Increase In Arterial Stiffness Research Articles

Myocardial work, combined with arterial stiffness and biomarkers, are able to detect earlier and predict cardiotoxicity in non-Hodgkin lymphoma

Abstract Funding Acknowledgements Type of funding sources: None. CHOP (cyclophosphamide, doxorubicin, oncovin, prednisone) in non-Hodgkin lymphoma (NHL) is limited by risk of cardiotoxicity. Aim. To define new parameters of LV myocardial work, arterial stiffness, and biomarkers for early diagnosis and prediction of cardiotoxicity. Methods. 91 patients (34 men, 57 ± 11 years), with NHL, with LVEF >50%, scheduled for CHOP, were assessed at baseline, and after 4th and 8th cycle (doxorubicin total dose of 341 ± 52 mg). 3D echo was used for LVEF; 2D STE for longitudinal strain (LS) and myocardial work: global constructive work (GCW) as "the positive" work of the heart; global wasted work (GWW) as "the negative" work of the heart; global work efficiency (GWE) by formula GCW/(GCW + GWW), and global work index (GWI) as sum of GCW and GWW; echo-tracking for pulse wave velocity (PWV) and β index. Troponin I and NTproBNP were measured. Cardiotoxicity was defined as LVEF decrease <50%, with >10% from baseline. Results. After 8th cycle, 17 patients (18%) (group I) developed cardiotoxicity (3D LVEF: 63 ± 3 vs. 48 ± 1, p < 0.0001), whereas 74 patients (group II) did not (3D LVEF: 63 ± 2 vs. 57 ± 3, p < 0.0001). There was a significant reduction of LS, GCW and GWE, with an increase of GWW and arterial stiffness, starting with the 4th cycle; changes in group I were higher than in group II (p < 0.001) (table). Univariate analysis showed significant correlation between reduction of 3D LVEF and decrease of LS, GCW, GWE (r = 0.65; r = 0.74; r = 0.54), and increase of GWW, PWV, β index, and troponin level after 4th cycle (r=-0.44; r=-0.38; r=-0.39; r=-0.35; all p < 0.05). Reduction of GCW after the 4th cycle was the best independent predictor of decrease of 3D LVEF after the 8th cycle (R2 = 0.48, p = 0.001). By ROC analysis, decrease of GCW by more than 29% after the 4th cycle predicted development of cardiotoxicity after the 8th cycle of CHOP (Sb 82%, Sp 81%). Conclusion. Assessment of myocardial work, combined with arterial stiffness and biomarkers, are able to detect early chemotherapy-induced cardiotoxicity and to predict further decline of LVEF in non-Hodgkin lymphoma. Myocardial work and cardiotoxicity CHOP Group I Group II LS(-%) Baseline 4th cycle 8th cycle 22 ± 2 17 ± 1† 13 ± 2† 22 ± 2 19 ± 2† 17 ± 2±† GCW (mmHg%) Baseline 4th cycle 8th cycle 2256 ± 123 1902 ± 133† 1633 ± 167† 2278 ± 168 2104 ± 111† 1937 ± 102† GWW (mmHg%) Baseline 4th cycle 8th cycle 84 ± 4 124 ± 18† 198 ± 24† 85 ± 11 94 ± 21† 113 ± 19† GWE (%) Baseline 4th cycle 8th cycle 98 ± 1 92 ± 2† 86 ± 2† 98 ± 1 95 ± 2 94 ± 1† GWI (mmHg%) Baseline 4th cycle 8th cycle 1982 ± 155 1888 ± 136† 1723 ± 172† 2003 ± 189 1945 ± 111 1873†±102† GCW = global constructive work; GWE = global work efficiency; GWI = global work index; GWW = global waste work; LS = longitudinal strain; † p < 0.001

Pemberian Minuman Jahe Terhadap Tekanan Darah Penderita Hipertensi Di Posyandu Lansia Surya Kencana Bulak Jaya Surabaya

Hypertension is a major modifiable risk factor to prevent cardiovascular disease and death, especially in the elderly. The increase in blood pressure in the elderly is affected by the loss of elastic tissue in the arteries and a concomitant increase in arterial stiffness. Management of hypertension is making lifestyle changes by limiting alcohol and sodium consumption, quitting smoking, increasing physical activity and adjusting diet. The therapy that will be used is ginger drink therapy. The aim of the study was to determine the effect of ginger drink therapy on blood pressure of hypertensive patients at the posyandu for elderly Suraya Kencana. The design of this research is Quasy Experimental using the Nonequivalent Control Group Design model. The sample of this study was 30 elderly people with hypertension without a history of hyperkalemia, kidney disease and gastritis. Determination of the sample using simple random sampling. Data analysis used the Mann-Whitney U test. Most of the respondents aged 60-65 years, women, had a history of cholesterol disease. The results of blood pressure in the intervention group before giving ginger drink in Grade 1 hypertension were 66.6% and after doing the Pre Hypertension category therapy amounted to 46.6%. The results of statistical tests showed the p value = 0.000 (<0.05) and the Z value count -3,758. Based on these results, it can be concluded that the effect of giving ginger drink to the blood pressure of hypertensive patients at the Posyandu for the Elderly Surya Kencana Bulak Jaya Surabaya.
 Keywords: Ginger Drink, Blood Pressure, Elderly, Hypertension

Clinical effectiveness of fish oil on arterial stiffness: A systematic review and meta-analysis of randomized controlled trials

AimsThe increase of arterial stiffness is an independent risk factor for cardiovascular diseases (CVD). Fish oil supplementation was shown to reduce the risk of CVD outcomes. However, the effects of fish oil on arterial stiffness remains controversial. This meta-analysis summarized existing randomized clinical trials (RCTs) to determine whether fish oil can affect arterial stiffness in adults. Data synthesisSystematic searches were performed using the PubMed/Medline, EMbase, Cochrane database, Clinical trials, and Web of Science. All RCTs assessed the effect of fish oil intervention on carotid to femoral-Pulse Wave Velocity (cf-PWV), brachial to ankle-PWV (ba-PWV), augmentation index (AIx) and AIx75 were considered. A fixed-effect model was used to calculate the pooled effect.A total of 14 RCTs were included. The pooled data analysis showed that fish oil significantly reduced PWV levels (SMD: −0.145, 95%CI: −0.265 to −0.033, P = 0.012) compared to the control group. In subgroup analyses, a significant decrease in PWV was found in trials that fish oil with low dosages (≤1.8 g/d), short time (<24 weeks), low DHA to EPA ratio (DHA/EPA<1) and among young participant (<50 years old). Besides, the effect of fish oil was more obvious in ba-PWV compared to cf-PWV. In contrast, the effect of fish oil supplementation on AIx (WMD: −0.588%, 95% CI: −2.745 to 1.568, P = 0.593) and AIx75 (WMD: 0.542%, 95% CI: −1.490 to 2.574, P = 0.601) was nonsignificant. ConclusionsThe current study showed that fish oil supplementation had a beneficial effect on pulse wave velocity.

Carotid Beta Stiffness Association with Thyroid Function

Background: Thyroid hormone modulation of cardiovascular function has been associated with cardiovascular disease. Recent evidence suggests that free thyroxine (FT4) levels are associated with an increase in systemic arterial stiffness, but little is known about the effects of FT4 at the local level of the common carotid artery. β-stiffness index is a local elastic parameter usually determined by carotid ultrasound imaging. Methods: We conducted a cross-sectional analysis in the ProgeNIA cohort, including 4846 subjects across a broad age range. For the purpose of this study, we excluded subjects with increased thyrotropin (TSH) levels and those treated with levothyroxine or thyrostatic. We assessed β stiffness, strain, wall–lumen ratio, carotid cross-sectional area (CSA), and stress and flow in the right common carotid artery. We tested whether FT4, heart rate, and their interactions were associated with carotid parameters. Results: FT4 was positively and independently associated with β stiffness index (β = 0.026, p = 0.041), and had a negative association with strain (β = −0.025, p = 0.009). After adding heart rate and the interaction between FT4 and heart rate to the model, FT4 was still associated with the β stiffness index (β = 0.186, p = 0.06), heart rate was positively associated with the stiffness index (β = 0.389, p < 0.001) as well as their interaction (β = 0.271, p = 0.007). Conclusion: This study suggests that higher FT4 levels increase arterial stiffness at the common carotid level, consistent with a detrimental effect on elastic arteries. The effect of FT4 is likely to be primarily attributable to its effect on heart rate.

Sex modulates the association of radial artery augmentation index with renal function decline in individuals without chronic kidney disease

PurposeAn increase in arterial stiffness is associated with rapid renal function decline (RFD) in patients with chronic kidney disease (CKD). The aim of this study was to investigate whether the radial augmentation index (rAI), a surrogate marker of arterial stiffness, affects RFD in individuals without CKD.MethodsA total of 3165 Chinese participants from an atherosclerosis cohort with estimated glomerular filtration rates (eGFR) of ≥ 60 mL/min/1.73 m2 were included in this study. The baseline rAI normalized to a heart rate of 75 beats/min (rAIp75) was obtained using an arterial applanation tonometry probe. The eGFRs at both baseline and follow-up were calculated using the equation derived from the Chronic Kidney Disease Epidemiology Collaboration. The association of the rAIp75 with RFD (defined as a drop in the eGFR category accompanied by a ≥ 25% drop in eGFR from baseline or a sustained decline in eGFR of > 5 mL/min/1.73 m2/year) was evaluated using the multivariate regression model.ResultsDuring the 2.35-year follow-up, the incidence of RFD was 7.30%. The rAIp75 had no statistically independent association with RFD after adjustment for possible confounders (adjusted odds ratio = 1.12, 95% confidence interval: 0.99–1.27, p = 0.074). When stratified according to sex, the rAIp75 was significantly associated with RFD in women, but not in men (adjusted odds ratio and 95% confidence interval: 1.23[1.06–1.43], p = 0.007 for women, 0.94[0.76–1.16], p = 0.542 for men; p for interaction = 0.038).ConclusionThe rAI might help screen for those at high risk of early rapid RFD in women without CKD.

The Role of SGLT2 Inhibitors in Vascular Aging.

Vascular aging is defined as organic and functional changes in blood vessels, in which decline in autophagy levels, DNA damage, MicroRNA (miRNA), oxidative stress, sirtuin, and apoptosis signal-regulated kinase 1 (ASK1) are integral thereto. With regard to vascular morphology, the increase in arterial stiffness, atherosclerosis, vascular calcification and high amyloid beta levels are closely related to vascular aging. Further closely related thereto, at the cellular level, is the aging of vascular endothelial cells (ECs) and vascular smooth muscle cells (VSMCs). Vascular aging seriously affects the health, economy and life of patients, but can be delayed by SGLT2 inhibitors through the improvement of vascular function. In the present article, a review is conducted of recent domestic and international progress in research on SGLT2 inhibitors,vascular aging and diseases related thereto, thereby providing theoretical support and guidance for further revealing the relationship between SGLT2 inhibitors and diseases related to vascular aging.

Effect of dapagliflozin on the structural and functional properties of arterial vessels in patients with type 2 diabetes mellitus in combination with obesity

Modern trends in the treatment of type 2 diabetes mellitus (DM) should include not only the normalization of carbohydrate metabolism disorders, but also a possible positive effect on the cardiovascular system. The use of the drug dapagliflozin for several years has proven to reduce the manifestations of heart failure. However, the possible significance of dapagliflozin in the reversal of structural and functional changes in the arteries in patients with type 2 DM and obesity has not been studied enough. The aim of the study was to establish the possibility of correction of structural and functional disorders of arterial vessels in patients with type 2 DM in combination with excess body weight (EBW) and obesity with dapagliflozin as part of complex therapy. Material and methods. 99 people were examined, including 71 patients with diabetes mellitus, the DM (type 2) diagnosis was verified according to the primary documentation. All patients provided written informed consent to participate in the study. Among the patients, the first group consisted of 36 people (14 women and 22 men) with EBW and obesity (body mass index >25), average age 55.91 ± 1.58 years, the duration of DM was on average 8.55 ± 0.65 years (with a range from the first identified to 18 years). The second group consisted of 35 people (11 women and 24 men with normal body weight (body mass index ≤25), the average age was 56.91 ± 1.95 years, the duration of DM was on average 5.73 ± 1.02 years (with a range from the first identified to 22 years). As a control, a group of 28 practically healthy individuals was examined, which was comparable to the first and second groups in terms of gender (11 women, 17 men) and age (56.05 ± 1.88 years old). Dapagliflozin was prescribed to the examined persons of the 1 st group in a daily dose of 10 mg as an antidiabetic agent as part of complex therapy. All examinations were carried out before the start of dapagliflozin treatment, as well as after 12 weeks of therapy. Results. Patients with type 2 DM and EBW showed the highest level of expression of caspase-3, TGF-β1 and an increase in arterial stiffness in elastic and muscular vessels compared to patients with type 2 DM without EBW, and especially compared to the control group. During treatment with dapagliflozin as part of complex therapy, a significant decrease in the TGF-β1 index, caspase-3 expression and a decrease in the speed of pulse wave propagation through the muscular and elastic arteries on the upper and lower extremities were recorded in patients with type 2 DM in combination with EBW and obesity. Conclusions. Dapagliflozin therapy, in addition to reliable inhibition of fibrosis processes and mechanisms of apoptosis activation in diabetes, also statistically significantly improves the arterial wall stiffness of both elastic and muscular vessels, reducing the progression of vasculopathies. In individuals with increased expression markers of fibrosis TGF-β1, significantly more rigid vessels of the elastic and muscular type are determined, which indicates a possible pathogenetic role of TGF-β1 as one of the potential prognostic biomarkers of arterial stiffness and a negative factor of cardiovascular risk in patients with type 2 DM in combination with EBW.

Cross‐sectional relations of subclinical cardiovascular disease to AD blood biomarkers in cognitively intact older adults

AbstractBackgroundSubclinical cardiovascular disease (CVD) is a key, early step in the development of frank CVD. Generally characterized by an age‐related increase in atherosclerosis and arterial stiffness, and/or reduced endothelial function, emerging evidence suggests subclinical CVD confers risk for Alzheimer’s disease and related dementias (ADRD) well before the onset of frank CVD. However, despite increasing recognition of the utility of blood biomarkers for understanding the pathophysiological events and progression of AD, little research has examined the association between markers of subclinical CVD and AD blood biomarkers. Thus, we sought to examine these associations in a sample of cognitively intact older adults enrolled in the Healthy Heart &amp; Mind Study.MethodParticipants were 34% male and 41.7% African American with a mean age of 68.43y. Participants completed a health and medication screening, a battery of cognitive tests, a psychosocial assessment, a fasting blood draw, vascular testing (including assessment of carotid intimal‐media thickening (IMT), pulse wave velocity (PWV), and brachial artery flow‐mediated dilation (FMD), and structural brain MRI. Serum Ab1‐40 and Ab1‐42 (and ratio) were available for 99 participants at the time of this analysis.ResultBivariate correlation results showed a significant, positive association between % FMD change and Ab1‐40 only (p&lt;.05). Ordinary least squares regression was run to further examine this association adjusting for the following potential confounding variables: age, gender, education, depression, and mean arterial BP. Results showed the significant, positive association between % FMD change and Ab1‐40 persisted after adjustment (p&lt;.05).ConclusionFindings showed that worse endothelial function may be associated with lower Ab1‐40 in healthy older adults. While some research illustrates Ab1‐40 is reduced in AD, other research suggests increased levels are associated with vascular conditions such as hypertension, ischemic heart disease, and white matter lesions. Thus, our findings suggest a need to further examine the association between endothelial function and AD blood biomarkers to confirm the directionality of the relationship. Longitudinal research is also needed to examine the association over time.

Abstract 13947: The Acute and Long-term Effects of Transcatheter Aortic Valve Implantation on Aortic Stiffness and Hemodynamics

Introduction: Transcatheter aortic valve implantation (TAVI) is a procedure that alters dramatically the hemodynamics in patients with severe aortic valve stenosis who undergo this procedure. Hypothesis: We investigated the hypothesis that arterial properties and hemodynamics are affected immediately after TAVI as well as in the long-term. Methods: We enrolled 90 patients (mean age 80.2 ± 8.1 years, 50% males) with severe symptomatic aortic stenosis undergoing TAVI. Carotid-femoral and brachial-ankle pulse wave velocity (cfPWV and baPWV) were used for the assessment of arterial stiffness. Augmentation index corrected for heart rate (AIx@75) and subendocardial viability ratio (SEVR) were measured non-invasively. Measurements were conducted at baseline, after the procedure (during hospitalization) and at 1 year. Results: Acutely after TAVI we observed a statistically significant increase in arterial stiffness (7.5 ± 1.5 m/s vs 8.4 ± 1.9 m/s, p=0.001 for cfPWV and 1,773 ± 459 cm/s vs 2,383 ± 645 cm/s, p&lt;0.001 for baPWV) without a concomitant change in systolic blood pressure (Figure). One year later, arterial stiffness was still increased compared to pre-TAVI measurements (7.5 ± 1.5 m/s vs 8.7 ± 1.7 m/s, p&lt;0.001 for cfPWV and 1,773 ± 459 cm/s vs 2,286 ± 575 cm/s, p&lt;0.001 for baPWV). We also found a decrease in AIx@75 (32.2 ± 12.9 % vs 27.9± 8.4 %, p=0.016) after TAVI that was attenuated at 1-year follow-up (32.2 ± 12.9 % vs 29.8± 9.1 %, p=0.38). SEVR displayed an increase acutely after TAVI (131.2 ± 30.0 % vs 148.4± 36.1 %, p=0.002) and remained improved 1 year after the procedure (131.2 ± 30.0 % vs 146± 32.2 %, p=0.01). Conclusions: In conclusion, shortly after TAVI the aorta exhibits a "stiffer" behavior in response to the acute change in hemodynamics, which settles in the long term. Our findings further elucidate the hemodynamic consequences of TAVI and may entail a prognostic role in this growing population.

Abstract 15867: Flexibility Modifies the Age-related Arterial Stiffness in Women With Systemic Lupus Erythematosus

Introduction: Systemic lupus erythematosus (SLE) is an autoimmune multisystemic disease associated with premature cardiovascular disease morbidity and mortality. Arterial stiffness is an age-dependent powerful cardiovascular risk predictor, which is elevated in SLE. The elasticity of the vascular wall and muscle flexibility are both partially determined by elastin-collagen composition, and whereas cardiorespiratory fitness seems to delay the age-related arterial stiffening in SLE, it might be speculated that flexibility (another component of physical fitness) could reduce the sympathetic nervous system dysfunction observed in patients with SLE and thus reduce arterial stiffness. However, whether higher flexibility is related to lower age-related arterial stiffness in SLE is unknown. Hypothesis: We assessed the hypothesis that flexibilitymay attenuate the negative effect of age on arterial stiffness in women with SLE. Methods: This cross-sectional study included 76 women with SLE (age 43.2, SD 13.8) with mild disease activity. Arterial stiffness was assessed with pulse wave velocity (PWV), flexibility by the back-scratch test, disease activity through SLEDAI, and cumulative organ damage with SDI, blood pressure by standardized methods and menopause status by questionnaire. Quantile regression tested the association of age, flexibility, and their interaction, with PWV (controlling for mean blood pressure, menopause, SLEDAI, SDI and corticosteroids exposure). Sample size was determined for a two-tailed test with a power of 0.8, significance p &lt; 0.05 and effect size &gt; 0.7 (n=34). Results: There was a back-scratchхage interaction effect on PWV ( p &lt;0.001). For women with -20 cm in the back-scratch test (i.e. short to touch her middle fingers behind the back), PWV was 0.107 m/s higher for 1-year increase in age, whereas for women with 15 cm, PVW was 0.064 m/s higher for 1-year increase in age. Conclusion: In conclusion, higher flexibility is associated with a lower increase in age-related arterial stiffness in SLE women. Further research is needed to determine whether improving flexibility through stretching exercises reduces the arterial stiffness associated with aging.

Early vascular ageing biomarkers in osteoporotic outpatients: a pilot study

Osteoporosis and atherosclerosis are significant public health problems that often coexist, especially in the elderly. Although some studies have reported an age-dependent relationship, others have suggested a causal relationship between osteoporosis and atherosclerosis. The aim of our study was to evaluate the cardiovascular risk in a population of patients with osteoporosis by measuring carotid intima-media thickness (cIMT) and carotid-femoral pulse wave velocity (cf-PWV). A total of 58 patients with osteoporosis and an equal number of healthy control subjects were enrolled. All subjects underwent (1) a bone densitometry examination using dual X-ray absorptiometry, (2) a vascular evaluation for the measurements of cIMT and cf-PWV and (3) a blood sample for the evaluation of lipids and phosphocalcic metabolism. Patients with osteoporosis had a significant increase in cIMT and cf-PWV. There was also a significant inverse correlation between the femoral neck BMD and cf-PWV values. In conclusion, osteoporotic outpatients have earlier vascular ageing, with an increase of arterial stiffness. These data support a possible association between osteoporosis and atherosclerosis independent of age.

The long-term impact of transcatheter aortic valve implantation on arterial stiffness and central hemodynamics

Abstract Background/Introduction The study of arterial properties in patients with aortic valve stenosis who undergo transcatheter aortic valve implantation (TAVI) remains challenging and results so far seem equivocal. Purpose We sought to investigate the acute and long-term effect of TAVI on arterial stiffness and wave reflections opting for a global approach. Methods We enrolled 90 patients (mean age 80.2±8.1 years, 50% males) with severe symptomatic aortic stenosis undergoing TAVI. Arterial stiffness was assessed by both carotid-femoral and brachial-ankle pulse wave velocity (cfPWV and baPWV). Augmentation index corrected for heart rate (AIx@75), an index of wave reflections, and central pressures were assessed with arterial tonometry. Measurements were conducted at baseline, after the procedure and at 1 year. Results Immediately post-TAVI there was a statistically significant increase in arterial stiffness (7.5±1.5 m/s vs 8.4±1.9 m/s, p=0.001 for cfPWV and 1,773±459 cm/s vs 2,383±645 cm/s, p&amp;lt;0.001 for baPWV) despite no change in systolic blood pressure. At 1-year follow-up, TAVI was still associated with an increase in arterial stiffness compared to pre-TAVI (7.5±1.5 m/s vs 8.7±1.7 m/s, p&amp;lt;0.001 for cfPWV and 1,773±459 cm/s vs 2,286±575 cm/s, p&amp;lt;0.001 for baPWV) but not to post-TAVI values. We also observed a decrease in AIx@75 (32.2±12.9% vs 27.9±8.4%, p=0.016) post-TAVI that was attenuated at 1 year (32.2±12.9% vs 29.8±9.1%, p=0.38). Conclusions Our study shows that after TAVI the arterial system exhibits an increase of stiffness in response to the acute relief of the obstruction, which is retained in the long term. Our findings further elucidate the immediate and long-term hemodynamic changes of TAVI to the aorta that may entail prognostic role in this growing population. Change of vascular biomarkers post-TAVI Funding Acknowledgement Type of funding source: None

Does arterial stiffness increase in patients with early surgical menopause?

Abstract Introduction Surgical early menopause is early menopause due to medical reasons rather than the natural aging process. Pulse wave velocity (PWV) and augmentation index (AIx) are simple and non-invasive parameters for assessment of arterial stiffness. The aim of this study investigated the arterial stiffness in the surgical early menopause patients. Method We included 40 patient early surgical menopause and 40 control group patients with clinically and demographically similar characteristics. Oscillometric measurement method with Mobil-O-Graph 24h-ABPM NG® arteriography was used to measure the arterial stiffness and cardiovascular hemodynamic parameters. Results Of the 40 patients who underwent surgical early menopause, 27 (67.5%) had malignancy, 11 (27.5%) with myoma and 2 (5%) with bleeding. There were no differences in baseline demographic, laboratory, echocardiographic parameters and coronary artery disease risk factors.In terms of arterial stiffness parameters, PWV were significantly higher in the early surgical menopause group than in the control group (6.5±0.8; 5.6±1.2 p&amp;lt;0.001), but there was no statistically significant difference in Alx (28.3±10.9; 27.4±9.0 p=0.69).Also, there was no statistically significant difference in terms of cardiac hemodynamic parameters and central aortic pressures. Conclusion When arterial stiffness is noninvasively evaluated by oscillometric method, it is significantly increased in surgical early menopause patients independent of other risk factors. Funding Acknowledgement Type of funding source: None

3D echocardiography, arterial stiffness, and biomarkers in early diagnosis and prediction of CHOP-induced cardiotoxicity in non-Hodgkin\u2019s lymphoma

CHOP (cyclophosphamide, doxorubicin, vincristine, prednisone) represents standard chemotherapy in non-Hodgkin's lymphoma (NHL) with risk of cardiotoxicity. To define new parameters, such as 3D myocardial deformation, arterial stiffness, and biomarkers for early diagnosis and prediction of cardiotoxicity. 110 NHL patients with LVEF > 50%, scheduled for CHOP, were evaluated at baseline, after third cycle and chemotherapy completion. 3DE assessed LVEF and myocardial deformation: longitudinal (LS), radial, circumferential, area strain. Echo-tracking analysed arterial stiffness: PWV, β index, wave intensity. Troponin I and NT-pro-BNP were measured. After chemotherapy completion, 18 patients (16%) (group I) developed cardiotoxicity (LVEF decrease < 50%, with > 10% from baseline); 92 patients (group II) did not. Significant reduction of 3D LV deformation and increase of arterial stiffness developed starting with third cycle, with greater changes in group I. LS reduction and PWV increase after third cycle were the best independent predictors for LVEF decrease; the association of LS decrease by > 19% and PWV increase by > 27% after third cycle predicted cardiotoxicity after chemotherapy completion (90% sensitivity and 81% specificity). 3D LS and PWV can detect early chemotherapy-induced cardiotoxicity and predict LVEF decline. These parameters should be incorporated in clinical protocols to monitor cardiovascular function during chemotherapy and early intervention.

Blood pressure variability in normotensive perimenopausal women: Non-dipping status, maximum blood pressure and arterial stiffness

BackgroundPostmenopausal women are more likely to have uncontrolled hypertension and are at higher risk of cardiovascular disease compared with age-matched men. Blood pressure variability is emerging as a predictor of adverse cardiovascular outcomes and may be implicated in the relationship between menopause and worsened vascular health in women. We conducted an observational study, BRAVE (Blood pRessure And Vascular hEalth around menopause) to study this relationship. MethodNormotensive perimenopausal women were recruited. Blood pressure variability was measured through 24-h blood pressure monitoring. Vascular health was assessed through arterial stiffness (carotid-femoral pulse wave velocity), carotid intima-media thickness and endothelial function (reactive hyperemic index). Multivariate models were performed to identify factors associated with blood pressure variability and arterial stiffness in perimenopausal women. ResultsForty-nine healthy women (mean age 52.9 ± 4.0, 63% postmenopausal) were recruited. There was a high prevalence (40%) of night non-dipping, a measure of an abnormal pattern of blood pressure variability. Aside from night dipping, other measures of blood pressure variability were similar between premenopausal and postmenopausal women. In the multivariate analysis, body mass index was the only factor associated independently with different measures of blood pressure variability, including the maximum overnight blood pressure (ß = 1.95, p < 0.01). The latter was also significantly associated with arterial stiffness (ß = 0.035, p = 0.048). Finally, poor sleep was independently associated with an increase in arterial stiffness. ConclusionsAbnormal blood pressure variability, particularly night non-dipping, is common in normotensive perimenopausal women. Maximum overnight blood pressure is independently associated with arterial stiffness and may identify women at higher cardiovascular risk.

Arterial Wall Stiffening in Caveolin-1 Deficiency-Induced Pulmonary Artery Hypertension in Mice.

Pulmonary artery hypertension (PAH) is a complex disorder that can lead to right heart failure. The generation of caveolin-1 deficient mice (CAV-1-/-) has provided an alternative genetic model to study the mechanisms of pulmonary hypertension. However, the vascular adaptations in these mice have not been characterized. To determine the histological and functional changes in the pulmonary and carotid arteries in CAV-1-/- induced PAH. Pulmonary and carotid arteries of young (4-6 months old) and mature (9-12 months old) CAV-1-/- mice were tested and compared to normal wild type mice. Artery stiffness increases in CAV-1-/- mice, especially the circumferential stiffness of the pulmonary arteries. Increases in stiffness were quantified by a decrease in circumferential stretch and transition strain, increases in elastic moduli, and an increase in total strain energy at physiologic strains. Changes in mechanical properties for the pulmonary artery correlated with increased collagen content while carotid artery mechanical properties correlated with decreased elastin content. We demonstrated that an increase in artery stiffness is associated with CAV-1 deficiency-induced pulmonary hypertension. These results improve our understanding of artery remodeling in PAH.

Sleep Quality is associated with Central Arterial Stiffness in Postmenopausal Women: A Cross-sectional Pilot Study

AbstractThis study aimed to investigate the associations between sleep quality and arterial stiffness in healthy postmenopausal women. A total of 31 healthy postmenopausal women aged between 50 and 74 years participated in this study. Objectively and subjectively measured sleep quantity and quality were concomitantly obtained by a waist-worn actigraphy, Pittsburgh Sleep Quality Index (PSQI) questionnaire, and daily sleep diary. Carotid-femoral pulse wave velocity (cfPWV), brachial-ankle PWV (baPWV), and femoral-ankle PWV (faPWV) were measured as indices of arterial stiffness. Based on the PSQI score, the participants were divided into good (PSQI &lt; 5.5; n = 21) and poor (PSQI &gt; 5.5; n = 10) sleepers. Self-reported sleep duration was significantly longer in poor sleepers than in good sleepers. However, there was no difference in total sleep time measured by actigraphy between the two groups. Additionally, sleep latency and wake after sleep onset significantly increased, and sleep efficiency significantly decreased in poor sleepers than in good sleepers. The cfPWV and baPWV were significantly higher in poor sleepers than in good sleepers, even after adjustment for risk factors (i.e., age, blood pressure, and physical activity), but no difference in faPWV. These results suggest that decreased sleep quality is associated with an increase in central arterial stiffness in postmenopausal women.

The importance of cardiac tomography in the evaluation of cardiac changes and coronary atherosclerosis in patients with betathalassemia major

Betathalassemic patients demonstrate an increased rate of extracardiac vascular complications, but very low prevalence for coronary artery disease. Computed tomography (CT) achieves excellent tissue characterization, with high spatial resolution and has developed as a gold standard for noninvasive angiography and calcium score assessment. Methods. We examined 7 patients with major beta-thalassemia and 7 patients who had an indication for cardiac CT for resting ECG changes, without symptoms of angina pectoris. We investigated the coronary atherosclerosis by assessing the coronary artery calcium (CAC) and arterial stifness. Usual tests and echocardiography measurement were performed. Cardiac computed tomography determined left ventricular mass, left ventricular ejection fraction (LVEF), coronary calcium score and coronary anatomy. An analysis of myocardial density was also performed. Artery stiffness was assessed by the cardio ankle vascular index (CAVI). Results. Arterial stiffness index in betathallasemic group was higher than control group, R-CAVI index was 6.21± 0.49 vs 5.65±0.37 and L-CAVI index was 6.21± 0.38 vs 5.71±0.31. The assessment of systolic function by echocardiography and cardiac CT examination in the 2 groups, shows that the LVEF in the betathallasemic group was significantly lower than in the control group, which means that some patients already had cardiomyopathy. LV myocardial mass was significantly higher in the group with beta-thalassemia, which is explained by the appearance of myocardial remodeling. The calcium score in patients with major beta-thalassemia was 0 and 8,5± 5,9 in the control group. Only 3 patients (42,8%) in the control group had a calcium score &gt; 10U. No atherosclerotic lesions were observed in patients with major beta-thalassemia, whereas the control group showed mild coronary atherosclerotic lesions. If myocardial density can be determined, calcium or iron deposits can be detected in the myocardium. In patients with beta-thalassemia, the density of the myocardium was higher, both in the left ventricle (49.29 8.87±HU) and in the septum (56.71± 8.1 HU). Calculation of Pearson’s correlation coefficient revealed a good association between CT and echocardiography, reproducibility of CT was significantly higher on an intra-observer level for LVEF and LV Mass. Conclusions: Patients with β–thalassemia major have a similar calcium score compared to control subjects, but they have an increase in arterial stiffness. However, zero frequencie of coronary heart disease, denotes coronary protection mechanisms in thalassemia, so future research should focus on the anti-atherogenic potential of blood lipids at these patients. The ability of cardiac tomography to detect calcifications and changes in myocardial density should be valued, as it can be a good tool for establishing the diagnosis of cardiomyopathy by iron loading.

The impact of transcatheter aortic valve implantation on arterial stiffness and wave reflections

BackgroundThe study of arterial properties in patients with aortic valve stenosis who undergo transcatheter aortic valve implantation (TAVI) remains challenging and results so far seem equivocal. We sought to investigate the acute and long-term effect of TAVI on arterial stiffness and wave reflections. MethodsWe enrolled 90 patients (mean age 80.2 ± 8.1 years, 50% males) with severe symptomatic aortic stenosis undergoing TAVI. Arterial stiffness was assessed by carotid-femoral and brachial-ankle pulse wave velocity (cfPWV and baPWV). Augmentation index corrected for heart rate (AIx@75), central pressures and subendocardial viability ratio (SEVR) were assessed with arterial tonometry. Measurements were conducted at baseline, after TAVI and at 1 year. ResultsImmediately after TAVI there was an increase in arterial stiffness (7.5 ± 1.5 m/s vs 8.4 ± 1.7 m/s, p = .001 for cfPWV and 1773 ± 459 vs 2383 ± 645 cm/s, p < .001 for baPWV) that was retained at 1 year (7.5 ± 1.5 m/s vs 8.7 ± 1.7 m/s, p < .001 and 1773 ± 459 cm/s vs 2286 ± 575, p < .001). Post-TAVI we also observed a decrease in AIx@75 (32.2 ± 12.9% vs 27.9 ± 8.4%, p = .016) that was attenuated 1 year later (32.2 ± 12.9% vs 29.8 ± 9.1%, p = .38), and an increase in SEVR (131.2 ± 30.0% vs 148.4 ± 36.1%, p = .002), which remained improved at 1 year (131.2 ± 30.0% vs 146.0 ± 32.2%, p = .01). ConclusionsAfter TAVI the arterial system exhibits an increase of stiffness in response to the acute relief of the obstruction, which is retained in the long term.

The Influence of Non-Alc oholic Fatty Liver Disease on Indicators of Arterial Stiffness and Risk of Cardiovascular Complications in Patients with Arterial Hypertension

Aim. To determine the value of concomitant non-alcoholic fatty liver disease in patients with arterial hypertension in the progression of rigidity of the main arteries and in increase of risk of cardiovascular complications. Material and methods. A cross-sectional comparative study was conducted. Group 1 (n=50, 35(70%) women, average age 57,4±6,9 years) included patients with arterial hypertension and non-alcoholic fatty liver disease, group 2 (n=50, 40(80%) women, average age 56,5±7,0 years) included patients with arterial hypertension only. The groups were comparable in the main clinical and demographic indicators (p&gt;0,05). A comparative analysis of pulse wave velocity, central aortic pressure, vascular age and a 10-year risk of developing cardiovascular complications in both groups was performed.Results. There is a statistically larger number of patients with metabolic index&gt;7,0 (58,0% vs 28,0%, p=0,0019). It was also established that systolic (121,9±10,9 mm Hg vs 115,9±8,9 mm Hg) and diastolic (82,5±9,3 mm Hg vs 77,4±8,9 mm Hg) aortic pressure, as well as the augmentation index (26,5±8,5% vs 18,6±4,2%), were significantly higher in patients with arterial hypertension and non-alcoholic fatty liver disease than in patients with isolated arterial hypertension. In the 1st group, a statistically significant increased pulse wave velocity was found both in muscular (12,0±3,1 m/s vs 10,6±1,8 m/s) and elastic (10,4±2,8 m/s vs 9,1±1,7 m/s) vessels, which indicates an increase in arterial stiffness. In addition, there was an increase in post-occlusal pulse wave velocity in this category of patients (11,0±3,3 m/s vs 9,4±1,9 m/s, p=0,0037). A significant increase in vascular age in relation to the passport age (60,4 [56,0:68,0] years vs 58,0 [53,0:60,0] years) and an increase in the 10-year fatal risk was detected (2,15 [1,42: 4,63] and 1,05 [0,52: 2,82] %, p = 0,0043 ) were also revealed in patients with arterial hypertension and non-alcoholic fatty liver disease compared to patients with isolated arterial hypertension. Significantly more patients with a high (13 (26,0%) vs 5 (10,0%), p = 0,0332) total cardiovascular risk were observed in group 1 than in group 2.Conclusions. Arterial stiffness was significantly higher in patients with arterial hypertension and non-alcoholic fatty liver disease than in patients with isolated arterial hypertension, which is confirmed by a statistically significant increase in pulse wave velocity and central aortic pressure. Comorbid patients have pronounced endothelial dysfunction, which is confirmed by a significant increase in the post-occlusion rate of the pulse wave. An increase in vascular age in relation to the passport age indicates earlier aging of blood vessels in the 1st group compared with the 2nd group. Patients in the main group have a higher incidence of a high 10-year risk of developing cardiovascular events compared with patients in the control group.