Carotid Pulse Wave Velocity Research Articles

Warfarin Induces Cardiovascular Damage in Mice

Vascular calcification is an independent risk factor for cardiovascular disease. Once thought to be a passive process, vascular calcification is now known to be actively prevented by proteins acting systemically (fetuin-A) or locally (matrix Gla protein). Warfarin is a vitamin K antagonist, widely prescribed to reduce coagulation by inhibiting vitamin K-dependent coagulation factors. Recently, it became clear that vitamin K antagonists also affect vascular calcification by inactivation of matrix Gla protein. Here, we investigated functional cardiovascular characteristics in a mouse model with warfarin-induced media calcification. DBA/2 mice received diets with variable concentrations of warfarin (0.03, 0.3, and 3 mg/g) with vitamin K1 at variable time intervals (1, 4, and 7 weeks). Von Kossa staining revealed that warfarin treatment induced calcified areas in both medial layer of aorta and heart in a dose- and time-dependent fashion, which could be inhibited by simultaneous vitamin K2 treatment. With ongoing calcification, matrix Gla protein mRNA expression decreased, and inactive matrix Gla protein expression increased. TdT-mediated dUTP-biotin nick end labeling-positive apoptosis increased, and vascular smooth muscle cell number was concomitantly reduced by warfarin treatment. On a functional level, warfarin treatment augmented aortic peak velocity, aortic valve-peak gradient, and carotid pulse-wave velocity. Warfarin induced significant calcification with resulting functional cardiovascular damage in DBA/2 wild-type mice. The model would enable future researchers to decipher mechanisms of vascular calcification and may guide them in the development of new therapeutic strategies.

GW24-e0651 Evaluation of Arterial Alterations and Associated Factors of Chronic Kidney Disease by Echo-tracking Technique

ObjectivesThe aim of our study is to evaluate the changes in the structural and elastic of the arteries in chronic kidney disease (CKD) patients with predialysisas by echo-tracking technique (ET).MethodsThirty-nine...

On-chip laser Doppler vibrometer for arterial pulse wave velocity measurement

Pulse wave velocity (PWV) is an important marker for cardiovascular risk. The Laser Doppler vibrometry has been suggested as a potential technique to measure the local carotid PWV by measuring the transit time of the pulse wave between two locations along the common carotid artery (CCA) from skin surface vibrations. However, the present LDV setups are still bulky and difficult to handle. We present in this paper a more compact LDV system integrated on a CMOS-compatible silicon-on-insulator substrate. In this system, a chip with two homodyne LDVs is utilized to simultaneously measure the pulse wave at two different locations along the CCA. Measurement results show that the dual-LDV chip can successfully conduct the PWV measurement.

Cardiovascular risk in pediatric-onset rheumatological diseases

Cardiovascular morbidity and mortality are becoming major health concerns for adults with inflammatory rheumatic diseases. The enhanced atherogenesis in this patient population is promoted by the exposure to traditional risk factors as well as nontraditional cardiovascular insults, such as corticosteroid therapy, chronic inflammation and autoantibodies. Despite definite differences between many adult-onset and pediatric-onset rheumatologic diseases, it is extremely likely that atherosclerosis will become the leading cause of morbidity and mortality in this pediatric patient population. Because cardiovascular events are rare at this young age, surrogate measures of atherosclerosis must be used. The three major noninvasive vascular measures of early atherosclerosis - namely, flow-mediated dilatation, carotid intima-media thickness and pulse wave velocity - can be performed easily on children. Few studies have explored the prevalence of cardiovascular risk factors and even fewer have used the surrogate vascular measures to document signs of early atherosclerosis in children with pediatric-onset rheumatic diseases. The objective of this review is to provide an overview on cardiovascular risk and early atherosclerosis in pediatric-onset systemic lupus erythematosus, juvenile idiopathic arthritis and juvenile dermatomyositis patients, and to review cardiovascular preventive strategies that should be considered in this population.

Abstract 114: Correlation of Specific HDL Subspecies with Arterial Stiffness in Youth with Type 2 Diabetes

Human epidemiological studies demonstrate that increased HDL cholesterol (HDL-C) concentrations are associated with a decreased risk of cardiovascular disease. However, recent drug therapies designed to raise plasma HDL-C concentrations have failed to reduce cardiovascular events. These findings suggest that the cardio-protective effects of HDL may lie in specific HDL subspecies and not in the HDL-C number. Thus, we sought to define the composition of HDL in adolescents with T2D and determine whether specific HDL subspecies are associated with early markers of arterial disease. Youth with T2D (n=10) and two control groups lean (n=9) and obese (n=11) adolescents were recruited in a cross sectional study. Plasma was separated into 18 fractions using gel filtration chromatography. Lipid associated proteins were then isolated and identified using mass spectrometry. Concurrently, arterial thickness and stiffness measures including common/bulb/internal carotid intima media thickness (IMT) and pulse wave velocity (PWV) were measured. Compared to lean and obese controls, youth with T2D exhibited decreased phospholipid content in fractions containing large HDL subspecies that was inversely associated with pulse wave velocity (p<0.001). No association between HDL-C and pulse wave velocity was seen. Proteomic analysis of the HDL sized fractions demonstrated decreases in 17 of 45 identified proteins in the T2D group compared to lean youth. The most striking protein decreases occurred in apolipoprotein (apo) A-1, apoC-I, apoE and paraoxonase-1 (p<0.05) in fractions associated with large HDL particles. Our data demonstrate early changes in the lipid and protein compositions of specific HDL subspecies in adolescents with T2D that are related to early markers of arterial disease. These findings suggest that analyzing the composition of HDL, rather than HDL-C, may be useful in assessing cardiovascular risk in this population.

Usefulness of Vascular Wall Deformation for Assessment of Carotid Arterial Stiffness and Association With Previous Stroke in Elderly

Carotid arterial stiffness measured by techniques of speckle tracking echocardiography is helpful to assess vascular wall deformation. We conducted a study to investigate the relationship between vascular deformation of the carotid artery and ischemic stroke in the elderly. We recruited 89 consecutive individuals aged ≥60 years (mean age = 72±6 years; 31 men) from a community health survey program. Ten (11%) had a history of ischemic stroke. Carotid B-mode images were acquired using a high-resolution vascular probe equipped on an echocardiographic system. Circumferential strain (CS) and strain rate (CSR) were obtained by speckle tracking techniques with a region of interest covering the entire depth of the common carotid arterial wall. Both CS and CSR were significantly correlated with beta index and distensibility but not with carotid intima-medial thickness and pulse wave velocity. In the comparison between patients with or without history of stroke, carotid CS (1.46% ± 0.54% vs. 2.75% ± 1.23%; P = 0.002) and CSR (0.30±0.13 1/s vs. 0.47±0.18 1/s; P = 0.007) were significantly lower in patients with stroke. Multivariable analysis showed that both carotid CS and CSR were independent factors associated with previous strokes. Carotid wall deformation indices are useful for assessment of local carotid arterial stiffness. CS and CSR of carotid artery measured by speckle tracking techniques were associated with previous ischemic stroke in the elderly.

Abstract WP413: High Purity Eicosapentaenoic Acid In Addition To A Strong Statin Makes Regression Of Intima-media Thickness In Patients With Asymptomatic Cerebral Infarction.

Background: JELIS indicated the efficacy of eicosapentaenoic acid (EPA) in addition to statin for coronary events and cerebrovascular events in terms of secondary prevention. However, there are few studies on the efficacy of additional EPA to a strong statin in a manner of randomized controlled study. Objective: To evaluate the efficacy of additional EPA to strong statin for carotid plaque using carotid echography and pulse wave velocity (PWV). Methods: Forty patients (mean age 70 y.o.) with asymptomatic cerebral infarction and coronary artery disease who were administrated 2mg/day of pitavastatin were randomly assigned to EPA-group (n=20) and non-EPA-group (n=20). The patients in EPA-group were additionally administered 1800mg/day of EPA for more than 6 months. In all patients carotid echography was performed before EPA administration and average 8 months later. At the same timing, PWV was recorded. Results: There were no significant changes in lipids profile, PWV and Ankle-Brachial index after randomization between 2 groups. There was significant reduction of intima-media thickness (IMT)in EPA-group compared with non-EPA-group (follow-up IMT - baseline IMT : 015±0.38 vs 0.85±1.2mm,respectively; p<0.05), and there was significant improvement of pulsatility index of carotid echography.(0.94±0.39 vs 1.49 ±0.35; p<0.05). EPA/Arachidonic acid (AA) ratio was increased in EPA-group (0.4±0.3 to 1.2±0.5; p<0.01). The change of IMT during follow-up was significantly associated with the change of EPA/AA ratio (r=0.4, p<0.05). Conclusion: EPA reduced IMT even under the strong statin administration in patients with asymptomatic cerebral infarction.

Comparison of sequentially measured Aloka echo-tracking one-point pulse wave velocity with SphygmoCor carotid-femoral pulse wave velocity.

Objectives:Recently, echo-tracking-derived measures of arterial stiffness have been introduced in clinical practice for the assessment of one-point pulse wave velocity. The purpose of this study was to find a relation between carotid–femoral pulse wave velocity and one-point carotid pulse wave velocity, and to find a value of one-point carotid pulse wave velocity that predicts carotid–femoral pulse wave velocity higher than 12 m/s.Methods:A total of 160 consecutive subjects (112 male/48 female, mean age = 51.5 ± 14.1 years; 96 healthy, 44 hypertensives, 13 with aortic valve disease, and 7 with left ventricular dysfunction) were studied. Carotid–femoral pulse wave velocity was measured with the SphygmoCor system and one-point carotid pulse wave velocity with high-definition echo-tracking system (ProSound Alpha10; Aloka, Tokyo, Japan).Results:Both carotid–femoral pulse wave velocity and one-point carotid pulse wave velocity correlated significantly with each other (r = 0.539, p < 0.001) and with age (one-point carotid pulse wave velocity r = 0.618, carotid–femoral pulse wave velocity r = 0.617, p < 0.0001 for both). Median value of carotid–femoral pulse wave velocity (7.2 m/s, 95% confidence interval = 6.2–8.9) was systematically higher than that of one-point carotid pulse wave velocity (5.8 m/s, 95% confidence interval = 5–6.6). The area under the receiver operating characteristic curve was 0.85, identifying the cutoff for one-point pulse wave velocity of 6.65 m/s as the best predictor of carotid–femoral pulse wave velocity more than 12 m/s (sensitivity = 0.818, specificity = 0.819).Conclusions:One-point carotid pulse wave velocity correlates with carotid–femoral pulse wave velocity, and the cutoff of 6.65 m/s was the best predictor of carotid–femoral pulse wave velocity over 12 m/s.

Blood pressure variability associates with carotid intima-media thickness but not carotid distensibility and pulse wave velocity in 1125 participants

Blood pressure variability associates with carotid intima-media thickness but not carotid distensibility and pulse wave velocity in 1125 participants

Assessment of carotid pulse wave velocity changes over cardiac cycle: An accelerometric approach

Assessment of carotid pulse wave velocity changes over cardiac cycle: An accelerometric approach

ASSESSMENT OF CAROTID ARTERY ELASTICITY IN THE NORMAL POPULATION BY TWO-DIMENSIONAL SPECKLE TRACKING IMAGING

ObjectivesTo investigate the value of two-dimensional speckle tracking imaging (2D-STI) in the assessment of carotid circumferential strain of the normal population.MethodsTotally 140 healthy people (age 20–95 years old), according to...

Abstract 152: John Henryism Active Coping, Blood Pressure, and Arterial Stiffness in Korean Americans

Introduction It is well known that blood pressure (BP) is inversely related to socioeconomic status (SES). John Henryism Active Coping (JHAC) is defined as a strong behavioral predisposition to cope with psychosocial stressors in an active and determined manner, and has been used to explain cardiovascular disparity in African Americans. According to JHAC hypothesis, the inverse relationship between cardiovascular risk and SES is more prominent for the individuals with high JHAC. High levels of psychological stress and high prevalence of hypertension (32%) have been reported in Korean Americans (KAs). Purpose The study was conducted to examine the main effects and the interaction effect of SES and JHAC on cardiovascular risk (measured by BP and arterial stiffness) in KAs. Methods Sample - 102 KAs (aged 21-60 years, 60% women) Measures - Age, gender, BMI, SES (measured by education and income), JHAC(measured by the 12-item JHAC Scale), BP, Arterial stiffness (measured by carotid and femoral pulse wave velocity [PWV]) Data Analysis - Two way factorial ANOVA and Duncan’s test by SAS 9.2. Results SBP (p=.03) and DBP (p=.01) were significantly higher in the low education group. The interaction effect of education and JHAC on SBP was significant (p=0.02), indicating that the education effect on SBP was greater in the low JHAC group. The main effect of education on PWV was not significant (p=0.64). However, the JHAC had a significant main effect on PWV (p=0.02), showing that the group with low JHAC score had higher PWV than the group with high JHAC. The interaction between education and JHAC on PWV was also significant (p=0.02), thus the effect of JHAC on PWV was greater in the low education group. Discussion The results demonstrated that the inverse relationship between education and cardiovascular measures was more severe in the low JHAC group, contrary to JHAC hypothesis. Furthermore, arterial stiffness, an important biomarker of cardiovascular disease, was predicted by JHAC, but not by education, showing the subjects with low JHAC had significantly higher arterial stiffness. This phenomenon was also more prominent in the subjects with low education. The findings suggest that JHAC has beneficial effect on cardiovascular health in KAs.

A new tool to assess retinal vessel caliber. Reliability and validity of measures and their relationship with cardiovascular risk

To analyze the reliability and validity of a semiautomated tool for assessing retinal vessel caliber and to describe the relationship of measures taken to cardiovascular risk and target organ damage. A total of 210 patients aged 34-75 years were selected with retinography. Retinal photographs were digitized, and superior and inferior temporal vessels were measured in an area 0.5-1 disk diameter from the optic disc with semiautomated software [arteriole/venule index (AVIx) calculator]. AVIx was also estimated. Vascular damage was assessed using carotid intima-media thickness and pulse wave velocity, cardiac damage using Cornell voltage-duration product, renal damage using the glomerular filtration rate and microalbuminuria, and cardiovascular risk with the Framingham score. Interobserver intraclass correlation coefficient (ICC) ranged from 0.96 [95% confidence interval (CI) 0.94-0.97] to 0.99 (95% CI 0.98-0.99), and intraobserver ICC ranged from 0.97 (95% CI 0.94-0.98) to 0.99 (95% CI 0.99-0.99). In the Bland-Altman plot, the limit of interobserver agreement was -0.009 (0.066 to -0.086) in right AVIx and -0.001 (0.083 to -0.085) in left AVIx, whereas the limit of intraobserver agreement for overall AVIx was -0.005 (-0.057 to -0.047). Cardiovascular risk and albumin-creatinine ratio were higher in the first tertile of AVIx as compared with the other two (P < 0.05). In multiple regression, AVIx and venule caliber, but not artery caliber, behaved as predictors of cardiovascular risk and microalbuminuria. This tool showed a high intraobserver and interobserver reliability, and results of the validity analysis agree with those from large studies in estimation of cardiovascular risk and evaluation of target organ damage.

The change in arterial stiffness over the cardiac cycle rather than diastolic stiffness is independently associated with left ventricular mass index in healthy middle-aged individuals

The current standard for arterial stiffness assessment, aortic pulse wave velocity (aPWV), is measured at diastolic pressure. Arterial stiffness, however, is pressure dependent. At the carotid artery level, the degree of this dependency can be quantified as the difference (ΔPWV) between systolic and diastolic (cPWVd) carotid pulse wave velocity. Biomechanically, a greater ΔPWV implies greater increases in left ventricular afterload with physical activity. Therefore, we hypothesized, that ΔPWV is more strongly associated with left ventricular mass index (LVMI) than aPWV and cPWVd. In 1776 healthy individuals from the Asklepios cohort (age 35-55 years), ΔPWV was obtained from combined carotid artery ultrasound and tonometry recordings. Multiple linear regression analysis was performed to investigate the associations of ΔPWV, cPWVd and aPWV with LVMI, adjusting for age, sex, mean blood pressure (MBP), central pulse pressure, and other possible confounders. ΔPWV was 2.4 ± 1.2 m/s (mean ± SD), ranging from 0.8 m/s, indicating almost constant arterial stiffness over the cardiac cycle, to 4.4 m/s, reflecting substantial pressure dependency. ΔPWV was significantly associated with LVMI (β of 2.46 g/m per m/s, P < 0.001), even after full adjustment (β of 0.56 g/m per m/s, P = 0.03). cPWVd and aPWV had clear crude associations with LVMI (P < 0.001), but lost significance after adjustment (β of -0.48 and -0.33 g/m per m/s, with P = 0.11 and 0.2, respectively). The change in arterial stiffness over the cardiac cycle, rather than diastolic stiffness, is independently associated with LVMI in healthy middle-aged individuals. Therefore, the pressure dependency of arterial stiffness should be considered in cardiovascular risk assessment.

Ambulatory arterial stiffness indices and target organ damage in hypertension

BackgroundThe present study was designed to evaluate which arterial stiffness parameter - AASI or the home arterial stiffness index (HASI) - correlates best with vascular, cardiac and renal damage in hypertensive individuals.MethodsA cross-sectional study was carried out involving 258 hypertensive patients. AASI and HASI were defined as the 1-regression slope of diastolic over systolic blood pressure readings obtained from 24-hour recordings and home blood pressure over 6 days. Renal damage was evaluated by glomerular filtration rate (GFR) and microalbuminuria; vascular damage by carotid intima-media thickness (IMT), pulse wave velocity (PWV) and ankle/brachial index (ABI); and left ventricular hypertrophy by the Cornell voltage-duration product (VDP) and the Novacode index.ResultsAASI and HASI were not correlated with microalbuminuria, however AASI and HASI- blood pressure variability ratio (BPVR) showed negative correlation with GRF. The Cornell PDV was positively correlated with AASI- BPVR-Sleep (r = 0.15, p < 0.05) and the left ventricular mass index with HASI-BPVR (r = 0.19, p < 0.01). Carotid IMT and PWV were positively correlated with all the parameters except the HASI, while ABI was negatively correlated with AASI and Awake-AASI. After adjusting for age, gender and 24 hours heart rate, statistical significance remains of the IMT with AASI, Awake AASI and AASI-BPVR. PWV with the AASI, Awake-AASI and Sleep-AASI. ABI with AASI and Awake-AASI. Odd Ratio to presence target organ damage was for AASI: 10.47(IC95% 1.29 to 65.34), Awake-AASI: 8.85(IC95% 1.10 to 71.04), Sleep-AASI: 2.19(IC95% 1.10 to 4.38) and AASI-BPVR-night: 4.09 (IC95% 1.12 to 14.92).ConclusionsAfter adjusting for age, gender and 24-hour heart, the variables that best associated with the variability of IMT, PWV and ABI were AASI and Awake-AASI, and with GFR was HASI-BPVR.

Cardiac Biomarkers and Noninvasive Predictors of Atherosclerosis in Chronic Peritoneal Dialysis Patients

Background: We investigated the relationship among serum cardiac biomarkers including N-terminal pro-brain natriuretic peptide (NT-pro-BNP), cardiac troponin T (cTnT), uric acid and high-sensitive C-reactive protein (hs-CRP) and noninvasive predictors of atherosclerosis including carotid intima-media thickness (IMT), aortic stiffness (pulse wave velocity (PWV)) and transthoracic coronary flow reserve (CFR) in peritoneal dialysis (PD) patients. Methods: 37 PD patients were included in the study. We measured (1) carotid IMT, (2) PWV and augmentation index (AIx), and (3) CFR. Simultaneous measurements of serum NT-pro-BNP, cTnT, uric acid and hs-CRP were also performed. Associations among these variables were analyzed. Results: cTnT was significantly associated with carotid IMT (r = 0.747, p < 0.001), PWV (r = 0.431, p = 0.035) and CFR (r = –0.439, p = 0.007). In multivariate analysis, cTnT was a significant independent predictor of carotid IMT (β = 4.446, p < 0.001) and CFR (β = –2.272, p = 0.013). Patients with high cTnT levels (≥0.01 ng/ml) significantly hadhigher carotid IMT and PWV values. Only the aortic PWV significantly correlated with residual renal function (r = –0.574, p = 0.004). Conclusions: Serum cTnT appeared to be a useful clinical biomarker for evaluating noninvasive predictors of atherosclerosis in chronic PD patients. Arterial stiffness as determined by PWV is also correlated with residual renal function.

The Leptin to Adiponectin Ratio is a Marker of the Number of Metabolic Syndrome Criteria in French Adults

Aim: Visceral distribution of adipose tissue (AT) is one of the key components of Metabolic Syndrome (MetS). Plasma concentrations of leptin and adiponectin are closely linked to AT distribution. Pulse wave velocity (PWV), a marker of arterial stiffness, is linked to metabolic syndrome and cardiovascular risk. The purpose of this study is to describe the extent of the usefulness of the Leptin/Adiponectin (L/A) ratio as a marker of MetS. Methods: Leptin and adiponectin concentrations, magnetic resonance image-based of visceral and subcutaneous fat measurements, and carotid PWV were analyzed in the subjects of a French prospective cohort composed of 97 subjects not presenting metabolic syndrome (MetS-), 122 patients with metabolic syndrome (MetS+) without diabetes, and 94 type 2 diabetics (T2D) with MetS. Results: After adjustment for gender and age, leptinemia was found to be higher in MetS+ patients than in T2D patients. Adiponectinemia alone was not discriminated. There was a statistically significant difference in the L/A ratio between MetS- patients and the other groups. For the whole population, there is a positive correlation between the L/A and waist circumference, waist-to-hip ratio, visceral fat (r=0.53), triglyceride concentrations, fasting glucose concentrations, insulinemia, systolic and diastolic blood pressure, and number of MetS criteria (r=0.39). The L/A ratio is also significantly correlated with carotid artery stiffness. Conclusion: This study demonstrates the potential usefulness of the L/A ratio as a marker, independent of age and gender, of a subject’s metabolic risk. The L/A Ratio is also a reliable marker for arterial stiffness.

Correlation of Pulse Wave Velocity with Left Ventricular Mass in Patients with Hypertension Once Blood Pressure has been Normalized

Vascular stiffness has been proposed as a simple method to assess arterial loading conditions of the heart which induce left ventricular hypertrophy (LVH). There is some controversy as to whether the relationship of vascular stiffness to LVH is independent of blood pressure, and which measurement of arterial stiffness, augmentation index (AI) or pulse wave velocity (PWV) is best. Carotid pulse wave contor and pulse wave velocity of patients (n=20) with hypertension whose blood pressure (BP) was under control (<140/90 mmHg) with antihypertensive drug treatment medications, and without valvular heart disease, were measured. Left ventricular mass, calculated from 2D echocardiogram, was adjusted for body size using two different methods: body surface area and height. There was a significant (P<0.05) linear correlation between LV mass index and pulse wave velocity. This was not explained by BP level or lower LV mass in women, as there was no significant difference in PWV according to gender (1140.1+67.8 vs 1110.6+57.7 cm/s). In contrast to PWV, there was no significant correlation between LV mass and AI. In summary, these data suggest that aortic vascular stiffness is an indicator of LV mass even when blood pressure is controlled to less than 140/90 mmHg in hypertensive patients. The data further suggest that PWV is a better proxy or surrogate marker for LV mass than AI and the measurement of PWV may be useful as a rapid and less expensive assessment of the presence of LVH in this patient population.

Adrenalectomy improves increased carotid intima-media thickness and arterial stiffness in patients with aldosterone producing adenoma

ContextPrimary aldosteronism (PA) is the most frequent cause of secondary hypertension, and is associated with more prominent vascular stiffness and atherosclerosis. However, the effect of adrenalectomy on reversibility of vascular damage is unclear. ObjectiveOur objective was to investigate the vascular changes and possibility of reversibility after adrenalectomy in PA patients. MethodsWe prospectively analyzed 20 patients with aldosterone producing adenoma (APA) that received adrenalectomy from October 2006 to December 2008 and 21 patients with essential hypertension (EH) were enrolled as the control group. Carotid intima media thickness (CIMT) measurement by B-mode ultrasound of the right common carotid arteries and pulse wave velocity (PWV) measurement including brachial–ankle PWV (baPWV) and heart–ankle PWV (haPWV) were performed in both groups. The follow-up measurements were performed one-year after adrenalectomy in APA group. ResultsAPA patients had significantly higher diastolic blood pressure, plasma aldosterone concentration (PAC) and aldosterone-renin ratio (ARR), but lower serum potassium level and plasma renin activity (PRA) than EH patients. APA patients had significantly higher CIMT (0.64±0.13 vs. 0.53±0.10mm, p=0.006), higher baPWV (1589±296 vs. 1405±187cm/s, p=0.024) and haPWV (1095±150 vs. 987±114cm/s, p=0.013) comparing with EH patients. One-year after adrenalectomy, CIMT reduced significantly from 0.64±0.13mm to 0.59±0.14mm (p=0.014), and baPWV and haPWV also showed significant reduction (baPWV, 1589±296 to 1463±188cm/s, p=0.035; haPWV, 1095±150 to 1017±109cm/s, p=0.019). ConclusionAPA patients have higher degree of early atherosclerosis and vascular stiffness. Adrenalectomy not only corrects the high blood pressure and biochemical parameters but also reverse adverse vascular change in APA patients.

Effects of thrice weekly nocturnal hemodialysis on arterial stiffness

Objective In this study, we compared the changes in arterial stiffness in chronic hemodialysis patients treated with 8-h vs. 4-h thrice weekly in-center hemodialysis. Methods Sixty prevalent chronic hemodialysis patients assigned to 8-h nocturnal in-center thrice weekly HD (NHD) and 60 control cases assigned to 4-h thrice weekly conventional HD (CHD) were followed for one year. Radial–carotid pulse wave velocity, augmentation index and echocardiography were performed at baseline and 12 th month. Results Mean age of the patients was 49 ± 11 years, 30.8% were female, 27.5% had diabetes mellitus and mean dialysis vintage was 57 ± 47 months. Baseline demographical, clinical and laboratory parameters were similar between groups. During a mean follow-up of 15.0 ± 0.1 months, blood pressure remained similar in both groups while the number of mean daily anti-hypertensive substances decreased in the NHD group. In the NHD group, time-averaged serum phosphorus and calcium–phosphorus product were lower than the CHD group. Pulse wave velocity and augmentation index decreased in the NHD group (from 11.02 ± 2.51 m/s to 9.61 ± 2.39 m/s and from 28.8 ± 10.3% to 26.2 ± 12.1%; p = 0.008 and p = 0.04, respectively). While augmentation index increased in the CHD group (28.0 ± 9.4 to 31.0 ± 10.7%, p = 0.02), pulse wave velocity did not change. Subendocardial viability ratio and ejection duration improved in the NHD group (from 135 ± 28 to 143 ± 25%, p = 0.01 and from 294 ± 34 ms to 281 ± 34 ms, p = 0.003, respectively), accompanied by regression of left ventricular mass index. In multiple stepwise linear regression analyses, NHD was associated with improvements in augmentation index, ejection duration and subendocardial viability ratio. Conclusions These data indicate that arterial stiffness is ameliorated by implementation of longer hemodialysis sessions.