Carotid-radial Pulse Wave Velocity Research Articles

Abstract P178: Relationship of Apolipoproteins With Subclinical Cardiovascular Risk in Youth

Introduction: Apolipoproteins are key regulators of cholesterol transport and clearance with each apolipoprotein having a specific protective or atherogenic role. The relationship between subclinical cardiovascular risk and each of the apolipoproteins in the pediatric population is insufficiently described within the literature. Therefore, the purpose of this study was to examine the association of apolipoproteins with measures of vascular structure and function in pediatric population. Hypothesis: We hypothesized apolipoprotein AI, AII, and CII would demonstrate a positive association, and apolipoprotein B, B/AI ratio, CIII, CIII/CII ratio, and E a negative association with carotid intima-media thickness (cIMT) and carotid-radial pulse wave velocity (PWV). Methods: A cross-sectional study of 338 children and adolescents (160 males, 178 females) aged 8-21 years (mean age 13.0±2.8 years) with a range of adiposities from normal body weight to severe obesity (mean BMI 26.8±8.9 kg/m 2 ). Apolipoproteins (AI, AII, B, CII, CIII, and E) were measured via human apolipoprotein magnetic bead panel (Millipore, MA, USA). Ultrasound imaging of the carotid artery was used to measure cIMT. PWV, a measure of arterial stiffness, was assessed via applanation tonometry (SphygmoCor TM ). Total body fat percent (BF%) was measured using dual X-ray absorptiometry. Linear regression models were adjusted for Tanner stage, sex, and race with further adjustments for BF%. Data are presented as mean [95% CI] with Holms-adjusted p-values to account for multiple testing. All apolipoprotein ratios were scaled to 0.1 μg/mL. Methods: There were significant positive associations between PWV and apolipoproteins: AII (0.036 m/sec per 10 μg/mL [0.017, 0.056], p = 0.010), E (0.158 m/sec per 10 μg/mL [0.08, 0.235], p = 0.002), and CIII/CII ratio (0.033 [0.014, 0.052], p = 0.019). After adding BF% to the models, PWV remained positively associated with higher levels of apolipoproteins: AII (0.036 m/sec per 10 μg/mL [0.016, 0.055], p = 0.012), E (0.161 m/sec per 10 μg/mL [0.082, 0.239], p = 0.002), and CIII/CII ratio (0.033 [0.014, 0.052], p = 0.02). Before accounting for multiple testing, apolipoprotein CIII/CII ratio was positively associated with cIMT (0.001 [0, 0.003], p = 0.033), but failed to maintain significance after p-value correction. Otherwise, there were no significant associations between any apolipoprotein and cIMT in the presence or absence of BF%. Conclusions: These findings suggest higher levels of apolipoprotein AII, E, and CIII/CII ratio are associated with higher arterial stiffness (PWV) in pediatrics, both in the presence and absence of excess body fat. Apolipoproteins, specifically AII, E, and CIII/CII ratio, may exert their effects on vascular function (PWV) before altering vascular structure (cIMT), which is congruent with the chronological pathophysiology of atherosclerosis.

Cardiotoxic Profile and Arterial Stiffness of Adjuvant Chemotherapy for Colorectal Cancer.

Background and PurposeEven though new cancer therapies have improved the overall survival, in some cases they have been associated with adverse effects, including increased cardiotoxicity. The purpose of the present study was to assess the cardiovascular effects of adjuvant chemotherapy for colorectal cancer and mainly the impact on arterial stiffness indices.Material and MethodsA total of 70 patients with non-metastatic colorectal cancer who were treated either with FOLFOX (n=16) or with XELOX (n=54) adjuvant chemotherapy were included in the study. All patients were subjected to full cardiovascular evaluation at the beginning and the end of chemotherapy. Arterial stiffness was assessed by means of pulse wave velocity (PWV) and augmentation index (Aix) and full laboratory examinations were conducted prior to, and soon after, the termination of chemotherapy.ResultsPatients exhibited significantly higher levels of carotid-radial PWV, carotid femoral RWV and Aix post-chemotherapy (p<0.001); these findings remained significant when examined separately in each treatment subgroup (FOLFOX, XELOX). The observed changes were independent of treatment regimen and baseline patient characteristics. Univariate regression analyses showed that baseline PWVc-r and PWVc-f were the only factors associated with PWVc-r and PWVc-f change, while Aix change was independent of its baseline value.ConclusionThere is a clear burden in arterial stiffness indices post-adjuvant chemotherapy for colorectal cancer in both chemotherapy groups. This is a finding of important clinical significance, however more prospective studies are required in order to encode the possible mechanisms involved.

Hematocrit levels and arterial stiffness: the Cardiometabolic Risk in Chinese (CRC) Study

We aimed to investigate the association of haematocrit (HCT) level with central and peripheral arterial stiffness in adults in China. We particularly focussed on the association between HCT and other cardiometabolic risk factors. Adults aged ≥ 20 years were included in the study. Carotid radial pulse wave velocity (crPWV), carotid femoral pulse wave velocity (cfPWV), carotid dorsalis pedis pulse wave velocity (cdPWV), and HCT were measured. Overall, 3225 individuals were included in the study. After adjustment for age, sex, and body mass index, HCT level was found to increase significantly with increases in cfPWV, crPWV, and cdPWV (p = 0.001). Following adjustment for heart rate, blood pressure, and blood lipids, the association of HCT level with crPWV and cdPWV was not significant (p = 0.090 and 0.053, respectively); however, the association between HCT level and cfPWV remained significant (p = 0.007). We found significant interactions of HCT level with hypertension and metabolic syndrome in the effect on cfPWV (p = 0.0419 and 0.026, respectively). In adults in China, HCT level was associated with elevated central arterial stiffness, independent of conventional cardiovascular risk factors. As a serological marker, HCT can predict the degree of central arterial stiffness. HCT combined with other traditional cardiovascular risk factors can better assess vascular heart disease.

5.2 Arterial Stiffness and Periodontitis: A Systematic Review and Meta-Analysis

BackgroundDespite a large number of studies linking cardiovascular diseases and periodontitis (Buhlin et al. 2011; Hansen et al. 2016; Pussinen et al. 2003), few studies make it possible to draw accurate conclusions on the link between periodontitis and arterial stiffness. Endothelial cells maintain vascular homeostasis but are affected by inflammatory injuries (Lacolley et al. 2017). Periodontal diseases involve bacteria-induced inflammation of the tissues supporting the teeth (Tomás et al. 2012), inducing endothelial dysfunction. We conducted a systematic review from existing studies for answering the following questions: (1) Do periodontitis patients have impaired arterial stiffness compared to controls? (2) Is periodontal treatment effective to improve pulse wave velocity (PWV) values?MethodsA systematic review of the literature, focusing on measurements of PWV in periodontitis patients, was conducted by two independent reviewers. The literature search was done until June 2019. Risk of bias was independently assessed. All clinical studies reporting PWV in patients with severe periodontitis were retrieved for full-text evaluation.ResultsFinal selection included 16 studies for qualitative analysis and 10 studies for quantitative analysis (meta-regression analysis). The results show that patients with severe periodontitis have increased PWV compared to controls (PWV mean difference 0.81 m/s; 95% CI: 0.56–1.06; p < 0.00001). This concerns both carotid to femoral, brachial ankle and carotid radial PWV. However, we were unable to identify a positive effect of periodontal treatment on PWV value.ConclusionThis systematic review and meta-analysis support an association between severe periodontitis and PWV.

Effect of Abdominal Aortic Aneurysm Repair (Arterial Stiffening) on Pulse Wave Velocity and its Impact on Cardiovascular Hemodynamics

Introduction: Aortic grafting and endografting has been reported to affect pulse wave velocity (PWV) and is considered a surrogate of arterial stiffness as well as a prognostic factor of cardiovascular morbidity. We aim to study potential correlations of PWV alterations post AAA repair using common aortic grafts with cardiovascular events, hypertension and kidney injury. Methods: Fifty-seven consecutive AAA patients from a single center were initially enrolled for a PWV analysis (Complior SP/ Analyze). Measurements were obtained pre-operatively, 1 week and 6 months post-operatively. Systolic blood pressure, carotid-radial (cr) PWV (central aortic stiffness), carotid-femoral (cf) PWV (peripheral aortic stiffness), cardiac events, medication adjustments and renal failure were recorded. Results: Ten open (6 Dacron, 4 ePTFE grafts) and 47 endovascular (OVATION stent-grafts), 49 elective and 8 urgent, AAA repairs were fully followed-up. Patient demographics included (mean values): age 69 years, aortic diameter 5.6 cm, BMI 27,6 kg/m2. All patients were men, 51 (92%) were smokers, 47 (83%) had hypertension, 15 (27%) Coronary Artery Disease, 6 (11%) diabetes mellitus, 33 (60%) dyslipidemia, 26 (47%) chronic obstructive pulmonary disease, 10 (18%) peripheral artery disease. We noticed an increase in c-f PWV (central aortic stiffness) (10.4,12.3,11.6; @preop, 1W and 6M postop, respectively, p< 0,001) and a decrease in c-r PWV (peripheral stiffness) (9.2,8.5,8.4, p< 0,01; respectively). 55% presented a rise greater than 10% of cf-PWV and 46% a decrease greater than 10% of cr-PWV. During the first 6 postoperative months, 3 (5%) needed adjustment of antihypertensive medical treatment presenting a greater than 20% rise of cf-PWV. 5 (8%) presented acute cardiovascular syndromes: 2 acute pulmonary oedema (greater than 20% rise of cf-PWV), 1 acute coronary syndrome (greater than 40% rise of cf-PWV), 1 aortic dissection (greater than 40% decrease of cr-PWV), 1 stroke (greater than 130% increase of cr-PWV). Five patients presented an acute kidney injury of which 3 presented a decrease of cf-PWV instead of an expected increase. Conclusion: PWV is an easy, reproducible and low cost examination, that can estimate modifications of aortic stiffness after AAA repair, either open or endovascular. This seems to have a subsequent effect on hypertension and major cardiovascular events. Current guidelines do not discriminate high risk subgroups for extensive cardiac follow up but thorough cardiac and renal consultation and lifetime follow may be crucial after AAA repair. More compliant new generation aortic grafts and endografts may decrease this effect. More studies are required to clarify the significance of PWV for AAA patients. Disclosure: Nothing to disclose

P1573Chemotherapy-induced vasotoxicity in patients undergoing therapy for breast cancer

Abstract Background Cardiotoxicity is a well-known adverse effect of anthracycline and HER-2 monoclonal antibodies, however the vascular effects of these agents remain less-well studied. Purpose To explore the effects of breast chemotherapy on vascular function. Methods A total of 57 female patients undergoing breast diagnosed with breast cancer and scheduled for anthracycline-based and HER-2 chemotherapy were included in this study. At baseline, at 3, 6 and 12 months, patients underwent assessment of cardiac function by transthoracic echocardiography, endothelial function assessment by brachial flow mediated dilation (FMD) and assessment of arterial stiffness by carotid-radial pulse wave velocity (PWV) and augmentation index (Aix). Results There was a significant decrease in left ventricular ejection fraction (LVEF) overtime compared to baseline (A). This was paralleled by a significant decrease in brachial FMD at 6 months (B) and a significant increase in PWV compared to baseline (C). There was no significant change in Aix compared to baseline levels (D). Chemotherapy-induced cardiotoxicity (expressed by the change in LVEF) was not associated with either the change in FMD or PWV at 6 months. Conclusions Breast chemotherapy-induced cardiotoxicity is paralleled by vasotoxicity, which is manifested as endothelial dysfunction and increased arterial stiffness. Systemic vasotoxicity is not directly related to cardiotoxicity, suggesting that monitoring of both cardiac and vascular function could be useful in identifying early signs of cardiovascular toxicity.

P6238International cardiovascular disease risk calculators do not identify high risk in young hodgkin lymphoma survivors

Abstract Background Cardiotoxic therapy causes significant morbidity and mortality in patients (pts) treated for Hodgkin lymphoma (HL). Cardiovascular (CVS) risk calculators do not include cancer therapy despite epidemiological data demonstrating increased risk. We have assessed modifiable CVS risk factors and predicted risk of CVS disease in a cohort of HL survivors. Hypothesis Cardiovascular risk calculators will not identify high risk in young HL survivors. Methods Pts now aged ≤50 treated with doxorubicin and/or radiotherapy (RT) to cardiac tissue for HL &gt;5 years ago were identified. Telephone review of CVS risk factors was offered to pts taking statins or already diagnosed with cerebrovascular or CVS disease. Remaining pts were offered clinical review to assess BMI, blood pressure, cholesterol and HbA1c. Carotid-radial pulse wave velocity (PWV) was measured if available. CVS risk was predicted using international risk calculators (European SCORE, QRISK3, Framingham). Results 160 eligible pts were identified. Median age was 43 years (26–50) and 52% were female. Median time since treatment was 182 months (61–367). Pts received doxorubicin (n=150), with RT (n=97) or RT alone (n=10). Pts were excluded from study due to severe medical condition (n=8), recurrence (n=1), relocation (n=3) or death (n=1). Data were gathered at clinical review (n=70) or telephone review (n=26). Existing cardiovascular diagnoses included hypertension (n=5), transient ischaemic attack (n=2), valvular disease (n=3), heart failure (n=1), atrial fibrillation (n=2), complete heart block (n=1) and coronary artery disease (n=1). At clinical review 51% pts had 3 or more modifiable risk factors with a median of 3 (0–5) per pt. Total cholesterol was &gt;5.0 mmol/L in 58% of patients with a median of 5.2 mmol/L (3.2–8.6). Median systolic blood pressure was 125.5 mmHg (103–164). Median body mass index was 26.3 kg/m-2 (18.6–56.1) with 60% of patients classed as overweight or obese.Advice was offered to all smokers (9%), pts that drank alcohol above UK recommended levels (20%) or exercised below the recommended amount (60%). Risk calculators classified 1.4% (QRISK3) and 10% (Framingham) of pts at high risk of CVS disease and 0% (European SCORE) at high risk of CVS mortality. Pulse wave velocity measured in 34 pts was elevated (&gt;8 m/s) in 76% of cases with a median 10.2 m/s (2.3–16.8). Conclusions Numerous modifiable CVS risk factors were identified in an HL survivor population known from epidemiological studies to be at high risk of CVS morbidity/mortality. None of the CVS risk calculators identified this high risk. Intriguing data indicate PWV may represent an accessible early indicator of CVS dysfunction. These data prompt comprehensive assessment and management of CVS risk factors in cancer survivors and review of the use of risk calculators in this population. Acknowledgement/Funding The Christie NHS Foundation Trust

Sex differences in lower-limb arterial stiffness following acute aerobic exercise

Summary Objectives This study was to investigate sex differences in central and peripheral arterial stiffness after exercise in young adults. Methods Sixty-one young adults (32 males, 29 females; age 18–35 years) performed an acute bout of aerobic exercise at 70% of heart rate reserve. The carotid-femoral, carotid-radial, and femoral-ankle pulse wave velocity, and carotid and femoral artery diameters, were measured before exercise and 30- and 60-min after exercise using applanation tonometry (Millar Instruments, Houston, TX, USA) and SphygmoCor (AtCor Medical, Sydney, Australia). Results The sex-by-time interactions were not significant for the carotid-femoral and carotid-radial pulse wave velocity, but were significant for the femoral-ankle pulse wave velocity (P = 0.03). There were also significant sex-by-time interactions for the relative diameter changes in the femoral artery (P = 0.043), but not in the carotid artery. The change in femoral-ankle pulse wave velocity from pre-exercise to 60-min post-exercise was significantly positively correlated with leg lean soft tissue mass in males (P = 0.01, R = 0.45), but not in females. Conclusion Our study shows that the effect of acute aerobic exercise on lower-limb arterial stiffness varies between the sexes, with greater reductions in arterial stiffness in young males than in females.

Elevated copeptin, arterial stiffness, and elevated albumin excretion in adolescents with type 1 diabetes

We sought to evaluate copeptin concentrations in adolescents with and without type 1 diabetes (T1D) and examine the associations between copeptin and measures of arterial stiffness and kidney dysfunction. This analysis included 169 adolescents with T1D (12-19 years of age, 59% girls, mean HbA1c 9.0 ± 1.5% and diabetes duration of 8.6 ± 2.9 years), in addition to 61 controls without T1D. Arterial stiffness including carotid-femoral pulse wave velocity (CF-PWV), carotid-radial PWV (CR-PWV), augmentation index normalized to heart rate of 75 bpm (AIx@HR75), and brachial artery distensibility (BAD). Serum copeptin, urinary albumin-to-creatinine ratio (UACR), and estimated glomerular filtration rate (eGFR) by serum creatinine and cystatin C were also assessed. Compared to controls, adolescents with T1D had higher median (Q1-Q3) copeptin (7.5 [5.2-11.3] vs 6.4 [4.8-8.3] pmol/L, P = .01), mean ± SD eGFR (121 ± 23 vs 112 ± 16 mL/min/1.73m2 , P = .002) and lower BAD (7.1 ± 1.3 vs 7.2 ± 1.2%, P = .02). Adolescents with T1D in the in high tertile copeptin group (>9.1 pmol/L) had higher AIx@HR75 (10.7 ± 1.2 vs 5 ± 1.2, P = .001), CR-PWV (5.30 ± 1.0 vs 5.18 ± 1.0 m/s, P = .04), and UACR (12 ± 1 vs 8 ± 1 mg/g, P = .025) compared to those in low tertile (<5.8 pmol/L) after adjusting for age, sex, and eGFR. Copeptin inversely associated with CF-PWV independent of age, sex, eGFR, SBP, and HbA1c in T1D adolescents. Our data demonstrate that elevated copeptin was associated with worse arterial stiffness in adolescents with T1D. These findings suggest that copeptin could improve CVD risk stratification in adolescents with T1D.

Increased aortic stiffness in adults with chronic indeterminate Chagas disease.

An ever-increasing number of patients with chronic indeterminate Chagas disease are diagnosed with early vascular and cardiac abnormalities, as cardiovascular imaging becomes more sensitive. However, the currently available information on aortic stiffness (a prognostic marker for adverse cardiovascular outcomes) in these patients is scarce. In this study, we consecutively recruited 21 asymptomatic Bolivian adult patients with chronic indeterminate Chagas disease and 14 Bolivian adults, who were seronegative for Trypanosoma cruzi infection. No participants had a prior history of heart disease, hypertension, diabetes, chronic kidney disease or atrial fibrillation. Carotid-femoral pulse wave velocity (cf-PWV), carotid-radial PWV (cr-PWV), carotid intima-media thickness and conventional echocardiographic measurements were recorded in all participants. Patients with chronic indeterminate Chagas disease had significantly higher cf-PWV (7.9±1.3 vs. 6.4±1.1 m/s, p = 0.003) and greater HOMA-estimated insulin resistance than subjects without Chagas disease. The two groups did not significantly differ in terms of age, sex, smoking, adiposity measures, blood pressure, plasma lipids, fasting glucose levels as well as cr-PWV, carotid intima-media thickness measurements, left ventricular mass and function. Presence of chronic indeterminate Chagas disease was significantly associated with increasing cf-PWV values (β coefficient: 1.31, 95% coefficient interval 0.44 to 2.18, p = 0.005), even after adjustment for age, sex, heart rate, systolic blood pressure and insulin resistance. In conclusion, asymptomatic Bolivian adult patients with chronic indeterminate Chagas disease have an early and marked increase in aortic stiffness, as measured by cf-PWV, when compared to Bolivian adults who were seronegative for Trypanosoma cruzi infection.

Digital microvascular reactivity does not decline with impaired renal function in chronic kidney disease

BackgroundThe reactive hyperemia index (RHI), measured by peripheral arterial tonometry (PAT), is a novel measurement of endothelial function and has been proven to be valuable in cardiovascular risk stratification in several populations. The current study aims to explore its relation to renal function and its association with traditional cardiovascular risk factors in patients with chronic kidney disease (CKD).MethodsSubjects with non-dialysis dependent CKD were recruited and 252 of them had a successful PAT test. In addition to general demographic and medical information, carotid-femoral pulse wave velocity (cfPWV), carotid-radial pulse wave velocity (crPWV) and augmentation index (AIx) were recorded.ResultsThe mean age of the study population was 57.7 (±14.7) years and 155 (61.5%) were males. The average RHI was 1.92 (±14.7) with no difference noted between males and females. There was no statistically significant correlation between RHI and eGFR (r = − 0.107, p = 0.089) or urine protein-to-creatinine ratio (r = 0.036, p = 0.570). With adjustment for age and sex, RHI was associated with systolic blood pressure (BP) (β = 0.006, p = 0.001), diastolic BP (β = 0.008, p = 0.010), heart rate (β = − 0.007, p = 0.015) crPWV (β = 0.037, p = 0.022) and AIx (β = 0.006, p = 0.001), but not with cfPWV or any other conventional risk factors analyzed. Systolic BP remained the only predictor for RHI in the stepwise regression analysis.ConclusionsRHI did not decline with reduced renal function in CKD patients and had a modest association with traditional cardiovascular risk factors. Further studies are warranted to determine if RHI could predict cardiovascular outcome in CKD patients.

AGE AND HYPERCHOLESTEROLEMIA EXPLAIN HIGH CAROTID-RADIAL PULSE WAVE VELOCITY IN FEMALES BUT TYPE 2 DIABETES MELLITUS IN MALES

Objective:To clarify the explanatory factors of carotid-radial (C-R) PWV in Finnish female and male drug-treated hypertensive patients.Design and method:A Doppler ultrasonography device (Micro Medical PulseTrace PWV, Micro Medical Ltd, Rochester, Kent, UK) was used to measure C-F and C-R PWV in 126

Regional Arterial Stiffness in Patients with Inflammatory Bowel Disease

Aim. To study muscular (brachial and radial arteries) and elastic (aorta) regional arterial stiffness in IBD patients in comparison with those without IBD, as well as to establish the relationship between arterial stiffness and the characteristics of the IBD course (the duration of illness, severity of attack, activity of systemic inflammation). Materials and methods. The study included 21 IBD patients and 30 patients in the comparison group. The values of regional aortic and muscular arterial stiffness were measured by applanation tonometry. The carotid–femoral pulse wave velocity (cfPWV) and the carotid-radial pulse wave velocity (crPWV) were determined. The laboratory research plan included the analysis of complete blood count, biochemical parameters, fibrinogen and a high sensitivity C-reactive protein (hsCRP).Results. crPWV, similar to cfPWV, was not significantly different between the groups. At the same time, the proportion of individuals with an increase in the cfPWV of more than 10 m/s was higher in the group of IBD patients. However, these differences did not reach the level of statistical significance. According to the results of the correlation analysis, the increase in cfPWV was associated with an increase in patient age (r = 0.564; p = 0.01), the duration of IBD history (r = 0.628; p = 0.003), fasting plasma glucose (r = 0.367; p = 0.034) and GFR decrease (r = -0.482; p = 0.031). The crPWV also directly correlated with the IBD duration (r = 0.630; p = 0.003). According to the results of the regression analysis, an increase in the IBD duration by 1 year is associated with an increase in cfPWV by 0.205 m/s, i.e. the increase in the IBD duration by 5 years is associated with an increase in the cfPWV of approximately 1 m/s.Conclusion. In IBD patients, the duration of the disease directly correlated with an increase in cfPWV and crPWV. The increase in the IBD duration by 1 year was associated with an increase in cfPWV by 0.205 m/s. The muscular and elastic regional arterial stiffness was not statistically significantly different between IBD patients and the comparison group.

Acute effects of aerobic exercise duration on blood pressure, pulse wave velocity and cerebral blood flow velocity in middle-aged adults

It is important to understand acute dose-response relationships on cardiovascular health and brain health. Thus, we evaluated the acute effects of 10- and 30-min exercise bout on blood pressure (BP), pulse wave velocity (PWV) and cerebral blood flow velocity (CBFv). Fifteen adults (mean age 45.4 ± 8.9 years, 87% female) participated in this randomized crossover study comprised of three acute experimental sessions: a 10-min exercise bout (EX10), a 30-min exercise bout (EX30) and a sitting control (SIT). Exercise consisted of walking on a treadmill at 70–75% of age-predicted maximum heart rate. BP, PWV and CBFv were measured 30 and 60 min after each experimental session. BP was obtained at the brachial artery while PWV was measured at the carotid-femoral and carotid-radial sites. CBFv was measured at the middle cerebral artery using a 2 MHz transcranial Doppler. Compared to SIT, BP was lower following EX10, and even lower following EX30 (P 0.05), EX10 resulted in a higher carotid-femoral PWV vs. EX30 and SIT at 30 min (both P = 0.02) and a lower carotid-radial PWV vs. SIT at 60 min (P = 0.004). CBFv did not differ across conditions (all P > 0.05). Our results suggest that 10- and 30-min aerobic exercise bouts have differential effects on BP and PWV. CBFv did not change in the hour following either bout. Further research is needed to elucidate the mechanisms and effects of 10- vs 30-min bouts of exercise.

Abstract P380: Validity and Reliability of Pulse Wave Velocity Measurement in a Seated Posture

Introduction: Accumulating evidence suggests that prolonged sitting may have adverse effects on vascular health. Pulse wave velocity (PWV) is a simple measurement of vascular stiffness that would be advantageous to measure in a seated posture. However, the reliability and validity of PWV measured in a seated posture are unknown. Objective: To assess day-to-day reliability and validity of seated peripheral PWV. Methods: This randomized cross-over study (N=20, 50% male, mean (SD) age = 25.9 (7.7)) consisted of two experimental visits, conducted a maximum of 14 days apart. Outcome measures were carotid-radial PWV (crPWV), carotid-ankle PWV (caPWV), and carotid-femoral PWV (cfPWV; supine position only) by tonometry using the Complior Analyse System. Measurements were completed in both a supine and seated posture (counterbalanced), preceded by a 10-minute rest, and following a 12-hr abstention from food, caffeine, nicotine, alcohol, and exercise. Intra-class correlations (ICCs) assessed day-to-day reliability with ≥0.75 as the criterion for good reliability. Validity was determined by comparing (Pearson’s correlation) peripheral PWV measures in the seated compared to supine posture as well as to central PWV measures (supine cfPWV). Results: ICCs for crPWV were 0.64 (supine) and 0.77 (seated) and for caPWV were 0.36 (supine) and 0.76 (seated). Supine vs. seated peripheral PWV measures were highly correlated for crPWV but not correlated for caPWV ( Figure ). Comparison of supine cfPWV to seated peripheral PWV were r=0.483 ( p =0.031) for crPWV and r=0.386 ( p =0.103) for caPWV. Conclusion: While measures of seated crPWV and caPWV were both reliable and small-to-moderately correlated with related vascular measures, only seated crPWV was valid compared to the standard supine measure. Future studies evaluating the impact of prolonged sitting and breaking up prolonged sitting could consider measuring crPWV in a seated posture.

Impact of the Aortic Graft on Arterial Stiffness and Inflammatory Biomarkers after Endovascular Aortic Repair or Open Surgical Repair in Abdominal Aortic Aneurysm Disease

Abdominal aortic aneurysm (AAA) is an important cardiovascular (CV)-related disease that requires surgical treatment to prevent rupture. The elevation of arterial stiffness (AS) is an increasingly recognized independent determinant of CV morbidity and mortality and plays a special role in atherosclerosis. The importance of the surgical technique used for AAA repair in the long-term outcomes still needs to be clarified, and whether endovascular aortic repair (EVAR) or open surgical repair (OSR) confers high AS measurements and thus worse prognosis in terms of CV morbidity needs further investigation. A prospective nonrandomized study that included consecutive patients requiring either EVAR or OSR for AAA disease between February 2015 and January 2016 was conducted. This study is registered on the National Institutes of Health website (ClinicalTrials.gov) and identified with NCT02642952. Several noninvasive measurements of AS and central aortic hemodynamics were obtained before surgery and in the first postoperative control (4-6weeks), with change from baseline in heart rate-adjusted augmentation index (AIx@75) as main outcome. Likewise, inflammatory circulating biomarkers were also measured in the same time line. We included 44 patients, 25 in the EVAR group and 19 in the OSR group. Subjects who underwent EVAR were older and presented larger aneurysm diameter at baseline. There was a significant decrease in AIx@75 in the EVAR group after treatment (-4.1±8.1%, P=0.018), for a moderate effect size (d=0.508), whereas the decreasing trend in the OSR group (-2.5±6.7%, P=0.127) was not statistically significant. No significant changes in carotid-radial pulse wave velocity (PWVCR) and central blood pressures were observed. The inflammatory markers increased after surgical repair, with significant changes in homocysteine in both EVAR (5.2±6.9μmol/L, P=0.002) and OSR (1.8±2.1μmol/L, P=0.002) groups. Our study suggests that both treatments confer better postoperative values of AS measured by AIx@75 and produces no changes in PWVCR, in the early term. Whether this situation is maintained during follow-up needs further investigation.

Loss of the Normal Gradient in Arterial Compliance and Outcomes of Chronic Kidney Disease Patients

Background: In dialysis patients, loss of the normal gradient in arterial compliance, assessed by the pulse wave velocity (PWV) ratio, predicts all-cause mortality better than does carotid-femoral PWV (CF-PWV) alone. However, the prognostic significance of the PWV ratio for outcome in chronic kidney disease (CKD) patients remains unclear. Methods: In this longitudinal cohort study, CKD patients who visited our CKD management clinic between April 27, 2006, and March 27, 2008, were included and followed up. To assess the gradient in arterial compliance, the PWV ratio was calculated using CF-PWV divided by carotid-radial PWV. Results: A total of 209 patients in CKD stages 1–4 with a median follow-up of 3.74 years were included. Patients with higher PWV ratio were relatively older (p < 0.001) and had worse renal function (p < 0.001), more hypertension (p < 0.001), diabetes mellitus (p < 0.001), and cardiovascular or cerebrovascular disease (p < 0.001). The median time to patient outcome (death, renal replacement therapy, or double increase in serum creatinine from baseline) in the group with a PWV ratio above the median (89.8 months, 95% CI 84.2–95.5) was shorter than that in the group with a PWV ratio below the median (105.3 months, 95% CI 101.3–109.3, p = 0.001). Univariate Cox regression analysis showed that both PWV ratio and CF-PWV were significantly associated with patient outcome. In multivariate Cox regression analysis, both PWV ratio and CF-PWV were associated with patient outcome. However, the HR for CF-PWV (2.177, 95% CI 1.064–4.453, p = 0.033) was slightly higher than that for PWV ratio (2.091, 95% CI 1.049–4.167, p = 0.036). There was a significant interaction effect between PWV ratio and CKD stage. It was shown that patients with advanced CKD stages and higher PWV ratios had a significantly higher risk of adverse CKD outcome (p = 0.006). Conclusions: The PWV ratio, as a measure of loss of the normal gradient in arterial compliance, was associated with CKD patient outcome. Patients with advanced CKD and a higher PWV ratio had a significantly higher risk of adverse CKD outcome.

Aortic-Brachial Stiffness Mismatch and Mortality in Peritoneal Dialysis Patients

Background/Aims: Possible predictive value of aortic-brachial arterial stiffness mismatch assessed by pulse wave velocity PWV ratio in peritoneal dialysis patients’ outcomes need to be further elucidated. The aim of this study is to investigate the predictor value of PWV ratio on peritoneal dialysis (PD) patients’ outcomes in China. Methods: In this longitudinal cohort study, patients who started PD during September 20, 2005, to February 05, 2008, were included. All the patients were followed until January 31, 2018. Aortic-brachial arterial stiffness mismatch was assessed using carotid-femoral pulse wave velocity divided by carotid-radial pulse wave velocity (PWV ratio). Results: A total of 181 incident PD patients were included. The median survival of patients in PWV ratio above median group (4.03 years, 95% CI 4.64-7.99 years) was shorter than that of PWV ratio below median group (10.43 years, 95% CI 9.74-11.12 years, p< 0.001). The cardiovascular mortality rate in PWV ratio above median group were significantly higher than that of PWV below median group (log rank test, p< 0.001). Univariate Cox regression analysis showed that both PWV ratio (HR 2.42, 95% CI 1.80-3.25, p< 0.001) and CF-PWV (HR 1.27, 95% CI 1.16-1.38, p< 0.001) were associated with high patients’ all-cause mortality. Multivariable Cox regression analysis showed that the PWV ratio was a strong and significantly predictor of cardiovascular mortality (HR 2.08 95% CI 1.16-3.71, p=0.014) after adjusting for coronary heart disease history (HR 2.39, 95% CI 1.20-4.76, p=0.013), diabetes mellitus history (HR 2.84, 95% CI 1.51-5.33, p=0.001). However, the CF-PWV was failed to be included as a significant predictor for both all-cause and CVD mortality in the multivariable Cox regression model. Conclusion: Aortic-brachial arterial stiffness mismatch as assessed by PWV ratio, a new arteries stiffness risk parameter, is a significant prognostic indicator of CVD mortality in PD patients. We demonstrated that the discriminative power of the PWV ratio for both all-cause and CVD mortality was better than that CF-PWV.

Impact of Circulating Triglycerides Concentration on Atherosclerotic Disease Status in Middle-Aged Saudi Arabian Dwellers.

A number of food micronutrients are reported to influence markers of cardio-metabolic health. There is an expectation that there may be an optimal endocrine profile, with triglycerides as a key factor, which may help minimise atherosclerotic disease and associated risk factors. This study involved 84 participants aged (mean ± SD) 48.2 ± 8.3 years from both sexes segregated into n = 30 controls, n = 25 at-risk, and n = 29 diagnosed with atherosclerosis, including 20 participants using statins. Atherosclerosis status and risk factors were assessed using a combination of clinical records, C-reactive protein (CRP), blood glucose (FBG), lipids profiles, vascular structural and functional characteristics (including carotid-radial pulse wave velocity (CR-PWV), central systolic blood pressure (C-SBP), peripheral systolic blood pressure (P-SBP), peripheral diastolic blood pressure (P-DBP), carotid intima-media thickness (IMT), and carotid artery inter-adventitial diameter (IAD)). There was a significant difference in triglycerides (TG) levels between the clinical groups (p < 0.05) and between the users and non-users of statin (p < 0.001). Significant associations were distinguished between TG and CRP, FBG, high-density lipoprotein (HDL), C-SBP, P-SBP, P-DBP, CR-PWV, heart rate (HR), and body weight in the pooled sample (p < 0.05). In non-users of statin, TG was associated with C-SBP, P-SBP, P-DBP, and HR. In sub-clinical groups, TG was also associated with most of the blood markers. After controlling for statin use, composite z-score analysis revealed 48%, 2%, and 0% differences in in vivo vascular phenotype between high and low TG subgroups in controls, at-risk, and diagnosed atherosclerosis groups, respectively. Thus, TG levels seem to be good indicators for incidence and risk factors of atherosclerosis.

Childhood Fat and Lean Mass: Differing Relations to Vascular Structure and Function at Age 8 to 9 Years

Objective- Childhood body mass index (BMI) has been related to vascular structure and function. However, little is known about the differing contributions of fat and lean mass to this relationship. Our objectives were to relate the fat and lean mass (bone excluded) components of BMI (fat mass index and lean mass index; mass [kg]/height [m]2) to vascular measures in prepubertal children. Approach and Results- In the UK Southampton Women's Survey mother-offspring cohort, 983 children had dual x-ray absorptiometry and vascular measurements at 8 to 9 years. Using linear regression analyses, we found that most vascular measures were related to BMI, but fat and lean mass contributed differently. Systolic blood pressure was positively associated with both fat mass index (β=0.91 [95% CI, 0.52-1.30] mm Hg) and lean mass index (β=2.16 [95% CI, 1.47-2.85] mm Hg), whereas pulse rate was positively associated with fat mass index (β=0.93 [95% CI, 0.48-1.38] b/min) but negatively associated with lean mass index (β=-1.79 [95% CI, -2.59 to -0.99] b/min). The positive relation between BMI and carotid intima-media thickness was mainly due to a positive association with lean mass index (β=0.013 [95% CI, 0.008-0.019] mm). Carotid-femoral pulse wave velocity, but not carotid-radial pulse wave velocity, was positively associated with fat mass index (β=0.06 [95% CI, 0.03-0.09] m/s). For systolic blood pressure, carotid-femoral pulse wave velocity and reactive hyperemia significant interactions indicated that the association with fat mass depended on the amount of lean mass. Conclusions- In prepubertal children, differences in vascular structure and function in relation to BMI probably represent combinations of adverse effects of fat mass, adaptive effects of body size, and relatively protective effects of lean mass.