Changes In Pulse Wave Velocity Research Articles

Treatment Site Does Not Affect Changes in Pulse Wave Velocity but Treatment Length and Device Selection Are Associated With Increased Pulse Wave Velocity After Thoracic Endovascular Aortic Repair.

Background: Endovascular treatment of aortic aneurysm is associated with an increase in pulse wave velocity (PWV) after surgery. However, the effect of different types of endovascular devices on PWV at different sites of the thoracic aorta remains unclear.Objectives: The purposes of this study were (1) to investigate the changes in PWV after endovascular treatment of thoracic aortic aneurysm; (2) to evaluate whether there is a difference in the changes in PWV at different treatment sites; and (3) to evaluate the effect of treatment length on changes in PWV.Methods: From July 2008 to July 2021, 276 patients underwent endovascular treatment of the true thoracic aortic aneurysm. Of these patients, 183 patients who underwent preoperative and postoperative PWV measurement within 1 year of surgery were included in the study. The treatment length index was calculated by treatment length divided by the height of the patients.Results: Five different types of endovascular devices were used (Najuta, Kawasumi Laboratories, Inc., Tokyo, Japan; TAG, W.L. Gore & Associates, Inc., AZ, USA; Relay, Bolton Medical, Inc., FL, USA; Talent/Valiant, Medtronic, MN, USA; and Zenith, Cook Medical, IN, USA). There was no significant change in PWV in patients receiving Najuta (Before: 2,040 ± 346.8 cm/s vs. After: 2,084 ± 390.5 cm/s, p = 0.14). However, a significant increase was observed in other devices: TAG (Before: 2,090 ± 485.9 cm/s vs. After: 2,300 ± 512.1 cm/s, p = 0.025), Relay (Before: 2,102 ± 465.3 cm/s vs. After: 2,206 ± 444.4 cm/s, p = 0.004), Valiant (Before: 1,696 ± 330.2 cm/s vs. After: 2,186 ± 378.7 cm/s, p < 0.001), and Zenith (Before: 2,084 ± 431.7 cm/s vs. After: 2,321 ± 500.6 cm/s, p < 0.001). There was a significant increase in PWV in patients treated from aortic arch (Before: 2,006 ± 333.7 cm/s vs. After: 2,132 ± 423.7 cm/s, p < 0.001) and patients treated from descending thoracic aorta (Before: 2,116 ± 460.9 cm/s vs. After: 2,292 ± 460.9 cm/s, p < 0.001). Multivariate analysis showed that treatment site was not an independent factor associated with changes in PWV. However, Najuta (Coef −219.43, 95% CI −322.684 to −116.176, p < 0.001) and treatment index (Coef 147.57, 95% CI 24.826 to 270.312, p = 0.019) were independent factors associated with changes in PWV.Conclusion: Najuta did not show a significant increase in PWV, while other commercially available devices showed a significant increase. The treatment site did not have a different effect on PWV. However, the treatment length was an independent factor associated with an increase in PWV.

Effect of long-term testosterone replacement therapy on arterial stiffness and systemic endothelial function in male patients with hypogonadism

Abstract Purpose The study aims at providing the long-term effect of testosterone replacement therapy on systemic endothelial function, aortic stiffness and wave reflections in men with testosterone deficiency (TD). Methods This is a randomized single-center double-blind placebo-controlled trial involving 24 men (aged 51±9 years) with erectile dysfunction (ED) and total testosterone (TT) levels below 3.5 ng/ml randomised to receive either intramuscular (i.m) testosterone undecanoate (TU) injections (1000 mg as a single 4 mL i.m. injection at 0, 6, 18, 30 and 42 weeks) or an identical placebo at similar time points. A TU /placebo 2:1 randomization list was generated and patients were centrally assigned to one of the two arms, consecutively. Central blood pressure (BP), augmentation index (AIx), carotid-femoral pulse wave velocity (PWV) and brachial flow mediated dilatation (FMD) were measured at baseline, and at 18, 24, 30 and 44 weeks. Results The changes in central systolic BP and pulse pressure were more potent in the TU group compared to placebo group, however the decreases in these parameters were not statistically significant in point-of-time and time and group interaction. Repeated measures ANOVA revealed that the in point-of-time decrease in AIx was statistically significant in the group receiving TU (P=0.029) compared to men receiving placebo (figure). The maximal response in AIx was observed at 18 and 24 weeks (by 4.2% and 5.0%, respectively, all P&amp;lt;0.05). The interaction of time and group was also statistically significant (P=0.012) indicating significant differences between the treatment groups and time. PWV in the TU therapy group decreases during the whole study period, however the in point-of-time change was not statistically significant (P&amp;gt;0.05, figure). In men receiving TU the change in PWV was marginally significant only at 24 weeks (reduction by 0.34 m/s, P=0.05), whereas there were no significant differences in PWV between baseline and all other assessment time points. TU minimally increased brachial FMD up to 24 weeks (increase by 0.15%, P=0.05) from the beginning of therapy and the in point of the time change was not statistically significant (P&amp;gt;0.05, figure). Conclusion The 44-week TU i.m therapy was associated with a beneficial sustained effect on central AIx wave reflections thorough the whole study period. PWV decreased, particularly at 24 weeks, however the change in aortic elastic properties during the whole study session was not significant. Systemic endothelial function minimally improved compared to placebo. Given that AIx is an independent marker of cardiovascular disease and predictor of the corresponding risk, these findings have important implications to assess the effect of testosterone replacement interventions on cardiovascular performance and the corresponding risk of patients with ED and TD. Funding Acknowledgement Type of funding sources: Private grant(s) and/or Sponsorship. Main funding source(s): Bayer Pharmaceuticals Figure 1. TU vs placebo Aix PWV and FMD changes

3D global longitudinal strain is the best predictor of late cardiotoxicity in non-Hodgkin's lymphoma

Abstract RCHOP chemotherapy (rituximab, cyclophosphamide, doxorubicin, vincristine, prednisone) in non-Hodgkin's lymphoma (NHL) has a high risk of cardiotoxicity, with increased morbidity and mortality. Aim To define new parameters, such as 3D LV deformation, arterial stiffness and biomarkers able to detect late cardiotoxicity. Methods 54 patients (26 men, 57±10 years) with NHL, scheduled to receive RCHOP, with LVEF&amp;gt;50%, were assessed at baseline, after the 4th cycle of RCHOP and 2 years after completion of therapy. Assessment included 3D echocardiography for LV EF and deformation - longitudinal, radial, circumferential, area strain (LS, RS, CS, AS), Arteriograph for pulse wave velocity (PWV) and biomarkers (troponin I, NT-pro-BNP). Cardiotoxicity was defined as a decrease of LVEF &amp;lt;50%, with &amp;gt;10% from the baseline value. Results 11 patients (group I) developed cardiotoxicity, while 43 patients did not (group II) (LVEF decreased from 59±3 to 56±2 vs 58±3 to 47±2, p&amp;lt;0.0001). From baseline to 2 years there was a significant reduction of LS, CS and AS, and an increase of arterial stiffness and troponin I; however, changes were greater in group I vs group II (p=0.001) (see table). Even if NT-pro-BNP increased from baseline to 2 years, no significant changes were found between group I and II. Decrease of 3D LVEF correlated with changes of LS, AS, PWV, and troponin (r=0.64, r=0.42, r=−0.37 and r=−0.29, p&amp;lt;0.05). LS reduction after the 4th cycle was the best independent predictor for LVEF decrease after 2 years from therapy completion (R2=0.43, p=0.001); thus, decrease of LS with more than 26% after the 4th RCHOP cycle predicted late cardiotoxicity, after 2 years, with a sensitivity of 87% and specificity of 71% (AUC=0.867). Conclusion Assessment of 3D myocardial deformation, arterial stiffness and biomarkers is able to detect late cardiovascular toxicity, and to predict further decline of LVEF in patients with NHL. LS is the best independent predictor for late cardiotoxicity. Funding Acknowledgement Type of funding sources: None. 123 Cardiovascular toxicity parameters

Novel Technique to Measure Pulse Wave Velocity in Brain Vessels Using a Fast Simultaneous Multi-Slice Excitation Magnetic Resonance Sequence.

In this study, we proposed a novel pulse wave velocity (PWV) technique to determine cerebrovascular stiffness using a 3-tesla magnetic resonance imaging (MRI) to overcome the various shortcomings of existing PWV techniques for cerebral-artery PWV, such as long scan times and complicated procedures. The technique was developed by combining a simultaneous multi-slice (SMS) excitation pulse sequence with keyhole acquisition and reconstruction (SMS-K). The SMS-K technique for cerebral-artery PWV was evaluated using phantom and human experiments. In the results, common and internal carotid arteries (CCA and ICA) were acquired simultaneously in an image with a high temporal resolution-of 48 ms for one measurement. Vascular signals at 500 time points acquired within 30 s could generate pulse waveforms of CCA and ICA with 26 heartbeats, allowing for the detection of PWV changes over time. The results demonstrated that the SMS-K technique could provide more PWV information with a simple procedure within a short period of time. The procedural convenience and advantages of PWV measurements will make it more appropriate for clinical applications.

SPARTE Study: Normalization of Arterial Stiffness and Cardiovascular Events in Patients With Hypertension at Medium to Very High Risk.

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Impact of high neutrophil-to-lymphocyte ratio on the cardiovascular benefit of PCSK9 inhibitors in familial hypercholesterolemia subjects with atherosclerotic cardiovascular disease: Real-world data from two lipid units

Background and aimsNeutrophil-to-lymphocyte ratio (NLR) is a novel inflammatory biomarker strongly associated with atherosclerotic cardiovascular disease (ASCVD). Our aim was to evaluate the role of NLR on pulse wave velocity (PWV) after adding-on proprotein convertase subtilisin/kexin type 9 inhibitor (PCSK9-i) in familial hypercholesterolemia (FH) subjects with ASCVD. Methods and resultsIn this prospective observational study, we evaluated 45 FH subjects with ASCVD on high-intensity statins plus ezetimibe and with an off-target LDL-C. Study population was divided into two groups according to the mean value of NLR. All patients received PCSK9-i therapy and obtained biochemical analysis as well as PWV evaluation at baseline and after six months of PCSK9-i. After six months of add-on PCSK9-i therapy, a significant reduction of TC, LDL-C, Non-HDL-C, Lp(a) and ApoB plasma levels was observed in the two groups; while low-NLR group exhibited a significant PWV reduction after six-month therapy with PCSK9-i (Δ −16.2%, p < 0.05), no significant changes in PWV were observed in the high-NLR group. ConclusionsOnly FH subjects with low-NLR experienced a significant reduction of PWV after PCSK9-i. Our findings suggest a role of NLR in predicting PCSK9-i effect in FH subjects with ASCVD.

Diurnal pattern of salivary cortisol and progression of aortic stiffness: Longitudinal study

BackgroundThe positive direct relation between stress and the development of cardiovascular disease has increasingly been recognized. However, the link between hypothalamic-pituitary-adrenal (HPA) dysregulation and subclinical cardiovascular disease has not been studied longitudinally. We investigated the relation of diurnal salivary cortisol, as a biological marker of stress levels, with progression of aortic stiffness over five years. MethodsA total of 3281 people (mean age 65.5) in the Whitehall II prospective study provided six saliva samples on a single weekday. We assessed the diurnal salivary cortisol using the daytime slope and bedtime level. Aortic stiffness was measured by carotid-femoral pulse wave velocity (PWV) at baseline (2007–2009) and five years later (2012–2013). Linear mixed models were used to estimate the association of diurnal salivary cortisol with baseline PWV and five-year longitudinal changes. ResultsDiurnal salivary cortisol were not associated with PWV at baseline. Among women but not men, a 1-SD shallower salivary cortisol slope at baseline was associated with a five-year increase in PWV (β = 0.199; 95% CI = 0.040, 0.358 m/s) and higher bedtime cortisol level (β = 0.208, 95% CI = 0.062, 0.354 m/s). ConclusionsDysregulation of the HPA axis measured using salivary cortisol (shallower slope, higher bedtime level) predicted the rate of progression of aortic stiffness among women.

Agreement Of Seated And Supine Pulse Wave Velocity Measurements With Prolonged Sitting

During prolonged sitting research, measuring pulse wave velocity (PWV) in the seated posture would minimize participant burden and preserve the detrimental vascular effects of inactivity. However, PWV is validated in the supine position and it is unknown how supine and seated PWV measures compare. PURPOSE: This study evaluated agreement between the following seated and supine measures of PWV: carotid-femoral (cf), brachial-femoral (bf), and femoral-ankle (fa). We evaluated: (i) the overall agreement between seated and supine measures and (ii) the repeated measures agreement. METHODS: cfPWV, bfPWV, and faPWV were recorded while supine and then seated, and then following a three-hour period of uninterrupted sitting, all measurements were repeated. Mixed model regression was used to calculate agreement between the supine and seated measures. For each PWV outcome, the supine measures were regressed against the seated measures and nested within subject and time (pre vs. post sitting), with subject and time specified as random. The random variance components were used to calculate intraclass correlation coefficients (ICC) with 95% confidence intervals. Overall agreement and repeated-measures ICCs were calculated. An ICC ≥ 0.70 represented strong agreement, and ICC ≥ 0.90 represented a very strong agreement. RESULTS: A total of 18 subjects were included in the final analysis (age: 22.6 ± 3.1 years, female: 6, cfPWV: 6.1 ± 0.9 m/s). The overall agreement between seated and supine measures was strong for cfPWV (ICC: 0.77, 95%CI: 0.63-0.86), weak but significant for bfPWV (ICC: 0.37, 95%CI: 0.11-0.58), and non-significant and weak for faPWV (ICC: 0.26, 95%CI: -0.02-0.49). The cfPWV measurement had strong repeated-measure (i.e., change in pre-sit vs change in post-sit) agreement (ICC: 0.87, 95%CI: 0.78-0.92). There was a very strong repeated measures agreement in bfPWV (ICC: 0.96, 95%CI: 0.93-0.98) and faPWV (ICC: 0.93, 95%CI: 0.88-0.96). CONCLUSIONS: There was strong overall seated and supine agreement for cfPWV but weak overall agreement for bfPWV and faPWV, which indicated that seated and supine measurements are only comparable for cfPWV. Strong to very-strong repeated-measures agreement for all measures suggest that change in PWV is comparable regardless of posture.

Association of incremental pulse wave velocity with cardiometabolic risk factors

We investigate the association of incremental pulse wave velocity (ΔC; the change in pulse wave velocity over a cardiac cycle) with cardiometabolic risk factors and report the first and (currently) the largest population-level data. In a cross-sectional study performed in a cohort of 1373 general population participants, ΔC was measured using clinically validated ARTSENS devices. There were 455 participants in the metabolic syndrome (MetS) group whose average ΔC was ~ 28.4% higher than that of the non-metabolic syndrome (Non-MetS) group. Females with MetS showed ~ 10.9% elevated average ΔC compared to males of the Non-MetS group. As the number of risk factors increased from 0 to 5, the average ΔC escalated by ~ 55% (1.50 ± 0.52 m/s to 2.33 ± 0.91 m/s). A gradual increase in average ΔC was observed across each decade from the younger (ΔC = 1.53 ± 0.54 m/s) to geriatric (ΔC = 2.34 ± 0.59 m/s) populations. There was also a significant difference in ΔC among the blood pressure categories. Most importantly, ΔC ≥ 1.81 m/s predicted a constellation of ≥ 3 risks with AUC = 0.615, OR = 2.309, and RR = 1.703. All statistical trends remained significant, even after adjusting for covariates. The study provides initial evidence for the potential use of ΔC as a tool for the early detection and screening of vascular dysfunction, which opens up avenues for active clinical and epidemiological studies. Further investigations are encouraged to confirm and establish the causative mechanism for the reported associations.

Impact of Bariatric Surgery on Pulse Wave Velocity as a Measure of Arterial Stiffness: a Systematic Review and Meta-analysis.

Weight loss during post-bariatric surgery period has been linked to both reduced ASCVD mortality and overall mortality. Atherosclerosis causes arteries to lose their elasticity and become more stiff resulting in increased pulse wave velocity (PWV). It has been revealed that PWV favorably predicts subsequent ASCVDs. The goal of this systematic review and meta-analysis was to see how bariatric surgery affected PWV, an index of arterial stiffness. A systematic literature search in four databases was performed. Also, Cochrane guidelines were reviewed to determine bias possibility in the related studies. Comprehensive Meta-Analysis (CMA) V2 software is used to conduct the meta-analysis. Studies were evaluated regarding heterogeneity in design, populations under investigation, and treatment duration using random-effects model and the generic inverse variance weighting approach. A random-effect meta-regression approach was used to investigate the association with the estimated effect size. Evaluation of funnel plot, Egger's weighted regression, and Begg's rank correlation tests were utilized to estimate the presence of publication bias in the meta-analysis. The results of meta-analysis on 13 trials including 1426 individuals demonstrated a remarkable decline of PWV after bariatric surgery (WMD: -0.652, 95% CI: -1.004, -0.301, p<0.001). The random-effects meta-regression revealed no evidence of significant correlation between the changes in PWV and initial BMI, BMI changes, or duration of follow-up. The decrease of PWV might be utilized as an independent surrogate marker of improvement of ASCVD risk after bariatric surgery.

18-OR: Longitudinal Changes in Vascular Stiffness and Heart Rate Variability (HRV) in Young Adults with Type 2 Diabetes (T2D): The TODAY Study

Little is known about how arterial stiffness and HRV progress in young adults with youth-onset T2D. We examined changes in pulse wave velocity (PWV), augmentation index (AIx), brachial distensibility and HRV over 5-years in young adults with T2D (n=304, 34% male, first assessment at mean age 21 years, mean diabetes duration 8 years) who participated in the Treatment Options for Type 2 Diabetes in Adolescents and Youth (TODAY) trial. Changes by sex, race/ethnicity, and the risk factors associated with the changes in arterial stiffness and HRV were assessed. PWV carotid-femoral, AIx and HRV worsened over 5-years (p<0.0001), Table. There were no differences in the 5-year change by race/ethnicity. In multivariable models, female sex (β=2.9, p=0.03) and mean arterial pressure (β=1.9 per 10 mmHg, p< 0.001) related to greater worsening in AIx. Mean arterial pressure related to PWV carotid-femoral (β=0.4 per 10 mmHg, p<0.0001). Higher time-weighted mean HbA1c, a measure of cumulative glycemic exposure, was related to worsening of both PWV carotid-femoral and HRV (β=0.1, p=0.03 and β=-3.8, p<0.0001, per 1% respectively). Targeting improvements in blood pressure and glycemic control may favorably influence the progression of arterial stiffness and HRV in T2D.View largeDownload slideView largeDownload slide DisclosureA. S. Shah: None. S. A. Arslanian: Advisory Panel; Self; Eli Lilly and Company, Novo Nordisk, Other Relationship; Self; AstraZeneca, Research Support; Self; Eli Lilly and Company, Novo Nordisk. E. M. Urbina: None. L. El ghormli: None. S. Gidding: None. K. S. Hughan: None. L. E. Katz: None. D. Koren: None. J. B. Tryggestad: None. F. Bacha: None. B. H. Braffett: None.FundingNational Institute of Diabetes and Digestive and Kidney Diseases (U01DK61212, U01DK61230, U01DK61239, U01DK61242, U01DK61254)

Association of changes of pulse wave velocity and augmentation index after isometric handgrip exercise with coronary lesion extent and revascularization

BackgroundArterial stiffness is associated with myocardial ischemia and incident coronary artery disease (CAD), and indexes of arterial stiffness are usually increased in patients with CAD. However, these indexes are often increased in elderly without CAD. Arterial stiffness in patients with CAD may become more evident after isometric handgrip exercise which increases systolic pressure and ventricular afterload. We investigated the association of the change of stiffness indexes after isometric handgrip exercise with the lesion extent of CAD and the necessity for coronary revascularization.MethodsPatients who were scheduled a routine coronary angiography via a femoral artery were enrolled. Arterial waveforms were traced at aortic root and external iliac artery using coronary catheters at baseline and 3 min after handgrip exercise. Augmentation index (AIx) was measured on the recorded aortic pressure waveform, and pulse wave velocity (PWV) was calculated using the ECG-gated time difference of the upstroke of arterial waveforms and distance between aortic root and external iliac artery.ResultsTotal 37 patients were evaluated. Both PWV and AIx increased after handgrip exercise. ΔPWV was significantly correlated with ΔAIx (r = 0.344, P = 0.037). Patients were divided into higher and lower ΔPWV or ΔAIx groups based on the median values of 0.4 m/sec and 3.3%, respectively. Patients with higher PWV had more 2- or 3-vessel CAD (69% vs. 27%, P = 0.034), and underwent percutaneous coronary intervention (PCI) more frequently (84% vs. 50%, P = 0.038), but higher ΔAIx was not associated with either the lesion extent or PCI. Area under curve (AUC) of ΔPWV in association with PCI by C-statistics was 0.70 (95% confidence interval [CI] 0.51–0.88; P = 0.056). In multiple logistic regression analysis, ΔPWV was significantly associated with PCI (odds ratio 7.78; 95% CI 1.26–48.02; P = 0.027).ConclusionsHigher ΔPWV after isometric handgrip exercise was associated with the lesion extent of CAD and the necessity for coronary revascularization, but higher ΔAIx was not.

Acute Effects of Short‐term Warm Water Immersion on Vascular Function

Cardiovascular disease (CVD) is a leading cause of death in the world. Currently, effective strategies for preventing CVD have been developed extensively. CVD is characterized by vascular dysfunction, including the decreased endothelial-dependent vasodilation and the increased arterial stiffness. In this line, regular physical activity (i.e., aerobic exercise) is one of the most established treatments of the primary prevention of CVD because it may restore impaired vascular function. However, not all populations can engage in physical activities. Thus, substitute interventions on vascular hemodynamics are needed for individuals with physical disabilities. Warm water immersion (WWI) has a potentially favorable effect on vascular health. However; the effects of short-term WWI on vascular function remain unclear. The present study aimed to determine the acute effects of short-term WWI on vascular function in healthy men. Ten healthy men (27-57 years, 44±12 years of mean age) underwent 5-minute WWI (40-41ºC) at the heart level. Heart rate, blood pressure (BP), aortic and leg pulse wave velocity (PWV), and femoral arterial blood flow and shear rate (SS) were measured before and 10 minutes after WWI. After 5-minute WWI, heart rate and brachial diastolic BP were significantly decreased. Aortic and leg PWV were decreased by 7.5% and 3.1%, respectively (P=0.006 and P=0.049). Femoral arterial blood flow was increased by 45.9% (P=0.002) and leg vascular resistance was decreased by 29.1% (P<0.001). Change in leg PWV was significantly correlated with corresponding change in femoral arterial blood flow (r = - 0.713, P = 0.181) and SS (r = - 0.724, P = 0.154). Our results indicate that a short-term WWI acutely improves vascular function. Further studies to determine the interaction between the residual effect of a single bout of short-term WWI and chronic change (e.g., adaptation) in vascular function are needed.

SEASONAL VARIABILITY OF PULSE WAVE VELOCITY IS ASSOCIATED WITH CARDIOVASCULAR OUTCOMES IN HYPERTENSIVE PATIENTS

Objective: The seasonal changes of blood pressure in hypertensive patients have been investigated and attracted an increasing scientific interest during the past years, but seasonal changes of pulse wave velocity (PW) in hypertensive patients have not been studied. And it is unclear whether PW variations are related to cardiovascular risk. The aim of the study was the examination of prognostic value of individual variability of PW in 24-hour, daytime and nighttime periods of hypertensive patients from two regions of the Russia (Ivanovo and Saratov). Design and method: Patients aged 40–79 years who visited ambulatory clinics for various reasons we. All participants provided written informed consent. The ambulatory blood pressure monitoring (ABPM) was performed with the BPLab device, twice in all patients: in winter (December-February 2012–2014) and in summer (June-August 2012–2014). The interval between ABPMs was 6 months ± 7 days. The selection criteria for ABPM records were: duration &gt; = 23.5 hours, absence of data gaps &gt;1 hour, and &gt; = 56 readings per 24 hours. We analyzed the individual PW in 24-hour, daytime and nighttime differences in each patient. The participants were followed up until October 31-st 2019 (mean follow-up 6.4 ± 0.4 years). The complex endpoint included death (from any reasons), stroke, myocardial infarction, transient ischemic attack, angina pectoris, and development of heart failure. The preliminary analyses included ANOVA and descriptive statistics. Results: In total, 770 patients completed both visits. The outcome information was available in 528 patients: 335 from Ivanovo and 193 from Saratov (mean age 55 ± 10 years, 220 men). The endpoints were registered in 50 patients. We found the mean winter-summer PW difference in the group of patients with cardiovascular outcomes. In contrast, this difference was positive in the other group (see Table1). Conclusions: The inverse seasonal PW variability, which could reflect the abnormal biological response to outside temperature, may be associated with a higher risk of cardiovascular events, compared to patients with standard PW variability (PW is higher in winter, than in summer). Our data demonstrate the preliminary argument in favor of additional ambulatory BP and PW control. The problem of seasonal PW variability is needed further studying.

Vascular conditioning prevents adverse left ventricular remodelling after acute myocardial infarction: a randomised remote conditioning study.

Remote ischemic conditioning (RIC) alleviates ischemia-reperfusion injury via several pathways, including micro-RNAs (miRs) expression and oxidative stress modulation. We investigated the effects of RIC on endothelial glycocalyx, arterial stiffness, LV remodelling, and the underlying mediators within the vasculature as a target for protection. We block-randomised 270 patients within 48h of STEMI post-PCI to either one or two cycles of bilateral brachial cuff inflation, and a control group without RIC. We measured: (a) the perfusion boundary region (PBR) of the sublingual arterial microvessels to assess glycocalyx integrity; (b) the carotid-femoral pulse wave velocity (PWV); (c) miR-144,-150,-21,-208, nitrate-nitrite (NOx) and malondialdehyde (MDA) plasma levels at baseline (T0) and 40min after RIC onset (T3); and (d) LV volumes at baseline and after one year. Compared to baseline, there was a greater PBR and PWV decrease, miR-144 and NOx levels increase (p < 0.05) at T3 following single- than double-cycle inflation (PBR:ΔT0-T3 = 0.249 ± 0.033 vs 0.126 ± 0.034μm, p = 0.03 and PWV:0.4 ± 0.21 vs -1.02 ± 0.24m/s, p = 0.03). Increased miR-150,-21,-208 (p < 0.05) and reduced MDA was observed after both protocols. Increased miR-144 was related to PWV reduction (r = 0.763, p < 0.001) after the first-cycle inflation in both protocols. After one year, single-cycle RIC was associated with LV end-systolic volume reduction (LVESV) > 15% (odds-ratio of 3.75, p = 0.029). MiR-144 and PWV changes post-RIC were interrelated and associated with LVESV reduction at follow-up (r = 0.40 and 0.37, p < 0.05), in the single-cycle RIC. RIC evokes "vascular conditioning" likely by upregulation of cardio-protective microRNAs, NOx production, and oxidative stress reduction, facilitating reverse LV remodelling. http://www.clinicaltrials.gov . Unique identifier: NCT03984123.

Increased pulse wave velocity in patients with an orthostatic blood pressure rise independent of other cardiovascular risk factors.

Positional changes in blood pressure (BP) have been shown to have effects on long-term outcomes. Although a BP drop with upright posture is frequently observed, an orthostatic rise in BP can also occur. Here, we aimed to investigate whether the phenotype of orthostatic hypertension is associated with more pronounced vascular hypertension-mediated organ damage (HMOD) and whether this is associated with other cardiovascular risk factors. In a cohort of 200 patients referred to our tertiary hypertension clinic, we prospectively assessed unattended seated automated office BP and the response to 1 min of upright posture. The difference in BP after standing up was calculated and pulse wave velocity (PWV) was assessed as a marker of vascular HMOD. Routine clinical cardiovascular risk markers were also assessed. Regression models were used to assess the association between orthostatic BP changes and pulse wave velocity. Baseline characteristics and clinic cardiovascular risk factors were similar between orthostatic BP response groups. A U-shaped association was evident between PWV and orthostatic BP changes with elevated PWV in patients with either a fall or a rise in BP in response to upright posture. The regression models remained significant after adjusting for other cardiovascular risk factors, including 24 h ambulatory BP. Both an orthostatic BP drop and rise were associated with elevated PWV. Although standing BP is commonly measured in elderly hypertensive patients to exclude significant orthostatic hypotension, this simple measurement may provide an additional independent risk factor for vascular HMOD at any age.

Improvement in Pulse Wave Velocity and Baroreflex Sensitivity Three-and Six-Month Postrenal Transplantation.

Cardiovascular diseases are an important cause of mortality in end-stage renal disease (ESRD) and increased arterial stiffness and autonomic dysfunction have been proposed to explain part of this excess cardiovascular risk. This prospective study was designed with the aim of noninvasive assessment of the vascular function, i.e., arterial stiffness in the form of pulse wave velocity (PWV) and autonomic function in the form of baroreflex sensitivity (BRS) in ESRD patients before renal transplantation (RT) and three and six months after RT. The study was conducted in 64 patients of ESRD slated for RT in the Department of Nephrology and was being followed up during all three visits (pretransplant, three-, and six-month posttransplant). The period of patient recruitment and data collection lasted for approximately 1½ years. Although PWV did not show a significant change, the change in PWV was negatively correlated with baseline PWV, and it was statistically significant. The BRS after RT had a significant improvement as early as three months. The correlation between change in PWV and change in BRS postrenal transplant was not seen. RT improves BRS, but it is still unknown that it is through amelioration of arterial properties or neural components or/and a relative contribution of both. We suggest that the improvement in BRS postrenal transplant is probably because of the improvement in autonomic neural functions rather than the improvement in compliance of barosensitive regions of large arteries.

Does Pulse Wave Velocity Increase Over Time in Hemodialysis Patients?

Objectives: Arterial stiffness, measured by pulse wave velocity (PWV), is reported to be increased in hemodialysis (HD) patients and increases cardiovascular mortality. Previous studies have reported an association between extracellular water (ECW) and PWV. We wished to review whether PWV increases over time and whether this is associated with ECW. Methods: We reviewed repeat aortic PWV measurements using an oscillograph method along with corresponding ECW measured by multifrequency bioimpedance in HD patients a minimum of 5 years apart. Results: Twenty-four patients (16 [66.7%] male and 11 [45.8%] diabetic, mean age 61.7 ± 15.2 years) had PWV and ECW initially measured after 46 (26–124) months of HD and then after 112 (97–202) months. Overall, there was no change in PWV or ECW (9.4 ± 2.2 vs. 8.1 ± 2.5 cm/s; 14.7 ± 2.5 vs. 15.2 ± 2.9 L, respectively), whereas the ECW/total body water ratio increased (0.399 ± 0.015 vs. 0.408 ± 0.021, p < 0.05). We found no association between changes in PWV and ECW (r = −0.05, p = 0.84), whereas there was an association with the change in peri-dialytic systolic blood pressure (SBP) (r = 0.59, p = 0.007). Conclusion: In our small observational study, there was no overall change in PWV, after 5 years of HD, with PWV increasing in 50% and falling in 50%. Changes in PWV were not associated with changes in ECW but were associated with changes in peri-dialytic SBP. Our study demonstrates that PWV does not increase in all HD patients with time, and interventional studies are required to determine whether targeted blood pressure control reduces PWV in HD patients.

No Evidence That Hyperpnea-Based Respiratory Muscle Training Affects Indexes of Cardiovascular Health in Young Healthy Adults.

IntroductionThe chronic effects of respiratory muscle training (RMT) on the cardiovascular system remain unclear. This investigation tested to which degree a single sessions of RMT with or without added vibration, which could enhance peripheral blood flow and vascular response, or a 4-week RMT program could result in changes in pulse wave velocity (PWV), blood pressure (systolic, SBP; diastolic, DBP) and other markers of cardiovascular health.MethodsSixteen young and healthy participants (8 m/8f) performed 15 min of either continuous normocapnic hyperpnea (RMET), sprint-interval-type hyperpnea (RMSIT) or a control session (quiet sitting). Sessions were performed once with and once without passive vibration of the lower limbs. To assess training-induced adaptations, thirty-four young and healthy participants (17 m/17f) were measured before and after 4 weeks (three weekly sessions) of RMET (n = 13, 30-min sessions of normocapnic hyperpnea), RMSIT [n = 11, 6 × 1 min (1 min break) normocapnic hyperpnea with added resistance] or placebo (n = 10).ResultsSBP was elevated from baseline at 5 min after each RMT session, but returned to baseline levels after 15 min, whereas DBP was unchanged from baseline following RMT. Carotid-femoral PWV (PWVCF) was elevated at 5 and 15 min after RMT compared to baseline (main effect of time, P = 0.001), whereas no changes were seen for carotid-radial PWV (PWVCR) or the PWVCF/PWVCR ratio. Vibration had no effects in any of the interventions. Following the 4-week training period, no differences from the placebo group were seen for SBP (P = 0.686), DBP (P = 0.233), PWVCF (P = 0.844), PWVCR (P = 0.815) or the PWVCF/PWVCR ratio (P = 0.389).Discussion/ConclusionAlthough 15 min of RMT sessions elicited transient increases in PWVCF and SBP, no changes were detected following 4 weeks of either RMET or RMSIT. Adding passive vibration of the lower limbs during RMT sessions did not provide additional value to the session with regards to vascular responses.

Hemodynamic response to heated water immersion in older individuals with hypertension.

The aim of this study was to evaluate blood pressure (BP), heart rate, arterial stiffness and endothelial reactivity responses to heated water immersion in older individuals with hypertension. Thirty-five sedentary individuals (67 ± 5 years) under treatment for hypertension were randomly assigned to water-based [n = 20; 30 min of seated resting in a heated swimming pool (30-32 °C)] or land-based group [n = 15; 30 min of seated resting in a quiet room with controlled temperature (21-23 °C)]. BP, heart rate, arterial stiffness and endothelial reactivity were measured before, immediately after (post) and 45 min after (recovery) each session. Heart rate reduced (P < 0.05) during the land-based session, and the reduction was maintained at post (~7 bpm) and recovery (~9 bpm), but no heart rate changes occurred during and after the water-based session. Systolic/diastolic BP increased (P = <0.001) at post (~29/10 mmHg) and recovery (~10/7 mmHg) in the water-based group, but not in the land-based group. No significant changes in pulse wave velocity and endothelial reactivity occurred in both groups. These results suggest that the hemodynamic response to heated water immersion should be taken into account when assessing the effect of heated water-based exercise on postexercise hypotension in older individuals with hypertension.