Higher Pulse Wave Velocity Values Research Articles

Arterial Stiffness Is an Important Predictor of Heart Failure with Preserved Ejection Fraction (HFpEF)—The Effects of Phosphate Retention

Heart failure with preserved ejection fraction (HFpEF) is a major health concern. There is a growing recognition of the causal interplay between arterial stiffness and HFpEF. We recently reported that phosphate retention is a trigger for arterial stiffness. This study focuses on whether arterial stiffness due to phosphate retention could be a predictor for HFpEF. Methods: The subjects of this study were 158 patients (68 males and 90 females, mean age 74.8 ± 11.2). HFpEF was defined according to the guidelines of the ESC 2019. Pulse wave velocity (PWV) and central systolic blood pressure (CSBP) were used as markers for arterial stiffness and afterload, respectively. We measured serum levels of fibroblast growth factor 23 (FGF23) as a marker of phosphate retention. Results: The serum levels of FGF23 had a significant relationship with PWV. PWV had significant relationships with LV mass index, plasma BNP levels, and relative wall thickness, e′, and E/e′ (p < 0.001, respectively). Multivariate logistic regression analysis revealed that higher PWV values and hypertension were significant predictors for the dependent factor (HFpEF). Arterial stiffness amplified afterload, leading to LV concentric hypertrophy and diastolic dysfunction. This study presents that arterial stiffness is a key predictor of HFpEF, and that phosphate retention is involved in the pathology of HFpEF.

Relationships between excessive daytime sleepiness and arterial stiffness with cognitive function in a racially diverse high‐risk cohort

AbstractBackgroundAs pathologic processes leading to Alzheimer’s disease (AD) begin many years before clinical diagnosis, assessment of pre‐clinical AD risk factors in high‐risk individuals is needed. Excessive daytime sleepiness (EDS) is associated with increased cardiovascular dysfunction, neuroinflammation, and neurodegeneration, leading to cognitive impairment. We tested the hypothesis that EDS and increased arterial stiffness are related to worse cognitive function in a cohort of Black or African American (B/AA) and non‐Hispanic White (NHW) participants.MethodA community‐based racially diverse sample of cognitively unimpaired adults (47‐83 years), most (87%) with a family history of AD, were enrolled. Cognitive testing took one hour and included domains of executive function, working memory, and verbal and visuospatial ability and language. Daytime sleepiness was measured with Epworth Sleepiness Scale (ESS); EDS was defined as ESS≥10. Arterial stiffness was measured using pulse wave velocity (PWV).ResultParticipants (N = 85) were 64±8 years of age, 75% female, 48% B/AA, and highly educated (81% ≥college). Mean central blood pressures were 126±18 mmHg (systolic) and 80±10 mmHg (diastolic), with no differences by race or sex. Scores were lower among B/AA versus NHW participants for Judgement of Line of Orientation (17.71±6.0 versus 23.53±6.0, p<.001, Cohen’s d = .083) and Multilingual Naming Test (28.25±2.7 versus 30.57±2.0, p = .005, d = .950). EDS was present among 15% of participants and associated with lower scores on Digit Symbol (p = .004, d = .917), and Multilingual Naming Test (p = .006, d = 1.455). Total time on Trails A was higher among those with EDS (36s versus 30s, p = .040, d = .575). Higher PWV values were associated with lower scores on Digit Symbol Substitution (r = ‐.259, p = .029), Buschke Selective Reminding Test (‐.298, p = .012), CERAD Word List (‐.306, p = .009), F‐A‐S (r = ‐.253, p = .033), and Animal Fluency (r = ‐.326, p = .006).ConclusionIn a racially diverse cohort at risk for AD, we found that excessive self‐reported daytime sleepiness and increased arterial stiffness were associated with worse scores across multiple cognitive domains. Poor sleep and vascular dysfunction are known contributors to AD pathology, providing potential modifiable targets of intervention to reduce or delay the development of AD in cognitively normal, but high‐risk individuals. Further work is needed for a better understanding of modifiable AD risk factors in diverse populations

Aortopathies: From Etiology to the Role of Arterial Stiffness.

The aorta and aortic wall have a complex biological system of structural, biochemical, biomolecular, and hemodynamic elements. Arterial stiffness could be considered a manifestation of wall structural and functional variations, and it has been revealed to have a strong connection with aortopathies and be a predictor of cardiovascular risk, especially in patients affected by hypertension, diabetes mellitus, and nephropathy. Stiffness affects the function of different organs, especially the brain, kidneys, and heart, promoting remodeling of small arteries and endothelial dysfunction. This parameter could be easily evaluated using different methods, but pulse-wave velocity (PWV), the speed of transmission of arterial pressure waves, is considered the gold standard for a good and precise assessment. An increased PWV value indicates an elevated level of aortic stiffness because of the decline in elastin synthesis and activation of proteolysis and the increase in fibrosis that contributes to parietal rigidity. Higher values of PWV could also be found in some genetic diseases, such as Marfan syndrome (MFS) or Loeys-Dietz syndrome (LDS). Aortic stiffness has emerged as a major new cardiovascular disease (CVD) risk factor, and its evaluation using PWV could be very useful to identify patients with a high cardiovascular risk, giving some important prognostic information but also being used to value the benefits of therapeutic strategies.

Investigation of the association between central arterial stiffness and aggregate g-ratio in cognitively unimpaired adults.

Stiffness of the large arteries has been shown to impact cerebral white matter (WM) microstructure in both younger and older adults. However, no study has yet demonstrated an association between arterial stiffness and aggregate g-ratio, a specific magnetic resonance imaging (MRI) measure of axonal myelination that is highly correlated with neuronal signal conduction speed. In a cohort of 38 well-documented cognitively unimpaired adults spanning a wide age range, we investigated the association between central arterial stiffness, measured using pulse wave velocity (PWV), and aggregate g-ratio, measured using our recent advanced quantitative MRI methodology, in several cerebral WM structures. After adjusting for age, sex, smoking status, and systolic blood pressure, our results indicate that higher PWV values, that is, elevated arterial stiffness, were associated with lower aggregate g-ratio values, that is, lower microstructural integrity of WM. Compared to other brain regions, these associations were stronger and highly significant in the splenium of the corpus callosum and the internal capsules, which have been consistently documented as very sensitive to elevated arterial stiffness. Moreover, our detailed analysis indicates that these associations were mainly driven by differences in myelination, measured using myelin volume fraction, rather than axonal density, measured using axonal volume fraction. Our findings suggest that arterial stiffness is associated with myelin degeneration, and encourages further longitudinal studies in larger study cohorts. Controlling arterial stiffness may represent a therapeutic target in maintaining the health of WM tissue in cerebral normative aging.

White coat hypertension is another clinical characteristic of patients with inflammatory bowel disease: A cross-sectional study.

In this cross-sectional study, our aim was to analyze association of ambulatory blood pressure monitoring (ABPM) values with pulse wave velocity (PWV) in inflammatory bowel disease (IBD) patients as well as the prevalence and characteristics of white coat hypertension (WCH) in this group of patients with chronic inflammation and high prevalence of anxiety. We enrolled 120 consecutive IBD patients (77 Crohn´s disease; 43 ulcerative colitis) who were not treated with antihypertensive drugs without cardiovascular, cerebrovascular and renal morbidity. Office blood pressure, ABPM, and PWV were measured with Omrom M6, SpaceLab 90207, and Arteriograph, respectively. The prevalence of true normotension, sustained hypertension and WCH was analyzed in IBD patients. WCH was found in 27.5% patients. IBD-WCH patients had significantly lower prevalence of traditional risk factors than general WCH subjects. PWV and augmentation index (AIx) values were higher in WCH than in true normotensive patients. When adjusted for age and duration of IBD, only PWV was a positive predictor of WCH, and patients with higher PWV and longer disease duration had OR´s for WCH of 0.69 and 2.50, respectively. IBD patients had significantly higher prevalence of WCH and higher PWV values than healthy control patients. WCH is highly prevalent in IBD patients but IBD-WCH patients have lower frequency of traditional cardiovascular risk factors than general WCH population. Our results suggest that WCH could be considered as another clinical characteristic of IBD which is associated with increased arterial stiffness and those patients should be monitored more closely.

COVID-19 and cardiovascular system: not only heart but also vascular. The effects of the infection on arterial stiffness

Abstract Background SARS-CoV-2 determines a framework of multi-organ dysfunction that can involve the cardiovascular system creating damages of different nature. Among these, endothelial damage could play a key role in increasing arterial stiffness and thus the cardiovascular risk of infected patients. The aim of this study is to evaluate the Pulse Wave Velocity (PWV) of a population of patients after recovery from infection and to compare them with those of a group affected by arterial hypertension. Methods This prospective observational monocentric study involved 143 patients with previous diagnosis of Covid-19 who undergone PWV measurement during the follow-up at a median time of 3.8 months after the infection. These patients were compared to a population of 143 patients with hypertension matched by age, sex, Systolic Blood Pressure values and Body Mass Index. Results PWV values were higher in Covid-19 group comparing to hypertension group (10.5±3.0 m/s VS 8.9±2.5 m/s). Furthermore, there is a correlation between higher PWV values and lower values of SpO2% at time of admission at the Emergency Department. (R=−0.302; p<0.001). Conclusions SARS-CoV-2 infection seems related to increased PWV values. Moreover, higher arterial stiffness seems correlated to a worse oxygen saturation in Emergency Department. More studies with longer follow-up time are necessary to establish whether the vascular damage is reversible and whether it correlates with an increase of long-term cardiovascular risk. Funding Acknowledgement Type of funding sources: Public hospital(s). Main funding source(s): Niguarda Hospital, Milan, Italy

Effect of congenital or acquired renal mass reduction on arterial stiffness.

The changes in kidney functions, adversely affect the cardiovascular system. The aim of this study was to investigate whether arterial stiffness (AS), an indicator of subclinical atherosclerosis, was affected in patients with congenital or acquired reduced renal mass. In this prospective study, a total 135 patients (mean age 43.4 ± 8.5 years and 71.9% female) with congenital unilateral small/nonfunctioning kidney or unilateral agenesis or with unilateral nephrectomy were included. As control group, 44 healthy individuals with similar age and gender (mean age, 42.5 ± 7.1 year and 61.4% female) were included. Estimated glomerular filtration rate (eGFR) was calculated by Modification of Diet in Renal Disease formula. Official blood pressures (BP) and 24-h ambulatory noninvasive BP of both groups were measured. AS was assessed with pulse wave velocity (PWV) by using Mobile-O-Graph new genarationarteriograph device using oscillometrical method. There was no difference in terms of BP parameters and body mass index between groups. eGFR values of control group and study group were 93 ± 19 ml/min/1.73 m² and 89 ± 28 ml/min/1.73 m², respectively (p = 0.379). Compared with control group, the study group had higher PWV values (6.72 ± 1.11 m/s vs. 6.29± 0.75 m/s, p = 0.018). In linear regression analysis, PWV was found to be correlated with age (β = 0.752, p < 0.001), and daytime ambulatory systolic BP (β = 0.345, p < 0.001). Our study showed that AS was increased in patients with reduced renal mass and this increase in AS was related to age and systolic BP. No relation was determined between AS and eGFR.

COVID-19 AND CARDIOVASCULAR SYSTEM: NOT ONLY HEART BUT ALSO VASCULAR. THE EFFECTS OF THE INFECTION ON ARTERIAL STIFFNESS

Objective: SARS-CoV-2 determines a framework of multi-organ dysfunction that can involve the cardiovascular system creating damages of different nature. Among these, endothelial damage could play a key role in increasing arterial stiffness and thus the cardiovascular risk of infected patients. The aim of this study is to evaluate the Pulse Wave Velocity (PWV) of a population of patients after recovery from infection and to compare them with those of a group affected by arterial hypertension. Design and method: This prospective observational monocentric study involved 143 patients with previous diagnosis of Covid-19 who undergone PWV measurement during the follow-up at a median time of 3.8 months after the infection. These patients were compared to a population of 143 patients with hypertension matched by age, sex, Systolic Blood Pressure values and Body Mass Index. Results: PWV values were higher in Covid-19 group comparing to hypertension group (10.5 ± 3.0 m/s VS 8.9 ± 2.5 m/s). Furthermore, there is a correlation between higher PWV values and lower values of SpO2% at time of admission at the Emergency Department. (R = -0.302; p &lt; 0.001). Conclusions: SARS-CoV-2 infection seems related to increased PWV values. Moreover, higher arterial stiffness seems correlated to a worse oxygen saturation in Emergency Department. More studies with longer follow-up time are necessary to establish whether the vascular damage is reversible and whether it correlates with an increase of long-term cardiovascular risk.

ARTERIAL STIFFNESS IN PATIENTS WITH HYPERTENSIVE CRISIS

Objective: The aim of this study was to determine if patients with the hypertensive crisis have higher pulse wave velocity compared to the patients with arterial hypertension without it. Design and method: In this case-control study which lasted from January 2020 to December 2021, 61 patients (36 males, 25 females) with the hypertensive crisis were analyzed at the Emergency department in Clinical Hospital Merkur, Zagreb. The hypertensive crisis was defined as a rapid increase in systolic blood pressure above 180 and/or diastolic above 120mmHg (SBP range 181–208mmHg). On the other hand, in the control group, we analyzed 45 patients (24 males, 21 females) with confirmed arterial hypertension by a 24h-ambulatory blood pressure monitor (BTL Cardiopoint, SBP &gt; 130/80mmHg or taking antihypertensives) without evidence of hypertensive crisis (SBP range 115–156mmHg) in two family medicine practices. Elementary lab results and pulse wave velocity (by Agedio B900) were checked in all patients. Patients were divided into two additional groups by age (51–60, 42 patients and 61–70 years, 64 patients). Mann-Whitney U test was used for the analysis of non-parametric variables in Statistica v.10.0. Results: Patients with hypertensive crisis had a significantly higher heart rate (median 78 vs. 69 bpm, U = 714; p &lt; 0.001), fasting glucose (median 5.5 vs. 6.0 mmol/L, U = 804.5; p &lt; 0.01), body mass index (median 31.0 vs. 27.9 kg/m2, U = 889; p &lt; 0.001), nocturnal SBP drop (median 15.5 vs. 9.8%, U = 386; p &lt; 0.05), and augmentation index (median 42 vs. 19%, U = 686; p &lt; 0.001). In both younger and older group, patients with hypertensive crisis had statistically significantly higher pulse wave velocity (median younger: 9.3 vs. 8.1m/s, U = 65.5; p &lt; 0.001; older: 10.7 vs. 9.0m/s, U = 19; p &lt; 0.001) shown in the Figure 1. In younger group patients with hypertensive crisis have 8.5 times higher chances of having pulse wave velocity above reference value (&gt;8.0m/s; CI = 1.57–46.87, p &lt; 0.001) while in older group that chance was 108 times higher than in controls (reference value &gt;9.5m/s; CI = 13.83–843.33, p &lt; 0.001). Conclusions: Patients with hypertensive crisis had statistically higher pulse wave velocity values, heart rate, fasting glucose, body mass index, and nocturnal SBP drop compared to patients with arterial hypertension without crisis.

Pulse Wave Velocity and Sarcopenia in Older Persons-A Systematic Review and Meta-Analysis.

Sarcopenia and cardiovascular disease share some of the pathophysiologic mechanisms. Sarcopenia is likewise an important feature of frailty and the one potentially related to cardiovascular pathology. Previously, the relationship between arterial stiffness and frailty has been established. In this study, we conducted a systematic review and a meta-analysis of studies where the relationship between pulse wave velocity (PWV) and sarcopenia has been addressed. We included six cross-sectional studies that enrolled 5476 participants. Using the WebPlotDigitizer, RevMan5, and SAS 9.4, we extracted or calculated the summary statistics. We then calculated standardized mean differences (SMD) of PWV in the sarcopenic and non-sarcopenic participants. The pooled SMD was 0.73 (95% CI 0.39–1.08, p < 0.0001, I2 = 90%) indicating higher value in the sarcopenic subjects. The three studies that presented odds ratios for sarcopenia as a function of PWV homogenously indicated a greater probability of concomitant sarcopenia with higher values of PWV. Greater stiffness of the aorta is associated with sarcopenia. It is impossible to establish the causation. However, the plausible explanation is that increased stiffness may translate into or be an intermediary phenotype of common vascular and muscle damage. On the other hand, sarcopenia, which shares some of the inflammatory mechanisms with cardiovascular disease, may wind up the age-related large arterial remodeling.

P389 COVID–19 AND CARDIOVASCULAR SYSTEM: NOT ONLY HEART BUT ALSO VASCULAR. THE EFFECTS OF THE INFECTION ON ARTERIAL STIFFNESS

IntroductionSARS–CoV–2 determines a framework of multi–organ dysfunction that can involve the cardiovascular system creating damages of different nature. Among these, endothelial damage could play a key role in increasing arterial stiffness and thus the cardiovascular risk of infected patients. The aim of this study is to evaluate the Pulse Wave Velocity (PWV) of a population of patients after recovery from infection and to compare them with those of a group affected by arterial hypertension.MethodsThis prospective observational monocentric study involved 143 patients with previous diagnosis of Covid–19 who undergone PWV measurement during the follow–up at a median time of 3.8 months after the infection. These patients were compared to a population of 143 patients with hypertension matched by age, sex, Systolic Blood Pressure values and Body Mass Index.ResultsPWV values were higher in Covid–19 group comparing to hypertension group (10.5 ± 3.0 m/s VS 8.9 ± 2.5 m/s). Furthermore, there is a correlation between higher PWV values and lower values of SpO2% at time of admission at the Emergency Department. (R= –0.302; p < 0.001).ConclusionsSARS–CoV–2 infection seems related to increased PWV values. Moreover, higher arterial stiffness seems correlated to a worse oxygen saturation in Emergency Department. More studies with longer follow–up time are necessary to establish whether the vascular damage is reversible and whether it correlates with an increase of long–term cardiovascular risk.

Arterial Stiffness in a Cohort of Young People Living With Perinatal HIV and HIV Negative Young People in England

BackgroundAntiretroviral therapy (ART) has increased life expectancy and consequently the risk of cardiovascular disease (CVD) in adults living with HIV. We investigated the levels and predictors of arterial stiffness in young people (YP) living with perinatal HIV (PHIV) and HIV negative YP in the Adolescents and Adults Living with Perinatal HIV (AALPHI) study.MethodsAALPHI was a prospective study evaluating the impact of HIV infection and exposure to ART on YP living with PHIV (aged 13–21 years) who had known their HIV status for at least 6 months, and HIV negative YP (aged 13–23 years) who either had a sibling, friend or parent living with HIV. Participants were enrolled from HIV clinics and community services in England. Two hundred and thirteen PHIV and 65 HIV negative YP (42% siblings of PHIV) had pulse wave velocity (PWV) measurements taken (Vicorder software) from the supra-sternal notch to the middle of the thigh cuff, at their second interview in the study between 2015 and 2017. Average PWV was calculated from the three closest readings (≥3 and ≤ 12 m/s) within 0.6 m/s of each other. Linear regression examined predictors of higher (worse) PWV, including age, sex, HIV status and height as a priori, ethnicity, born outside UK/Ireland, alcohol/nicotine/drug use, weight, waist-to-hip-ratio, mean arterial pressure (MAP), caffeine 2 h before PWV and nicotine on day of PWV. A separate PHIV model included CD4, viral load, years taking ART and ART regimen.FindingsOne hundred and twenty eight (60%) PHIV and 45 (69%) HIV negative YP were female (p = 0.18), with median (IQR) age 18 (16, 20) and 18 (16, 21) years (p = 0.48) respectively. Most PHIV were taking a combination of three ART drugs from two classes. There was a trend toward higher (worse) mean PWV in the PHIV group than the HIV negative group [unvariable analysis 6.15 (SD 0.83) m/s vs. 5.93 (0.70) m/s, respectively, unadjusted p = 0.058], which was statistically significant in the multivariable analysis [adjusted p (ap) = 0.020]. In multivariable analysis being male (ap = 0.002), older age (ap < 0.001), higher MAP (ap < 0.001) and nicotine use on day of measurement (ap = 0.001) were also predictors of higher PWV. The predictors were the same in the PHIV model.InterpretationBy late adolescence PHIV had worse PWV in comparison to HIV negative peers, and traditional risk factors for CVD (higher arterial pressure, being male and older age) were associated with higher PWV values. Regular detailed monitoring of cardiovascular risk factors should become standard of care for every young person with PHIV worldwide.

Evaluation of pulse wave velocity for predicting major advanced cardiovascular events in patients with chronic myocardial infarction

Abstract Introduction Increased aortic pulse wave velocity (PWV) as a strong predictor of major advanced cardiovascular events (MACE) has a prognostic relevance in patients after myocardial infarction (MI). Several non-invasive methods have been proposed for the assessment of arterial stiffness, but the PWV values show significant differences according to the applied techniques. Cardiac magnetic resonance imaging (CMR) provides an accurate method to measure PWV and infarct size in patients after MI. Purpose Calculated PWV values of CMR based phase-contrast (PC) and invasively validated oscillometric methods were compared in this prospective observational study. We aimed to evaluate the cut-off PWV values for each method, while MACE predicted and validated the prognostic value of high PWV in post-infarcted patients in a 6-year follow-up. Methods 3D aortic angiography and PC velocity imaging was performed using a Siemens Avanto 1,5 T CMR device. Oscillometric based Arteriograph (AG) was used to assess PWV using direct body surface distance measurements. The comparison between the two techniques was tested. Patients received follow-up for MACE comprising all-cause death, non-fatal MI, ischemic stroke, hospitalization for heart failure and coronary revascularization. Event-free survival was analysed using Kaplan-Meier plots and log-rank tests. Univariable and multivariable Cox regression analysis was performed to identify outcome predictors. Results 75 patients (56 male, 19 female, average age: 56±13 years) referred for CMR were investigated, of whom 50 had coronary artery disease (CAD) including 35 patients with previous MI developing ischaemic late gadolinium enhancement (LGE) pattern. AG and CMR derived PWV values were significantly correlated (rho: 0,343, p&amp;lt;0,05), however absolute PWV values were significantly higher for AG (median (IQR): 10,4 (9,2–11,9) vs. 6,44 (5,64–7,5); p&amp;lt;0,001). Bland Altman analysis showed an acceptable agreement with a mean difference of 3,7 m/s between the two measures. In patients with CAD significantly (p&amp;lt;0,01) higher PWV values were measured by AG and CMR, respectively. During the median follow-up of 6 years, totally 69 MACE events occurred. Optimized PWV cut-off values for MACE prediction were calculated (CMR: 6,47 m/s; AG: 9,625 m/s) by receiver operating characteristic analysis. Kaplan-Meier analysis in both methods showed a significantly lower event-free survival in case of high PWV (p&amp;lt;0,01, respectively). Cox regression analysis revealed PWV for both methods as a predictor of MACE (PWV CMR hazard ratio (HR): 2,6 (confidence interval (CI) 1,3–5,1), PWV AG HR: 3,1 (CI: 1,3–7,1), p&amp;lt;0,005, respectively). Conclusions Our study showed good agreement between the AG and CMR methods for PWV calculation. Both techniques are feasible for MACE prediction in postinfarcted patients. However, different AG and CMR PWV cut-off values were calculated to improve risk stratification. Funding Acknowledgement Type of funding sources: None. Agreement between the two methodsKaplan-Meier event curves for MACE

Pediatric obstructive sleep-disordered breathing is associated with arterial stiffness.

The association between obstructive sleep-disordered breathing (oSDB) and arterial stiffness, an independent predictor of cardiovascular outcomes, is not well established in children. This study compared cardiovascular parameters between healthy and oSDB children and aimed to identify predictors of arterial stiffness indices in children with oSDB. Cross-sectional study realized in a tertiary hospital from June 2018 to January 2020. Forty-eight children (3 to 10years old) with clinical diagnosis of oSDB and indication for adenotonsillectomy and 24 controls were evaluated. Cardiovascular parameters were measured non-invasively by brachial artery oscillometry with a portable device. The main arterial stiffness indices assessed were augmentation index and pulse wave velocity, both derived from the aortic pulse wave. In the oSDB group, the questionnaires Obstructive Sleep Apnea-18 (OSA-18)and Pediatric Quality of Life Inventory version 4.0 (PedsQL 4.0)were applied. The oSDB group had higher values of reflection coefficient (p = 0.044) and augmentation index (p = 0.003) than the control group. Stepwise multiple regression analysis revealed that age, female sex, reflection coefficient, and systolic volume were independent predictors of augmentation index. Higher pulse wave velocity values were associated with worse quality of life assessed by PedsQL 4.0questionnaire. There was no association with OSA-18. The vascular and hemodynamic parameters were similar in both groups.Conclusion: Children with oSDB have increased augmentation index, an independent predictor of cardiovascular outcomes. The early identification of subclinical cardiovascular changes reinforces the importance of treating the disease, as well as changing lifestyle habits, to prevent complications in adulthood. What is Known: • The association between oSDB and cardiovascular risk in adults is well described in the literature. • Children with oSDB, regardless of their weight or sex, have higher PWV values when compared to non-snoring children. What is New: • Children with oSDB have augmented arterial stiffness, evidenced by the increase in AIx@75, measured non-invasively by brachial artery oscillometry with a portable device. • Low quality of life and therefore a high disease burden in children with oSDB may be a risk factor for arterial stiffness.

Relationship Between Dietary Phosphate Intake and Biomarkers of Bone and Mineral Metabolism in Australian Adults With Chronic Kidney Disease

Higher serum phosphate is associated with increased adverse outcomes including cardiovascular disease. Abnormalities of bone and mineral metabolism in chronic kidney disease (CKD), including higher serum phosphate, are important risk factors for increased cardiovascular disease. Associations between dietary phosphate intake and biochemical and cardiovascular parameters in non-dialysis CKD patients, however, have not been adequately studied. This study aimed to explore associations between phosphate intake and biomarkers of bone and mineral metabolism and intermediate cardiovascular markers in adults with stage 3-4 CKD. One hundred thirty-two participants enrolled in the IMpact of Phosphate Reduction On Vascular End-points in Chronic Kidney Disease trial were invited to participate in this sub-study. At baseline, dietary phosphate intake and its source (animal, plant, or a mixture of animal and plant) were determined using a 7-day self-administered diet food record, and measurements were made of serum and urinary phosphate, serum calcium, parathyroid hormone, fibroblast growth factor-23, and the intermediate cardiovascular markers pulse wave velocity (PWV) and abdominal aortic calcification. The relationships between dietary phosphate intake and these bone metabolism and cardiovascular markers were explored using Pearson's correlation and linear regression. The effect of source of phosphate intake was analyzed using compositional data analysis. Ninety participants (age 64±12years, 68% male, estimated glomerular filtration rate 26.6±7.6mL/min/1.73m2, daily phosphate intake 1,544±347mg) completed the study. Correlations among dietary phosphate intake and biochemical measures, PWV, and abdominal aortic calcification ranged from r=-0.13 to r=+0.13. Linear regression showed no association between dietary phosphate measurements and biochemical or cardiovascular parameters. Source of phosphate intake was associated with PWV (P=.01), but not with other biomarkers of bone and mineral metabolism. Higher PWV values were associated with higher intake of plant-based relative to animal-based phosphate (1.058 [1.020-1.098], P=.003). Levels of total dietary phosphate intake measured by dietary food record show no statistically significant relationship with biochemical markers of bone and mineral metabolism or intermediate cardiovascular markers. Higher PWV levels associated with higher intake of plant-based relative to animal-based phosphate intake were an unexpected finding and further research is needed in this area.

Estimated pulse wave velocity (ePWV) as a potential gatekeeper for MRI-assessed PWV: a linear and deep neural network based approach in 2254 participants of the Netherlands Epidemiology of Obesity study

Pulse wave velocity (PWV) assessed by magnetic resonance imaging (MRI) is a prognostic marker for cardiovascular events. Prediction modelling could enable indirect PWV assessment based on clinical and anthropometric data. The aim was to calculate estimated-PWV (ePWV) based on clinical and anthropometric measures using linear ridge regression as well as a Deep Neural Network (DNN) and to determine the cut-off which provides optimal discriminative performance between lower and higher PWV values. In total 2254 participants from the Netherlands Epidemiology of Obesity study were included (age 45–65 years, 51% male). Both a basic and expanded prediction model were developed. PWV was estimated using linear ridge regression and DNN. External validation was performed in 114 participants (age 30–70 years, 54% female). Performance was compared between models and estimation accuracy was evaluated by ROC-curves. A cut-off for optimal discriminative performance was determined using Youden’s index. The basic ridge regression model provided an adjusted R2 of 0.33 and bias of < 0.001, the expanded model did not add predictive performance. Basic and expanded DNN models showed similar model performance. Optimal discriminative performance was found for PWV < 6.7 m/s. In external validation expanded ridge regression provided the best performance of the four models (adjusted R2: 0.29). All models showed good discriminative performance for PWV < 6.7 m/s (AUC range 0.81–0.89). ePWV showed good discriminative performance with regard to differentiating individuals with lower PWV values (< 6.7 m/s) from those with higher values, and could function as gatekeeper in selecting patients who benefit from further MRI-based PWV assessment.

ARTERIAL HYPERTENSION IN POSTMENOPAUSAL WOMEN WITH ABDOMINAL OBESITY: ROLE OF INFLAMMATORY RESPONSE MARKERS, LEPTIN AND SEX HORMONES IN PATHOGENESIS OF VASCULAR WALL STIFFNESS

Objective: Arterial hypertension (AH) with abdominal obesity, especially during postmenopause, remains one of the most serious medical and social problems. The objective was to study features of AH in postmenopausal women with abdominal obesity and to assess the role of markers of inflammatory response, leptin and female sex hormones in the pathogenesis of vascular wall stiffness. Design and method: The study included 164 patients randomized into 3 groups. Group 1 (control) consisted of 42 healthy women aged 44.43 ± 14.26 years, group 2 - 62 women aged 60.69 ± 7.09 years with AH and group 3 included 60 women aged 57.24 ± 7.4 years with AH and abdominal obesity. Parameters of 24-hour ambulatory blood pressure monitoring; sphygmography - pulse-wave velocity (PWV); lipid profile parameters, inflammatory markers (high-sensitivity C-reactive protein, TNF-alpha, homocysteine, interleukin-1 beta, -6, -8); endothelial dysfunction markers (endothelin-1, nitrites) and hormonal profile (sex hormone levels, cortisol and testosterone), leptin were measured. Results: Analysis results revealed that systolic and diastolic blood pressure indices were significantly higher in group 3 in comparison with group 2. An excess of the variability of systolic blood pressure at night was recorded in group 2 and 3 (p &lt; 0.017). Higher PWV values were registered in group 2. Lower levels of sex hormones and significant increase in the level of inflammatory markers were found in groups 2 and 3 compared to the control group. We revealed multiple multidirectional correlations between the studied parameters. Logistic regression method detected the main biochemical markers that affect increase in stiffness of the vascular wall, such as leptin (odds ratio (OR): 1.021, 95% confidence interval (CI): 1.004–1.039, p = 0.018), high-sensitivity C-reactive protein (OR: 1.300; 95% CI 1.091–1.549, p = 0.003) and endothelin-1 (OR: 1.0242; 95% CI 1.042–1.794, p = 0.024). Rise of each marker by unit of measurement leads to increase in PWV by 2.1%; 1.3 times by 2.4%, respectively. Conclusions: Features of AH in postmenopausal women with abdominal obesity are systolic-diastolic AH with increase in variability of systolic blood pressure at night. The main markers determining the state of elastic properties of the vascular wall are leptin, high-sensitivity C-reactive protein and endothelin-1.

Arterial Stiffness Changes in Severe Aortic Stenosis Patients Submitted to Valve Replacement Surgery.

ResumoFundamento:Pouco se sabe sobre o impacto da estenose aórtica (EA) grave na rigidez aórtica e se ocorre alguma alteração após a remoção da barreira de EA com a cirurgia de substituição da válvula aórtica (SVA).Objetivo:Estimar as mudanças na velocidade de onda de pulso carotídeo-femoral (VOP) após a cirurgia de SVA e definir os preditores de VOP alta em pacientes com EA grave.Métodos:Estudo de coorte retrospectivo unicêntrico, incluindo pacientes com EA grave submetidos à cirurgia de SVA com bioprótese, entre fevereiro de 2017 e janeiro de 2019, e medições da VOP (Complior®) antes e depois do procedimento (2±1 meses). Antes e depois da SVA, os valores da VOP foram comparados por meio de testes pareados. foram analisadas as associações de VOP com dados clínicos, bem como aplicados modelos de regressão linear multivariada para estimar os preditores independentes da VOP pré- e pós-operatória. O nível de significância foi estabelecido em 5%.Resultados:Foram incluídos na amostra 150 pacientes, com média de idade de 72±8 anos, sendo 51% deles do sexo masculino. Identificamos um aumento estatisticamente significativo nos valores de VOP após a cirurgia (9,0 ± 2,1 m/s vs. 9,9 ± 2,2, p<0,001, antes e depois da SVA, respectivamente) e uma associação inversa com as variáveis de gravidade da EA. No modelo de regressão linear multivariada, idade e pressão arterial sistólica (PAS) foram estabelecidas como preditores independentes da VOP pré- e pós-operatória mais alta, enquanto o gradiente valvar médio mais alto foi considerado um determinante da VOP pré-SVA mais baixa.Conclusão:Identificamos uma correlação inversa da rigidez arterial com a gravidade da EA em pacientes acometidos, e um aumento significativo nos valores da VOP após a cirurgia de SVA. Idade avançada e PAS elevada foram associadas a valores mais altos da VOP, embora as medidas de função arterial estivessem dentro da normalidade. (Arq Bras Cardiol. 2021; 116(3):475-476)

Abstract WP485: Racial Differences in the Association Between Central Hemodynamic Parameters and Neuropsychological Assessments

Introduction: Despite a significantly younger at time of stroke, African Americans are at increased risk for post-stroke cognitive impairment compared to whites. Although central arterial stiffness is a well-established correlate of cognitive function in whites, its predictive value in African Americans is not well characterized. We hypothesized that arterial stiffness measures previously associated with declines in cognition may be more robust in African Americans compared to whites. Methods: We administered the Mini Mental State Examination (MMSE), Trail Making Test Part-A (TMTA) and Part-B (TMTB), and Symbol Digit Modalities Test (SDMT) to 54 stroke-free adults (28 African Americans and 26 whites). Central hemodynamic parameters including carotid-femoral pulse wave velocity (PWV), central systolic blood pressure (cSBP), central pulse pressure (cPP), and heart rate-corrected augmentation index (AIx@75) were recorded for each study participant. Univariate analysis was used to evaluate age, sex and mean arterial pressure (MAP) mean-adjusted differences in central hemodynamics. We also evaluated associations between central hemodynamics and neuropsychological test by race. Results: Mean-adjusted PWV values were significantly higher in African Americans compared to whites with values ranging from 8.8 m/s to 7.8 m/s, respectively. Adjusted mean cSBP and AIx@75 were also significantly increased in African Americans. Among whites, unadjusted PWV values were negatively associated with TMTA and TMTB z-scores. Unadjusted AIx@75 was negatively associated with TMTB z-scores in African Americans but not whites. African Americans with MMSE and SDMT z-scores &lt;0 had higher PWV values compared to whites ((9.4 m/s vs 7.9 m/s) and (9.7 m/s vs 7.7 m/s), respectively) and those with TMTB z-scores &lt;0 had higher cSBP values (123.1 mmHg vs 114.4 mmHg). Conclusion: African Americans had higher arterial stiffness compared to whites. Neuropsychological test were associated with arterial stiffness in white study participants but only arterial wave reflections in African Americans. Longitudinal follow-up is warranted to assess specific central hemodynamic parameters associated with cognitive impairments and dementia in African Americans.

True Arterial Stiffness Does Not Change between Dialysis Sessions during 1 Week in Outpatients on Intermitted Hemodialysis

Introduction: End-stage renal disease (ESRD) is associated with exponentially elevated cardiovascular mortality. Arterial stiffness (AS) – usually expressed with pulse wave velocity (PWV) – is an established independent predictor of cardiovascular risk beyond the traditional risk factors. Higher PWV values are frequently observed in patients with ESRD. Due to the intrinsic physiologic relationship between PWV and prevailing arterial pressure, PWV can change without relevant changes in the arterial wall structure, and thus an individual pressure-independent expression of PWV is essential. Methods: The study is a single-center observational study. Repeated measurements of blood pressure (BP) and pulse wave analysis were performed during each dialysis session of 1 week. Aortic PWV was then adjusted to 120 mm Hg central systolic BP (PWV120) based on individually determined relationship. PWV120 values were compared between single sessions. Calculation of the PWV120 was performed retrospectively. Results: Fifty-four subjects were included, 61.1% of whom were male. The median age was 75.5 years, and median dialysis vintage was 33.1 months. Mean systolic/diastolic BP was 121.4/70.5 mm Hg, and the median heart rate was 64.6 beats/min. Mean PWV was 10.9 m/s, and mean PWV120 was 11.3 m/s. PWV120 did not change across single dialysis session during 1 week, while systolic, diastolic BP, PWV, and ultrafiltration volume differed significantly. Discussion/Conclusions: Our data suggest that true AS does not change in the short-term course in dialysis patients. The observed changes in PWV are rather associated with BP change due to intrinsic pressure dependence. Our analytical approach represents a novel method for this purpose, which is easy in performance and also applicable for large interventional trials and clinical practice.