Assessment Of Pulse Wave Velocity Research Articles

Pregnancy-related events associated with subclinical cardiovascular disease burden in late midlife: SWAN

Background and aimsReproductive factors are associated with later life CVD in women (e.g., age at first birth, preeclampsia, gestational diabetes), but studies have focused largely on premenopausal women. We examined the relationship of reproductive factors with subclinical CVD burden in late midlife women. MethodsWe included 964 parous women from the Study of Women's Health Across the Nation (SWAN), who completed a reproductive history questionnaire at the 13th SWAN visit (2011–2012), and a carotid ultrasound and brachial-ankle pulse wave velocity (baPWV) assessment. The primary outcomes were carotid intima-media thickness, plaque, and baPWV; our secondary outcome was a composite subclinical CVD index created using these measures. Linear and logistic regression was performed to examine associations with individual subclinical CVD measures, and multinomial logistic regression was used in analyses of the composite index. Models adjusted for socio-demographics and cardiovascular risk factors. ResultsMean age at subclinical CVD assessment was 60.2 years (SD ± 2.7). History of gestational hypertension/preeclampsia was associated with greater carotid IMT (β: 0.038, p = 0.004). Earlier age at first birth was associated with subclinical CVD, but not when accounting for CVD risk factors. History of gestational diabetes was associated with greater baPWV, but not related to our composite index. ConclusionsPregnancy history is an important marker of subclinical CVD in late midlife and may impact the vasculature through distinct pathways. Future studies are necessary to evaluate racial/ethnic differences in the observed associations and to assess the benefit of a composite subclinical CVD index for earlier CVD risk modification in midlife women.

Assessment of Pulse Wave Velocity in Obese Adults using ECG and Finger Tip Photo Pulse Plethysmography


 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 Introduction
 The World Health Organization has recently defined obesity as a disease. Obesity is the result of imbalance between food intake and energy expenditure. Obese individuals with excess fat deposition in the abdominal region are at risk for CHD, hence this study was taken up to see if any association is there between obesity and PWV.
 Aim
 1. To measure the pulse wave velocity (PWV) in obese individuals.
 2. To compare if there is any correlation between pulse pressure, PWV and BMI.
 Material and Method
 68 obese adults were included for the study, 45 males and 23 females. The study was started after getting clearance from IEC. Informed oral consent was obtained from the subjects. Height and weight of the subjects were recorded. All of them were in the age group of 27 to 62 years and had BMI > 30.
 Resting blood pressure was recorded, then Lead II ECG was recorded along with left forefinger tip photo pulse for a period of 15 secs. Distance between the R wave and the foot of the finger pulse was measured in msec. The arm span was measured from the left lateral border of sternum to tip of left forefinger which was taken as distance(D) travelled by the pulse. Using V=? T/D, PWV was calculated.
 Results
 The mean BP in male and female was 106 ±9 & 94.7 ±4.4 mmHg respectively where as the PWV was 5.8 ± 0.7 mts/sec in male and 5 ± 0.5mts/sec in females which is in normal limits. Analysis of data was done by applying Pearson's Correlation and paired Student T test which revealed there was positive correlation between mean BP versus PWV r = 0.21 & BMI versus mean BP r = 0.26. P value were highly significant which was < 0.001
 PWV is influenced by tethering of vessel and stiffening of the arterial wall, so increase in velocity may not be a good index to assess risk factor in all cardiac conditions.
 Conclusion
 PWV is influenced by tethering of vessel and stiffening of the arterial wall, so increase in velocity may not be a good index to assess risk factor in all cardiac conditions unless it is corrected with respect to age and Blood pressure.
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

PULSE WAVE VELOCITY AND CIRCADIAN VARIABILITY IN WELL CONTROLLED HYPERTENSIVE PATIENTS

Objective: Pulse wave velocity (PWV) is the gold standard for measuring large artery stiffness. A PWV >10m/s is considered a conservative estimate of significant alterations of aortic function in middle-aged hypertensive patients. Although commonly used, there are only a few reports investigating the 24-hour variability in PWV measurements, the determination of which is important when using PWV as a clinical marker of target organ damage. The aim of this study was to investigate the variability in PWV measurements and factors that may influence PWV variability during 24 hours. Design and method: A prospective study was conducted in 55 well controlled hypertensive patients (mean age 65.8 ± 11.8 years) and 21 healthy control subjects (mean age 55.6 ± 18.9 years). In all subjects, complete blood chemistry (including SUA determination), echocardiographic examination, office and 24 h ambulatory blood pressure (BP) as well as 24 h ambulatory PWV and central (BP) measurement were performed Results: 24 hours systolic BP, central BP and PWV (p < 0.001) were significantly higher in hypertensive patients in confront to health subjects, but not diastolic BP (p = 0.140) levels. Specifically, the mean of PWV, SBP and cBP during 24 h was 9.7 (±0.3) vs 7.7 (± 0.3); 131.6 (±4.6) vs 122.8 (±5.9) and 137.7 (±4.3) vs 125.6 (± 4.2) for hypertensives and controls respectively. However, the mean of DBP during 24 h was 78.7 (±4.1) for patients and 79.4 (±5.6) for controls. Moreover, PWV of patients was significantly correlated with SBP, DBP (r = 0.411) and cBP (r = 0.717) levels (p < 0.001). Significant correlations were found between PWV of controls and SBP (r = 0.616), DBP (r = 0.499) and cBP (r = 0.579) levels (p < 0.001). PWV levels presented a small variability during the whole 24 hours (±0,3) suggesting that measurement and reproducibility of this marker are not influenced by a circadian rhythm. Conclusions: PWV assessment may be performed any time during 24 hours in an outpatient clinic. In our study, we didn’t find a circadian variability that may influence the reproducibility of PWV.

THE DELAYED INEFFICIENCY OF ANTIHYPERTENSIVE THERAPY AND INCREASED ARTERIAL STIFFNESS

Objective: To detect predictors of the delayed inefficiency of antihypertensive therapy (AHT) among arterial stiffness parameters. Design and method: The AHT (2–3 drugs from various groups) was assigned to 102 hypertensive patients (52 men, 54.2 ± 9.8 years). Antihypertensive agents and their dosages were selected during 2–3 weeks of ambulatory management, with a possible single correction of the initially prescribed AHT. In all participants were achieved the target BP levels at the inclusion stage, which were confirmed by office blood pressure measurement (<130/80 mm Hg, oscillometric method, OMRON, Japan), and by 24-hour ambulatory blood pressure monitoring (mean 24-hour BP < 130/80 mm Hg, oscillometric method, BpLab, Russia). In addition, the applanation tonometry was carried out with carotid-femoral pulse wave velocity (cf-PWV) assessment (SphygmoCor, AtCor Medical, Australia). 1 and 3 months after inclusion stage the evaluation of the efficacy of AHT was carried out by OBPM and ABPM. Results: During the first three months of taking recently prescribed AHT, 34 patients (33.3%) demonstrated the escape phenomenon in according to the data of at least one of the measurement methods. There weren’t differences between two groups (with and without the escape phenomenon) by the classical cardiovascular risk factors. In one-factorial logistic regression models, the next predictors of the escape phenomenon were detected: cf-PWV > 10,8 m/c (OR 2,9, 95% CI 1,24 – 7,17, p = 0,01), 24ASI > 137 (OR 4,9, 95% CI 1,72 – 13,43, p = 0,002), 24PBP > 46 mm Hg (OR 6,3, 95% CI 2,27 – 17,6, p = 0,0003). The maximum sensitivity and specificity for the 24PBP was revealed (81,8% and 58,5% resp., pic. 1).Conclusions: After the AHT administration, in addition to the control BP measurements, it is important to provide the arterial stiffness assessment – to determine the odds ratio of the escape phenomenon.

Cardiovascular Organ Damage and Blood Pressure Levels Predict Adverse Events in Multiple Myeloma Patients Undergoing Carfilzomib Therapy.

Carfilzomib is a second-generation proteasome inhibitor approved for the treatment of multiple myeloma (MM). It seems to determine cardiovascular toxicity, primarily arterial hypertension. No predictive factors for cardiovascular adverse events (CVAEs) are known in patients affected by multiple myeloma treated with carfilzomib. We evaluated the role of cardiovascular organ damage parameters to predict CVAEs in MM patients taking carfilzomib. Seventy patients affected by MM were prospectively enrolled. A comprehensive cardiovascular evaluation was performed before carfilzomib therapy; they underwent a transthoracic echocardiogram and the assessment of carotid-femoral pulse wave velocity. All the patients were followed up (FU) to determine the incidence of CVAEs. The mean age was 60.3 ± 8.2, and 51% were male. The median FU was 9.3 (4.3; 20.4) months. A proportion of 33% experienced CVAEs, 91% of them had uncontrolled hypertension, 4.5% acute coronary syndrome, and 4.5% cardiac arrhythmias. Subjects with CVAEs after carfilzomib treatment had significantly higher blood pressure values, left ventricular mass (98 ± 23 vs. 85 ± 17 g/m2, p = 0.01), and pulse wave velocity (8.5 ± 1.7 vs. 7.5 ± 1.6 m/s, p = 0.02) at baseline evaluation compared to the others. Furthermore, baseline uncontrolled blood pressure, left ventricular hypertrophy, and pulse wave velocity ≥ 9 m/s were able to identify patients at higher risk of developing CVAEs during FU. These preliminary findings indicate that blood pressure control, left ventricular mass, and pulse wave velocity may predict CVAEs in MM patients treated with carfilzomib.

Unreliable Estimation of Aortic Pulse Wave Velocity Provided by the Mobil-O-Graph Algorithm-Based System in Marfan Syndrome.

BackgroundSeveral devices have been proposed to assess arterial stiffness in clinical daily use over the past few years, by estimating aortic pulse wave velocity (PWV) from a single measurement of brachial oscillometric blood pressure, using patented algorithms. It is uncertain if these systems are able to provide additional elements, beyond the contribution carried by age and blood pressure levels, in the definition of early vascular damage expressed by the stiffening of the arterial wall.Methods and ResultsThe aim of our study was to compare the estimated algorithm‐based PWV values, provided by the Mobil‐O‐Graph system, with the standard noninvasive assessment of aortic PWV in patients with Marfan syndrome (ie, in subjects characterized by premature aortic stiffening and low blood pressure values). Aortic stiffness was simultaneously evaluated by carotid‐femoral PWV with a validated arterial tonometer and estimated with an arm cuff–based ambulatory blood pressure monitoring Mobil‐O‐Graph device on 103 patients with Marfan syndrome (50 men; mean±SD age, 38±15 years). Aortic PWV, estimated by the Mobil‐O‐Graph, was significantly (P<0.0001) lower (mean±SD, 6.1±1.3 m/s) than carotid‐femoral PWV provided by arterial tonometry (mean±SD, 8.8±3.1 m/s). The average of differences between PWV values provided by the 2 methods (±1.96×SD) was −2.7±5.7 m/s.ConclusionsThe Mobil‐O‐Graph provides PWV values related to an ideal subject for a given age and blood pressure, but it is not able to evaluate early vascular aging expressed by high PWV in the individual patient. This is well shown in patients with Marfan syndrome.

Arterial stiffness relates to executive dysfunction in later life

ABSTRACTCardiovascular disease in older people is often linked with cognitive impairment, particularly in domains of executive function and processing speed. Our aims examined whether carotid-femoral pulse wave velocity (PWV) related to subtle changes of executive function and processing speed. Fifty-six individuals with subjective mood and/or cognitive concerns underwent PWV and neuropsychological assessments of processing speed (Trail Making Test Part A) and executive functioning (Delis Kaplan Executive Function System Stroop Task; Trail Making Test Part B, TMT-B). Individuals with high PWV (≥12.0m/s) had poorer performance on TMT-B, compared to low PWV (<12.0m/s), and a moderate negative correlation (r = −0.38, p = .004) between PWV and TMT-B performance. Our results confirm that in older adults at-risk for cognitive decline, early markers of CVD are associated with subtle decrements in rapid set-shifting (executive function), supporting efforts towards early detection of CVD as a secondary prevention strategy for older individuals with cognitive decline.

Comparison of 24-hour and Office Pulse Wave Velocity for Prediction of Mortality in Hemodialysis Patients

Background: Mortality in hemodialysis patients still remains unacceptably high. Enhanced arterial stiffness is a known cardiovascular risk factor, and pulse wave velocity (PWV) has proven to be a valid parameter to quantify risk. Recent studies showed controversial results regarding the prognostic significance of PWV for mortality in hemodialysis patients, which may be due to methodological issues, such as assessment of PWV in the office setting (Office-PWV). Method: This study cohort contains patients from the “Risk stratification in end-stage renal disease – the ISAR study,” a multicenter prospective longitudinal observatory cohort study. We examined and compared the predictive value of ambulatory 24-hour PWV (24 h-PWV) and Office-PWV on mortality in a total of 344 hemodialysis patients. The endpoints of the study were all-cause and cardiovascular mortality. Survival analysis included Kaplan-Meier estimates and Cox regression analysis. Results: During a follow-up of 36 months, a total of 89 patients died, 35 patients due to cardiovascular cause. Kaplan-Meier estimates for tertiles of 24 h-PWV and Office-PWV were similarly associated with mortality. In univariate Cox regression analysis, 24 h-PWV and Office-PWV were equivalent predictors for all-cause and cardiovascular mortality. After adjustment for common risk factors, only 24 h-PWV remained solely predictive for all-cause mortality (hazard ratio 2.51 [95% CI 1.31–4.81]; p = 0.004). Conclusions: Comparing both measurements, 24 h-PWV is an independent predictor for all-cause-mortality in hemodialysis patients beyond Office-PWV.

Pulse wave analysis using the Mobil-O-Graph, Arteriograph and Complior device: a comparative study

Purpose: Pulse wave velocity (PWV) is a marker of arterial stiffness with major prognostic value. We compared Arteriograph and Complior devices with the Mobil-O-Graph for assessment of PWV and central systolic blood pressure (cSBP).Materials and Methods: We studied 316 consecutive subjects (age: 55 ± 14 years). For each individual, we measured PWV and cSBP with Arteriograph, Complior and Mobil-O-Graph and compared the readings. Differences in values among three devices were calculated for each measurement. We used Bland-Altman analysis, intraclass correlation coefficient (ICC) and coefficient of variation (CV).Results: Bland-Altman analysis indicated a mean difference for PWV: i.0.5 m/s (limits of agreement -1.4–2.4) between Complior and Mobil-O-Graph, ii.0.6 m/s (limits of agreement -1.4–2.6) between Arteriograph and Mobil-O-Graph. cSBP mean difference was 3.8 mmHg between Complior and Mobil-O-Graph (limits of agreement -12.5–20.1) and 9.2 mmHg between Arteriograph and Mobil-O-Graph (limits of agreement -7.6–26). ICC for PWV was 0.86 between Arteriograph and Mobil-O-Graph, 0.87 between Complior and Mobil-O-Graph and for cSBP 0.92 and 0.91 respectively. CV for PWV was 9.5% between Arteriograph and Mobil-O-Graph, 8.8% between Complior and Mobil-O-Graph. Respective values for cSBP were 6.8% and 5.1%.Conclusion: Our study shows acceptable agreement among the three devices regarding pulse wave analysis markers though Mobil-O-Graph appears to underestimate the values of these markers. Further studies are needed to explore the agreement between the 3 devices in various clinical settings and patient populations.

Short- and Long-Term Effects of Bariatric Surgery on Vascular Phenotype.

Retinal microvascular diameters and large artery stiffness are valid biomarkers of cardiovascular risk. This study assessed short- and long-term micro- and macrovascular improvements after bariatric surgery (BS). Sixteen patients (44 ± 12years) underwent BS in this observational study. Two weeks before as well as 6weeks and 4years after surgery, retinal vessel analysis and assessment of brachial-ankle pulse wave velocity (baPWV), cardio-ankle vascular index (CAVI), and anthropometry were performed. Three patients were lost to follow-up. Six weeks after BS, retinal arteriolar diameters (CRAE) were wider (180.1μm vs. 188.1μm; p = 0.001), and the arteriolar-to-venular diameter ratio (AVR) was higher (0.82 vs. 0.86; p < 0.001) compared to baseline levels. During the 4years of follow-up, the retinal changes sustained but further improvements did not occur. Both indices of large artery stiffness, baPWV and CAVI, remained unchanged 6weeks and 4years after surgery. Retinal microvascular phenotype improved 6weeks after BS. The improvements in microvascular health were maintained during 4years of follow-up but, despite significant further reductions in body mass index, did not improve further long-term. baPWV and CAVI were unaffected after surgery indicating that BS primarily affects microvascular phenotype rather than large artery stiffness. Retinal vessel imaging seems to be a feasible diagnostic tool to monitor microvascular health after BS. Normalization of BMI and blood pressure may be necessary to achieve long-term improvement of large artery phenotype after BS.

Assessment of Pulse Wave Velocity in Obese Adults using ECG and Finger Tip Photo Pulse Plethysmography

Introduction The World Health Organization has recently defined obesity as a disease. Obesity is the result of imbalance between food intake and energy expenditure. Obese individuals with excess fat deposition in the abdominal region are at risk for CHD, hence this study was taken up to see if any association is there between obesity and PWV. Aim 1. To measure the pulse wave velocity (PWV) in obese individuals. 2. To compare if there is any correlation between pulse pressure, PWV and BMI. Material and Method 68 obese adults were included for the study, 45 males and 23 females. The study was started after getting clearance from IEC. Informed oral consent was obtained from the subjects. Height and weight of the subjects were recorded. All of them were in the age group of 27 to 62 years and had BMI > 30. Resting blood pressure was recorded, then Lead II ECG was recorded along with left forefinger tip photo pulse for a period of 15 secs. Distance between the R wave and the foot of the finger pulse was measured in msec. The arm span was measured from the left lateral border of sternum to tip of left forefinger which was taken as distance(D) travelled by the pulse. Using V=? T/D, PWV was calculated. Results The mean BP in male and female was 106 ±9 & 94.7 ±4.4 mmHg respectively where as the PWV was 5.8 ± 0.7 mts/sec in male and 5 ± 0.5mts/sec in females which is in normal limits. Analysis of data was done by applying Pearson's Correlation and paired Student T test which revealed there was positive correlation between mean BP versus PWV r = 0.21 & BMI versus mean BP r = 0.26. P value were highly significant which was < 0.001 PWV is influenced by tethering of vessel and stiffening of the arterial wall, so increase in velocity may not be a good index to assess risk factor in all cardiac conditions. Conclusion PWV is influenced by tethering of vessel and stiffening of the arterial wall, so increase in velocity may not be a good index to assess risk factor in all cardiac conditions unless it is corrected with respect to age and Blood pressure.

Comparison of the SphygmoCor XCEL device with applanation tonometry for pulse wave velocity and central blood pressure assessment in youth.

Vascular phenotype by assessing carotid-femoral pulse wave velocity (cf-PWV) and central SBP (cSP) in the young could be used as an intermediate cardiovascular outcome measure. Tonometry is considered the gold-standard technique, but its use is challenging in clinical practice, especially when used in children. The purpose of this study was to validate cf-PWV and cSP assessment with novel oscillometric device (SphygmoCor XCEL) in children and adolescents. cf-PWV and cSP were measured in 72 children and adolescents aged 6-20 years. Measurements were performed by applanation tonometry and by the SphygmoCor XCEL device at the same visit under standardized conditions. Regression analysis and Bland-Altman plots were used for comparison of the tonometer-based with oscillometric-based method. Mean cf-PWV measured by applanation tonometry was 4.85 ± 0.81 m/s and measured by SpygmoCor XCEL was 4.75 ± 0.81 m/s. The mean difference between the two devices was 0.09 ± 0.47 m/s (P = NS). cSP measured by SpygmoCor XCEL was strongly correlated with cSP measured by applanation tonometry (R = 0.87, P < 0.001). Mean cSP measured by applanation tonometry was 103.23 ± 9.43 mmHg and measured by SpygmoCor XCEL was 103.54 ± 8.87 mmHg. The mean cSP difference between the two devices was -0.30 ± 3.34 mmHg (P = NS), and fulfilled the AAMI criterion 1. The estimated intersubject variability was 2.17 mmHg. The new oscillometric SphygmoCor XCEL device provides equivalent results for cf-PWV and cSP values to those obtained by tonometry in children and adolescents. Thus, the SphygmoCor XCEL device could be appropriate for assessing cf-PWV and cSP in the pediatric population.

The effectiveness of combination antihypertensive therapy in patients with arterial hypertension and additional risk factors: obesity and obstructive sleep apnea syndrome.

To study the effectiveness of a fixed combination of perindopril and amlodipine, with the subsequent addition of indapamide-retard in male patients with arterial hypertension (AH), obesity and severe sleep apnea (OSAS). The study included 43 male patients in whom antihypertensive therapy titration was performed to achieve target blood pressure values with a fixed combination of calcium antagonist amlodipine (10 mg) and an angiotensin-converting inhibitor perindopril (5-10 mg) and indapamide-retard. At baseline and after 4-6 weeks, the effectiveness of antihypertensive therapy was monitored according to clinical measurements and ambulatory blood pressure monitoring (ABPM). An assessment of the carotid-femoral pulse wave velocity (cfPWV), aortic PWV (aoPWV), and ankle-brachial PWV (abPWV) was performed. Target blood pressure values (according to clinical blood pressure, 24-hour blood pressure monitoring) during therapy with amlodipine 10 mg and perindopril 10 mg reached 65% of patients and another 30% reached target blood pressure when adding indapamide-retard 1.5 mg, that is - 95% of all patients included in the study. Upon reaching the target blood pressure values, a significant decrease in cfPWV, aoPWV and abPWV was observed. The fixed combination of perindopril arginine and amplodipine, with the addition of indapamide retard in male patients with hypertension 1st degree in the presence of obesity and severe OSAS allows to reach effective control of blood pressure and improve the elastic properties of large arteries, which can lead to a favorable organoprotective effect in this category of patients.

Migraine and Markers of Carotid Atherosclerosis in Middle-Aged Women: A Cross-Sectional Study.

This study evaluated the association between migraine and the markers of carotid artery disease. Migraine increases the risk of cardiovascular events, but its relationship with vascular dysfunction is unclear. In this cross-sectional study, middle-aged women with no known cardiovascular diseases underwent clinical, neurological, and laboratory evaluations; pulse wave velocity (PWV) assessment; and carotid artery ultrasonography. We divided the participants based on the presence of migraine and, further, based on the type of migraine. Associations between migraine and carotid thickening (intima-media thickness >0.9 mm), carotid plaques, or arterial stiffening (PWV >10 m/s) were evaluated using a multiple regression analysis. The study comprised 112/277 (40%) women with migraine, of whom 46/277 (17%) reported having an aura. Compared to the non-migraineurs, the migraine with aura group had an increased risk of diffuse carotid thickening (3/46 [6.8%] vs 2/165 [1.3%], adjusted OR = 7.12, 95% CI 1.05-48.49). Migraine without aura was associated with a low risk of carotid plaques (3/66 [4.7%] vs 26/165 [16.7%], adjusted OR = 0.28, 95% CI 0.08-0.99) and arterial stiffening (21/66 [34.4%] vs 82/165 [51.2%], adjusted OR = 0.39, 95% CI 0.19-0.79). There were no correlations between migraine characteristics and arterial stiffness or carotid thickness measurements. Migraine with aura is associated with an increased risk of carotid thickening, and migraine without aura is associated with a low risk of carotid plaques and arterial stiffening.

Assessment of carotid pulse wave velocity (carPWV) in patients with Ankylosing Spondylitis

IntroductionAnkylosing spondylitis (AS) is an inflammatory rheumatic disease associated with accelerated atherosclerosis and increased cardiovascular morbidity and mortality.ObjectivesTo assess the local arterial stiffness in carotid artery in subjects with AS compared with controls evaluated by carotid artery pulse wave velocity (carPWV).MethodsUltrasound examinations were conducted with a Mylab One color Doppler ultrasound diagnostic system (Esaote, Firenze, Italy), the right common carotid artery (RCCA) was scanned, using a 5–12 MHz vascular probe with built-in quality arterial stiffness (QAS) which calculate carPWV.ResultsForty-seven male subjects (20 with Ankylosing Spondylitis and 27 controls) aged between 20 and 75 (mean age 41.17 ± 11) were evaluated. AS patients have not Hypertension, history of cardiovascular risk factors or smoking). Higher carPWV was observed in patients with AS (6.27 ± 0.72 vs 5.56 ± 1.02 m/s; p = 0.0123) compared with controls, respectively.ConclusionsAS subjects showed higher carPWV compared with controls, this novel assessment for local arterial stiffness could be useful in the future to calculate cardiovascular risk, more studies should be developed with this method in this pathology in our population.Figure 1AS, ankylosing Spondylitis: cPWY, carotid artery pulse wave velocity; SD: standard deviation. Continuous variables are shown as median with analysis by t-rest.

Assessment of Pulse Wave Velocity as Arterial Stiffness Parameter in Adolescent Elite Wrestlers

Assessment of Pulse Wave Velocity as Arterial Stiffness Parameter in Adolescent Elite Wrestlers

Parameters of pulse wave velocity: determinants and reference values assessed in the population-based study LIFE-Adult

Aims and backgroundParameters of arterial stiffness such as pulse wave velocity (PWV) were recently proposed as independent risk factors of cardiovascular events. We analyse three PWV parameters in the large population-based study LIFE-Adult to identify risk factors, normal and reference values.Methods and resultsBrachial-ankle (ba), brachial-femoral (bf) and carotid-femoral (cf) PWV assessment was performed using Vicorder device. 8509 participants aged 19–80 were analysed. PWV parameters were moderately correlated (r(ba/bf) = 0.6, r(ba/cf) = 0.46, r(bf/cf) = 0.59). Age and blood pressure are the dominant determinants of PWV parameters explaining > 18% of variability. Sex was only relevant for bfPWV and cfPWV. All further analysed cardiovascular and other risk factors are of minor importance. We provide age-dependent percentiles for the population (reference values) and for the subgroup of normotonic individuals. All percentiles show a strong increase with age. The difference between normotonic and all individuals is small for younger age groups but increases up to 1 m/s for elderly subjects.ConclusionOur study confirms and further underpins the strong impact of age and blood pressure on arterial stiffness and the relatively weak contribution of other factors, supporting an independent role of arterial stiffness in cardiovascular disease development. Age-dependent reference and normal values were provided on the basis of the so far largest study sample facilitating the implementation of PWV assessment in clinical practice. Due to better compliance, handling and stronger association with age and blood pressure, baPWV could serve as an alternative to cfPWV. Follow-up data are required to estimate the clinical significance of specified PWV cut-offs.

Assessment of aortic stiffness in patients with ankylosing spondylitis using cardiovascular magnetic resonance.

To evaluate aortic stiffness in patients with ankylosing spondylitis (AS) using cardiovascular magnetic resonance (CMR) and to assess its association with AS characteristics and left ventricular (LV) remodeling. In this prospective study, 14 consecutive AS patients were each matched to two controls without cardiovascular symptoms or known cardiovascular disease who underwent CMR imaging for the assessment of aortic arch pulse wave velocity (PWV) at 1.5 Tesla. To enhance comparability of the samples, matching was done with replacement resulting in 20 unique controls. Only AS patients with abnormal findings on screening echocardiography were included in this exploratory study. Cine CMR was used to assess LV geometry and systolic function, and late gadolinium enhancement was performed to determine the presence of myocardial hyperenhancement (i.e., fibrosis). Aortic arch PWV was significantly higher in the AS group compared with the control group (median 9.7m/s, interquartile range [IQR] 7.1 to 11.8 vs. 6.1m/s, IQR 4.6 to 7.6m/s; p < 0.001). PWV was positively associated with functional disability as measured by BASFI (R: 0.62; p = 0.018). Three patients (21%) with a non-ischemic pattern of hyperenhancement showed increased PWV (11.7, 12.3, and 16.5m/s) as compared to the 11 patients without hyperenhancement (9.0m/s, IQR 6.6 to 10.5m/s; p = 0.022). PWV was inversely associated with LV ejection fraction (R: - 0.63; p = 0.015), but was not found to be statistically correlated to LV volumes or mass. Aortic arch PWV was increased in our cohort of patients with AS. Higher PWV in the aortic arch was associated with functional disability, the presence of non-ischemic hyperenhancement, and reduced LV systolic function.

OPTIMAL ORGANOPROTECTION, CONTROL OF bLOOD PRESSURE AND METAbOLIC DISORDER WITH THE FIxED COMbINATION OF LISINOPRIL, AMLODIPINE AND ROSUVASTATIN IN SYSTEMIC HYPERTENSION

Aim. Evaluation of the ability of the fixed combination of lisinopril, amlodipine and rosuvastatin (Equamer) in achievement of additional angioprotection in patients with systemic arterial hypertension (AH) and high pulse wave velocity (PWV), regardless of previous antihypertensive therapy (AHT).Material and methods. To the open multicenter observational study 24 weeks duration, 60 patients included, taking double AHT during 6 months. All participants underwent ambulatory 24 hour blood pressure (BP) monitoring, applanation tonometry (augmentation index and central BP), pulse wave velocity assessment, laboratory tests (lipids, fasting glucose, insulin resistance index (HOMA), leptin, high sensitive C-reactive protein (hsCRP) before and after transition to the fixed combination of lisinopril, amlodipine and rosuvastatin (Equamer).Results. By the data from office BP measurement, after transition of patients from the double combinations to fixed combination of lisinopril, amlodipine and rosuvastatin, there was additional decrease of systolic BP (SBP) by 14,3% and diastolic BP (DBP) by 18,5%. By the data from ABPM, decrease of SBP was 16,1%, and DBP — 21,8%. Combination of lisinopril, amlodipine and rosuvastatin decreased PWV by 14,4%, augmentation index by 14,5%, central SBP by 8,1% (p&lt;0,01 for all comparisons with baseline). Fixed combination of lisinopril, amlodipine and rosuvastatin made it to decrease low density lipoproteides by 44%, triglycerides by 36,1% and increase of high density lipoproteides by 10,3% (p&lt;0,01 for all with baseline). Usage of combination of lisinopril, amlodipine and rosuvastatin showed significant decrease of insulin resistance, hsCRP and leptin levels.Conclusion. Fixed combination of lisinopril, amlodipine and rosuvastatin makes it to better control BP, improve vascular elasticity parameters (augmentation index, PWV, central BP) and facilitates the improvement of lipid and glucose metabolism, decrease of inflammation, leptin resistance in patients taking at baseline double antihypertensive therapy.

CD271+, CXCR7+, CXCR4+, and CD133+ Stem/Progenitor Cells and Clinical Characteristics of Acute Ischemic Stroke Patients

Ischemic stroke causes mobilization of various groups of progenitor cells from bone marrow to bloodstream and this correlates with the neurological status of stroke patients. The goal of our study was to identify the activity of chosen progenitor/stem cells in the peripheral blood of acute ischemic stroke patients in the first 7 days after the incident, through associations between the levels of the cells and clinical features of the patients. Thirty-three acute ischemic stroke patients and 15 non-stroke control subjects had their venous blood collected repeatedly in order to assess the levels of the CD45–CD34 + CD271+, the CD45–CD34 + CXCR4+, the CD45–CD34 + CXCR7+, and the CD45–CD34 + CD133+ stem/progenitor cells by means of flow cytometry. The patients underwent repeated neurological and clinical assessments, pulse wave velocity (PWV) assessment on day 5, and MRI on day 1 and 5 ± 2. The levels of the CD45–CD34 + CXCR7+ and the CD45–CD34 + CD271+ cells were lower in the stroke patients compared with the control subjects. Only the CD45–CD34 + CD271+ cells correlated positively with lesion volume in the second MRI. The levels of the CD45–CD34 + CD133+ cells on day 2 correlated negatively with PWV and NIHSS score on day 9. The patients whose PWV was above 10 m/s had significantly higher levels of the CD45–CD34 + CXCR4+ and the CD45–CD34 + CXCR7+ cells on day 1 than those with PWV below 10 m/s. This study discovers possible activity of the CD45–CD34 + CD271+ progenitor/stem cells during the first 7 days after ischemic stroke, suggests associations of the CD45–CD34 + CD133+ cells with the neurological status of stroke patients, and some activity of the CD45–CD34 + CD133+, the CD45–CD34 + CXCR4+, and the CD45–CD34 + CXCR7+ progenitor/stem cells in the process of arterial remodeling.