Arterial Elastic Properties Research Articles

Characteristics Of Pathogenetic Links In Vascular Remodeling And Bone Tissue Destruction In Postmenopausal Women With Arterial Hypertension

Background — Much attention is drawn to the role of the nonspecific immune inflammatory vascular response as a link of general pathogenetic mechanisms with changes in the elastic properties of arteries and the phenomena of destructive changes in bones. Objective — We aimed to study the role of nonspecific immune inflammatory markers, parathyroid hormone and female sex hormones as predictors of cardiovascular and degenerative bone changes in postmenopausal women with arterial hypertension (AH) and osteoporosis (OP). Methods — We examined 104 patients (mean age: 54.03±9.56 years) distributed among three groups: healthy women, females with AH and osteopenia, and women with AH and OP. The markers of immune inflammatory response, endothelial dysfunction, hormonal, mineral, and vitamin statuses were analyzed simultaneously with 24-hour ambulatory monitoring of blood pressure, and parameters of vascular wall stiffness and densitometry to elucidate the predictors of cardiovascular and degenerative bone changes in postmenopausal women. Results — For patients with AH and osteopenia, a significant parameter associated with the risk of OP was pulse wave velocity (PWV); its increase exceeding 12.05 m/s was associated with a 3.8-fold increase in the risk of OP. Levels of proinflammatory indicators, interleukins IL-6 and IL-8, tumor necrosis factor-α, high-sensitivity C-reactive protein, and parathyroid hormone were elevated, while levels of progesterone and IL-10 were decreased. Conclusion — Timely specialized multidirectional research of biochemical and instrumental parameters (PWV and densitometry) could become the basis for the development of a personalized strategy for the prevention and treatment of women in order to avoid dangerous cardiovascular and bone complications.

GUT MICROBIOME IN ACUTE CORONARY SYNDROME

Introduction: The intestinal microbiome is a diagnostic indicator and therapeutic target for non-communicable diseases. The aim of this work is to test the relationship between arterial stiffness, elasticity, gut microbiota and inflammation markers in the patients with acute coronary syndrome.
 Methods: Elastic properties of arteries were evaluated by non-invasive arteriography (Tensiomed, Hungary), and intestinal microbiota was studied with the determination of key representatives by routine culturing methodology using biochemical identification kits (LACHEMA, Czech Republic). The level of SIgA and cytokines were detected by enzyme-linked immunosorbent assay (ELISA). The data obtained for the clinical experimental group of patients were compared with the results obtained for the control group.
 Results: Obtained data demonstrated a strong correlation between intestinal colonization by Enterococcus faecalis and PPbr (r=0.98), AIbr (r=-0.99) and AIao (r=-0.99). Significant correlations were found for Escherichia coli (lac+) and PPbr indicators (r=-0.97), and for Klebsiella oxytoca and SBP (r=-0.95), the systolic area index of the volumetric curve (r=+0.99), and the index of the diastolic area of the volumetric curve (r=-0.99). Indexed areas of the volumetric curve were correlated with colonization of Streptococcus spp. (r=-0.9 and 0.9 for systolic and diastolic area, respectively). Blood pressure correlated with the consentration of Candida spp. (r=0.95).
 Conclusion: Detected bacteria (E. faecalis, K. oxytoca), pro-inflammatory cytokines, and intestine level of SIgA correlated with increased arterial stiffness and elasticity observed in patients with acute coronary syndromes (ACS) might be used as a rationale for the prevention and individual treatment of ACS in the earlier stages of the disease.

Comprehensive echocardiographic assessment of right ventricular function, pulmonary arterial elastic properties and ventricular-vascular coupling in adult patients with repaired tetralogy of fallot: clinical significance of 3D derived indices.

We aimed to comprehensively analyze by three-dimensional speckle-tracking echocardiography (3DSTE) and Doppler echocardiography right ventricular (RV) performance, pulmonary arterial (PA) elastic properties and right ventricular-pulmonary artery coupling (RVPAC) in patients with repaired tetralogy of Fallot (rTOF) and assess the feasibility and clinical utility of related echocardiographic indices. Twenty-four adult patients with rTOF and twenty-four controls were studied. RV end-diastolic volume(3D-RVEDV), RV end-systolic volume(3D-RVESV), RV ejection fraction(3D-RVEF), RV longitudinal strain(3D-RVLS) and RV area strain(3D-RVAS) were calculated by 3DSTE. RV end-systolic area (RVESA) was obtained by planimetry. Pulmonary regurgitation (PR) was assessed as trivial/mild or significant by cardiac magnetic resonance (CMR) and color-Doppler. Pulmonary artery (PA) elastic properties were determined using two-dimensional/Doppler echocardiography. RV systolic pressure (RVSP) was measured using standard Doppler methods. RVPAC was assessed using various 3DSTE-derived parameters (3DRVAS/RVSP, 3DRVLS/RVESA, 3DRVAS/RVESV). Overall, 3DRVEF and 3DRVAS were impaired in rTOF patients compared with controls. PA pulsatility and capacitance were reduced (p = 0.003) and PA elastance was higher (p = 0.0007) compared to controls. PA elastance had a positive correlation with 3DRVEDV (r = 0.64, p = 0.002) and 3DRVAS (r = 0.51, p = 0.02). By ROC (receiver operating characteristics) analysis, 3DRVAS/RVESV, 3DRVAS/RVSP and 3DRVLS/RVESA cutoff values of 0.31%/mmHg, 0.57%/mmHg and 0.86%/mmHg, respectively, had 91%, 88% and 88% sensitivity and 81%, 81% and 79% specificity in identifying exercise capacity impairment. In rTOF patients increased 3DSTE-derived RV volumes and impaired RV ejection fraction and strain are associated with reduced PA pulsatility and capacitance and increased PA elastance. 3DSTE-derived RVPAC parameters using different afterload-markers are accurate indices of exercise capacity.

Effects of acute cervical stretching on arterial wall elastic properties.

Purpose: Acute (immediate) or regular (mid- or long-term) stretching increases arterial compliance and reduces arterial stiffness. Stretching is widely known to induce arterial functional factor changes, but it is unclear whether stretching alters arterial structural factors. Ultrasound shear wave elastography can quantify the distribution of tissue elastic properties as an index of arterial structural factors. This study thus aimed to examine the effects of acute cervical stretching on arterial wall tissue elastic properties. Methods: Seventeen healthy young adults participated in two different trials for 15min in random order on separate days: a resting and sitting trial (CON) and a supervised cervical stretching trial (CS). In CS, subjects performed 10 different stretches. At each site, the stretch was held for 30s followed by a 10-s relaxation period. In CON, subjects rested on a chair for 15min. Results: After the experiment, carotid arterial compliance, assessed by combined ultrasound imaging and applanation tonometry, was significantly increased in CS, but not in CON. However, there was no significant change in tissue elasticity properties of the arterial wall in either trial, as assessed by ultrasound shear wave elastography. Conclusion: Acute cervical stretching significantly increased carotid artery compliance in young participants, but did not reduce elastic tissue properties (i.e., arterial structural factors) of the carotid artery wall. These results strongly suggest that changes in structural factors have little relation to stretching-induced acute increases in arterial compliance.

Modern approaches to the diagnosis of occupational hearing loss in workers exposed to noise

Rheovasography (RVG) is a modern non-invasive method for studying the intensity of peripheral circulation, the severity of collateral circulation, assessing the state of vascular tone and the venous system. Impedancemetry allows you to establish, evaluate the function of the endothelial layer of blood vessels, the elastic properties of arteries and the state of the microcirculatory bed, which allows you to choose the most optimal treatment tactics.

Histomorphometric study of placental blood vessels of chorion and chorionic villi vascular area among women with preeclampsia

IntroductionThe direction of blood movement in normal and abnormal placenta is curious from a morphometric point of view. Once pregnancy is compromised by an illness like hypertension, maternal and foetal distress can lead to negative outcomes. The quantitative variations in the blood vessels within the chorion and the chorionic villi in placentas from pregnancies are complicated by preeclampsia (PE) and are poorly defined. The purpose of this study was to calculate and explore the morphometric measurement of blood vessels involved in the progress of hypertension through pregnancy within the chorion and the chorionic villi among normotensive women (n = 39) versus a preeclamptic group (n = 35). MethodsMeasurements used a computerized morphometry system and a Vascular Medicine Institute (VMI) calculator. ResultsOur data showed a significant decrease in vessel area (VA), wall area (WA), lumen area (LA), mean wall thickness-boundary (MWTB), mean wall thickness-rosette (MWTR), mean diameter-rosette (MDR), mean wall thickness-skeleton (MWTS), and external diameter-skeleton (EDS) in preeclampsia women compared to normotensive women. There were no significant differences between preeclampsia and control group in lumen area. DiscussionWe concluded that preeclamptic chorion and chorionic villi vessels are linked with significant structural discrepancies; future studies should address morphological events that occur throughout pregnancy including associations between arterial elastic properties—mainly collagen and structural proteins in hypertensive patients. A more integrated approach involving parallel analysis of the effects of potential vasoactive factors on the morphology of foetal vessel alteration is also needed.

On the examination of the viscous response of the brachial artery during flow-mediated dilation

In this study, mechanotransduction is investigated through a physics-based viscoelastic model describing the arterial diameter response during a brachial artery flow mediated dilation (BAFMD) test. The study is a significant extension of two earlier studies by the same group, where only the elastic response was considered. Experimental BAFMD responses were collected from 12 healthy volunteers. The arterial wall's elastic and viscous properties were treated as local variable quantities depending on the wall shear stress (WSS) sensed by mechanotransduction. The dimensionless parameters, arising from the model which serve as a quantitative assessment of the artery's physical state, were adjusted to replicate the experimental response. Among those dimensionless parameters, the viscoelastic ratio, which reflects the relative strength of the viscous response compared to its elastic counterpart, is of special relevance to this paper's main conclusion. Based on the results, it is concluded that the arterial wall's mechanical behavior is predominantly elastic, at least in the strict context of the BAFMD test. Recommendations for potential future research and applications are provided.

Acute changes in forearm vascular compliance during transient sympatho-excitation.

The study of vascular regulation often omits important information about the elastic properties of arteries under conditions of pulsatile flow. The purpose of this study was to examine the relationship between muscle sympathetic nerve activity (MSNA), vascular bed compliance, and peripheral blood flow responses in humans. We hypothesized that increases in MSNA would correlate with reductions in vascular compliance, and that changes in compliance would correspond with changes in peripheral blood flow during sympatho‐excitation. MSNA (microneurography), blood pressure (Finopres), and brachial artery blood flow (Doppler ultrasound), were monitored in six healthy males at baseline and during the last 15 s of voluntary end‐inspiratory, expiratory apneas and 5 min of static handgrip exercise (SHG; 20% maximum voluntary contraction) and 3 min of post‐exercise circulatory occlusion (SHG + PECO; measured in the non‐exercising arm). A lumped Windkessel model was employed to examine vascular bed compliance. During apnea, indices of MSNA were inversely related with vascular compliance, and reductions in compliance correlated with decreased brachial blood flow rate. During SHG, despite increased MSNA, compliance also increased, but was unrelated to increases in blood flow. Neither during SHG nor PECO did indices of MSNA correlate with forearm vascular compliance nor did vascular compliance correlate with brachial flow. However, during PECO, a linear combination of blood pressure and total MSNA was correlated with vascular compliance. These data indicate the elastic components of the forearm vasculature are regulated by adrenergic and myogenic mechanisms during sympatho‐excitation, but in a reflex‐dependent manner.

Blood lipid spectrum and elastic properties of arteries in patients with chronic pancreatitis in combination with arterial hypertension

110 patients aged 45-65 years with chronic pancreatitis were examined. The first group consisted of patients with a combined course of chronic pancreatitis with arterial hypertension; the second group - patients with chronic pancreatitis without concomitant hypertension. All patients were examined for total cholesterol, triglycerides, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, and very low-density lipoprotein cholesterol. Arterial stiffness was determined by the pulse wave velocity. It was found that patients of the 1st group had significantly higher levels of triglycerides (37.2%), low-density lipoprotein cholesterol (13%), total cholesterol (25%), atherogenic ratio (19.6%) and significantly lower levels of high-density lipoprotein cholesterol (15.4%). Correlations between age and the level of atherogenic ratio, low-density lipoprotein cholesterol were established – r=0.35; p<0.01; r=0.37; p<0.01, respectively. The duration of chronic pancreatitis positively correlated with the level of triglycerides, low-density lipoprotein cholesterol – r=0.43; p<0.01; r=0.34; p<0.01, respectively. The level of brachial artery augmentation index was significantly lower by 43% in patients with chronic pancreatitis in combination with arterial hypertension, while the aortic augmentation index was significantly higher by 37.6% (p<0.01). It was found that patients of the 1st group had a significantly higher pulse wave velocity in the carotid-femoral segment compared to the 2nd group – by 7.5% (p<0.01). Significant correlations have been established between the brachial artery augmentation index and age, total cholesterol, atherogenic ratio, high and low density lipoprotein cholesterol, triglycerides, cardiovascular risk level by the SCORE scale in patients with a combined course of chronic pancreatitis with arterial hypertension. Conclusions. Patients with the combination of chronic pancreatitis and hypertension had significantly higher levels of triglycerides, low-density lipoprotein cholesterol and total cholesterol. Changes in the elastic properties of arteries in patients with chronic pancreatitis with comorbid hypertension were characterized by an increase in the augmentation index and the pulse wave velocity in the carotid-femoral segment.

Current views on the assessment of vascular wall elasticity in pregnant women with arterial hypertension

Introduction. Arterial hypertension is the most common somatic pathology in pregnant women. Arterial hypertension is a factor of high risk for the development of severe preeclampsia, placental insufficiency, intrauterine growth restriction, premature birth, maternal and perinatal mortality, nervous disorder and vascular heart disease of newborns and women’s distant cardiovascular disorders. The pathogenesis of gestational complications is associated with pathology of placentation, endothelial dysfunction and a decrease in vascular elasticity. The pathogenesis has not studied yet. Nowadays there are no tests with enough sensitivity and specificity ensuring early diagnostics and risk identification at development of great obstetric syndromes. Aim of the study was to improve our understanding about a clinical and prognostic role of vascular wall elasticity in pregnant women with arterial hypertension. Materials and Methods. We searched publications and analyzed literature using various scientific databases, including Index Medicus, PubMed/MEDLINE, Embase, Cochrane Library and Russian scholarly journals related to obstetrics, gynecology, cardiology for the last 9 years. Results and Discussion. Today changes in the elastic properties of arteries is a modern marker of a high risk of cardiovascular events in patients with essentialhypertension. Endothelial dysfunction develops already in the early stages of arterial hypertension and initiates structural changes in the vascular wall and an increase in arterial stiffness. High activity of the sympathetic nervous system is the cause of changes in the elastic properties of arteries in pregnant women with arterial hypertension. Conclusion. The role of vascular wall elasticity in pregnant women with arterial hypertension is of tremendous importance and deserves close attention. The study of elastic properties of vessels is relevant for assessing the risk of gestational complications in pregnant women with arterial hypertension.

Вплив гіперурикемії на пружно-еластичні властивості артерій у пацієнтів з артеріальною гіпертензією

Актуальність. Підвищення рівня сечової кислоти (СК) є вкрай поширеним станом як у популяції в цілому, так і серед кардіологічних хворих зокрема, воно дуже негативно впливає на прогноз. Однак у нашій країні вивченню цього питання приділяють недостатньо уваги. Матеріали та методи. Обстежені 110 осіб, серед яких було 68 пацієнтів з артеріальною гіпертензією (АГ) та 42 особи із нормальним рівнем артеріального тиску (АТ). Пацієнтам було проведено такі дослідження: вимірювання зросту та маси тіла, індексу маси тіла, вимірювання офісних систолічного (САТ), діастолічного (ДАТ) артеріального тиску та частоти серцевих скорочень, добове моніторування АТ, неінвазивне визначення центрального САТ та швидкості поширення пульсової хвилі по артеріях еластичного та м’язового типів (ШППХе та ШППХм), біохімічне дослідження крові з визначенням рівнів сечової кислоти, глюкози, загального холестерину, тригліцеридів, холестерину ліпопротеїнів високої та низької щільності сироватки крові, ехокардіографію та ультразвукове обстеження сонних артерій. Статистичну обробку результатів проводили з використанням програмного забезпечення IBM Statistics SPSS 21. Результати. Пацієнти з АГ та особи групи контролю були порівнянні за віком. Першим етапом аналізу була оцінка поширеності гіперурикемії в обстежених осіб. У 55 % пацієнтів із АГ спостерігалося підвищення рівня СК. Тільки 17 % пацієнтів із нормальним рівнем АТ мали підвищений рівень СК. Групу пацієнтів із АГ було поділено на 2 підгрупи: перша підгрупа — із підвищеним рівнем сечової кислоти, друга — з нормальним її рівнем. В обох підгрупах пацієнти були одного віку та переважно з надмірною вагою тіла або ожирінням, чоловіків було більше в обох підгрупах. За основними клініко-демографічними характеристиками пацієнти не відрізнялися між собою. У підгрупі хворих з АГ та гіперурикемією ШППХе була достовірно вищою на 1,6 м/с (р = 0,044), ніж у підгрупі хворих із АГ та нормоурикемією. При цьому величина ШППХм була однаковою в обох підгрупах. Спостерігалася достовірна кореляція рівня СК із наявністю в анамнезі транзиторної ішемічної атаки або інсульту, ретинопатії, аритмії, а також із середньодобовими САТ і ДАТ. Також було продемонстровано достовірну кореляцію із центральним артеріальним тиском (R = 0,293; P = 0,007), часом викиду (R = 0,49; P < 0,001), субендокардіальним індексом життєздатності міокарда (R = 0,47; P < 0,001), тиском аугментації (R = 0,53; P < 0,001) та стандартизованим індексом аугментації (R = 0,24; P = 0,016), а також ШППХе (R = 0,47; P < 0,001). Достовірний взаємозв’язок рівня СК спостерігався з низкою ехокардіографічних та біохімічних параметрів. Висновки. Підвищений рівень сечової кислоти зустрічається в 55 % пацієнтів з АГ та 17 % пацієнтів зрілого віку без підвищення АТ. У пацієнтів з АГ та гіперурикемією швидкість поширення пульсової хвилі по артеріях еластичного типу була достовірно вищою, ніж у пацієнтів із АГ та нормальним рівнем сечової кислоти. Спостерігалася асоціація концентрації сечової кислоти в плазмі крові із жорсткістю артерій та показниками центрального артеріального тиску та індексу аугментації.

Arterial stiffness improves with effective chemotherapy in patients with lymphoma

Abstract Introduction Arterial stiffness independently predicts cardiovascular risk and has been associated with the presence of inflammation. Chemotherapy-induced cardiac dysfunction is a major contributor to adverse morbidity and mortality rates in cancer patients. There is extensive literature describing the cardiotoxic effects of anti-cancer treatment on left ventricular systolic function, that may be the result of direct effects of the cancer treatment on heart function, or due to an indirect acceleration of atherosclerosis. However there is only little evidence regarding chemotherapy effects on arterial elastic properties. The gold standard for measuring arterial stiffness is carotid femoral pulse wave velocity (cfPWV) and it is calculated as a function of transit time and distance of the pulse wave derived from the carotid and femoral arteries. Purpose Our aim was to investigate the effect of chemotherapy in aortic stiffness in patients with lymphoma, a malignancy with known high metabolic burden. Methods Sixty-six patients (22 male, mean age 56 years) with Hodgkin (n=34) or non-Hodgkin lymphoma (n=32) were enrolled in the study. Patients with Hodgkin Lymphoma underwent therapy with Doxorubicin, bleomycin, vinblastine and dacarbazine (ABVD). The interim of their treatment was set at 1 to 3 days prior to initiating the 3rd chemotherapy cycle. Patients with non Hodgkin Lymphoma underwent therapy with cyclophosphamide, doxorubicin, vincristine, and prednisone+rituximab (R-CHOP). Blood pressure (BP) and carotid-femoral pulse wave velocity (c-f PWV) were measured at baseline, interim and after completion of chemotherapy. Results Changes in systolic and diastolic BP from baseline, to interim phase and 6 weeks post therapy were insignificant (decrease by 3.87±1.37 mmHg p-0.277 and 3.05±0.92 mmHg p-0.422 respectively). Figure illustrates c-f PWV changes from baseline to interim and 6 weeks after completion of chemotherapy. As figure shows, c-f PWV progressively decreased at the interim phase and at 6–8 weeks after chemotherapy completion (by 0.37±0.14 m/s), (overall P-0.010, by ANOVA) The progressive decrease in c-f PWV remained statistically significant after adjustment for age, systolic BP and diabetes (F=5.173, P-0.009). Patients' baseline characteristics are demonstrated in table 1. Conclusion Carotid-Femoral PWV decreased at 6–8 weeks post chemotherapy in patients with lymphoma, suggesting that aortic elastic properties improve with chemotherapy in these patients. Considering that aortic stiffness increases due to systemic inflammation and that lymphomas are increased metabolic burden tumors, the significant improvement in arterial stiffness implies that the presence of inflammation caused by the malignancy may play a significant role in the arterial stiffness progression. Funding Acknowledgement Type of funding sources: None.

Effects of hormone replacement therapy on arterial stiffness, endothelial function and myocardial deformation in women with Turner syndrome

Abstract Funding Acknowledgements Type of funding sources: None. Background/Introduction: Turner syndrome (TS) is associated with congenital or acquired cardiovascular diseases. Purpose We investigated whether hormone replacement therapy (HRT) affects arterial elastic properties, endothelial function and myocardial deformation in women with TS. Methods In 25 women with TS (age: 29 ± 9years) we measured in the oestrogen phase of HRT cycle and 1 month after discontinuation of HRT: a)Pulse wave velocity (PWV-Complior), central systolic blood pressure (cSBP) and augmentation index (AI) of the aortic pulse wave, b)perfused boundary region (PBR) of the sublingual arterial microvessels, as a marker of endothelial glycocalyx thickness, c)carotid intima-media thickness (cIMT), d)flow-mediated dilatation (FMD) of the brachial artery and percentage difference of FMD (FMD%), and e)global LV longitudinal strain (GLS) and left atrium (LA) strain using speckle tracking echocardiography. Ten healthy subjects of similar sex, age and BMI served as control group. Results Compared to controls, women with TS under HRT had higher PWV (9.1 ± 2.4 vs. 7.5 ± 0.5m/s), AI (18 [7 to 27] vs. 5.8 [-10 to 19]%), cSBP (130 ± 15 vs. 121 ± 6mmHg), cIMT (0.66 ± 0.06 vs. 0.55 ± 0.05mm), FMD (7.2 ± 4 vs. 10 ± 2.3%) and lower LA volume index (14.3 ± 4 vs. 24 ± 13 mL/m²) and GLS (-18.8 ± 2.7 vs. -21.9 ± 1.5) (p < 0.05 for all comparisons). PBR was negatively related with FMD% (r=-0.58, p = 0.022) in women with TS under HRT. One month after discontinuation of HRT, all women reduced PWV, AI, cSBP and increased FMD. There were no statistically significant changes in BMI, PBR, cIMT, LA volume index, LA strain and LV GLS (p > 0.05 for all comparisons) (Table). The percent decrease of cSBP was associated with the percent decrease of PWV (r = 0.54) and inversely related with the percent increase of FMD (r=-0.57) (p < 0.05 for all comparisons). Conclusions Hormone replacement treatment in women with TS deteriorates arterial stiffness and endothelial function probably due to increased central arterial blood pressure. Women with Turner syndrome under HRT (n = 25) Women with Turner syndrome one month after discontinuation of HRT (n = 25) p-value PWV, m/s 9.1 ± 2.4 7.8 ± 1.7 0.028 Central SBP, mmHg 130 ± 15 123 ± 14 0.007 PBR, 5-25μm 2.11 ± 0.3 2.12 ± 0.2 0.983 cIMT, mm 0.66 ± 0.06 0.67 ± 0.06 0.947 FMD, % 7.2 ± 4 11.7 ± 6 0.042 LA strain, % 51 ± 12 54 ± 15 0.400 LV GLS, % -18.8 ± 2.7 -19.3 ± 2.3 0.594 Table

Optimal Organ Protection and Blood Pressure Control with the Single Pill Combination Lisinopril, Amlodipine and Indapamide in Arterial Hypertension

Aim. To evaluate the single pill combination with lisinopril, amlodipine and indapamide ability in additional angioprotection achievement in patients with arterial hypertension and high pulse wave velocity (PWV) regardless on previous antihypertensive therapy (AHT).Material and methods. To the open non-randomized study duration 12 weeks 40 patients were included taking triple AHT during 6 months. All participants underwent ambulatory 24 hour blood pressure (BP) monitoring, applanation tonometry (augmentation index and central BP), pulse wave velocity assessment, laboratory tests (HbA1c, serum uric acid, high sensitive C-reactive protein [hsCRP], serum uric acid).Results. We observed additional systolic BP (SBP) and diastolic BP (DBP) reduction by 16.9% and 22.11% on lisinopril, amlodipine and indapamide single pill combination. Lisinopril, amlodipine and indapamide single pill combination decreased 24 h mean SBP by 16.77%, and 24 h mean DBP -23.5% (ABPM data), PWV by 19.7%, augmentation index by 14.81%, central SBP by 11.9% (p<0,05). There were positive changes in hsCRP level (-13.0%, p<0.05) and serum uric acid (-9.0%, p<0.05).Conclusion. Lisinopril, amlodipine and indapamide single pill combination provided control BP, arterial elastic properties improving (augmentation index, PWV, central BP) and favorable influence on inflammation and serum uric acid level.

Sodium-glucose cotransporter-2 inhibitors and their combination with glucagon like peptide-1 receptor agonists improve endothelial glycocalyx and arterial stiffness in type-2 diabetes

Abstract Background/Introduction Type-2 diabetes mellitus (T2DM) is associated with endothelial and arterial 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 endothelial and arterial function of T2DM patients. Methods A hundred-sixty T2DM patients (age: 58±10 years) 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 (ranged from 5 to 25μm) using Sideview Darkfield imaging. Increased PBR indicates reduced glucocalyx thickness, b) pulse wave velocity (PWV-Complior), central systolic blood pressure (cSBP) and augmentation index (AI) of the aortic pulse wave. Results Twelve months post-treatment, all patients improved PBR, PWV and AI (p<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<0.05). SGLT-2i or combined therapy with GLP-1RA and SGLT-2i showed a greater decrease of PWV (−10.1% and −13% vs. −3.6% and −8.6%) and cSBP (−3% and −5.5% vs. −0.8% and −1.5%)than insulin or GLP-1RA (p<0.05 for all comparisons). GLP-1RA or GLP-1RA+SGLT-2i provided a greater decrease of AI (−42.7% and −48.6% vs. +6.2% vs. −3.8%) compared with insulin or SGLT-2i (Table). The dual therapy showed the greatest effect on measured markers in patients with LVEF <55% (p<0.05). Conclusions Twelve-month treatment with SGLT-2i and its combination with GLP-1RA, showed a greater improvement on arterial elastic properties than GLP1RA or insulin treatment in T2DM. The combined therapy as second line was superior to either insulin, or GLP-1RA and SGLT-2i separately. Funding Acknowledgement Type of funding source: None

414 Ventricular-arterial interaction predicts response to cardiac resynchronization therapy: a link with improvement of endothelial function and arterial elastic properties

Abstract Background Endothelial dysfunction (ED) is a hall mark of chronic heart failure and has been linked to disease progression, hospitalizations and mortality. Purpose to evaluate the impact of cardiac resynchronization therapy (CRT) in ED and to determine predictors of response to CRT Methods CRT recipients from 19/07/2016 until 19/10/2018 were studied at baseline and 3 months after. In each visit we evaluated a 12 lead ECG, carotid to femoral pulse wave velocity (cfPWV), flow-mediated dilatation of the brachial artery (FMD), left ventricle ejection fraction (LVEF) and left ventricle (LV) global longitudinal strain (GLS). We evaluated arterial elastance (Ea) to ventricular elastance (Ees) ratio (Ea/Ees) by echocardiography and the ratio of cfPWV to GLS, as valid markers of ventricular-arterial interaction. We also assessed the layer of endothelial glycocalyx by measurement of Perfused Boundary Region (PBR) of the sublingual microvessel range:5-25 microns. Results 32 patients with a mean age 65.5 (±10.9) years and severe LV systolic dysfunction were enrolled. During follow-up, LVEF, GLS, LVESV and all ED markers exhibited significant improvement (table 1). 23 patients were responders. Among the baseline vascular function markers, only the ratio cfPWV/GLS predicted response to CRT (OR: 0.245, 95%CI: 0.042-0.759, p = 0.044).Threshold analysis showed that the best threshold of cfPWV/GLS for response to CRT was 2.75 (specificity: 0.67%, sensitivity: 0.94%). Conclusions After 3 months of CRT, endothelial function, arterial elasticity and ventricular arterial interaction are improved. The baseline ratio cfPWV/GLS, a novel marker of ventricular arterial interaction, can be applied to predict response to CRT. table 1 Baseline Follow-up Change Measurement mean (sd) mean (sd) mean (sd) p-value SBP (mmHg) 126 (19) 128 (16) 2.18 (11.98) 0,465 DBP (mmHg) 79 (9) 80 (9) 1.06 (8.58) 0,618 LVEF (%) 27 (7) 35 (9) 7.50 (4.77) <0.001 LVESV (mL) 151 (42) 120 (46) -26.91 (17.20) <0.001 GLS (%) 6.47 (2.89) 9.33 (4.18) 2.85 (2.28) <0.001 FMD (%) 5.88 (2.79) 10.25 (3.67) 4.37 (3.34) <0.001 Ea/Ees 2.81 (1.10) 2.04 (0.99) -0.77 (0.47) <0.001 cfPWV 11.11 (2.61) 10.01 (2.45) -1.10 (1.56) 0,003 PBR 5-25(microns) 2.26 (0.20) 2.14 (0.24) -0.13 (0.25) 0,028 cfPWV/GLS 2.18 (1.46) 1.45 (1.11) -0.73 (0.55) <0.001 Measurements at baseline, follow-up and their change during study Abstract 414 Figure. picture 1

P957 Prognostic value of pulmonary artery elastic properties in patients with pulmonary hypertension - a comparison of Eisenmenger syndrome to other types of pulmonary hypertension

Abstract Patients with Eisenmenger’s syndrome (ES) have better survival than other patients with pulmonary arterial hypertension (PAH) probably due to the preservation of right ventricular (RV) function. As in PAH patients RV remodeling and function depend not only on pulmonary artery (PA) pressure but also on the intrinsic properties of PA wall, there is also a possible role of PA stiffness (PAS) as outcome predictor in this setting. Purpose. To study the prognostic role of PAS parameters assessed by 2D transthoracic echocardiography in patients with ES compared to other patients with pulmonary hypertension (PH) receiving specific vasodilator therapy. Methods. Sixty-eight PH patients were enrolled: 27 ES patients and 41 non-ES patients, including patients with other types of PAH (12 idiopathic PAH, 5 operated congenital heart disease, 10 connective tissue disease, 7 other forms of PAH) or chronic thromboembolic PH (7 patients) receiving oral vasodilator therapy. Clinical data, B-type natriuretic peptide (BNP), RV function and PAS parameters were assessed: pulmonary capacitance (PC), PC indexed to body surface area (PC/BSA), pulsatility, elastic modulus (EP), beta-index. PH patients were followed-up for 2.9 years (4 months-6.8 years). Results. Pulmonary vascular resistance (PVR) assessed by right heart catheterization was similar in both groups (11.9 ± 8.0 vs 11.0 ± 6.4 Wood units, p = 0.68). ES patients had lower BNP levels (lnBNP 3.63 ± 1.31 vs 5.31 ± 1.33, p < 0.001) and better RV function than non-ES patients: RV-free wall S wave, RV-S (12.2 ± 2.3 vs 10.2 ± 2.0 cm/s, p < 0.001), RV fractional area change, RV-FAC (40 ± 7 vs 32 ± 9%, p < 0.001), RV global longitudinal strain (RV-GLS) on 3 segments (-20.2 ± 4.4 vs -14.8 ± 6.0%, p = 0.001) or 6 segments (-16.2 ± 4.2 vs -13.1 ± 4.9%, p = 0.011). In ES patients PAS parameters were less impaired than in non-ES group (PC 1.68 ± 0.86 vs 1.18 ± 0.66 ml/mmHg, p = 0.014; PC/BSA 1.05 ± 0.53 vs 0.68 ± 0.37 ml/mmHg m2, p = 0.003; pulsatility 18.8 ± 8.4 vs 13.8 ± 6.4%, p = 0.007, EP 390.7 ± 198.6 vs 578.8 ± 341.6 mmHg, p = 0.007; beta index 6.09 ± 2.85 vs 10.77 ± 6.21, p < 0.001). During follow-up, 12 cardiac deaths occurred: 1 in ES group and 11 in non-ES group (p = 0.021). In non-ES group, predictors of cardiac death were parameters of RV function and PAS: BNP levels (lnBNP 6.20 ± 1.10 in deceased patients vs 4.97 ± 1.27 in survivors, p = 0.007), RV-S (9.1 ± 2.0 vs 10.6 ± 1.9 cm/s, p = 0.038), RV-FAC (25 ± 8 vs 35 ± 7%, p = 0.001), RV-GLS on 3 segments (-11.1 ± 4.4 vs -16.2 ± 6.0%, p = 0.015) or 6 segments (-9.0 ± 3.7 vs -14.6 ± 4.4%, p = 0.001), PC (0.86 ± 0.29 vs 1.32 ± 0.72 ml/mmHg, p = 0.01; PC/BSA (0.51 ± 0.17 vs 0.76 ± 0.41 ml/mmHg m,2 p = 0.013). Conclusion: Patients with ES have better RV function and less impaired PAS compared to patients with other types of PH and similar PVR. Moreover, besides RV function, PAS parameters emerged as predictors of cardiac death in non-ES patients that had worse prognosis than ES patients. The impact of these findings on clinical outcomes in ES patients remains to be further studied.

Myocardial remodeling and arterial stiffness depending on aldosterone level in patients with chronic kidney disease and arterial hypertension

The aim. To analyze the relationship between serum aldosterone levels and myocardial remodeling and changes in elastic properties of arteries in patients with chronic kidney disease (CKD) and hypertension (AH).Materials and methods. A cross-secitonal study of 44 patients (14 men and 30 women, aged 56.0 [52.0; 60.5] years) with CKD and AH who were treated with angiotensine-converting enzyme inhibitors or angiotensine receptor blockers at a stable dose for at least of 3 months was performed. Serum aldosterone levels, elastic properties of the arteries, and transthoracic echocardiography using a standard method were performed. Arterial stiffness was defined as a pulse wave velocity, which was calculated using equation proposed by Arterial Stiffness Society and was measured using a device BAT41-2.Results. In 8 patients (18.2 %) we detected serum aldosterone levels above 90 pg/ml. The proportion of female patients among patients with normal aldosterone levels was significantly higher (P = 0.03). Patients with elevated aldosterone levels had a 5-year higher median age and 10 ml/min lower glomerular filtration rate. Serum aldosterone levels correlated significantly with myocardial structural and functional parameters (left ventricle (LV) end-systolic and end-diastolic dimensions and volumes, LV myocardial mass and LV mass index, thickness of interventricular septum) in men and patients over 55 years of age. Women showed a weak correlation of aldosterone levels with systolic and diastolic blood pressure.Conclusions. An association was found between serum aldosterone levels above 90 pg/ml in patients with CKD and hypertension with dilatation of left ventricular and atrial cavities, and with left ventricular hypertrophy (by LV mass and mass index). This association was stronger for males and for patients aged >55 years. A correlation between aldosterone level and arterial stiffness (augmentation index on the brachial artery and aorta) has only been found in patients over 55 years of age.

Arterial elastic properties and central aortic pressure in patients with ankylosing spondylitis

In recent years, arterial stiffness has been shown to be increased in ankylosing spondylitis (AS). However, this issue has not been sufficiently studied today. Objective: to investigate central aortic pressure values and pulse wave velocity (PWV) in patients with AS and their relationship to the clinical manifestations of the disease. Subjects and methods . A total of 47 patients (mean age 37.0+10.1) with AS were examined. ASDAS-CRP averaged 3.2+0.9; the duration of AS was 6.0+4.6 years; and the radiographic stage of sacroiliitis was 2.3+1.4. A control group included 33 healthy individuals. The groups were matched for age, gender, and office blood pressure (BP). Central aortic pressure and PWV were determined by applanation tonometry on a SphygmoCor apparatus (AtCorMedical, Australia). The Mann-Whitney U test and the Spearman correlation coefficient test were used for statistical analysis. Results and discussion . In the patients with AS, central systolic and diastolic BP was significantly higher than that in the controls (115.4+14.04 and 101.1 + 10.2 mm Hg, p=0.00001 and 78.6+12.3 and 71.8+7.3 mm Hg respectively, p=0.001). The patients with AS showed a 15.01% increase in mean central aortic pressure values compared to the control group (106.5+13.7 and 92.6+9.4 mm Hg, respectively; p=0.0001). Carotid-femoral PWV averaged 6.6+1.7 m/sec in the patients with AS and 5.20+0.96 m/sec in the controls (p=0.0001). There was a direct correlation of PWV with the occiput-wall distance r= 0.36; p=0.01) and an inverse correlation with Schober's test (r=-0.54; p=0.0001). Conclusion. The patients with AS were found to have increased arterial stiffness parameters, such as PWV, central aortic pressure, central diastolic BP, and central hemodynamic pressure. PWV was demonstrated to be related to clinical data.

Effects of novel antidiabetic agents on the arterial wall elastic properties as a marker of vascular function in patients with type 2 diabetes mellitus

Effects of novel antidiabetic agents on the arterial wall elastic properties as a marker of vascular function in patients with type 2 diabetes mellitus