Pressure Pulse Wave Research Articles

Pulsometric Analysis of the Functional State of Cardiovascular System in Humans

Application of the method of arterial piezopulsometry to studying the individual characteristics of the functional state of the cardiovascular system (CVS) in patients of different ages and health states is discussed. Development of a new algorithm for the two-channel simultaneous analysis of the parameters of blood pressure pulse wave plots recorded by two piezoelectric transducers has allowed us to perform a comparative analysis of cardiohemodynamics in different arteries, as well as to evaluate the elasticity of their walls and the nature of the autonomic regulation of CVS effectors with high accuracy. This comprehensive analysis enhances the predictive value of early pulsometric diagnostics of the individual functional state of CVS in humans.

Textile‐Enabled Highly Reproducible Flexible Pressure Sensors for Cardiovascular Monitoring

AbstractFlexible piezoresistive sensors (FPS) with high reproducibility and hysteresis‐free pressure response are highly desirable for various emerging biomedical applications. In this work, the potential of using regularly interlaced textile materials to achieve high‐repeatability and low‐hysteresis FPS is explored. It is found that the structural flexibility and surface regularity of knitted fabric structures can in general provide reproducible pressure response; however, response fluctuations and hysteresis are still present due to the inevitable inelastic deformation of the textiles. To address this limitation, carbon black particles and polyvinylidene fluoride are introduced in the knitted fabric as the electrical and mechanical interconnects, respectively, between the fibers. Through composition optimization, the pressure response variation is reduced to below 2% and the hysteresis loop deviation is decreased to below 10% for single sensors. The performance variation among multiple sensors is as low as 5%, much smaller than the 33% variation of the sensors made with nonwoven fabrics. Utilizing the high sensor repeatability, sensor arrays and multisite sensor network are successfully realized for monitoring superficial temporal artery pulse pressure and pulse wave velocity, which demonstrate the potential of using wearable sensing systems for multifunctional cardiovascular monitoring.

PP.24.09] THE ROLE OF STRUCTURAL AND FUNCTIONAL ALTERATIONS OF LARGE ARTERIES IN VENTRICULAR HYPERTROPHY AND DIASTOLIC DYSFUNCTION IN PATIENTS WITH ESSENTIAL HYPERTENSION

Objective: The aim of the study was to evaluate the influence of structural and functional alterations of large arteries on left ventricular hypertrophy and diastolic dysfunction in hypertensive patients. Design and method: Individuals with essential hypertenstion without any signs and symptoms of diastolic heart failure (n = 98, age 40–70 years, mean age: 55.1 ± 8.8 years, 42% females) were included in the study. Excluding criteria were: any other cardiovascular disease, diabetes and renal impairment with eGFR < 60 ml/min/m2. Applanation tonometry was used to determine central aortic pressures: cSBP, cDBP, Pulse Pressure (PP), Augmentation Index (AIx) and carotid-femoral pulse wave velocity (PWV). Intima media thickness of common carotid artery was measured by multiarray echotracking system. Echocardiography was used to assess left ventricular mass index (LVMI) and diastolic dysfunction: mitral peak E and A wave velocity, E/A ratio, Deceleration Time of peak E wave velocity (DecT), isovolumetric relaxation time (IVRT), pulsed wave TDI mitral e’ and a’ velocity, E/e’ ratio, pulmonary veins systolic (S) and diastolic (D) velocity, S/D ratio, atrial reversal velocity in pulmonary veins (Ar v) and left atrium volume index (LAVI). Results: IMT was negatively correlated with E/A ratio (r = −0.22, p < 0.05), septal e’ (r = −0.3, p < 0.05) and lateral e’ (r = −0.21, p < 0.05), however it was not related to LVMI. PWV was significantly related to LAVI (r = 0.29, p < 0.05), E/A ratio (r = −024, p < 0.05), lateral e’ (r = −0.17, p < 0.05), Ar v (r = 0.31, p < 0.05) and to LVMI (r = 0.30, p < 0.05). There was significant relationship between cSP and septal e’ (r = −0.26, p < 0.05), E/e’ ratio (r = 0.32, p < 0.05) and Ar v (r = 0.32, p < 0.05). Whereas, cDP was only correlated with Ar v (r = 0.28, p < 0.05). Central PP was significantly associated with E/A ratio (r = −0.28, p < 0.05) and septal e’ (r = −0.26, p < 0.05). There was negative correlation of AIx and E/A ratio (r = −0.28, p < 0.05), septal e’ (r = −0.27, p < 0.05, lateral e’ (r = −0.38, p < 0.05) and positive correlation with E/e’ ratio (r = 0.30, p < 0.05) Central aortic pressures were not associated with LVMI. Conclusions: All structural and functional measurements of large arteries relate to diastolic dysfunction and might be usefull to detrmine it at preclinical stage. Only PWV was associated with LVMI.

OP.7B.11] DETERMINANTS OF PULSE PRESSURE AMPLIFICATION IN DRUG NAÏVE HYPERTENSIVE PATIENTS

Objective: Normally there is an amplification of the pressure pulse wave from the large arteries to the smaller conduit arteries and this can be understood as a “gradual widening” of the pulse pressure as it travels distally. This is known as pulse pressure amplification and is defined as the peripheral pulse pressure/central pulse pressure ratio. Of course aging is correlated with PPA but few studies have been conducted to assess its correlations with peripheral arterial resistance. The aim of the present study was to find determinants of PPA in drug naïve hypertensive patients to get insights of this phenomenon. Design and method: We recruited 87 drug naïve (mean age = 52.2 ± 12.5) 55 females, newly diagnosed hypertensive patients that visited the hypertension clinic of a tertiary hospital. Central systolic aortic BP (CSBP), Central diastolic BP (CDBP) was assessed by applanation tonometry and PWV was measured by Sphygmocor (Atcor Medical) and clinic SBP and DBP were measured according to international guidelines. Hemodynamics were assessed by impendance cardiography (ICG) by means of the Cardioscreen 2000 rheocardiographic system. The PPA ratio was defined as the peripheral pulse pressure/central pulse pressure. We used Pearson's r correlation to identify significant correlations of PPA and measured parameters and used multivariate regression analysis to identify independent determinants of PPA. Results: PPA was significantly correlated with age, bmi, gender, heart rate, urea, potassium, augmentation index, velocity index (VI), acceleration index (AI), left ventricular ejection time (LVET), systolic time ratio index (STRI), Ejection time index (ETI), left stroke work index (LSWI). In the regression model heart rate (β = 0.41, p < 0.001) and augmentation index (β = −0.71, p < 0.001) were the two significant determinants of PPA accounting for 77.4% of its variability. Conclusions: PPA is determined by heart rate and thus sympathetic nervous system amplification, and also the augmentation index which is well known marker of arterial stiffness. Overall, these two markers eliminate all other hemodynamic markers as determinants of PPA.

White matter hyperintensities in migraine: Clinical significance and central pulsatile hemodynamic correlates.

Background The role of central pulsatile hemodynamics in the pathogenesis of white matter hyperintensities in migraine patients has not been clarified. Methods Sixty patients with migraine (20-50 years old; women, 68%) without overt vascular risk factors and 30 demographically-matched healthy controls were recruited prospectively. Cerebral white matter hyperintensities volume was determined by T1-weighted magnetic resonance imaging with CUBE-fluid-attenuated-inversion-recovery sequences. Central systolic blood pressure, carotid-femoral pulse wave velocity, and carotid augmentation index were measured by applanation tonometry. Carotid pulsatility index was derived from Doppler ultrasound carotid artery flow analysis. Results Compared to the controls, the migraine patients had higher white matter hyperintensities frequency (odds ratio, 2.75; p = 0.04) and greater mean white matter hyperintensities volume (0.174 vs. 0.049, cm3, p = 0.04). Multivariable regression analysis showed that white matter hyperintensities volume in migraine patients was positively associated with central systolic blood pressure ( p = 0.04) and carotid-femoral pulse wave velocity ( p < 0.001), but negatively associated with carotid pulsatility index ( p = 0.04) after controlling for potential confounding factors. The interaction effects observed indicated that the influence of carotid-femoral pulse wave velocity ( p = 0.004) and central systolic blood pressure ( p = 0.03) on white matter hyperintensities formation was greater for the lower-carotid pulsatility index subgroup of migraine patients. White matter hyperintensities volume in migraine patients increased with decreasing carotid pulsatility index and with increasing central systolic blood pressure or carotid-femoral pulse wave velocity. Conclusions White matter hyperintensities are more common in patients with migraine than in healthy controls. Increased aortic stiffness or central systolic blood pressure in the presence of low intracranial artery resistance may predispose patients with migraine to white matter hyperintensities formation.

Autonomic Dysfunction after Mild Traumatic Brain Injury.

A mild traumatic brain injury (mTBI) is a complex pathophysiologic process that has a systemic effect on the body aside from solely an impairment in cognitive function. Dysfunction of the autonomic nervous system (ANS) has been found to induce abnormalities in organ systems throughout the body, and may contribute to cardiovascular dysregulation and increased mortality. Autonomic dysfunction, also known as dysautonomia, has been studied in moderate and severe TBI, and has emerged as a major contributing factor in the symptomatology in mTBI as well. Analysis of the ANS has been studied through changes in heart rate variability (HRV), pupillary dynamics, eye pressure, and arterial pulse wave in those with mild TBI. Graded exercise testing has been studied as both a method of diagnosis and as a means of recovery in those with mild TBI, especially in those with persistent symptoms. Given the studies showing persistence of autonomic dysfunction after symptomatic resolution of concussions, further research is needed to establish return to play protocols

ДОСТАВКА КИСЛОРОДА, ГАЗОВЫЙ СОСТАВ И КИСЛОТНО-ОСНОВНОЕ СОСТОЯНИЕ АРТЕРИАЛЬНОЙ КРОВИ ВО ВРЕМЯ КСЕНОНОВОЙ АНЕСТЕЗИИ ПО ЗАКРЫТОМУ КОНТУРУ

Xenon is an inert gas being very close to an ideal anesthetic. Goal of the study: to evaluate changes in gases and acid-base balance of arterial blood during general xenon anesthesia with the closed circuit and to compare it with general anesthesia with sevoflurane. Methods. The article describes a prospective assessment of anesthesia with expanded hemodynamic monitoring in 50 patients undergoing planned surgery. Based on the main inhalation anesthetic (xenon or sevoflurane) patients were divided into two groups. The monitoring included blood gases and O 2 delivery; cardiac output was evaluated through analysis of arterial pressure pulse wave after calibration by transpulmonary thermodilution (PiCCO). Results. Xenon anesthesia did not result in serious disorders of acid-base balance and O2 delivery and compared to sevoflurane the metabolic acidosis was less frequent as well as the need to manage it. Changes in the lactate level provided the evidence that both inhalation anesthetics did not result in serious disorders of tissue perfusion and gas exchange.

Measurement of carotid blood pressure and local pulse wave velocity changes during cuff induced hyperemia.

We present a prototype design of dual element photoplethysmograph (PPG) probe along with associated measurement system for carotid local pulse wave velocity (PWV) evaluation in a non-invasive and continuous manner. The PPG probe consists of two identical sensing modules placed 23 mm apart. Simultaneously measured blood pulse waveforms from these arterial sites were processed and the pulse transit time delay was resolved using the developed application-specific software. The ability of developed PPG probe and associated measurement system to detect acute changes in carotid local PWV due to blood pressure (BP) variations was experimentally validated by an in-vivo study. Intra-subject carotid BP elevation was achieved by an upper arm cuff based occlusion, which offered a controlled way of local PWV escalation. The elevated carotid BP values were also recorded by a calibrated pressure tonometer prior to the study, and was used as a reference. A significant increment (1.0 - 2.6 m/s) in local PWV was observed and was proportional to the BP increment induced by the occlusive reactive hyperemia. Study results demonstrated the feasibility of real-time signal acquisition and reliable local PWV evaluation under normal and elevated BP conditions using the developed measurement system.

The effect of combined therapy on the properties of the vessel wall in patients at high risk of cardiovascular complications

Introduction. The evaluation of therapy effectiveness in patients at high risk of cardiovascular complications includes the evaluation of target organs condition. A complex approach means follow-up control of laboratory and instrumental data. Materials and methods. The study included 113 patients with hypertension and nonstenotic atherosclerosis of brachiocephalic arteries. All the patients received antihypertensive therapy and some received hypolipidemic drugs. Cholesterol and low density lipoproteins (LDL) levels, brachial and central blood pressure (BP), brachial-ankle and carotid-femoral pulse wave velocity (baPWV and cfPWV, respectively), augmentation index (AI) of fibrosis markers (C-terminal telopeptide from collagen I (CITP) and C-terminal terminal propeptide of pro-collagen I (PINP) were assessed at baseline, after 6 months and 12 months of treatment with fixed combination of amlodipine, lisinopril and rosuvastatin. Results. The conducted therapy was followed by lowering the LDL levels from 3.9 (3.1; 4.6) to 2 (1.8; 2.3) mmol/L (p

P845Assessment of pulse wave pressure changes for detection of arrhythmia and comorbidities using a wrist-worn wearable device

P845Assessment of pulse wave pressure changes for detection of arrhythmia and comorbidities using a wrist-worn wearable device

Hemodynamic changes caused by acupuncture in healthy volunteers: a prospective, single-arm exploratory clinical study

BackgroundRadial pressure pulse wave (RPPW) examination has been a key diagnostic component of traditional Chinese medicine. The objective of this study was to investigate the changes in RPPW along with various hemodynamic variables after acupuncture stimulation and to examine the validity of pulse diagnosis as a modern diagnostic tool.MethodsWe conducted acupuncture stimulation at both ST36 acupuncture points in 25 healthy volunteers. We simultaneously assessed the RPPW by pulse tonometry; heart rate variability (HRV) by electrocardiogram; photoplethysmogram (PPG) signals, respiration rate, peripheral blood flow velocity and arterial depth by ultrasonography; and cardiac output by impedance cardiography, before, during and after a session of acupuncture stimulation.ResultsWe observed consistent patterns of increased spectral energy at low frequency (<10 Hz) and pulse power using RPPW examination and in the amplitude and systolic area of the PPG signal during the entire acupuncture session. The low- and high-frequency domains of HRV increased and decreased, respectively, during the acupuncture session. The peripheral blood velocity rose shortly after needle insertion, reached a maximum in the middle of the session and decreased afterwards. The augmentation index (AIX) and pulse transit time (PTT) obtained from RPPW did not change significantly.ConclusionAcupuncture stimulation at ST36 in healthy subjects increased the peripheral pulse amplitudes (pressure pulse wave (PPW) and PPG), blood flow velocity (ultrasonography) and sympathetic nerve activity (HRV). The lack of changes in the AIX and PTT suggests that the increased pulse amplitudes and blood flow velocity may result from increased cardiac output.Trial registrationClinical Research Information Service (KCT0001663).

Characteristics of capillary discharge channel and its effect on concrete splitting-off by electro-blasting method

The numerical simulation results on fracture of a concrete block due to dynamic explosive loads applied to the walls of a blast hole are presented. The influence of the pulse shape on the shock-wave dynamics is considered. A comparison of mechanical stresses in direct and reflected pressure waves induced in the concrete block by explosion pulses of various durations and amplitudes shows that the shorter pulses with higher amplitudes and steeper rise times provide a higher blasting efficiency. The wire application for the discharge initiation enables the operating voltage of the generator to decrease, the discharge gap to increase, and hence, the channel energy to lead to the demolition build-up at electro burst. The significant dependence of the stress-wave profile on the pressure pulse wave shape at the borehole wall, which is determined by the rate of electrical energy release in the plasma channel, has been shown. An analysis of the stress-wave dynamics has shown that the rapid power deposition into a plasma channel tends to shift an amplitude of the tangential stresses in a reflected wave to the higher values and to extend the region of tensile tangential stresses initiating the main crack propagation from the borehole walls to a free material surface.

Ultrasound detection of altered placental vascular morphology based on hemodynamic pulse wave reflection.

Abnormally pulsatile umbilical artery (UA) Doppler ultrasound velocity waveforms are a hallmark of severe or early onset placental-mediated intrauterine growth restriction (IUGR), whereas milder late onset IUGR pregnancies typically have normal UA pulsatility. The diagnostic utility of these waveforms to detect placental pathology is thus limited and hampered by factors outside of the placental circulation, including fetal cardiac output. In view of these limitations, we hypothesized that these Doppler waveforms could be more clearly understood as a reflection phenomenon and that a reflected pulse pressure wave is present in the UA that originates from the placenta and propagates backward along the UA. To investigate this, we developed a new ultrasound approach to isolate that portion of the UA Doppler waveform that arises from a pulse pressure wave propagating backward along the UA. Ultrasound measurements of UA lumen diameter and flow waveforms were used to decompose the observed flow waveform into its forward and reflected components. Evaluation of CD1 and C57BL/6 mice at embryonic day (E)15.5 and E17.5 demonstrated that the reflected waveforms diverged between the strains at E17.5, mirroring known changes in the fractal geometry of fetoplacental arteries at these ages. These experiments demonstrate the feasibility of noninvasively measuring wave reflections that originate from the fetoplacental circulation. The observed reflections were consistent with theoretical predictions based on the area ratio of parent to daughters at bifurcations in fetoplacental arteries suggesting that this approach could be used in the diagnosis of fetoplacental vascular pathology that is prevalent in human IUGR. Given that the proposed measurements represent a subset of those currently used in human fetal surveillance, the adaptation of this technology could extend the diagnostic utility of Doppler ultrasound in the detection of placental vascular pathologies that cause IUGR.NEW & NOTEWORTHY Here, we describe a novel approach to noninvasively detect microvascular changes in the fetoplacental circulation using ultrasound. The technique is based on detecting reflection pulse pressure waves that travel along the umbilical artery. Using a proof-of-principle study, we demonstrate the feasibility of the technique in two strains of experimental mice.

Increasing accuracy of pulse transit time measurements by automated elimination of distorted photoplethysmography waves

Photoplethysmography (PPG) is a widely available non-invasive optical technique to visualize pressure pulse waves (PWs). Pulse transit time (PTT) is a physiological parameter that is often derived from calculations on ECG and PPG signals and is based on tightly defined characteristics of the PW shape. PPG signals are sensitive to artefacts. Coughing or movement of the subject can affect PW shapes that much that the PWs become unsuitable for further analysis. The aim of this study was to develop an algorithm that automatically and objectively eliminates unsuitable PWs. In order to develop a proper algorithm for eliminating unsuitable PWs, a literature study was conducted. Next, a ‘7Step PW-Filter’ algorithm was developed that applies seven criteria to determine whether a PW matches the characteristics required to allow PTT calculation. To validate whether the ‘7Step PW-Filter’ eliminates only and all unsuitable PWs, its elimination results were compared to the outcome of manual elimination of unsuitable PWs. The ‘7Step PW-Filter’ had a sensitivity of 96.3% and a specificity of 99.3%. The overall accuracy of the ‘7Step PW-Filter’ for detection of unsuitable PWs was 99.3%. Compared to manual elimination, using the ‘7Step PW-Filter’ reduces PW elimination times from hours to minutes and helps to increase the validity, reliability and reproducibility of PTT data.

Longitudinal Changes in LV Structure and Diastolic Function in Relation to Arterial Properties in General Population

ObjectivesWe assessed to what extent arterial properties measured at baseline and follow-up predict longitudinal alterations in echocardiographic indexes reflecting left ventricular (LV) structure and function. BackgroundSerial imaging studies are needed to clarify the relation of changes in LV structure and function to arterial stiffness. MethodsIn 607 participants (50.7% women; mean age 50.7 years), using echocardiography and Doppler imaging, we measured LV dimensions, transmitral blood flow, and mitral annular tissue velocities at baseline and after 4.7 years. Using applanation tonometry, we assessed central pulse pressure (cPP) and carotid-femoral pulse wave velocity (PWV) at baseline. We regressed longitudinal changes in LV indexes on the arterial stiffness parameters and reported standardized effect sizes as a fraction of SD of LV change. ResultsAfter full adjustment, longitudinal increase in LV septal (standardized effect size: +14.4%; p = 0.0018) and posterior wall (+12.6%; p = 0.0027) thickness was associated with higher baseline PWV, whereas LV internal diameter (-12.4%; p = 0.012) decreased during follow-up with PWV. Consequently, greater increase in relative wall thickness was associated with higher baseline PWV (+17.2%; p <0.0001). Participants with higher baseline PWV had a greater risk to develop or retain LV concentric remodeling during follow-up (odds ratio 1.35; p = 0.028). In addition, in women, baseline cPP predicted a greater increase in LV mass (+22.8%; p = 0.0009) and E/e′ ratio (+36.1%; p <0.0001). ConclusionsProgression to LV concentric remodeling pattern was associated with higher baseline PWV. In women, cPP predicted worsening of LV diastolic function. Our study highlights the importance of arterial properties as mediator of LV concentric remodeling in men and women, and diastolic dysfunction in women.

Relationships between lifestyle patterns and cardio-renal-metabolic parameters in patients with type 2 diabetes mellitus: A cross-sectional study.

IntroductionWhile individuals tend to show accumulation of certain lifestyle patterns, the effect of such patterns in real daily life on cardio-renal—metabolic parameters remains largely unknown. This study aimed to assess clustering of lifestyle patterns and investigate the relationships between such patterns and cardio-renal-metabolic parameters.Participants and methodsThe study participants were 726 Japanese type 2 diabetes mellitus (T2DM) outpatients free of history of cardiovascular diseases. The relationship between lifestyle patterns and cardio-renal-metabolic parameters was investigated by linear and logistic regression analyses.ResultsFactor analysis identified three lifestyle patterns. Subjects characterized by evening type, poor sleep quality and depressive status (type 1 pattern) had high levels of HbA1c, alanine aminotransferase and albuminuria. Subjects characterized by high consumption of food, alcohol and cigarettes (type 2 pattern) had high levels of γ-glutamyl transpeptidase, triglycerides, HDL-cholesterol, blood pressure, and brachial-ankle pulse wave velocity. Subjects characterized by high physical activity (type 3 pattern) had low uric acid and mild elevation of alanine aminotransferase and aspartate aminotransferase. In multivariate regression analysis adjusted by age, gender and BMI, type 1 pattern was associated with higher HbA1c levels, systolic BP and brachial-ankle pulse wave velocity. Type 2 pattern was associated with higher HDL-cholesterol levels, triglycerides, aspartate aminotransferase, ɤ- glutamyl transpeptidase levels, and diastolic BP.ConclusionsThe study identified three lifestyle patterns that were associated with distinct cardio-metabolic-renal parameters in T2DM patients.Trial registrationUMIN000010932

Parameters Extracted From Arterial Pulse Waves as Markers of Atherosclerotic Changes: Performance and Repeatability.

Arterial diseases are significant and increasing cause of mortality and morbidity. In this study, we analyze and compare the discrimination capability of different arterial pulse wave (PW) based indices, both earlier proposed and novel ones, for describing the vascular health. The repeatability of the indices is also evaluated. Both volume PWs and dynamic pressure PWs are recorded by using photoplethysmographic and electromechanical film (EMFi) sensors connected to a wireless body sensor network. The study population consists of 82 subjects, 30 atherosclerotic patients, and 52 control subjects. In addition, day-to-day variability of the derived indices is studied with ten test subjects examined on three different days. The results are evaluated in terms of statistical tests and receiver operating characteristic (ROC) curves as well as coefficient of variation (CV) and intraclass correlation coefficient (ICC). Altogether 24 out of the evaluated 40 PW parameters showed statistical differences ( or less) between controls and atherosclerotic patients. Maximum area under curve was 0.88. Most of the indices had ICCs higher than 0.8 and average CVs less than 0.1. The study shows that the amplitude ratios and time intervals between different PW peaks could be a useful additional tool for the detection of atherosclerosis. The results encourage us for further studies in this field. Up to our knowledge, the performance and the repeatability of different PW derived indices have previously not been studied and compared with each other this extensively. Our findings also provide evidence for the utility of PW measurements for the detection of atherosclerotic changes.

Endothelin type A receptor blockade reduces vascular calcification and inflammation in rats with chronic kidney disease.

Arterial stiffness and calcification are nontraditional cardiovascular risk factors in chronic kidney disease (CKD). Using a rat model of CKD with mineral imbalance, medial vascular calcification has been associated with inflammation and increased endothelin-1 (ET-1) production. We therefore hypothesized that ET-1, through the endothelin type A (ETA) receptor, induces vascular inflammation, calcification and stiffness in CKD. CKD was induced in Wistar rats by renal mass ablation. To induce medial vascular calcification, mineral imbalance was established with a identified as calcium-rich/phosphate-rich diet and vitamin D supplementation (Ca/P/VitD). One group of CKD + Ca/P/VitD rats was given the ETA receptor antagonist atrasentan (10 mg/kg/day) for 6 weeks. Hemodynamic parameters including SBP, pulse pressure (PP) and pulse wave velocity (PWV) were determined. Vascular calcification, smooth muscle cells osteoblastic differentiation and expression of inflammatory markers such as inflammatory cytokines and calgranulins S100A8 and S100A9 were assessed in the thoracic aorta. As compared with CKD control rats, CKD + Ca/P/VitD rats developed medal vascular calcification that was associated with increased SBP, PP and PWV. These changes were also associated with increased macrophage infiltration and expression of IL-6, calgranulins and osteoblastic markers. Treatment of CKD + Ca/P/VitD rats with atrasentan reduced vascular calcification, SBP, PP and PWV, macrophage infiltration and expression of IL-1β, IL-6, tumor necrosis factor, calgranulins and osteoblastic markers. This study shows that ETA receptor blockade reduced vascular inflammation, smooth muscle cells differentiation, calcification and stiffness indicating a pivotal role for ET-1 in medial vascular calcification in this rat remnant kidney model of CKD with mineral imbalance. Therefore, the endothelin system may be a potential therapeutic target for improving cardiovascular morbidity in patients with CKD.

Влияние комбинированной терапии на состояние сосудистой стенки у больных высокого сердечно-сосудистого риска

Introduction. The evaluation of therapy effectiveness in patients at high risk of cardiovascular complications includes the evaluation of target organs condition. A complex approach means follow-up control of laboratory and instrumental data. Materials and methods. The study included 113 patients with hypertension and nonstenotic atherosclerosis of brachiocephalic arteries. All the patients received antihypertensive therapy and some received hypolipidemic drugs. Cholesterol and low density lipoproteins (LDL) levels, brachial and central blood pressure (BP), brachial-ankle and carotid-femoral pulse wave velocity (baPWV and cfPWV, respectively), augmentation index (AI) of fibrosis markers (C-terminal telopeptide from collagen I (CITP) and C-terminal terminal propeptide of pro-collagen I (PINP) were assessed at baseline, after 6 months and 12 months of treatment with fixed combination of amlodipine, lisinopril and rosuvastatin. Results. The conducted therapy was followed by lowering the LDL levels from 3.9 (3.1; 4.6) to 2 (1.8; 2.3) mmol/L (p<0.01), brachial systolic and diastolic BP levels from 127 (116; 139) to 123 (115; 131) mm Hg (p<0.01) and from 79 (72; 89) to 75 (70; 83) mm Hg (p<0.01) respectively, central systolic and diastolic BP levels from 126 (112; 137) to 120 (110; 124) mm Hg (p<0.01) and from 80 (75; 87) to 76 (70; 81) mm Hg (p<0.01) respectively; by decreasing arterial stiffness: baPWV from 13.6 (12.5; 15.9) to 12.9 (11.8; 14.3) m/s (p<0.01) and cfPWV from 11 (9; 12.2) to 9.4 (8.4; 10.2) m/s (p<0.01), AI decreased from 31 (25; 35) to 26 (21; 32); p<0.05. The arterial stiffness index calculated without BP levels (cardio-ankle vascular index) decreased from 7.2 (6.6; 8.3) to 7.0 (6.6; 7.9) m/s (p<0.05). Treatment with Ekvamer® resulted in PINP levels decreasing from 49.8 (33; 67) to 35 (21; 52) mg/dL (p<0.05) and CITP - from 0.44 (0.24-0.6) to 0.3 (0.18-0.46) mg/dL (p<0.05). No difference between initial and final PINP/CITP levels was observed. The dynamics of PINP levels was associated with aortal stiffness dynamics, cfPWV (r=0.5; p<0.05). Conclusion. Treatment with fixed combination of amlodipine, lisinopril and rosuvastatin resulted in reaching target levels of LDL, brachial and central BP, and arterial stiffness decrease in patients at high risk of cardiovascular complications. The cfPWV dynamics was inter-related with collagen synthesis marker PINP levels.

Non-Invasive Assessment of Early Atherosclerosis Based on New Arterial Stiffness Indices Measured with an Upper-Arm Oscillometric Device

The clinical significance of detecting early atherosclerosis is now widely recognized. Measurement methods available at present are usually not suitable for use in primary care where rapid screening for a large population is needed. The Arterial Velocity-pulse Index (AVI) and Arterial Pressure-volume Index (API) are new noninvasive arterial stiffness indices that can be rapidly measured using an oscillometric device. The purpose of this study was to determine whether high AVI and API values are predictive of early atherosclerosis prior to the onset of obstructive coronary artery disease (CAD). A total of 183 patients were enrolled and allocated to the CAD group (n = 109), early atherosclerosis (AS) group (n = 34) or an apparently healthy (non-AS) group (n = 40) based on the results of angiographic examinations. Measurements for arterial blood pressure, AVI, API and brachial-ankle pulse wave velocity (baPWV) were collected. Statistical analyses revealed that AVIs were significantly lower in the non-AS group than in the AS group and the CAD group. The inter-group differences in API were not statistically significant among the 3 patient groups. As a reference, baPWV was found to be statistically higher in the CAD group than in the non-AS group, whereas there was no significant difference between the CAD group and the AS group, or between the AS group and the non-AS group. The AVI and API were both significantly correlated with baPWV. This study demonstrated that AVI was more sensitive than baPWV and API in indicating early atherosclerosis, although elevated AVI and baPWV were both predictive of CAD.