Measure Of Aortic Stiffness Research Articles

Abnormal Aortic Wall Properties in Women with Turner Syndrome.

Background Turner syndrome (TS) is associated with aortic dilatation and dissection, but the underlying process is unclear. The aim of this study was to investigate the elastic properties and composition of the aortic wall in women with TS. Methods In this cross-sectional study, 52 women with TS aged 35 ± 13 years (50% monosomy, 12 with bicuspid aortic valve [BAV] and 4 with coarctation) were investigated using carotid-femoral pulse wave velocity (CF-PWV) by echocardiography and ascending aortic distensibility (AAD) and aortic arch pulse wave velocity (AA-PWV) by magnetic resonance imaging (MRI). As control group, 13 women with BAV without TS and 48 healthy patients were included. Results Women with TS showed a higher AA-PWV (β = 1.08, confidence interval [CI]: 0.54–1.62) after correcting for age and comorbidities compared with controls. We found no significant difference in AAD and CF-PWV. In women with TS, the presence of BAV, coarctation of the aorta, or monosomy (45, X) was not associated with aortic stiffness. In addition, aortic tissue samples were investigated with routine and immunohistochemical stains in five additional women with TS who were operated. The tissue showed more compact smooth muscle cell layers with abnormal deposition and structure of elastin and diminished or absent expression of contractile proteins desmin, actin, and caldesmon, as well as the progesterone receptor. Conclusion Both aortic arch stiffness measurements on MRI and histomorphological changes point toward an inherent abnormal thoracic aortic wall in women with TS.

Relationship between common carotid distensibility/aortic stiffness and cardiac left ventricular morphology and function in a group of patients affected by chronic rheumatic diseases: an observational study

Chronic inflammatory arthritis (CIAs), including rheumatoid arthritis (RA), psoriatic arthritis (PsA) and ankylosing spondylitis (AS) are characterised by high cardiovascular disease (CVD) risk, partly due to endothelial dysfunction and increased arterial stiffness of the carotid artery and aorta. The aim of the present study is to determine whether ultrasonography measures of carotid and aortic stiffness are correlated with left ventricular mass and function in patients affected by CIAs. In this cross-sectional study, we consecutively enrolled outpatients diagnosed with CIAs with no overt CVD. For each participant we assessed disease characteristics, CVD risk factors, medications, including disease-modifying anti-rheumatic drugs (DMARDs), blood pressure, lipids and glucose levels. Carotid ultrasonography was performed in all patients using carotid distensibility (CD) and aortic stiffness index (AoSI) as measures of arterial stiffness. Participants underwent the same day a full echocardiographic study including assessment of left ventricular function and mass (LVM). The study population comprised 208 CIAs patients (mean age 57.4±11.4 y; females 63.9%), including 137 (65.9%) RA, 42 (20.2%) PsA and 29 (13.9%) AS patients. In multiple regression analysis, CD correlated with age (β=-0.198, p<0.0001), mean arterial pressure (β=-0.281, p<0.0001) and treatment with DMARDs (β=-1.976, p=0.021), while AoSI was not associated with any anthropometric, haemodynamic or clinical covariates. CD was inversely related to LVM (r=-0.20, p=0.005), whereas AoSI was directly correlated with diastolic function of the left ventricle (E/E'; r=0.191, p=0.007). Our results underline the strict correlation between arterial stiffness and left ventricular mass and function in patients with CIAs.

Clinical Associations of Vascular Stiffness, Microvascular Dysfunction, and Prevalent Cardiovascular Disease in a Black Cohort: The Jackson Heart Study.

BackgroundMeasures of vascular dysfunction are related to adverse cardiovascular disease (CVD) outcomes in non‐Hispanic, White populations; however, data from Black individuals are limited. We aimed to investigate the associations between novel hemodynamic measures and prevalent CVD in a sample of Black individuals.Methods and ResultsAmong older Black participants of the Jackson Heart Study, we assessed noninvasive vascular hemodynamic measures using arterial tonometry and Doppler ultrasound. We assessed 5 measures of aortic stiffness and wave reflection (carotid‐femoral pulse wave velocity, pulse wave velocity ratio, forward pressure wave amplitude, central pulse pressure, and augmentation index), and 2 measures of microvascular function (baseline and hyperemic brachial flow velocity). Using multivariable logistic regression models, we examined the relations between vascular hemodynamic measures and prevalent CVD. In models adjusted for traditional CVD risk factors, higher carotid‐femoral pulse wave velocity (odds ratio [OR],1.25; 95% CI, 1.01–1.55; P=0.04), lower augmentation index (OR, 0.84; 95% CI, 0.70–0.99; P=0.05), and lower hyperemic brachial flow velocity (OR, 0.77; 95% CI, 0.65–0.90; P=0.001) were associated with higher odds of CVD. After further adjustment for hypertension treatment, lower augmentation index (OR, 0.84; 95% CI, 0.70–0.99; P=0.04) and hyperemic brachial flow velocity (OR, 0.79; 95% CI, 0.67–0.94; P=0.006), but not carotid‐femoral pulse wave velocity (OR, 1.23; 95% CI, 0.99–1.051; P=0.06), were associated with higher odds of CVD.ConclusionsIn a sample of older Black individuals, more severe microvascular damage and aortic stiffness were associated with prevalent CVD. Further research on hemodynamic mechanisms that contribute to cardiovascular risk among older Black individuals is merited.

DIFFERENCES IN PULSE WAVE VELOCITY BETWEEN TRANSPLANTED BOYS AND GIRLS: LONGITUDINAL ANALYSIS OF 4C-T STUDY

4C Study. Background: Mortality rates in children with end stage renal disease (ESRD) are higher in girls1. Cardiovascular complications are among the most common causes of death2. Pulse wave velocity (PWV), a measure of aortic stiffness, is associated with mortality in adults with ESRD. We investigated whether sex differences in aortic PWV were present in children who underwent tx in the 4C study. Method: Of 336 children undergoing RRT, 236 (156 boys) received tx and were longitudinally analyzed. PWV was normalized for sex and height; systolic and diastolic blood pressure (BP) for age, sex, and height. Results: Whereas PWV z-scores did not differ between girls and boys as they entered chronic kidney disease (CKD) stage 4 (boys=0.18±1.6 and girls=0.18±1.9), PWV was higher in girls at the last visit before start of RRT (0.45±1.9 vs. 0.25±1.5) and three years after tx (0.83±1.3 vs. 0.30±1.1). We did not find sex differences in the mean time between reaching eGFR ≤30 ml/min/1.73m2 to tx or the months on dialysis. At inclusion eGFR was similar (boys=24.3±8.7; girls=23.4±8.2 ml/min/1.73m2), but the current rate of eGFR loss at the last visit before RRT start was greater in girls than in boys (-0.42±0.48 vs -0.33±0.57 ml/min/1.73m2 per month). A stratified analysis of the time periods before and after tx disclosed an association of PWV increase with eGFR decline prior to RRT in girls (an average eGFR decline of -1 ml/min/1.73m2/month within the period before RRT start was associated with an increase of 0.58 PWV). Further independently associated factors contributing to higher PWV were increasing diastolic BP z-score (DBP), serum calcium, and HDL, whereas RAAS blockers had a protective effect. In the model after tx, the higher PWV in girls after transplantation was explained by the faster eGFR decline in girls prior to tx. Further factors associated with higher PWV were longer time after tx, higher DBP, larger cholesterol increase and higher PWV at last visit prior to RRT. Discussion: Girls with advanced CKD show more pronounced aortic stiffening when compared to boys, leading to a significant sex difference that persists after tx. This difference could explain the higher mortality rate seen in girls with ESRD.

Increased aortic augmentation index is associated with reduced exercise capacity after heart transplantation.

Exercise capacity is often reduced after heart transplantation. We aimed to investigate the association between aortic stiffness and exercise capacity after heart transplantation. We retrospectively analyzed the data of patients who underwent a cardiopulmonary exercise test and central hemodynamic measurements over 1 year following heart transplantation, from Janary 2011 to June 2018. A total of 54 patients (mean age, 49 years; 72% men) were analyzed. The median peak oxygen uptake level was 21.1 ml/kg per min at a median time of 13 months after heart transplantation. In univariate linear regression, recipient age, pulmonary arterial pressure, pulmonary capillary wedge pressure, hemoglobin level, estimated glomerular filtration rate, aortic augmentation index, and pulse wave velocity were significant predictors for peak oxygen uptake level. After adjustment for other confounding variables, heart rate-corrected aortic augmentation index was a significant predictor for peak oxygen uptake (β = -0.141, 95% confidence interval, -0.263 to -0.058, P = 0.003). In the present study, increased aortic augmentation index was associated with reduced exercise capacity after heart transplantation. Therefore, this simple measurement of aortic stiffness should be periodically used for the evaluation of exercise capacity after heart transplantation.

Aortic pulse wave velocity and its relationship with transaortic flow and gradients in patients with severe aortic stenosis undergoing aortic valve replacement

BackgroundLow-flow, low-gradient severe aortic stenosis (LFLGAS) is a common clinical entity and is associated with poor prognosis. Increased left ventricular (LV) afterload is one of the mechanisms contributing to low LV stroke volume index (SVi) in these patients. Aortic stiffness is an important determinant of LV afterload, but no previous study has evaluated its relationship with LVSVi in patients with AS. MethodsFifty-seven patients (mean age 66 ± 8 years, 71.9% men) with severe AS [aortic valve area (AVA) < 1.0 cm2] undergoing aortic valve replacement (AVR) were included in this study. Echocardiographic parameters of AS were correlated with carotid-femoral pulse wave velocity (cfPWV), a measure of aortic stiffness, derived using PeriScope® device. ResultsMean AVA was 0.63 ± 0.17 cm2 with mean and peak transvalvular gradient 56.5 ± 18.8 mmHg and 83.2 ± 25.2 mmHg, respectively. Nearly half (26 of 57, 45.6%) of the subjects had SVi <35 mL/m2, indicative of low-flow severe AS. These subjects had lower AVA, lower aortic valve gradient, and LV ejection fraction. CfPWV was numerically lower in these subjects [median 1467 (interquartile range 978, 2259) vs 1588 (1106, 2167)] but the difference was not statistically significant (p = 0.66). However, when analyzed as a continuous variable, cfPWV had significant positive correlation with SVi (Pearson's r 0.268, p = 0.048) and mean aortic valve gradient (Pearson's r 0.274, p = 0.043). ConclusionsIn patients with severe AS undergoing AVR, aortic stiffness measured using cfPWV is not a determinant of low-flow state. Instead, an increasing cfPWV tends to be associated with increasing transvalvular flow and gradient in these patients.

OR17-07 Retinol Binding Protein 4 Predicts Functional Vascular Disease in Early Postmenopausal Women

Introduction: The impact of gender on the development of cardiovascular disease has long been recognized. The potential effect of sex-specific cardiovascular risk factors on molecular mediators of oxidative stress has received limited attention and the results remain conflicting. Hypothesis: To assess the link between retinol binding protein 4 (RBP4) and menopause-specific cardiovascular risk factors, on indices of early subclinical atherosclerosis, in a sample of apparently healthy young, postmenopausal women. Methods: This cross-sectional study included a total of 123 healthy postmenopausal women, recruited from a University Menopause Clinic. Participating women were, not on hormone therapy, antihypertensive or hypolipidemic treatment and had a menopausal age of up to 10 years. Fasting venous blood samples were obtained for hormonal and biochemical assessment, including levels of RBP4. Sonographical studies were performed on the same day and included carotid-femoral pulse wave velocity (PWV) and calculation of the carotid artery stiffness index (SI). Major results: Univariate analysis showed that RBP4 values correlated positively with age, total cholesterol, triglycerides, LDL-cholesterol, testosterone-to-estrogen ratio; negatively with circulating estrogen and almost significantly with homocysteine levels. Levels of homocysteine were inversely associated with RBP4 (homocysteine: RBP4 <10.5ng/ml vs ≥10.5ng/ml: 11.2±2.81μmol/L vs 12.52±3.44μmol/L, p-value=0.049 ANCOVA, adjusted for age, BMI, HOMA-IR). Multivariate analysis showed that PWV values were predicted by RBP4 (b-coefficient=0.435, p-value=0.006), age, pulse pressure, homocysteine. S.I. beta was predicted independently by RBP4 levels (b-coefficient=0.324, p-value=0.039). Both models were adjusted for menopausal age, LDL-cholesterol, FEI, smoking, HOMA-IR. Conclusion: RBP4 levels are linked with measures of local carotid and aortic arterial stiffness, in this sample of healthy postmenopausal women. This association seems to be mediated by higher levels of homocysteine, which may interfere with retinoic acid synthesis. Larger studies are required to further elucidate the significance of our findings.

Associations of Arterial Stiffness With Cognitive Performance, and the Role of Microvascular Dysfunction: The Maastricht Study.

The mechanisms underlying cognitive impairment are incompletely understood but may include arterial stiffness and microvascular dysfunction. In the population-based Maastricht Study, we investigated the association between arterial stiffness and cognitive performance, and whether any such association was mediated by microvascular dysfunction. We included cross-sectional data of 2544 participants (age, 59.7 years; 51.0% men; 26.0% type 2 diabetes mellitus). We used carotid-femoral pulse wave velocity and carotid distensibility coefficient as measures of aortic and carotid stiffness, respectively. We calculated a composite score of microvascular dysfunction based on magnetic resonance imaging features of cerebral small vessel disease, flicker light-induced retinal arteriolar and venular dilation response, albuminuria, and plasma biomarkers of microvascular dysfunction (sICAM-1 [soluble intercellular adhesion molecule-1], sVCAM-1 [soluble vascular adhesion molecule-1], sE-selectin [soluble E-selectin], and vWF [von Willebrand factor]). Cognitive domains assessed were memory, processing speed, and executive function. A cognitive function score was calculated as the average of these domains. Higher aortic stiffness (per m/s) was associated with lower cognitive function (β, -0.018 SD [95% CI, -0.036 to -0.000]) independent of age, sex, education, and cardiovascular risk factors, but higher carotid stiffness was not. Higher aortic stiffness (per m/s) was associated with a higher microvascular dysfunction score (β, 0.034 SD [95% CI, 0.014 to 0.053]), and a higher microvascular dysfunction score (per SD) was associated with lower cognitive function (β, -0.089 SD [95% CI, -0.124 to -0.053]). Microvascular dysfunction significantly explained 16.2% of the total effect of aortic stiffness on cognitive function. The present study showed that aortic stiffness, but not carotid stiffness, is independently associated with worse cognitive performance, and that this association is in part explained by microvascular dysfunction.

Determinants and clinical significance of aortic stiffness in patients with moderate or severe aortic stenosis

BackgroundPatients with degenerative aortic stenosis (AS) are often older and have systemic hypertension and atherosclerosis, which all lead to increased aortic stiffness. We aimed to assess the determinants of carotid-femoral pulse wave velocity (cf-PWV), a direct measure of aortic stiffness, and its association with revealed symptoms and clinical outcome in patients with AS. MethodsWe included 103 asymptomatic patients aged 66.6 ± 13.2 years (range 27–85 years, 69% males) with moderate (n = 50) and severe (n = 53) AS. All underwent a comprehensive echocardiography, exercise treadmill test (ETT) and assessment of aortic stiffness derived from cf-PWV by applanation tonometry. ResultsThe mean cf-PWV was 10.6 ± 3.1 m/s and resting brachial blood pressure (BP) 139 ± 20/79 ± 11 mmHg. Increased cf-PWV (≥10 m/s) was found in 44% (n = 45) patients. Patients with moderate and severe AS had a similar degree of aortic stiffness (cf-PWV 10.7 ± 3.3 vs. 10.5 ± 3.0 m/s, p = 0.698). In a univariate logistic regression analysis, higher cf-PWV was not associated with revealed symptoms (odds ratio [OR] for 1SD higher cf-PWV 1.12; 95% CI 0.62–2.04, p = 0.706). In a multivariable linear regression analysis, age, resting brachial systolic BP and diabetes were associated with higher cf-PWV independent of antihypertensive treatment and left ventricular ejection fraction. The event-free survival was significantly lower in patients with cf-PWV ≥10 m/s compared to those with cf-PWV <10 m/s (p = 0.015). ConclusionIncreased cf-PWV was common in patients with moderate or severe AS, and was associated with higher cardiovascular disease burden and impaired prognosis. cf-PWV did not correlate with the severity of AS or the frequencies of revealed symptoms by ETT.

Variability of MRI Aortic Stiffness Measurements in a Multicenter Clinical Trial Setting: Intraobserver, Interobserver, and Intracenter Variability of Pulse Wave Velocity and Aortic Strain Measurement.

To assess intraobserver, interobserver, and scan-rescan variability of MRI aortic stiffness measurements in a multicenter trial setting. This study was a retrospective analysis of prospectively collected data in a multicenter prospective clinical trial (clinicaltrials.gov ID NCT01870739). Forty-five adult patients (31 men; mean age, 58 years ± 12 [standard deviation]; 15 patients per center; three centers) with arterial hypertension underwent standardized 3-T baseline MRI assessments between June and September 2014. Aortic strain was calculated from maximum and minimum aortic area measurements repeated three times by three readers at three aortic levels on three retrospectively gated axial gradient-echo (GRE) data sets. Pulse wave velocity (PWV) was assessed three times by five readers as Δx/Δt: Δx was measured on a parasagittal GRE image of the aortic arch, and Δt was extracted from ascending and descending aortic velocity curves created on three axial phase-contrast acquisitions. Intraobserver, interobserver, and scan-rescan variability was calculated using percentage coefficient of variation (COV). Aortic strain variability was lowest at the level of the distal descending aorta (DDA) with median COVs of 1.6% for intraobserver variability, 4.0% for interobserver variability, and 10.3% for scan-rescan variability. It was highest at the ascending aorta (AA) with COVs of 3.6% for intraobserver variability, 10.7% for interobserver variability, and 19.8% for scan-rescan variability. Variability of PWV was low: 0.7% for intraobserver variability, 1.5% for interobserver variability, and 8.1% for scan-rescan variability. Low variability can be achieved for aortic strain and PWV measurements in a multicenter trial setting using standardized MRI protocols. Although COV was lower when measuring aortic strain at DDA compared with AA, variability was acceptable at both anatomic locations.Supplemental material is available for this article.© RSNA, 2020.

Abstract P425: Central Aortic Stiffening in Late-life and Odds of Dementia: The Atherosclerosis Risk in Communities Neurocognitive Study (ARIC-NCS)

Introduction: Stiffening of the aorta is associated with greater pulse pressure and transmission of pulsatile energy into the cerebral circulation, which can increase susceptibility to microvascular damage in the brain. We tested the hypothesis that higher aortic stiffness measured in late-life is associated with a greater prevalence odds of dementia measured ~5 years later. Methods: Dementia-free ARIC-NCS participants (n=4753; mean age: 75 years; 42% male; 21% black) with measures of aortic stiffness at the visit 5 (2011-2013) examination were included. Aortic stiffness was measured by carotid-femoral pulse wave velocity (cfPWV) using the VP-1000 Plus device (Omron Co., Japan) and modeled as continuous (per standard deviation (SD)), categorical into distribution-based quartiles, and as elevated vs. non-elevated cfPWV according to the upper 25 th percentile (13.34 m/s). Cognitive status (normal/mild cognitive impairment (MCI)/dementia) was ascertained at the visit 5 and 6 (2016-2017) examinations with expert review by an adjudication committee of in-person cognitive testing. A multivariable logistic regression model estimated the adjusted association of cfPWV with 5-year odds of dementia. Results: Among dementia-free participants, a 1 SD higher cfPWV was associated with a greater odds of dementia (Odds Ratio (OR): 1.19 (95% Confidence Interval (CI): 1.03, 1.39). Elevated cfPWV (upper 25 th percentile) was also associated with a greater odds of dementia (OR: 1.54, 95% CI: 1.08, 2.19) in this sample. This association was stronger among participants who were cognitively normal at visit 5 (n=3758, Table): the multivariable-adjusted OR of dementia = 2.16 (95% CI: 1.35, 3.47) for elevated vs. non-elevated cfPWV. The risk of dementia among those with baseline MCI (n=955) was not associated with cfPWV levels. Results were robust to adjustment for vascular risk factors. Conclusions: Among older adults, especially when MCI is not present, greater central aortic stiffness is associated with dementia risk.

Abstract P427: Coronary Artery Calcium Assessed Years Before Was Positively Associated With Subtle White-matter Injury in Asymptomatic Middle-aged Men: The Framingham Heart Study

Introduction: Using magnetic resonance (MR) diffusion tensor imaging (DTI), we previously showed a cross-sectional association between carotid-femoral pulse wave velocity (CFPWV), a measure of aortic stiffness, and subtle white-matter injury in clinically asymptomatic middle-age adults. Although coronary artery calcification (CAC) predicted cerebral small vessel diseases evident in conventional MR technique in some studies, it remains unclear whether CAC predicts DTI-based subtle white matter injuries. Hypothesis: CAC and CFPWV are associated with global measures of subtle white-matter injury in middle-aged adults free of clinical brain diseases. Methods: We studied third-generation participants of the Framingham Heart Study who were assessed for CAC (2002-2005), CFPWV, and brain DTI (2009-2013). After excluding prevalent stroke, dementia, other neurological conditions, or those with missing data, 1052 participants (women, 45.4%, mean age: 45.4 years) were analyzed. Two DTI-based outcomes were examined (average within voxels from the white matter mask): free water (FW) and FW-corrected fractional anisotropy (FA). Using linear regression, we calculated slopes of the outcomes per 20-80 th percentiles higher CAC (log-transformed Agatston score) or CFPWV (negative inverse) after adjustment for age and age squared at CAC or CFPWV, time between at CAC/CFPWV and DTI exam, systolic blood pressure, diabetes, total cholesterol, medication(s) for hypertension or dyslipidemia, smoking, and total cranial volume. Results: After multivariable adjustment, in men, CAC was associated only with FA (p=0.033), whereas CFPWV was associated only with FW (p=0.030) ( Figure ). No associations were observed in women. Conclusions: In men, CAC assessed at &gt;7.5 years earlier was associated with worse FA, while CFPWV assessed at 1.7 years earlier was associated with worse FW. CAC may be a sensitive maker to predict subtle white-matter injury in asymptomatic middle-aged men.

Abstract P402: Aortic Stiffness and 5-year Cognitive Decline Among Community-dwelling Older Adults: The Atherosclerosis Risk in Communities Neurocognitive Study (aric-ncs)

Background: Vascular aging is associated with cognitive decline. Aortic stiffness is a hallmark of vascular aging. We tested the hypothesis that greater aortic stiffness is associated with a faster rate of cognitive decline over 5 years among older adults. Methods: A prospective cohort study at the 5th (2011-2013) and 6th (2016-2017) examinations of the Atherosclerosis Risk in Communities Neurocognitive Study (ARIC-NCS) was conducted to quantify the association between baseline aortic stiffness and cognitive decline over 5 years. A total of 4639 participants (mean age: 75 years, 41% men, 22% Black) with baseline measures of aortic stiffness and cognitive function were included in the analysis. Aortic stiffness was measured as carotid-femoral pulse wave velocity (cfPWV) using the Omron VP-1000 Plus device and analyzed continuously per 1 standard deviation meter/second (3.20 m/s). Elevated aortic stiffness was defined as the upper 25th percentile of cfPWV (13.39 m/s). Cognitive function was based on ten neuropsychological tests across multiple domains of cognition, including memory, executive function/processing speed, and language. A global cognitive performance factor score was estimated based on all cognitive tests at both visits. Multivariable linear regression was used to examine the associations of each standard deviation (SD) increment in cfPWV and elevated cfPWV with annual cognitive decline over 5 years. Interactions with baseline cognitive status were assessed. To account for attrition (35% over 5 years), multiple imputation by chained equations was used to impute missing global cognitive performance factor scores at visit 6. Results: Each 1 SD increase in cfPWV was associated with 0.008 SD (Beta (β)=-0.008, 95% confidence interval (CI): -0.010, -0.003) annual rate of decline in cognitive function after adjustment for age, sex, education, race-center and ApoE4. With additional adjustment for ever smoking, total weekly physical activity time, mean arterial pressure, diabetes, and body mass index, each SD higher cfPWV was associated with 0.005 SD (β=-0.005, 95% CI: -0.010, -0.001) annual rate of decline in cognitive function. Elevated cfPWV was associated with 0.015 SD (β=-0.015, 95% CI: -0.024, -0.005) annual decline in cognitive function, and with 0.010 SD (β=-0.010, 95% CI: -0.020, 0.0001) annual decline after additional adjustment. Conclusion: Higher aortic stiffness is associated with the rate of decline in global cognitive function among community-dwelling older adults. The hemodynamic sequelae of aortic stiffening may contribute to cognitive decline among older adults.

Family patterns of arterial stiffness across three generations in the Malmö Offspring Study.

Central haemodynamics have in recent years emerged as a promising predictor of cardiovascular health and risk of cardiovascular disease (CVD). Central haemodynamics are affected early in the development of vascular aging and contributes to target organ damage. Carotid-femoral pulse wave velocity (c-f PWV), augmentation index (Aix) and central SBP (cSBP) are variables that reflect arterial stiffness and central haemodynamics. To study the association between patterns of central haemodynamics across three related generations focusing on c-f PWV. In all, 1131 participants from the Malmö Diet Cancer Study (MDCS) and Malmö Offspring Study (MOS) were included. c-f PWV was measured (Sphygmocor) in grandparents and in all offsprings. Correlation analyses of c-f PWV between offspring and c-f PWV in parents and grandparents were conducted. Parents and grandparents were stratified into quartiles by c-f PWV. Offspring c-f PWV means were compared with one-way ANOVA analyses. Multiple regression analyses were adjusted for age, sex, BMI, SBP and fasting glucose. Bonferroni corrections were used. c-f PWV in offsprings was positively correlated with c-f PWV in parents (r = 0.26, P < 0.001) and in grandparents (r = 0.29, P < 0.001). Parents with high c-f PWV had offspring with significantly higher means of c-f PWV. A measure of aortic stiffness (c-f PWV) is positively correlated across three related generations in this population-based study.

Echocardiographic Assessment of Aortic Pulse Wave Velocity as a New Diagnostic Parameter for Left Ventricular Diastolic Dysfunction

Abstract Background The association between increased arterial stiffness and Left ventricular (LV) diastolic dysfunction (DD) has been well characterized, suggesting a close interaction between the arterial system and the left ventricle. Aortic pulse-wave velocity (PWV) is a measure of aortic stiffness, and it has an established prognostic role in cardiovascular diseases and in the general population. Aim Evaluation of aortic PWV assessed by echocardiography as a new diagnostic parameter for LV DD by correlation with current echocardiographic LV DD indices, and also evaluation of aortic PWV prognostic value in patients with DD by correlation with Brain natriuretic peptide (BNP). Methods This study was conducted at Ain-Shams and Helwan University hospitals from December 2017 to December 2018. It included 100 subjects aged from 55 to 60 years; they were divided into two groups, 1st group (case group): 80 patients with asymptomatic LV DD with preserved ejection fraction ≥50%, 2nd group (control group): 20 patients with normal diastolic function. All patients were subjected to full history and thorough physical examination. BNP, ECG and full echocardiography with assessment of aortic PWV were done. Results A total of 100 patients were enrolled, 38 (47.5%) males in case group vs. 9 (45%) in control group. Hypertension, diabetes and dyslipidemia were significantly higher in case vs. control (P-values: &amp;lt;0.001, 0.005, 0.002 respectively). Aortic PWV has significant positive correlation with both age and body mass index (r = 0.422, r = 0.847 respectively with P &amp;lt; 0.001 for both). Aortic PWV has significant positive correlation with E/e’ (r = 0.957, P &amp;lt; 0.001), tricuspid regurge velocity (r = 0.941, P &amp;lt; 0.001), and left atrial volume index (r = 0.947, P &amp;lt; 0.001), but it has significant negative correlation with septal e’ (r=-0.970, P &amp;lt; 0.001) and lateral e’ (r=-0.932, P &amp;lt; 0.001). Aortic PWV has significant positive correlation with plasma BNP level (r = 0.958, P &amp;lt; 0.001). Aortic PWV was significantly higher in case vs. control group with mean values (15.5±1.32 vs. 10.11±0.78 m/s respectively; P &amp;lt; 0.001). The area under the ROC curve for aortic PWV to detect DD was 0.86 (95% CI, 0.76–0.98; P &amp;lt; 0.001) and the optimal cutoff point of 12.5 m/s produced 92.3% sensitivity and 75.0% specificity (the positive and negative predictive values were 93.5 and 72.7%, respectively with an accuracy of 89.0%). Conclusion Echocardiographic assessment of aortic PWV appears not only to be a highly sensitive, reliable, easy, rapid and practical parameter for LV DD detection but also has a promising prognostic value in patients with LV DD.

Echocardiographic assessment of aortic pulse wave velocity as a diagnostic and prognostic parameter for left ventricular diastolic dysfunction.

Aortic pulse wave velocity (PWV) is a standard measurement of aortic stiffness. It has been suggested that increased arterial stiffness promotes left ventricular diastolic dysfunction (LVDD). We designed this study to evaluate role of aortic PWV as a new diagnostic parameter for LVDD by correlation with echocardiographic LVDD indices and to evaluate its prognostic value in patients with LVDD by correlation with brain natriuretic peptide (BNP). One hundred patients with age >50 were divided into two groups: case group consisted of 80 patients with asymptomatic LVDD with EF ≥50% while controlgroup consisted of 20 patients with normal LVDD. BNP blood test and echocardiography with assessment of aortic PWV were done. Mean age was 59±7.47 vs. 57±6.35 years in case and control groups respectively (P= 0.73), 38 (47.5%) males in case vs. 9 (45%) in control (P=0.84). Aortic PWV showed positive correlation with E/e' (r=0.957, P<0.001), tricuspid regurgitation (TR) velocity (r=0.941, P<0.001), and LA volume index (r=0.947, P<0.001). Negative correlation with septal e' (r=-0.970, P<0.001) and lateral e' (r=-0.932, P<0.001) were reported. Moreover, positive correlation with plasma BNP (r=0.958, P<0.001) was reported. The area under the ROC curve for aortic PWV to detect DD was 0.86 (95% CI, 0.76-0.98; P<0.001) and the optimal cutoff point of 12.5 m/s produced 92.3% sensitivity and 75.0% specificity with an accuracy of 89.0%. Echocardiographic assessment of aortic PWV appears not only to be a sensitive and reliable for LVDD detection but also has a promising prognostic value in patients with LVDD.

CMR based measurement of aortic stiffness, epicardial fat, left ventricular myocardial strain and fibrosis in hypertensive patients

IntroductionA combined assessment of different parameters of cardiovascular (CV) risk and prognosis can be supportive and performed with cardiac magnetic resonance (CMR). Aortic stiffness, epicardial fat volume (EFV), left ventricular (LV) strain and fibrosis were evaluated within a single CMR examination and results were related to the presence of hypertension (HTN) and diabetes mellitus (DM). Methods20 healthy controls (57.2 ± 8.2 years(y); 26.2 ± 3.9 kg/m2), 31 hypertensive patients without DM (59.6 ± 6.7 y; 28.4 ± 4.7 kg/m2) and 12 hypertensive patients with DM (58.8 ± 9.9y; 30.7 ± 6.3 kg/m2) were examined at 1.5Tesla. Aortic stiffness was evaluated by calculation of aortic pulse wave velocity (PWV), EFV by a 3D-Dixon sequence. Longitudinal & circumferential systolic myocardial strain (LS; CS) were analyzed and T1-relaxation times (T1) were determined to detect myocardial fibrosis. ResultsEFV was highest in hypertensive patients with diabetes (78.4 ± 28.0 ml/m2) followed by only hypertensive patients (64.2 ± 27.3 ml/m2) and lowest in controls (50.3 ± 22.7 ml/m2; p < 0.05). PWV was higher in hypertensive patients with diabetes (9.8 ± 3.3 m/s) compared to only hypertensive patients (8.6 ± 1.7 m/s; p < 0.05) and to controls (8.1 ± 1.9 m/s; p < 0.05). LS&CS were worse in hypertensive patients with diabetes (LS:-20.9 ± 5.1% and CS: −24.4 ± 5.7%) compared to both only hypertensive patients (LS: −24.7 ± 4.6%; CS: −27.1 ± 5.0%; p < 0.05) and to controls (LS: −25.5 ± 3.8; CS: −28.3 ± 4.1%; p < 0.05). Both hypertensive groups with and without DM had higher T1́s (994.0 ± 43.2 ms; 991.6 ± 35.5 ms) than controls (964.6 ± 40.3 ms; p < 0.05). ConclusionCMR revealed increased aortic stiffness and EFV in hypertensive patients, which were even higher in the presence of DM. Also signs of LV myocardial fibrosis and a reduced strain were revealed. These parameters support the assessment of CV risk and prognosis. They can accurately be measured with CMR within a single examination when normally different techniques are needed.

Abstract TP485: Aortic Stiffness Detrimental Effect in Brain Blood Flow Autoregulation

Background: Cerebral hemodynamic dysfunction is associated with brain small artery disease and poorer cognition. With aging, systemic arteries stiffen, magnifying the spread of pulsatility to distal organs. The brain is especially susceptible to pulsatility due to low impedance to flow. Increased pulsatility causes abnormal brain arteriolar remodeling in animal models. Therefore, we hypothesize that measures of aortic stiffness relate to poorer cerebral autoregulation, an in-vivo measure of arteriolar function. Methods: We recruited participants in the Washington Heights-Inwood Community Aging Project for this study. For autoregulation, both middle cerebral arteries were insonated at a depth of 50-58 mm. End-tidal CO2 (EtCO2) was measured continuously with a facemask. After ten minutes of baseline recording, a mixture of air enriched with 5% CO2 was administered through the facemask for 2 minutes. Cerebrovascular reactivity was calculated as % change in mean CBFV (mCBFV) per 1 mm increase in mean EtCO2 during CO2 inhalation. We averaged the right and left CO2 reactivity percentage. For aortic stiffness, we acquired carotid-femoral pulse wave velocity (cfPWV) with non-invasive oscillometry using the Vicorder system (Skidmore Medical Limited, Bristol, UK). We used generalized linear model to obtain beta estimates of the association between CO2 reactivity and cfPWV. Results: We included 158 participants (mean age 77±6.4 years, 67% women, 40% non-Hispanic black, 38% non-Hispanic white, and 20% Hispanic). Hypertension was present in 54% of the participants. cfPWV was associated with poorer CO2 reactivity (B=-0.038, P=0.047), independent of age, sex, ethnicity, and hypertension. Brachial pulse pressure (B=0.007, P=0.38) and mean arterial pressure (B=-0.017, P=0.21) were not associated with CO2 reactivity, and adding brachial pulse pressure and mean arterial pressure to the adjusted model did not change the association between cfPWV and poorer CO2 reactivity. Conclusions: Aortic stiffness is associated with poorer CO2 reactivity independent of traditional measures of hypertension, a marker of cerebral autoregulation and arteriolar health. Poorer CO2 reactivity may mediate the reported effects of aortic stiffness on brain outcomes.

P343 Evaluation of the age-related reference values of aortic pulse wave velocity in healthy subjects using Doppler echocardiography

Abstract Introduction Aortic pulse wave velocity (aPWV) is a measure of aortic stiffness, which is an indicator of vascular aging and has established independent prognostic role in predicting cardiovascular complications. aPWV can be measured with various non-invasive methods, but with different reference values depending on the technique used. The Doppler echocardiography method is potentially widely accessible and has been recently showed to have high correlation with invasive reference method of aPWV based on intraarterial pressure evaluation. Purpose The aim of the study was to establish reference values of aPWV, measured by Doppler method during a standard echocardiography in healthy subjects. Methods 121 healthy adults, normotensive, non-smoking, without chronic diseases and not taking medication, were included. All the patients were divided into 5 groups due to age criterion (D1-age 21-30 yrs., n = 33; D2-age 31-40 yrs., n= 23; D3-age 41-50 yrs., n = 26; D4-age 51-60 yrs., n = 22; and D5-age 61-70 yrs., n = 17). During a routine echocardiographic examination with a cardiac probe, standard echocardiographic and anthropometric parameters were acquired. Additionally, 10 Doppler waveforms were recorded in the distal aortic arch and then in the left external iliac artery. The transit time was calculated as a difference between time delay of the two points of the Doppler recordings relative to ECG signal. The distance between proximal and distal points was measured over the body surface using a flexible measuring tape. aPWV values were calculated according to the formula: PWV = distance/transit time. Results The mean age of the studied group was 42 ± 13 yrs., BMI 24.5 ± 3.4, SBP 123 ± 10.39 mm Hg, DBP 76.98 ± 6.53 mm Hg, HR 64 ± 10 bpm. aPWV 5.28 ± 1.07; LVEDD 4.6 ± 0.4 cm; LA 3.65 ± 0.33 cm; aorta 3.26 ± 0.38 cm; LVMI 87.12 ± 15.00 g/m2. In the studied subjects, aPWV did not differ according to sex (females, n = 53, aPWV 5.38 ± 1.21 m/s vs. males, n = 68, aPWV 5.21 ± 0.94 m/s, p = 0.37). In the multivariate linear regression analysis only age and SBP were independently associated with aPWV, but none of the echocardiographic parameters studied. Mean aPWV values with 95% confidence interval (95%CI) for each decade of life were recorded as follows: D1-age 21-30, aPWV 4.56 m/s (95%CI 4.41 to 4.72), D2-age 31-40, aPWV 4.65 m/s (95%CI 4.37 to 4.94), D3-age 41-50, aPWV 5.15 m/s (95%CI 4.88 to 5.43), D4-age 51-60, aPWV 5.96 m/s (95%CI 5.54 to 6.38), D5-age 61-70, aPWV 6.88 m/s (95%CI 6.42 to 7.34). Conclusions We report age-related values of aPWV in a healthy population measured by Doppler echocardiography method. This may be helpful in future research exploring the associations between aortic stiffness, cardiac function and cardiovascular prognosis in a large population of patients referred for echocardiography.

Intrauterine exposure to chronic hypoxia in the rat leads to progressive diastolic function and increased aortic stiffness from early postnatal developmental stages.

AimWe sought to explore whether fetal hypoxia exposure, an insult of placental insufficiency, is associated with left ventricular dysfunction and increased aortic stiffness at early postnatal ages.MethodsPregnant Sprague Dawley rats were exposed to hypoxic conditions (11.5% FiO2) from embryonic day E15‐21 or normoxic conditions (controls). After delivery, left ventricular function and aortic pulse wave velocity (measure of aortic stiffness) were assessed longitudinally by echocardiography from day 1 through week 8. A mixed ANOVA with repeated measures was performed to compare findings between groups across time. Myocardial hematoxylin and eosin and picro‐sirius staining were performed to evaluate myocyte nuclear shape and collagen fiber characteristics, respectively.ResultsSystolic function parameters transiently increased following hypoxia exposure primarily at week 2 (p < .008). In contrast, diastolic dysfunction progressed following fetal hypoxia exposure beginning weeks 1–2 with lower early inflow Doppler velocities, and less of an increase in early to late inflow velocity ratios and annular and septal E’/A’ tissue velocities compared to controls (p < .008). As further evidence of altered diastolic function, isovolumetric relaxation time was significantly shorter relative to the cardiac cycle following hypoxia exposure from week 1 onward (p < .008). Aortic stiffness was greater following hypoxia from day 1 through week 8 (p < .008, except week 4). Hypoxia exposure was also associated with altered nuclear shape at week 2 and increased collagen fiber thickness at week 4.ConclusionChronic fetal hypoxia is associated with progressive LV diastolic dysfunction, which corresponds with changes in nuclear shape and collagen fiber thickness, and increased aortic stiffness from early postnatal stages.