max-C-IMT), which was evaluated using carotid artery ultrasonography (r = 0.49, P < 0.001). Regarding CVD biomarkers, the CAVI was significantly correlated with estimated glomerular filtration rate (r = -0.18, P < 0.001), high-sensitivity C-reactive protein (r = 0.36, P < 0.001), whole blood passage time as a marker of blood rheology (r = 0.41, P < 0.001), and skin autofluorescence as a marker of advanced glycation end products in tissues (r = 0.46, P < 0.001), although no significant correlation was noted between serum lipid parameters and the CAVI. Multiple regression analysis identified max-C-IMT (β = 0.35, P < 0.001), whole blood passage time (β = 0.18, P = 0.007), skin autofluorescence (β = 0.17, P = 0.011), and age (β = 0.16, P = 0.018) as variables independently associated with CAVI.ConclusionThe present study indicated that the CAVI is an essential CVD risk factor among postmenopausal women with hypercholesterolemia. Moreover, impaired blood rheology and increase of skin autofluorescence were associated with elevated CAVI in such patients.

Abstract 14469: The Automatically Assessed P-wave Notch Associated With Not Only Left Atrial Enlargement but Also Cardio-ankle Vascular Index in Patients With Cardiovascular Risks: The Coupling Study

Background: The notched P-wave characteristics is associated with atrial remodeling. However, the relationship between notched P-wave characteristics and atherosclerosis remains unclear. Hypothesis: We hypothesized that notched P-wave would associated with measurements of atherosclerosis in patients with cardiovascular risk factors. Methods: We enrolled 4,877 subjects from the coupling Study who had ≥1 of cardiovascular risk factors. Twelve-lead electrocardiography was conducted, and the peak-to-peak distance in the M-shape was calculated automatically using a 12-lead ECG Analysis system (Fukuda Denshi, Tokyo). P waves were defined as "notched" if the peak-to-peak distance in the M-shape was ≥40 msec in lead II. We measured cardio-ankle vascular (CAVI), NT-proBNP, and Troponin T. We also assessed the left atrial diameter and left ventricular mass index (LVMI) by echocardiography in 501 patients. Results: The CAVI with notched P wave were significantly higher than those in the patients without notched P wave (9.75±1.56 vs. 8.86±1.37, p&lt;0.001). The LA diameter, LVMI, and BNP in the patients with notched P wave were significantly higher than those in the patients without notched P wave (LA dia.: 40.2±7.0 vs. 37.0±5.0 mm, p=0.008; LVMI: 105.7±25.7 vs. 96.9±25.2 g/m 2 , p&lt;0.001; median BNP: 41.6 vs. 16.5 pg/dL, p&lt;0.001). A multivariate regression analysis including age, gender, smoking, history of hypertension, dyslipidemia, diabetes revealed that notched P wave was independently associated with an increase of CAVI (odds ratio 2.14, 95%CI 1.40-3.27, p&lt;0.001). Conclusions: The automatically assessed P-wave notch associated with not only left atrial enlargement but also CAVI in patients with cardiovascular risks.

Assessment of cardio-ankle vascular index in patients with abdominal aortic aneurysm: An observational study.

Arterial stiffness is associated with major adverse cardiovascular events. The aim of this study is to investigate arterial stiffness by cardio-ankle vascular index (CAVI) in patients with abdominal aortic aneurysm (AAA). This observational and cross-sectional study involved 59 subjects with AAA and 32 healthy subjects. All subjects underwent ultrasonography examination. CAVI was measured by VaSera-1000 CAVI instrument. Mean abdominal aortic diameter of AAA patients and controls were 43.88 ± 9.28 mm and 20.43 ± 3.14 mm, consecutively. Baseline clinical characteristics of the patients and controls were similar for age, presence of hypertension, diabetes, dyslipidemia, coronary artery disease and smoking. Left ventricle ejection fraction and Left ventricle mass index (LVMI) were similar between groups. CAVI was significantly higher in patients with AAA than controls (9.74 ± 1.50 vs. 7.60 ± 1.07, p < 0.001). CAVI was positively correlated with AAA diameter (r = 0.461, p < 0.001) and negatively correlated with left ventricle ejection fraction (r= -0.254, p = 0.015). CAVI >8.3 had a sensitivity 89.8% and a specificity of 78.1% for predicting the presence of AAA in ROC analysis (area under curve = 0.897, 95%CI = 0.816-0.951, p < 0.001). CAVI is increased in patients with AAA. Increased arterial stiffness may be a mechanical link between AAA, coronary artery disease and peripheral artery disease or a common mechanism effects the arterial stiffness, coronary artery disease, peripheral artery disease and AAA. Therefore, CAVI may be used as a valuable marker for risk stratification for the development of AAA in susceptible patients.

Age-related difference of the association of cardiovascular risk factors with the cardio-ankle vascular index in the Cardiovascular Prognostic Coupling Study in Japan (the Coupling Registry).

The value of the cardio-ankle vascular index (CAVI) increases with age. All large-scale studies of the CAVI have investigated patients <80years old. Thus, the clinical characteristics of high CAVI in patients aged 80 or more remain unclear. Therefore, we investigated (1) the CAVI in very elderly patients and (2) the determinants of a high CAVI in high-risk patients, including very elderly patients. The Cardiovascular Prognostic Coupling Study in Japan (Coupling Registry) is a prospective observational study of Japanese outpatients with any cardiovascular risk factors. We enrolled 5109 patients from 30 institutions (average age 68.7±11.4years, 52.4% males). We investigated the determinants of the CAVI by separating the patients into three groups: 970 middle-aged (<60years), 3252 elderly (60-79years), and 887 very elderly (≥80years) patients. The CAVI values of the males were significantly higher those of the females in all age groups (<60years: 7.81±1.11 vs. 7.38±0.99, P<.001; 60-79years: 9.20±1.29 vs. 8.66±1.07, P<.001; ≥80years: 10.26±1.39 vs. 9.51±1.12, P<.001). In all age groups, the CAVI of the patients with diabetes/glucose tolerance disorder was higher than that of the patients without diabetes/glucose tolerance disorder (<60years: 7.82±1.22 vs 7.58±1.03, P=.002; 60-79years: 9.23±1.20 vs 8.78±1.19, P<.001; ≥80years: 10.04±1.24 vs 9.75±1.32, P=.002). The determinants of the CAVI in these very elderly patients were age, male sex, low BMI, and mean blood pressure. Diabetes/glucose tolerance disorder and glucose were independently associated with the CAVI in the patients aged <60years and 60-79years, but not in those aged ≥80years after adjusting for other covariates.