Common Carotid Artery Stiffness Research Articles

INCREASED DIAMETER AND STIFFNESS OF ELASTIC BUT NOT MUSCULAR ARTERIES IN MEN WITH ABDOMINAL AORTIC ANEURYSM.

It has been proposed that formation of abdominal aortic aneurysm (AAA) is part of a systemic arterial dilatative disease. However, arteries in the upper extremity are scarcely studied and it remains unclear whether both muscular and elastic arteries are affected by the proposed systemic arterial dilatation. The aim of this study was to investigate diameter and stiffness of muscular and elastic arteries in arterial branches originating from the aortic arch. Twenty-six men with AAA (69 ± 4 years) and fifty-seven men without AAA (70 ± 5 years) were included in the study. Ultrasound was used to examine the distal and proximal brachial artery, axillary artery, and common carotid artery (CCA), and measurement of diameter and diameter change were performed with wall-tracking software. Blood pressure measurements were used to calculate local arterial wall stiffness indices. The AAA cohort presented larger arterial diameters in the CCA and axillary artery after adjustment for body surface area (p=0.002, respectively), while the brachial artery diameters were unchanged. Indices of increased stiffness in CCA (e.g., lower distensibility, p=0.003) were seen in subjects with AAA, after adjustments for body mass index and mean arterial blood pressure. This study supports the theory of a systemic arterial dilating diathesis in in peripheral elastic, but not in muscular, arteries. Peripheral elastic arteries also exhibited increased stiffness, in analogy with findings in the aorta in AAA.

Estimation of local arterial stiffness using non-invasive flow measurements: a study on a stenosed carotid artery

Arterial stiffness is a well-established independent prognostic bio-marker in the human cardiovascular system (CVS). Despite its value as a predictive bio-marker, the inclusion of vascular stiffness into standard clinical procedures or guidelines is limited. This has come about as a result of the abundance of tools created to estimate and evaluate local arterial stiffness in people. This study employs a non-invasive technique to measure local arterial stiffness in the human carotid arteries using proximal flow measurements. Within this work, a viscoelastic lumped-parameter (0D) model of the carotid arteries is developed in complement with the non-invasive flow measurements obtained from the Doppler ultrasound. Further, concepts of sensitivity analysis and parameter estimation are applied to estimate arterial stiffness using the flow measurement taken at the common carotid artery (CCA). After the successful estimation of arterial stiffness in CCA, results show good agreement between model simulations and actual measurement.

Effects of accumulated exercise on the stiffness and hemodynamics of the common carotid artery.

Purpose: This research aims to study and compare the effects of moderate-intensity continuous exercise and accumulated exercise with different number of bouts on common carotid arterial stiffness and hemodynamic variables. Methods: Thirty healthy male adults were recruited to complete four trials in a randomized crossover design: no-exercise (CON); continuous exercise (CE, 30-min cycling); accumulated exercise including two or three bouts with 10-min rest intervals (AE15, 2 × 15-min cycling; AE10, 3 × 10-min cycling). The intensity in all the exercise trials was set at 45%-55% heart rate reserve. Blood pressure, right common carotid artery center-line velocity, and arterial inner diameter waveforms were measured at baseline and immediately after exercise (0min), 10 min, and 20 min. Results: 1) The arterial stiffness index and pressure-strain elastic modulus of the CE and AE15 groups increased significantly at 0min, arterial diameters decreased in AE15 and AE10, and all indicators recovered at 10min. 2) The mean blood flow rate and carotid artery center-line velocity increased in all trials at 0min, and only the mean blood flow rate of AE10 did not recover at 10min. 3) At 0min, the blood pressure in all trials was found to be increased, and the wall shear stress and oscillatory shear index of AE10 were different from those in CE and AE15. At 20min, the blood pressure of AE10 significantly decreased, and the dynamic resistance, pulsatility index, and peripheral resistance of CE partially recovered. Conclusion: There is no significant difference in the acute effects of continuous exercise and accumulated exercise on the arterial stiffness and diameter of the carotid artery. Compared with continuous exercise, accumulated exercise with an increased number of bouts is more effective in increasing cerebral blood supply and blood pressure regulation, and its oscillatory shear index recovers faster. However, the improvement of blood flow resistance in continuous exercise was better than that in accumulated exercise.

Short-Term Changes in Arterial Stiffness Measured by 2D Speckle Tracking in Patients Undergoing Transcatheter Aortic Valve Implantation.

Arterial stiffness has received increasing interest as a cardiovascular marker in patients with aortic valve stenosis (AS). So far, studies on the impact of aortic valve replacement (AVR) on arterial stiffness have been equivocal. Two-dimensional speckle tracking (2DST) is a novel, non-invasive method to measure the motion of the vessel wall. In this prospective observational study, we aimed to assess the change in arterial stiffness of the common carotid artery (CCA) measured by 2DST in patients undergoing transcatheter aortic valve implantation (TAVI). A total of 47 patients were included in the study (age 80.04 ± 6.065 years). Peak circumferential strain (CS) was significantly improved after TAVI (4.50 ± 2.292 vs. 5.12 ± 2.958, p = 0.012), as was the peak strain rate (CSR) (0.85 ± 0.567 vs. 1.35 ± 0.710, p = 0.002). Body mass index (BMI), mean arterial pressure (MAP) and hemodynamic parameters were associated with this change. 2DST results did not correlate with aortic pulse wave velocity (aPWV) or augmentation index normalized to heart rate (AIx@75), suggesting a distinct difference between arterial stiffness of the CCA and other stiffness parameters. 2DST seems to be a promising new tool to assess arterial stiffness in TAVI patients.

Local arterial stiffness measured by ultrafast ultrasound imaging in childhood cancer survivors treated with anthracyclines.

There is conflicting literature regarding the long-term effect of anthracycline treatment on arterial stiffness. This study assessed local arterial stiffness using ultrafast ultrasound imaging (UUI) in anthracycline treated childhood cancer survivors, at rest and during exercise. 20 childhood cancer survivors (mean age 21.02 ± 9.45 years) treated with anthracyclines (mean cumulative dose 200.7 ± 126.80 mg/m2) and 21 healthy controls (mean age 26.00 ± 8.91 years) were included. Participants completed a demographic survey, fasting bloodwork for cardiovascular biomarkers, and performed a submaximal exercise test on a semi-supine bicycle. Pulse wave velocity (PWV) was measured in the left common carotid artery by direct pulse wave imaging using UUI at rest and submaximal exercise. Both PWV at the systolic foot (PWV-SF) and dicrotic notch (PWV-DN) were measured. Central (carotid-femoral) PWV was obtained by applanation tonometry. Carotid measurements were taken by conventional ultrasound. Measures were compared using two-tailed Students t-test or Chi-squared test, as appropriate. There was no statistically significant difference (p > 0.05) between childhood cancer survivors and healthy controls in demographic parameters (age, sex, weight, height, BMI), blood biomarkers (total cholesterol, triglycerides, LDL-c, HDL-c, hs-CRP, fasting glucose, insulin, Hb A1c), cardiovascular parameters (intima media thickness, systolic and diastolic blood pressure, heart rate, carotid diameters, distensibility) or PWV measured by UUI at rest or at exercise. There was also no difference in the cardiovascular adaptation between rest and exercise in the two groups (p > 0.05). Multivariate analysis revealed age (p = 0.024) and LDL-c (p = 0.019) to be significant correlates of PWV-SF in childhood cancer survivors, in line with previously published data. We did not identify a significant impact of anthracycline treatment in young survivors of childhood cancer on local arterial stiffness in the left common carotid artery as measured by UUI.

SEQUENTIAL NEPHRON BLOCKADE VERSUS DUAL RENIN-ANGIOTENSIN SYSTEM BLOCKADE IN TRUE RESISTANT HYPERTENSIVE PATIENTS: A SYSTEMATIC REVIEW

Objective: True resistant hypertension (RHTN) is a challenging medical condition in which the blood pressure remains uncontrolled despite the use of three different classes of antihypertensive agents at maximum tolerated dose. In order to reduce the sodium and volume overload in these patients and bring the blood pressure to acceptable levels, several pharmacologic agents that promote sequential nephron blockade (SNB) or dual renin- angiotensin system blockade (DRASB) can be used. Therefore, this review aims to evaluate the data presented in some clinical trials comparing the SNB to the DRASB. Design and method: A systematic search following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline was conducted in MEDLINE, Cochrane Library, EMBASE and LILACS, resulting in a total of 123 articles. One abstract and 4  randomized controlled trials were selected to be assessed in this review. Results: Both treatments decreased systolic blood pressure and diastolic blood pressure in ambulatory blood pressure monitoring. In one of the protocols, the decreases in the SNB group were significantly greater than in the DRASB group. A sub-analysis showed that the improvements in blood pressure were significant only in those with acceptable adherence to treatment. The two interventions reduced office blood pressure, with one study indicating that the reduction was superior in SNB. In markers of arterial stiffening and aging, there were no significant improvements. Pulse wave velocity and common carotid artery stiffness were similar in both groups and tended to decrease. One of the studies showed improvement in echocardiographic parameters for diastolic dysfunction. Conclusions: Despite the improvements in blood pressure in both groups, SNB therapy has a higher potential as a treatment for RHTN, especially when there is good adherence to the medication. Also, SNB tended to improve arterial stiffness and diastolic dysfunction. Nonetheless, there is a need for more studies for a better evaluation of these outcomes.

VASCULAR REMODELING AND FIBROSIS INDEXES IN NAFLD SUBJECTS

Objective: Non-alcoholic fatty liver disease (NAFLD) is a growing public health problem and is related to an increased burden of cardiovascular disease. Aim of the study: to assess the relation between non-invasive scoring systems for liver fibrosis (Fibrosis-4 Index and NAFLD Fibrosis Score) and structural and functional vascular properties in NAFLD patients. Design and method: The study enrolled 30 consecutive patients (mean age 64±13, BMI 29.3±6.1 kg/m2, male 60%) who underwent hepatological evaluation in our department. Atherosclerotic burden was evaluated by B-mode ultrasound in each carotid artery segment (common, bulb, internal), bilaterally, and expressed as mean of carotid intima-media thickness (mean-IMT) and mean of maximum IMT (M-MAX), right common carotid artery distensibility and stiffness (CardioVascular Suite 4, Quipu, Italy). Aortic stiffness was measured by applanation tonometry (PulsePen DiaTecne, Italy) and was expressed as carotid-femoral pulse wave velocity (PWV). Results: In our cohort vascular properties were: carotid mean-IMT 0.83±0.15 mm, M-MAX 0.98±0.17 mm, carotid distensibility 18.8±8.3 10-3/kPa, and carotid compliance CC 0.88±0.40 mm2/kPa. We found a significant correlation between NAFLD Fibrosis Score and PWV (mean PWV = 10.9±2.9m/s; Fibrosis Score = -0.97±1.80; R = 0.422, p = 0.020), which remained significant after adjustment for mean arterial blood pressure and sex (p = 0.017). No correlation was found between carotid ultrasound parameters and fibrosis scores. Conclusions: In NAFLD patients, our preliminary observation shows a correlation between a liver fibrosis score and PWV, an established marker of aortic stiffness, while no correlation was observed with carotid atherosclerosis markers. This vascular remodeling phenotype needs to be confirmed in a larger population.

Sex differences in middle cerebral artery reactivity and hemodynamics in 6-month-old Sprague-Dawley rats independent from systemic arterial stiffness or blood pressure

Cerebrovascular disease (CVD) is a major risk factor for developing cognitive impairment. Young women are protected against CVD compared with older women or men, however the underlying mechanisms are not well understood. Greater peripheral arterial stiffness has been linked to increased cerebral flow pulsatility and cognitive impairment. In this study we determined whether sex differences in middle cerebral artery (MCA) reactivity are associated with changes in cerebral [MCA, intracranial internal carotid artery (ICA)] or systemic [common carotid artery (CCA), thoracic aorta (TAo)] arterial resistance and stiffness in six month-old Sprague-Dawley (SD) rats. No differences in systolic or diastolic blood pressures measured by tail-cuff method were observed between sexes. Heart rate was higher in the female versus male SD (438±9 vs. 343±10 bpm, p<0.05, n=8-12). The pulsatility (PI) and resistance indexes (RI) of left MCA and left intracranial ICA were calculated as follows: PI=(Peak systolic velocity (Vs)-End-diastolic velocity (Vd))/Vmean, or RI=(Vs-Vd)/Vs (Vevo LAZR, FUJIFILM VisualSonics). Left MCA PI and RI indexes were lower in the female versus male SD (PI: 0.75±0.09 vs. 1.17±0.11; RI: 0.49±0.04 vs. 0.63±0.03, all p<0.05; n=7-8), while no differences in left ICA blood flow (n=4-9) or resistance (n=7-10) were observed between sexes. There were no differences in arterial stiffness of TAo or left CCA evaluated by pulse wave velocity (PWV) measurements. To investigate vascular reactivity, left MCA segments were isolated and mounted on a wire Multi Myograph (DMT-USA). Data were acquired and analyzed with Powerlab 8 and LabChart v8 (ADInstruments). Female left MCA had lower contraction to potassium (K+: 0.6±0.1 vs. 1±0.2 mN/mm, p<0.05), but similar maximal contraction (109±10 vs. 116±6 %KMAX, p>0.05) and sensitivity (7.3±0.2 vs. 7.2±0.2, p>0.05) to thromboxane A2 receptor agonist U46619. Pre-incubation with indomethacin lowered maximal response (97±5 vs. 116±6 %KMAX, p<0.05) and sensitivity (6.8±0.1 vs. 7.2±0.2, p<0.05) to U46619 in male MCA, with no effect in female MCA (Male: 109±9 vs. 113±7 %KMAX; Female: 7.3±0.2 vs. 7.3±0.2). MCA collagen deposition (by trichrome staining) was similar between sexes, however eNOS immunoreactivity tended to increase in the female versus male MCA (7.3±2 vs. 1.2±0.6; n=3-4, p=0.07). No sex differences in MCA COX-2 expression were found. In summary, lower PI and RI of MCA in 6-month-old females suggests decreased cerebrovascular resistance compared with age-matched male SD. Increased eNOS expression may contribute to the lower contraction observed in female MCA, whereas vasoconstrictor prostaglandins appear to have a greater role in male versus female MCA. Our results demonstrate sex differences in MCA vascular reactivity associated with a protective functional profile of MCA in 6-month-old female versus male SD rats independent from changes in systemic arterial stiffness or blood pressure. Studies were supported by the WFUSM CVSC Pilot Award and NIH 5R01HL155420. This is the full abstract presented at the American Physiology Summit 2023 meeting and is only available in HTML format. There are no additional versions or additional content available for this abstract. Physiology was not involved in the peer review process.

4 days in dry immersion increases arterial wall response to ultrasound wave as measured using radio-frequency signal, comparison with spaceflight data.

Recent studies have reported a significant increase in common carotid artery (CCA) intima media thickness, wall stiffness and reflectivity to ultrasound, in astronauts, after six months of spaceflight. The hypothesis was that 4 days in dry immersion (subjects under bags of water) will be sufficient to change the CCA wall reflectivity to ultrasound similar to what observed after spaceflight. Such response would be quantified using the amplitude of the ultrasound signal returned to the probe by the target concerned. [coefficient of signal return (Rs)]. The Rs for anterior and posterior CCA wall, sternocleidomastoid muscle, intima layer and CCA lumen were calculated from the ultrasound radio frequency (RF) data displayed along each echographic line. After four days of DI, Rs increased in the CCA posterior wall (+15% +/- 10 from pre DI, p < 0.05), while no significant change was observed in the other targets. The observed increase in Rs with DI was approximately half compared to what was observed after six months of space flight (+34% +/- 14). This difference may be explained by dose response (dry immersion only four days in duration). As a marker of tissue-level physical changes, Rs provide complimentary information alongside previously observed CCA wall thickness and stiffness.

No Sex Differences In Common Carotid Artery Stiffness Response Following Maximal Oxygen Consumption Test

No Sex Differences in Common Carotid Artery Stiffness Response Following Maximal Oxygen Consumption Test HEYSEL MORALES, MICHAEL DIAZ, ZARIA OPARA, STEVEN HAWKINS, LOUISE KELLY, ALLAN KNOX. PURPOSE: Previous investigations have reported sex differences in the time course of age-related arterial stiffness, with postmenopausal women presenting increased risk of cardiovascular diseases. Using sex as a biological variable has identified differences between males and females in physiological responses to equivalent doses of exercise. The purpose of this study was to determine if sex differences exist in arterial stiffness response to a maximum oxygen consumption (VO2max) exercise test. METHODS: VO2max was measured by indirect calorimetry. Body composition was measured by air displacement plethysmography (BODPOD). Indices of common carotid artery (CCA) stiffness (Peterson’s elastic modulus [Ep], Beta stiffness [B1], distensibility [DIST], and diameter compliance [DC]) were calculated before and within 5 minutes following VO2max. CCA’s were imaged for 1 minute by duplex Doppler ultrasound approximately 2-3cm below bifurcation and stored for offline analysis of velocities and diameters. Brachial blood pressures were captured by automated cuff. RESULTS: Males (n=14) and females (n=15) were matched for age (p=0.549), fat mass (p =0.775), body fat percentage (p=0.08), fat free mass percentage (p=0.087), and VO2max (p=0.349). Males had higher body mass (p < 0.001) and fat free mass (p<0.001). No sex differences were observed before or after exercise for Ep, B1, DIST, and DC (p >0.05 for all). No sex differences were identified for delta changes in any CCA stiffness indices (p >0.05). CONCLUSION: The CCA response to VO2max test is equivalent in males and females who are matched for baseline VO2max, despite males presenting high fat free masses. Previously reported sex differences in response to equivalent exercise dose may not be evident in the CCA stiffness characteristics.

Maximum Aerobic Exercise Induces Common Carotid Vasoconstriction And Increased Vascular Resistance

Michael Diaz, Zaria Opara, Heysel Morales, Steven Hawkins, Louise Kelly, Allan Knox PURPOSE: Low-to-moderate intensity aerobic exercise has been reported to elicit changes in systemic hemodynamics. Recent evidence suggests that the cerebral circulation reacts independently to systemic circulations to the same physiological stimuli. The aim of this is to determine the influence of high-intensity aerobic exercise on common carotid artery (CCA) hemodynamics. METHODS: Hemodynamic measurements were recorded before and following the cessation of a maximum oxygen uptake test (VO2max). One minute video of the CCA by Doppler ultrasound were recorded and used to determine peak systolic velocity (PSV), end diastolic velocity (EDV), time averaged mean blood velocity (TAMEAN), timed average maximum velocity (TAMAX), pulsatility index (PI), and resistance index (RI). CCA diameters were calculated by commercially available vessel tracking software. Carotid stiffness index (β), Peterson’s pressure modulus (Ep), arterial compliance (AC) was also calculated. RESULTS: A total of 29 individuals, 14 male and 15 females, participated in this study (21.9 ± 3.9 years). Following the cessation of exercise, PSV (p < 0.001), TAMAX (p = 0.0085), RI (p < 0.001), and PI (p = 0.0032) significantly increased whilst the minimum diameter (p = 0.005), and maximum diameter (p = 0.020) decreased. No changes were observed for β (p = 0.491), Ep (p = 0.834) or AC (p = 0.535). CONCLUSION: The results show hemodynamic changes in the CCA following VO2max exercise. Specifically, increases in vascular resistance are likely due to the reductions in arterial diameter, which may be evident downstream of the CCA. Acute maximal aerobic exercise does not change CCA stiffness parameters.

The Impaired Elasticity of Large Arteries in Systemic Sclerosis Patients.

(1) Background: Systemic sclerosis (SSc) is an autoimmune disease characterized by endothelial dysfunction and fibrosis of skin and visceral organs. In the last decade, attention has been focused on the macrovascular involvement of the disease. In particular, the observation of increased arterial stiffness represented an interesting aspect of the disease, as predictor of cardiovascular risk. (2) Methods: We recruited 60 SSc patients (52 ± 12 years old, 90% females) and 150 age/sex-matched healthy controls in order to evaluate both intima-media thickness of the right common carotid artery and arterial stiffness using the B-mode echography and the SphygmoCor system® tonometer. (3) Results: The carotid-femoral pulse wave velocity (PWV) was higher in SSc patients than in controls (8.6 ± 1.7 vs. 7.8 ± 1.5 m/s; p < 0.001), as was the carotid-radial PWV (7.8 ± 1.1 vs. 6.7 ± 1.4 m/s; p < 0.001). The intima-media thickness was higher in SSc than in controls (654 ± 108 vs. 602 ± 118 µm; p = 0.004). The other parameters measured at carotid (radial strain, Young’s modulus, compliance and distensibility) all indicated that arterial stiffness in tension was more pronounced in SSc. Of interest, the direct correlation between PWV and age corresponded closely in SSc. Moreover, a significant difference between SSc and controls as regards the carotid parameters was evident in younger subjects. (4) Conclusions: SSc patients showed an increased arterial stiffness compared to healthy controls. In particular, an SSc-related pathologic effect was suggested by the more pronounced increase in PWV with age and lower values of carotid elasticity in younger SSc patients than in age-matched controls.

LIPID INDICES, ARTERIAL DAMAGE AND ALBUMINURIA IN PEDIATRIC PATIENTS WITH UNTREATED PRIMARY HYPERTENSION

Adult data proved that dyslipidemia is associated with cardiovascular risk. Our study aimed to analyze the relation between lipid indices, arterial damage and urinary albumin excretion (UAE) in children with primary hypertension (PH).In 87 pediatric patients (15.10 ± 2.68 years, 60 boys, 27 girls) with untreated PH, we nalysed total, high-density, and low-density lipoprotein cholesterol (T-C, LDL-C, HDL-C), triglycerides (TG), and lipid indices: TG/HDL-C, Non-HDL-C, T-C/HDL-C, LDL-C/HDL-C, atherogenic index of plasma (AIP), atherogenic index (AI), lipoprotein combine index (LCI), and CHOLIndex (LDL-C - HDL-C). Additionally, we assessed 24 h ABPM, central and peripheral office BP, and arterial damage: aortic PWV, AIx75HR, cIMT, carotid arterial stiffness estimated by ultrasonic wall tracking (E-tracking - ET) and UAE [mg/24 h]. Lipid reference values were taken from the American Academy of Paediatrics 2011 Guidelines.In the study group, borderline/high T-C was found in 22 (25.3%), LDL-C in 10 (11.5%), TG in 45 (51.7%), and borderline/low HDL-C in 28 (32.2%) patients; overall, 60 (69.0%) patients had dyslipidemia. Children with borderline/high LDL-C had significantly higher aPWV (5.83 ± 1.78 vs. 5.26 ± 0.78 [m/s], p = 0.047) and UAE (16 [8-122] vs. 8 [5-22] [mg/24], p = 0.034) compared to patients with normal LDL-C. In 87 studied children, UAE correlated with T-C and LDL-C (R = 0.269, p = 0.017; R = 0.245, p = 0.030) and AIx75HR with T-C (R = 0.228, p = 0.035). Also, ET augmentation index (ET AIx) correlated with HDL-C, T-C/HDL-C and AI (R = -0.245, p = 0.023; R = 0.233, p = 0.031; R = 0.233, p = 0.031), and maximal diameter of common carotid artery (D_max) with HDL-C, TG/HDL-C, T-C/HDL-C, LDL-C/HDL-C, AIP, and AI (R = -0.332, p = 0.002; R = 0.220, p = 0.042; R = 0.255, p = 0.018; R = 0.223, p = 0.039; R = 0.220, p = 0.042; R = 0.255; p = 0.018). Logistic regression revealed that the rise in CHOLIndex increased risk of elevated (>30 mg/24 h) UAE (OR: 1.035 95CI: 1.008-1.070).1. Lipid disturbances are common in pediatric patients with PH2. Elevated lipid indices are associated with common carotid artery diameter and stiffness in hypertensive children and adolescents.3. Pediatric patients with PH and abnormal LDL cholesterol are at risk of increased aortic stiffness.4. CHOLIndex may serve as a marker of risk of hypertensive nephropathy in pediatric patients with PH.

Effect of Arterial Stiffness and Cerebral Pulsatility on Hippocampal Tissue Integrity in Healthy Adults

Elevated large elastic artery (i.e. aorta and common carotid) stiffness has emerged as a risk factor of cognitive impairment in older adults. Stiffening of these arteries leads to increased pulsatile energy transmission into the brain, which may result in structural damage to neuronal tissue, and potentially precipitate cognitive decline. In this regard, changes to microstructural integrity of the hippocampus (HC), a brain structure essential for memory encoding, may reflect the impact of age‐related increases in arterial stiffness and pulsatile blood flow through the middle cerebral artery (MCA). Therefore, the purpose of this study was to determine whether large elastic artery stiffness and associated pulsatile hemodynamics are related with HC integrity in healthy adults across the lifespan. We included 25 participants (16M/9F, age: 44±16 y; age range: 22‐69 y; BMI: 27±5 kg/m2; BP: 115±11/71±10 mmHg) in this study. Aortic stiffness was assessed as carotid‐femoral pulse wave velocity (PWV) using applanation tonometry (AtCor Medical, Sydney, Australia). Common carotid artery (CCA) stiffness was measured using duplex ultrasound (Logiq e, GE Healthcare, Chicago, IL) and analyzed with an offline wall‐tracking software (Cardiovascular Suite, Pisa, Italy). CCA blood pressures were acquired from applanation tonometry. Transcranial Doppler ultrasound was used to measure basal mean blood flow velocity of the MCA (MCAv) from which Gosling’s pulsatility index (PI) was calculated as the difference between peak systolic MCAv and end‐diastolic MCAv over mean MCAv. HC tissue integrity was measured using magnetic resonance elastography (MRE), which was acquired using a Siemens 3T Prisma MRI scanner coupled with shear waves generated via a pneumatic actuator (Resoundant, Rochester, MN) at 50 Hz. Bilateral HC stiffness (µ) and HC damping ratio (ξ) were estimated from MRE displacement data using a nonlinear inversion algorithm. A correlation matrix was used to determine if arterial stiffness, vascular hemodynamics, and other lifestyle factors (e.g., age, sex, BMI) were related with HC integrity. BMI (r=‐0.40, p=0.048), CCA pulse pressure (PP) (r=‐0.61, p=0.001), and MCAv PI (r=‐0.48, p=0.01) were associated with HC µ while age (r=0.66, p=0.0004), BMI (r=0.45, p=0.02), SBP (r=0.52, p= 0.008), aortic PWV (r=0.65, p=0.0004), and CCA stiffness (r=0.60, p=0.002) were associated with HC ξ. Next, multiple linear regressions were performed to determine the independent associations among arterial stiffness, vascular hemodynamics of interest, and HC integrity while correcting for age and BMI. HC µ remained significantly associated with CCA PP (β=‐0.52, p=0.03) and was trending towards negative association with MCAv PI (β=‐0.37, p=0.06). There were no significant independent associations among the variables of interest and HC ξ, however, together these variables significantly explained variance in HC ξ (R2=0.37, p=0.03). Our results suggest increased pulsatile pressure through the carotid artery along with elevated cerebral pulsatility negatively impacts HC tissue integrity. Future studies should consider how our current findings affect functional outcomes like memory and age‐related neurological conditions.

Common carotid artery characteristics in patients with repaired aortic coarctation compared to other cardiovascular risk factors

AimsIncreased common carotid artery (CCA) intima media thickness (cIMT) is a well-known risk factor for cardiovascular morbidity and mortality. cIMT thickening has been described in patients with repaired aortic coarctation (CoA), but data on mechanism and clinical relevance in this population are scarce. Our aim was to gain mechanistic insights into cIMT thickening of patients with repaired CoA by comparing their wall architecture to patients with coronary artery disease (CAD), other congenital heart diseases (oCHD), and healthy controls. Methods and resultsA total of 310 subjects were included (CoA (n ​= ​58), oCHD (n ​= ​96), CAD (n ​= ​68) and healthy controls (n ​= ​88)). CIMT and lumen diameter (LD) were determined using semiautomated analysis software. Linear regression analyses were performed correcting for relevant covariates. While patients with repaired CoA and CAD both had significantly increased cIMT and cIMT/LD ratios, LD was increased only in CoA patients. Furthermore, patients with repaired CoA had decreased CCA stiffness. CCA characteristics in the oCHD group were not significantly different from controls. ConclusionThe mechanism of cIMT thickening in patients with repaired CoA may differ from CAD. While there is concentric remodeling in the latter, we see predominant eccentric remodeling in the CoA group, which could be due to increased flow as a result of compliance mismatch at the CoA repair site. We therefore suggest that the prognostic value of cIMT in post-CoA patients should be validated separately prior to using it to guide clinical management in this group.

Abstract 9234: Effects of a 26-Week Randomized, Controlled Exercise Intervention on Arterial Stiffness, Endothelial Function, and Cognition in Adults Atrisk for Alzheimer Disease

Introduction: Arterial stiffness progresses with age and is associated with cardiovascular disease (CVD) events and cognitive decline. Alzheimer’s disease (AD) risk factors like physical inactivity overlap significantly with progression of arterial stiffness. Aerobic exercise training reduces arterial stiffness and may bolster cognition at a time of life when the risk of AD heightens. Hypothesis: Following a 26-week aerobic exercise intervention, improvements in cognitive function will be significantly correlated with improvements in carotid artery stiffness and endothelial function. Methods: Late-middle-aged adults with normal cognition and parental history of AD were randomized to a 26-week exercise training intervention designed to increase physical activity (PA) levels (Enhanced PA; n=11) or maintain Usual PA (n=12). At baseline and following the intervention we used ultrasound to measure local stiffness of the right common carotid artery, brachial artery flow mediated dilation, and tested cognitive function. Pre- and post- intervention changes in outcome variables were compared between groups using independent sample t-tests or ANCOVA and results are presented as mean ± standard deviation. The association between pre-post intervention changes in arterial stiffness and cognitive function were assessed using Pearson correlation coefficients. Results: The pre-post intervention changes for Usual PA vs Enhanced PA were not different for carotid artery stiffness (Young’s Elastic Modulus: (219 ± 1088 mmHg vs -131 ± 384, p=0.12) or endothelial function (0.49 ± 1.69 vs 0.47 ± 1.71, p=0.32). Improvements in cognitive function were not significantly correlated with changes in arterial stiffness or endothelial function (r = -.27-.25, p = .24-.81). Conclusions: The findings of this pilot study do not support the hypothesis that improved cognition following exercise would be associated with improved carotid artery stiffness and endothelial function.

Multi-centre cross-sectional study on vascular remodelling in children following successful coarctation correction.

Coarctation of the aorta is an arteriopathy with life-long sequelae, with remarkably increased cardiovascular events in young adults even after successful repair and despite blood pressure status. There are data on arterial remodelling in adults after coarctation correction, however, these data are scarce in childhood. Thus, the aim of this cross-sectional study was to evaluate changes in arterial wall function and morphology in children following successful coarctation repair and to compare these changes among patients with different blood pressure status and coarctation correction modes. Blood pressure status, echocardiographic parameters, arterial wall structure and stiffness, endothelial function and central blood pressure measurements were evaluated in 110 children aged 6-18 years following successful coarctation repair with right arm blood pressure not exceeding leg blood pressure by ≥20 mmHg. The prevalence of arterial hypertension was 50%. The mean carotid intima-media thickness SDS was 3.1 ± 1.5 and above 1.65 SDS in 91 of 110 patients. Increased right carotid intima-media thickness was associated with left ventricular hypertrophy, office blood pressure difference between leg and right arm, recoarctation in the past and interventional coarctation correction. Increased local common carotid artery stiffness was associated with increased pulse pressure and central systolic blood pressure. Potentially decreased endothelial function was related to a slight increase of peak and mean systolic gradient in the descending aorta. After successful coarctation repair and with a low blood pressure gradient, children still have a high prevalence of arterial hypertension and significant arterial remodelling, indicating accelerated biological age and advanced arteriosclerosis.

Narrative Review of Carotid disease and the kidney.

Patients with chronic kidney disease (CKD) have an increased cardiovascular (CV) risk that is only in part explained by established risk factors. Carotid arteriosclerosis and atherosclerosis are increased in CKD, play a role in the causation of CV disease in these patients and can affect the progression of renal disease. The arterial stiffening process is evident even in CKD patients with a very mild reduction of glomerular filtration rate (GFR) whereas arterial thickening is evident in more advanced stages. Possible mechanisms include functional and structural alterations of the arterial wall. Arterial stiffness can mediate the effect of CKD on target organs (i.e., brain, kidney and heart). In this review we discuss the arterial phenotype of patients with CKD. This is characterized by increased common carotid artery stiffness and outward remodeling (enlargement and thickening of the arterial wall) and a normal/reduced stiffness paired with an inward remodeling (narrowing of the arterial wall) of muscular arteries. We also discuss the consequences of carotid dysfunction, including the involvement of large elastic arteries stiffness on ventricular-vascular coupling, the mechanisms linking carotid stiffening and increased cardio- and cerebrovascular risk in CKD patients, and the therapeutic options to improve carotid function.

Circumferential strain and local arterial stiffness in carotid arteries in healthy individuals and in patients with cardiovascular risk factors

&lt;p&gt;&lt;strong&gt;Aim.&lt;/strong&gt; To assess the parameters affecting circumferential strain and local arterial stiffness in carotid arteries in healthy individuals and in patients with cardiovascular risk factors.&lt;br /&gt;&lt;strong&gt;Methods.&lt;/strong&gt; We analysed data from 111 adults, aged 20–45 years (38.3 ± 7 years). Of these, 63.06% of men had no known medical history of clinically manifest atherosclerosis. Study participants were categorised into two groups—group I (n = 50) comprising of healthy volunteers without known cardiovascular risk factors and group II (n = 61) consisting of individuals with one of the modifiable risk factors (e.g., smoking, obesity, hypertension or hypercholesterolemia). Patients with diabetes mellitus, cardiac arrhythmias or asymptomatic atherosclerotic plaques in the carotid arteries, even if hemodynamically insignificant, were excluded. The following were measured for the common carotid artery (CCA): circumferential strain (CS, %), strain rate (CSR, &lt;!-- x-tinymce/html --&gt;s&lt;sup&gt;−1&lt;/sup&gt;), time to peak (TTP) strain (ms), and fraction area change CCA (FAC, %) and local arterial stiffness (β2).&lt;br /&gt;&lt;strong&gt;Results.&lt;/strong&gt; CCA mechanics correlated with age, blood pressure, body mass index and left-ventricular myocardial mass index. The lowest CS values were seen in group II patients with hypertension (HTN) (with HTN, 2.4% ± 0.9%, 95% CI = 2.07–2.86; without HTN, 3.6% ± 1.1%, 95% CI = 3.2–4). β2 increased to the greatest extent in patients with HTN (19.3% ± 6.1%, 95% CI = 16–21) as compared to those without HTN (13.5% ± 4.5%, 95% CI =13–16). FAC was inversely correlated with age, both in healthy subjects (Rs = −0.63, p = 0.0001) and in patients with cardiovascular risk factors (Rs = −0.61, p = 0.0001).&lt;br /&gt;&lt;strong&gt;Conclusion.&lt;/strong&gt; While CS, strain rate and FAC decreased with age, TTP strain and local arterial stiffness increased. Both mechanics and function of the CCA in patients at risk of developing cardiovascular complications demonstrate a close association with hypertension, obesity, smoking and hypercholesterolemia.&lt;/p&gt;&lt;p&gt;Received 19 November 2020. Revised 14 January 2021. Accepted 18 January 2021.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Funding:&lt;/strong&gt; The study did not have sponsorship.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conflict of interest:&lt;/strong&gt; Authors declare no conflict of interest.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Author contributions&lt;/strong&gt;&lt;br /&gt;Conception and study design: Yu.S. Sinelnikov, E.N. Orekhova, T.V. Matanovskaya, E.O. Kopytova, D.O. Baranova&lt;br /&gt;Data collection and analysis: E.O. Kopytova, D.O. Baranova&lt;br /&gt;Statistical analysis: E.N. Orekhova, T.V. Matanovskaya&lt;br /&gt;Drafting the article: E.N. Orekhova&lt;br /&gt;Critical revision of the article: Yu.S. Sinelnikov&lt;br /&gt;Final approval of the version to be published: Yu.S. Sinelnikov, E.N. Orekhova, T.V. Matanovskaya, E.O. Kopytova, D.O. Baranova&lt;/p&gt;

Cognitive performance is lower among individuals with overlap syndrome than in individuals with COPD or obstructive sleep apnea alone: association with carotid artery stiffness.

Chronic obstructive pulmonary disease (COPD) and obstructive sleep apnea (OSA) are both independently associated with increased cardiovascular disease (CVD) risk and impaired cognitive function. It is unknown if individuals with both COPD and OSA (i.e., overlap syndrome) have greater common carotid artery (CCA) stiffness, an independent predictor of CVD risk, and lower cognitive performance than either COPD or OSA alone. Elevated CCA stiffness is associated with cognitive impairment in former smokers with and without COPD in past studies. We compared CCA stiffness and cognitive performance between former smokers with overlap syndrome, COPD only, OSA only and former smoker controls using analysis of covariance (ANCOVA) tests to adjust for age, sex, body mass index (BMI), pack years, and postbronchodilator FEV1/FVC. We also examined the association between CCA stiffness and cognitive performance among each group separately. Individuals with overlap syndrome (n = 12) had greater CCA β-stiffness index (P = 0.015) and lower executive function-processing speed (P = 0.019) than individuals with COPD alone (n = 47), OSA alone (n = 9), and former smoker controls (n = 21), differences that remained significant after adjusting for age, BMI, sex, pack years, and FEV1/FVC. Higher CCA β-stiffness index was associated with lower executive function-processing speed in individuals with overlap syndrome (r = -0.58, P = 0.047). These data suggest that CCA stiffness is greater and cognitive performance is lower among individuals with overlap syndrome compared with individuals with COPD or OSA alone and that CCA stiffening may be an underlying mechanism contributing to the lower cognitive performance observed in patients with overlap syndrome.NEW & NOTEWORTHY Previous studies have demonstrated greater carotid artery stiffness and lower cognitive function among individuals with COPD alone and OSA alone. However, the present study is the first to demonstrate that individuals that have both COPD and OSA (i.e., overlap syndrome) have greater carotid artery stiffness and lower executive function-processing speed than individuals with either disorder alone. Furthermore, among individuals with overlap syndrome greater carotid artery stiffness is associated with lower executive function-processing speed.