Determinants Of Pulse Wave Velocity Research Articles

#2570 Non-invasive blood pressure monitoring in dialysis patients using pulse wave velocity

Abstract Background and Aims Dialysis patients are at high risk of circulatory dysregulation and hypotension during treatment. Intradialytic hypotension (IDH) is a potentially life-threatening complication. The main causes are high ultrafiltration volumes and high ultrafiltration rates when patients tend to gain a lot of weight between dialysis treatments. A lack of patient compliance with regard to drinking volumes and a lack of residual diuresis are risk factors for this. Close circulatory monitoring and therapy settings to avoid absolute or relatively high UF rates to prevent IDH are frequently used. These are primarily the frequent non-invasive measurement of blood pressure using cuffs, the measurement of relative blood volume and the adjustment of ultrafiltration rates to these values. Prophylactically, the dialysis time can be extended, ultrafiltration profiles or ultrafiltration breaks can be planned, the dialysate temperature can be lowered and the composition of the dialysate can be adjusted. Despite all attempts, however, the incidence of IDH in everyday clinical practice is too high. The non-invasive measurements with cuffs are not carried out frequently enough, the measurement of the relative blood volume only covers a partial range, sudden changes in vascular tension or cardiac output are not recorded. Method The pulse wave velocity (PWV) is a well-known parameter for describing the propagation of the pressure wave after ejection of the heart beat volume in the arteries. The PWV is dependent on blood pressure, vessel wall tension and cardiac output. Changes in blood pressure can therefore be recognised by measuring the PWV. With the help of a measuring device (PESAS) for the ECG signal and peripheral pulse plethysmography, PWV can be measured non-invasively, continuously, for every heartbeat and, above all, hardly noticed by the patient. The PESAS allows the time-synchronised measurement of ECG and peripheral plethysmography curves and thus the determination of PWV. It is an experimental device. We would like to present a study showing the use of a measuring device (PESAS) in 15 prevalent dialysis patients for the detection of IDH. All study participants were examined during 3 dialysis treatments. Results The measurement of PWV in chronic dialysis patients during treatment is technically feasible. The measurement is tolerated by the patients. Changes in PWV could be detected in the patients during the course of dialysis; these were also dependent on the ultrafiltration rates. Individual patient reactions to volume withdrawal varied, with both increases and decreases in PWV being demonstrated. An acute change in PWV was usually associated with a drop in blood pressure. Continuous measurement allowed IDH events to be detected earlier than intermittent blood pressure measurement with cuffs. Sudden drops in blood pressure could be detected better and earlier with the PESAS system than by measuring the relative blood volume. Conclusion The PESAS system is suitable for monitoring dialysis patients to prevent IDH. Further adjustments and optimisation of the evaluation algorithms are necessary.

Association between proinflammatory cytokines and arterial stiffness in type 1 diabetic adolescents.

Type 1 diabetes mellitus is considered a state of chronic low-grade inflammation and activation of the innate immune system, which is regulated by several proinflammatory cytokines and other acute-phase reactants. Arterial stiffness, a dynamic property of the vessels evaluated by the determination of pulse wave velocity (PWV), is increased in diabetic patients and is associated with microvascular and macrovascular complications of diabetes and higher cardiovascular risk. In the present study, we aimed to compare the proinflammatory state and arterial stiffness in diabetic and non-diabetic adolescents, and to characterize the association between these two parameters. Twenty-three type 1 diabetic patients, aged 12-16 years, followed at a tertiary center, and 23 adolescents nonoverweighted healthy controls, from a Portuguese birth-cohort, were included in the present analysis. Anthropometry, blood pressure, glycemic control data, and lipid parameters were collected. Arterial stiffness was evaluated by carotid-femoral pulse wave velocity. Proinflammatory cytokines' concentrations (TNF-α, IL-1β, IL-6, IL-10, IFN-γ, and GM-CSF) were quantified by multiplex immunoassays using a Luminex 200 analyzer. There were no statistically significant differences between the proinflammatory cytokines' concentrations in the two groups. PWV [6.63 (6.23-7.07) vs. 6.07 (5.15-6.65) m/s, p=0.015] was significantly higher in the diabetic group. PWV was negatively correlated with GM-CSF (ρ=-0.437, p=0.037) in the diabetic group. A linear association was found between diabetes duration and PWV (with PWV increasing by 0.094 m/s (95 % confidence interval, 0.019 to 0.169) per month of disease duration). In the diabetic group, HbA1c was negatively correlated with IL-10 (ρ=-0.473, p=0.026). Negative correlations were also found between IL-10 and total, HDL, and LDL cholesterol only in the diabetic group. Diabetic adolescent patients present higher PWV, when compared to their healthy counterparts, even though we could not find differences in the levels of several proinflammatory cytokines between the two groups. The negative correlation found between IL-10 and HbA1c might translate a protective counterbalance effect of this anti-inflammatory cytokine, which might also explain the negative correlations found with blood lipids. Further studies are needed to better clarify the association between arterial stiffness and the proinflammatory milieu of diabetes.

Arterial stiffness assessment in obese black South African patients.

Increased arterial stiffness is a determinant of cardiovascular mortality and an independent marker of cardiovascular disease. The objective of this study was to asses arterial elasticity by determination of pulse-wave velocity (PWV) and augmentation index (Aix) in obese black patients. PWV and Aix were assessed non-invasively using the AtCor SphygmoCor® system (AtCor Medical, Inc, Sydney, Australia). The study participants were divided into four groups; healthy volunteers (HV) (n = 29), patients with concomitant diseases but normal body mass index (Nd) (n = 23), obese patients without concomitant diseases (OB) (n = 29) and obese patients with concomitant diseases (OBd) ( n = 29). The difference in the mean levels of PWV was statistically significant in the obese group with and without concomitant disease. The PWV in the OB group (7.9 ± 2.9 m/s) and in the OBd group (9.2 ± 4.4 m/s) was, respectively, 19.7 and 33.3% higher than in the HV group (6.6 ± 2.1 m/s). PWV was directly correlated with age, glycated haemoglobin level, aortic systolic blood pressure and heart rate. The risk of cardiovascular diseases in the obese patient without additional diseases was increased by 50.7%. The presence of concomitant diseases (type 2 diabetes mellitus and hypertension) in addition to obesity increased arterial stiffness by a further 11.4% and therefore also increased the risk of cardiovascular diseases by a further 35.1%. Aix was increased in the OBd and Nd groups by 8.2 and 16.5%, respectively, however the increase was not statistically significant. Aix was directly correlated with age, heart rate and aortic systolic blood pressure. The obese black patients had a higher PWV, indicating increase in arterial stiffness and therefore a higher risk for cardiovascular disease. In addition, aging, increased blood pressure and type 2 diabetes mellitus contributed further to arterial stiffening in these obese patients.

IMPACT OF BODY POSITION ON ARTERIAL STIFFNESS OF ELASTIC AND MUSCULAR ARTERIES

Objective: Arterial stiffness is assessed through determination of pulse wave velocity (PWV) over an arterial segment of interest. Measurements are traditionally done in a supine position, which is both practical for high quality arterial pressure wave recordings, and the stability of pressure exerted on the arterial wall along the arterial path. The aim of this project was to study the effect of body position on the stiffness of elastic and muscular arteries. Design and method: This study was conducted with healthy adults. Aortic (cf-PWV) and brachial stiffness (CR-PWV) were repeatedly measured in three different positions (supine, 30̊ and 60̊) using the Complior Analyse. Brachial blood pressure (Mobil-O-graph) was also measured in each position. Generalized Estimating Equations in SPSS were performed to establish changes of PWV between positions. Results: In 23 healthy individuals (65% female, mean age of 36±15 years, and mean systolic (SBP) and diastolic blood pressures (DBP) of 120±2 mmHg and 76±2 mmHg, respectively), CF-PWV increased progressively with body tilting (8.7 (CI95% = 8.0–9.4) m/s supine, 9.4 (CI95% = 8.8–10.0) m/s at 30̊ and 9.5 (CI95% = 8.8–10.1) m/s at 60̊) (p<0.001)). On the other hand, CR-PWV didn’t significantly change with body tilting (8.7 (CI95% = 8.0–9.3) m/s supine, 8.8 (CI95% = 8.0–9.6) m/s at 30̊ and 8.9 (CI95% = 8.1–9.6) m/s at 60̊). SBP didn’t significantly change with body tilting (120 (CI95% = 116-125) mmHg supine, 121 (CI95% = 116–125) mmHg at 30̊ and 122 (CI95% = 117-126) mmHg at 60̊), while DBP increased (76 (CI95% = 71-80) mmHg supine, 78 (CI95% = 73–83) mmHg at 30̊ (p<0.022) and 81 (CI95% = 77-85) mmHg at 60̊ (p<0.001)). Heart rate also increased with body tilting (68 (CI95% = 64–72) BPM supine, 69 (CI95% = 65–73) BPM at 30̊ and 77 (CI95% = 72–82) BPM at 60̊ (p<0.001)). Conclusions: These preliminary results show that elastic and muscular arteries tend to react differently to body positions, without significant changes in arterial stiffness of medium muscular arteries in the arm.

IMPACT ASSESSMENT MONO- AND COMBINATION ANTIHYPERTENSIVE THERAPY LERCANIDIN AND DILTIAZEM ON CENTRAL BLOOD PRESSURE AND ARTERIAL STIFFNESS IN PATIENTS WITH MILD TO MODERATE ARTERIAL HYPERTENSION

Nowadays widely debated search of new methods to reduce cardiovascular risk in thepopulation. Many randomized studies have proven the value of the arterial wall stiffnessin the forecast deterioration of cardiac patients. Therefore, based on these considerationstherapy that improves the elasticity of the arteries may have greater efficacy in preventingmajor cardiovascular events.Purpose – to compare the effectiveness of combination lerсanidipin and diltiazem indifferent dose in patients with mild and moderate arterial hypertension on effects oncentral blood pressure and arterial stiffness.Materials and methods. The study included 123 patients with mild to moderate arterialhypertension, the average office systolic (SBP) / diastolic (DBP) blood pressure – 149,12/ 91,92 ± 1,42 / 0,93 mm Hg. Average age of patients was 51,83 ± 0,86 years. All patientswere divided into group therapy. The first group (n = 20) – diltiazem administered topatients at a dose of 240 mg per day in two divided doses. The second group (n = 20) –patients lerkanidipin 20 mg administered once daily. The third group (n = 22) – patientsintended unfixed combination lerkanidipin 20 mg and 240 mg diltiazem day. The fourthgroup (n = 20) – patients intended unfixed combination lerkanidipin 10 mg and 240 mgdiltiazem day. The fifth group (n = 21) –patients intended unfixed combination lerkanidipin10 mg and 120 mg diltiazem day. The sixth group (n = 20) – patients intended unfixedcombination lerkanidipin 20 mg and 120 mg diltiazem day.All patients at the beginning and end of treatment conducted the following studies:measurement of body weight and height, calculation of body mass index. Measurementoffice SBP, DBP and HR, ambulatory blood pressure monitoring (DMAT), determinationof pulse wave velocity in elastic arteries (PWVe) and muscle (PWVm) types, the definitionof central BP, biochemical blood which included determination of total cholesterol(cholesterol), triglycerides (TG), high density lipoprotein cholesterol (HDL cholesterol),low density lipoprotein cholesterol (LDL-C). Duration of treatment was 1 month.Results. After analyzing all the data, it was found that the сentral blood pressure in alltreatment groups decreased effectively and equally. In the group of 240 mg diltiazemcentral BP significantly decreased by 10.95 mmHg; in group lercanidipin 20 mg 12.18mmHg; in the combination group lercanidipin 20 mg / diltiazem 240 mg 14.13 mm Hg. Inthe combination group lercanidipin 10 mg / diltiazem 240 mg central BP decreased on11.93 mmHg; in the combination group lercanidipin 10 mg / diltiazem 120 mg centralblood pressure decreased on 13.11 mmHg; in the combination group lercanidipin 20 mg /diltiazem 120 mg central blood pressure decreased on 14.82 mmHg. That is, all selectedtreatment regimens were equally effective in reducing central blood pressure. There wasno negative impact on the treatment of all levels of blood lipid spectrum. All treatmentregimen did not significantly affect the average values of indicators characterizing theelastic properties of the arteries (due to short-term observation).Conclusion. Therapy based on both mono and combination lercanidipin and diltiazemwas effective in reducing central blood pressure and did not significantly affect theaverage values of indicators characterizing the elastic properties of the arteries.

PS-BPC10-3: DETERMINATION OF AORTIC STIFFNESS USING TWO ESTABLISHED ALGORITHMS

Objectives: Arterial stiffness is a risk factor for cardiovascular disease. Aortic stiffness is assessed by determination of pulse wave velocity using pulse transit time and the distance between carotid and femoral arteries. Transit time is obtained by using the foot-to-foot method to define the transit time through intersecting tangents algorithm or the point of maximal upstroke during systole (2nd derivative). Millasseau et al have proposed a formula for converting transit time between methods using SphygmoCor (intersecting tangents) and the Complior Analyse (2nd derivative). Based on a mathematical modeling of the proposed formula, there is discrepancy between values of pulse wave velocities, especially in subjects with higher aortic stiffness. The objective is to directly compare the two methods using the same pressure waveforms obtained by the newer generation of Complior Analyse and using Millasseau formula. Design and Methods: In a cross-sectional study of heterogeneous subjects, aortic stiffness was assessed by the Complior device which uses 2nd derivative. The pulse waveforms were extracted and used for the analysis by custom MATLAB algorithm for intersecting tangents, and the results were compared to the formula proposed by Millasseau. Results: The preliminary results of the first 24 patients (men: 71%; mean age: 61 ± 18 years) show that Millasseau formula underestimates the transit times values by about 19% in comparison with the transit times obtained by the intersecting tangents method using MATLAB software (50 ± 19 ms vs 62 ± 19 ms; P < 0.001). This results in an overestimation of the pulse wave velocities values by about 30% (13.8 ± 3.8 m/s vs 10.6 ± 2.7 m/s; P < 0.001). Conclusions: Our preliminary results allow us to conclude that the values of pulse wave velocities obtained with Millasseau formula overestimate values as compared to the values obtained by intersecting tangents method. Increasing the number of subjects will allow us to examine the possibility of a more reliable formula for converting transit times between methods.

Photoplethysmographic imaging and analysis of pulsatile pressure wave in palmar artery at 10 wavelengths.

As a noncontact method, imaging photoplethysmography (iPPG) may provide a powerful tool to measure pulsatile pressure wave (PPW) in superficial arteries and extract biomarkers for monitoring of artery wall stiffness. We intend to develop a approach for extraction of the very weak cardiac component from iPPG data by identifying locations of strong PPW signals with optimized illumination wavelength and determining pulse wave velocity (PWV). Monochromatic in vivo iPPG datasets have been acquired from left hands to investigate various algorithms for retrieval of PPW signals, distribution maps and waveforms, and their dependence on arterial location and wavelength. A robust algorithm of pixelated independent component analysis (pICA) has been developed and combined with spatiotemporal filtering to retrieve PPW signals. Spatial distributions of PPW signals have been mapped in 10 wavelength bands from 445 to 940nm and waveforms were analyzed at multiple locations near the palmar artery tree. At the wavelength of 850nm selected for timing analysis, we determined PWV values from 12 healthy volunteers in a range of 0.5 to 5.8m/s across the hand region from wrist to midpalm and fingertip. These results demonstrate the potentials of the iPPG method based on pICA algorithm for translation into a monitoring tool to characterize wall stiffness of superficial artery by rapid and noncontact measurement of PWV and other biomarkers within 10s.

Arterial Stiffness and Chronic Kidney Disease Progression in Children.

CKD has been linked to increased arterial stiffness in adults, but data in children with CKD remain conflicting. We aimed to investigate the longitudinal dynamics and determinants of pulse wave velocity in children with CKD and its association with CKD progression. We performed an analysis of the Cardiovascular Comorbidity in Children with Chronic Kidney Disease (4C) study, which prospectively followed children aged 6-17 years with CKD stages 3-5. Follow-up was censored at the time of KRT initiation. Two separate analyses were performed: with absolute pulse wave velocity (primary outcome) and with pulse wave velocity standardized to height (z score; restricted to participants ≤17 years) as a sensitivity analysis. In total, 667 patients with a mean baseline eGFR of 27 ml/min per 1.73 m2 were included. Pulse wave velocity above the 95th percentile was observed in 124 (20%) patients at baseline. Absolute pulse wave velocity increased gradually over the median follow-up of 2.7 (interquartile range, 0.7-4.4) years, whereas pulse wave velocity z score remained relatively stable. Absolute pulse wave velocity over time associated with time; older age; higher mean arterial pressure, LDL cholesterol, and albuminuria; and lower ferritin. Pulse wave velocity z score (n=628) was associated with the same variables and additionally, with higher diastolic BP z score, lower height z score, younger age, and girls. Of 628 patients, 369 reached the composite end point of CKD progression (50% eGFR loss, eGFR <10 ml/min per 1.73 m2, or the start of KRT) during a median follow-up of 2.4 (interquartile range, 0.9-4.6) years. Pulse wave velocity z score did not associate with CKD progression by univariable or multivariable proportional hazard analysis correcting for the established predictors eGFR, proteinuria, and BP. Pulse wave velocity is increased in children with CKD but does not associate with eGFR or CKD progression.

Diabetes Affects the Relationship between Heart Rate Variability and Arterial Stiffness in a Gender-Specific Manner.

Background and Aims: Heart rate variability (HRV), i.e., the beat-by-beat fluctuations in heart rate (HR) reflecting the autonomic nervous system balance, is altered in patients with diabetes. This has been associated with arterial aging (stiffer arteries) and differs in men and women. The present study hypothesized that the impact of HRV on arterial aging, indexed as carotid–femoral pulse wave velocity (PWV), differs in a gender-specific manner and is affected by diabetes mellitus. Method: A total of 422 outpatients (187 women and 235 men) were studied. PWV was measured using the validated SphygmoCor device (AtCor Medical). Time-domain and frequency-domain parameters were measured to assess HRV. Results: The prevalence of diabetes was 30.8% with a slight, but nonsignificant, greater prevalence in men. Both age and SBP were independent determinants of PWV in each of the four groups (men and women with or without diabetes). Low-frequency activity was inversely correlated with PWV. It was greater in women without diabetes, but it was not significant in men regardless of the presence of diabetes. Conclusions: Beyond age, blood pressure, and diabetes, impaired cardiac autonomic function assessed by determination of HRV was significantly associated with arterial aging. The association between lower sympathetic and parasympathetic activity and stiffer arteries was significant in women, but not in men.

DIRECT COMPARISON OF INTERSECTING-TANGENTS VERSUS SECOND DERIVATIVE FOR DETERMINATION OF PULSE TRANSIT TIME AND PULSE WAVE VELOCITY

Objective: Arterial stiffness is a non-traditional risk factor for cardiovascular disease. Aortic stiffness is assessed by determination of pulse wave velocity using pulse transit time and the distance between carotid and femoral arteries. Transit time is obtained by using the foot-to-foot method to define the transit time through intersecting tangents algorithm or the point of maximal upstroke during systole (2nd derivative). Millasseau et al have proposed a formula for converting transit time between methods using SphygmoCor (intersecting tangents) and the Complior Analyse (2nd derivative). Based on a mathematical modeling of the proposed formula, there is discrepancy between values of pulse wave velocities, especially in subjects with higher aortic stiffness. The objective of this study is to directly compare the two methods using the same pressure waveforms obtained by the newer generation of Complior Analyse and using Millasseau’s formula. Design and method: In a cross-sectional study of heterogeneous subjects, aortic stiffness was assessed by the Complior Analyse device which uses 2nd derivative. The pulse waveforms were extracted and used for the analysis by custom MATLAB algorithm for intersecting tangents, and the results were compared to the formula proposed by Millasseau. Results: The preliminary results of the first 24 patients (men: 71%; mean age: 61 ± 18 years) show that Millasseau’s formula underestimates the transit times values by about 19% in comparison with the transit times obtained by the intersecting tangents method using MATLAB software (49,8 ± 18,8 ms vs 61,6 ± 18,6 ms; P &lt; 0,001). This results in an overestimation of the pulse wave velocities values by about 30% (13,8 ± 3,8 m/s vs 10,6 ± 2,7 m/s; P &lt; 0,001). Conclusions: Our preliminary results allow us to conclude that the values of pulse wave velocities obtained with Millasseau’s formula are overestimated values when comparing with values obtained by using the intersecting tangents method. Increasing the number of subjects will allow us to examine the possibility of a more reliable formula for converting transit times from one method to the other.

Association between Long-Term Change in Arterial Stiffness and Cardiovascular Outcomes in Kidney Transplant Recipients: Insights from the TRANSARTE Study.

(1) Background: Increased arterial stiffness is associated with cardiovascular (CV) diseases in end-stage renal disease (ESRD) patients, and CV mortality remains higher in kidney transplantation (KT) recipients compared to in the general population. KT is associated with an improvement in arterial stiffness in the early post-transplant period, followed by a potential re-worsening in the late period. In a cohort of KT patients, we evaluated the associations of pulse-wave velocity (PWV) measured at different time-points (pre-transplant, and early and late post-transplant periods) with CV morbi-mortality, as well as the evolution between these measurements with CV morbi-mortality. (2) Methods: Forty KT recipients with a 10-year follow-up were included. The association of PWV with CV events was assessed with multivariable cox analysis. Backward linear regressions were conducted to identify the determinants of PWV at 1 year and those of the long-term evolution of PWV after KT (delta PWV at 1 year—latest PWV). (3) Results: The absence of arterial stiffening during the long-term follow-up after KT is associated with a lower CV outcome rate (HR for the delta PWV = 0.76 (0.58–0.98), p = 0.036). Age at KT is associated with the worsening of arterial stiffness in the late post-transplantation period (β for the delta PWV = −0.104, p = 0.031). A high PWV at 1 year was associated with a potential for recovery during follow-up (β = 0.744, p < 0.0001). (4) Conclusions: The absence of PWV worsening in the late post-transplantation period was significantly associated with a lower risk of CV events, whereas early changes in PWV were not. Finding an intervention capable of reducing long-term PWV could improve the prognosis of KT recipients.

Feasibility of Calculating Aortic Pulse Wave Velocity from Oscillometric Upper Arm Pulse Waves Using the Antares Algorithm

BackgroundAntares is an algorithm for oscillometric blood pressure (BP) monitors to determine aortic pulse wave velocity (PWV) solely using oscillometric pulse waves without dependence of any other input. The aim of this study is to test Antares PWV for feasibility and whether the known age and blood pressure dependence of PWV can be shown with Antares PWV.MethodsIn total, 259 patients were investigated for PWV as sub-study of the invasive validation of Antares algorithm, of which 219 entered analyses. Non-invasive PWV determination by Antares algorithm, integrated into an oscillometric BP monitor (custo screen 400) was compared to five different ePWV equations based on age, BP, or both. Additionally, in a subset of 27 patients, comparison of ARCSolver PWV algorithm (Mobil-O-Graph) with Antares PWV and ePWV was conducted.ResultsMean differences ± SD between Antares PWV and (A) ePWV (based on age and systolic BP) was − 0.05 ± 1.06 m/s (Spearman’s rank correlation coefficient, rS = 0.805); (B) ePWV (based on age) was − 1.75 ± 1.17 m/s (rS = 0.829); (C) ePWV (based on mean BP) was − 1.35 ± 1.24 m/s (rS = 0.763), and (D) ePWV (based on age and mean BP) was − 1.64 ± 1.22 m/s (rS = 0.810) and − 1.69 ± 1.18 m/s (rS = 0.802). Comparison of Antares PWV with ARCSolver PWV revealed a mean difference of − 0.65 ± 1.31 m/s (rS = 0.854).ConclusionThe Antares algorithm confirmed its feasibility to use an oscillometric BP monitor as a single-point measurement device to calculate aortic PWV with acceptable comparability and high correlation to both estimated PWV and ARCSolver PWV. Antares achieves these results solely based on analysis of waveform features without requiring any secondary input, like BP or age.

P242 Latent Tuberculosis: frequency of occurrence and effect on clinical, laboratory, endoscopic and morphological activity of the course Inflammatory Bowel Diseases

Abstract Background Early diagnosis of tuberculosis remains challenging due to the nonspecific clinical manifestations that can mimic other gastrointestinal diseases and range from acute to chronic abdominal disease. In recent decades, latent tuberculosis (LTI) has been of particular interest. Patients with inflammatory bowel disease (IBD) are at risk of contracting tuberculosis. Aim to identify the incidence of LTI in patients with IBD and its effect on the clinical, laboratory, endoscopic and morphological activity of IBD. Methods The study included 350 patients with IBD, who were monitored and a group of patients (188 people (UC = 80, CD = 101, MC = 7) who did not respond / or poorly respond to basic IBD therapy were identified. In this group, the determination of the quantiferon test was carried out. To achieve this goal, two main hypotheses were considered: assessment of IBD-associated and systemic vascular lesions (h/s CRP, platelet count, homocysteine, vit D, urine albumin, fecal calprotectin and lactoferrin; α-TNF, IL-1,IL-2,IL-4,IL-6,IL-8,IL-10,IL-18; endoscopic examination with pathomorphological assessment), assessment of changes in the thickness of the vascular intima and blood flow velocity (based on the doppler determination of the pulse wave velocity (PWV) and the thickness of the intima media (CIMT) on the common carotid, vertebral and subclavian arteries). Results The number of positive responses to the quantiferon test was found in 37 patients (19.7%) / 10.6%) out of 188 patients (53.7%); positive skin tests (Mantoux reaction) ≥5 mm in 78 (22.3%) patients; altered peritoneal lymph nodes in 28 (8%), pulmonary and pleural TB in 9 (2.57%) patients. There were no patients with intestinal TB / “+” TB PCR in the gastrointestinal tract tissue. The prevalence of positive cases according to the quantiferon test was: in the general group of patients - 10.6%. Laboratory indicators for both IBD and systemic vascular lesions were higher in the group of patients with latent tuberculosis (Table 1, Table 2). Damage to the vascular bed (based on doppler determination of pulse wave velocity (PWV) and intimal thickness (CIMT) on the common carotid, vertebral and subclavian arteries) was more pronounced in the group of patients with latent tuberculosis (CIMT (mm) 0.68 ± 0, 1 / 0.67 ± 0.2; PWV (sm / s) 93.3 ± 2.2 / 97.2 ± 1.4). Conclusion Conclusion. Comparing the results of the data before and after the treatment of latent TB in patients with IBD, certain dependences of the influence of infection on the course of IBD (h/s CRP, platelet levels, homocysteine, fecal calprotetin and lactoferrin, IL-8 and a decreased vit. D; changes, associated with damage to the vascular bed), endoscopic and morphological activity.

Pulse Wave Velocity, Central Haemodynamic Parameters, and Markers of Kidney Function in Children

Objectives: Chronic kidney disease (CKD) is a well-established risk factor for cardiovascular diseases. Studies in adults have demonstrated the association between mildly decreased kidney function or even normal values of markers of kidney function to pulse wave velocity (PWV), a measure of arterial stiffness and a predictor of cardiovascular events. Our study aimed to evaluate associations between markers of CKD, PWV, and central haemodynamic parameters in children and adolescents at risk of subclinical kidney damage. Methods: 182 children and adolescents with hypertension, obesity, or hypercholesterolaemia (risk factors for subclinical kidney damage) were included in the study. The subjects were subdivided into 4 groups comprising children and adolescents with hypertension (group 1), obesity (group 2), hypercholesterolaemia (group 3), and a group with a combination of risk factors, such as obesity-related hypertension and metabolic syndrome (group 4). The study groups were compared to a group of healthy controls (group 5). PWV was measured by applanation tonometry (SphygmoCor, SCOR-Vx, Sydney, NSW, Australia) and laboratory parameters (serum creatinine, serum cystatin C, and microalbuminuria) were collected. Results: Pearson’s correlation coefficient demonstrated a statistically significant correlation between PWV and serum creatinine in group of all subjects (r = 0.220, p = 0.002). Further subdivision showed the correlation was significant in group 4 (r = 0.370, p = 0.002). In group 2 a correlation between PWV and cystatin C was found (r = −0.535, p = 0.009). In multiple regression analysis of all subjects with PWV as the dependent variable, age and diastolic blood pressure were statistically significant. Correlations between markers of kidney function and central haemodynamic parameters also showed significant correlations between serum creatinine and heart rate (HR) (r = −0.476, p < 0.001) as well as associated parameters (augmentation index, standardized at HR 75/min, ejection duration, and subendocardial viability ratio). Conclusions: Our study demonstrated a correlation between serum creatinine and PWV in children with combined risk factors for atherosclerosis and probable subclinical kidney damage. Further prospective research is needed to confirm the findings, and thus the preventive role of PWV determination in paediatric nephrology.

АЛГОРИТМ СТРАТИФИКАЦИИ СЕРДЕЧНО-СОСУДИСТОГО РИСКА У МУЖЧИН В ВОЗРАСТЕ 18-29 ЛЕТ С СИНДРОМОМ АРТЕРИАЛЬНОЙ ГИПЕРТЕНЗИИ

Background: Arterial hypertension (AH) is a leading factor of cardiovascular risk (CVR), and stratification of CVR in young patients with AH is an important area of clinical research. Aim: to develop an algorithm for CVR stratification in men aged 18-29 years with AH syndrome (AHS). Materials and methods: 165 men underwent a complete physical examination, which included standard clinical, laboratory and instrumental methods, ergomtry test, analysis of heart rate variability, pulse wave velocity determination. Results: The clinical characteristics and features of the cardiovascular system functioning at rest and during ergometry test have been determined, depending on the nosological form of AHS and the established CVR. The algorithm has been developed based on the assessment of the type of hemodynamic response and determination of the probability of cardiovascular outcomes within 10 years. Conclusion: the proposed algorithm enables to optimize therapeutic, diagnostic and preventive measures in men aged 18-29 years with AHS.

RELATIONSHIPS HOMOCYSTEINE AND ARTERIAL STIFFNESS IN PATIENTS WITH H-TYPE ARTERIAL HYPERTENSION

Objective: The aim of our study was to evaluate the prevalence of hyperhomocystinemia in patients with mild to moderate hypertension, to investigate the relationship between hyperhomocystinemia with arterial stiffness. Design and method: In the study was included 40 patients with mild and moderate hypertension. Performed measurements of office SBP, DBP, (24AMBP), determination of pulse wave velocity in arteries of elastic (PWVel) and muscular (PWVm) types, central SBP, biochemical blood test with homocysteine. Homocysteine &gt; = 10 μmol / l), the called H-type hypertension. Patients treatment mono-, dual or triple combination (telmisartane, amlodipine, hydrochlortiazide). All tests was performed before and after 6 month therapy. Statistical results was performed using the software IBM Statistics SPSS 21. Results: The mean age of patients was 55.85 ± 2.09 (26 – 74) years. The average body weight was 87.3 ± 2.77 kg. The average BMI is 29.41 ± 0.63 kg / m2. The average office SBP/DBP at the beginning of the study were 155.88 ± 1.63/92.60 ± 1.43 mm Hg. The average office heart rate 71.40 ± 1.29 beats / min. Mean 24 SBP/DBP monitoring were 139.37 ± 1.49/82.47 ± 1.84 mm Hg. The average daily heart rate 71.38 ± 1.32 beats / min. We found that at the beginning of the study, 75% (30 patients with mild and moderate hypertension) had elevated of blood homocysteine more than 10 μmol / l). PWV was associated after regression analyses with homocysteine. PWV el after treatment (r = 0,307, p = 0,001). PWV m after treatment (r = - 0,733, p = 0,001). Office SBP after treatment (r = 0,423, p &lt; 0,001). Office DBP after treatment (r = - 0,675, p = 0,001). CKD-EPI after treatment (r = - 0,342, p = 0,005). BMI after treatment (r = 0,227, p = 0,026). Creatinine before treatment (r = -0,411, p = 0,003). Creatinine after treatment (r = 0,572, p = 0,011). Conclusions: Homocysteine associated with vascular stiffness, independent of the blood pressure reduction during treatment.

RELATIONSHIP BETWEEN ARTERIAL STIFFNESS, PHYSICAL ACTIVITY &amp; SEDENTARY TIME IN A YOUNG MIDDLE-EASTERN POPULATION

Objective: Arterial stiffness (AS) and physical activity are independent cardiovascular(CV) risk factors and predict outcome. We and others have shown that PA is associated with AS; however, the data is largely derived from older, Caucasian populations assessing PA with questionaires. The aim of this study was to explore the relationship between AS and PA using actigraphy in a young Middle-Eastern population, hitherto not studied. Design and method: Four-hundred and two apparently healthy subjects (mean age 20.7 ± 3 years, 52% females) were enrolled in this cross-sectional study. Anthropometric measurements performed included weight, height, waist and hip, total body fat, visceral fat and muscle mass. Participants received an accelerometer (ActiGraph™) to wear on the wrist for 7 consecutive days. The average minutes/day spent at different PA intensities (min/day) was determined according to established cut-points as well as metabolic equivalents (METS). Arterial stiffness was measured using the SphygmoCor™ and Mibilograph® as pulse wave velocity (PWV), central BP and augmentation index(AIx), after fifteen minutes of supine rest. The data was analysed using JMP Pro version 13 (SAS for Windows, NC, USA). Results: 30% of the population met the AHA Guidelines for PA with no gender difference. None of the subjects achieved moderate-vigorous or very vigorous activity with almost 50% of the time spent in being sedentary. There was a significant association between daily step count and body fat and body muscle content (p &lt; 0.001). PWV was associated with age (r = 0.25, p &lt; 0.001), brachial systolic BP(r = 0.57, p &lt; 0.0001), aortic systolic BP(r = 0.65, p &lt; 0.0001), cardiac output(r = 0.39, p &lt; 0.0001), METS achieved(r = -0.42, p &lt; 0.0001), light activity (r = -0.25, p &lt; 0.001), moderate-to-vigorous (r = -0.29, p &lt; 0.001), sedentary time (r = 0.45, P &lt; 0.0001), waist(r = 0.47, p &lt; 0.0001), visceral fat(r = 0.39, p &lt; 0.001) and muscle mass(r = -0.31, p &lt; 0.01). In a stepwise regression model with PWV as the dependent variable, age, MAP, gender, METS achieved and sedentary time emerged as independent determinants of PWV (R2 = 0.39, p &lt; 0.0001). Conclusions: Unhealthy life-style is a strong risk factor for CVD, partly through the development of premature arterial stiffening. Our results highlight the deleterious effects of sedentary time on vascular function, independent of physical activity and energy consumption in a young, healthy population.

IS BP LOAD ON AMBULATORY MONITORING A PREDICTOR OF TARGET ORGAN DAMAGE IN YOUTH? THE SHIP AHOY STUDY

Objective: Ambulatory BP monitoring (ABPM) is increasingly utilized for the diagnosis of hypertension (HTN). Pediatric guidelines consider BP load (% of reading above the ‘normal’ threshold) in risk-stratification of the ABPM phenotype. We sought to determine if load was an independent predictor of target organ damage (TOD) in youth. Design and method: Casual BP, ABPM, anthropometrics, echo for LV mass index (LVMI), systolic strain, diastolic function (E’/e’ ratio) and pulse wave velocity (PWV) for arterial stiffness (PWV) were measured in 367 adolescents (mean 15.6 + 1.7 years, 63% white, 58% male). ABPM was performed with Ontrak device (Spacelabs Inc., Snoqualmie, WA). Subjects were stratified by load (low &lt;25% = 215, mid 25-&lt;50% = 62, high &gt;=50% =47) according to sex- and height-specific pediatric cut points. ANOVA was used to evaluate differences in CV risk factors and TOD across load groups. General linear models were used to evaluate load as an independent predictor of TOD after adjusting age, demographics, body mass index (BMI), and mean daytime SBP on ABPM. Results: There was a graded increase in most clinic and ambulatory BP means and loads across load groups (all p &lt; 0.05). There was only a trend for higher LVMI (p = 0.06) and reduced strain (p = 0.05) in low vs high load groups. Diastolic function (E/e’) was lower in high vs low and mid groups and there was a graded increase in arterial stiffness (PWV) across load groups. Daytime SBP load was an independent determinant of all forms of TOD after adjusting for age and sex but lost significance for LVMI after adjusting for BMI%. Load remained a significant determinant of PWV &amp; E/e’ after adjusting for BMI% and mean daytime ambulatory SBP. Load group was also a significant determinant of PWV and E/e’ even after adjustment for age, sex, BMI% and daytime ambulatory SBP (all p &lt; 0.0001). Conclusions: Daytime SBP load adds to prediction of diastolic dysfunction and arterial stiffness but not LVMI or systolic function. Increased load on ABPM may indicate need for advanced imaging to detect early TOD in youth with HTN.

Age dependence of brachial cuff-based ambulatory PWV in end-stage kidney disease patients undergoing long-term peritoneal dialysis.

The newly introduced device Mobil-O-Graph (IEM, Stolberg, Germany) combines brachial cuff oscillometry and pulse wave analysis, enabling the determination of pulse wave velocity (PWV) via complex mathematic algorithms during 24-h ambulatory blood pressure monitoring (ABPM). However, the determinants of oscillometric PWV in the end-stage kidney disease (ESKD) population remain poorly understood. In this study, 81 ESKD patients undergoing long-term peritoneal dialysis underwent 24-h ABPM with the Mobil-O-Graph device. The association of 24-h oscillometric PWV with several demographic, clinical and haemodynamic parameters was explored using linear regression analysis. In univariate analysis, among 21 risk factors, 24-h PWV exhibited a positive relationship with age, body mass index, overhydration assessed via bioimpedance spectroscopy, diabetic status, history of dyslipidaemia and coronary heart disease, and it had a negative relationship with female sex and 24-h heart rate. In stepwise multivariate analysis, age (β: 0.883), 24-h systolic blood pressure (BP) (β: 0.217) and 24-h heart rate (β: -0.083) were the only three factors that remained as independent determinants of 24-h PWV (adjusted R 2 = 0.929). These associations were not modified when all 21 risk factors were analysed conjointly or when the model included only variables shown to be significant in univariate comparisons. The present study shows that age together with simultaneously assessed oscillometric BP and heart rate are the major determinants of Mobil-O-Graph-derived PWV, explaining >90% of the total variation of this marker. This age dependence of oscillometric PWV limits the validity of this marker to detect the premature vascular ageing, a unique characteristic of vascular remodelling in ESKD.

Relationship of Apolipoproteins with Subclinical Cardiovascular Risk in Youth

To examine the association of apolipoproteins with arterial stiffness and carotid artery structure in children and adolescents. A total of 338 children and adolescents (178 female) with a mean age 13.0±2.8years were examined. Apolipoproteins (AI, AII, B100, CII, CIII, and E) were measured via human apolipoprotein magnetic bead panel. Applanation tonometry determined pulse wave velocity and ultrasound imaging measured carotid intima-media thickness. Dual X-ray absorptiometry measured total body fat percent. Linear regression models were adjusted for Tanner stage, sex, and race with further adjustments for body fat percent. Linear regression models also examined the interaction between Tanner stage and apolipoproteins. There was a significant positive association between pulse wave velocity and apolipoproteins: AI (0.015m/s/10μg/mL [CI 0.005-0.026], P=.003), AII (0.036m/s/10μg/mL [0.017-0.056], P<.001), B100 (0.009m/s/10μg/mL [0.002-0.016], P=.012), E (0.158m/s/10μg/mL [0.080-0.235], P<.001), and CIII:CII (0.033/μg/mL [0.014-0.052], P<.001). After we added body fat percent to the models, pulse wave velocity (PWV) remained positively associated with greater levels of apolipoproteins: AI, AII, B100, E, and CIII:CII. Both with and without the adjustment for body fat percent, there were no significant associations between any apolipoprotein and carotid intima-media thickness. There were no significant interactions between Tanner stage and apolipoproteins. These findings suggest that greater levels of apolipoprotein AII, E, and CIII:CII are associated with increased arterial stiffness in children and adolescents, both with and without adjusting for percent body fat. These specific apolipoproteins may be useful as biomarkers of cardiovascular risk.