Decrease In Pulse Wave Velocity Research Articles

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.

Effects of glucagon like peptide-1 receptor agonists, sodium-glucose cotransporter-2 inhibitors and their combination on vascular function and myocardial work index in patient with type-2 diabetes

Abstract Background/Introduction Type-2 diabetes mellitus (T2DM) is associated with endothelial and myocardial dysfunction. Purpose We investigated the effects of insulin, glucagon like peptide-1 receptor agonists (GLP-1RA), sodium-glucose cotransporter-2 inhibitors (SGLT-2i) and their combination on vascular and cardiac function of T2DM patients. Methods A hundred-sixty T2DM patients were randomized to insulin (n=40), liraglutide (n=40), empagliflozin (n=40) or their combination (GLP-1RA+SGLT-2i) (n=40) as add-on to metformin. We measured at baseline, 4 and 12 months post-treatment: a) perfused boundary region (PBR) of the sublingual arterial microvessels (marker of glycocalyx thickness), b) pulse wave velocity (PWV), central systolic blood pressure (cSBP), c) global LV longitudinal (GLS), circumferential (GCS) and radial (GRS) strain, d) the ratio PWV/GLS, as an index of ventricular-arterial interaction, e) myocardial work index (GWI) using speckle tracking imaging. Results Twelve months post-treatment, all patients improved PBR, PWV, GLS, GCS and GRS (p&amp;lt;0.05). GLP-1RA, SGLT-2i and their combination showed a greater reduction of PBR, PWV and cSBP than insulin, despite a similar HbA1c reduction (p&amp;lt;0.05). GLP-1RA or GLP-1RA+SGLT-2i provided a greater decrease of PWV/GLS (28.1% and 31% vs. 11.1% and 14.5%) and a greater increase of GWI (12.7% and 17.4% vs. 3.1% and 2%) compared with insulin or SGLT-2i. SGLT-2i or GLP-1RA+SGLT-2i showed a greater decrease of PWV (10.1% and 13%), cSBP than insulin or GLP-1RA (PWV: 3.6% and 8.6%) (p&amp;lt;0.05 for all comparisons) (Table 1). The dual therapy showed the greatest effect on measured markers in patients with LVEF &amp;lt;55% (p&amp;lt;0.05). Conclusions Twelve-month treatment with GLP-1RA, SGLT-2i and their combination showed a greater improvement of vascular markers and effective cardiac work than insulin in T2DM. The combined therapy was superior to either insulin, or GLP-1RA and SGLT-2i separately. Funding Acknowledgement Type of funding source: None

Tocilizumab improves oxidative stress and endothelial glycocalyx: A mechanism that may explain the effects of biological treatment on COVID-19

We investigated the effects of tocilizumab on endothelial glycocalyx, a determinant of vascular permeability, and myocardial function in rheumatoid arthritis (RA). Eighty RA patients were randomized to tocilizumab (n = 40) or conventional synthetic disease-modifying antirheumatic drugs (csDMARDs) and glucocorticoids (GC) (n = 40) for 3 months. Forty healthy subjects with similar age and sex served as controls. We measured: (a)perfused boundary region (PBR) of the sublingual arterial microvessels (increased PBR indicates reduced glycocalyx thickness), (b)pulse wave velocity (PWV), (c)global LV longitudinal strain (GLS), (d)global work index (GWI) using speckle tracking echocardiography and e)C-reactive protein (CRP), malondialdehyde (MDA) and protein carbonyls (PCs) as oxidative stress markers at baseline and post-treatment. Compared to controls, RA patients had impaired glycocalyx and myocardial deformation markers (P < 0.05). Compared with baseline, tocilizumab reduced PBR(2.14 ± 0.2 versus 1.97 ± 0.2 μm; P < 0.05) while no significant differences were observed post-csDMARDs + GC(P > 0.05). Compared with csDMARDs + GC, tocilizumab achieved a greater increase of GLS, GWI and reduction of MDA, PCs and CRP(P < 0.05). The percent improvement of glycocalyx thickness (PBR) was associated with the percent decrease of PWV, MDA, PCs and the percent improvement of GLS and GWI(P < 0.05). Tocilizumab improves endothelial function leading to a greater increase of effective myocardial work than csDMARDs + GC through a profound reduction of inflammatory burden and oxidative stress. This mechanism may explain the effects of tocilizumab on COVID-19. Clinical trial registrationurl: https://www.clinicaltrials.gov. Unique identifier: NCT03288584.

Decrease in Pulse Wave Velocity is Associated with Clinical Improvement in Patients with Ischemic Stroke

BackgroundArterial stiffness is an independent determinant of cardiovascular and cerebrovascular risks. The relationship between the increase in arterial stiffness parameters and the severity of stroke has been shown in previous studies. We aimed to investigate the association between clinical improvement and changes in arterial stiffness parameters in patients presenting acute ischemic stroke. MethodsA total of 107 patients were enrolled in this study. On the first and seventh day of the hospitalization, 24 h non-invasive blood pressure was monitored and arterial stiffness parameters were measured. The National Institutes of Health Stroke Scale (NIHSS) was used to determine the severity of stroke, and the Modified Rankin Scale was used to determine dependency and to evaluate functional improvements. ResultsArterial stiffness parameters of augmentation index (AIx@75) and pulse wave velocity (PWV) were significantly higher in patients who died during hospitalization than patients who were discharged (respectively p <0.001, p = 0.04). In the group with clinical improvement, PWV values measured on the seventh day were significantly lower than PWV values measured on the first day (p = 0.032). When the changes in PWV value measured on the first and seventh day for both groups were analyzed using mixed ANOVA test, p value were significant (p = 0.033). Multivariate binary logistic regression analyses showed that negatively change in PWV and CDBP independently predicts the clinical improvement. ConclusionsIncreased AIx@75 and PWV appear to be associated with higher in-hospital mortality rates in patients with acute ischemic stroke. Additionally, clinical improvement in patients with ischemic stroke is associated with a decrease in PWV .

Renin Angiotensin System Inhibitors Reduce Aortic Stiffness and Flow Reversal After a Cryptogenic Stroke

Blood flow reversal is a possible mechanism for retrograde embolism in the setting of high-risk atherosclerotic plaques in the descending aorta (DAo). Evidence suggests that pulse wave velocity (PWV) is a determinant of blood flow reversal and can be reduced by the destiffening effect of renin-angiotensin system inhibitors (RASI). To evaluate the impact of antihypertensive therapy on in vivo changes in PWV and flow reversal in patients with cryptogenic stroke. Prospective. Sixteen patients (69 ± 9 years; 10 males) included after cryptogenic stroke. 3T. 4D flow sequence (temporal resolution = 19.6 msec) ASSESSMENT: Patients underwent aortic MRI at baseline and at 6-month follow-up. Patients received standard-of-care antihypertensive therapy that were classified as RASI vs. non-RASI medications (ie, destiffening vs. nondestiffening).We compared aortic PWV, flow reversal fraction (FRF), aortic measurements, cardiac function, and other aortic and cardiac measurements in the antihypertensive therapy groups. Two-tailed paired or unpaired Student's t-tests (normal distributions) or Wilcoxon tests (nonnormal distribution). Univariate correlations using Pearson correlation coefficients. There was a significant decrease in PWV in the RASI (n = 10) group (9.4 ± 1.6 m/s vs. 8.3 ± 1.9 m/s; P < 0.05), as well as FRF (18.6% ± 4.1% vs. 16.3% ± 4.0%; P < 0.05) between baseline and the 6-month MRI studies. There were no changes in PWV or FRF in the non-RASI (n = 6) group (P = 0.146 and P = 0.32). A decrease in FRF was significantly correlated with a decrease in PWV (r = 0.53; P < 0.05). The findings of our study suggest that RASI therapy after cryptogenic stroke resulted in a decrease of blood flow reversal and aortic stiffness. 1 TECHNICAL EFFICACY STAGE: 4.

Arterial Function in Healthy Pregnant Women vs. Non-Pregnant Women-A 10-Year Study.

Introduction. Maternal age for the first pregnancy is increasing and so, the prevalence of cardiovascular risk factors in pregnancy is also increasing. Heart disease is the main reason for maternal death during pregnancy in developed countries. Arterial stiffness is an independent risk factor for atherosclerosis and a predictor of cardiovascular morbidity and mortality. The most widespread parameters for detecting subclinical atherosclerosis are augmentation index (AIx) and pulse wave velocity (PWV). The objective of this prospective study was to assess the differences between arterial function in pregnant vs. non-pregnant women of the same age, and its changes throughout the gestation period. Materials and Methods. Between 2010–2019, 887 patients were enrolled into 2 groups: pregnant (N1 = 471) and non-pregnant (N2 = 416). Data about their anthropometric characteristics, arterial function (for group 1 in all three trimesters and 6 weeks post-partum), smoking status and physical activity were collected. Results. There were statistically significant differences (p < α, α = 0.05) between the two groups regarding the body mass index, brachial AIx, systolic, diastolic and central blood pressure, and pulse pressure values. In the first group, there was a decrease of both brachial AIx and PWV in the second and third trimester, followed by a post-partum increase; better outcomes were noticed in physically active women. Conclusions. Arterial function modifies during pregnancy and these alterations differ according to the trimester of gestation. Further research is needed to establish the cut-off values for this category. Pregnant women can have better outcomes through physical activity.

Restless legs syndrome and arterial stiffness in pre-dialysis chronic kidney disease

Despite plenty of restless legs syndrome (RLS) studies conducted with hemodialysis patients, it has been scarcely studied in patients with predialysis chronic kidney disease (CKD). In the present study, we aimed to investigate the frequency of RLS in patients with nondialysis chronic kidney disease and explore the relationship between RLS with sleep quality, depression, pulse wave velocity (PWV), and clinical parameters. This cross-sectional study included 259 stage 3–5 predialysis CKD patients. The diagnosis of RLS was defined according to the diagnostic criteria defined by the international RLS study group. Beck depression inventory (BDI) was employed to assess depression while Pittsburgh Sleep Quality Index (PSQI) was employed to assess sleep quality. 41 patients (16%) were diagnosed with RLS. BDI and PSQI scores of patients with RLS were significantly higher than those without RLS (p = 0.01, p = 0.03, respectively). Pulse wave velocity (PWV) was significantly lower in patients with RLS (8.0 ± 1.8) than those without RLS (8.6 ± 1.9) (p = 0.05). Decrease in PWV and increase in BDI score demonstrated by multivariate analysis were shown as independent predictors of RLS development (ExpB = 1.266, p = 0.02 and ExpB = 0.957, p = 0.007 and p = 0.04, respectively). RLS is a significant problem in predialysis CKD patients and depression, and poor sleep quality is typical in these patients. Arterial stiffness is lower in these patients and any factors related to the pathophysiology of RLS might play important roles in modulating atherosclerosis.

Effect of 12weeks continuous positive airway pressure on day and night arterial stiffness and blood pressure in patients with type 2 diabetes and obstructive sleep apnea: A randomized controlled trial.

The objective of this study was to evaluate the effect of continuous positive airway pressure treatment on pulse wave velocity and blood pressure in patients with type 2 diabetes and obstructive sleep apnea. A randomized controlled study was performed, including 72 patients with type 2 diabetes and newly diagnosed obstructive sleep apnea recruited from outpatient clinics at three Danish hospitals. The patients were randomized to continuous positive airway pressure for 12weeks or no continuous positive airway pressure. Office measurements were performed at baseline, 4 weeks and 12weeks. At baseline and 12weeks, a 24-hr measurement of pulse wave velocity and blood pressure was performed. No significant change was observed in the primary outcome variable of carotid-femoral pulse wave velocity measured with SphygmoCor. With the Mobil-O-Graph, changes in office pulse wave velocity between the groups were significant: 0.3m/s; 95% confidence interval, 0.1-0.6; p=.02. The group receiving continuous positive airway pressure had a larger decrease in pulse wave velocity than controls but none of the changes within the groups were significant. No significant change in ambulatory blood pressure was observed in any of the two groups after 12weeks. In conclusion, continuous positive airway pressure treatment for 12weeks does not significantly reduce pulse wave velocity or blood pressure in patients with type 2 diabetes and obstructive sleep apnea.

Circuit resistance training and cardiovascular health in breast cancer survivors.

Cardiovascular disease is the leading cause of death in breast cancer survivors. While evidence shows circuit resistance training (CRT) is effective for improving muscle and cardiorespiratory fitness, whether CRT is an efficacious therapy for decreasing cardiovascular risk in cancer survivors is unclear. Fifty-one breast cancer survivors were recruited to either 12weeks CRT (n=26), or a non-exercising wait-list control (n=25). Two supervised 60min CRT sessions per week were undertaken, comprising resistance and functional exercises, and aerobic exercise stations. Primary outcome measure was the gold-standard assessment of arterial stiffness, aortic pulse wave velocity (PWV). Secondary outcomes included: cardiorespiratory fitness (CRF), upper and lower body strength, arterial wave reflections, central blood pressure and rate pressure product. Compared to the control group, the CRT group had a statistically significant medium effect decrease in PWV 0.9m/s (95% CI: 0.1, 1.7). There were large effect improvements in VO2 max (4.3mlkg-1 min-1 , 95% CI: 5.8, 2.8), upper and lower body strength (3.7kg, 95% CI: 1.9, 5.6 and 10.4kg, 1.6, 19.1) respectively. Findings support the existing literature demonstrating that 12weeks CRT improves muscle and cardiorespiratory fitness and is also an effective strategy for decreasing a proven cardiovascular risk factor in breast cancer survivors.

P1356 Effects of sacubitril/valsartan on vascular resistance in patients with heart failure with reduced ejection fraction and arterial hypertension

Abstract Introduction Vascular resistance as assessed by noninvasive measurement of the pulse-wave velocity (PWV) is a well-established separate risk factor for early cardiovascular morbidity and mortality. High vascular resistance leads to higher pulse wave velocities and augmented values of systolic blood pressure (SBP). That leads to elevation in myocardial oxygen consumption and elevated left ventricular (LV) wall stress, indirectly worsening the systolic function of an already failing LV. PWV can be taken as an integral index of the vascular structure and function. Sacubitril/valsartan is the first ARNI approved for the treatment of heart failure with reduced ejection fraction (HFrEF) – it simultaneously inhibits the renin-angiotensin-aldosterone system and employs the positive effects of the natriuretic peptides. The mechanisms of these remarkable effects – reduction of cardiovascular morbidity, of heart failure hospitalisations, of sudden cardiac death and of composite mortality, in patients with HFrEF are quite complex. The concomitant lowering of BP is an important element of the pathophysiologic process that improves the haemodynamic status of the patients. Purpose To evaluate the effect of sacubitril/valsartan on vascular level parameters. Materials and methods In 18 newly established patients with HFrEF and arterial hypertension we prescribed 6-month sacubitril/valsartan treatment protocol at a dose level 97/103 mg. We measured the baseline office pressure, LV ejection fraction, 2D LV strain and Е/E1 values, and we performed analysis of the arterial rigidity by measuring the following parameters: Arterial elastance Еа= systolic BP / LV stroke volume LV endsystolic elastance ЕV = systolic BP / LV telesystolic volume End-systolic stress of the LV wall: ЕSS = (0.33 х TSDLV х SBP) / PW х (1 + PW) / TSDLV) Ventricular-arterial impedance: Zva = (SBP + mean transaortic gradient) / indexed LV stroke volume. At the end of the six months" treatment protocol we measured the same parameters again. Results During the six months treating period the systolic arterial pressure fell significantly from 128 ± 9.8 mmHg to 113 ± 17 mmHg (р=0.002), and diastolic BP, also significantly, fell from 83.5 ± 9.5 mmHg to 70.1 ± 6.8 mmHg (р=0.001). There was a significant decrease in PWV, arterial elastance, end-systolic LV wall stress and in ventricular-arterial impedance, but not in the other measured parameters. Conclusion Treatment with sacubitril/valsartan at a high dose level of 97/103 mg for six months improves the indices of arterial rigidity, but does not lead to significant change in ventricular-arterial coupling, despite of significant lowering of the arterial elastance and pulse wave velocity.

Combined aerobic and low-intensity resistance exercise training increases basal nitric oxide production and decreases arterial stiffness in healthy older adults.

Meta-analyses have concluded that combined aerobic and high-intensity or moderate-intensity resistance exercise training has no effects on arterial stiffness. However, a recent study demonstrated that combined aerobic training and resistance training using rubber bands increases basal nitric oxide (NO) production and decreases arterial stiffness with marked reduction of body weight in obese adolescent girls. To investigate whether combined aerobic and low-intensity resistance training increases basal NO production and decreases arterial stiffness without body weight reduction in older adults, 27 healthy older individuals participated in a 6-week program as a part of the training group (mean body mass index, 21 kg/m2; walking and resistance training using one’s body weight) or the control group (22 kg/m2, asked not to modify their lifestyle). The exercise intervention increased aerobic capacity, muscle strength, and plasma concentrations of nitrite/nitrate (end products of NO) and decreased pulse wave velocity (an index of arterial stiffness) without changes in body weight. In the control group, there were no differences in these measures before and after the study period. These results suggest that combined aerobic and low-intensity resistance exercise training increases basal NO production and decreases arterial stiffness in healthy older adults.

P6244Cytomegalovirus (CMV) burden may be used to enhance algorithms to predict future cardiovascular health in renal transplant recipients and healthy controls

Abstract Background Cytomegalovirus (CMV) has been implicated in accelerated cardiovascular changes and may warrant inclusion in predictive algorithms. This is addressed here in healthy older adults and in renal transplant recipients (RTR) stable on therapy as they retain a high burden of CMV. Methods RTR (n=45) stable &gt;2 years after transplantation and 58 age-matched healthy adults were recruited in 2014 and returned in 2017. Venous blood samples and saliva were collected, frozen and stored. Plasma proteins linked with inflammation [soluble interferon a receptor 2 (sIFNaR2), sTNFR1, sCD14, C-reactive protein (CRP)], vasculopathy [p-selectin, intercellular adhesion molecule 1 (ICAM-1), vascular cell adhesion molecule 1 (VCAM-1)], and metrics of CMV burden [antibodies reactive with CMV lysate, gB or IE-1 (by ELISA), CMV DNA in saliva (by PCR) and T-cell IFNg responses to CMV antigens (by ELISpot)] were assessed in 2014. In 2017, vascular endpoint measurements included brachial artery flow mediated dilatation (FMD), pulse wave analysis [augmented index corrected to heart rate of 75 beats per minute (Aix@75)] and pulse wave velocity (PWV). Results In 2017, RTR had lower FMD % (p&lt;0.001), higher PWV (&lt;0.001) and slightly higher Aix@75 values (p=0.14) compared with healthy adults, indicating inferior vascular health. In a multivariable regression model (adjusted R2=0.42) predicting 2017 FMD in RTR (adjusted for age, sex, BMI, eGFR, sCD14, CMV gB Ab and saliva CMV DNA), each 1AU/mL increase of CMV gB Ab (p=0.03) predicted a 5% increase in FMD – associating with better vascular outcomes, but detectable saliva CMV DNA (p=0.02) associated with a 3% increase in FMD. In healthy adults, however, while predicting 2017 FMD (adjusting for p-selectin, ICAM-1, age, sex, BMI, eGFR; adjusted R2=0.22), a 1 ng/mL increase in p-selectin (p=0.03) predicted a 0.04% increase in FMD, and 1 ng/mL increase in ICAM-1 (p=0.03) associated with 0.03% lower FMD. From the pulse wave analyses of RTR, every 1ng/mL increase of sIFNaR2 (p=0.06) marginally predicted 1.4 unit decrease in Aix@75 (adjusted for CMV IE-1 Ab, sIFNaR2, age, sex, BMI and eGFR; adjusted R2=0.37). However in healthy adults, each 1ng/mL increase of sIFNaR2 levels (p=0.04) associated with 3.5 units worsening of Aix@75 (p=0.04) (adjusted R2 = 0.40). Each 1 AU/mL increase in CMV IE-1 Ab levels associated with 0.08 units decrease in PWV (p=0.02) (adjusting for CMV IE-1 Ab, sCD14, age, sex, BMI and eGFR adjusted R2=0.55). Conclusions Overall measures of a high burden of CMV, predicted a low FMD marking poor peripheral vascular health in RTR several years after assessment, with more potency than was achieved with plasma markers of systemic and vascular inflammation, which was observed in healthy controls. CMV antibodies can predict future measures of arterial stiffness such as Aix@75 and PWV in healthy controls, but need further investigation in larger cohorts.

P4568Effect of intravitreal anti-vascular endothelial growth factor therapy on aortic stiffness and serum interleukin-6 levels in hypertensive patients with age-related macular degeneration

Abstract Purpose Age-related macular degeneration (AMD) is the leading cause of irreversible blindness in adults over 65 years old and it is associated with moderate to severe arterial hypertension and increased aortic stiffness. Anti-vascular endothelial growth factor (anti-VEGF) agents, injected intravitreally, can reverse the symptoms of neovascular (wet) AMD. We sought to investigate whether intravitreal anti-VEGF therapy may influence aortic elastic properties of hypertensive patients with AMD. Methods 54 hypertensive patients with exudative (“wet”) AMD received intravitreal ranibizumab (0.5mg) and blood pressure (BP) and carotid-femoral pulse wave velocity (PWV) were measured at baseline (approximately 2 days before the first injection), 24 h after the first and second injection (time interval between the injections: 1 month) and 1 month after the second injection. Serum levels of high sensitivity interleukin-6 (hsIL-6) were measured at three time points (baseline, first injection, 1 month after the second injection). Results Systolic BP decreased by 3.2 mmHg and by 3.0 mmHg after the first and second injection respectively and remained decreased (by 2.6 mmHg) 1 month after the second injection (overall p=0.07, by ANOVA). The changes in diastolic BP were minimal (overall p=0.74). Ranibizumab injection caused a significant decrease of PWV after the first (by 0.34 m/s) and the second injection (by 0.31 m/s). Furthermore, as upper figure shows, PWV remained decreased 1 month after the second injection. Among the treated naïve eyes, 45 (83%) had a good response to ranibizumab while 9 (17%) were poor responders. Interestingly, PWV decreased significantly in good responders to AMD therapy (overall p=0.004) whereas, it increased in poor responders (overall p=0.21) over the study period. In responders to therapy serum hsIL-6 decreased after the first injection and remained decreased 1 month after the second injection (by 0.63 pg/ml, overall p=0.02, lower figure). The levels of hsIL-6 increased in poor responders (overall p=0.54). Ranibizumab, PWV and serum hsIL-6 levels Conclusions This is the first study showing that intravitreal administration of ranibizumab, a anti-VEGF used for improvement of wet AMD was associated with a beneficial acute and mid-term systematic effect on aortic elastic properties. Changes in systemic inflammatory activation may be involved. The findings have important implications for assessing the effect of anti-VEGF interventions on cardiovascular performance in hypertensive patients with exudative AMD.

Effect of 9 months of vitamin D supplementation on arterial stiffness and blood pressure in Graves' disease: a randomized clinical trial.

Risk of cardiovascular disease (CVD) is increased in Graves' disease (GD). CVD is predicted by increased pulse wave velocity (PWV) and blood pressure (BP). GD and these risk factors are all associated with lower levels of vitamin D. We aimed to assess the effect of supplemental vitamin D on PWV and BP in GD. In a double-blinded trial, newly diagnosed GD patients were randomized to vitamin D3 70 µg/day (n = 44) or placebo (n = 42) as add-on to anti-thyroid medication. At baseline, 3 and 9 months PWV, BP and wave analysis were performed in office and 24 h setting. Between-group differences in change at 9 months were analyzed using linear mixed modelling. In subanalysis, effect of intervention in regard to baseline vitamin D insufficiency (25(OH)D < 50 nmol/L) was investigated. (The DAGMAR study, clinicaltrials.gov ID NCT02384668). PWV was unaffected by intervention in main analysis. However in the subanalysis, comparing the response to intervention in the vitamin D insufficient (n = 28) and the vitamin D replete patients, supplemental vitamin D induced a significant decrease in office PWV of 1.2 (95% CI: -2.3; -0.1) m/s compared to placebo. Of notice, baseline PWV was non-significantly higher among the vitamin D insufficient as compared to the replete participants. In response to vitamin D, office central systolic BP (-3.9 (95% CI: -7.5; -0.3) and brachial mean BP (-3.3 (95% CI: -6.5; -0.3) declined whereas 24 h measurements were unaffected. High-dose vitamin D supplementation did not affect PWV. We observed significant reduction in office but not 24 h BP. Subanalysis showed a clinically relevant PWV reduction among vitamin D insufficient participants, although regression towards the mean might contribute to findings. Further studies on supplemental vitamin D in GD should focus on patients with vitamin D insufficiency.

OBESITY REMAINS A MAJOR RISK FACTOR ASSOCIATED WITH VASCULAR STIFFENING IN TYPE 2 DIABETES

Objective: Obesity is a modifiable risk factor for cardiovascular disease. Associations between body mass index (BMI) and vascular stiffness have been described previously, and weight loss has been found to improve vascular health. Despite this, obesity remains a major health issue in people with Type 2 diabetes (T2D). Design and method: The Proteomic prediction and Renin angiotensin aldosterone system Inhibition prevention Of early diabetic nephRopathy In TYpe 2 diabetic patients with normoalbuminuria (PRIORITY) study is a prospective stratified clinical trial assessing prediction of progression from normo to microalbuminuria in people with T2D. We measured vascular stiffness in 133 participants (carotid-femoral pulse wave velocity (PWV)) at baseline and end of study (mean follow-up 2.8 years). Results: Participants (age, 62 ± 7 years; 28% female) were characterised by well controlled traditional risk factors: blood pressure 135 ± 13 / 77 ± 9 mmHg; HbA1c, 63 ± 12 mmol/mol; total cholesterol, 4.3 ± 1.1 mmol/L; urinary albumin:creatinine ratio, 6.5 ± 4.6 mg/g; estimated glomerular filtration rate; 87 ± 13 mL/min. Median BMI was 30.7 kg/m2 (range, 20.4 to 48.9 kg/m2). During follow-up PWV remained on average stable (baseline, 9.6 ± 1.6; follow-up, 9.6 ± 1.7 m/s; P = 0.884) although 71 participants experienced an increase and 62 a decrease in PWV. Of all the above baseline parameters only BMI was associated with change in PWV (r = 0.277; P = 0.001), and BMI (median, 29.4 vs 30.5 kg/m2; P = 0.047) was the only significantly different factor (P = 0.010) between the two extreme change in PWV quartiles (−1.5 ± 0.1 vs +1.9 ± 0.3 m/s). We found that obese participants (BMI > 30 kg/m2; n = 75) had greater increase in PWV (+0.26 ± 1.18 vs −0.25 ± 1.37; P = 0.025) than normal and overweight participants (BMI < 30 kg/m2; n = 58). Conclusions: In this cohort with well controlled risk factors there was overall no significant change in PWV during follow-up. Obese people, however, experienced greater PWV progression than normal and overweight individuals. Whilst blood pressure and diabetes control are very good in this cohort, obesity remains a difficult-to-treat risk factor for vascular stiffening. In people at risk of diabetic kidney disease such as participants of the PRIORITY study, weight reduction strategies could help to further improve cardiovascular health.

Effect of Parathyroidectomy on Cardiovascular Risk Factors in Primary Hyperparathyroidism: A Randomized Clinical Trial.

It remains unclear whether risk of cardiovascular diseases is increased in patients with mild (<1.45 mmol/L) to moderate (≥1.45 to 1.60 mmol/L) primary hyperparathyroidism (PHPT). We aimed to determine the short-term effect of parathyroidectomy (PTX) on arterial stiffness, cholesterol levels, and blood pressure (BP). This study was a clinical trial randomly allocating patients to either PTX or a control group (no surgery). Follow-up was performed 3 months after surgery in the PTX group and 3 months after baseline in the control group. University hospital. We recruited 79 patients with PHPT; 69 participants completed the study. Office and ambulatory 24-hour BP, pulse wave velocity (PWV), augmentation index, and fasting plasma cholesterol levels. At baseline, participants had a median level of ionized calcium of 1.41 mmol/L (range, 1.33 to 1.60 mmol/L) and PTH of 10.4 pmol/L (4.5 to 30.4 pmol/L). Median age was 64 years (range, 18 to 81) and 72% were females. Following PTX, plasma total cholesterol levels decreased significantly compared with the controls (P = 0.04). Changes in PWV, augmentation index, and ambulatory 24-hour BP did not differ between groups, except for an increase in ambulatory diastolic BP following PTX. However, in patients with baseline levels of ionized calcium ≥1.45 mmol/L, PWV decreased significantly in response to PTX compared with the control group (P = 0.03). PTX may decrease risk of cardiovascular diseases in PHPT by lowering total cholesterol levels, although ambulatory diastolic BP increases in response to surgery. Patients with moderate to severe hypercalcemia may benefit from PTX by a decrease in PWV.

Physiotherapeutic correction of arterial stiffness at the comorbidity of arterial hypertension and hyperuricemia

Hyperuricaemia is included in the risk factors for arterial hypertension. Arterial stiffness is one of the risk factors for arterial hypertension. The purpose of the study: to evaluate the effectiveness of low level laser therapy for the correction of hyperuricaemia and stiffness of the arterial wall at the comorbidity of hyperuricaemia with arterial hypertension. The study included 92 patients: 1st group — 42 patients with arterial hypertension, 2nd group — 50 patients with arterial hypertension in combination with hyperuricaemia. The low level laser therapy was performed by the Mustang 2000 apparatus with a wavelength of 635 nm. Correlation relationship between the level of uric acid and pulse wave velocity. After low level laser therapy, the level of uric acid decreased in the 1st group by 3.4 %, in the 2nd — by 19.1 %. In the 2nd group, the decrease in uric acid after low level laser therapy was 15.7 % more intense than in the 1st group. After low level laser therapy there was a pulse wave velocity decrease in both groups. Thus, the effectiveness of low level laser therapy for the correction of arterial hypertension and the reduction of arterial wall stiffness with arterial hypertension comorbidity with hyperuricaemia are proved.

The effect of intensive therapy of atorvastatin on vascular rigidity and lipid profile in patients with ST-segment elevation myocardial infarction

Objective. To evaluate the effect of 24-week atorvastatin therapy on the lipid profile, structure and functions of the large arteries in patients with ST-elevation myocardial infarction (STEMI) with single-vessel hemodynamically significant stenosis of the coronary arteries.Design and methods. We enrolled 85 patients with STEMI aged 33 to 66 years (51,9 ± 9,3 years), 75 men (88 %), and 10 women (12 %). Inclusion criteria were: age from 30 years to 70 years, STEMI confirmed by electrocardiogram and increased troponin I and creatine kinase-MB, the presence of a significant stenosis of the infarct-related artery, stenosis of other arteries less than 50 %, and the stenosis of the trunk of the left coronary artery less than 30 %. Patients underwent laboratory (lipids) and instrumental examination at baseline (7–9 days from the symptoms onset) and 24 weeks after the therapy was started. We assessed carotid atherosclerosis by the ultrasound scanner MyLab 90 (“Esaote”, Italy). Central pressure parameters and arterial stiffness were evaluated using the applanation tonometry (SphygmoCor, “AtCorMedical”, Australia).Results. After 24 weeks of treatment patients from the control group demonstrated a decrease in total cholesterol by 26 %, low density lipoproteins — by 40,5 % and high density lipoproteins — by 3 %. Patients receiving atorvastatin 80 mg/day showed similar reduction of the parameters: by 45 %, 55 % and 14 %, respectively. Patients who took lower dose of atorvastatin showed no change in intima-media thickness (IMT), but there was a positive change of the coefficient of transverse extensibility — DC, which increased by 25 % (p &lt; 0,05). In the same cohort of patients, locPsys and locPdia increased by 5,4 and 3,6 mm Hg, respectively, and there was a 3,5-fold increase in the augmentation index (p &lt; 0,05). In the group of high-dose atorvastatin therapy carotid IMT decreased by 11 % after 24 weeks (p &lt; 0,05). The coefficient of transverse compliance (CC) increased by 11 % (p &lt; 0,05), the stiffness indices α and β significantly decreased by 11 % and 13 %, respectively (p &lt; 0,05). There was also a decrease in pulse wave velocity (PWV) measured locally in the carotid arteries by 6 % (p &lt; 0,05). We found a 3-fold increase in augmentation pressure (AP) and augmentation index (Aix) after 6 months of therapy (p &lt; 0,05).Conclusions. Patients who receive the maximum daily dose of atorvastatin develop a more significant improvement of lipid profile compared to the control group. Our results are consistent with the statement of the American Association of Cardiologists proving that high-dose statin therapy can reduce the level of low density lipids by more than 50 % compared to the baseline values. Using the radiofrequency analysis of the ultrasound signal (echotracking), we analyzed the stiffness parameters α and β, the compliance and distensibility coefficients, which reflect the vascular wall rigidity, regardless of the arterial pressure level. When comparing two schemes of atorvastatin therapy, intensive therapy showed a more evident favourable effect on carotid stiffness.

Abstract P318: Cardiac and Vascular Changes in Patients With Morbid Obesity at 12 Months After Bariatric Surgery

Aim: To analyze changes in echocardiographic parameters and vascular stiffness in patients with morbid obesity, with either normal or high blood pressure, at 12 months after BS. Methods: We prospectively studied 62 patients (61% normotensive) with morbid obesity (BMI 42.7 ± 5.6 Kg/m 2 ) before and 12 months post-BS. Pulse wave velocity (PWV) was determined, as well as different morphological and functional echocardiographic parameters. Results: generalized estimation equations showed a decrease in PWV at 6 months [mean (95% CI): -0.13 (-0.25 to -0.02), p=0.021], losing statistical significance at 12 months. Regarding cardiac involvement, the Table shows the changes in the different parameters at 12 months post-BS. Significant decreases were observed in the left ventricular mass (LVM), thickness of the interventricular septum (IST) and posterior wall (PWT), and relative wall thickness (RWT), as well as in the index E/e 'of ventricular filling, but not in the left ventricular mass index (LVMI). These changes were especially significant in normotensive patients (p=0.005 for RWT and IST, p=0.001 for the PWT and p = 0.004 for the LVM). In the adjusted analyzes, it was found that the changes observed in the LVM were determined by changes in weight (p &lt;0.001) and changes in 24h-systolic BP(p=0.011). Conclusion: patients with morbid obesity experience 12 months after BS a significant reduction of the structural parameters of the left ventricle, especially when they are assessed with the RWT but not by LVMI. These changes are also significant in normotensive people, suggesting that factors other than obesity per se determine structural cardiac changes in them.

Measurement of pulse wave velocity, augmentation index, and central pulse pressure in atrial fibrillation: a proof of concept study

Individualized weighing of the risk benefit of anticoagulation is recommended in patients with atrial fibrillation (AF) who have low established risk scores or, conversely, are at increased risk for bleeding. Parameters of arterial stiffness and wave reflection could improve risk stratification, but their use has not been evaluated in arrhythmia. We measured carotid-femoral pulse wave velocity (PWV), central augmentation index (AI), and central pulse pressure (CPP) using the SphygmoCor system in 34 patients (53 to 85 years; 25 males) with AF before and after elective electrical cardioversion. Agreement was assessed using the intraclass correlation coefficient (ICC) and the coefficient of variation, completed with Bland–Altman plots. After cardioversion, mean arterial blood pressure (MAP) and heart rate (HR) decreased significantly by 8 mmHg and 18 bpm, respectively. PWV decreased from 11.8 m/s to 10.7 m/s, AI increased from 24% to 29%, and CPP rose from 38 mmHg to 43 mmHg. The decrease in PWV was related to the decrease in MAP (beta = 0.57; R2 = 0.33; P < .001), whereas changes in AI and CPP were related to the decrease in HR (AI: beta = −0.59; R2 = 0.35; P < .001, CPP: beta = −0.55; R2 = 0.28; P = .001). After adjustment for changes in MAP and HR, reliability analysis showed an excellent agreement for PWV (ICC = 0.89; 95% confidence interval (CI): 0.79–0.95) but moderate agreement for AI (ICC = 0.59; 95% CI: 0.17–0.80). Excellent agreement was also found for CPP (ICC = 0.89; 95% CI: 0.72–0.95). Measurement of PWV and CPP is reliable in patients with AF, as they appear unaffected by the presence of arrhythmia.