Femoral Pulse Research Articles

P390 ADIPOSITY AND VASCULAR AGEING: WHICH PARAMETER BETTER CORRELATES?

Abstract The increase in stiffness of large arteries is one of the mechanisms that could play a role in the association between obesity and increased risk of cardiovascular (CV) events. Carotid–femoral pulse wave velocity (cfPWV), known as an independent CV risk factor, represents a validated measure of large arteries stiffness and a good proxy of arterial ageing. We aimed at evaluating which body composition parameters better correlated with cfPWV and whether this correlation differed between men and women. cfPWV was measured in all subjects with Sphigmocor by sequentially recording electrocardiogram–gated carotid and femoral artery waveforms; body composition was measured by bioimpedance analysis and waist circumference (W). Furthermore, each subject was characterized by sex, age, height, weight, body mass index (BMI), brachial blood pressure (BP) and heart rate. A linear correlation was used to define the relationship between cfPWV and parameters. Univariate and multivariate analysis were performed in male and female subgroups separately to select the main determinants of arterial stiffness, considering the following parameters: age, mean BP (mBP), BMI, W, fat mass (FM) and skeletal muscle mass (SMM). We enrolled 69 subjects (37 men, 32 women) with average age 34.5 years (min 19–max 76). cfPWV was significantly correlated with age (r = 0.65, p<.0001), and mBP (r = 0.38, p<.01). Among the body composition parameters, W, BMI and FM percentage were significantly correlated with cfPWV (respectively: r = 0.48, r = 0.42, r = 0.41; p<.0001). Multivariable regression analysis in men revealed that age and mBP were significant determinants of cfPWV (respectively: b = 0.042, p = 0.002; b = 0.051, p = 0.004). Conversely, multivariate analysis in women showed that age, FM and SMM are retained as main determinants of increased cfPWV (respectively: b = 0.079; p < 0.0001; b = 0.217, p = 0.012; b = 0.125, p = 0.011). Irrespectively of gender, age is the main determinant of arterial stiffness. Our results demonstrated that the relationship between adiposity and arterial stiffness is verified only in female subjects. This suggests that this relationship is influenced by complex and not fully known mechanisms. Moreover, technical factors (algorithm and indirect methods to assess body composition) contribute to uncertainty regarding which parameter exploring adiposity is more accurate in stratifying CV risk. The present study recalls attention on possible gender–specific determinants of arterial ageing.

Parameters indicating development of hypertension in three-year follow-up study of subjects with high normal blood pressure

Abstract Funding Acknowledgements Type of funding sources: None. Background/Introduction The clinical importance of a hypertensive response to exercise (HRE) in subjects with high normal blood pressure (BP) is not fully elucidated, while sympathetic overactivity followed by arterial stiffening are linked with development of hypertension (HTN). Purpose The aim of this study was to assess the relation of HRE with sympathetic drive as assessed by muscle sympathetic nerve activity (MSNA) and arterial stiffness in subjects with high normal BP who developed hypertension in a 3 year follow up. Methods 100 subjects with high normal office BP [systolic BP=130-139 mmHg and diastolic BP=85-89 mmHg] underwent a treadmill exercise stress test. Arterial stiffness was evaluated based on carotid to femoral pulse wave velocity (PWV). Sympathetic drive was assessed by MSNA levels. Follow up was every 6 months for 3 years, where BP was measured at both office (OffBP) and ambulatory blood pressure monitoring (ABPM). All participants offered lifestyle advises. Endpoint was development of HTN diagnosed either from OffBP or from ABPM. Then they were divided into Group I: those developed HTN and Group II: those remained normotensive. Results Mean age 54±8 years, 42 males, baseline offBP: 132/82 mmHg, ABPM: 122/76 mmHg). Out of them, 50 subjects developed HRE (BP ³210mmHg in men and ³190 mmHg in women) and 40 HTN. Group I developed higher HRE (75% vs. 13%, p=0.026), higher levels of PWV (8.35 vs 7.5 m/sec, p=0.043) and MSNA levels (37 vs. 31 bursts, p=0.04), while did not differ at their metabolic profile. Echocardiographically left ventricular mass index did not differ statistically as E/A ratio of mitral valve inflow (0.92 vs 1.05, p=0.034). Those who developed HTN was related to night systolic BP from ABPM (116 vs 112 mmHg, p<0.04), as also to intermediate stage intervals of 3 min (160 vs 147 mmHg, p=0.068) and 6 min (181 vs 164, p=0.035) of Bruce protocol. A novel metric, the SBP/MET-slope [(peak SBP—resting SBP)/(peak MET-1)] found to add crucial information. Regarding those who developed HTN, SBP/MET-slope was higher in all stages till peak exercise (stage 1: 6.25 vs 4.25, stage 2: 7.6 vs 5.3, peak: 7.22 vs 5.1, p=0.035). It was noticed that they performed a higher exercise capacity (10 vs 11.5 METs) and additionally differ significantly in their maximal heart rate (HR) at peak exercise (154 vs 164, p=0.001). Conclusion In subjects with high normal BP, a HRE, the intermediate BP intervals along with the SBP/MET-slope, identifies a state of systemic vascular resistance, arterial stiffening and sympathetic overdrive, as reflected by increased PWV and MSNA levels respectively. Additionally, exercise capacity demonstrates cardiovascular functional tolerance. These findings suggest that exercise testing provides determining clinical information regarding the overall cardiovascular status, proving its superior prognostic value as a hypertension screening tool, that alarms the physician to warn the patient to take action.

Endoleak Type III and COVID-19: A Lethal Combination

A 72 year old man presented with new onset intermittent claudication and weak femoral pulses bilaterally. After endovascular repair of a 6.0 cm abdominal aortic aneurysm (AAA) in 2018 (AFX2 plus Vela, Endologix, Irvine, CA, USA), the patient discontinued follow up after three months with a stable aneurysm. Computed tomography angiography showed AAA diameter increase to 6.8 cm and component disconnection (type III endoleak, arrow, A). Decreased main body perfusion caused claudication (arrow, B). Open repair risk was considered too high because of an active COVID-19 infection. While waiting for endovascular materials, the patient died in hospital from AAA rupture, confirmed by autopsy.Image 1

MO531: The Differential Effect of Third-Generation Intravenous Iron Preparations (Ferric Carboxymaltose, Ferric Derisomaltose) on Cardiovascular Parameters in Patients With Non-Dialysis Dependent CKD and Iron Deficiency Anaemia

Abstract BACKGROUND AND AIMS Intravenous (IV) iron is commonly used to alleviate iron deficiency anaemia in patients with non-dialysis chronic kidney disease (CKD). Treatment with IV iron in patients with iron deficiency and heart failure has demonstrated an improvement in functional status and cardiac biomarkers; however, concerns remain regarding the potential pro-oxidative effect of IV iron and possible cardiovascular injury. Newer agents [such as ferric carboxymaltose (FCM) and ferric derisomaltose (FDI)] are increasingly used due to their advantage in delivering large amounts of iron effectively and safely; however, they differ as to their effect on serum phosphate and fibroblast growth factor 23, factors that have been previously shown to affect cardiac function. Given the above potential concerns, it is important to explore the comparative effect of IV iron in this population in terms of cardiac injury and vascular function. METHOD The exploratory single-centre double-blinded randomized controlled trial ‘Iron and Phosphaturia—ExplorIRON-CKD’ aimed primarily to not only assess the differential effects of FCM and FDI on levels of fibroblast growth factor 23 and phosphate, but also explore any cardiovascular effect. Non-dialysis patients with CKD and iron deficiency with/without anaemia defined as serum ferritin <200 µg/L or transferrin saturation ≤20% and serum ferritin 200–299 µg/L were recruited and randomized in a 1:1 ratio. Participants received 1000 mg at baseline and 500–1000 mg at 1 month to achieve replenishment. Measurements of NT-proBNP were taken at baseline, 1 month, 2 months and 3 months, whilst measurements of Troponin T were taken at every visit (total of eight visits). Vascular function was assessed using pulse wave velocity measurements at baseline, 1 month, 2 months and 3 months, monitoring carotid to femoral pulse wave velocity (PWVcf) and aortic augmentation index (AIx). RESULTS Twenty-six patients were recruited; 14 were randomized to receive FDI and 12 to receive FCM. All patients received at least one iron dose (1000 mg), 10 patients received two FDI doses and 11 received two FCM doses. There was a trend to an increase in NT-pro BNP (10.3%) in the combined group, with no statistical difference between the FCM and FDI groups [median for the combined population: baseline: 875.5 (3033.0) ng/L versus Visit 8: 967.0 (2976.0) ng/L] (Figure 1). Troponin T values remained constant throughout the study period in the combined and individual groups (Table 1). A decrease in both PWVcf and AIx was noted in the participants receiving IV iron irrespective of the compound used. A greater decrease was seen in the FDI group in terms of PWVcf; however, there was no statistically significant difference for the percentage change from baseline to the end of the study between the groups (FCM: −4.3 (33.6)% versus FDI: −11.9 (23.4)%; P = .60) (Figure 2). CONCLUSION Treatment of non-dialysis CKD patients with FDI or FCM was not associated with any cardiovascular safety signals. Troponin T was unaffected and there was no worsening in vascular function. Pulse wave velocity improved, as noted by the decreasing trends for PWVcf and AIx. The decrease in PWVcf was greater with FDI than FCM, but the difference was not statistically significant. A small rise in NT-proBNP was noted in the combined group, but there was no statistically significant difference between the FDI and FCM groups. These results suggest that newer IV iron compounds are not associated with any detriment in terms of vascular function and potentially no resulting cardiac insult. The study sample is small and therefore the results should be interpreted with caution; nonetheless, the evidence provided from a comparative view directs to no negative sequela.

MO745: Serum Endocan as a Risk Factor for Aortic Stiffness in Patients on Maintenance Hemodialysis

Abstract BACKGROUND AND AIMS Endocan is secreted by the activated endothelium and plays a central role in inflammation and endothelial dysfunction, angiogenesis and vascular smooth muscle cell proliferation, it is associated with cardiovascular disease. This cross-sectional study aimed to assess the relationship between serum endocan levels and carotid–femoral pulse wave velocity (cfPWV) in patients on maintenance hemodialysis (HD). METHOD Blood samples and baseline characteristics were collected from 122 HD patients. Serum endocan concentrations were measured with an enzyme-linked immunosorbent assay kit. Aortic stiffness was defined as a cfPWV of more than 10 m/s. RESULTS Of the 122 HD patients, aortic stiffness was diagnosed in 53 (43.4%), and higher percentages of diabetes (P < 0.001) and hypertension (P = 0.030) were of older age (P = 0.007) and had higher systolic blood pressure (P = 0.011) and endocan levels (P < 0.001) in those with aortic stiffness than those without. After adjusting for factors significantly associated with aortic stiffness by multivariate logistic regression analysis, serum endocan [odds ratio (OR) 1.566, 95% confidence interval (95% CI) 1.224–2.002; P < 0.001], age (OR 1.040, 95% CI 1.001–1.080; P = 0.045), and diabetes (OR 4.067, 95% CI 1.532–10.798; P = 0.005) were independently associated with aortic stiffness in patients with chronic HD. Multivariable forward stepwise linear regression analysis also confirmed that the logarithmically transformed endocan level (β =0.405, adjusted R2 change = 0.152; P < 0.001) was an independent predictor of cfPWV values. The area under the receiver operating characteristic (ROC) curve predicting aortic stiffness by serum endocan level was 0.713 (95% CI 0.620–0.806; P < 0.001). CONCLUSION Serum endocan level positively correlates with cfPWV and is also an independent predictor of aortic stiffness in maintenance HD patients.

MO188: Elevated Serum Soluble Urokinase-Type Plasminogen Activator Receptor Level is Linked to Aortic Stiffness in Chronic Haemodialysis Patients

Abstract BACKGROUND AND AIMS Soluble urokinase-type plasminogen activator receptor (suPAR) is associated with inflammation and contributing in the pathogenesis of atherosclerosis. Aortic stiffness is associated with aging-associated vascular diseases and is also an independent risk factor of cardiovascular morbidity and mortality. We evaluated the association between serum suPAR and aortic stiffness in patients with chronic haemodialysis (HD). METHOD A total of 135 patients with HD were enrolled in this study. Carotid–femoral pulse wave velocity (cfPWV) was measured using the SphygmoCor system. Patients with cfPWV >10 m/s were defined as the aortic stiffness group. Serum suPAR levels were measured using a commercial enzyme-linked immunosorbent assay kit. RESULTS Fifty-five HD patients (40.7%) had aortic stiffness and higher percentages of diabetes (P = .001), hypertension (P = .039), were of older age (P = .007) and had higher systolic blood pressure (P = .025), serum glucose level (P = .019), C-reactive protein (P = .039) and suPAR levels (P < .001) compared to control group. After adjusting for factors significantly associated with aortic stiffness by multivariate logistic regression analysis, serum suPAR [odds ratio (OR): 1.910, 95% confidence interval (CI): 1.485–2.458, P < .001] and age (OR: 1.040, 95% CI: 1.001–1.080, P = .048) were independently associated with aortic stiffness in patients with chronic HD. After multivariable forward stepwise linear regression analysis also noted that serum suPAR level (β = 0.442, adjusted R2 change = 0.250, P < .001) was positively associated with with cfPWV values in HD patients. CONCLUSION Serum suPAR level is positively associated with cfPWV values and is a biomarker for aortic stiffness in patients with chronic HD.

Increased Dephospho-uncarboxylated Matrix Gla-Protein Is Associated With Lower Axial Skeletal Muscle Mass in Patients With Hypertension.

Matrix Gla-protein (MGP) is a well-established inhibitor of vascular calcification that is activated by vitamin K-dependent carboxylation. In the setting of vitamin K2 deficiency, dephospho-uncarboxylated MGP (dpucMGP) levels increase, and have been associated with large artery stiffening. Vitamin K2 is also a mitochondrial electron carrier in muscle, but the relationship of vitamin K2 deficiency and dpucMGP with muscle mass is not well understood. We therefore aimed to examine the association of vitamin K2 deficiency and dpucMGP with skeletal muscle mass in patients with hypertension. We studied 155 hypertensive adults without heart failure. Axial skeletal muscle mass was measured using magnetic resonance imaging from axial steady-state free precession images. DpucMGP was measured with ELISA. Carotid-femoral pulse wave velocity (CF-PWV) was measured from high-fidelity arterial tonometry recordings. We found an inverse relationship between dpucMGP levels and axial muscle mass, with progressively rising dpucMGP levels correlating with decreasing axial muscle mass. In an unadjusted linear regression model, correlates of dpucMGP included axial skeletal muscle area factor (β = -0.32; P < 0.0001) and CF-PWV (β = 0.31; P = 0.0008). In adjusted analyses, independent correlates of dpucMGP included axial skeletal muscle area factor (β = -0.30; P = 0.0003) and CF-PWV (β = 0.20; P = 0.019). In hypertensive adults, dpucMGP is independently associated with lower axial muscle mass, in addition to increased large artery stiffness. Further studies are required to investigate the role of vitamin K supplementation in this population.

Blood Pressure and Arterial Stiffness after a Maximal Aerobic Exercise in Young Adult Binge Drinkers and Moderate Drinkers

Exaggerated systolic blood pressure (SBP) response to exercise predicts the development of hypertension. In normotensive young adults, alcohol consumption is associated with increased arterial stiffness, which potentially influence exercise SBP response. Young adults who have alcohol drinking habits usually exercise regularly, but their exercise SBP response has received little attention. Whether alcoholic drinking pattern influences exercise SBP response remains to be determined. The purpose of this study is two‐fold: 1) to investigate SBP and arterial stiffness in response to maximal aerobic exercise; and 2) to examine if alcoholic drinking pattern influences the response. Twenty healthy young adults (9 women; age: 27±3 years; BMI: 24.1±2.1 kg/m2; mean±SD) with a history of alcohol consumption over the past year were included in this study. Based on the self‐reported alcoholic drinking pattern, participants were categorized as binge drinkers (n=10; BD) or moderate drinkers (n=10; MOD). Brachial SBP and central SBP and arterial stiffness (carotid to femoral pulse wave velocity; cfPWV) were measured before and after a maximal graded exercise test on a cycle ergometer. At the end of maximal exercise, brachial SBP increased (BD: 110±13 vs. 172±15 mmHg; pre‐ vs. post‐ex; P&lt;0.0005 and MOD: 110±9 vs. 158±22 mmHg; P&lt;0.0005), regardless of drinking pattern (P=0.1 for BD vs. MOD). Central systolic BP (BD: 101±10 vs. 113±7 mmHg and MOD: 102±8 vs. 112±8 mmHg; P≤0.01 for both groups) increased in all participants after exercise (obtained ~ 4min post‐ex), regardless of drinking pattern (P=0.5 for BD vs. MOD). After exercise (~15 min), cfPWV did not increase in MOD (5.6±0.8 vs. 5.7±1.1 m/s; P=0.8), while cfPWV increased in BD (5.5±0.5 vs. 6.3±0.9 m/s; P=0.02). In conclusion, our study found that SBP response to maximal aerobic exercise was similar between BD and MOD. However, arterial stiffness was higher following maximal aerobic exercise in BD, suggesting a negative adaptation in vasculature associated with binge drinking. Future studies with larger sample sizes and a group of alcohol abstainers are needed to confirm our findings.

Neonate with Respiratory Distress, Bilateral Microtia, Hypocalcemia, and Lymphopenia.

Neonate with Respiratory Distress, Bilateral Microtia, Hypocalcemia, and Lymphopenia.

Sedentary Behaviour and Its Relationship with Early Vascular Ageing in the General Spanish Population: A Cross-Sectional Study.

Sedentary behaviour is associated with a greater predisposition to developing cardiovascular diseases. The aim of the study was to analyse the relationship between sedentary time and early vascular ageing. A total of 501 participants (49.70% men) were recruited through random sampling stratified by age group and sex. Vascular ageing was evaluated considering three criteria: (1) the vascular ageing index (VAI); (2) the carotid–femoral pulse wave velocity (cfPWV) 10th and 90th percentiles of the reference values in the European population by age; and (3) the Framingham’s heart age. The carotid intima–media thickness was measured using a Sonosite Micromaxx ultrasound, the presence of peripheral artery disease was assessed by calculating the ankle–brachial index using a VaSera VS-1500, and the cfPWV was measured with a SphygmoCor® device. Weekly sedentary hours were evaluated through a sitting time questionnaire. The average age of the population was 55.90 ± 14.24 years. The men spent more hours sitting per week (47.6 ± 16.6 vs. 36.8 ± 17.3 h/W), at work (16.7 ± 16.2 vs. 9.73 ± 14.9 h/W), and watching TV (21.6 ± 12.5 vs. 18.7 ± 11.9 h/W). In the logistic regression analysis, the individuals with early vascular aging (EVA), with respect to those with healthy vascular aging (HVA), spent more hours sitting per week (OR = 1.03 vs. OR = 1.02; p < 0.05) and watching TV (OR = 1.03 vs. OR = 1.03; p < 0.05), using the criteria of the European guideline and VAI, and more hours sitting when commuting (OR = 1.04; p < 0.05), using Framingham’s heart age to define EVA. The results of this study indicate that sedentary time is associated with early vascular ageing. Therefore, reducing sedentary time would improve vascular health.

Failing to palpate femoral pulses in adult hypertensive patients may lead to diagnostic wandering and major cerebrovascular events in cases of undetected aortic coarctation

In developed countries, aortic coarctation (AC) is generally diagnosed by fetal echocardiography during the third trimester of pregnancy, or during the neonatal period based on the absence of femoral pulses or the presence of a left supraclavicular systolic murmur. However, AC may be diagnosed late, such as in adult migrants arriving from developing countries without documented medical history although they may require healthcare support during their stay. We report three cases of the incidental diagnosis of thoracic aortic malformations in adults (27, 38 and 43 years) referred for the management of uncontrolled high blood pressure, with major cerebrovascular events for the two oldest. Doppler ultrasound imaging indicated for suspected renal artery stenosis and atheroma lesions revealed abnormal lower-body and normal upper-body arterial blood flow velocity waveforms constitutive of a pathognomonic hemodynamic pattern of AC, a diagnostic which was in all three cases confirmed by multidetector computed tomography-angiography. None of these patients had undergone complete cardiovascular examination, particularly with effective peripheral pulse palpation, during the period preceding the occurrence of major cardiovascular events or at any other time after birth. Our observation suggests that a simple medical examination could have prevented diagnostic wandering and, possibly, the occurrence of severe cerebrovascular complications in two of these three patients.

Six-month longitudinal tracking of arterial stiffness and blood pressure in young adults following SARS-CoV-2 infection.

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) can increase arterial stiffness 3-4 wk following infection, even among young, healthy adults. However, the long-term impacts of SARS-CoV-2 infection on cardiovascular health and the duration of recovery remain unknown. The purpose of this study was to elucidate potential long-lasting effects of SARS-CoV-2 infection on markers of arterial stiffness among young adults during the 6 mo following infection. Assessments were performed at months 1, 2, 3, 4, and ∼6 following SARS-CoV-2 infection. Doppler ultrasound was used to measure carotid-femoral pulse wave velocity (cfPWV) and carotid stiffness, and arterial tonometry was used to measure central blood pressures and aortic augmentation index at a heart rate of 75 beats·min-1 (AIx@HR75). Vascular (VCAM-1) and intracellular (ICAM-1) adhesion molecules were analyzed as circulating markers of arterial stiffness. From months 1-6, a significant reduction in cfPWV was observed (month 1: 5.70 ± 0.73 m·s-1; month 6: 4.88 ± 0.65 m·s-1; P < 0.05) without any change in carotid stiffness measures. Reductions in systolic blood pressure (month 1: 123 ± 8 mmHg; month 6: 112 ± 11 mmHg) and mean arterial pressure (MAP; month 1: 97 ± 6 mmHg; month 6: 86 ± 7 mmHg) were observed (P < 0.05), although AIx@HR75 did not change over time. The month 1-6 change in cfPWV and MAP were correlated (r = 0.894; P < 0.001). A reduction in VCAM-1 was observed at month 3 compared with month 1 (month 1: 5,575 ± 2,242 pg·mL-1; month 3: 4,636 ± 1,621 pg·mL-1; P < 0.05) without a change in ICAM-1. A reduction in cfPWV was related with MAP, and some indicators of arterial stiffness remain elevated for several months following SARS-CoV-2 infection, possibly contributing to prolonged recovery and increased cardiovascular health risks.NEW & NOTEWORTHY We sought to investigate potential long-lasting effects of SARS-CoV-2 infection on markers of arterial stiffness among young adults for 6 mo following infection. Carotid femoral pulse wave velocity was significantly reduced while carotid stiffness measures remained unaltered over the 6-mo period. These findings suggest several months of recovery from infection may be necessary for young adults to improve various markers of arterial stiffness, possibly contributing to cardiovascular health and recovery among those infected with SARS-CoV-2.

Non-Invasive Assessment of Arterial Stiffness: Pulse Wave Velocity, Pulse Wave Analysis and Carotid Cross-Sectional Distensibility: Comparison between Methods.

Background: The stiffening of large elastic arteries is currently estimated in research and clinical practice by propagative and non-propagative models, as well as parameters derived from aortic pulse waveform analysis. Methods: Common carotid compliance and distensibility were measured by simultaneously recording the diameter and pressure changes during the cardiac cycle. The aortic and upper arm arterial distensibility was estimated by measuring carotid–femoral and carotid–radial pulse wave velocity (PWV), respectively. The augmentation index and blood pressure amplification were derived from the analysis of central pulse waveforms, recorded by applanation tonometry directly from the common carotid artery. Results: 75 volunteers were enrolled in this study (50 females, average age 53.5 years). A significant inverse correlation was found between carotid distensibility and carotid–femoral PWV (r = −0.75; p < 0.001), augmentation index (r = −0.63; p < 0.001) and central pulse pressure (r = −0.59; p < 0.001). A strong correlation was found also between the total slope of the diameter/pressure rate carotid curves and aortic distensibility, quantified from the inverse of the square of carotid–femoral PWV (r = 0.67). No correlation was found between carotid distensibility and carotid–radial PWV. Conclusions: This study showed a close correlation between carotid–femoral PWV, evaluating aortic stiffness by using the propagative method, and local carotid cross-sectional distensibility.

FEATURES OF THE CLINICAL COURSE OF NON-ST-SEGMENT ELEVATION ACUTE CORONARY SYNDROME DEPENDING ON THE INDICATOR OF THE PULSE WAVE VELOCITY

Pulse wave velocity (PWV) could be used as a predictor of the course of CVD. A carotid–femoral PWV above 10 m/s was determined in 2018 ESC/ESH Guidelines for the Management of Arterial Hypertension as factors influencing cardiovascular risk in patients with hypertension. Exactly the carotid–femoral PWV is considered the gold standard for arterial stiffness assessment in clinical practice. Usually PWV predict the long-term outcomes (in a few month or years) of the development of cardiovascular events. There are a lack of information about using PWV as prognostic marker in acute coronary syndrome.&#x0D; The aim: to study the features of the clinical course of the non-ST-segment elevation acute coronary syndrome (NSTE-ACS) depending on the carotid–femoral pulse wave velocity (PWV) and find out possibilities of using PWV as marker of intrahospital clinical outcomes.&#x0D; Materials and methods. 80 patients were recruited. All patients were hospitalized into myocardial infarction departments with a diagnosis of NSTE-ACS. Patients over 18 years of age who were hospitalized for the first 3 days after the onset of pain and signed the agreement to participate in the study were included. Exclusion criteria were the moderate or severe anemia, severe chronic renal failure, and chronic diseases in the acute or decompensated stage. The average age of patients was 64.5 [55; 72] years. Male patients are 45 persons (56.3%). Were performed standard general laboratory and instrumental examinations. Measuring of free DNA levels, and ischemic albumin were performed on 1st and 6th days of hospitalization. Also noninvasive measured of PWV. Noninvasive PWV measurements were performed after stabilization of the hemodynamic for excluding incorrect results due to its strong connection with current blood pressure. 2 groups were formed depend on the PWV above or less than 10 m/s. The analysis was performed by using non-parametric statistical methods (Mann-Whitney test, Wilcoxon T-test, Pearson's χ2 test). The results were considered statistically significant at p &lt;0.05.&#x0D; Results. Patients did not have a statistically significant difference in such parameters as gender, anamnestic data (hypertension, myocardial infarction, chronic heart failure, atrial fibrillation, and diabetes mellitus), hemodynamic parameters, ECG changes at the moment of hospitalization and laboratory parameters. There was a tendency that patients with elevated PWV were older (69 [55.3; 77.8] years vs. 63.5 [55.3; 70.8] years) (p = 0.077). Such parameters as left ventricular ejection fraction and discharge diagnosis were similar. Patients with elevated PWV had significantly more active cytolysis. This is proved by significantly higher levels of free DNA both on the first day and on the 6th day of hospitalization. In patients with normal PWV levels, free DNA decreased in dynamics, while in patients with PWV above 10 m / s this marker remained at the same level. It was also founded that patients with elevated PWV had delayed ischemia (on the 6th day of hospital stay), which was confirmed by a higher level of ischemia-modified albumin than in the group with PWV less 10 m / s.&#x0D; Conclusions. Patients with increased and normal PWV have quite similar group characteristic according typical clinical signs, results of laboratory and instrumental investigations. Due to the studying of free DNA and ischemia-modified albumin were clarified that PWV above 10 m/s is associated with delayed ischemia and longer tissue damage and could be used to predict it.

Influence of lipid profile and statin administration on arterial stiffness in renal transplant recipients.

BackgroundHyperlipidemia is one of the major risk factors for developing a cardiovascular disease (CVD) and it is a frequent post-transplant complication, occurring in up to 60% of the renal transplant recipients (RTRs). Lipid lowering therapy with HMG-CoA reductase inhibitors (statins) is generally recommended and may reduce the overall cardiovascular risk. The aim of this study was to evaluate the lipid profile, statin administration and their relationship with arterial stiffness parameters in RTRs.MethodsThree hundred and forty-four stable RTRs (62.5% male) transplanted between 1994 and 2018 were randomly enrolled to the study. The following parameters of arterial stiffness was measured in each patient: ankle brachial index, carotid femoral pulse wave velocity (baPWV left and right, cfPWV) and pulse pressure (PP right and left). The study group was divided based on the use statins: 143 (41.6%) and 201 (58.4%). RTRs were qualified to the statin (+) and the statin (−) group, respectively.ResultsIn the statin (+) as compared to statin (−) group there were more patients with a CVD (32.9% vs. 14.9%) and diabetes (25.2% vs. 14.4%). In the whole study group, CVD was associated with a significant increase of both baPWV and cfPWV as well as PP (8.5 mmHg). There were significant differences in arterial stiffness parameters (baPWV, cfPWV, PP) between the statin (+) and the statin (−) group.ConclusionsArterial stiffness was increased in RTRs with CVD and hyperlipidemia. The control of hyperlipidemia was poor in RTRs.

AORTIC COARCATATION IN ADULTS : STILL A LATE DIAGNOSIS

Aortic coarctation is the most common congenital cardiac malformation due to a narrowing of the aorta, most commonly occurring just beyond the left subclavian artery.The diagnosis is mostly neonatal by the systemic palpation of the femoral pulses but can be later discovered at the big childs even at the adult. This fact is illustrated through our observation of a 36-year-old man admitted after a head injury, during his hospitalization the diagnosis of aortic coarctation was made following hypertensive peaks resistant to antihypertensive drugs.

Age and Serum Adipocyte Fatty-Acid-Binding Protein Level Are Associated with Aortic Stiffness in Coronary Artery Bypass Graft Patients.

Old age has been proven to be related to progressed arterial or aortic stiffness. Aortic stiffness is an independent predictor of all-cause and cardiovascular disease mortalities in patients who have undergone coronary artery bypass grafting (CABG) surgery. Higher serum concentrations of adipocyte fatty-acid-binding protein (A-FABP) could be considered a predictor of aortic stiffness in patients with hypertension or diabetes mellitus. This study aims to investigate the relationships between A-FABP and aortic stiffness in patients who have received CABG. A total of 84 CABG patients were enrolled in our study from September 2018 to May 2019. Serum A-FABP levels were determined using a commercial enzyme immunoassay. Carotid–femoral pulse wave velocity (cfPWV) > 10 m/s was defined as aortic stiffness. Of the 84 CABG patients, 28 (33.3%) with aortic stiffness had a higher average age; exhibited higher rates of diabetes; and had higher serum creatinine, C-reactive protein, and A-FABP levels compared to controls. Multivariable logistic regression revealed that serum A-FABP levels (odds ratio (OR) = 1.068, 95% confidence interval (CI) 1.017–1.121, p = 0.008) and age (OR = 1.204, 95% CI 1.067–1.359, p = 0.003) were independent predictors of aortic stiffness. Multivariable stepwise linear regression revealed significant positive correlations of age and A-FABP levels with cfPWV values. Serum A-FABP level is positively correlated with cfPWV values, and a high serum A-FABP level is associated with aortic stiffness in patients who have undergone CABG.

Association between Arteriosclerosis and Uncontrolled Blood Pressure in Patients with Essential Hypertension: Cross-Sectional Observational Study Results of the BEST Study

Whether arteriosclerosis can influence the hypertension control remains incompletely understood. We hypothesized that higher arteriosclerosis may be associated with uncontrolled hypertension. Arteriosclerosis was assessed by carotid femoral artery pulse wave velocity (CF-PWV) and uncontrolled hypertension (systolic blood pressure [BP] ≥130 mm Hg or diastolic BP ≥80 mm Hg). The multivariable-adjusted logistic regression was used for analysis. A total of 1,428 patients with essential hypertension (mean age 68 years, 49.6% male) were enrolled into the study from 2010 to 2017. The BP was uncontrolled in 50.7% of the participants and the mean level of CF-PWV was 12.3 m/s. All the cardiovascular risk factors were worse and CF-PWV was higher in patients with uncontrolled hypertension (all p < 0.05). Multivariable-adjusted logistic regression analysis showed that CF-PWV as a continuous variable (odd ratio [OR] 1.093, 95% confidence interval [CI] 1.046–1.142) was independently associated with uncontrolled hypertension, after male (OR 1.511) and total cholesterol (OR 1.167), followed by body mass index (OR 1.092), fasting plasma glucose (OR 1.075), and creatinine (OR 1.010) (all p < 0.05). As a binary variable, CF-PWV >12 m/s was also independently associated with uncontrolled hypertension (OR 1.690, 95% CI 1.320–2.164, p < 0.05). Arteriosclerosis is independently associated with uncontrolled BP in patients with hypertension.

Periodontitis is associated with higher subclinical atherosclerosis in patients with systemic lupus erythematosus.

AimTo determine periodontitis prevalence in patients with systemic lupus erythematosus (SLE) and to assess whether periodontitis in SLE patients is associated with a greater subclinical atherosclerosis.MethodsAn observational case–control study was conducted in SLE (cases) and patients without any rheumatic diseases (controls), matched for sex. Sociodemographic and cardiometabolic variables were gathered, and SLE activity was assessed through several indexes. Periodontal examination registered probing pocket depth, clinical attachment level, bleeding on probing, plaque index, and tooth loss. Subclinical atherosclerosis was assessed by measuring the carotid–femoral pulse wave velocity (PWV) by Doppler velocimetry, homocysteine levels, C‐reactive protein (CRP), and erythrocyte sedimentation rate (ESR). Bivariate analyses and logistic regression were used to assess the association of any of the studied variables with SLE.ResultsSeventy‐one cases and 72 controls were included in the study. Thirty‐nine SLE patients (54.9%) were diagnosed with periodontitis, compared with 16 controls (22.2%). High levels of PWV (≥7.7 m/s, 75th percentile) were shown by 44.3% of the cases vs. 22.4% of the controls (p = .011). Among SLE patients, those with periodontitis showed higher PWV values (8.1 ± 1.52 vs. 7.16 ± 1.11 m/s, p = .006) and higher homeostasis model assessment index (indicative of insulin resistance) (1.7 ± 0.73 vs. 2.92 ± 3.05, p = .028) compared to those with periodontal health. Logistic regression showed that waist circumference (OR 1.06, 95% CI 1.01–1.12, p = .015); ESR (OR 1.09, 95% CI 1.03–1.16, p = .003); and bleeding on probing (OR 1.1, 95% CI 1.01–1.19, p = .018) were associated with the risk of SLE.ConclusionSystemic lupus erythematosus patients showed a higher periodontitis percentage than controls. Higher PWV values were found in SLE patients with periodontitis, indicating a higher prevalence of subclinical atherosclerosis. Patients with higher gingival bleeding showed a higher risk of SLE.

Fatty acid desaturase genetic variations and dietary omega-3 fatty acid intake associate with arterial stiffness.

AimsLong-chain polyunsaturated fatty acids (PUFAs) generate diverse bioactive lipid mediators, which tightly regulate vascular inflammation. The effects of omega-3 PUFA supplementation in cardiovascular prevention however remain controversial. In addition to direct dietary intake, fatty acid desaturases (FADS) determine PUFA levels. Increased arterial stiffness represents an independent predictor of mortality and cardiovascular events. The aim of the present study was to determine the association of PUFA intake, FADS1 genotype, and FADS expression with arterial stiffness.Methods and resultsA cross-sectional population-based cohort study of 1464 participants without overt cardiovascular disease was conducted. Dietary intake was assessed using a food frequency questionnaire. Arterial stiffness was assessed by carotid–femoral pulse wave velocity (cfPWV), and the FADS1 locus variant was determined. Blood cell transcriptomics was performed in a subset of 410 individuals. Pulse wave velocity was significantly associated with the FADS1 locus variant. Differential associations between PWV and omega-3 PUFA intake were observed depending on the FADS1 genotype. High omega-3 PUFA intake attenuated the FADS1 genotype-dependent associations. Carriers of the minor FADS1 locus variant exhibited increased expression of FADS2, which is associated with PWV.ConclusionTaken together, these findings point to FADS1 genotype-dependent associations of omega-3 PUFA intake on subclinical cardiovascular disease. These findings may have implications for identifying responders and non-responders to omega-3 PUFA supplementation and open up for personalized dietary counselling in cardiovascular prevention.