Common Carotid Artery Distensibility Research Articles

PRECLINICAL VASCULAR ORGAN DAMAGE AND VASCULAR AGEING ASSESMENT IN NON-ALCOHOLIC FATTY LIVER DISEASE AND METABOLIC ASSOCIATED FATTY LIVER DISEASE PATIENTS

Objective: Non-alcoholic fatty liver disease (NAFLD) and metabolic associated fatty liver disease (MAFLD) are a growing health problem, with a growing prevalence due to its association with metabolic syndrome and diabetes. It is known to be a risk factor for the development of cirrhosis and hepatocarcinoma, but it is also known to be an important cardiovascular risk factor. The aim of this study is to assess the burden of preclinical vascular organ damage. Design and method: The study enrolled 80 consecutive patients (mean age 63.3±15.0) who underwent hepatological evaluation in our department, with evaluation of liver fibrosis score (APRI score, FIB-4) and liver stiffness, and quantification of cardiovascular risk according to Guidelines (2021 ESC Guidelines on cardiovascular disease prevention in clinical practice). Carotid atherosclerotic burden was evaluated by B-mode ultrasound in each segment (common, bulb, internal), bilaterally, and expressed as mean of maximum IMT (M-MAX), right common carotid artery distensibility and stiffness (CardioVascular Suite 4, Quipu, Italy). Aortic stiffness was evaluated as carotid-femoral pulse wave velocity (PWV), measured by applanation tonometry (PulsePen DiaTecne, Italy), with calculation of vascular ageing. Results: We found no significant correlation between ultrasound or tonometry parameters and liver stiffness and fibrosis scores. VPWV was significantly above upper limit of normal of 10 m/s (11.6±6.0 m/s, p=0.02), and the percentiles for age were significantly higher than 50th (61.7±25.1, p<0.001), with 52,5% of patients showing increased PWV. Similarly, M-MAX was higher than the upper normality level of 0.9 mm (1.09±0.30 mm, p<0.001). 70% of patients had an increased M-MAX. Vascular age based on arterial stiffness resulted significantly higher than biological age (mean difference 4.6 years, p<0.001). 76.2% (71/80) of the overall cohort and 45,2% (14/31) of patients classified as low risk showed at least one type of vascular organ damage. Conclusions: Patients with NAFLD or MAFLD showed a large prevalence of arterial stiffening and increased IMT and an enhanced vascular ageing, even among those classified at low cardiovascular risk according to Guidelines. Vascular organ damage evaluation could be useful to identify preclinical organ damage in these patients

VASCULAR REMODELING AND FIBROSIS INDEXES IN NAFLD SUBJECTS

Objective: Non-alcoholic fatty liver disease (NAFLD) is a growing public health problem and is related to an increased burden of cardiovascular disease. Aim of the study: to assess the relation between non-invasive scoring systems for liver fibrosis (Fibrosis-4 Index and NAFLD Fibrosis Score) and structural and functional vascular properties in NAFLD patients. Design and method: The study enrolled 30 consecutive patients (mean age 64±13, BMI 29.3±6.1 kg/m2, male 60%) who underwent hepatological evaluation in our department. Atherosclerotic burden was evaluated by B-mode ultrasound in each carotid artery segment (common, bulb, internal), bilaterally, and expressed as mean of carotid intima-media thickness (mean-IMT) and mean of maximum IMT (M-MAX), right common carotid artery distensibility and stiffness (CardioVascular Suite 4, Quipu, Italy). Aortic stiffness was measured by applanation tonometry (PulsePen DiaTecne, Italy) and was expressed as carotid-femoral pulse wave velocity (PWV). Results: In our cohort vascular properties were: carotid mean-IMT 0.83±0.15 mm, M-MAX 0.98±0.17 mm, carotid distensibility 18.8±8.3 10-3/kPa, and carotid compliance CC 0.88±0.40 mm2/kPa. We found a significant correlation between NAFLD Fibrosis Score and PWV (mean PWV = 10.9±2.9m/s; Fibrosis Score = -0.97±1.80; R = 0.422, p = 0.020), which remained significant after adjustment for mean arterial blood pressure and sex (p = 0.017). No correlation was found between carotid ultrasound parameters and fibrosis scores. Conclusions: In NAFLD patients, our preliminary observation shows a correlation between a liver fibrosis score and PWV, an established marker of aortic stiffness, while no correlation was observed with carotid atherosclerosis markers. This vascular remodeling phenotype needs to be confirmed in a larger population.

Color M-Mode Ultrasound to Assess Carotid Arteries: A Feasibility Study

Introduction: The gradual process of atherosclerosis involves both structural and functional changes that can accumulate over years and contribute to cardiovascular risk. We propose the use of color M-mode ultrasound to evaluate the distensibility of the carotid artery as a quantitative measurement of dynamic function that could evaluate age-related vascular change when considering atherosclerotic cardiovascular disease evaluation and risk. The aim of the study was to assess the feasibility of color M-mode ultrasound to evaluate age-related changes in the carotid arteries. Methods: Color M-mode ultrasound of the distal common carotid artery (CCA) with concurrent electrocardiogram tracing was performed on 62 adults (19 men and 43 women) in 3 age groups: young adult (20-44 years; n = 22), middle age (45-64 years; n = 20), and senior (≥65 years; n = 20). Color M-mode ultrasound images of the CCA were processed offline using ImageJ to quantify total, red, green, and blue (RGB) pixels in systole and diastole. The CCA distensibility was calculated by using the following equation: distensibility coefficient (DC) = (systolic − diastolic diameter)/(diastolic diameter × pulse pressure). The difference in ultrasound parameters among the 3 age groups was analyzed by one-way analysis of variance (ANOVA). Intraobserver and interobserver reliability of offline imaging processing was tested using intraclass correlation coefficient (ICC). Results: We observed a significant difference in CCA distensibility among the 3 age groups ( P < .05). The interobserver reproducibility and intraobserver repeatability in performing offline image processing were excellent (ICC >0.85). Conclusion: These findings suggest that color M-mode ultrasound is feasible in evaluating changes in CCA distensibility and systolic pixel values representing CCA blood flow significantly decreased in seniors.

Comparison between Carotid Distensibility-Based Vascular Age and Risk-Based Vascular Age in Middle-Aged Population Free of Cardiovascular Disease.

The concept of vascular age (VA) was proposed to provide patients with an understandable explanation of cardiovascular (CV) risk and to improve the performance of prediction models. The present study compared risk-based VA derived from Framingham Risk Score (FRS) and Systematic Coronary Risk Estimation (SCORE) models with value-based VA derived from the measurement of the common carotid artery (CCA) distensibility coefficient (DC), and it assessed the impact of DC-based VA on risk reclassification. In 528 middle-aged individuals apparently free of CV disease, DC was measured by radiofrequency-based arterial wall tracking that was previously utilised to establish sex- and age-specific reference values in a healthy population. DC-based VA represented the median value (50th percentile) for given sex in the reference population. FRS-based and SCORE-based VA was calculated as recommended. We observed a good agreement between DC-based and FRS-based VA, with a mean difference of 0.46 ± 12.2 years (p = 0.29), while the mean difference between DC-based and SCORE-based VA was higher (3.07 ± 12.7 years, p < 0.0001). When only nondiabetic individuals free of antihypertensive therapy were considered (n = 341), the mean difference dropped to 0.70 ± 12.8 years (p = 0.24). Substitution of chronological age with DC-based VA in FRS and SCORE models led to a reclassification of 28% and 49% of individuals, respectively, to the higher risk category. Our data suggest that the SCORE prediction model, in which diabetes and antihypertensive treatment are not considered, should be used as a screening tool only in healthy individuals. The use of VA derived from CCA distensibility measurements could improve the performance of risk prediction models, even that of the FRS model, as it might integrate risk prediction with additional risk factors participating in vascular ageing, unique to each individual. Prospective studies are needed to validate the role of DC-based VA in risk prediction.

Association of Vascular Properties With the Brain White Matter Hyperintensity in Middle-Aged Population.

BackgroundThe periventricular white matter is more sensitive to the systemic hemodynamic alterations than the deep white matter because of differences in its vascular structure and systemic circulation relationship. We hypothesize that periventricular white matter hyperintensity (PVWMH) volume shows greater association than deep white matter hyperintensity (DWMH) volume with vascular properties (VPs) reflecting arterial stiffness and cardiovascular remodeling, indicators of the systemic circulation.Methods and ResultsA total of 426 participants (age, 59.0±6.1 years; 57.5% women; and 39.7% Black race) in the Genetic Study of Atherosclerosis Risk who were aged ≥50 years and had brain magnetic resonance imaging were studied. VPs included pulse pressure, hypertensive response to exercise, diastolic brachial artery diameter, diastolic common carotid artery diameter, common carotid artery distensibility coefficient, and left ventricular function. The relative associations of VPs with PVWMH and DWMH as multiple measures within the same individual were determined using multilevel linear models. We also determined if age modified the differences in VPs associations with PVWMH and DWMH. Our findings indicated that, within the same subject, PVWMH volume had greater association than DWMH volume with pulse pressure (P=0.002), hypertensive response to exercise (P=0.04), diastolic brachial artery diameter (P=0.012), and diastolic common carotid artery diameter (P=0.04), independent of age and cardiovascular risk factors. The differences of PVWMH versus DWMH associations with VPs did not differ at any age threshold.ConclusionsWe show, for the first time, that PVWMH has greater association than DWMH, independent of age, with vascular measurements of arterial stiffness and cardiovascular remodeling suggesting that changes in the systemic circulation affect the PVWMH and DWMH differently.

Abstract WP14: Association Of Vascular Properties With The Periventricular And Deep White Matter Hyperintensity In Middle-age Population

Introduction: The periventricular white matter is more sensitive to alterations in the hemodynamics of the systemic circulation than the deep white matter due to differences in its vascular supply and relationship to systemic circulation. We hypothesize that periventricular white matter hyperintensity volume (PVWMH) shows greater association than deep white matter hyperintensity (DWMH) volume with vascular property measures of arterial stiffness (AS) and cardiovascular remodeling, important indicators of the systemic circulation. Methods: Participants in the Genetic Study of Atherosclerosis Risk ≥ 50 years of age with brain MRI were selected. Vascular property measures included pulse pressure (PP), hypertension response to exercise (HRE), diastolic brachial artery (BA) diameter, diastolic common carotid artery (CCA) diameter, CCA distensibility coefficient, and left ventricular function. PVWMH and DWMH were measured using semi-automated segmentation approach. The relative associations of these parameters with PVWMH and DWMH volumes as multiple measures within the same individual further nested within families were determined using multilevel linear models. We also determined if differences between PVWMH and DWMH associations were modified by age. Results: 426 participants (age 59.0±6.1 years, 57.5% females, and 39.7% African American) were included. Within the same subject, PVWMH volume showed greater association than DWMH volume with PP (P=0.002), HRE (p=0.04), diastolic BA diameter (p=0.012), and diastolic CCA diameter (p=0.04) independent of age and cardiovascular risk factors. This difference in PVWMH versus DWMH association with vascular properties did not differ at any age threshold. Conclusions: We show for the first time that PVWMH volume has greater association than DWMH volume, independent of age, with vascular property measurements of AS and cardiovascular remodeling. Our findings suggest that changes in the systemic circulation may affect PVWMH and DWMH differently adding to a growing body of literature that PVWMH and DWMH may represent different phenotypes of cerebral small vessel disease.

Circulating Bile Acids Profiles in Obese Children and Adolescents: A Possible Role of Sex, Puberty and Liver Steatosis.

Background. Childhood obesity is becoming a major health issue and contributes to increasing the risk of cardiovascular disease in adulthood. Since dysregulated metabolism of bile acids (BAs) plays a role in progression of obesity-related disorders, including steatosis and hypertension, this study aimed to investigate BAs profiles in obese children with and without steatosis and hypertension, as well as exploring the interplay between BAs profile and vascular function. Methods. BAs concentrations were quantified with liquid chromatography-tandem mass spectrometry in 69 overweight/obese children and adolescents (mean age, 11.6 ± 2.5 years; 30 females). Liver steatosis was defined with abdomen ultrasonography, whilst hypertension was defined according to the current European guidelines. Vascular function was assessed with ultrasound technique, by measuring carotid intima media thickness (cIMT) and common carotid artery distensibility (cDC). Results. Total and individual glycine-conjugated BAs concentrations were found to be significantly higher in males compared to females, as well as in pre-pubertal compared to pubertal stage (p < 0.05 for both). No difference in BAs concentration was observed between hypertensive and normotensive subjects. Total BAs and glycine conjugated BAs were significantly higher in participants with steatosis compared to those without (p = 0.004 for both). The values of total glycine-conjugate acids were positively correlated with cDC and this association remained significant in linear regression after adjusting for sex, age, pubertal stage, body mass index and aspartate aminotransferase. Conclusion. The results suggest a possible role of BAs in the pathogenesis of liver and/or vascular damage in children and adolescent. Further studies are hence needed to validate these preliminary findings.

Arterial structure and function during and after long-duration spaceflight.

Spaceflight missions expose astronauts to increased risk of oxidative stress and inflammatory damage that might accelerate the development of asymptomatic cardiovascular disease. The purpose of this investigation was to determine whether long-duration spaceflight (>4 mo) results in structural and functional changes in the carotid and brachial arteries. Common carotid artery (CCA) intima-media thickness (cIMT), CCA distensibility and stiffness, and brachial artery endothelium-dependent and -independent vasodilation were measured in 13 astronauts (10 men, 3 women) ~180 and 60 days before launch, during the mission on ~15, 60, and 160 days of spaceflight, and within 1 wk after landing. Biomarkers of oxidative stress and inflammation were measured at corresponding times in fasting blood samples and urine samples from 24- or 48-h pools. Biomarkers of oxidative stress and inflammation increased during spaceflight, but most returned to preflight levels within 1 wk of landing. Mean cIMT, CCA stiffness, and distensibility were not significantly different from preflight at any time. As a group, neither mean endothelium-dependent nor -independent vasodilation changed from preflight to postflight, but changes within individuals in endothelial function related to some biomarkers of oxidative stress. Whereas biomarkers of oxidative stress and inflammation are elevated during spaceflight, CCA and brachial artery structure and function were not changed by spaceflight. It is unclear whether future exploration missions, with an extended duration in altered gravity fields and higher radiation exposure, may be problematic.NEW & NOTEWORTHY Carotid artery structure and stiffness did not change on average in astronauts during long-duration spaceflight (<12 mo), despite increased oxidative stress and inflammation. Most oxidative stress and inflammation biomarkers returned to preflight levels soon after landing. Brachial artery structure and function also were unchanged by spaceflight. In this group of healthy middle-aged male and female astronauts, spaceflight in low Earth orbit does not appear to increase long-term cardiovascular health risk.

Distensibility coefficient of the common carotid artery in acute cerebral infarct by M-mode ultrasound: A cross-sectional study

Introduction: Distensibility coefficient (DC) is abnormal in most cases of acute cerebral infarct patients. Intima-media thickness (IMT) is measured by B (brightness)-mode and distensibility by M (motion)-mode ultrasound. DC is not routinely measured in clinical practice even though it is the earliest functional change to occur in common carotid arteries. IMT represents structural change and DC represents functional changes that occur in common carotid.Aim: DC is a valid independent indicator for risk assessment of acute cerebral infarcts. The present study is aimed at knowing the association of abnormal DC with acute cerebral infarct patients.Materials and Methods: Cross sectional study was undertaken over a period of 9 months with 210 cases of acute cerebral infarct. Distensibility of common carotid artery was measured by M-mode ultrasound. Cramer's V value ranged from 0.0 to 1.0 and P < 0.05 was considered statistically significant.Results: DC was reduced in 62.8% of the total 210 cases of acute cerebral infarct. Maximum cases (38%) were in the age groups of 61–70 years. Cramer's V value ranged from <15 to <24 × 10−3 kPa (P < 0.001). There was a good association between reduced DC and acute cerebral infarct in the present study.Conclusion: DC is a valid independent risk factor for acute cerebral infarct. DC represents functional vessel wall property and decreases with age. M-mode-derived measurements for DC are valid, and abnormal DC value is associated well with acute cerebral infarct.

Arterial stiffness in children with and without probable developmental coordination disorder

BackgroundChildren with cardiovascular disease risk factors demonstrate adverse arterial alterations that are predictive of cardiovascular morbidity and mortality in adults. Children with developmental coordination disorder (DCD) are at cardiovascular risk as they are more likely to be obese and inactive. AimThe purpose of this study was to assess arterial structure and function in children with and without probable DCD (p-DCD). MethodsA cross-sectional study of 33 children with p-DCD (22 male) and 53 without (30 male). The Movement Assessment Battery for Children was used to classify those with p-DCD. Adiposity was assessed using the BOD POD. Compliance, distensibility, and intima-media thickness were measured at the common carotid artery (CCA). ECG R-wave-to-toe pulse wave velocity (PWV) was also measured. ResultsCompared to controls, males with p-DCD had lower CCA distensibility (p=0.034) and higher PWV (p=0.001). No differences were evident in females. Body fat percent was a significant predictor of CCA distensibility and removed the effect of p-DCD on PWV in males. ConclusionsThe present study demonstrates augmented arterial stiffness in males with p-DCD, likely attributed to body fat. These findings underscore the importance of targeted interventions in children with p-DCD, specifically males, in order to prevent future cardiovascular risk.

A non-contact approach for PWV detection: application in a clinical setting

A need for screening methods for arteriosclerosis led to the development of several approaches to measure pulse wave velocity (PWV) being indicative of arterial stiffness. Carotid-femoral PWV (cfPWV) can be measured between common carotid artery (CCA) and femoral artery (FA) displaying the physiologically important stiffness of the conduit arteries. However, this measurement approach has several disadvantages, and a local PWV-measurement of CCA-stiffness has been proposed as an alternative in the past.In the presented pilot study, laser Doppler vibrometry (LDV) is used to measure PWV locally in the CCA (PWVLDV) in 48 patients aged between 48 and 70, with known atherosclerotic arterial disease: stabilized coronary artery disease (CAD), cerebro-vascular disease (CVD) or peripheral artery disease (PAD). Additionally, cfPWV, CCA distensibility coefficient (DC), CCA intima-media thickness (IMT), blood pressure (BP) and age were evaluated.LDV is a valid method for local PWV-measurement. The method is potentially easy to use, and causes no discomfort to the patient. PWVLDV correlates with age (R = 0.432; p = 0.002) as reported in related studies using other techniques, and measured values lay between 2.5 and 5.8 m s−1, which is well in line with literature measures of local PWV in the CCA.In conclusion, PWVLDV potentially is a marker for arterial health, but more research in a larger and more homogeneous patient population is mandatory. In future studies, blood velocity measurements should be incorporated, as well as a reference method such as pulse wave imaging (PWI) or magnetic resonance imaging (MRI).

Aortic stiffening and its impact on left atrial volumes and function in patients after successful coarctation repair: a multiparametric cardiovascular magnetic resonance study.

BackgroundThe increased cardiovascular morbidity of adults with late repair of aortic coarctation (CoA) has been well documented. In contrast, successful CoA repair in early childhood has a generally good prognosis, though adverse vascular and ventricular characteristics may be abnormal, which could increase long-term risk. This study sought to perform a comprehensive analysis of aortic elasticity and left ventricular (LV) function in patients with aortic coarctation (CoA) using cardiovascular magnetic resonance (CMR). In a subgroup of patients, we assessed structure and function of the common carotid arteries to probe for signs of systemic vascular remodeling.MethodsFifty-one patients (median age 17.3 years), 13.9 ± 7.5 years after CoA repair, and 54 controls (median age 19.8 years) underwent CMR.We determined distensibility and pulse wave velocity (PWV) at different aortic locations. In a subgroup, common carotid artery distensibility, PWV, wall thickness and wall area were measured. LV ejection fraction (EF), volumes, and mass were measured from short axis views. Left atrial (LA) volumes and functional parameters (LAEFPassive, LAEFContractile, LAEFReservoir) were assessed from axial cine images.ResultsIn patients distensibility of the whole thoracic aorta was reduced (p < 0.05) while PWV was only significantly higher in the aortic arch (p < 0.01). Distensibility of the descending aorta at the level of the pulmonary arteries and PWV in the descending aorta, both correlated negatively with age at CoA repair. LA volume before atrial contraction and minimal LA volume were higher in patients (p < 0.05). LAEFPassive and LAEFReservoir were reduced (p < 0.05), and LAEFReservoir correlated negatively with aortic arch PWV (p < 0.05). LVEF, volumes and mass were not different from controls. Carotid wall thickness and PWV were higher in patients compared to controls (p < 0.05).ConclusionsPatients after CoA repair have impaired bioelastic properties of the thoracic aorta with impact on LV diastolic function. Reduced descending aortic elasticity is associated with older age at time of CoA repair. The remodeling of the common carotid artery in our sub-study suggests systemic vessel wall changes.

Carotid artery stiffness is related to hyperinsulinemia and insulin-resistance in middle-aged, non-diabetic hypertensive patients

Background and aimsGlycometabolic abnormalities are frequently found in hypertension and could affect the mechanical properties of carotid arteries. The aim of the study was to investigate the relationship of glucose tolerance, plasma insulin, and insulin sensitivity with carotid distensibility in middle-aged, non-diabetic hypertensive patients free of cardiac and vascular complications. Method and resultsIn 93 patients with grade 1–2, uncomplicated, primary hypertension and 68 matched normotensive controls we measured plasma glucose and insulin at fast and after an oral glucose load (OGTT), calculated the HOMA-index as a marker of insulin sensitivity, and assessed distensibility of common carotid arteries by B-mode ultrasonography. Hypertensive patients were hyperinsulinemic and insulin-resistant as compared to normotensive controls. Hypertensive patients with impaired fasting glucose and/or impaired glucose tolerance had comparable distensibility of carotid arteries. Patients with decreased carotid distensibility were older and had higher body mass, fasting and post-OGTT plasma insulin, HOMA-index, and carotid IMT than the remaining patients, but no differences in glycated hemoglobin, and fasting or post-OGTT plasma glucose. Carotid coefficient of distensibility was inversely related and β-stiffness directly related with fasting and post-OGTT plasma insulin, and HOMA-index. Multivariate logistic regression showed that age and post-OGTT plasma insulin levels predicted carotid artery stiffening independent of body mass index, sex, blood pressure, and plasma glucose levels. ConclusionsThe study demonstrates that decreased insulin sensitivity and the related hyperinsulinemia but not hyperglycemia could contribute to carotid artery stiffening in middle-aged, non-diabetic hypertensive patients free of cardiovascular complications.

The association between arterial properties and blood pressure in children.

Elevated blood pressure (BP) in adults is associated with increased arterial stiffness and thickness; however, its effect on arterial health in a pediatric population is less understood. The purpose of this study was to identify the relationship between childhood BP and arterial markers of arteriosclerotic progression. The study consisted of 106 children across a wide range of BP values divided into 2 BP groups: high BP (HBP; ≥ 95th percentile; n = 21) and normal BP (NBP; < 90th percentile; n = 85) based on consistent automated BP measures taken at 2 time points. The laboratory examination involved systemic pulse wave velocity (PWV), common carotid artery (CCA) intima media thickness (IMT) and distensibility, as well as body mass index (BMI) and pubertal maturation. BMI and heart rate, as well as PWV (HBP: n = 15 and NBP: n = 56), were higher in the HBP group (p < 0.001) with no difference between groups for both CCA distensibility and IMT (HBP: n = 21 and NBP: n = 83). Multivariate linear regression revealed that BP group (p = 0.003) was an independent predictor of PWV after controlling for age, sex, BMI, heart rate, and maturation. Our findings demonstrate a higher systemic PWV with no difference in CCA IMT or distensibility in children with elevated BP. Hence, markers of cardiovascular disease risk are augmented in healthy children with elevated BP.

Parathyroid hormone and calcium are independently associated with subclinical vascular disease in a community-based cohort

ObjectiveDiseases with abnormal levels of parathyroid hormone (PTH) and calcium, such as primary and secondary hyperparathyroidism, are associated with an increased risk of cardiovascular morbidity and mortality. However, there is paucity on the association between calcium, PTH and abnormalities in the vascular system in the general population. MethodsIn the PIVUS study (Prospective Investigation of the Vasculature in Uppsala Seniors), a community based cohort of 70-year old men and women (n = 1016), the associations between s-calcium, p-PTH and endothelial function, arterial stiffness and blood pressures were investigated, adjusting for cardiovascular risk factors and mineral metabolism. ResultsIn multivariable linear regression models 1 SD increase in calcium was associated with 1.1 units decrease in the stroke volume/pulse pressure ratio and 0.06 decrease in common carotid artery distensibility (p < 0.001) indicative of increased arterial stiffness. Further, calcium was associated with increasing calculated central pulse pressure with 1.3 mmHg elevation per 1 SD increase in calcium (p < 0.05). 1 SD increase in PTH was associated with 1.9 and 1.0 mmHg increase in intra-arterially measured brachial artery systolic and diastolic blood pressures, respectively (p < 0.01), as well as 1.6 and 0.9 mmHg increase in calculated central systolic and diastolic blood pressures (p < 0.05). PTH was not associated with arterial stiffness, endothelial function or pulse pressure. ConclusionIn a large community-based sample of elderly, calcium was independently associated with increased arterial stiffness, and PTH independently to intra-arterial peripheral and calculated central blood pressures. The findings indicate a possible link between the vasculature and mineral metabolism.

Carotid Arterial Wall Dynamics During Gravity Changes on Partial-g Parabolic Flights

The investigation of systemic blood pressure (BP) responses under partial-g conditions is of particular importance with respect to post-space-flight orthostatic intolerance. In this study, changes in vessel diameter and wall distension of the common carotid artery (CCA) were assessed under graded gravity. Measurements were performed on 8 healthy subjects in standing position under lunar (0.16 g), Martian (0.38 g), 1.0 g and hypergravity (1.8 g) during partial-g parabolic flights. Data are reported as means ± SE estimated by linear mixed effects modeling. The CCA diameter was significantly enlarged under Martian and lunar-g (6.55 ± 0.2 and 6.54 ± 0.2 mm; p < 0.001 each) with respect to 1.0 g (6.39 ± 0.2 mm). The CCA distension showed significant enlargement under Martian-g (622 ± 91μm) with respect to 1.0 g (603 ± 82μm; p < 0.05). Furthermore, the distension was significantly lower under hyper-g with respect to 1.0 g (550 ± 88μm; p < 0.001). These results show that rapid changes of gravitational stress induce significant modifications of hemodynamic parameters reflected in the CCA vessel wall diameter and distension. The increased vessel wall diameter under partial-g is likely due to the rise in mean BP at the CCA level caused by the absence of hydrostatic pressure and may trigger the baroreflex to maintain homeostatis. We can assume that the increase in distension during the partial-g phase originates from a larger stroke volume and enhanced BP reflections. Furthermore, this study demonstrates the reliability of functional high resolution vascular ultrasound technique during parabolic flights.

Common Carotid Artery Stiffness Is Associated with Left Ventricular Structure and Function and Predicts First Hospitalization for Acute Heart Failure

Aims: Proximal aortic stiffness may be more important than carotid-femoral pulse wave velocity (cf-PWV) in the pathogenesis of heart failure. The present study investigated the associations of common carotid artery (CCA) stiffness, which might be a surrogate for proximal aortic stiffness, with left ventricular (LV) structure and function, and the development of acute heart failure (AHF). Methods and Results: Outpatients without a history of heart failure (114 subjects aged 63.5 ± 17.5 years) were enrolled for comprehensive noninvasive cardiovascular examinations. The LV mass index, the LV ejection fraction (EF), and the ratio of the early diastolic transmitral flow velocity to the early septal mitral annular diastolic velocity (E/E') were measured by echocardiography. CCA mechanical properties, including the incremental elastic modulus (Einc), β stiffness index, CCA distensibility (CD) and circumferential strain (CS), were assessed by carotid artery ultrasonography. cf-PWV was measured by arterial tonometry. CD was significantly associated with the LV mass index, and all CCA stiffness indices were significantly associated with EF and E/E' independently of age, mean blood pressure, and cf-PWV. During a mean follow-up of 265 ± 106 days, 9 patients presented with AHF. Einc (hazard ratio 6.56, 95% confidence interval 1.64-26.26, by quartile analysis), CS (6.82, 1.70-27.35), and β stiffness index (3.91, 1.05-14.57) but not cf-PWV (1.62, 0.41-6.51) significantly predicted the events. Conclusions: In patients at risk for heart failure, CCA stiffness was significantly associated with LV structure and function independently of cf-PWV. In addition, CCA stiffness but not cf-PWV predicted first AHF. © 2014 S. Karger AG, Basel

Investigating relationships between arterial stiffness and collagen turnover in humans

Understanding the factors regulating changes in vascular structure may assist in designing strategies for decreasing the development and progression of cardiovascular disease. Previous research has shown links between various markers of collagen turnover and arterial stiffness in clinical populations (McNulty, 2006 &amp; Chatzikyriakou, 2008). The purpose of this study was to investigate the relationship between functional assessments and blood markers of arterial wall structure. Arterial stiffness and markers of collagen turnover were assessed in 20 overweight women, 20 elderly healthy men, 23 individuals with coronary artery disease, 16 individuals with spinal cord injury and 10 young healthy men. Carotid artery stiffness was determined through assessment of common carotid artery distensibility with simultaneous B‐mode ultrasound imaging and applanation tonometry. Fasting venous blood samples were analyzed for serum levels of pro‐collagen type I (PIP) and cross‐linked telopeptide of collagen type I (CTX); markers of type I collagen synthesis and degradation, respectively. There was a significant positive relationship observed between CTX and carotid artery distensibility (R = 0.330, p = 0.001) and a weak but significant inverse relationship (R = −0.224, p = 0.034) observed between carotid artery distensibility and type I collagen turnover, expressed as a ratio of PIP to CTX. These findings suggest a link exists between type I collagen turnover and central arterial distensibility, however this relationship appears to be opposite to that previous observed in the literature in older hypertensive individuals (McNulty, 2006). Funded by Canadian Institute of Health Research, Natural Sciences and Engineering Research Council, Innovation Center for US Dairy, Dairy Farmers of Canada and the Ontario Neurotrauma Foundation.

Comparison of common carotid artery distension wave with tonometry for central pulse pressure assessment

Comparison of common carotid artery distension wave with tonometry for central pulse pressure assessment

Influence of Erythropoietin on Arterial Stiffness and Endothelial Function in Renal Transplant Recipients

Background/Aims: Recent retrospective studies suggest an association of therapy with erythropoiesis-stimulating agents (ESAs) and increased mortality in renal transplant recipients (RTR). Large artery structure and function are significantly impaired in RTR which contributes to their high cardiovascular morbidity and could be altered by erythropoietin. We aimed to examine the influence of ESA therapy on large artery stiffness and endothelial function in RTR. Methods: 63 RTR with chronic allograft dysfunction and renal anemia were randomized to a group receiving darbepoetin alfa (Dar) and a control group (Co). At baseline and after 8 months of treatment (cumulative Dar dose 11.1 µg/kg b.w.) brachial and common carotid artery distensibility coefficients, aortic pulse wave velocity, brachial artery flow-mediated and nitroglycerin-mediated vasodilation were measured as well as the following biomarkers of vascular function: vWF, sVCAM, sICAM, E-selectin, t-PA and PAI-1. Results: 23 patients in the Dar group and 17 patients in the Co group were available for per-protocol analysis. Hemoglobin increased significantly from 10.9 to 12.6 g/dl after 8 months in the Dar group, whereas it remained stable at 11.3 g/dl in the Co group. Effects on large artery stiffness, endothelial function and biomarkers of vascular function did not differ significantly between the two groups. Conclusion: Therapy with Dar during 8 months did not significantly impact parameters of large artery stiffness and endothelial function in RTR. These data suggest that therapy with erythropoietin does not deteriorate arterial stiffness and endothelial function in RTR.