Non-invasive Assessment Of Cardiovascular Risk Research Articles

Dedicated devices for non-invasive cardiovascular risk assessment - the future of cardiovascular prevention.

Dedicated devices for non-invasive cardiovascular risk assessment - the future of cardiovascular prevention.

Diabetic patients with chronic kidney disease: Non-invasive assessment of cardiovascular risk.

The prevalence and burden of diabetes mellitus and chronic kidney disease on global health and socioeconomic development is already heavy and still rising. Diabetes mellitus by itself is linked to adverse cardiovascular events, and the presence of concomitant chronic kidney disease further amplifies cardiovascular risk. The culmination of traditional (male gender, smoking, advanced age, obesity, arterial hypertension and dyslipidemia) and non-traditional risk factors (anemia, inflammation, proteinuria, volume overload, mineral metabolism abnormalities, oxidative stress, etc.) contributes to advanced atherosclerosis and increased cardiovascular risk. To decrease the morbidity and mortality of these patients due to cardiovascular causes, timely and efficient cardiovascular risk assessment is of huge importance. Cardiovascular risk assessment can be based on laboratory parameters, imaging techniques, arterial stiffness parameters, ankle-brachial index and 24 h blood pressure measurements. Newer methods include epigenetic markers, soluble adhesion molecules, cytokines and markers of oxidative stress. In this review, the authors present several non-invasive methods of cardiovascular risk assessment in patients with diabetes mellitus and chronic kidney disease.

Conceptual design of a machine learning-based wearable soft sensor for non-invasive cardiovascular risk assessment

The number of elderly people is increasing, and heart diseases are a major issue in a healthy aging of population. Indeed, the possibility of hospital care is limited and the avoidance of crowded hospitals recently became even more essential. Meanwhile, the possibility to exploit e-health technology for home care would be desirable. In this framework, the concept design of a soft sensor for measuring cardiovascular risk of a patient in real time is here reported. ECG, blood oxygenation, body temperature, and data acquired from patients’ interviews are processed to extract characterizing features. These are then classified to assess the cardiovascular risk. Experimental results show that patients’ classification accuracy can be as high as 80% when employing a random forest classifier, even with few data employed for training. Finally, method evaluation was extended by exploiting further data and by means of a noise robustness test.

Doppler ultrasonography of the ophthalmic artery in perimenopausal and postmenopausal women: a new approach

Background The vascular endothelium has specific estrogen receptors and the impact of hormone therapy (HT) on circulation is associated with cardiovascular protection in perimenopause and postmenopause. Blood vessels can be assessed by ultrasound Doppler velocimetry, and more specifically the study of the ophthalmic artery (OA) can be used for brain vessel assessment; more recently, it is a possible method for cardiovascular risk assessment. Methods A cross-sectional study involved perimenopausal and postmenopausal women divided into three groups: 60 non-HT users (control group), 23 users of estrogen therapy (ET group), and 23 users of estrogen–progesterone therapy (EPT group). Doppler velocimetry of the OA was performed with analysis of the resistance index (RI), pulsatility index (PI), systolic peak velocity (P1), second systolic peak velocity (P2), peak velocity ratio (PVR), final diastolic velocity (FDV), and ratio between means of systolic and diastolic velocity (SDR). Results There was no significant difference between the groups in Doppler velocimetry indices of the OA: RI (p = 0.94), PI (p = 0.85), P1 (p = 0.81), P2 (p = 0.53), PVR (p = 0.41), FDV (p = 0.76), and SDR (p = 0.84). We observed a positive correlation of the SDR with age only in the control group (r = 0.34, p = 0.01). Conclusions There is a positive correlation between the SDR and age in the control group. Therefore, this new index is a promising instrument in the non-invasive assessment of cardiovascular risk.

Inflammatory Markers for Arterial Stiffness in Cardiovascular Diseases.

Arterial stiffness predicts an increased risk of cardiovascular events. Inflammation plays a major role in large arteries stiffening, related to atherosclerosis, arteriosclerosis, endothelial dysfunction, smooth muscle cell migration, vascular calcification, increased activity of metalloproteinases, extracellular matrix degradation, oxidative stress, elastolysis, and degradation of collagen. The present paper reviews main mechanisms explaining the crosstalk between inflammation and arterial stiffness and the most common inflammatory markers associated with increased arterial stiffness, considering the most recent clinical and experimental studies. Diverse studies revealed significant correlations between the severity of arterial stiffness and inflammatory markers, such as white blood cell count, neutrophil/lymphocyte ratio, adhesion molecules, fibrinogen, C-reactive protein, cytokines, microRNAs, and cyclooxygenase-2, in patients with a broad variety of diseases, such as metabolic syndrome, diabetes, coronary heart disease, peripheral arterial disease, malignant and rheumatic disorders, polycystic kidney disease, renal transplant, familial Mediterranean fever, and oral infections, and in women with preeclampsia or after menopause. There is strong evidence that inflammation plays an important and, at least, partly reversible role in the development of arterial stiffness, and inflammatory markers may be useful additional tools in the assessment of the cardiovascular risk in clinical practice. Combined assessment of arterial stiffness and inflammatory markers may improve non-invasive assessment of cardiovascular risk, enabling selection of high-risk patients for prophylactic treatment or more regular medical examination. Development of future destiffening therapies may target pro-inflammatory mechanisms.

Mean arterial pressure values calculated using seven different methods and their associations with target organ deterioration in a single-center study of 1878 individuals.

To assess the differences among seven different methods for the calculation of mean arterial pressure (MAP) and to identify the formula that provides MAP values that are more closely associated with target organ deterioration as expressed by the carotid cross-sectional area (CSA), carotid-to-femoral pulse-wave velocity (cf-PWV) and left ventricular mass (LVM). The study population consisted of 1878 subjects who underwent noninvasive cardiovascular risk assessment. Blood pressure (BP) was assessed in all subjects, and MAP was calculated by direct oscillometry and six different formulas. Carotid artery ultrasound imaging was performed in 1628 subjects. The CSA of the right and left common carotid artery (CCA) were calculated and used as surrogates of arterial wall mass and hypertrophy. Aortic stiffness was evaluated in 1763 subjects by measuring the cf-PWV. Finally, 218 subjects underwent echocardiographic examination for the assessment of LVM. Among the examined methods of MAP calculation, the formula MAP1=[diastolic BP]+0.412 × [pulse pressure] yielded the strongest correlations with the LVM, cf-PWV and CSA of the right and left CCA, even after adjusting for age and gender. The MAP calculation using the 0.412 was superior compared with the traditional formula that uses the 0.33 for the discrimination of subjects with left ventricular and carotid wall hypertrophy, as well as subjects with increased aortic stiffness. MAP estimated with the 0.412 is better correlated with target organ deterioration compared with other formulas. Future studies are needed to explore the accuracy of these formulas for MAP estimation compared with direct intra-arterial BP measurement.

Coronary Artery Calcium Assessment in CKD: Utility in Cardiovascular Disease Risk Assessment and Treatment?

Coronary artery calcification (CAC) is a strong predictor of cardiovascular event rates in the general population, and scoring with multislice computed tomography commonly is used to improve risk stratification beyond clinical variables. CAC is accelerated in chronic kidney disease, but this occurs as a result of 2 distinct pathologic processes that result in medial (arteriosclerosis) and intimal (atherosclerosis) deposition. Although there are data that indicate that very high CAC scores may be associated with increased risk of death in hemodialysis, average CAC scores in most patients are elevated at a level at which discriminatory power may be reduced. There is a lack of data to guide management strategies in these patients based on CAC scores. There are even fewer data available for nondialysis patients, and it is uncertain whether CAC score confers an elevated risk of premature cardiovascular morbidity and mortality in such patients. In this article, we review the evidence regarding the utility of CAC score for noninvasive cardiovascular risk assessment in individuals with chronic kidney disease, using a clinical vignette that highlights some of the limitations in using CAC score and considerations in risk stratification.

P180 Non-invasive assessment of cardiovascular risk in young patients with inflammatory bowel disease (IBD) compared with healthy controls (HC)

P180 Non-invasive assessment of cardiovascular risk in young patients with inflammatory bowel disease (IBD) compared with healthy controls (HC)

The role of flow-mediated dilatation in the evaluation and development of antiatherosclerotic drugs

The present article reviews the use of flow-mediated dilatation in clinical cardiovascular research. Its value as a surrogate tool for development of antiatherosclerotic drugs and noninvasive assessment of cardiovascular risk is also discussed. Atherosclerosis remains the leading cause of cardiovascular morbidity and mortality. Development of new drugs is required to target both the evolution of this disease and its clinical consequences. Noninvasive measures of arterial function and structure have been widely used as intermediate phenotypes in clinical trials. Numerous studies have demonstrated the interplay between vascular risk factors and endothelial function as assessed by flow-mediated dilatation in children and adults. Additionally, a number of studies have documented the prognostic value of the method. Detection of early arterial changes can prove particularly useful in clinical research for the development of antiatherosclerotic drugs. They permit identification of vascular toxicity as well as characterization of the safety and risk profile of a new cardiovascular treatment modality on vascular health. This approach is likely to prove cost-effective before embarking on large longitudinal studies to assess cardiovascular morbidity and mortality.

Noninvasive cardiovascular risk assessment in women with type 2 diabetes

Noninvasive cardiovascular risk assessment in women with type 2 diabetes

Non-invasive cardiovascular risk assessment in women with type 2 diabetes

This study assessed and compared carotid intima-media thickness (IMT) in postmenopausal women with type 2 diabetes with that in postmenopausal women without type 2 diabetes and compared risk factors that contribute to increased carotid IMT in these groups of women. Carotid IMT, a non-invasive assessment of cardiovascular risk, was measured using high-resolution ultrasound in 20 postmenopausal women with type 2 diabetes and 20 postmenopausal women without type 2 diabetes who had no known coronary heart disease. Risk factors (age, race, family history, diabetes, hypertension, high cholesterol, years past menopause, use of hormone replacement therapy, perceived level of physical activity, and body mass index) known to contribute to coronary heart disease were also assessed. Mean carotid IMT was .88 mm for women with type 2 diabetes compared with .74 mm for women without type 2 diabetes. There were no differences between groups in age, race, cholesterol, and perceived level of physical activity. Women with type 2 diabetes, however, reported more hypertension ( P = .004), greater body mass index ( P = .026), and less use of hormone replacement therapy ( P = .027). Of concern is that 10% of the women with diabetes had stenosis that required surgical intervention. Findings suggest that carotid IMT is a valid way to screen for cardiovascular risk, particularly in postmenopausal women who are at high risk for coronary heart disease. It may also be a feasible, non-invasive method for the detection and prevention of the macrovascular complications of diabetes.

Carotid intima-media thickness and plaque in patients with familial hypercholesterolaemia mutations and control subjects.

In individuals with familial hypercholesterolaemia (FH), ultrasonographic measurement of carotid intima-media thickness (IMT) and plaque may provide a non-invasive assessment of cardiovascular risk. We examined carotid artery IMT and its determinants in 79 non-smoking, normotensive, treated men and women with FH aged 26-46 years, and in 79 non-smoking, normotensive sex-, age- and body mass index-matched control subjects. FH was verified by molecular genetic analyses. The underlying mutation in the low-destiny lipoprotein receptor gene included a splice-site mutation, mutations predicted or shown to lead to class 2B mutations or other mutations that probably represent class I mutations (null alleles). The carotid bifurcation and common carotid artery IMT was increased in men with FH compared with control subjects (0.81 +/- 0.15 mm vs. 0.74 +/- 0.19 mm and 0.61 +/- 0.13 mm vs. 0.55 +/- 0.14 mm respectively; P < 0.05). The carotid bifurcation IMT was increased in women with FH compared with control subjects (0.74 +/- 0.17 vs. 0. 66 +/- 0.15; P = 0.005). More subjects with FH had carotid plaque (54% vs. 14%; P = 0.0001). In multivariate analysis, male gender, level of low-density lipoprotein-cholesterol, cholesterol-years score and xanthoma were associated with IMT and plaque in subjects with FH. FH subjects with class 2B mutations had lower cholesterol levels than subjects with mutations belonging to the other classes. They also had a tendency towards a decreased common carotid artery IMT. These findings confirm the importance of gender, xanthoma and lifetime cholesterol levels in relation to carotid atherosclerosis in FH. Whether the type of mutation causing FH modulates carotid artery IMT and plaque requires further study.