Carotid-radial Pulse Wave Velocity Research Articles

The relationship between calcium kidney stones, arterial stiffness and bone density: unraveling the stone-bone-vessel liaison.

Kidney stone disease is associated with a higher incidence of cardio-vascular (CV) events for still unclear reasons. Reduced bone density is also a frequent finding in calcium kidney stones. The association of reduced bone density with increased vascular stiffness and calcification has been discovered in a number of conditions. We investigated the hypothesis that patients with calcium kidney stones have increased arterial stiffness, which would be associated with reduced bone density and higher CV risk. We compared measures of arterial stiffness [carotid-radial pulse-wave velocity (CR-PWV), carotid-femoral pulse-wave velocity (CF-PWV) and augmentation index (AI)] and of bone density (T-scores determined at lumbar spine, neck and hip) among 42 idiopathic calcium stone formers compared with 42 age- and sex-matched healthy volunteers. Stone formers had higher values of CR-PWV, CF-PWV and AI, and lower values of all T-scores. Furthermore, the prevalence of abnormal arterial stiffness and reduced bone density was significantly higher among stone formers. Statistical adjustment for age, sex, body mass index and other covariates did not change the results. Our study confirms that stone formers have increased arterial stiffness and reduced bone density. Abnormal arterial stiffness appears to be independent of reduced bone density and may explain the higher CV risk observed in stone formers.

Increased systemic blood pressure and arterial stiffness in young adults born prematurely.

Recent studies have shown that a low birth weight is a risk factor for increased systemic blood pressure (BP) in adulthood. Further, systemic BP and arterial stiffness (AS) are reported to be increased in adolescents born prematurely. The purpose of this study was to characterize systemic BP and AS in young adults born preterm. Systemic BP was measured using an automated oscillometric device. AS was assessed by measuring the right carotid-radial pulse wave velocity (PWV) using a validated non-invasive automated method. Systemic BP, pulse pressure, and PWV [mean (confidence intervals)] were compared between 16 adults (age 21 years) born preterm (age at birth 32 weeks of gestation) with a birth weight (1710 g) appropriate for their gestational age and 15 adults (21 years) born at term (40 weeks of gestation) with a birth weight (3430 g) appropriate for their gestational age. Adults born preterm had a significantly higher systolic BP [122 mmHg (114-144) v. 112 (106-127)], mean BP [89 mmHg (86-98) v. 84 (81-91)], diastolic BP [69 mmHg (66-76) v. 65 (62-78)], pulse pressure [54 mmHg (47-72) v. 47 (42-60)], and PWV [7 m/s (6.3-8.6) v. 6.4 (5.8-8)] than did those born at term. Our findings suggest that young adults with a low birth weight due to preterm birth have increased systemic BP and AS. Accordingly, preterm birth may predispose individuals to cardiovascular diseases in adulthood due to increased AS.

Carotid-radial pulse wave velocity responses following hyperemia in patients with congestive heart failure

Carotid-radial pulse wave velocity (PWV) normally decreases following hyperemia and is an indicator of vasodilator reserve. This response is impaired in patients with congestive heart failure (CHF). To identify specific factors related to an impaired response, we studied 50 patients (60 ± 14 years, 67% male) with chronic CHF. Baseline PWV was measured using applanation tonometry and repeated 1 minute after release of upper arm occlusion for 5 minutes. Percentage changes (Δ) of PWV were normally distributed and mean ΔPWV was −2.2 ± 15.3%. On univariate analyses, ΔPWV correlated with New York Heart Association class, mean arterial pressure, log brain natriuretic peptide (BNP) levels, and baseline PWV, but not with left ventricular ejection fraction. Multivariate linear regression analysis demonstrated log BNP levels, mean arterial pressure, and baseline PWV (all P < .05) as independent predictors of ΔPWV. Hyperemia increased PWV in 42% of patients. On logistic regression, higher BNP levels and lower baseline PWV were independent predictors of a PWV increase. Higher BNP levels and lower baseline PWV are independent predictors of an abnormal hyperemic PWV response in patients with CHF. Higher BNP levels may reflect abnormal vasodilator reserve. Forty-two percent of heart failure patients showed an increase in PWV following hyperemia, which may reflect more severe arterial vasodilator impairment.

Neck circumference and early stage atherosclerosis: the cardiometabolic risk in Chinese (CRC) study.

BackgroundNeck circumference (NC) has been previously related to cardiometabolic risk factors. In this study we examined the association between NC and early stage atherosclerosis in Chinese adults.MethodsThe study samples were from a community-based health examination survey in central China. In total 2,318 men and women (18-64 y) were included in the final analyses. Carotid radial pulse wave velocity (crPWV), carotid femoral PWV (cfPWV), carotid artery dorsalis pedis PWV (cdPWV) and NC were measured.ResultsAfter adjustment for age, sex, lipids, glucose, blood pressure, heart rate, body mass index (BMI), high NC was significantly associated with an increasing trend of cfPWV, cdPWV and crPWV (P = 0.001, 0.049, and 0.038; respectively). In addition, we found significant interaction between hypertension status and NC level in relation to cfPWV, adjusted for age, sex, BMI, fasting glucose, lipids and heart rate(P for interaction = 0.034). The associations between NC and cfPWV were significant (P = 0.02) among those with hypertension, but not significant among those without hypertension.ConclusionsOur data showed that high NC was associated with an increased risk of early stage atherosclerosis in Chinese adults, independent of other metabolic risk factors. Hypertension might modify the association between NC and cfPWV.

Relationship between arterial stiffening and skeletal muscle atrophy in hemodialysis patients: a gender comparative study.

Dear Editor, Composition of regional muscle and fat masses are related to arteriosclerotic changes in the general population [1]. This study was aimed to clarify the association of muscle mass in the lower limbs and abdominal fat mass with arteriosclerotic parameters in patients on chronic hemodialysis (HD). We measured abdominal subcutaneous fat mass area (ASFA), abdominal visceral fat mass area (AVFA), and thigh muscle area (TMA) from computed tomography (CT) images and adjusted those by body mass index (BMI) in 124 HD patients (age 61 ± 11 [37–79] years, time on HD 11 ± 10 [0–36] years, male/female = 84/40). Brachial-ankle pulse wave velocity (baPWV) and ankle brachial pressure index (ABI) were also measured together and automatically in CAVI-VaSera VS-1000 (Fukuda Denshi Co, Ltd, Tokyo, Japan) just before HD session. A significant association was found between baPWV and TMA/BMI ratio in male (r = −0.32, p < 0.01). Male patients in the top tertile of baPWV had a significantly lower TMA/BMI ratio when compared with those in the middle tertile and those in the bottom tertile (Table 1). Table 1 Baseline characteristics according to the baPWV tertile TMA/BMI ratio was also correlated with ABI (r = 0.46, p < 0.01) in female patients. There was a significantly lower TMA/BMI ratio in patients with the lowest ABI compared to those with the second and with the highest tertile (Table 2). There was rather an inverse association between AVFA/BMI ratio with baPWV in women (r = −0.38, p < 0.05). Table 2 Baseline characteristics according to the ABI tertile A multiple linear regression analysis adjusted by conventional, nutritional, and anthropometric parameters revealed that TMA/BMI was independently associated with baPWV in male, while with ABI in female (Table 3). In contrast, there was no relationship between AVFA/BMI and ASFA/BMI ratios and arteriosclerotic parameters in men. Table 3 Independent determinants of baPWV and ABI in male and female patients It has been demonstrated that skeletal muscle atrophy is associated with accelerated arteriosclerosis. TMA is inversely associated with baPWV in general subjects [2, 3]. A higher PWV is related to a more profound decline in sarcopenic index in older men [4]. Skeletal muscle mass to visceral fat area ratio is also inversely associated with baPWV [5]. In this study, we showed that TMA/BMI ratio was independently associated with baPWV in male, while with ABI in female HD patients, suggesting a possible association of muscle wasting with arteriosclerotic changes in HD patients. Visceral adiposity is linked to arteriosclerosis. AVFA is positively correlated with baPWV and carotid-femoral PWV in general subjects [2, 6]. Visceral fat level was a predictor of carotid-femoral PWV in peritoneal dialysis patients [7]. A positive relationship between AVFA and baPWV was also observed in diabetic HD patients [8]. In this study, however, AVFA/BMI was rather negatively associated with baPWV in female HD patients. The reasons for this discrepancy are not known, but may be due to a well-preserved nutritional status in female patients with abdominal adiposity. An increased body fat mass volume is paradoxically associated with better outcomes in HD patients [9]. The protective role of accumulated trunk fat on subclinical vascular damage, assessed by carotid-radial PWV, was also observed in the elderly women [10]. In summary, we found that reduced TMA/BMI ratio was independently associated with increased baPWV in male, while with decreased ABI in female patients. The findings support a possible relationship between arteriosclerosis and thigh muscle atrophy even in the dialysis population.

Effect of baseline mean flow velocity, carotid-radial pulse wave velocity and laser doppler flowmetry on the hyperemic response

Effect of baseline mean flow velocity, carotid-radial pulse wave velocity and laser doppler flowmetry on the hyperemic response

Determinants of the blunted carotid-radial pulse wave velocity decline to hyperemia in patients with congested heart failure

Determinants of the blunted carotid-radial pulse wave velocity decline to hyperemia in patients with congested heart failure

Increased arterial stiffness in inflammatory bowel diseases is dependent upon inflammation and reduced by immunomodulatory drugs

BackgroundInflammatory bowel diseases (IBD) are associated with an increased cardiovascular risk that is not fully explained by traditional cardiovascular risk factors but may be due to inflammation and mediated by an increased arterial stiffness. Aims: Study 1, to investigate the relationship between inflammation and arterial stiffening; Study 2, to look whether aortic stiffening is reduced by immunomodulatory therapy in IBD. MethodsStudy 1 (Cross-sectional study): pulse wave velocity (PWV) was measured in 74 IBD subjects (40 ulcerative colitis and 34 Crohn's disease) and 80 matched controls. Study 2 (Longitudinal study): the effect of therapy on PWV was measured at baseline and 3.4 ± 0.5 years later in 14 IBD subjects treated only with salicylates, 11 subjects treated with steroids and azathioprine, 7 subjects treated with anti TNF-alpha and 30 matched controls. ResultsStudy 1: All parameters were comparable between subjects with ulcerative colitis and Crohn's disease. Compared to controls, subjects with ulcerative colitis and those with Crohn's disease have both higher carotid-femoral PWV (7.0 ± 1.1, 7.8 ± 1.7 and 8.0 ± 1.6 m/s, respectively; P < 0.001) and carotid-radial PWV (7.2 ± 0.9, 8.8 ± 1.4 and 8.8 ± 1.3 m/s, respectively; P < 0.001). In fully adjusted models carotid-femoral PWV was positively associated with disease duration whereas carotid-radial PWV was associated with C-reactive protein and history of relapse. Study 2: in fully adjusted model carotid-femoral PWV increased significantly at follow-up in IBD subjects treated with salicylates but not in those treated with steroids and azathioprine or anti TNF-alpha. ConclusionIncreased arterial stiffness in IBD is dependent upon inflammation and reduced by immunomodulatory drugs.

Association between serum homocysteine and arterial stiffness in elderly: a community-based study.

BackgroundArterial stiffness and homocysteine are both powerful predictors of cardiovascular disease, especially in older populations. Previous studies have investigated the association of homocysteine with arterial stiffness in human subjects, while the relationship between homocysteine and arterial stiffness in the elderly is still indefinite. The current study examined the association of homocysteine with arterial stiffness in Chinese community-based elderly persons.MethodsWe related serum levels of homocysteine to two measures of arterial stiffness (carotid-femoral pulse wave velocity (PWV) and carotid-radial PWV) in 780 participants (46.3% men, mean age 71.9 years (ranging 65–96 years old)) from two communities of Beijing, China. Arterial stiffness was measured within two days of the time of biomarker measurement.ResultsIn multiple-adjusted models, homocysteine levels were strongly associated with the carotid-femoral PWV (standardized β = 0.13, P < 0.001), even after adjustment for classical risk factors of cardiovascular disease. The association is also stronger when the carotid-femoral PWV is elevated above normal, whereas no significant association with homocysteine was observed for carotid-radial PWV.ConclusionsIn Chinese elderly persons, serum homocysteine levels are associated with alterations of aortic stiffness.

Vascular Dysfunction and Chronic Obstructive Pulmonary Disease

Chronic obstructive pulmonary disease (COPD) is characterized by low pulmonary function, inflammation, free radical production, vascular dysfunction, and subsequently a greater incidence of cardiovascular disease. By administering an acute oral antioxidant cocktail to patients with COPD (n=30) and controls (n=30), we sought to determine the role of redox balance in the vascular dysfunction of these patients. Using a double-blind, randomized, placebo-controlled, crossover design, patients with COPD and controls were ingested placebo or the antioxidant cocktail (vitamin C, vitamin E, α-lipoic acid) after which brachial artery flow-mediated dilation and carotid-radial pulse wave velocity were assessed using ultrasound Doppler. The patients exhibited lower baseline antioxidant levels (vitamin C and superoxide dismutase activity) and higher levels of oxidative stress (thiobarbituic acid reactive species) in comparison with controls. The patients also displayed lower basal flow-mediated dilation ( P &lt;0.05), which was significantly improved with antioxidant cocktail (3.1±0.5 versus 4.7±0.6%; P &lt;0.05; placebo versus antioxidant cocktail), but not controls (6.7±0.6 versus 6.9±0.7%; P &gt;0.05; placebo versus antioxidant cocktail). The antioxidant cocktail also improved pulse wave velocity in patients with COPD (14±1 versus 11±1 m·s −1 ; P &lt;0.05; placebo versus antioxidant cocktail) while not affecting controls (11±2 versus 10±1 m·s −1 ; P &gt;0.05; placebo versus antioxidant). Patients with COPD exhibit vascular dysfunction, likely mediated by an altered redox balance, which can be acutely mitigated by an oral antioxidant. Therefore, free radically mediated vascular dysfunction may be an important mechanism contributing to this population’s greater risk and incidence of cardiovascular disease.

Serum uric acid is associated with arterial stiffness in men with newly diagnosed type 2 diabetes mellitus

Increased serum uric acid levels and vascular atherosclerosis are very common in diabetes. However, few studies focused on the relationship between serum uric acid and aortic or peripheral arterial stiffness in newly diagnosed diabetic patients. This study investigated the association between serum uric acid levels and carotid-femoral pulse wave velocity (cfPWV) or carotid-radial (cr) PWV in male patients with newly diagnosed type 2 diabetes mellitus (T2DM). 106 male patients with newly diagnosed T2DM were recruited. cfPWV and crPWV as well as anthropometric parameters, blood pressure, serum uric acid, blood glucose, fasting insulin, C-reactive protein and blood lipids were measured. The subjects were divided into low uric acid (UA) subgroup and high UA subgroup according to uric acid median. cfPWV and crPWV were significantly higher in high UA subgroup. Serum uric acid significantly correlated with cfPWV (r = 0.533, P < 0.001), crPWV (r = 0.334, P = 0.001), waist circumference (r = 0.350, P < 0.001), waist-to-hip ratio (r = 0.254, P = 0.009), fasting insulin (r = 0.432, P < 0.001), HOMA-IR (r = 0.173, P = 0.042), fasting blood glucose (r = -0.271, P = 0.005), haemoglobin A1c (r = -0.202, P = 0.038), and HDL-cholesterol (r = -0.267, P = 0.006) after correction for age. Stepwise multiple regressions showed that the independent determinants of cfPWV were serum uric acid, age, C-reactive protein, HDL-cholesterol, and smoking status. And the independent determinants of crPWV were serum uric acid, age, diastolic blood pressure, and HDL-cholesterol. Serum uric acid is significantly associated with increased aortic and peripheral arterial stiffness in men with T2DM at the early stage.

The effect of empagliflozin on arterial stiffness and heart rate variability in subjects with uncomplicated type 1 diabetes mellitus

BackgroundIndividuals with type 1 diabetes mellitus are at high risk for the development of hypertension, contributing to cardiovascular complications. Hyperglycaemia-mediated neurohormonal activation increases arterial stiffness, and is an important contributing factor for hypertension. Since the sodium glucose cotransport-2 (SGLT2) inhibitor empagliflozin lowers blood pressure and HbA1c in type 1 diabetes mellitus, we hypothesized that this agent would also reduce arterial stiffness and markers of sympathetic nervous system activity.MethodsBlood pressure, arterial stiffness, heart rate variability (HRV) and circulating adrenergic mediators were measured during clamped euglycaemia (blood glucose 4–6 mmol/L) and hyperglycaemia (blood glucose 9–11 mmol/L) in 40 normotensive type 1 diabetes mellitus patients. Studies were repeated after 8 weeks of empagliflozin (25 mg once daily).ResultsIn response to empagliflozin during clamped euglycaemia, systolic blood pressure (111 ± 9 to 109 ± 9 mmHg, p = 0.02) and augmentation indices at the radial (-52% ± 16 to -57% ± 17, p = 0.0001), carotid (+1.3 ± 1 7.0 to -5.7 ± 17.0%, p < 0.0001) and aortic positions (+0.1 ± 13.4 to -6.2 ± 14.3%, p < 0.0001) declined. Similar effects on arterial stiffness were observed during clamped hyperglycaemia without changing blood pressure under this condition. Carotid-radial pulse wave velocity decreased significantly under both glycemic conditions (p ≤ 0.0001), while declines in carotid-femoral pulse wave velocity were only significant during clamped hyperglycaemia (5.7 ± 1.1 to 5.2 ± 0.9 m/s, p = 0.0017). HRV, plasma noradrenalin and adrenaline remained unchanged under both clamped euglycemic and hyperglycemic conditions.ConclusionsEmpagliflozin is associated with a decline in arterial stiffness in young type 1 diabetes mellitus subjects. The underlying mechanisms may relate to pleiotropic actions of SGLT2 inhibition, including glucose lowering, antihypertensive and weight reduction effects.Trial registrationClinical trial registration: NCT01392560

Epithelial Sodium Channel Inhibition by Amiloride on Blood Pressure and Cardiovascular Disease Risk in Young Prehypertensives

Overactivity of the epithelial sodium channel (ENaC) is considered to be one mechanism underlying obesity-related blood pressure (BP) elevation. In an open-labeled, nonplacebo-controlled clinical trial (Clinicaltrials.gov: NCT-01308983), the authors aimed to comprehensively evaluate the effects of amiloride monotherapy, an ENaC blocker, on BP and cardiovascular risk in young adults with prehypertension (n=17). The mean body mass index of participants was 28.45±1.30 kg/m(2) . Following 10 mg daily amiloride for 4 weeks, peripheral systolic BP (SBP), central SBP, and carotid-radial pulse wave velocity were significantly reduced by -7.06±2.25 mm Hg, -7.68±2.56 mm Hg, and -0.72±0.33 m/s, respectively, whereas flow-mediated dilation was significantly increased by 2.2±0.9%. Following amiloride monotherapy for 4 weeks, a significant increase in serum aldosterone was observed (5.85±2.45 ng/dL). ENaC inhibition by amiloride may be used as an early intervention to halt the progression to full hypertension and cardiovascular disease in young adults with prehypertension.

Determinants of Progression of Aortic Stiffness in Hemodialysis Patients

Aortic stiffness is associated with increased cardiovascular mortality in patients with chronic kidney disease. However, the rate of progression of arterial stiffness and the role of cardiovascular risk factors in the progression of arterial stiffness has never been established in a longitudinal study. In a prospective, longitudinal, observational study, carotid-femoral pulse wave velocity and carotid-radial pulse wave velocity were assessed in 109 hemodialysis patients at baseline and after a mean follow-up of 1.2 years. We examined the impact of age, atherosclerotic cardiovascular disease, diabetes mellitus, dialysis vintage, and pentosidine (a well-characterized, advanced glycation end products) on the rate of progression of aortic stiffness. The annual rate of changes in carotid-femoral pulse wave velocity and carotid-radial pulse wave velocity were 0.84 m/s per year (95% confidence interval, 0.50–1.12 m/s per year) and −0.66 m/s per year (95% confidence interval, −0.85 to −0.47 m/s per year), respectively. Older subjects, and patients with diabetes mellitus or atherosclerotic cardiovascular disease had higher aortic stiffness at baseline, however, the rate of progression of aortic stiffness was only determined by plasma pentosidine levels ( P =0.001). The degree of baseline aortic stiffness was a significant determinant of the regression of brachial stiffness ( P &lt;0.001) suggesting that the regression of brachial stiffness occurs in response to central aortic stiffness. These findings suggest that traditional cardiovascular risk factors may play some role in the progression of aortic stiffness before development of advanced chronic kidney disease, and that the enhanced rate of progression of aortic stiffness in chronic kidney disease patients on dialysis are probably determined by more specific chronic kidney disease–related risk factors such as advanced-glycation end products.

Exercise Training Reduces Peripheral Arterial Stiffness and Myocardial Oxygen Demand in Young Prehypertensive Subjects

Large artery stiffness is a major risk factor for the development of hypertension and cardiovascular disease. Persistent prehypertension accelerates the progression of arterial stiffness. Forty-three unmedicated prehypertensive (systolic blood pressure (SBP) = 120-139 mm Hg or diastolic blood pressure (DBP) = 80-89 mm Hg) men and women and 15 normotensive time-matched control subjects (NMTCs; n = 15) aged 18-35 years of age met screening requirements and participated in the study. Prehypertensive subjects were randomly assigned to a resistance exercise training (PHRT; n = 15), endurance exercise training (PHET; n = 13) or time-control group (PHTC; n = 15). Treatment groups performed exercise training 3 days per week for 8 weeks. Pulse wave analysis, pulse wave velocity (PWV), and central and peripheral blood pressures were evaluated before and after exercise intervention or time-matched control. PHRT and PHET reduced resting SBP by 9.6±3.6mm Hg and 11.9±3.4mm Hg, respectively, and DBP by 8.0±5.1mm Hg and 7.2±3.4mm Hg, respectively (P < 0.05). PHRT and PHET decreased augmentation index (AIx) by 7.5% ± 2.8% and 8.1% ± 3.2% (P < 0.05), AIx@75 by 8.0% ± 3.2% and 9.2% ± 3.8% (P < 0.05), and left ventricular wasted pressure energy, an index of extra left ventricular myocardial oxygen requirement due to early systolic wave reflection, by 573±161 dynes s/cm(2) and 612±167 dynes s/cm(2) (P < 0.05), respectively. PHRT and PHET reduced carotid-radial PWV by 1.02±0.32 m/sec and 0.92±0.36 m/sec (P < 0.05) and femoral-distal PWV by 1.04±0.31 m/sec and 1.34±0.33 m/sec (P < 0.05), respectively. No significant changes were observed in the time-control groups. This study suggests that both resistance and endurance exercise alone effectively reduce peripheral arterial stiffness, central blood pressures, augmentation index, and myocardial oxygen demand in young prehypertensive subjects.

Effect of a short-term intermittent exercise-training programme on the pulse wave velocity and arterial pressure: a prospective study among 71 healthy older subjects

Stiffening of large arteries has been associated with increased cardiovascular outcomes among older subjects. Endurance exercises might attenuate artery stiffness, but little is known about the effects of intermittent training programme. We evaluate the effect of a short Intermittent Work Exercise Training Program (IWEP) on arterial stiffness estimated by the measure of the pulse wave velocity (PWV). Seventy-one healthy volunteers (mean age: 64.6 years) free of symptomatic cardiac and pulmonary disease performed a 9-week IWEP that consisted of a 30-min cycling twice a week over a 9-week period. Each session involved six 5-min bouts of exercise, each of the latter separated into 4-min cycling at the first ventilatory threshold alternated with 1-min cycling at 90% of the pretraining maximal tolerated power. Before and after the IWEP, the following measurements were made: carotid-radial PWV and carotid-femoral PWV with a tonometer and systolic and diastolic blood pressure. Training resulted in a non-significant decrease of the carotid-radial PWV, a significant decrease of the carotid-femoral PWV from 10.2 to 9.6 m/s (p < 0.001) (that was no longer significant after adjustment for mean arterial pressure) and a significant decrease in both systolic and diastolic blood pressure, respectively, from 129.6 ± 14.9 mmHg to 120.1 ± 14.1 mmHg (p < 0.001) and from 77.2 ± 8.8 mmHg to 71.4 ± 10.1 mmHg (p < 0.001). The present results support the idea that a short-term intermittent aerobic exercise programme may be an effective lifestyle intervention for reducing rapidly blood pressure and probably central arterial stiffness among older healthy subjects.

Carotid Endarterectomy Improves Peripheral but not Central Arterial Stiffness

Carotid endarterectomy (CEA) reduces the risk of cerebrovascular events due to the presence of atherosclerotic plaque in the internal carotid artery. Arterial stiffness is an indicator of cardiovascular risk and strongly associates with the development of atherosclerosis. This study aims to assess the short-term effect of CEA on arterial stiffness and haemodynamics. Prospective observational study. Measurements of arterial stiffness and haemodynamics, including carotid-femoral pulse wave velocity (cfPWV), carotid-radial PWV (crPWV), augmentation pressure, augmentation index, subendocardial viability ratio, central pressures and pulse pressure amplification, were performed pre- and 6 weeks post-CEA on both surgical and non-surgical sides. Fifty-nine patients completed the study (n = 46 men, age 68.9 ± 10.1 years). crPWV was decreased after CEA on the surgical (P = 0.01) and non-surgical side (P = 0.0008), AIx75 tended to decrease only on the surgical side (P = 0.06). cfPWV did not change significantly on either side. We assessed, for the first time, the short-term effect of CEA on arterial stiffness and haemodynamics. CEA improved peripheral but not central arterial stiffness. This study provides evidence for significant changes in certain arterial stiffness and haemodynamic parameters. Longer-term follow-up will assess whether these changes are sustained and whether CEA is associated with further haemodynamic benefits.

Augmentation index and aortic stiffness in bicuspid aortic valve patients with non-dilated proximal aortas

BackgroundWe compared aortic stiffness, aortic impedance and pressure from wave reflections in the setting of bicuspid aortic valve (BAV) to the tricuspid aortic valve (TAV) in the absence of proximal aortic dilation. We hypothesized BAV is associated with abnormal arterial stiffness.MethodsTen BAV subjects (47 ± 4 years, 6 male) and 13 TAV subjects (46 ± 4 years, 10 male) without significant aortic valve disease were prospectively recruited. Characteristic impedance (Zc) was derived from echocardiographic images and pulse wave Doppler of the left ventricular outflow tract. Applanation tonometry was performed to obtain pulse wave velocity (PWV) at several sites as measures of arterial stiffness and augmentation index (AIx) as a measure of wave reflection.ResultsThere were no significant differences between BAV and TAV subjects with regard to heart rate or blood pressure. Zc was similar between BAV and TAV subjects (p=0.25) as was carotid-femoral pulse wave velocity (cf-PWV) and carotid-radial PWV (cr-PWV) between BAV and TAV subjects (p=0.99). Carotid AIx was significantly higher in BAV patients compared with TAV patients (14.3 ± 4.18% versus -3.02 ± 3.96%, p=0.007).ConclusionsAortic stiffness and impedance is similar between subjects with BAV and TAV with normal aortic dimensions. The significantly higher carotid AIx in BAV, a proxy of increased pressure from wave reflections, may reflect abnormal vascular function distal to the aorta.

Relation of vascular stiffness with epicardial and pericardial adipose tissues, and coronary atherosclerosis

ObjectivesIncreased measured vascular stiffness is an early marker of atherosclerosis and is associated with cardiovascular risk factors. Coronary artery calcium (CAC) and adipose tissues are accurate markers of overall burden of coronary atherosclerosis and metabolic status, respectively. We evaluated the relation of vascular stiffness with epicardial (EAT) and pericardial (PAT) adipose tissues, as well as the presence and severity of CAC. MethodsOne hundred and eleven consecutive subjects, mean age 59 ± 11 years, 78% male, underwent 64-multidetector row cardiac computed tomography (MDCT) and their carotid-radial pulse wave velocity (PWV) was measured using SphygmoCor tonometry. EAT and total thoracic adipose tissue (TAT) volumes were measured using MDCT. PAT was calculated as TAT–EAT. The highest tertile of EAT (≥111 ml) and PAT (≥103 ml) were defined as significant adipose tissue depots. ResultsPWV was moderately associated with EAT (r = 0.46, p < 0.001), and PAT (r = 0.41, p < 0.001). PWV increased proportionally with the severity of CAC from 0 to 400+. The relative risk of highest vs. lowest tertile of PWV was 3.03 (95% CI 1.22–7.51, p = 0.01) for significant EAT, 2.34 (95% CI 1.10–4.90, p = 0.02) for significant PAT and 2.46 (95% CI 1.13–3.14, p = 0.01) for significant CAC (CAC 100+) after adjustment for conventional cardiovascular risk factors. This relative risk was increased after combination of CAC 100+ with each significant adipose tissue. ConclusionsIncreased vascular stiffness is associated with increase in EAT, PAT and coronary atherosclerosis. EAT was associated with higher relative risk of PWV, compared with CAC, suggesting a role of adipose tissue in vascular stiffness.

Characteristics of pulse wave velocity in elastic and muscular arteries

Although aortic pulse wave velocity (PWV) has been accepted as gold standard of arterial stiffness, characteristics of PWVs in other arteries have never been reported. We measured carotid-femoral, carotid-pedis, carotid-radial, and femoral-pedis PWVs by a validated tonometry PulsePen, and assessed body fat percentage by bioelectrical impedance analyzer, carotid intima-media thickness (IMT) by ultrasonograph, and other cardiovascular risk factors, in 198 patients from our ambulatory cardiovascular department. Carotid-femoral and carotid-pedis PWVs increased significantly and progressively with age in both men and women (P ≤ 0.03), whereas only in men, a slight increase and decrease in carotid-radial and femoral-pedis PWVs, respectively, were detected with aging (P ≤ 0.006). Carotid-femoral and carotid-pedis PWVs, but not carotid-radial and femoral-pedis PWVs, were significantly associated with age, body height and body fat percentage, brachial mean blood pressure (MBP), and pulse pressure (PP), carotid PP, PP amplification, carotid IMT, plasma glucose and taking antihypertensive agent (P ≤ 0.047). In full adjustment models, carotid-femoral PWV increased by 0.89 ± 0.21, 0.38 ± 0.13, 0.74 ± 0.26, 0.40 ± 0.16, 0.51 ± 0.23 m/s, with an increase of 10 years in age, of 1 mmol/l in plasma glucose, of 10 mmHg in brachial PP, of 100 μm in IMT, and of 10 mmHg in brachial MBP, respectively, whereas carotid-pedis PWV increased by 0.31 ± 0.11 and 0.33 ± 0.12 m/s with an increase of 10 years in age and of 10 mmHg in brachial MBP, respectively. Arterial stiffness in elastic arteries, but not in muscular arteries, increased significantly and progressively with age, and was more closely correlated to BP, plasma glucose and arterial thickness.