Estimation Of Arterial Stiffness Research Articles

Estimation of local arterial stiffness using non-invasive flow measurements: a study on a stenosed carotid artery

Arterial stiffness is a well-established independent prognostic bio-marker in the human cardiovascular system (CVS). Despite its value as a predictive bio-marker, the inclusion of vascular stiffness into standard clinical procedures or guidelines is limited. This has come about as a result of the abundance of tools created to estimate and evaluate local arterial stiffness in people. This study employs a non-invasive technique to measure local arterial stiffness in the human carotid arteries using proximal flow measurements. Within this work, a viscoelastic lumped-parameter (0D) model of the carotid arteries is developed in complement with the non-invasive flow measurements obtained from the Doppler ultrasound. Further, concepts of sensitivity analysis and parameter estimation are applied to estimate arterial stiffness using the flow measurement taken at the common carotid artery (CCA). After the successful estimation of arterial stiffness in CCA, results show good agreement between model simulations and actual measurement.

ESTIMATED ARTERIAL STIFFNESS, COGNITIVE DECLINE, AND DEMENTIA AMONG MIDDLE-AGED AND OLDER ADULTS

Abstract Prior research suggests arterial stiffness may be a useful vascular biomarker that predicts age-related cognitive decline. In this paper, we use the Health and Retirement Study (HRS) to examine the relationship between estimated pulse wave velocity (ePWV), which is an under-analyzed but readily available estimate of arterial stiffness, and cognitive decline. The HRS assesses cognitive function with the Telephone Interview for Cognitive Status (TICS). In this 27-point TICS measure, scores between 7 and 11 indicate cognitively impaired but no dementia (CIND) and scores between 0 and 6 indicate dementia. We modeled the relationship between ePVW and cognitive status change from 2006/2008 through 2018. The findings indicate ePWV increases the odds of having CIND and dementia relative to having no CIND or dementia. In addition, ePWV increases the odds of transitioning into CIND and dementia from a higher cognitive functioning state. The results are robust to controlling for: age, age squared, age cubed, systolic and diastolic blood pressure along with sociodemographic characteristics (gender, race, ethnicity, wealth, income, education), health status (history of cardiovascular disease (CVD,) diabetes, and stroke and related medication use), health behaviors (smoking, physical activity, body mass index), and CVD-related biomarkers (C-reactive protein, cystatin-C, hemoglobin A1c, total cholesterol, high-density lipoprotein (HDL) cholesterol). These findings suggest that ePWV is a simple screening tool and novel biomarker that can be used to monitor vascular cognitive aging and CIND progression in middle-aged and older adults.

Sexual function scores are associated with arterial stiffness in postmenopausal women.

Female sexual dysfunction (FSD) has been suggested to be correlated with the burden of cardiovascular risk factors. We aimed to evaluate the possible association between functional indices of vascular function and FSD scores in apparently healthy postmenopausal women. This cross-sectional study included 116 postmenopausal women who underwent assessment of endothelial function with measurement of flow-mediated dilation (FMD) of the branchial artery and arterial stiffness estimation with measurement of the carotid-femoral pulse wave velocity (PWV). We used the Greene Climacteric Scale to evaluate vasomotor symptomatology, the Female Sexual Function Index (FSFI) to evaluate FSD and the Beck Depression Inventory to evaluate mood disorder. Low sexual function was defined as an FSFI score <26.55. These included FSFI and low sexual function scores as well as measures of PWV and FMD. Sexual function scores were associated with measures of blood pressure (normal vs low sexual function; systolic blood pressure: 120.2 ± 15.0 mm Hg vs 113.4 ± 14.6 mm Hg; analysis of covariance P = .026; diastolic blood pressure: 75.9 ± 10.5 mm Hg vs 70.3 ± 9.9 mm Hg; analysis of covariance P = .012; both adjusted for age, body mass index, current smoking, and PWV). Systolic blood pressure, but not diastolic blood pressure, was associated with FSFI (B = 0.249, P = .041) and PWV (B = 0.392, P < .001). PWV measures were associated with FSFI (B = -0.291, P = .047) and pulse pressure (B = 0.355, P = .017). FMD measures were also associated with FSFI (B = 0.427, P = .033). All models were adjusted for age, body mass index, current smoking, insulin resistance, vasomotor symptomatology, and Beck Depression Inventory. Our findings demonstrate that lower scores of sexual function are associated with deteriorated vascular function mainly manifested as arterial stiffening, further contributing to systolic blood pressure changes. The strength of this study is the carefully selected healthy sample of postmenopausal women, with simultaneous assessment of climacteric symptomatology and mood disorders. The limitations include the small sample size, the cross-sectional design, and the recruitment of consecutive outpatients of a university menopause clinic. Longitudinal studies and interventions to improve FSD should further assess the clinical relevance of these findings.

Value of estimating pulse wave velocity compared to SCORE in cardiovascular risk stratification in community pharmacies

ObjectivesArterial stiffness is considered to be an intermediate marker with independent prognostic value. The objective of this study is to assess whether the estimation of arterial stiffness can improve CV risk stratification compared to SCORE in patients at community pharmacies. MethodsObservational prospective epidemiological study in which consecutive individuals entering a participating Community Pharmacy are offered a voluntary measurement of blood pressure and estimation of pulse wave velocity by oscillometry (AGEDIO, IEM®) to stratify their CV risk according to SCORE compared to the use of arterial stiffness. ResultsAfter nine months of recruitment, data from 923 patients (570 women, 353 men) were collected. 16/122 (13.1%) patients under 40 years and 72/364 (19.8%) over 65 years of age presented pathological stiffness and could be classified as high-risk, even though being out of the age-range of SCORE. Of the 437 (47.3%) patients who were susceptible to calculating SCORE, 42/437 patients (9.6%) presented pathological arterial stiffness. Cholesterol values were available in 281 patients (64.3%). Among them, according to SCORE, only 6 (2.1%) fell into the high-risk category. ConclusionsMore than half of the subjects who randomly enter a community pharmacy had ages that make it impossible to calculate the CV risk by SCORE. Among them, arterial damage was detected in 18.1%. Of the other half, 9.6% presented arterial damage and, therefore, high CV risk, when SCORE only detected it in 2.1%. Therefore, estimating arterial stiffness in community pharmacies markedly improves detection of high CV risk compared to SCORE.

Value of estimating pulse wave velocity compared to SCORE in cardiovascular risk stratification in community pharmacies

ObjectivesArterial stiffness is considered to be an intermediate marker with independent prognostic value. The objective of this study is to assess whether the estimation of arterial stiffness can improve CV risk stratification compared to SCORE in patients at community pharmacies. MethodsObservational prospective epidemiological study in which consecutive individuals entering a participating Community Pharmacy are offered a voluntary measurement of blood pressure and estimation of pulse wave velocity by oscillometry (AGEDIO, IEM®) to stratify their CV risk according to SCORE compared to the use of arterial stiffness. ResultsAfter nine months of recruitment, data from 923 patients (570 women, 353 men) were collected. 16/122 (13.1%) patients under 40 years and 72/364 (19.8%) over 65 years of age presented pathological stiffness and could be classified as high-risk, even though being out of the age-range of SCORE. Of the 437 (47.3%) patients who were susceptible to calculating SCORE, 42/437 patients (9.6%) presented pathological arterial stiffness. Cholesterol values were available in 281 patients (64.3%). Among them, according to SCORE, only 6 (2.1%) fell into the high-risk category. ConclusionsMore than half of the subjects who randomly enter a community pharmacy had ages that make it impossible to calculate the CV risk by SCORE. Among them, arterial damage was detected in 18.1%. Of the other half, 9.6% presented arterial damage and, therefore, high CV risk, when SCORE only detected it in 2.1%. Therefore, estimating arterial stiffness in community pharmacies markedly improves detection of high CV risk compared to SCORE.

Agreement between cardiac output estimation with a wireless, wearable pulse decomposition analysis device and continuous thermodilution in post cardiac surgery intensive care unit patients.

Pulse Decomposition Analysis (PDA) uses integration of the systolic area of a distally transmitted aortic pulse as well as arterial stiffness estimates to compute cardiac output. We sought to assess agreement of cardiac output (CO) estimation between continuous pulmonary artery catheter (PAC) guided thermodilution (CO-CCO) and a wireless, wearable noninvasive device, (Vitalstream, Caretaker Medical, Charlottesville, VA), that utilizes the Pulse Decomposition Analysis (CO-PDA) method in postoperative cardiac surgery patients in the intensive care unit. CO-CCO measurements were compared with post processed CO-PDA measurements in prospectively enrolled adult cardiac surgical intensive care unit patients. Uncalibrated CO-PDA values were compared for accuracy with CO-CCO via a Bland-Altman analysis considering repeated measurements and a concordance analysis with a 10% exclusion zone. 259.7h of monitoring data from 41 patients matching 15,583 data points were analyzed. Mean CO-CCO was 5.55L/min, while mean values for the CO-PDA were 5.73L/min (mean of differences +- SD 0.79 ± 1.11L/min; limits of agreement - 1.43 to 3.01L/min), with a percentage error of 37.5%. CO-CCO correlation with CO-PDA was moderate (0.54) and concordance was 0.83. Compared with the CO-CCO Swan-Ganz, cardiac output measurements obtained using the CO-PDA were not interchangeable when using a 30% threshold. These preliminary results were within the 45% limits for minimally invasive devices, and pending further robust trials, the CO-PDA offers a noninvasive, wireless solution to complement and extend hemodynamic monitoring within and outside the ICU.

CARFILZOMIB-BASED REGIMEN AND CARDIOTOXICITY IN MULTIPLE MYELOMA: INCIDENCE OF CARDIOVASCU-LAR EVENTS AND ORGAN DAMAGE IN CARFILZOMIB-DEXAMETHASONE VERSUS CARFIL-ZOMIB-LENALIDOMIDE

Objective: Cardiotoxicity is a known adverse effect of Carfilzomib therapy, nevertheless few data are available on cardiovascular complications induced by different Carfilzomib-regimens in a real-life setting. The aim of this perspective study was to investigate the difference in incidence and time of onset of cardiovascular adverse events between Kd and KRd in MM patients in real-life conditions. Furthermore, we investigated differences in subclinical organ damage (both cardiac and vascular ) induced by the two regimens, and offer a discussion on how these data might support different follow up strategies for patients treated with Kd or KRd regimen Design and method: In this prospective study, adults with MM who had haematological indication to Kd or KRd, were consecutively enrolled. They underwent a baseline cardiovascular assessment before treatment initiation and a follow-up evaluation at 6 months, including office blood pressure measurements, ambulatory blood pressure monitoring, 12-leads EKG, trans-thoracic echocardiography with global longitudinal strain assessment (GLS), and estimation of arterial stiffness by the carotid-femoral pulse wave velocity (cfPWV) measurement. Results: A total of 109 patients were enrolled, 47 (43%) received Kd and 62 (57%) KRd. All-types of cardiovascular and hypertensive events occurred more frequently in Kd group compared to KRd (59% vs 40% and 55% vs 35.5% patients, respectively, p&lt;0.05), with higher incidence of hypertensive urgencies. Furthermore, the time of onset of all-type of CVAEs, major and hypertensive event was shorter in Kd regimen compared to KRd (3.6 vs. 10.2 months, 4.0 vs. 10.8 months and 8.6 vs. 14.6 months, respectively (p &lt; 0.05)). At follow-up, Kd patients developed more frequently signs of cardiac as decline of global longitudinal strain (-19.7 vs -21.3, p = 0.009) and vascular organ damage demonstrated by a rise of pulse wave velocity (8.5 vs 1.9, p = 0.009), with respect to KRd. Conclusions: In conclusion, Kd regimen showed greater cardiovascular toxicity with respect to KRd and earlier onset of events. Thus, a closer and careful follow-up should be considered.

A correlation study of arterial stiffness, cardiac autonomic neuropathy and lipid profile in type 2 diabetes mellitus patients

Objectives: Micro and macrovasculopathy are common complications of undertreated or undiagnosed type 2 diabetes mellitus (T2DM) patients. One of the underlying factors of macrovasculopathy is arterial stiffness, which may lead to cardiovascular and cerebrovascular diseases. Understandably, diabetic micro and macrovasculopathy affect vital functions, which may affect the well-being of the individual. However, few studies have attempted to determine arterial stiffness, cardiac autonomic neuropathy (CAN) and lipid profile separately in South Asian population and examined its associations with T2DM. Moreover, there is a need to understand the mechanistic links among cardiovascular risk factors. This forms the basis of the present study. Materials and Methods: T2DM patients of 53–62 years and age- and gender-matched healthy control subjects were recruited in the cross-sectional and observational study (n = 30 each, eight women). Anthropometric measurements, physiological parameters such as resting heart rate, peripheral blood pressure (PBP), central blood pressure (CBP), augmentation index% (AIx%), brachial-ankle pulse wave velocity and lead II ECG for analysis of heart rate variability parameters were recorded after obtaining the consent of the study participants. The lipid profile and fasting blood glucose were also analysed. Results: Peripheral systolic blood pressure was significantly higher (P = 0.05) in T2DM patients. Dyslipidaemia was evident in T2DM patients. Atherogenic index of plasma (AIP) was also significantly higher in T2DM patients. Correlation analysis revealed a positive association between AIx% with PBP and CBP as well as between AIP index and central systolic blood pressure, serum triglyceride (TG), low-density lipoprotein cholesterol (LDL-C) and very low-density lipoprotein cholesterol (VLDL-C) levels. AIP index was found to be negatively associated with HF (nu). Serum TG, high-density lipoprotein cholesterol (HDL-C) levels and AIP index have emerged as significant independent predictors of T2DM vasculopathy by multiple regression analysis. Conclusion: In the present study, atherogenic dyslipidaemia was observed in T2DM patients in combination with increased serum levels of TG, VLDL-C and decreased serum levels of HDL-C. Moreover, AIP index, a predictor cardiovascular risk, was found to be significantly higher in T2DM patients. Dyslipidaemia was found to be associated with dysregulation of autonomic nervous system in those patients. A positive association between noninvasive, surrogate markers of arterial stiffness with PBP and CBP indicates that enhanced arterial stiffness may elevate systemic arterial pressure. Therefore, early screening of T2DM patients for the estimation of serum lipid profile, arterial stiffness and cardiac autonomic neuropathy may be performed to unravel diabetic vasculopathy.

Carfilzomib-Based Regimen and Cardiotoxicity in Multiple Myeloma: Incidence of Cardiovascular Events and Organ Damage in Carfilzomib-Dexamethasone versus Carfilzomib-Lenalidomide-Dexamethasone. A Real-Life Prospective Study.

Carfilzomib-mediated cardiotoxicity in multiple myeloma (MM) is a well-established adverse effect, however limited data are available on the comparison of cardiovascular complications in patients treated with Carfilzomib-dexamethasone (target dose of K 56 mg/m2) versus Carfilzomib-lenalidomide-dexamethasone (target dose of K 27 mg/m2) beyond controlled trials. A total of 109 patients were enrolled, 47 (43%) received Kd and 62 (57%) KRd. They then underwent a baseline and follow-up evaluation including trans-thoracic echocardiography and arterial stiffness estimation. All types of cardiovascular and hypertensive events occurred more frequently in the Kd group compared with the KRd (59% vs. 40% and 55% vs. 35.5% patients, respectively, p ≤ 0.05), with higher incidence of hypertensive. The time of onset of any type of CVAE, and of major and hypertensive events was shorter in the Kd regimen (p ≤ 0.05). At follow-up, Kd patients more frequently developed signs of cardiac (decline of global longitudinal strain) and vascular organ damage (rise of pulse wave velocity), as compared with KRd. Despite the older age, longer history of MM and longer period of pre-treatment of Kd patients, these factors did not increase the probability of incidence for all types of cardiovascular events at multivariate analysis (p > 0.05). In conclusion, the Kd regimen showed greater cardiovascular toxicity and earlier onset of events with respect to KRd. Thus, a closer and thorough follow-up should be considered.

An image-based approach for the estimation of arterial local stiffness in vivo.

The analysis of mechanobiology of arterial tissues remains an important topic of research for cardiovascular pathologies evaluation. In the current state of the art, the gold standard to characterize the tissue mechanical behavior is represented by experimental tests, requiring the harvesting of ex-vivo specimens. In recent years though, image-based techniques for the in vivo estimation of arterial tissue stiffness were presented. The aim of this study is to define a new approach to provide local distribution of arterial stiffness, estimated as the linearized Young's Modulus, based on the knowledge of in vivo patient-specific imaging data. In particular, the strain and stress are estimated with sectional contour length ratios and a Laplace hypothesis/inverse engineering approach, respectively, and then used to calculate the Young's Modulus. After describing the method, this was validated by using a set of Finite Element simulations as input. In particular, idealized cylinder and elbow shapes plus a single patient-specific geometry were simulated. Different stiffness distributions were tested for the simulated patient-specific case. After the validation from Finite Element data, the method was then applied to patient-specific ECG-gated Computed Tomography data by also introducing a mesh morphing approach to map the aortic surface along the cardiac phases. The validation process revealed satisfactory results. In the simulated patient-specific case, root mean square percentage errors below 10% for the homogeneous distribution and below 20% for proximal/distal distribution of stiffness. The method was then successfully used on the three ECG-gated patient-specific cases. The resulting distributions of stiffness exhibited significant heterogeneity, nevertheless the resulting Young's moduli were always contained within the 1-3MPa range, which is in line with literature.

Beat-to-Beat Estimation of Peripheral Arterial Stiffness From Local PWV for Quantitative Evaluation of Sympathetic Nervous System Activity.

Sympathetic nervous system activity (SNSA) can rapidly modulate arterial stiffness, thus making it an important biomarker for SNSA evaluation. Pulse wave velocity (PWV) is a well-known quantitative indicator of arterial stiffness, but its functional responsivity to SNSA has not been elucidated. This paper reports a method to estimate rapid changes in peripheral arterial stiffness induced by SNSA using local PWV (LPWV) and to further quantify SNSA based on the estimated stiffness. LPWV was measured from the artery near the wrist to the artery near the forefinger using a biodegradable piezoelectric sensor and a photoplethysmography sensor in an electrocutaneous stimulus experiment in which pain evokes the SNSA. The relationship between LPWV, simultaneously measured peripheral arterial stiffness index, and self-reported pain intensity was quantified. The stiffness estimated by LPWV alone and the stiffness estimated by LPWV and arterial pressure both approximate the peripheral arterial stiffness index (R2 = 0.9775 and 0.9719). Pain intensity can be quantitatively evaluated in a sigmoidal relationship by either the estimated stiffness based on LPWV alone (r = 0.8594) or the estimated stiffness based on LPWV and arterial pressure (r = 0.9738). Our results demonstrated the validity of LPWV in the quantitative evaluation of SNSA and the optionality of blood pressure correction depending on application scenarios. This study advances the understanding of sympathetic innervation of peripheral arteries through the sympathetic responsivity of LPWV and contributes a quantitative biomarker for SNSA evaluation.

Association Between Estimated Pulse Wave Velocity and Cognitive Performance in Older Black and White Adults in NHANES.

Aging-associated cognitive decline is greater in non-Hispanic Black (NHB) adults than non-Hispanic White (NHW) adults. An important risk factor for cognitive decline with aging is arterial stiffening, though the importance to racial variation remains poorly understood. We examined the association of an estimate of arterial stiffness with cognitive function in a bi-racial sample of 60-85-year-old adults (N = 3,616, 26.5% NHB) enrolled in the National Health and Nutrition Examination Survey (NHANES) between 1999-2002 and 2011-2014. As a measure of vascular aging, pulse wave velocity was estimated (ePWV) using an equation incorporating age and mean arterial pressure and expressed as m/s. Using the digit symbol substitution test (DSST), cognitive function was expressed as the number of correctly matched symbols (out of 133) within 120 s. Linear regression models examined associations between ePWV and DSST. In models that adjusted for sex, education, smoking, body mass index, history of cardiovascular disease, and hypertension, ePWV was inversely associated with DSST score in NHB adults (β= -3.47, 95% CI = -3.9 to -3.0; p < 0.001) and NHW adults (β= -3.51, 95% CI = -4.4 to -2.6; p < 0.001). ePWV is inversely associated with a measure of cognitive function in older Black and White adults. ePWV may be a useful measure of vascular aging that can offer insight into cognitive aging.

ROLE OF ESTIMATING PULSE WAVE VELOCITY IN COMMUNITY PHARMACIES IN SPAIN COMPARED TO SCORE

Objective: European Guidelines clearly state the need to estimate cardiovascular (CV) risk using tables validated for this purpose. However, they also recommend assessing subclinical organ damage to improve stratification, since target organ lesions, such as arterial stiffness, estimated by brachial oscillometry, have an independent and additional prognostic value. Previous studies have shown that Community Pharmacies are able to correctly measure arterial stiffness.The objective of this study is to assess whether the estimation of arterial stiffness can improve CV risk stratification according to SCORE in Community Pharmacies. Design and method: This is an observational prospective epidemiological study in which everyone who enters the participating Community Pharmacies will be offered a voluntary measurement of blood pressure and arterial stiffness to compare the stratification of their CV risk according to SCORE with or without considering pulse wave velocity. The expected duration of the study is 12 months. Results: In the first month of recruitment, data from 275 patients (173 women, 102 men) were collected. Five of 39 (12.8%) patients under 40 years of age and 42 of 109 (38.5%) over 65 years of age presented pathological stiffness and could be classified as high risk even though being out of the age-range of SCORE. Of the 133 (48.4%) who were capable of calculating SCORE, the cholesterol value was available only in 69 patients (51.9%). Among them, according to SCORE, 18 patients (26.0%) were at low risk, 50 (72.5%) at moderate risk and only 1 (1.5%) at high risk, while 28 patients (21.1%) presented pathological arterial stiffness. Conclusions: Almost half of the people who randomly enter a community pharmacy had ages that make it impossible to calculate the CV risk by SCORE. Among them, arterial damage was detected in a third. Of the other half, one in five presented arterial damage and, therefore, high CV risk, when SCORE only detected it in a single patient. Therefore, estimating arterial stiffness in community pharmacies markedly improves detection of high CV risk compared to SCORE.

Estimated pulse wave velocity improves risk stratification for all-cause mortality in patients with COVID-19

Accurate risk stratification in COVID-19 patients consists a major clinical need to guide therapeutic strategies. We sought to evaluate the prognostic role of estimated pulse wave velocity (ePWV), a marker of arterial stiffness which reflects overall arterial integrity and aging, in risk stratification of hospitalized patients with COVID-19. This retrospective, longitudinal cohort study, analyzed a total population of 1671 subjects consisting of 737 hospitalized COVID-19 patients consecutively recruited from two tertiary centers (Newcastle cohort: n = 471 and Pisa cohort: n = 266) and a non-COVID control cohort (n = 934). Arterial stiffness was calculated using validated formulae for ePWV. ePWV progressively increased across the control group, COVID-19 survivors and deceased patients (adjusted mean increase per group 1.89 m/s, P < 0.001). Using a machine learning approach, ePWV provided incremental prognostic value and improved reclassification for mortality over the core model including age, sex and comorbidities [AUC (core model + ePWV vs. core model) = 0.864 vs. 0.755]. ePWV provided similar prognostic value when pulse pressure or hs-Troponin were added to the core model or over its components including age and mean blood pressure (p < 0.05 for all). The optimal prognostic ePWV value was 13.0 m/s. ePWV conferred additive discrimination (AUC: 0.817 versus 0.779, P < 0.001) and reclassification value (NRI = 0.381, P < 0.001) over the 4C Mortality score, a validated score for predicting mortality in COVID-19 and the Charlson comorbidity index. We suggest that calculation of ePWV, a readily applicable estimation of arterial stiffness, may serve as an additional clinical tool to refine risk stratification of hospitalized patients with COVID-19 beyond established risk factors and scores.

Multiple Myeloma Patients Undergoing Carfilzomib: Development and Validation of a Risk Score for Cardiovascular Adverse Events Prediction

Simple SummaryDespite the relationship between Carfilzomib (CFZ) therapy in multiple myeloma (MM) and cardiovascular adverse events (CVAEs), no specific validated protocols on cardiovascular risk assessment are available. In this prospective study, we investigated major predictors of CVAEs prior to starting CFZ, applying the European Myeloma Network management protocol (EMN). Five predictors were identified: office systolic blood pressure, 24-h blood pressure variability, left ventricular hypertrophy, pulse wave velocity value and global longitudinal strain. The resulting ‘CVAEs risk score’ defined a low- and a high-risk group (negative predicting value for the high-risk group of 90%). 62 patients experienced one or more CVAEs: 17 major and 45 hypertension-related events. In conclusion, CVAEs are frequent and a specific management protocol is required. The EMN protocol and ‘CFZ risk score’ proved to be effective in estimating the baseline risk of CVAEs during CFZ therapy in MM patients, targeting the appropriate follow-up.Cardiovascular adverse events (CVAEs) are linked to Carfilzomib (CFZ) therapy in multiple myeloma (MM); however, no validated protocols on cardiovascular risk assessment are available. In this prospective study, the effectiveness of the European Myeloma Network protocol (EMN) in cardiovascular risk assessment was investigated, identifying major predictors of CVAEs. From January 2015 to March 2020, 116 MM patients who had indication for CFZ therapy underwent a baseline evaluation (including blood pressure measurements, echocardiography and arterial stiffness estimation) and were prospectively followed. The median age was 64.53 ± 8.42 years old, 56% male. Five baseline independent predictors of CVAEs were identified: office systolic blood pressure, 24-h blood pressure variability, left ventricular hypertrophy, pulse wave velocity value and global longitudinal strain. The resulting ‘CVAEs risk score’ distinguished a low- and a high-risk group, obtaining a negative predicting value for the high-risk group of 90%. 52 patients (44.9%) experienced one or more CVAEs: 17 (14.7%) had major and 45 (38.7%) had hypertension-related events. In conclusion, CVAEs are frequent and a specific management protocol is crucial. The EMN protocol and the risk score proved to be useful to estimate the baseline risk for CVAEs during CFZ therapy, allowing the identification of higher-risk patients.

Progress in the Assessment of Arterial Stiffness

In this brief review, we will introduce arterial stiffness, describe how it is currently measured and point to new developments that might lead towards arterial stiffness estimation outside of specialized clinics in the future. In almost all methods for measuring arterial stiffness, the arterial pulse plays an important role. Therefore, new developments are related to novel non-invasive sensors for acquiring the arterial pulse, simulation and modeling of the arterial pulse waves, parameter estimation of the stiffness parameters through physical models of the arterial pulse and machine learning methods for predicting the arterial stiffness.

Arterial stiffness estimation with shear wave elastography

In arterial shear wave elastography, the arterial wall is excited with acoustic radiation force and the resulting wave propagation through the arterial wall is analyzed to estimate the wall modulus. In this talk, we present a guided wave inversion framework not only to estimate elastic modulus but also the viscoelasticity, which is often considered an important additional biomarker.

HFpEF score discriminates severity of cardiovascular profile in asymptomatic treated hypertensive patients: the campania salute network

Abstract Background The heart failure with preserved ejection fraction (HFpEF) score is easy to use and potentially useful to discriminate HFpEF from noncardiac causes of dyspnea. HFpEF score may be expressed also as probability to have HFpEF. Purpose We investigated whether a high HFpEF score can identify specific cardiovascular (CV) profile in treated hypertensive patients even without dyspnea. Methods From September to December 2019, we consecutively enrolled treated hypertensive patients without dyspnea, with normal left ventricular (LV) ejection fraction (&amp;gt;50%), and chronic kidney disease of no more than stage III. In addition to standard echocardiographic parameters we evaluated: 1) inappropriate LV mass, identified as a percent of predicted LV mass &amp;gt;128%, 2) myocardial energetic efficiency as the ratio of stroke volume to heart rate normalized by LV mass (MEEi), and 3) an estimate of arterial stiffness, i.e. the ratio of pulse pressure and stroke index (by allometric normalization by height), as previously reported. The probability of HFpEF was calculated from the HFpEF score, using body mass index, pulmonary systolic pressure, mitral E/E' ratio, age, and history or evidence of atrial fibrillation. Results 188 patients with complete data were analyzed (42% women, age 61±14 years, 9% diabetic). Patients were then divided into 3 groups according to HFpEF probability tertiles and compared by ANOVA and trend analysis (Table 1). Conclusions Probability of HFpEF using HFpEF score and non-standard echocardiographic parameters identify worse CV profile in treated hypertensive patients without dyspnea. Funding Acknowledgement Type of funding source: None

Estimated Arterial Stiffness and Prediction of Vascular Aging: The Rising of a New Era.

Arterial stiffness has been associated with cardiovascular events and correlated with cardiovascular risk factors. In the new guidelines of the European Society of Hypertension, the evaluation of arterial stiffness, and specifically carotid-femoral pulse wave velocity (c-f PWV), was taken into account for the detailed screening of the hypertensive population. Despite the importance of arterial stiffness as a target organ damage, the measurement is time-consuming, not practical, needs expensive equipment and experienced staff. For all these reasons, c-f PWV is not recommended for the everyday clinical practice and its current use is restricted for research purposes. The importance of arterial properties in clinical practice and cardiovascular prevention is well known. Hence, the estimation of arterial stiffness and vascular health based on parameters that affect arterial stiffness, but without the use of a machine, is a new promising field. Furthermore, the relationship between age-related MRI abnormalities as well as ultrafast ultrasound with vascular effect gives a new promise for future vascular aging assessment.

A NEW COMPLEX MARKER FOR ELEVATED ARTERIAL STIFFNES ESTIMATION

Age is one of the well known strongest risk factors of cardiovascular diseases (CVD). At the same time, vessel age or arterial wall stiffness is one of the major determinants of so called biological age. Aim of the study was basing on the earlier obtained data to create a new complex marker for non-invasive estimation of elevated arterial stiffness. Material and methods. Totally 202 subjects (33.2 % men) aged 25–75, who according to ambulatory check-up at the National Research center for Preventive Medicine were free of atherosclerosis-related diseases, were included into the study. Pulse wave velocity (PWV) > 10 m/s was used as a measure of arterial stiffness. Blood biochemical parameters were measured by standard methods. Results. Preliminary analysis of mathematical models including various biochemical markers and clinical parameters allowed us to select the most significant variables associated with PWV: blood pressure (both systolic and diastolic, SBP and DBP, respectively), body mass index (BMI), triglyceride (TG), and C-peptide content. ROC-analysis gave their optimal cut-off points: SBP/DBP > 120/75 mm Hg; BMI > 26.3 kg/m 2 ; blood plasma TG content > 1.0 mmol/l; C-peptide content > 1.67 ng/ml. These variables were combined as a complex marker (CM). A special score was generated: if any of these parameters exceeded the threshold value, it was assigned 1 point. It turned out that the combination of at least two variables indicates an elevated arterial stiffness. Analytical characteristics of CM were determined. Conclusion. To estimate the probability to have elevated arterial stiffness, indicating on accelerated biological ageing, a new biomarker was created with the sensitivity of 82.7 %, specificity – 62.3 %, and correct prognosis of 71.6 %.