Independent Predictor Of Pulse Wave Velocity Research Articles

Assessment of Cardiovascular Risk and Arterial Stiffness in Patients With Human Immunodeficiency Virus.

Several studies suggest that patients infected with the human immunodeficiency virus (HIV) under highly active antiretroviral therapy (HAART) have a higher cardiovascular risk than the general population. Arterial stiffness is an independent predictor of cardiovascular events and can be measured through carotid-femoral pulse wave velocity (PWV). The objectives of this study were to characterize a sample of HIV-infected patients under HAART regarding cardiovascular risk, compare PWV values of this group with those of uninfected controls,and investigate predictors of PWV in the HIV-infected group. PWV was measured, and data was collected from a sample of 125 HIV-infected patients under HAART. PWV measurements in the study group were compared with those in a control group of 250 subjects similar in sex, age, prevalence of hypertension, and type 2 diabetes mellitus (DM). A linear regression model was constructed to identify predictors of PWV in the HIV-infected group. In the HIV-infected group, composed mostly of men, the mean age and respective standard deviation were 48.6 ± 11.6 years. In this group, 112 individuals (89.6%) presented moderate to very high cardiovascular risk. Significant differences were found in median PWV between HIV-infected and control groups (8.56 vs. 8.00 m/s,p= .002). Age, peripheral systolic blood pressure, presence of DM, amount of alcohol consumed, and current CD4+T cell count were independent predictors of PWV in the HIV-infected group. Conclusions: The HIV-infected group showed higher cardiovascular risk and arterial stiffness measurements than the general population. PWV may be an important predictor of subclinical cardiovascular disease in HIV-infected patients.

Synergistic effect of albuminuria on atherosclerosis in patients with primary aldosteronism.

Primary aldosteronism (PA) has been associated with atherosclerosis beyond the extent of essential hypertension, but the impact of albuminuria remains unknown. To investigate the effect of concomitant albuminuria on arterial stiffness in PA. Prospective cohort study. A prospective cohort study was conducted to evaluate the association of albuminuria (>30 mg/g in morning spot urine) with arterial stiffness, as measured non-invasively by pulse wave velocity (PWV) in patients with PA. Propensity score matching (PSM) with age, sex, diabetes, systolic and diastolic blood pressure, creatinine, potassium, number of antihypertensive medications, and hypertension history was used to balance baseline characteristics. The effects of albuminuria on PWV before and 1 year after treatment were analyzed. A total of 840 patients with PA were enrolled, of whom 243 had concomitant albuminuria. After PSM, there were no significant differences in baseline demographic parameters except alpha-blocker and spironolactone use. PWV was greater in the presence of albuminuria (p = 0.012) and positively correlated with urine albumin-creatinine ratio. Multivariable regression analysis identified albuminuria, age, body weight, systolic blood pressure, and calcium channel blocker use as independent predictors of PWV. As for treatment response, only PA patients with albuminuria showed significant improvements in PWV after PSM (p = 0.001). The magnitude of improvement in PWV increased with urine albumin-creatinine ratio and reached plateau when it exceeded 100 mg/g according to restricted cubic spline analysis. Concomitant albuminuria in PA was associated with greater arterial stiffness and more substantial improvement after targeted treatment. Both the baseline and the improved extent of PWV increased in correlation with rising urine albumin-creatinine ratio levels, reaching a plateau when the urine albumin-creatinine ratio surpassed 100 mg/g.

Arterial stiffness and nocturnal hypertension in preterm children and adolescents.

Preterm birth has been associated with increased risk for developing hypertension and other chronic diseases during childhood and adulthood. The aim of the current prospective case-control study was to investigate the associations of preterm birth with ambulatory blood pressure (BP) levels and arterial stiffness during childhood and adolescence. The study population included 52 children and adolescents born preterm and 26 healthy children born full term with similar age. The participants underwent ambulatory BP monitoring (ABPM) and assessment of carotid-femoral pulse wave velocity (PWV). Preterm children presented higher night SBP z score values compared to controls, but did not differ in other ABPM parameters, office peripheral and central SBPs. Nocturnal hypertension was found in 78% (7/9) of ex-preterm children with ambulatory BP hypertension. Preterm birth was an independent predictor of PWV z score adjusted for heart rate. Estimated marginal means for PWV z score adjusted for age, sex, presence of kidney disease at birth, office BPs, night BPs, central SBP, and BMI z scores were significantly higher in preterm individuals compared to controls (0.703, 95% confidence interval [CI] 0.431-0.975 versus -0.19, 95% CI -0.574-0.536, respectively, P = 0.027). Preterm children who were overweight presented the highest values of night SBP and PWV z score. Preterm birth is associated with higher nocturnal BP and increased arterial stiffness in childhood and adolescence. Increased awareness for detection of hypertension and prevention of obesity in childhood could prevent future adverse cardiovascular outcomes in preterm individuals.

HYPERTENSION AND ARTERIAL STIFFNESS IN PRETERM CHILDREN AND ADOLESCENTS

Objective: The aim of the current study was to investigate the association between preterm birth and ambulatory blood pressure (BP) levels and arterial stiffness during childhood and adolescence. Design and method: In this prospective case control study we included children and adolescents born preterm (cases) and children born full-term (controls) aged 5–19 years old. The participants underwent measurement of somatometric characteristics, office BP, central systolic BP, ambulatory BP monitoring (ABPM) and assessment of carotid-femoral pulse wave velocity (PWV). According to the Body Mass Index (BMI), the study population was classified as preterm-normal BMI, preterm-overweight/obese, full term- normal BMI and full term-overweight/obese. Results: Overall, 74 children participated in the study with a mean age of 10.7 (±3.63) years old out of which 52 were preterm and 22 were full-term children. Preterm children presented higher night SBP z score values compared to controls (p < 0.05), but did not differ in other BP parameters. Preterm birth and BMI z score were predictors of night SBP z score. Preterm children also presented marginally higher PWV z score values (p = 0.06). Prematurity was an independent predictor of PWV z score. Estimated marginal means for PWV z score adjusted for age, sex, presence of kidney disease at birth, office BPs, night BPs, central SBP, and BMI z scores were significantly higher in preterm individuals compared to controls (0.703, 95%CI 0.431–0.975 versus -0.19, 95%CI -0.574–0.536, respectively, p = 0.027). Preterm children who were overweight presented the highest values of night SBP and PWV z score. Conclusions: Preterm birth is associated with higher nocturnal BP and increased arterial stiffness in childhood and adolescence. Early detection of hypertension and prevention of obesity in childhood could prevent future adverse health outcomes in individuals born preterm.

Echocardiographic assessment of pulse wave velocity in psoriatic patients with and without psoriatic arthritis

Abstract Funding Acknowledgements Type of funding sources: None. Background Psoriasis (PSO) is an inflammatory disorder which in its more severe form affects cardiovascular system (CVS) leading to more rapid atherosclerosis progression. Moreover, some data suggested that the presence of psoriatic arthritis (PSA) may further increase CVS deterioration. Purpose Our aim was to compare the pulse wave velocity (PWV) between psoriatic patients without and with psoriatic arthritis (PSA 0 and 1 group, respectively). Methods We examined 31 consecutive patients (20 males and 11 females) with moderate to severe PSO taking systemic anti-inflammatory medications (TNF-alpha inhibitor, IL-17 inhibitor, IL-23 inhibitor or IL12/23 inhibitor) with transthoracic echocardiography with the evaluation of PWV The group was divided into two 17 patients without PSA (PSA 0) and 14 with concomitant PSA (PSA 1). To achieve PWV value the time from R wave in ECG to the onset of arterial flow was measured respectively in carotid (T1) and femoral artery (T2) with further calculation of time difference (delta T). The distance between supraclavicular area and groin was measured during physical examination of patient. PVW was expressed as the ratio between assessed distance (in meters) and time difference (in seconds). Results Patients with psoriatic arthritis (PSA 1) had more frequently hypertension and higher BMI but did not differ significantly from the group without joints involvement regarding other demographics, risk factors and basic echocardiographic data. They also showed similar PSO severity as assessed with PASI score, see Table. The PWV assessment was feasible in all patients and the respective mean values achieved 9.2 ± 3.7 m/s in PSA 0 vs 10 ± 2.8 m/s in PSA 1 group, p = ns. Both T1 and T2 correlated significantly with duration of PSO, see Figure, and even better with patient’s age r = -0.61, p = 0.0003 for T1 and r = -0.77, p < 0.0001 for T2, whereas PWV correlated significantly only with patient’s age. In the model of 12 variables only older age was the independent predictor of PWV >10 m/s in multivariate logistic analysis, OR 1.08 95% CI 1.003- 1.165. Conclusions Patients with PSA showed tendency to the higher prevalence of obesity and hypertension when compared with patients with skin PSO only. Measurement of PWV during echocardiography or even more simple times to flow spectrum onset in carotid or femoral arteries provided quantitative parameters reflecting cardiovascular impairment in PSO and PSA. Abstract Table. Group comparison. Abstract Figure. PSO duration, T1, T2 and PVW.

Associations between Intrinsic Heart Rate, P Wave and QT Interval Durations and Pulse Wave Analysis in Patients with Hypertension and High Normal Blood Pressure.

The present study aimed to explore the relationship between electrocardiographic (ECG) and pulse wave analysis variables in patients with hypertension (HT) and high normal blood pressure (HNBP). A total of 56 consecutive, middle-aged hypertensive and HNBP patients underwent pulse wave analysis and standard 12-lead ECG. Pulse wave velocity (PWV), heart rate, intrinsic heart rate (IHR), P wave and QT interval durations were as follows: 7.26 ± 0.69 m/s, 69 ± 11 beats/minute, 91 ± 3 beats/minute, 105 ± 22 mm and 409 ± 64 mm, respectively. Significant correlations were obtained between PWV and IHR and P wave duration, respectively, between early vascular aging (EVA) and P wave and QT interval durations, respectively. Linear regression analysis revealed significant associations between ECG and pulse wave analysis variables but multiple regression analysis revealed only IHR as an independent predictor of PWV, even after adjusting for blood pressure variables and therapy. Receiver-operating characteristic (ROC) curve analysis revealed P wave duration (area under curve (AUC) = 0.731; 95% CI: 0.569–0.893) as a predictor of pathological PWV, and P wave and QT interval durations were found as sensitive and specific predictors of EVA. ECG provides information about PWV and EVA in patients with HT and HNBP. IHR and P wave durations are independent predictors of PWV, and P wave and QT interval may predict EVA.

Arterial stiffness and chronic stress: role of gender – Rigidità arteriosa e stress cronico: ruolo del genere

AimEvaluate whether exposure to chronic stress is associated with early vascular aging in hypertensive patients and possible gender differences in this relationship.MethodsPatients where recruited in a Hypertension outpatient clinic during a visit for the evaluation of subclinical organ damage. Aortic stiffness was measured as carotid-femoral pulse wave velocity (PWV) by applanation tonometry; common carotid intima-media thickness (IMT) and distensibility were evaluated by automated analysis of carotid ultrasound clips. Chronic stress was assessed using three different standardized scales: Perceived Stress Score 4 (PSS4), Depression Anxiety Stress Scale (DASS) and Chronic Stress Burden (CSB).ResultsData from 125 patients (age 56.7 ± 12.5years) were analyzed. No significant differences were found between men and women in terms of PWV [8.90 (1.9) vs 8.55 (1.8) m/s, p = 0.14], carotid distensibility (22.34 ± 8.79 vs 21.17±8.74 kPa−1, p = 0.545) and IMT (0.74 ± 0.12 vs 0.70 ± 0.13 mm, p = 0.132). Women presented significantly higher scores of PSS4 (7(3) vs 5(3), p = 0.007) and CSB (1.42 ± 1.24 vs 0.59 ± 0.85, p = 0.004). In the linear multiple regression analysis, CBS was correlated with PWV in the general population (beta = 0.37, p = 0.050) being responsible for 4% of the variance of PWV, without significant gender differences. Among the components of CBS, difficulties in relationships with someone close to the participant were associated with increased PWV only in women (p = 0.01). In a multiple regression model, this variable tended to be an independent predictor of PWV (beta = 0.37, p = 0.057), responsible for 7% of the PWV variance.ConclusionsIn hypertensive patients, chronic stress burden is associated with greater arterial stiffness; in particular, stress related to difficulties in relationships seems to be associated with greater vascular stiffness only in women.

Evaluation of Cardiovascular Risk With Arterial Stiffness in Patients With Nonfunctioning Pituitary Adenoma

Nonfunctioning pituitary adenoma (NFPA) accounts for 30% of all pituitary adenomas, and its incidence has been increasing compared to previous years. Increased risk of cardiovascular effects shown in recent studies is noteworthy in patients with NFPA diagnosis, but the number of studies on the subject is limited. In this study, we aimed to assess possible cardiovascular effects and risk via arterial stiffness measurements in patients diagnosed with NFPA. We performed arterial stiffness measurements for 30 patients diagnosed with NFPA and 30 healthy volunteers and compared the results to explore the relationship between arterial stiffness parameters, hormone levels, and adenoma size. Systolic blood pressure (SBP), diastolic blood pressure (DBP), mean blood pressure (MBP), central SBP, central DBP, augmentation index corrected for a heart rate of 75 beats per minute (AIx@75), and pulse wave velocity (PWV) values of the patients with NFPA diagnosis were significantly higher than the control group. PWV was found to have a significant and negative correlation with growth hormone and insulin-like growth factor 1 (IGF-1). A significant and positive correlation was found between adenoma median short-axis length and PWV. IGF-1 was found to have a significant and negative correlation with adenoma median long- and short-axis length. In multivariate linear regression analysis, we found that IGF-1 was an independent predictor of PWV. Both arterial stiffness parameters such as AIx@75 and PWV and peripheral SBP, DBP, and MBP values were found to be high in NFPA patients with no cardiovascular risk factors. Our findings suggest increased cardiovascular effect and risk in patients with NFPA diagnosis, and therefore, we recommend that patients are monitored closely in this respect. ACTH = adrenocorticotropic hormone; AIx@75 = augmentation index corrected for a heart rate of 75 beats per minute; BMI = body mass index; CVD = cardiovascular disease; DBP = diastolic blood pressure; FSH = follicle-stimulating hormone; GH = growth hormone; HT = hypertension; IGF-1 = insulin-like growth factor 1; LH = luteinizing hormone; MBP = mean blood pressure; MRI = magnetic resonance imaging; NFPA = nonfunctioning pituitary adenoma; PP = pulse pressure; PWA = pulse wave analysis; PWV = pulse wave velocity; SBP = systolic blood pressure; TSH = thyroid-stimulating hormone.

Sclerostin is a possible candidate marker of arterial stiffness: Results from a cohort study in Catania.

Osteoporosis and cardiovascular disease are worldwide public health issues. Recent evidence indicates a possible role of the canonical Wnt/β-catenin signalling pathway as a common mediator between these two diseases. The aim of the present study was to investigate the relationship between serum concentrations of sclerostin and Dkk1, two extracellular inhibitors of Wnt/β-catenin signalling, with carotid intima-media thickness(CIMT) and with arterial stiffness, evaluated by measuring the pulse wave velocity(PWV) in an ambulatory population of adults. To this aim, 67subjects were recruited in the 'Atherosclerosis and osteoporosis: identification of common pathogenetic factors' investigation. Serum sclerostin levels correlated positively with CIMT (r=0.314, p=0.03) and inversely with the augmentation index, a marker of arterial stiffness (r=-0.286, p<0.05), whereas Dkk1 did not. Moreover, in a multivariate linear regression model, sclerostin [β -0.1472; p=0.0023; standard error (SE)=0.04620] was an independent predictor of PWV in the study subjects. Our study shows that, following adjustment for confounders, sclerostin is an independent predictor of arterial stiffness in an ambulatory population, whereas Dkk1 is not.

Investigating a Liver Fat: Arterial Stiffening Pathway in Adult and Childhood Obesity.

To investigate the relationship between hepatic fat content, circulating triglyceride levels and aortic stiffness in adult and childhood obesity. Seventy-seven adults and 18 children across a wide range of body mass index (18.5-52.6 kg/m(2); percentile 8-100) with no identifiable cardiac risk factors underwent; 1H- magnetic resonance spectroscopy to quantify hepatic fat content and magnetic resonance imaging to assess aortic pulse wave velocity (PWV) and regional distensibility. In adults, multivariable regression showed age (β=0.09; P=0.02), liver fat (β=2.5; P=0.04), and serum triglyceride (β=0.47; P=0.01) to be independent predictors of PWV. Age and blood pressure-adjusted, moderated regression showed that 43% of the total negative effect of hepatic fat on PWV is attributable to indirect effects via increased triglyceride (P=0.005). In addition, regional distensibility was positively correlated with hepatic fat (ascending; r=-0.35; descending, r=-0.23; abdominal, r=-0.41; all P<0.001). Similar to that seen in adults, PWV (r=0.72; P<0.001) and abdominal regional distensibility (r=-0.52; P<0.001) were correlated with liver fat in children. Increasing age, liver fat, and triglyceride are all related to increased aortic stiffness in adults. Even when controlling for the effects of age and blood pressure, hepatic fat has a negative effect on PWV, with substantial indirect effect occurring via increased circulating triglyceride level. This relationship between hepatic fat and aortic stiffness occurs early in the obesity process and is also seen in children. As such, hepatic fat content is a potential therapeutic target to treat the elevated vascular risk in obesity.

Determinants of arterial stiffness progression in a Han-Chinese population in Taiwan: a 4-year longitudinal follow-up.

BackgroundArterial stiffness predicts the future risk of macro- and micro-vascular diseases. Only a few studies have reported longitudinal changes. The present study aimed to investigate the progression rate of arterial stiffness and the factors influencing stiffness progression in a Han Chinese population residing in Taiwan.MethodsThe pulse wave velocity (PWV), elasticity modulus (Ep) and arterial stiffness index (β) of the common carotid artery were measured in 577 stroke- and myocardial infarction-free subjects at baseline and after an average interval of 4.2 ± 0.8 years. Stepwise multivariate linear regression was conducted to elucidate the predictors of stiffness progression.ResultsFor both baseline and follow-up data, men had significantly higher values of PWV, Ep and β in comparison to women. The progression rates of PWV, Ep and β were faster in men, but the difference was not statistically significant (ΔPWV = 0.20 ± 0.20 and 0.18 ± 0.20 m/s/yr; ΔEp = 8.17 ± 8.65 and 6.98 ± 8.26 kPa/yr; Δβ = 0.70 ± 0.64 and 0.67 ± 0.56 for men and women, respectively). In the multivariate regression analyses, age, baseline stiffness parameters, baseline mean arterial pressure (MAP), baseline body mass index (BMI) and changes in MAP (ΔMAP) were independent predictors of PWV and Ep progression. There was an inverse correlation between the stiffness parameters at baseline and their progression rate (correlation coefficient (r) = −0.12 to −0.33, p = 0.032–1.6 × 10−16). Changes in MAP (ΔMAP) rather than baseline MAP were more strongly associated with PWV progression (p = 8.5 × 10−24 and 1.9 × 10−5 for ΔMAP and baseline MAP, respectively). Sex-specific analyses disclosed that baseline BMI and changes in BMI (ΔBMI) were significantly associated with stiffness progression in men (p = 0.010–0.026), but not in women.ConclusionsAging and elevated blood pressure at baseline and during follow-up were the major determinants of stiffness progression in the Han Chinese population. For men, increased baseline BMI and changes in BMI were additional risk factors.Electronic supplementary materialThe online version of this article (doi:10.1186/s12872-015-0093-2) contains supplementary material, which is available to authorized users.

Modifiable risk factors for increased arterial stiffness in outpatient nephrology.

Arterial stiffness, as measured by pulse wave velocity (PWV), is an independent predictor of cardiovascular events and mortality. Arterial stiffness increases with age. However, modifiable risk factors such as smoking, BP and salt intake also impact on PWV. The finding of modifiable risk factors may lead to the identification of treatable factors, and, thus, is of interest to practicing nephrologist. We have now studied the prevalence and correlates of arterial stiffness, assessed by PWV, in 191 patients from nephrology outpatient clinics in order to identify modifiable risk factors for arterial stiffness that may in the future guide therapeutic decision-making. PWV was above normal levels for age in 85/191 (44.5%) patients. Multivariate analysis showed that advanced age, systolic BP, diabetes mellitus, serum uric acid and calcium polystyrene sulfonate therapy or calcium-containing medication were independent predictors of PWV. A new parameter, Delta above upper limit of normal PWV (Delta PWV) was defined to decrease the weight of age on PWV values. Delta PWV was calculated as (measured PWV) - (upper limit of the age-adjusted PWV values for the general population). Mean±SD Delta PWV was 0.76±1.60 m/sec. In multivariate analysis, systolic blood pressure, active smoking and calcium polystyrene sulfonate therapy remained independent predictors of higher delta PWV, while age, urinary potassium and beta blocker therapy were independent predictors of lower delta PWV. In conclusion, arterial stiffness was frequent in nephrology outpatients. Systolic blood pressure, smoking, serum uric acid, calcium-containing medications, potassium metabolism and non-use of beta blockers are modifiable factors associated with increased arterial stiffness in Nephrology outpatients.

The association between arterial properties and blood pressure in children.

Elevated blood pressure (BP) in adults is associated with increased arterial stiffness and thickness; however, its effect on arterial health in a pediatric population is less understood. The purpose of this study was to identify the relationship between childhood BP and arterial markers of arteriosclerotic progression. The study consisted of 106 children across a wide range of BP values divided into 2 BP groups: high BP (HBP; ≥ 95th percentile; n = 21) and normal BP (NBP; < 90th percentile; n = 85) based on consistent automated BP measures taken at 2 time points. The laboratory examination involved systemic pulse wave velocity (PWV), common carotid artery (CCA) intima media thickness (IMT) and distensibility, as well as body mass index (BMI) and pubertal maturation. BMI and heart rate, as well as PWV (HBP: n = 15 and NBP: n = 56), were higher in the HBP group (p < 0.001) with no difference between groups for both CCA distensibility and IMT (HBP: n = 21 and NBP: n = 83). Multivariate linear regression revealed that BP group (p = 0.003) was an independent predictor of PWV after controlling for age, sex, BMI, heart rate, and maturation. Our findings demonstrate a higher systemic PWV with no difference in CCA IMT or distensibility in children with elevated BP. Hence, markers of cardiovascular disease risk are augmented in healthy children with elevated BP.

The Association between Arterial Stiffness and Fluid Status in Peritoneal Dialysis Patients

In this study our aim was to evaluate the relationship between degree of fluid status and arterial stiffness measured by pulse wave velocity (PWV) in peritoneal dialysis (PD) patients. Fluid status was determined by different methods including fluid overload measured by bioimpedance (Body Composition Monitor, BCM), calf normalized resistivity (CNR), plasma N-terminal fragment of B-type natriuretic peptide (NT-proBNP) and extracellular to intracellular water ratio (ECW/ICW). Sixty PD patients were evaluated. They were stratified into normo- and hypervolemic groups according to their fluid overload (FO). CNR was calculated from resistance at 5 kHz using calf bioimpedance spectroscopy. Arterial stiffness was assessed by PWV. Additionally, all patients underwent transthoracic echocardiography and had levels of NT-proBNP measured. PWV was higher in the hypervolemic compared to normovolemic patients (9.99 ± 2.4 m/sec vs 7.48 ± 2.3 m/sec, p < 0.001). Hypervolemic patients had higher NT-proBNP levels (3065 ± 981 pg/mL vs 1095 ± 502 pg/mL, p < 0.001), a higher ratio of ECW/ICW; (0.93 ± 0.11 vs 0.81 ± 0.08, p < 0.001) and lower CNR (13.7 ± 2.4 vs 16.0 ± 3.3 W m(3)/kg(*)10(-2), p = 0.005). NT-pro BNP level, ECW/ICW ratio, relative FO, and left ventricular (LV) mass index were positively and CNR negatively correlated with PWV. Relative FO and CNR independently predicted PWV in multivariate analysis adjusted for age, duration of PD, body mass index and mean arterial pressure. Arterial stiffness is increased in fluid-overloaded PD patients. Our results indicated that fluid status is an independent predictor of PWV.

ECHO-DOPPLER ASSESSMENT OF AORTIC STIFFNESS IN ADOLESCENT FEMALES WITH ANOREXIA NERVOSA

Anorexia nervosa (AN) is associated with cardiovascular complications and abnormalities of biomarkers associated with cardiovascular risk. Arterial stiffness, which is a risk factor for cardiovascular disease, has not been previously studied in patients with AN. This study aimed to determine the biophysical properties of the aorta in adolescent females with AN as compared to control subjects using Doppler echocardiography. This was a retrospective case-control study. Aortic diameter and pulse wave transit time were measured with echo-Doppler. Blood pressure was recorded at the time of the echocardiogram. Pulse wave velocity (PWV), aortic input impedance (Zi), characteristic impedance (Zc), arterial pressure-strain elastic modulus (Ep), and arterial wall stiffness index (β-index) were calculated. Patients were divided into those with BMI ≤ or > 10th percentile to assess the effect of patient malnutrition on the biophysical properties of the aorta. There were 94 adolescent females with AN and 60 adolescent female controls. There was no difference in age between AN patients and controls (15.5±1.7 vs 15.1±2.6 years, p=0.220). BMI (16.0±2.4vs 19.7 ± 2.7, p<0.001) and BMI percentile (9.4±15.6.vs 45.5 ± 26.2, p<0.001) were significantly lower for AN patients than for controls. PWV (443±106 vs 383±77cm/s, p<0.001), Zc (179±55 vs 149±37, p<0.001), and β-index (3.07±1.09 vs 2.66±0.75, p=0.013) were significantly higher in AN patients than controls. There was no significant difference in Zi (198±53 vs 197±36, p=0.869) while Ep was decreased (232±84 vs 267±79, p=0.014) in AN patients compared to controls. PWV remained elevated compared to controls when AN patients were divided into those with BMI ≤ or > 10th percentile. Using multiple linear regression, the only independent predictor of PWV was the presence of AN. The increased PWV, which is the most sensitive indicator of vascular dysfunction, indicates increased aortic stiffness in adolescent females with AN compared to controls. Increased PWV was not related to the degree of patient malnutrition. Our study suggests that patients with AN may be at increased risk of future cardiovascular disease. Further studies are required to determine if these changes persist with treatment and to determine long term outcomes.

Arterial stiffness in adult patients after Fontan procedure

ObjectivesIncreased arterial stiffness is a risk factor of atherosclerosis and cardio-vascular complications. The aim of the study was to determine whether peripheral vascular function might be an early marker of impaired health status in patients with a single ventricle after Fontan procedure.Methods and resultsTwenty five consecutive adults (11 women and 14 men) aged 24.7 ± 6.2 years after the Fontan procedure and 25 sex, age and BMI match healthy volunteers underwent physical examination, blood analysis, transthoracic echocardiography and noninvasive assessment of aortic stiffness. Augmented pressure and Augmentation Index (AIx) were both significantly elevated in Fontan when compared to the controls (6,08 ± 0,7 vs. 2,0 ± 3,7; p = 0.002 and 17,01 ± 3,3 vs. 6,05 ± 11; p < 0.001, respectively). There were no differences in pulse wave velocity (PWV), mean blood pressure (BP), brachial pulse pressure (PP), central: systolic BP, diastolic BP and PP. In Fontan group we find negative correlation between PWV and SatO2 (r = −0.68; p = 0.04) and positive correlation with WBC (0.72; p = 0.72; p = 0.013), INR (0.81; p = 0.008), TNFα (r = 0.45; p = 0.04), and postoperative time (r = 0.77; p = 0.02). AIx correlates positively only with age at surgery (r = 0.45; p = 0.04). Bilirubin level correlates positively with brachial PP (r = 0.71; p = 0.02) and central PP (r = 0.68; p = 0.03).The multivariate model showed that SatO2 (β = −0.44, p = 0.04) was the only independent predictor of PWV (R2 = 0.32, p = 0.03).ConclusionAdult Fontan patients have an increased arterial stiffness assessed by a noninvasive technique. Low arterial oxygen saturation postoperative time, age at surgery, white blood cells, TNFα and bilirubin level are associated with arterial stiffening in these patients. The combination of blood parameters of the hepatic function and noninvasive measurements of arterial stiffness could be helpful in comprehensive care of patients with Fontan circulation.

Smoking and Arterial Stiffness in Youth with Type 1 Diabetes: The SEARCH Cardiovascular Disease Study

To evaluate the effects of smoking on early markers of cardiovascular disease (arterial stiffness) in adolescents with and without type 1 diabetes (T1D) in the SEARCH Cardiovascular Disease Study. Participants included 606 youth (18.9 ± 3.3 years, 83% non-Hispanic white; 50% male). Six groups were defined: (1) smokers with T1D (n = 80); (2) former smokers with T1D (n = 88); (3) nonsmokers with T1D (n = 232); (4) smokers without T1D (n = 40); (5) former smokers without T1D former (n = 51); and (6) nonsmokers without T1D (n = 115). Arterial stiffness measurements included pulse wave velocity (PWV), augmentation index, and brachial distensibility. Multivariate linear regression was used to assess the independent and joint effects of T1D and smoking on arterial stiffness. Nearly 20% of both youth with and without T1D and T1D were smokers. In youth without T1D, smokers had higher trunk and arm PWV. After adjustment for potential confounders, T1D, but not smoking, was an independent predictor of PWV (P < .05). Moreover, smoking status did not modify the association between T1D and increased arterial stiffness. We found a high prevalence of smoking among youth with and without T1D; however, smoking status was not independently associated with increased arterial stiffness in youth with T1D.

Assessment of arterial stiffness and cardiovascular hemodynamics by oscillometric method in psoriasis patients with normal cardiac functions

Arterial stiffness is associated with increased cardiovascular risk. Pulse wave velocity (PWV) and augmentation index (AIx) are non-invasive markers for assessment of arterial stiffness. Increased arterial stiffness is associated with atherosclerosis in patients with psoriasis. Previous studies have shown that high neutrophil-to-lymphocyte ratio (NLR) predicts poor cardiovascular outcome. The aim of this study was to evaluate arterial stiffness and cardiovascular hemodynamics by oscillometric method in psoriasis patients with normal cardiac functions. Fifty consecutive patients with the diagnosis of psoriasis and 50 controls were included in the study. NLR was calculated as the ratio of neutrophil count to lymphocyte count. All patients underwent echocardiographic examination. Measurements of arterial stiffness were carried out using a Mobil-O-Graph arteriograph system. Fifty patients with psoriasis (26 male, mean age 43.3 ± 13.2 years) and 50 controls (33 male, mean age 45.0 ± 6.1 years) were included into the study. The distribution of cardiovascular risk factors was similar between the two groups, and NLR was significantly higher in patients with psoriasis (2.74 ± 1.78 versus 1.82 ± 0.52, p = 0.002). There was a weak correlation between NLR and PASI score without reaching statistical significance (r = 0.300, p = 0.060). While echocardiographic and hemodynamic parameters were comparable between psoriasis and control groups, heart rate was significantly higher in psoriasis group (81.5 ± 15.1 and 75.2 ± 11.8 beats/min, p = 0.021). Psoriasis patients had significantly higher AIx and PWV values as compared to controls (25.8 ± 13.1 versus 17.4 ± 12.3%, p = 0.001 and 6.78 ± 1.42 versus 6.18 ± 0.80 m/s, p = 0.011, respectively). AI and PWV were significantly associated with psoriasis when adjusted by heart rate (p = 0.005, odds ratio 1.04, 95% confidence interval 1.01-1.08 and p = 0.035, odds ratio 1.52, 95 % confidence interval 1.02-2.26, respectively). PWV significantly correlated with blood pressure, lipid levels, and several echocardiographic indices. AIx only correlated with left atrial diameter (r = 291, p = 0.040). Linear regression analysis was performed to find predictors of PWV. Central systolic blood pressure, left atrial diameter, and total cholesterol were independent predictors of PWV. PWV and AIx were significantly higher in patients with psoriasis. Assessment of arterial stiffness parameters may be useful for early detection of cardiovascular deterioration in psoriasis patients with normal cardiac functions. Novel inflammatory biomarkers such as NLR may elucidate the mechanism of vascular dysfunction in such patients.

The combined effect of hypertension and type 2 diabetes mellitus on aortic stiffness and endothelial dysfunction: An integrated study with high-resolution MRI

PurposeThe purpose of this study was to investigate the combined effect of hypertension and type 2 diabetes mellitus (DM2) on aortic stiffness and endothelial dysfunction by using an integrated MRI approach. Materials and MethodsA total of 31 non-hypertensive DM2 patients and 31 hypertensive DM2 patients underwent 3.0-T MRI. Aortic distensibility (AD), pulse wave velocity (PWV) and brachial artery flow-mediated dilation (FMD) were assessed. Student's t-test, Mann–Whitney U test, chi-squared test, Pearson correlation analysis, and univariable and multiple linear regression analyses were used for statistical analyses. ResultsThe hypertensive patients showed lower AD at multiple levels (ascending aorta [AA]: 2.07±0.98×10−3mm Hg−1 vs. 3.21±1.70×10−3mm Hg−1, p<0.01; proximal thoracic descending aorta [PDA]: 2.58±0.72×10−3mm Hg−1 vs. 3.58±1.47×10−3mm Hg−1, p<0.01; distal descending aorta [DDA]: 3.11±1.84×10−3mm Hg−1 vs. 4.27±1.75×10−3mm Hg−1, p<0.01); faster PWV (7.46±2.28m/s vs. 5.82±1.12m/s, p<0.05) and lower FMD (12.67%±6.49% vs. 20.66%±9.7%; p<0.01). Systolic blood pressure was an independent predictor of PWV, AA-AD, DDA-AD and FMD. FMD was statistically significantly associated with PWV (r=−0.37, p<0.01) and AD (p<0.01). ConclusionsHypertension has a contributive effect on aortic stiffness and endothelial dysfunction in DM2 patients.

Arterial stiffness is increased in asymptomatic nondiabetic postmenopausal women with a polycystic ovary syndrome phenotype

The metabolic dysfunction accompanying the polycystic ovary syndrome (PCOS) may increase the risk of hypertension and cardiovascular disease (CVD). Although menopause per se may be an additional risk factor of CVD, the association between PCOS in postmenopausal women and cardiovascular risk has not been adequately investigated. We aimed to evaluate the effect of PCOS on markers of subclinical atherosclerosis in nondiabetic postmenopausal women. This cross-sectional study included 286 postmenopausal women with intact ovaries. PCOS phenotype was defined if three of the following were present: insulin resistance, current hyperandrogenism or history of clinical androgen excess, history of infertility, central obesity and history of irregular menses. Traditional CVD risk factors, as well as indices of arterial structure (intima-media thickness, atheromatous plaques presence) and function [flow-mediated dilation, pulse wave velocity (PWV), augmentation index] were compared between women with a PCOS phenotype and the rest of the sample, who served as controls. Women with the PCOS phenotype (N=43) had higher SBP and triglycerides and lower high-density lipoprotein (HDL)-cholesterol than controls. Mean values of PWV differed significantly between PCOS cases and controls (9.46±1.74 vs. 8.60±1.51 m/s, P=0.001, univariate). Multivariate regression analysis showed that the PCOS phenotype, age and SBP were the only independent predictors of PWV. Arterial stiffness is increased in asymptomatic, nondiabetic women with a putative PCOS phenotype, independently of age, BMI or blood pressure. This might present one mechanism through which PCOS increases the risk of CVD and hypertension later in life.