Cardio-ankle Vascular Index Levels Research Articles

Descriptive study of possible relation between cardio-ankle vascular index and lipids in hypertension subjects

Aim: The cardio-ankle vascular index (CAVI) is a new evaluation indicator for arteriosclerosis. This study investigated the relationship between the CAVI and lipid levels in patients with hypertension in a real clinical environment. Methods: This descriptive study enrolled 2,656 patients (male/female: 1,016/1,640) from the Outpatient Department of Vascular Medicine of Peking University Shougang Hospital and Jinding Street Community Health Service Center. CAVI was measured using a VaseraVS-1000 vascular screening system (Fukuda Denshi, Tokyo, Japan). Results: Age, body mass index (BMI), waist circumference, hip circumference, CAVI, systolic blood pressure (SBP), diastolic blood pressure (DBP), creatinine, fasting plasma glucose (FPG), uric acid (UA), hypersensitive C-reactive protein (hs-CRP), homocysteine, HbA1c, and triglyceride (TG) were significantly higher in the hypertension group than in the non-hypertension group. The levels of total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), and high-density lipoprotein cholesterol (HDL-C) were significantly lower in the hypertension group than in the non-hypertension group. The CAVI value was significantly higher in patients with hypertriglyceridemia and normal LDL-C than in those with normal TG and hyper-LDL-C. Age, waist circumference, UA, FPG, HDL-C, hs-CRP, HbA1c, BMI, SBP, and DBP were independently associated with CAVI in all patients. Beta blockers were negatively correlated with CAVI (β = –0.411, P = 0.011). Sex (male) and history of hypertension and diabetes mellitus were positively correlated with CAVI (β = 0.419, P < 0.001; β = 0.247, P = 0.011; β = 0.638, P < 0.001; respectively). Conclusions: The CAVI was significantly higher in patients with hypertension and exhibited differences based on sex. Although we did not find a significant correlation between CAVI and TG, it remains crucial to maintain blood pressure to prevent the development of arteriosclerosis.

The Impact of Chemotherapy on Arterial Stiffness and Ventricular-Arterial Coupling in Women with Breast Cancer.

The cardiac toxicity of chemotherapy for breast cancer is not uncommon and has been associated with elevated morbidity and mortality. In the present study, we assessed the impact of chemotherapy on cardiovascular function by assessing the cardio-ankle vascular index (CAVI), global longitudinal strain (GLS) and ventricular-arterial coupling (VAC: CAVI/GLS ratio) in chemotherapy-treated women. This prospective study enrolled 78 women with breast cancer who were receiving anthracycline-based chemotherapy +/- anti-HER2 therapy (trastuzumab +/- pertuzumab). Forty-one age-matched healthy women served as controls. We comparatively evaluated left ventricular ejection fraction (LVEF), CAVI, GLS and VAC, between the chemotherapy and control groups. We also assessed their changes over time (baseline, 3-month and 6-month time point) and their independent association with the incidence of cancer therapy-related cardiovascular dysfunction (CTRCD) in the chemotherapy group. In comparison to healthy controls, women receiving chemotherapy presented with significantly higher GLS (from -21.02 ± 2.09% to -19.01 ± 2.81%, p < 0.001) and VAC (-0.36 ± 0.06 to -0.41 ± 0.11, p < 0.001). The presence of CTRCD was associated with a further increase in GLS and CAVI and a significant decline in LVEF and VAC compared to CTRCD-free women (p < 0.001). Baseline, CAVI, GLS and VAC were independently associated with CTRCD development during follow-up. Women with breast cancer undergoing chemotherapy displayed abnormal levels of CAVI, VAC and GLS, compared to healthy individuals. Those effects on VAC and CAVI were more exaggerated among women with CTRCD, implicating their potential use to refine screening and therapeutic strategies for this specific population.

Relationship Between Arterial Stiffness, Measured by Cardio-Ankle Vascular Index, and Uremic Toxins, Vascular Calcification, and Inflammation Markers After Kidney Donation.

This study investigated whether kidney transplant donors experience increased arterial stiffness compared with the general population and how arterial stiffness changes over time. Our study included 59 kidney transplant donors and 27 healthy volunteers. All subjects underwent cardio-ankle vascular index measurements. We studied fibroblast growth factor23, klotho, monocyte chemoattractant protein-1, N-terminal pro-B-type natriuretic peptide, indoxyl sulfate, and p-cresyl sulfate levels. Cardio-ankle vascular index level was higher in donors 6 to 11 years after donation (8.02 ± 0.24 m/s) than in donors 2 to 6 years after donation (7.02 ± 0.27 m/s) and healthy volunteers (6.65 ± 0.22 m/s). Cardioankle vascular index level was positively correlated with age (r = 0.382, P < .001) and levels of triglyceride (r = 0.213, P = .049), blood urea nitrogen (r = 0.263, P = .014), creatinine (r = 0.354, P = .001), calcium (r = 0.228, P = .035), indoxyl sulfate (r = 0.219, P = .042), p-cresyl sulfate (r = 0.676, P ≤ .001), and monocyte chemoattractant protein-1 (r = 0.451, P ≤ .001) and negatively correlated with estimated glomerular filtration rate (r = -0.383, P < .001). Multiple linear regression analysis revealed that age (P = .026, B = 0.244), mean arterial blood pressure (P < .001, B = 0.446), blood urea nitrogen (P = .006, B = 0.302), creatinine (P = .032, B = 0.236), estimated glomerular filtration rate (P = .003, B = -0.323), fibroblast growth factor-23 (P = .007, B = 0.294), N-terminal pro-B-type natriuretic peptide (P = .005, B = 0.304), and monocyte chemoattractant protein-1 (P ≤ .001, B = 0.434) independently predicted cardio-ankle vascular index levels. Even without additional risk factors, kidney donors should be followed closely for arterial stiffness and cardiovascular disease, especially in the long-term (>5 years) after kidney transplant.

Altered Arterial Stiffness, Ventricular-Arterial Coupling and Troponin Levels in Patients with Systemic Lupus Erythematosus.

Introduction: Systemic Lupus Erythematosus (SLE) is an autoimmune disease associated with an increased risk of cardiovascular diseases (CVDs), leading to elevated mortality rates among patients. We aimed to evaluate the levels of cardio-ankle vascular index (CAVI), global longitudinal strain (GLS), ventricular-arterial coupling (VAC), and high-sensitivity cardiac troponin I (hsTnI) in SLE patients and to explore their relationship with clinical parameters. Methods: This cross-sectional study enrolled 82 SLE patients without evident cardiac or kidney impairment and 41 age- and sex-matched healthy controls. We comparatively evaluated CAVI, GLS, VAC, and hsTnI between SLE patients and controls, and we assessed their association among SLE patients with disease activity based on the SELENA-SLEDAI Activity Index. Multivariate regression analysis was performed to identify independent predictors of CAVI and hsTnI within the SLE cohort. Results: In comparison to healthy controls, SLE patients presented with significantly higher CAVI, GLS, and hsTnI levels, while VAC was significantly reduced (p < 0.001). Furthermore, SLE patients with active disease (SELENA-SLEDAI ≥ 4) exhibited higher levels of CAVI and troponin than those with inactive disease (p < 0.001). SLEDAI was an independent predictor of CAVI, while VAC and SLEDAI were independent determinants of hsTnI in the SLE cohort. Conclusions: SLE patients displayed abnormal levels of CAVI, VAC, GLS, and troponin compared to healthy individuals. Our findings implicate the potential of those CV novel CVD risk factors to refine screening and therapeutic strategies for this specific population.

The effects of severe periodontitis on arterial stiffness using cardio-ankle vascular index in patients with type 2 diabetes.

Arterial stiffness, which is a measure of the elasticity of the arteries, is also a risk factor for the development of cardiovascular diseases and its measurement is important for evaluating the atherosclerosis process. The purpose of this cross-sectional study to investigate whether severe periodontitis in short-term type 2 diabetes may be associated with increased cardio-ankle vascular index (CAVI) values specified for subclinical atherosclerosis risk. A total of 136 subjects, including 69 subjects with short-term type 2 diabetes (35 with severe periodontitis and 34 with periodontally healthy) and 67 systemically healthy subjects (32 with severe periodontitis and 35 with periodontally healthy) were enrolled to this study. Assessment of all participants included in this study in terms of arterial stiffness was determined by CAVI. Serum fasting plasma glucose (FPG), glycated haemoglobin (HbA1c), triglyceride (TRG), high-density lipoprotein (HDL), low-density lipoprotein (LDL), total cholesterol (TC) and C-reactive protein (CRP) levels were calculated using standard methods. Full mouth periodontal measurements were recorded. Multiple linear regression analysis was performed to evaluate the relationship between periodontal parameters and mean CAVI values of the groups. Mean CAVI levels were significantly higher in diabetic and periodontitis group compared to the other study groups (p < .05). In diabetes and periodontitis group, CAVI was showed positive correlations with CRP (r = .337, p = .048) and HbA1c (r = .442, p = .008). Also, positive significant correlations were found with probing depth (PD) and clinical attachment level (CAL) in the periodontitis groups. Multiple regression analysis revealed that CAL independently predicted CAVI levels in periodontitis groups (β = .433, p = .019 in diabetes and periodontitis groups and β = .57, p = .001 in systemically healthy and periodontitis group respectively). This is the first study investigating the association between severe periodontitis and CAVI in patients with short-term diabetes. Our findings suggest that severe periodontitis may be an intermediate factor in the pathway between type 2 diabetes and cardiovascular disease by increasing the arterial stiffness.

Novel Biomarkers and Imaging Indices for the "Vulnerable Patient" with Carotid Stenosis: A Single-Center Study.

We investigated the relationship of matrix metalloproteinases (MMPs), cardio-ankle vascular index (CAVI), and Gray-Scale Median (GSM) score with the severity and vulnerability of carotid atherosclerosis and major adverse cardiovascular events (MACE) during follow-up of carotid artery revascularization. We enrolled 262 patients undergoing carotid revascularization therapy (GRT), 109 asymptomatic patients with low-grade carotid stenosis (40-70%) receiving conservative treatment (GCT), and 92 age- and sex-matched control subjects without carotid atherosclerosis (GCO). All participants underwent carotid ultrasound and we assessed at baseline clinical parameters, metabolic profile, CAVI, GSM, and circulating levels of hsCRP, MMP-3,-7,-9, and TIMP-1. Both GRT and GCT presented with elevated CAVI, MMPs, and TIMP-1 levels compared to GCO (p < 0.001). The escalation highly correlated to the presence of symptoms or paralleled the degree of carotid stenosis (p < 0.001). During follow-up (mean duration: 55 months), 51 GRT patients experienced MACE unrelated to the revascularization procedure. Within GRT, diabetes (HR: 2.07; CI: 1.55-2.78, p < 0.001), smoking (HR: 1.67; CI: 1.35-1.95, p < 0.001), high CAVI (HR: 1.22; CI: 1.09-1.43, p = 0.023) and MMP-9 (HR: 1.44; CI: 1.29-2.15, p = 0.005), and low GSM (HR: 1.40; CI: 1.16-2.12, p = 0.002) independently predicted MACE occurrences, despite the optimum medical therapy. Novel imaging and biochemical biomarkers were positively associated with atherosclerosis severity, while CAVI, MMP-9, and low GSM showed a positive, independent relationship with MACE after carotid revascularization, describing "vulnerable patients".

Correlation Between Smoking and Il-1 Level and Arterial Stiffness as Measured By Cavi in the Young Adult Population Without other Cardiovascular Risk Factors.

Background: Recent studies have shown that arterial stiffness is a strong predictor of cardiovascular events and all-cause mortality, with CAVI (Cardio-Ankle Vascular Index) as a non-invasive arterial stiffness testing method in daily practice. Objective: This study was conducted to examine the relationship between smoking -as a risk factor for arterial stiffness- and CAVI values, as well as levels of IL-1β (Interleukin 1β) as a cytokine that plays a role in the pathophysiology of arterial stiffness. Methods: Eighty-four participants, including smokers and non-smokers without other cardiovascular risk factors, were included in the study. Demographic data, medical history, and smoking behavior were taken using a questionnaire, then IL-1β and CAVI levels were examined Results: The mean level of IL-1β in smoking subjects was significantly higher (15.09 ± 0.48) than in non-smoking subjects (5.53 ± 0.79; p=0.001). CAVI values in smoking subjects were also significantly higher (8.0 ± 0.06) than in non-smoking subjects (6.9 ± 0.02; p=0.001). Further analysis showed a strong positive correlation between smoking and IL-1β levels (r=+0.776; p=0.001) and CAVI values (r=+0.759; p=0.001). Conclusion: This study shows that smoking significantly correlates with IL-1β levels and CAVI values. The greater number of cigarettes used per day and the longer duration of smoking, there was a positive correlation between IL-1β levels and arterial stiffness as measured by CAVI.

Association between Cardio-Ankle Vascular Index and Masked Uncontrolled Hypertension in Hypertensive Patients: A Cross-Sectional Study.

Detection of masked uncontrolled hypertension (MUCH) that was defined for treated hypertensive individuals who had normal office blood pressure (BP) but elevated ambulatory BP remains largely challenging. Arterial stiffness is one of the leading risk markers for hypertension and can be clinically assessed by the cardio-ankle vascular index (CAVI). This study aimed to evaluate the association between CAVI and MUCH. A total of 155 hypertensive patients were included with their office BP levels and ambulatory BP monitoring measurements, which were divided into controlled hypertension (CH), MUCH, and sustained uncontrolled hypertension (SUCH) groups, respectively. There were 48 patients with CH, 56 patients with MUCH, and 51 patients with SUCH. Both MUCH and SUCH groups had a significantly higher CAVI than the CH group (9.05 (8.20-9.91) vs. 8.33 (7.75-9.15), p = 0.017, and 9.75 (8.35-10.50) vs. 8.33 (7.75-9.15), p = 0.002, respectively). There was no significant difference in CAVI values between the MUCH and SUCH groups. Multinomial logistic regression analysis exhibited that compared with the CH group, increased CAVI levels were positively associated with the presence of MUCH and SUCH (OR 2.046, 95% CI (1.239-3.381), p = 0.005; OR 2.215, 95% CI (1.310-3.747), p = 0.003) after adjusting for confounders. However, there was a similar trend of the CAVI in the MUCH and SUCH groups (OR 0.924, 95% CI (0.629-1.356), p = 0.686). In summary, our findings support, for the first time, the novel notion that CAVI as an arterial stiffness parameter is an independent risk factor for MUCH, being equally important to MUCH and SUCH. When the assessed CAVI is high in hypertensive patients with normotensive office BP levels, it is necessary to further investigate with a 24 h ambulatory BP monitoring to estimate the longstanding BP control. CAVI may be used as a noninvasive indicator to identify patients with MUCH earlier.

Synergistic effects of liver fibrosis and sarcopenia on endothelial dysfunction and arterial stiffness in patients with type 2 diabetes.

AimsTo investigate synergistic effects of liver fibrosis evaluated by FibroScan and sarcopenia on endothelial function and arterial stiffness in patients with type 2 diabetes.MethodsThis cross-sectional study evaluated liver fibrosis (LF) and sarcopenia in 115 patients with type 2 diabetes. LF was assessed as the liver stiffness measurement (LSM) in transient elastography (FibroScan) and was defined as an LSM greater than or equal to 8.0 kPa. Sarcopenia was defined as a ratio of appendicula skeletal muscle mass to body mass index of<0.789 in men and<0.512 in women. Endothelial function was measured by reactive hyperemia index (RHI) with tonometry, and arterial stiffness was evaluated by the cardio-ankle vascular index (CAVI). Endothelial dysfunction was defined an RHI value below 1.67, while arterial stiffness was defined a CAVI value above 9.0. Patients were divided into four groups: no LF and no sarcopenia; LF but no sarcopenia; no LF but sarcopenia; and LF and sarcopenia. The composite of endothelial dysfunction of arterial stiffness was defined as an outcome.ResultsIn patients with LF, RHI was significantly lower and CAVI was significantly higher than in patients without LF. Furthermore, RHI was significantly lower in patients with sarcopenia than in those without it. Patients with both LF and sarcopenia had the lowest RHI and the highest CAVI and urinary albumin levels. Sarcopenia and HDL cholesterol were independent factor the composite of endothelial dysfunction and arterial stiffness.ConclusionLF and sarcopenia are independently associated with endothelial dysfunction and arterial stiffness in patients with type 2 diabetes. Coexistence of LF and sarcopenia may synergistically lead to vascular damage and thus contribute to the high risk of cardiovascular disease in people with type 2 diabetes.

Relationship of arterial and cardiac stiffness in rotating shift workers in the Arctic

Objective . To investigate factors associated with arterial hypertension (HTN), evaluate their interrelationship in rotational shift workers in the Arctic. Design and methods . In the polar settlement of Yamburg (68 N), on the basis of Health Service LLC “Gazprom Dobycha Yamburg” medical unit, 183 out of 213 subjects were enrolled in the study: 100 males (M) aged 48,8 ± 8,4 years, 83 females (F) aged 49,7 ± 7,1 years (p = 0,443), comparable in te duration of rotational shift work: 16,5 ± 8,6 and 16,3 ± 8,9 years, respectively. Patients were divided into 2 groups according to the level of blood pressure (BP): Group 1 (Gr. 1) included 86 individuals with HTN1, 2 stages (BP &gt; 140/90 mm Hg); Group 2 (Gr. 2) comprised 97 individuals with BP &lt; 140/90 mm Hg. Ultrasound examination of carotid arteries was performed, and the indicators of local arterial stiffness (Peterson’s elastic modulus (Ep), β -stiffness) were assessed. The following diagnostic procedures were performed: ambulatory BP monitoring; cardio-ankle vascular index (CAVI) and pulse wave velocity (PWV) assessment; echocardiography with the assessment of probability for heart failure with preserved ejection fraction (HFpEF) by the H2FPEF score (Heavy; Hypertensive; Atrial Fibrillation; Pulmonary Hypertension; Elder; Filling Pressure); biochemical blood tests with the evaluation of homocysteine, high-sensitivity C-reactive protein (hs-CRP), pro-brain natriuretic peptide (pro-BNP). Results . In Gr. 1 vs Gr. 2, elevated levels of left CAVI (p = 0,022) and right CAVI ( р = 0,045) were registered; PWV in Gr. 1 was significantly higher than in Gr. 2 [right (p &lt; 0,001) and left (p &lt; 0,001)], and homocysteine (p = 0,025) level was higher in HTN group. Probability of HFpEF by the H2FPEF score was higher in Gr. 1 than in Gr. 2 ( р &lt; 0,001). According to logistic regression analysis, there was a relationship between HTN and PWV (odds ratio (OR) = 1,44; 95% confidence interval (CI) 1,22–1,75), 24-hour diastolic BP variability (DBPV24) (OR = 1,16; 95% CI 1,01–1,38), with the probability of HFpEF (OR = 1,67; 95% CI 1,23–2,33). Peterson’s elastic modulus (Ep) correlated with left ventricular myocardial mass (LVMM) (r = 0,39, p &lt; 0,01), left ventricular myocardial mass index (LVMMI) (r = 0,39, p &lt; 0,01), HFpEF probability (r = 0,27, p &lt; 0,01); while β -stiffness index of common carotid arteries correlated with LVMM (r = 0,25, p &lt; 0,01). Conclusions . According to logistic regression analysis results, relationship between PWV, DBPV24 and signs of HFpEF by the H2FPEF score and HTN was registered in rotational shift workers in the Arctic region. Obtained data defined HTN as a risk factor for HFpEF even in asymptomatic patients and might be taken into account for cardiovascular prevention in terms of rotational shift work. The associations of arterial stiffness with LVMM and LVMMI, signs of HFpEF by the H2FPEF score may indicate simultaneous interconnected processes of arterial and cardiac stiffness formation.

Algorithm for predicting cardiovascular events in low/moderate risk patients using traditional and new factors: data from 10-year follow-up study

Aim. To create an advanced algorithm for predicting cardiovascular events (CVE) in low/moderate risk patients using a complex of traditional and new factors.Material and methods. The study included 700 patients with Systematic Coronary Risk Evaluation (SCORE) &lt;5%, examined in 20092010. In addition to standard investigations, blood biochemistry tests, including high-sensitivity C-reactive protein (hsCRP), and sphygmography were carried. In 2019, a follow-up phone call was made to participants to identify recent CVEs: cardiovascular death, myocardial infarction, unstable angina, stroke, revascularization. The response rate was 79,6% (n=557; men, 100; women, 457).Results. CVEs were observed in 48 (8,6%) patients. The risk of CVEs increases systolic blood pressure (SBP) &gt;130 mmHg (odds ratio (OR), 1,9 (95% confidence interval (CI), 1,0-3,6)), hsCRP &gt;2,3 mg/L (OR, cardio-ankle vascular index (CAVI) &gt;8,05 (OR, 1,25 (95% CI, 1,0-1,6)). In patients with a combination of ≥2 lipid profile abnormalities, SBP &gt;130 mm Hg, hsCRP &gt;2,3 mg/L and pulse wave velocity &gt;13 m/s, the probability of developing CVEs (including cardiovascular death) increases 3,55 times (95% CI, 1,32-7,67).Conclusion. Levels of pulse wave velocity, CAVI, urea and hsCRP should be considered as additional risk factors for CVE in patients with low/moderate risk, estimated using standard scales. Combinations of traditional and new risk factors demonstrate a cumulative effect.

Arterial stiffness and the risk of heart failure formation in rotational shift workers in the arctic

Abstract Aim To investigate factors associated with arterial hypertension (AH) development, evaluate arterial stiffness (AS) and the risk of heart failure formation in rotational shift workers in the Arctic. Methods Within 6 days of September 2019, in the polar settlement of Yamburg (68 N), on the basis of Yamburggazdobycha LLC medical unit, 183 individuals (48.7±8.3 years), working rotating shifts (16.9±8.7 years) were enrolled via medical examination. Patients were divided into 2 groups according to the level of blood pressure (BP): Group 1 (Gr. 1) included 86 individuals with AH of 1,2 stages; Group 2 (Gr. 2) comprised 97 individuals with BP &amp;lt;140/90 mm Hg. Ultrasound examination of carotid arteries (CA) was performed, Peterson's elastic modulus (Ep), β-stiffness index, cardio-ankle vascular index (CAVI), pulse wave velocity (PWV) were determined; ABPM was performed; EchoCG was conducted using calculation of probability for heart failure with preserved ejection fraction (HFpEF) by the H2FPEF score (Heavy; Hypertensive; Atrial Fibrillation; Pulmonary Hypertension; Elder; Filling Pressure); blood lipid spectrum, inflammatory markers, brain natriuretic peptide were determined. Results In Gr.1 vs Gr.2, elevated levels of left CAVI (7.9 vs 7.4) (p=0.022) and right CAVI (7.9 vs 7.5) (p=0.045) were registered; PWV: 13.8 m/s vs 12.6 m/s (right), (p&amp;lt;0.001) and 13.9 m/s vs 12.6 m/s (left), (p&amp;lt;0.001); triglycerides, (p=0.03); very low density lipoprotein cholesterol, (p=0.054); homocysteine, (p=0.025). Probability of HFpEF by the H2FPEF score was higher in Gr.1 than Gr.2 (p&amp;lt;0.001). According to logistic regression analysis, data of odds ratio (OR) determined the risk of AH developing with increasing of PWV (OR=1.444); 24-hour diastolic blood pressure variability (DBPV24) (OR = 1.164); probability of HFpEF by the H2FPEF score (OR = 1.677). Relationships of Peterson's elastic modulus (Ep) of common carotid artery (CCA) with left ventricular myocardial mass (LVMM) (r=0.39), (p&amp;lt;0.01), LVMMI (r=0.39), (p&amp;lt;0.01), probability HFpEF by H2EPEF score (r=0.27), (p&amp;lt;0.01); β-stiffness index of CCA with LVMM (r=0.25), (p&amp;lt;0.01) were found. Conclusion Interrelation of AH with PWV (OR=1.444), DBPV24 (OR=1.677), probability of HFpEF by the H2FPEF score (OR = 1.677) should be considered for prognostication of the risk of AH with HFpEF formation in rotational shift workers in the Arctic. Associations of AS with LVMM and LVMMI, HFpEF signs may indicate processes of simultaneous interconnected formation of arterial and cardiac stiffness. Funding Acknowledgement Type of funding sources: None.

The Association of Cardio-Ankle Vascular Index (CAVI) with Biatrial Remodeling in Atrial Fibrillation.

Aim: Arterial stiffness results in elevated left ventricular filling pressure and can promote atrial remodeling due to chronic pressure overload. However, the impact of arterial stiffness on the process of atrial remodeling in association with atrial fibrillation (AF) has not been fully evaluated. Methods: We enrolled 237 consecutive patients diagnosed with AF who had undergone ablation; data from 213 patients were analyzed. Cardio-ankle vascular index (CAVI) was used as a marker of arterial stiffness. The left atrial (LA) and right atrial (RA) volumes were determined by computed tomography imaging; atrial conduction and voltage amplitude were evaluated using a three-dimensional electromapping system used to guide the ablation procedure. Result: In univariate analysis, CAVI significantly correlated with atrial structural and electrical remodeling (LA volume index, r =0.297, P =0.001; RA volume index, r =0.252, P =0.004; LA conduction velocity, r =0.254, P = 0.003; LA mean voltage, r =−0.343, P =0.001, RA mean voltage; r =−0.245, P =0.015). Multivariate regression analysis revealed that CAVI and plasma levels of N-terminal B-type natriuretic peptide were independent determinants of LA and RA remodeling, respectively. On the other hand, age and LA conduction velocity were independent variables with respect to CAVI. Age-adjusted CAVI was highest in long-standing persistent AF when compared with measures of persistent or paroxysmal AF. Conclusion: CAVI was closely associated with biatrial remodeling in patients diagnosed with AF. These results suggest that arterial stiffness may play a significant role with respect to disease progression.

Cardiovascular Disease Risk Factors among Copper Industry Workers of the Sverdlovsk Region

Introduction. Cardiovascular diseases (CVD) are the leading cause of death in the working-age population including occupational deaths. Materials and methods. We conducted general clinical and biochemical studies among copper industry workers including a complete cholesterol test, blood lead and copper tests, volumetric sphygmography with determination of the cardio-ankle vascular index (CAVI), and ultrasound examination of the carotid arteries with intima-media thickness measurements (IMT). Results. We established that the main cardiovascular disease risk factors among our subjects were smoking (72.2%), different types of obesity (33.3%), total cholesterol levels higher than 4.9 mmol/L (57.9%), fasting hyperglycemia (73.9%), and hypertension stages 1 and 2 (40.7%). We also observed increased arterial stiffness by CAVI in 28.7% of the subjects that became more prevalent with the rise in the total CVD risk by SCORE (p=0.00105). Conclusions. We found correlations between CAVI and blood copper levels (r=0.33), years of exposure to occupational risk factors (r=0.187), and IMT (r=0.41). This finding enabled us to recommend the use of CAVI for identification and follow-up of workers at risk of cardiovascular diseases with a simultaneous decrease in exposures to occupational risk factors.

Cardio-ankle vascular index is linked to deranged metabolic status, especially high HbA1c and monocyte-chemoattractant-1 protein, in predialysis chronic kidney disease.

Arterial stiffness is an independent predictor of cardiovascular disease in chronic kidney disease (CKD). Cardio-ankle vascular index (CAVI) is a newly developed method used to assess arterial stiffness, independent of changes in blood pressure. CAVI reflects stiffness and atherosclerosis at the thoracic, abdominal, common iliac, femoral, and tibial artery levels. In predialysis stage 3-5 diabetic and nondiabetic CKD patients, CAVI levels and its relation to atherosclerosis-associated risk factors including monocyte-chemoattractant protein-1 (MCP-1), sclerostin, fibroblast growth factor-23 (FGF-23), Klotho, and 25-OH vitamin D were determined. The study was performed on three age-matched and gender-matched groups. Group 1 included 46 stage 3-5 nondiabetic CKD patients, group 2 included 44 stage 3-5 diabetic CKD patients, and group 3 included 44 non-uremic controls. All subjects underwent CAVI measurement. Serum glycated hemoglobin (HbA1c), total calcium, phosphorus, parathormone, FGF-23, Klotho, MCP-1, sclerostin, and 25-OH vitamin D were determined using standard methods. CAVI level was 8.22 ± 0.18m/s in diabetic CKD patients and significantly higher than in nondiabetic CKD (7.61 ± 0.18m/s) and control (7.59 ± 0.17m/s) patients. FGF-23 level was higher in the CKD groups than controls but not statistically significant. MCP-1 level was significantly higher in diabetic CKD patients. Klotho and sclerostin levels were significantly lower in diabetic CKD patients. In the whole cohort, CAVI showed positive correlations with age (r = 0.447, p < 0.0001), smoking (r = 0.331, p = 0.035), mean arterial blood pressure (MABP; r = 0.327, p < 0.0001), fasting blood glucose (r = 0.185, p = 0.033), and HbA1c (r = 0.258, p = 0.003). Stepwise regression analysis revealed that age (p = 0.0001, B = 0.461), MABP (p < 0.0001, B = 0.365), HbA1c (p = 0.003, B = 0.251), and MCP-1 (p = 0.013, B = 0.214) independently predicted CAVI levels. Our results indicate higher CAVI levels, therefore, resulting in increased arterial stiffness in the setting of diabetic CKD. Apart from age and MABP, deranged metabolic status, especially increased HbA1c and MCP-1 levels, is also independently associated with increasing CAVI levels in CKD patients. These results emphasize the importance of metabolic control in the development of arterial stiffness in CKD patients, which is an early predictor of developing cardiovascular complications.

Abstract TP236: Cardio-ankle Vascular Index Is Related To The Predicted 10-year Stroke Risk In Middle-aged Japanese Individuals

Background: The cardio-ankle vascular index (CAVI), which is a novel parameter of arterial stiffness has recently been known as a surrogate marker for cardiovascular diseases. However, whether CAVI levels are related to the risk of stroke in the Japanese general individuals remains unclear. Methods: We examined 280 Japanese subjects (92 female, mean age, 52.6 ± 5 years) with no history of cardio-cerebrovascular disease. Each subject’s CAVI level and various risk factors were assessed; the predicted 10-year stroke risk was calculated using the point-based prediction model from the Japan Public Health Center study, which consists of six risk factors (age, sex, smoking status, BMI , BP and DM are used to calculate the predicted risk of stroke. Results: The subjects were divided into four groups based on predicted stroke risk: low, &lt;1%; low-medium, 1- &lt;5%; medium, 5-&lt;10%; medium-high, ≥10%; and high. In a multiple linear regression analysis, sex, age, BMI and systolic BP were significant independent determinants of CAVI levels. When the subjects were divided into four groups based on predicted stroke risk, according to the JPHC study risk prediction algorithm, CAVI levels were significantly higher in the high-predicted risk group than in the medium-low and low-predicted risk groups. A significant odds ratio (OR) for very high predicted stroke risk (10-year risk ≥10%) was noted in the highest quartile of CAVI levels (OR, 13.76; 95% CI, 3.06-61.99), compared with the lowest quartile, after adjusting for potential confounding factors. A significant OR for high-predicted stroke risk was also found for each quartile increase (adjusted OR, 2.85; 95% CI, 1.80-4.53) and 1-point increase (adjusted OR, 2.23; 95% CI, 1.54-3.23) in CAVI level. Conclusion: Elevated CAVI levels were significantly associated with an increased predicted stroke risk, suggesting that measuring CAVI may be useful for identifying Japanese individuals with a high risk of stroke.

Standard therapy potentiation of patients with Stable Angina FC III with concomitant Hypertension through nitric oxide donator L-arginine administration

The purpose of the study was to improve treatment of patients with Stable Angina functional class III (FC) with concomitant arterial hypertension (AH) through a combination of standard therapy with L-arginine. There were examined63 patients with Stable Angina III FK with AH. All patients in the clinic were analyzedby the test with reactive hyperemia, were measured levels of cardio-ankle vascular index, pulse wave velocity, aortic stiffness index and the thickness of the complex "intima-media". It has been established that in studied patients with L-arginine significantly improves endothelium dependent vasodilatation, presumably due to the supply of substrate for the synthesis of nitric oxide, as well as due to antioxidant properties, which prevents the excessive formation of toxic peroxynitrite in conditions of high oxidation stress. Endothelial-independent vasodilation in the standard therapy group was significantly lowered, while in the L-arginine group, the incidence of changes was unreliable, which may indicate a decrease in sensitivity to nitrates in Group I. Thus, the inclusion to antianginal and antihypertensive therapyof L-arginine is more pronouncedaffects subclinical parameters of arterial rigidity, than in the background of treatment with standard therapy.

Standard therapy potentiation of patients with Stable Angina FC III with concomitant Hypertension through nitric oxide donator L-arginine administration

The purpose of the study was to improve treatment of patients with Stable Angina functional class III (FC) with concomitant arterial hypertension (AH) through a combination of standard therapy with L-arginine. There were examined63 patients with Stable Angina III FK with AH. All patients in the clinic were analyzedby the test with reactive hyperemia, were measured levels of cardio-ankle vascular index, pulse wave velocity, aortic stiffness index and the thickness of the complex "intima-media". It has been established that in studied patients with L-arginine significantly improves endothelium dependent vasodilatation, presumably due to the supply of substrate for the synthesis of nitric oxide, as well as due to antioxidant properties, which prevents the excessive formation of toxic peroxynitrite in conditions of high oxidation stress. Endothelial-independent vasodilation in the standard therapy group was significantly lowered, while in the L-arginine group, the incidence of changes was unreliable, which may indicate a decrease in sensitivity to nitrates in Group I. Thus, the inclusion to antianginal and antihypertensive therapyof L-arginine is more pronouncedaffects subclinical parameters of arterial rigidity, than in the background of treatment with standard therapy.

FACTORS ASSOCIATED WITH PATHOLOGICAL CARDIO-ANKLE VASCULAR INDEX IN PATIENTS WITH ACUTE ISCHEMIC STROKE

Aim. To compare the clinical significance of the pathological cardio-ankle vascular index (CAVI) and the abnormal ankle-brachial index (ABI) in patients with acute stroke, and to assess the factors associated with the presence of pathological CAVI in these patients. Methods. 375 patients with stroke (aged 65,0±7,5 years, 200 men and 175 women) were examined in the Department of Neurology at Cardiac Dispensary. All patients were assigned into three groups based on CAVI and ABI: Group 1 - patients with CAVI&lt;9.0 and ABI&gt;0.9 (n= 131), Group 2 - patients with CAVI&gt;9.0 and ABI&gt;0.9 (n = 153), Group 3 - patients with ABI&lt;0.9 (n = 91).Data on rior vascular events and the presence of cardiovascular disease were colledcted. All patients underwent colour Duplex scanning of brachiocephalic arteries, echocardiography, electrocardiography, and laboratory testing (lipid profile, complete blood count, biochemical blood assay, coagulation profile). Arterial stiffness was measured with the VaSera VS-1000. Results We found that patients with abnormal levels of CAVI (40.8%) were more likely to have concomitant cardiovascular disease (diabetes, chronic heart failure, rhythm disturbances). Patients with abnormal CAVI more often had extracranial artery stenoses (p = 0.001), thickened intima-media complex (p = 0.02), and atrial fibrillation (p = 0.007) compared to patients with normal CAVI. Conclusion The assessment of cardio-ankle vascular index is preferable in patients with stroke. It allows timely identifying patients with increased arterial stiffness and peripheral artery disease and initiating targeted therapeutic procedures.

Abstract TP183: Brain White Matter Lesions Are Indepentendly Associated With Arterial Stiffness Evaluated by Cardio-Ankle Vascular Index

Background: The cardio-ankle vascular index (CAVI) is a surrogate marker of arteriosclerosis in patients with acute ischemic stroke that is independent of blood pressure. Brain white matter lesions (WMLs) on magnetic resonance imaging (MRI) is the core marker of cerebral small vessel diseases, including lacunar infarction or microbleeds. However, whether WMLs are associated with CAVI is still unclear. This study was conducted to clarify whether the WMLs detected during medical checkup in subjects without cardio-cerebrovascular diseases were associated with the CAVI or vascular risk factors. Methods: CAVI and vascular risk factors were assessed in 280 subjects (mean age, 52.6 years) who underwent brain MRI. Arterial stiffness was evaluated using CAVI. The patients were divided into two groups according to the presence or absence of WMLs. Clinical characteristics were compared between the two groups. WML was defined as a cap or pencil-thin lining of periventricular hyperintensity and/or punctate focus of a deep white-matter hyperintense lesion according to the Fazekas grades on fluid-attenuated inversion recovery (FLAIR). Results: CAVI was significantly higher in the subjects with than in those without WMLs (8.17 vs 7.22, p &lt; 0.001). In the multivariable analyses, CAVI, particularly a 1-point increase in CAVI (odds ratio [OR], 2.26; 95% confidence interval [CI], 1.68-3.03), was independently associated with the presence of WMLs. Hypertension (HT) was also independently associated with the presence of WMLs (OR, 2.01; 95% CI, 1.15-3.52). The effects of the four combinations of low/high levels of CAVI and the subjects with or without HT on the presence of WMLs were also analyzed. After adjustment for age, sex, and diabetes mellitus, the subjects with a higher CAVI (median, ≥7.4) and HT had greater odds that they may have WMLs (OR, 3.44; 95% CI, 1.04-11.4) than the subjects with lower CAVI and without HT. By contrast, the OR was not significant in the combinations of lower CAVI and HT, and higher CAVI and without HT. Conclusions: Both increased CAVI and HT were independently associated with the presence of WML even in its early stage. Nevertheless, the presence of a WML could be predicted more reliably by considering these two factors together rather than either alone.