Stiffness In Women Research Articles

Characterizing left ventricular stiffness in women with signs and symptoms of ischemia with no obstructive coronary arteries

Abstract Background Women with signs and symptoms of ischemia and no obstructive coronary arteries (INOCA) have evidence of diastolic dysfunction and are at increased risk of developing heart failure with preserved ejection fraction (HFpEF). However, mechanisms contributing to HFpEF development are poorly understood and often attributed to underlying cardiovascular risk factors. Purpose To compare clinical, invasive, and imaging parameters in women with suspected INOCA and various degrees of left ventricular (LV) stiffness (as measured by invasive end-diastolic pressure [EDP]/end diastolic volume [EDV]). Methods Women with suspected INOCA underwent invasive LV pressure-volume loop analysis at rest and coronary function testing with a Doppler wire in the left anterior descending artery. Intracoronary vasoactive substances (adenosine, acetylcholine, nitroglycerin) were infused into the left main artery, as published. Rest and adenosine stress cardiac magnetic resonance (CMR) imaging was performed to evaluate LV function, structure, perfusion, and fibrosis. Women in different tertiles of EDP/EDV ratio were compared using t-tests. Results A total of 62 women with complete invasive data were included; 2 did not complete CMR. Compared to the lower EDP/EDV tertile, women in the upper tertile were older, had higher ejection fraction, higher mass/volume ratio, worse diastolic function, greater aortic stiffness and worse coronary microvascular function (Table 1). Traditional cardiovascular risk factors were not significantly different. Conclusion Among women with INOCA, older age, coronary microvascular dysfunction, and aortic stiffness were related to greater LV stiffness at rest. Those with the highest EDP/EDV ratio had hyperdynamic LV systolic function and the smallest LV size. More work is needed to understand contribution of coronary microvascular dysfunction to HFpEF progression. Funding Acknowledgement Type of funding sources: Other. Main funding source(s): National Institutes of HealthErika Glazer Women's Heart Health Project

Obstetric and gynecological history and arterial stiffness in women of different age groups

Aim. To study the correlation between the features of obstetric and gynecological anamnesis with indicators of arterial stiffness in women of different age groups to assess additional risk factors for the development of cardiovascular diseases.
 Materials and methods. The single centre study involved women aged 18 to 65 years. The surveyed 161 women were divided into three groups: 1st group 52 young women from 18 to 30 years old; 2nd group 54 women from 31 years old to the onset of menopause; 3rd group 55 postmenopausal women. The 1 and 2nd groups included women with preserved reproductive function. All women underwent a questionnaire survey, clinical examination, determination of anthropometric data, measurement of cfPWV, determination of arterial stiffness by volume sphygmography, 24-hour blood pressure monitoring with assessment of aortic stiffness and characteristics of the central pulse wave.
 Results. In group 1, the early age of menarche was associated with an increase in the rate of morning rise in SBP (r=-0.46, p=0.002) and a decrease in SEVR (r=0.33, p=0.03); the use of combined oral contraceptives correlates with an increase in the Weissler coefficient PEP/ET (R=0.3, p=0.03) and amplification of pulse pressure PPA (R=0.29, p=0.04). A history of 1 or 2 pregnancies is associated with a decrease in arterial stiffness. At the same time, 3 or more pregnancies in the anamnesis create the prerequisites for the formation of arterial stiffness. The early onset of pregnancy pathologies, namely, starting from the 1st or 2nd trimester of pregnancy, is associated with a violation of the characteristics of the reflected wave at a young age and the formation of arterial stiffness in the menopausal period. History of abortions was associated with PWVao (R=0.45, p=0.002), ASI (R=0.43, p=0.002) in group 2. History of miscarriages is associated with SEVR (R=0.52, p=0.00005) and SEVR to HR75 (R=0.27, p=0.04) in the menopausal period.
 Conclusion. Pathology of pregnancy, three or more pregnancies in history, early age of menarche, taking combined oral contraceptives, abortions and miscarriages in history are associated with an increase in arterial stiffness in the future, which predisposes women to the development of CVD and should be taken into account for preventive purposes.

Acute Effects of Foam Rolling Exercises on Arterial Stiffness, Flexibility and Autonomic Nervous System Function in Young and Middle-Aged Women

PURPOSE: Arterial stiffness is an independent risk factor for cardiovascular disease and inversely associated with flexibility. Self-myofascial release (SMR) using a foam roller is a popular intervention to improve flexibility, restore the muscles, fascia, tendons, and ligaments, and regain soft-tissue extensibility. This study aimed to investigate whether a single bout of SMR has a beneficial effect on arterial stiffness and the function of the autonomic nervous system and the relationships among these variables in young and middle-aged women by age.METHODS: Ten healthy young (23.20±0.59 years) and 10 middle-aged women (44.50±0.91 years) completed an instructed SMR using a foam roller. Brachial-ankle pulse wave velocity (baPWV), augmentation index (AIx), trunk flexibility, shoulder flexibility, heart rate variability, including standard deviation of normal R-R intervals (SDNN), and the root mean square of the standard deviation of the time between heartbeats (RMSSD) were measured before and after one 30-minutes bout of SMR.RESULTS: After one bout of SMR, trunk and shoulder flexibility increased in both groups of women, while AIx decreased significantly (from 6.9±2.9 to -1.9±4.6%, p=.0072, young women group; from 22.1±3.4 to 14.7±1.7%, p=.0049, middle-aged women group). However, the baPWV, RMSSD, and SDNN did not change. In the analysis of correlations between all measured variables, changes in AIx showed negative correlations with flexibility and SDNN.CONCLUSIONS: This study suggests that one bout of SMR using a foam roller positively affected arterial stiffness in women by reducing AIx and improving flexibility.

Abstract 12182: Candesartan vs Lisinopril on Measures of Arterial Stiffness and Wave Reflections in Older, Hypertensive Adults

Introduction: Higher arterial stiffness independently predicts risk of future cardiovascular events. Although angiotensin converting enzyme inhibitors (ACEi) and angiotensin-receptor blockers (ARBs) reduce blood pressure, their impact on vascular function may vary. Hypothesis: We hypothesized differences in the impact of ACEi compared to ARBs on arterial stiffness, wave reflections and microvascular function in hypertension among older men and women. Methods: We measured vascular function at baseline and after 1 year in 176 (87 Candesartan, 89 Lisinopril therapy) hypertensive participants with mild cognitive impairment (age 65.9 +/-7.7 years, 57% female). Pulse-wave velocity (PWV), central pulse pressure (CPP) and central augmentation index (AIx) were measured using applanation tonometry and the reactive hyperemia index using digital pulse amplitude tonometry. Results: While Candesartan and Lisinopril lowered blood pressure equally, only Lisinopril therapy resulted in a lower PWV (-0.7 ± 0.4 m/s, p=0.03) and CPP (-7 ± 4 mmHg, p=0.01) after 1 year, while Candesartan produced no significant change. There was a significant interaction by sex whereby arterial stiffness was lowered only in women with Lisinopril. Candesartan lowered AIx more than Lisinopril (-4 ± 7% vs -1.5 ± 8%, p=0.05) in both sexes. After adjustment for sex and cardiovascular risk factors, Lisinopril remained a significant predictor of lower PWV and CPP after 1 year (all p<0.05). Conclusions: In a cohort of older hypertensive patients, despite equipotent anti-hypertensive effects, Lisinopril was more effective than Candesartan at lowering arterial stiffness in women. Candesartan was effective in lowering wave reflections compared to Lisinopril.

MP63-12 UTILITY OF TRANSVAGINAL ULTRASOUND SHEAR WAVE ELASTOGRAPHY FOR INVESTIGATING THE POSTERIOR BLADDER WALL OF ACONTRACTILE BLADDER (ACB)/DETRUSOR UNDERACTIVITY (DU) IN WOMEN

You have accessJournal of UrologyUrodynamics/Lower Urinary Tract Dysfunction/Female Pelvic Medicine: Non-neurogenic Voiding Dysfunction II (MP63)1 Sep 2021MP63-12 UTILITY OF TRANSVAGINAL ULTRASOUND SHEAR WAVE ELASTOGRAPHY FOR INVESTIGATING THE POSTERIOR BLADDER WALL OF ACONTRACTILE BLADDER (ACB)/DETRUSOR UNDERACTIVITY (DU) IN WOMEN Cheng Chu, Chih-Chieh Lin, William J. Huang, and Alex T.L. Lin Cheng ChuCheng Chu More articles by this author , Chih-Chieh LinChih-Chieh Lin More articles by this author , William J. HuangWilliam J. Huang More articles by this author , and Alex T.L. LinAlex T.L. Lin More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002103.12AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Acontractile bladder (AcB)/detrusor underactivity (DU) were urodynamic-based diagnosis with similar pathologenic mechanism but different clinical presentations. They share common pathophysiology with myogenic changes related to ischemia, which lead to bladder detrusor wall fibrosis and loss of detrusor muscle contractility. The aim of this study was to investigate the correlation between the thickness and stiffness (measured by shear wave velocity, SWE) of detrusor muscle, both measured by transvaginal ultrasonography, in women with acontractile bladder (AcB)/detrusor underactivity (DU) under different degree of bladder filling. METHODS: During the period from October of 2019 to January of 2021, 26 patents were enrolled in this prospective study. According to urodynamic results, 17 women were classified as AcB/DU and remaining 9 women were classified as detrusor normoreflexia. Transvaginal ultrasound were performed by using an ultrasound machine (Aplio i-Series A800, Canon Medical System) with a transcavitary curvilinear probe (3 to 11 mHz) equipped with SWE. Detrusor wall thickness (DWT) and SWE of posterior bladder wall were acquired sequentially starting from empty bladder, different degree of bladder filling (50ml, 100ml, 150ml, 200ml), and once again empty bladder. Pearson correlation coefficients were applied to evaluate the relationship between shear wave modulus and DWT in both AcB/DU and detrusor normoreflexia. An independent t-test was used for comparing two groups under different bladder volume. Two-tailed p value of less than 0.05 was considered statistically significant. RESULTS: The mean age was 68.0±15.1 years old for patients with AcB/DU, 67.8±11.5 years old for patients with detrusor normoreflexia. DWT decreases during the bladder filling, and no statistical difference was found between AcB/DU and normoreflexia. Patients with AcB/DU showed significantly greater mean shear wave modulus than those with detrusor normoreflexia under distended bladder (at 100cc, 150cc and 200cc). The AcB/DU group also showed positive correlation between increased mean shear wave modulus and increased DWT at initial empty bladder (r=0.500, p=0.015), 150cc (r=0.716, p =0.001), 200cc (r=0.737, p =0.000) and second-time empty bladder (after distention) (r=0.397, p=0.033). We also observed, although not statistically significant, a trend of negative correlation between DWT and stiffness in women with detrusor normoreflexia under distended bladder (at 150cc, r= - 0.196, p=0.466; at 200cc, r= -0.181, p=0.472). CONCLUSIONS: Both mean DWT of AcB/DU and detrusor normoreflexia became thinner under bladder distention. AcB/DU women had significant increase in detrusor stiffness under bladder distention. Even under thinner detrusor, there is a positive correlation between DWT and stiffness in women with AcB/DU. This finding may be explained by fibrotic changes of detrusor muscle that resulted in AcB/DU. In summary, shear wave elastography is a feasible and reliable tool for predicting AcB/DU. Source of Funding: Departmental © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e1106-e1106 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Cheng Chu More articles by this author Chih-Chieh Lin More articles by this author William J. Huang More articles by this author Alex T.L. Lin More articles by this author Expand All Advertisement PDF downloadLoading ...

Abstract MP65: Increased Sedentary Time Is Associated With Greater Postpartum Blood Pressure In Women With A History Of Preeclampsia

Introduction: Women with a history of preeclampsia (hxPE) are at a four-fold increased risk for chronic hypertension and have elevated aortic stiffness compared withhealthy pregnancy (HP). Higher sedentary time (ST) is related to higher odds of hypertension in clinic among young women regardless of the amount of moderate-to-vigorous physical activity (MVPA). As pregnancy and postpartum are uniquely vulnerable times of increased sedentary behavior, the objectives of this study were to determine whether ST is associated with higher blood pressure (BP) and aortic stiffness in women with hxPE compared with HP 1-3 years postpartum, and if change in ST from late pregnancy to postpartum is related to change in BP or aortic stiffness. Methods: Women with hxPE (N=33) and HP (N=46) completed the Pregnancy Physical Activity Questionnaire (PPAQ) 18±6 months postpartum. BP was assessed in triplicate in clinic and by 24-hour ambulatory blood pressure monitoring and aortic stiffness by carotid-femoral pulse wave velocity (CFPWV). In a subset of women (N=20), clinic BP, CFPWV and the PPAQ were previously evaluated in the third trimester. Results: Women with hxPE reported more leisure-time ST compared with HP (18 [7-19] vs 7 [5-7] MET-hr/wk, P<0.001), whereas MVPA did not differ (77 [39-106] vs 56 [35-88] MET-hr/wk, P=0.13). 24-hour ambulatory BP was higher in women with hxPE (120 [114-126] vs 114 [109-120] mmHg, P=0.049; 78 [72-82] vs 74 [70-77] mmHg, P=0.056), but CFPWV did not differ independently of BP (6.1 vs 5.5 m/s, P=0.33). Postpartum ST, but not MVPA, was associated with higher 24-hr systolic (ρ=0.24, P=0.04) and diastolic BP (ρ=0.27, P=0.02) and higher CFPWV (ρ=0.31, P=0.008) independent of body mass index. Increases in ST from late pregnancy to postpartum (0 [-3-2] ΔMET-hr/wk, P=0.22) was related to increased BP (systolic ρ=0.42, P=0.06; diastolic ρ=0.44, P=0.050) and increases in CFPWV (ρ=0.54, P=0.02) despite a reported increase in MVPA (21.5 [-0.5-63] ΔMET-hr/wk, P=0.04). Conclusions: Greater ST is related to higher BP and aortic stiffness 1-3 years postpartum, and women with hxPE report greater leisure-time ST compared with HP controls. Reduction in ST may represent an achievable interventional strategy to improve cardiovascular health in women with hxPE.

Impact of Habitual Aerobic Exercise on Arterial Stiffness in Perimenopausal Women

Arterial stiffness progressively increases with age, and is associated with increased risk of cardiovascular disease. Although postmenopausal women have higher levels of arterial stiffness than premenopausal women, recent data demonstrate elevations in arterial stiffness leading up to menopause (menopausal transition). Habitual aerobic exercise attenuates arterial stiffness in healthy postmenopausal women, however, the impact of habitual aerobic exercise on arterial stiffness in perimenopausal women (PERI) remains unclear. Purpose: To test the hypothesis that arterial stiffness would be lower in perimenopausal women that are highly active compared to those who are inactive. Methods: We classified 13 PERI using the STRAW+10 staging criteria, and grouped women by weekly aerobic exercise self-reported on a standard medical history questionnaire (HIGH: n=7, 50±2 yrs, 5±2 d/week vs LOW: n=6, 50±2 yrs, 1±1 d/week). Arterial stiffness was measured at rest via carotid-femoral pulse wave velocity (PWV, m/s), and augmentation index (AIx, %) was measured as an index of wave reflection (SphygmoCor XCEL) defined as the percentage ratio of the pressure increment caused by the reflected wave (augmentation pressure) to the pulse pressure. Student's t-Tests were used to compare arterial stiffness between highly active and inactive PERI. Data presented are mean ± standard deviation. Results: Resting heart rate (HIGH: 63±14 vs LOW: 62±4 bpm, P=0.87), mean arterial pressure (HIGH: 83±7 mmHg vs LOW: 79±9 mmHg, P=0.40), and pulse pressure (HIGH: 33±4 mmHg vs LOW: 35±4 mmHg, P=0.47) were similar between groups. Highly active PERI had lower body mass index (HIGH: 23±2 kg/m2 vs LOW: 25±2 kg/m2, P=0.04). PWV (HIGH: 6.5±0.4 m/s vs LOW: 7.1±0.6 m/s; P=0.05), AIx (HIGH: 24±9% vs LOW: 37±8%, P=0.02), and augmentation pressure (HIGH: 8±3 mmHg vs LOW: 13±4 mmHg, P=0.02) were lower in highly active PERI compared to inactive PERI. Conclusion These preliminary data suggest arterial stiffness is lower among perimenopausal women who self-report frequent engagement in aerobic exercise. Future studies using objective measures of physical activity and fitness are needed to determine the effects of habitual aerobic exercise and aerobic training interventions on arterial stiffness in women across reproductive ages, particularly throughout the menopausal transition.

FORWARD WAVE AND ITS IMPACT ON AUGMENTATION INDEX: DO GENDER DIFFERENCES EXIST?

Objective: Some studies have found that women have markedly higher aortic augmentation index (Aix) than men. Traditionally, this difference has been attributed to the early return of the reflected wave because of shorter stature and increased aortic stiffness in women. However, augmentation pressure is also affected by the shape of the forward wave. We aimed to assess the impact of gender on the association between forward aortic wave time, pressure and Aix in hypertensive patients. Design and method: 30 men and 37 women with hypertension were enrolled. Central hemodynamic was assessed using applanation tonometry method (SphygmoCor-Australia). We estimated central systolic and diastolic pressure, Aix, Aix adjusted by heart rate (Aix@75), pulse wave velocity (PWV), forward wave pressure (FWP), ejection duration (ED), time to peak forward wave (T1), time to peak systolic wave (T2) and reflected wave foot time (Tr). Results: Men and women had similar median of age (64 vs 66, p = 0.34), heart rate (77 vs 78, p = 0.40), peripheral systolic (133 vs 130mmHg, p = 0.32) and diastolic (80 vs 77mmHg, p = 0.16) pressure. Despite similar central systolic (119 vs 117mmHg, p = 0.47), diastolic (81 vs 78mmHg, p = 0.19) pressure and PWV (9.9 vs 9.4m/s, p = 0.79), women had higher Aix (33 vs 23%, p < 0.001), and Aix@75 (34 vs 26%; p < 0.001). Men and women had similar T2 and FWP, but Tr was higher in men (134 vs 130ms; p = 0.04), whereas ED (301 vs 314ms) and T1 (105 vs 109ms) – in women (p < 0.05). Tr minus T1 was higher in men (30 vs 22ms; p = 0.014). In a multivariate regression analysis in men Aix@75 was significantly associated with PWV (beta = 0.75, p = 0.005), whereas in women – with T1 (beta = 0.32, p = 0.04) and Tr (beta = 0.42, p = 0.009). Conclusions: As according to previous reports, women had higher Aix and Aix@75 and shorter time to backward wave return. However, we also found that men and women had different ejection patterns and women had higher forward wave peak time, that was significantly related to Aix@75 only in them. It may indicate that shape and time of the forward wave may also contribute to higher Aix in women compared to men.

IMPACT OF PREVIOUS HYPERTENSIVE DISORDER DURING PREGNANCY ON ANTHROPOMETRIC MEASUREMENTS, 24-HOUR BLOOD PRESSURE AND ARTERIAL STIFFNESS

Objective: Preeclampsia (PE) increased the risk of cardiovascular diseases even in women without previous arterial hypertension (AH). The possible causes include changes in metabolic profile and vascular abnormalities, such as increased arterial stiffness. We aim to compare anthropometric measurements, 24-hour blood pressure profile, and arterial stiffness in women who developed PE during pregnancy with (superimposed PE) or without (isolated PE) a previous history of AH. Design and method: We selected from registries of a tertiary hospital women with a previous pregnancy complicated by isolated PE or superimposed PE that occurred 2 to 5 years earlier. Anthropometric measurements: weight, height, body mass index – BMI and waist circumference (WC); Blood pressure (BP) measurements: office Systolic BP (SBP) and diastolic BP (DBP); 24-ambulatory BP monitoring; Arterial stiffness: pulse wave velocity (PWV) measured by Arteriograph® method. Results: Twenty-five patients were evaluated. Conclusions: Women previous superimposed PE had higher values of WC, awake SBP and PWV when compared to women with isolated PE. These results indicate incremental impairment of vascular and metabolic profile of PE on women with previous chronic AH.

Prevalence of obesity in women of different ages and its relationship with arterial stiffness

Background. General and abdominal obesity is widespread among women in the Russian population. The relationship between obesity and arterial stiffness, as a predictor of the development of cardiovascular diseases, in women of different ages remains unclear. Aims: to study the relationship between obesity and arterial stiffness and dynamics of central aortic pressure in women of different ages with preserved and lost reproductive function. Methods. 161 women were examined and divided into 3 groups. Two groups included women with preserved reproductive function: group 1 consisted of 52 young women aged from 18 to 30 years (23.8 5.3 years); group 2 included 54 women aged from 31 years to the menopause (41 5.9 years). Group 3 included 55 postmenopausal women (55.4 5.8 years). All the women underwent a clinical examination with anthropometry; questioning; 24-hour monitoring of the dynamics of blood pressure with measuring the indicators of arterial stiffness and daily aortic central pressure; determination of the carotid-femoral pulse wave velocity (cfPWV); study of vascular stiffness by volume sphygmography. Results. The anthropometric data in groups 2 and 3 were comparable in terms of the prevalence of general obesity (GO). Abdominal obesity (AO) was detected in 19.2% of the 1st group; 51.9% of the 2nd and 76.4% of the 3rd group. In the 1st group AO had the strongest correlation with the aortic pulse wave velocity PWVao (R = 0.41, p = 0.002) and the corrected to HR75 augmentation index Aixao (R = 0.38, p = 0.005). In the 2nd group AO correlates with cfPWV (R = 0.4, p = 0.003); GO with PWVao (R = 0.38, p = 0.005) and aortic cardio-ankle vascular index CAVIao (R = 0.48, p = 0.001). In the 2nd group AO and GO are also interconnected with the central and peripheral pressure. In the 3rd group AO correlates with PWVao (R = 0.33, p = 0.01), cfPWV (R = 0.32, p = 0.02); GO with the index of the double product IDP (R = 0.36, p = 0.01). Conclusions. Obesity, especially its abdominal type, is an important factor determining the development of vascular wall stiffness in women of the reproductive age. It is necessary to conduct a comprehensive assessment of arterial stiffness and daily dynamics of central aortic pressure in women of all ages, suffering from obesity and, first of all, its abdominal type, in order to early diagnose subclinical changes in the vascular wall and central hemodynamic disorders.

Abstract 15867: Flexibility Modifies the Age-related Arterial Stiffness in Women With Systemic Lupus Erythematosus

Introduction: Systemic lupus erythematosus (SLE) is an autoimmune multisystemic disease associated with premature cardiovascular disease morbidity and mortality. Arterial stiffness is an age-dependent powerful cardiovascular risk predictor, which is elevated in SLE. The elasticity of the vascular wall and muscle flexibility are both partially determined by elastin-collagen composition, and whereas cardiorespiratory fitness seems to delay the age-related arterial stiffening in SLE, it might be speculated that flexibility (another component of physical fitness) could reduce the sympathetic nervous system dysfunction observed in patients with SLE and thus reduce arterial stiffness. However, whether higher flexibility is related to lower age-related arterial stiffness in SLE is unknown. Hypothesis: We assessed the hypothesis that flexibilitymay attenuate the negative effect of age on arterial stiffness in women with SLE. Methods: This cross-sectional study included 76 women with SLE (age 43.2, SD 13.8) with mild disease activity. Arterial stiffness was assessed with pulse wave velocity (PWV), flexibility by the back-scratch test, disease activity through SLEDAI, and cumulative organ damage with SDI, blood pressure by standardized methods and menopause status by questionnaire. Quantile regression tested the association of age, flexibility, and their interaction, with PWV (controlling for mean blood pressure, menopause, SLEDAI, SDI and corticosteroids exposure). Sample size was determined for a two-tailed test with a power of 0.8, significance p < 0.05 and effect size > 0.7 (n=34). Results: There was a back-scratchхage interaction effect on PWV ( p <0.001). For women with -20 cm in the back-scratch test (i.e. short to touch her middle fingers behind the back), PWV was 0.107 m/s higher for 1-year increase in age, whereas for women with 15 cm, PVW was 0.064 m/s higher for 1-year increase in age. Conclusion: In conclusion, higher flexibility is associated with a lower increase in age-related arterial stiffness in SLE women. Further research is needed to determine whether improving flexibility through stretching exercises reduces the arterial stiffness associated with aging.

Relationship Between Hip Frontal Dynamic Joint Stiffness and Frontal and Transverse Plane Hip Kinematics During Gait: Sex Differences.

Previous studies have reported that the incidence of patellofemoral pain in women is 2.2 times higher than that in men. Lower hip frontal dynamic joint stiffness in women may be related to the magnitude of hip adduction and internal rotation associated with patellofemoral pain. To identify sex differences in hip frontal dynamic joint stiffness and examine the relationship between hip frontal dynamic joint stiffness and hip adduction and internal rotation during gait. Cross-sectional study. University campus. A total of 80 healthy volunteers (40 women and 40 men) participated in this study. Kinematic and kinetic data during gait were collected using a motion capture system and force plates. Hip frontal dynamic joint stiffness, hip adduction, and hip internal rotation were calculated during gait. Women demonstrated lower hip frontal dynamic joint stiffness than men during gait (P < .01). They also displayed decreased hip frontal dynamic joint stiffness associated with increased hip adduction (r = -.85, P < .001) and internal rotation (r = -.48, P < .001). Conversely, in men, decreased hip frontal dynamic joint stiffness was associated with increased hip adduction (r = -.74, P < .001) but not internal rotation (r = .17, P = .28). Sex differences between hip frontal dynamic joint stiffness and hip internal rotation during gait may contribute to the increased incidence of patellofemoral pain in women.

Locomotion Pattern Alters Apparent Joint Stiffness During Unloaded And Loaded Bipedal Ambulatory Tasks In Women

Soldiers often perform bipedal ambulatory tasks with load carriage. During marching they are encouraged to use a walk pattern instead of running (RN) despite translating at a velocity above their gait transition (GTV), known as forced marching (FM). Apparent joint stiffness provides an opportunity to quantify the modulation of lower extremity elasticity during dynamic activity in regard to joint loading. Moreover, joint stiffness potentially has implications on mechanical efficiency. However, little is known how load magnitude and locomotion pattern affects joint stiffness at relative velocities. PURPOSE: To determine interactive effects of load magnitude and locomotion on lower extremity joint stiffness in women. METHODS: Twelve healthy females (24.75 ± 2.17 years, 60.98 ± 9.74kg) completed 2 testing sessions collecting kinematic (100 Hz) and kinetic (1000 Hz) data. Subjects wore combat boots and a dual-sided weighted vest. Trials were conducted at body weight (BW) and loaded; +25%, +45%. At each load, 2 locomotion types (RN and FM) were performed at 10% above their GTV. Joint angles (θ) were relative and moments (M) normalized to system weight. Joint stiffness (K) [sagittal plane] calculated as ΔMjoint/Δθjoint during the braking portion of stance phase. Multifactorial RMANOVA, load by locomotion (3x2), were conducted on each K for each limb (dominant [DOM] & nondominant [NON]) separately. Bonferroni-corrected pairwise comparisons were conducted when necessary (α=p<.05). RESULTS: Kankle had a main effect of locomotion (DOM: p=.02, NON: p=.002); RN (.81 ± .22 Nm/kg/°) ~82.5% greater than FM (.14 ± .04Nm/kg/°) for both limbs. Kknee had a main effect of locomotion (DOM: p<.001, NON: p<.001); RN (.09 ± .01 Nm/kg/°) ~80.5% greater than FM (.03 ± .004 Nm/kg/°) for both limbs. For KHip had a main effect of load (NON: p=.01); +45% ~10% less than +25%. CONCLUSIONS: Ankle and knee joint stiffness were not significantly altered by changes in load magnitude, demonstrating the importance of locomotion pattern on modulating apparent joint stiffness. Unlike the ankle and knee, the hip may only mediate lower extremity stiffness with the addition of load. Greater observed joint stiffness during RN may exhibit the greater elastic energy potential that can be leveraged for energy absorption and horizontal propulsion compared to FM.

Left atrial stiffness in women with ischemia and no obstructive coronary artery disease: Novel insight from left atrial feature tracking.

BackgroundWomen with signs and symptoms of ischemia and no obstructive coronary artery disease (INOCA) are at risk of heart failure with preserved ejection fraction (HFpEF); however, the mechanism for HFpEF progression remains unclear. Studies in INOCA have largely focused on left ventricular function. The left atrium serves an important role in maintaining transmitral flow, and is impaired in HFpEF; however, it remains unclear if left atrial function is impaired in INOCA.HypothesisLeft atrial function is progressively worse in INOCA and HFpEF compared to controls.MethodsWe compared 39 reference control subjects to 64 women with INOCA and 22 subjects with HFpEF. Left atrial strain was assessed by feature tracking using magnetic resonance cine images.ResultsPeak left atrial strain was reduced in HFpEF compared to controls (22.9 ± 4.8% vs 25.9 ± 3.2%, P < .01), but similar in INOCA (24.8 ± 4.5%) compared to HFpEF and controls (P = .18). However, left ventricular end‐diastolic pressure (LVEDP) was elevated in 33% of INOCA participants, suggesting that left atrial stiffness (LVEDP/LA strain) is elevated in a large portion of women with INOCA.ConclusionsTaken together, we interpret these data to support our working hypothesis that INOCA is a pre‐HFpEF state, with left atrial stiffness preceding overt left atrial dysfunction; representing a putative therapeutic target to prevent HFpEF progression in this at‐risk population.

Effects of MTHFR genetic polymorphism on inflammatory protein osteopontin in RA patients: A gender based study in North Indian population

BackgroundRheumatoid arthritis (RA) is a systemic chronic inflammatory disease that ultimately damages bone and cartilage of joints leading to disability. Genetic polymorphism in methylene tetrahydrofolate reductase (MTHFR) gene has been identified as potential marker of susceptibility or disease severity in RA. Risk of RA is three times higher in women than men. Several cytokines and proteins play significant role in synovitis of RA patients. Osteopontin (OPN) is the pro-inflammatory cytokine reported to be associated with synovitis in RA, as it generates T-helper-1 (TH1)-mediated cellular immune response. ObjectiveTo study the impact of MTHFR gene polymorphism on the serum levels of OPN in RA patients and to investigate the cause of greater disease severity in women than men. Patients and methodsThe study included sixty RA patients (eleven men and forty-nine women) from different regions of Uttar Pradesh, North India. OPN was estimated by using enzyme-linked immunosorbent assay and other serological parameters such as Serum glutamic oxaloacetic transaminase (SGOT), Serum glutamic pyruvic transaminase (SGPT), C-reactive protein (CRP), triglycerides (TGA), cholesterol, uric acid, albumin and total protein were estimated using commercially available kits. MTHFR A1298C and C677T polymorphism was genotyped using restriction fragment length polymorphism-polymerase chain reaction (RFLP-PCR) based assays. Disease activity score and health questionnaire was assessed in all patients. ResultsMean age of patients was 44.53 ± 1.59 in women and 46.27 ± 4.22 in men with greater duration of morning stiffness in women than men. There were differences in TJC, SJC and DAS-28 score between men and women. OPN levels were found significantly higher in women than men. Other serological parameters were insignificantly higher in women than men. Genotypic study revealed that MTHFR genotypes are not associated with serum OPN levels. However, the disease activity scores (DAS-28), total joint count (TJC) and swollen joint count (SJC) were significantly associated with 1298CC genotype. Frequency distribution of MTHFR gene between men and women indicates that 1298CC genotype was more frequent in women than men and hence it might be one of the factors to cause disease severity more in women than men. ConclusionA1298C polymorphism is a predictor to the disease severity in RA patients. Patients with homozygous mutant CC genotype have a higher DAS-28 score along with TJC and SJC. The significantly higher OPN levels in female subjects suggest that disease severity is more in women than men. However, other parameters such as SGOT, SGPT, CRP, TGA, creatinine, uric acid, albumin and total protein were higher in women but the change was insignificant.

Association Between sRAGE and Arterial Stiffness in Women with Systemic Lupus Erythematosus.

sRAGE (soluble receptor for advanced glycation end products) is known to play a protective role in chronic inflammatory diseases, and has been found to be related to arterial stiffness in hypertensive or diabetic patients. This cross-sectional study was designed to study the potential association of sRAGE with arterial stiffness in systemic lupus erythematosus(SLE) patients. A total of 94 female SLE patients were enrolled. Brachial-ankle pulse wave velocity (baPWV) was measured by an automatic pulse wave analyzer. The patients were divided into two groups according to the baPWV values, those with values greater than 1400cm/s were placed in the high arterial stiffness group. Biochemical parameters were compared between the two groups. Linear and logistic regression analysis was used to observe the association between sRAGE and arterial stiffness in these patients. Thirty-five patients were placed in the high arterial stiffness group in which sRAGE levels were lower (P<0.05). sRAGE levels were significantly related to baPWV(standardized β=1.18, P<0.01) by linear regression analysis. Multivariate logistic regression analysis showed that sRAGE, SLE duration, systolic blood pressure, and low-density lipoprotein cholesterol were independent predictors of arterial stiffness in these patients. The results revealed that sRAGE was negatively associated with arterial stiffness in Chinese female SLE patients.

Depressive symptoms, its sub-factors, and augmentation index: the modifying effects according to inflammatory markers

Background This study aimed to investigate the association between depression and the augmentation index (AIx), and to further investigate whether there is a difference in this association according to the patients’ inflammatory status.Methods This study included 458 men and 815 women (mean age: 49.35 years), a community-dwelling and middle-aged Korean population. The Korean version of the Beck Depression Inventory-II (BDI-II) was used to assess depressive symptoms. Arterial stiffness was evaluated via an AIx normalized to 75 beats/min. We confirmed two factors from BDI-II after conducting a factor analysis. Multiple regression models were used after adjusting for socio-demographic factors, lifestyle factors, systolic blood pressure, diabetes history, and body mass index. We further stratified the data according to inflammatory biomarkers with cutoffs of the 75th percentile.Results There was a significant positive association between the BDI-II score and arterial stiffness (ß= 0.09, p-value=0.037). In women, the somatic-affective factor showed a stronger positive association (ß= 0.20, p-value=0.018) with arterial stiffness than the cognitive factor (ß= 0.12, p-value=0.148). There was no significant association in men (ß= -0.01, p-value=0.943). In subgroup analyses, women showed significant positive associations between the somatic affective factor of depressive symptoms on and arterial stiffness according to both inflammatory markers (IL-6: ß= 0.17, p-value=0.039; hs-CRP: ß= 0.17, p-value=0.094)Limitations The design of the cross-sectional study limits causal interpretation.Conclusion Depression and its somatic-affective factor were positively associated with arterial stiffness in women. Inflammatory status may be involved in modifying the association between depressive symptoms, its sub-factors, and AIx.

The effect of Total resistance exercise vs. aquatic training on self-reported knee instability, pain, and stiffness in women with knee osteoarthritis: a randomized controlled trial

BackgroundKnee Instability (KI) is described as a sense of knee buckling, shifting, or giving way during the weight bearing activities. High prevalence (60–80%) has been reported for KI amongst the patients with knee osteoarthritis (KOA). In this line, the present study targeted the effect of two interventions on self-reported KI and affected factors.MethodsIn this single blind, randomized, and controlled trial, 36 patients with radiographic grading (Kellgren–Lawrence ≥ II) of KOA were selected. Patients were divided into three groups namely, aquatic (n = 12), Total Resistance exercises (TRX) (n = 12) and control (n = 12) by random. Then both 8-week TRX and aquatic exercises were carried out by experimental groups. The following measure were taken before and after interventions: Pain by visual analog scale (VAS), balance by Berg Balance Scale (BBS), quadriceps strength by dynamometer, knee flexion range of motion (ROM) by inclinometer, knee stiffness with Western Ontario and McMaster Universities Osteoarthritis (WOMAC), and self-reported KI with Felson’s questionnaire.ResultsThe results demonstrated that KI, VAS, BBS improved over time both in TRX and aquatic groups significantly (p < 0.05), but WOMAC(stiffness), knee flexion ROM, and quadriceps strength were significantly improved over time only for TRX (p < 0.05). Post hoc test, also, showed that there were significant differences between interventions and control groups (p < 0.05) for the VAS, KI, BBS, but for WOMAC(stiffness), a significant difference was observed only between TRX and control groups (p = 0.05).ConclusionsAlthough TRX and aquatic interventions had a similar effect on the patients’ balance, pain and KI, TRX had more effect on WOMAC(stiffness), quadriceps strength, and knee flexion ROM than aquatic exercises.Trial registrationThis study was registered in the Iranian Clinical Trial Center with the number IRCT20181222042070N1, http://www.irct.ir/trial/36221, registered 02 February 2019.

Assessment of Risk Factors of Cardiovascular Diseases and Arterial Stiffness in Women of Different Ages

Objective:A comprehensive study of the prevalence and structure of risk factors (RF) of cardiovascular diseases (CVD), the daily dynamics of central aortic pressure and arterial stiffness in healthy women of different age groups.Materials and methods:the study involved 161 women aged 18 to 65 years with one or more CVD RF. All volunteers underwent a survey, 24-hour blood pressure monitoring with determination of arterial stiffness and daily dynamics of central aortic pressure, determination of carotid-femoral pulse wave velocity (cfPWV) and vascular stiffness by volume sphygmography.Results:the examined were divided into 3 groups: 1 group of 52 women of young age from 18 to 30 years (23.8 Ѓ} 5.3 years); 2 group of 54 women from 31 years before the onset of menopause (41 Ѓ} 5.9 years); group 3 — 54 women in the postmenopausal period (55.4 Ѓ} 5.8 years). High prevalence of modifiable CVD RF among women of various ages was revealed: smoking, non-compliance with dietary recommendations, lack of physical activity. Obstetric and gynecological pathologies prevail in younger age groups. In group 1 the studied parameters correspond to normal in most parameters. Significant differences in central and peripheral pressure, arterial stiffness indicators, with the exception of cfPWV, were identified in group 2 in comparison with young women. A comparative analysis of groups 2 and 3 showed a significant difference and worsening of indicators characterizing the degree of development of arterial stiffness, the contribution of the reflected wave and the associated dysfunction of the left ventricle.Conclusion:a comprehensive study of arterial stiffness allows you to identify subclinical changes in the vascular wall and evaluate their progression in women of different age groups.

Assessment of Risk Factors of Cardiovascular Diseases and Arterial Stiffness in Women of Different Ages

Objective: A comprehensive study of the prevalence and structure of risk factors (RF) of cardiovascular diseases (CVD), the daily dynamics of central aortic pressure and arterial stiffness in healthy women of different age groups.Materials and methods: the study involved 161 women aged 18 to 65 years with one or more CVD RF. All volunteers underwent a survey, 24-hour blood pressure monitoring with determination of arterial stiffness and daily dynamics of central aortic pressure, determination of carotid-femoral pulse wave velocity (cfPWV) and vascular stiffness by volume sphygmography.Results: the examined were divided into 3 groups: 1 group of 52 women of young age from 18 to 30 years (23.8 Ѓ} 5.3 years); 2 group of 54 women from 31 years before the onset of menopause (41 Ѓ} 5.9 years); group 3 — 54 women in the postmenopausal period (55.4 Ѓ} 5.8 years). High prevalence of modifiable CVD RF among women of various ages was revealed: smoking, non-compliance with dietary recommendations, lack of physical activity. Obstetric and gynecological pathologies prevail in younger age groups. In group 1 the studied parameters correspond to normal in most parameters. Significant differences in central and peripheral pressure, arterial stiffness indicators, with the exception of cfPWV, were identified in group 2 in comparison with young women. A comparative analysis of groups 2 and 3 showed a significant difference and worsening of indicators characterizing the degree of development of arterial stiffness, the contribution of the reflected wave and the associated dysfunction of the left ventricle.Conclusion: a comprehensive study of arterial stiffness allows you to identify subclinical changes in the vascular wall and evaluate their progression in women of different age groups.