Stiffness Index In Patients Research Articles

Динамика индекса сосудистой жесткости START у пациентов с ишемической болезнью сердца после коронарного шунтирования

Aim: this study aims to assess the alterations in the START vascular stiffness index and identify potential risk factors influencing these changes in patients with coronary artery disease (CAD) one year following coronary artery bypass grafting (CABG). Patients and Methods: the study included patients with CAD who underwent CABG at the Research Institute of Complex Problems of Cardiovascular Diseases in Kemerovo. Preoperative measurement of peripheral artery stiffness was performed using the VaSera VS-1000 sphygmograph (Fukuda Denshi, Japan). The cardio-ankle vascular index (CAVI) and the novel domestic haSTART arterial stiffness index were determined using brachial-ankle pulse wave velocity (baPWV). These measurements were repeated one-year post-CABG, and the changes were analyzed. The final cohort consisted of 197 patients, divided into two groups: group I included patients with a reduction in the haSTART index (n=107), while group II comprised those with an increase (n=90). Results: the mean patient age was 59.4±8.3 years. Group II had a higher percentage of male patients (82.2% vs. 68.2%, p=0.024). Psychological distress predisposition was observed in 32.7% of group I and 52.2% of group II (p=0.006). Calcium channel blocker use was noted in 26.2% of group I versus 12.2% in group II (p=0.013). Group I also had a higher overall number of consultations during the follow-up period (p=0.013). Significant increases in baPWV and CAVI were found in group II (p<0.001). Factors associated with an increased haSTART index at one-year post-surgery included age (r=0.407, p<0.001), diabetes mellitus (r=0.181, p=0.048), multifocal atherosclerosis (r=0.145, p=0.04), heart failure (r>0.217, p=0.009), a higher CABG risk according to EuroSCORE (r≤0.30, p<0.001), and a predisposition to psychological distress (r=0.171, p=0.02). Conclusion: time-domain measurement of vascular stiffness via the haSTART index is valuable for assessing treatment efficacy and provides crucial prognostic information for patients with CAD in clinical settings. KEYWORDS: START index, vascular stiffness, vascular wall stiffness, coronary artery disease. FOR CITATION: Shcheglova A.V., Sumin A.N., Barbarash O.L. Changes of the START vascular stiffness index in patients with coronary artery disease after coronary bypass surgery. Russian Medical Inquiry. 2024;8(7):366–374 (in Russ.). DOI: 10.32364/2587-6821-2024-8-7-1.

The effect of SGLT2 inhibitors, GLP1 agonists, and their sequential combination on cardiometabolic parameters: A randomized, prospective, intervention study

BackgroundPulse wave velocity (PWV) and augmentation index (AIx) are indices used to assess arterial stiffness. We aim to compare the effect of empagliflozin, liraglutide and their sequential combination on arterial stiffness indices in patients with type 2 diabetes (T2D). MethodsThis was a randomized single blind study evaluating the effect of empagliflozin vs liraglutide in adult patients with T2D. Patients were randomized to liraglutide titrated gradually to 1.8 mg or empagliflozin 25 mg in 1:1 ratio. Three months later empagliflozin was added to the liraglutide group, and liraglutide was added to the empagliflozin group. Patients were assessed with non-invasive tests for arterial stiffness (i.e., carotid-femoral PWV and AIx of aortic pressure) at baseline, 3-month and 9-month visits (final visit was extended for 3 months from the initial design due to Covid 19 pandemic). The primary outcome was the between-group difference of PWV change (ΔPWV) and ΔAIx at 3 months. Secondary outcomes included the between-group difference of ΔPWV and ΔAIx at 9 months, as well as the ΔPWV and ΔAIx between baseline and 9-month visit when total study population was assessed. ResultsA total of 62 patients with T2D (30 started liraglutide; 32 empagliflozin, mean age 63 years, 25 % with established cardiovascular disease) participated in the study. We failed to show any significant between-group differences of ΔPWV and ΔΑΙx at 3 and 9 months, as well as between-group difference of ΔPWV and ΔAIx for the total study population between baseline and 9-month visit. In contrast, systemic vascular resistance and lipoprotein(a) levels improved, showing better results with liraglutide than empagliflozin. Favorable effects were also observed on body weight, body mass index, body and visceral fat, blood pressure, HbA1c, and uric acid levels. ConclusionNo evidence of a favorable change in arterial stiffness indices was seen with empagliflozin or liraglutide or their combination in this study. Well-designed powerful studies are needed to address any potential effects on arterial stiffness in selected populations.

Prognostic Implications of Left Atrial Stiffness Index in Heart Failure Patients With Preserved Ejection Fraction

BackgroundThe left atrium (LA) plays an important role in the pathophysiology and disease progression of heart failure with preserved ejection fraction (HFpEF). ObjectivesThis study sought to assess the prognostic potential of LA stiffness index in patients who have HFpEF. MethodsThis study retrospectively screened patients with elevated left ventricular end-diastolic pressure (≥16 mm Hg) and preserved ejection fraction (≥50%) between January 1, 2004, and December 31, 2019. All patients underwent left heart catheterization to measure left ventricular end-diastolic pressure. Among these, 307 patients who had suitable image quality for left peak atrial longitudinal strain (PALS) measurement were analyzed. The study population was classified into low LA stiffness (n = 178, early diastolic transmitral inflow velocity/mitral annulus early diastolic velocity [E/e′]/PALS ≤0.26) and high LA stiffness (n = 129, E/e′/PALS >0.26) according to the best LA stiffness index (E/e′/PALS) cutoff value. The primary outcome was a composite of mortality or hospitalization caused by heart failure during follow-up. ResultsLA stiffness index showed good correlations with E/e′ (r = 0.737; P < 0.001), LA volume index (r = 0.529; P < 0.001), right ventricular systolic pressure (r = 0.404; P < 0.001), and log N-terminal pro–B-type natriuretic peptide (r = 0.540; P < 0.001). LA stiffness index demonstrated better predictive performance than echocardiographic diastolic parameters did (P < 0.001). Patients with low LA stiffness had better clinical outcomes than those with high LA stiffness during a median follow-up of 6 years did (P < 0.001). In multivariable analysis, LA stiffness index was independently associated with increased risk of the composite endpoint of death or heart failure hospitalization (HR: 1.59 [95% CI: 1.01-2.51]; P = 0.044). ConclusionsIncreased LA stiffness was associated with increased risk for all-cause mortality and hospitalization caused by heart failure in patients who have HFpEF, and its prognostic role was more pronounced than that of indexes of left ventricular filling pressure.

ARTERIAL STIFFNESS INDICATORS OF CARRIERS OF NOS2 GENE DIFFERENT ALLELIC VARIATIONS IN ARTERIAL HYPERTENSION

Arterial stiffness indicators (reflected wave propagation time (RWTT), aortic pulse wave velocity (PWV), arterial stiffness index (ASI), augmentation index (AIx)) were assessed in healthy people and patients with arterial hypertension with different allelic variants of the NOS2 gene (rs1730017 (C&gt;T), rs1800482 (G&gt;C)). We examined healthy individuals (64 people, age 38.58 ± 2.19 years, 28 men and 36 women) and patients with AH (stage I-II) (36 people, age 38.04 ± 1.20 years , 20 men and 16 women). In the group of patients with AH, differences in ASI values between carriers of the T allele and CC genotype of rs1730017 (p = 0.036) and daily average AIx, AIx daily values in individuals with GG and GC + CC genotypes rs1800482 (G&gt; C) were revealed (p = 0.049, p = 0.017, respectively). In the group of healthy people, a significant increase in daily AIx was found in carriers of the C allele at rs1800482 (p = 0.048). Carriage of the T allele by rs1730017, for which a protective effect on the development of AH has been previously shown, causes lower values of the arterial stiffness index in patients with this disease. The presence of the C allele of by rs1800482 in the genotype of healthy and sick people, associated with an increased risk of hypertension, is probably one of the reasons for the increase in AIx, as one of the indicators of arterial stiffness.

The central arterial stiffness parameters in decompensated versus compensated states of heart failure: a paired comparative cohort study

BackgroundArterial stiffness is strongly linked to the pathogenesis of heart failure and the development of acute decompensation in patients with stable chronic heart failure. This study aimed to compare arterial stiffness indices in patients with heart failure with reduced ejection fraction (HFrEF) during the acute decompensated state, and three months later after hospital discharge during the compensated state.ResultsOne hundred patients with acute decompensated HFrEF (NYHA class III and IV) and left ventricular ejection fraction ≤ 35% were included in the study. During the initial and follow-up visits, all patients underwent full medical history taking, clinical examination, transthoracic echocardiography, and non-invasive pulse wave analysis by the Mobil-O-Graph 24-h device for measurement of arterial stiffness. The mean age was 51.6 ± 6.1 years and 80% of the participants were males. There was a significant reduction of the central arterial stiffness indices in patients with HFrEF during the compensated state compared to the decompensated state. During the decompensated state, patients presented with NYHA FC IV (n = 64) showed higher AI (24.5 ± 10.0 vs. 16.8 ± 8.6, p < 0.001) and pulse wave velocity (9.2 ± 1.3 vs. 8.5 ± 1.2, p = 0.021) than patients with NYHA FC III, and despite the relatively smaller number of females, they showed higher stiffness indices than males.ConclusionsCentral arterial stiffness indices in patients with HFrEF were significantly lower in the compensated state than in the decompensated state. Patients with NYHA FC IV and female patients showed higher stiffness indices in their decompensated state of heart failure.

Comparing the central arterial stiffness indices in the decompensated and compensated states of heart failure: a cohort study

Abstract Background Arterial stiffness is strongly linked to the pathogenesis of heart failure (HF), and development of acute decompensation of patients with stable chronic HF. Purpose To compare the arterial stiffness indices in patients with heart failure with reduced ejection fraction (HFrEF) during hospitalization with acute decompensated state, and then three months later after discharge during the compensated state. Methods One hundred patients with acute decompensated HFrEF (NYHA class III and IV) and left ventricular ejection fraction (LVEF) ≤35% were included in the study. Fifty-six patients (56%) had ischemic cardiomyopathy (ICM) and the rest had dilated cardiomyopathy (DCM). During the initial and follow up visits, all patients were subjected to full medical history taking, clinical examination, electrocardiography (ECG), transthoracic echocardiography (TTE), routine labs and non-invasive pulse wave analysis (PWA) by the Mobil-O-Graph 24h PWA device for measurement of arterial stiffness parameters. Results The mean age was 51.6±6.1 years and 80% were males. There was a significant reduction of the central arterial stiffness indices in patients with HFrEF during the compensated state as compared to their decompensated state values, table (1). During the decompensated state, patients with ICM showed a significantly higher PWV as compared to patients with DCM (9.2±1.1 vs 8.6±1.4 m/sec, P=0.042), patients presented with NYHA FC IV (n=64) showed higher AI (24.5±10.0 vs 16.8±8.6, p&amp;lt;0.001) and PWV (9.2±1.3 vs 8.5±1.2, p=0.021) than patients with NYHA FC III, and despite the relatively smaller number of females, they showed higher stiffness indices than males, table (2). Conclusion Central arterial stiffness indices derived from the non-invasive Mobil-O-Graph 24h PWA device in patients with HFrEF were significantly lower in the compensated state as compared to the decompensated state. Patients with ICM, NYHA FC IV and females showed higher stiffness indices in their decompensated state of heart failure. Funding Acknowledgement Type of funding sources: None.

The Relationship of Modifiable Risk Factors with Indicators of Arterial Stiffness and Vascular Age in Patients with Arterial Hypertension

Aim. To study the relationship of modifiable risk factors (RF) with indicators of arterial stiffness and vascular age based on the contour analysis of the pulse wave velocity in hypertensive patients.Material and methods. The material of the study was the data from a survey of patients undergoing clinical observation at the polyclinic of MMC SOGAZ. A total of 107 patients were examined, in which 70 were men and 37 were women. The average age was 52.3±18.29. Photoplethysmography was used as a special research method, performed using the AngioScan-01 diagnostic complex. The main indicators used to evaluate the stiffness of large vessels were: stiffness index (SI), reflection index (RI), augmentation index (Alp75), age index (AGI), pulse wave types (PV) and vascular age (VA).Results. The mean values of arterial stiffness indices in patients with essential arterial hypertension (AH) and healthy individuals (control) had significant differences. The mean SI, Alp75, and VA values in the group of patients with AH were 7.8±1.03, 7.0±14.44 and 50.8±15.93 versus 7.2±1.73, 0.5±18.02 and 43.8±16.94, respectively (p&lt; 0.05). In both groups, a strong inverse correlation of passport age with C-type PV was revealed (r=0.74, p&lt; 0.01), which reflected the dynamics of a gradual age-dependent decrease in vascular compliance. The average VA value in the control group was 63.1±16.99 years with an average passport age of 59.5±8.79 years, which significantly differed from VA in hypertensive patients (p&lt; 0,05). Overweight, hypercholesterolemia, elevated low-density lipoprotein levels, lack of adequate antihypertensive control, and left ventricular diastolic dysfunction were significantly associated with early vascular (arterial) aging.Conclusion. Patients with hypertension, in addition to high blood pressure, significantly differ from normotensive control in terms of arterial stiffness. The lack of control over modifiable RF of patients with hypertension is associated with early vascular aging.

Quality of life and arterial stiffness indices in patients with chronic limb-threatening ischemia

Quality of life and arterial stiffness indices in patients with chronic limb-threatening ischemia

Biomechanical Properties of Common Carotid Arteries Assessed by Circumferential 2D Strain and β Stiffness Index in Patients With Ankylosing Spondylitis.

Ankylosing spondylitis (AS) is associated with an elevated risk of cardiovascular disease (CVD) related to atherosclerosis, preceded by arterial stiffness. We aimed to examine common carotid artery (CCA) biomechanical properties using ultrasound to calculate β stiffness index (indicating arterial stiffness) and, a more recently developed technique, 2-dimensional (2D) speckle tracking strain (indicating arterial motion and deformation, strain) to (1) compare with age- and sex-matched controls, and (2) analyze relationships between strain and stiffness with disease characteristics and traditional risk factors for CVD in patients with AS. In this cross-sectional study, a cohort of 149 patients with AS, mean age 55.3 ± 11.2 years, 102 (68.5%) men, and 146 (98%) HLA-B27-positive, were examined. Bilateral CCA were examined for circumferential 2D strain and β stiffness index. A subgroup of 46 patients was compared with 46 age- and sex-matched controls, both groups without hypertensive disease, diabetes, myocardial infarction, or stroke. Mean bilateral circumferential 2D strain was lower in AS patients compared with controls (7.9 ± 2.6% vs 10.3 ± 1.9%, P < 0.001), whereas mean bilateral β stiffness index was higher (13.1 ± 1.7 mmHg/mm vs 12.3 ± 1.3 mmHg/mm, P = 0.02). In multivariable linear regression analyses, strain was associated with age, erythrocyte sedimentation rate, history of anterior uveitis, and treatment with conventional synthetic disease-modifying antirheumatic drugs (DMARD) and/or biological DMARD (R2 0.33), while stiffness was associated with age (R2 0.19). Both CCA circumferential 2D strain and β stiffness index differed between patients with AS and controls. Strain was associated with AS-related factors and age, whereas only age was associated with stiffness, suggesting that the obtained results reflect different pathogenic vascular processes.

A cross-sectional study of the ambulatory central artery stiffness index in patients with hypertension.

The present study aimed to investigate the characteristics of the ambulatory central artery stiffness index (AcASI) and its related factors. The association between AcASI and the left ventricular mass index (LVMI), and other factors related to atherosclerosis were explored.Patients with primary hypertension were enrolled into this study. Ambulatory central artery blood pressure (CABP) and ambulatory brachial artery blood pressure (BABP) were assessed using a Mobil-O-Graph NG hemomanometer, whereas AcASI and the ambulatory arterial stiffness index (AASI) were determined. LVMI was assessed by echocardiography.A total of 136 patients with primary hypertension were enrolled from May 2011 to January 2013 in Beijing Hospital. AcASI was significantly associated with AASI (r = 0.879, P < .001). AcASI was significantly lower than AASI (0.422 ± 0.302 vs 0.482 ± 0.270; P < .001). AcASI increased with age, ambulatory brachial mean blood pressure (MBP), and fasting glucose. AcASI was significantly associated with office pulse pressure (PP), ambulatory brachial PP, ambulatory central PP, and pulse wave velocity (PWV). AcASI, but not AASI, was significantly associated with LVMI. Receiver operator characteristic analysis indicated that AcASI and AASI could may be a predictor of left ventricular hypertrophy (LVH). Multiple regression analysis indicated that AcASI, chronic kidney disease, and hypertension course were associated with LVMI, but AASI was not.AcASI, which is obtained from ambulatory CABP monitoring, could be a new marker for the evaluation of atherosclerosis. AcASI may be stronger associated with LVH than AASI.

Increased aortic stiffness index in patients with type 1 diabetes without cardiovascular disease compared to controls.

Increased arterial stiffness is an early sign of endothelial dysfunction. Nevertheless, measures of the elastic properties of the aortic root in patients with type 1 diabetes are still lacking. The aim of this study was to compare aortic root stiffness index in type 1 diabetes and healthy controls. Ninety-three patients with type 1 diabetes without cardiovascular diseases were recruited and compared to 33 healthy controls. Aortic root elastic properties were estimated by measuring the systolic and diastolic diameters on M-mode acquisition. None of the subjects showed alterations of either systolic or diastolic echocardiographic parameters. Patients with type 1 diabetes had a very low prevalence of chronic complications and their metabolic control was good. Significantly increased aortic stiffness index was found in type 1 diabetes compared to controls, and the same different pattern was found in men and women. The presence of type 1 diabetes and increased pulse pressure was significantly associated with aortic stiffness index in a multivariate linear analysis. This study strongly suggests that patients with type 1 diabetes develop aortic root stiffness in the absence of cardiovascular diseases. This alteration may be part of a more generalized arterial dysfunction in type 1 diabetes.

The evaluation of left ventricle stiffness index in patients suffering from hypertension

Many diseases can produce cardiac overload, of these disease hypertension, valve disease congenital anomaly in addition to many other disease. One of the most common diseases causing left ventricle overload is hypertension. A long term hypertension can cause myocardium hypertrophy leading to changes in the cardiac contractility and reduced efficiency. The investigations were carried out using conventional echocardiography techniques in addition to the tissue Doppler imaging (TDI) from which many noninvasive measurements can be readily obtained. The study has involved the effect of hypertension on the myocardium stiffness index through the measurement of early diastolic filling (E) and the early velocity of lateral mitral annulus (Ea) from which left ventricle filling pressure can be obtained. Our aim was to investigate the changes in the myocardium index of diastolic stiffness using TDI for patients suffering from systemic hypertension. We studied 263 hypertensive patients (105 males and 158 females of average age of 54.07± 12.7) and 166 healthy subjects (age range 40.06± 12.8,53 males and 113 females) as a control group. Measurements were carried out using tissue Doppler imaging (TDI) of the mitral annulus in addition to other echocardiographic measurements for the assessment of left ventricle end diastolic dimension (LVEDD), Doppler peak early (E) and late (A) diastolic filling velocities. Results reveal that mitral annular early diastolic velocity (Ea) measured by TDI, that (Ea) was significantly lower for the hypertensive group in comparison with the control group (Ea 9.81 ± 2.87 cm/s for hypertensive vs. 12.90 ± 2.395 cm/s for control p value &lt;0.001. Hypertensive group also showed a significantly higher mitral annular late diastolic velocity (Aa) in comparison with control group as Aa 11.21 ± 2.504 cm/s for hypertensive vs. 9.787 ±2.201cm/s for control, p value &lt;0.001.. In conclusion, LV myocardial diastolic stiffness index is increased in hypertensive patients.

A2459 Ambulatory Arterial Stiffness Index in Patients with Hypertension and Rheumatoid arthritis

A2459 Ambulatory Arterial Stiffness Index in Patients with Hypertension and Rheumatoid arthritis

Segmental aortic stiffness in patients with bicuspid aortic valve compared with first-degree relatives.

To compare the stiffness index in patients with bicuspid aortic valve (BAV) with first-degree relatives at each segment of the thoracic ascending aorta and to compare segmental analysis of aortic stiffness in association with BAV morphotype and function. 219 patients with BAV and 148 first-degree relatives (without BAV) were consecutively included at a reference centre for BAV. Ultrasound assessment of aortic and carotid stiffness was based on the variation of the segmental arterial diameters during the cardiac cycle and on blood pressure. Without adjustment, the ascending aorta of patients with BAV seemed stiffer at each segment compared with controls (stiffness index at the sinus of Valsalva: 17.0±10.9 vs 8.9±6.1, p<0.001; tubular aorta: 20.4±31.3 vs 12.7±4.8, p=0.04). However, after adjustment on aortic diameter and age, only the sinus of Valsalva remained stiffer (p<0.001), whereas the tubular aorta no longer differed (p=0.610). In patients with BAV, aortic diameters were not influenced by the valve morphotype, except for the arch, which was more dilated in the case of 1- Non coronary sinus-Right subtype of BAV : 36.1 vs 27.6 mm, p<0.001. Aortic regurgitation was associated with an increase in aortic diameters at the sinus of Valsalva (p<0.001) and the tubular aortic levels (p=0.04). Stiffness increase at the sinus of Valsalva level is independent of aortic dilatation in patients with BAV, contrary to the classic relationship between stiffness and dilatation found on the other segments. The relationship between stiffness and clinical impact needs to be assessed at each aortic segment.

The Use of the Ambulatory Arterial Stiffness Index in Patients Suspected of Secondary Hypertension.

The ambulatory arterial stiffness index (AASI) is a marker of arterial stiffness and is derived from ambulatory 24-h blood pressure registration. We studied whether the AASI could be used as a predictive factor for the presence of renal artery stenosis (RAS) in patients with a suspicion of secondary hypertension and as such as a diagnostic tool for RAS. We included 169 patients with difficult-to-treat hypertension. They all underwent 24-h ambulatory blood pressure monitoring registration, imaging of the renal arteries, and cardiovascular risk measurement, including smoking, history, biometrics, blood pressure, renal function, lipids, and glucose metabolism. Performing univariate and multivariate analyses, we investigated if AASI and the other cardiovascular risk factors were related to the presence of RAS. Of the 169 patients (49% women), 31% had RAS. The mean AASI was 0.44 (0.16). The presence of RAS showed no significant correlation with AASI (r = 0.14, P = 0.06). Age (r = 0.19, P = 0.01), hypercholesterolemia (r = 0.26, P = 0.001), history of CVD (r = 0.22, P = 0.004), and creatinine clearance (r = −0.34, P < 0.001) all demonstrated a correlation with RAS. Although AASI is higher in patients with RAS, AASI does not independently predict the presence of RAS in hypertensive subjects.

Cardiovascular alterations do exist in children with stage-2 chronic kidney disease.

Cardiovascular disease (CVD) is an important complication of chronic kidney disease (CKD) in children. However, it is not well known when and how cardiovascular alterations start. This cross-sectional, controlled study consisted of 25 patients and 28 healthy controls. 24-h ambulatory blood pressure monitoring, aortic pulse wave velocity (aPWV), carotid intima-media thickness (cIMT) and carotid distensibility (distensibility coefficient and β stiffness index), and echocardiography were assessed to evaluate CVD. Routine biochemical parameters, fibroblast growth factor-23 (FGF23) and high sensitive C- reactive protein were measured to determine cardiovascular risk factors. Hypertension was found in 12 patients (48%). Patients had higher FGF23 levels and aPWV-standard deviation score (SDS) as compared to the controls (p=0.003 and p=0.002, respectively). Aortic PWV-SDS was predicted by increased daytime systolic blood pressure load (β=0.512, p=0.009, R 2=0.262). Neither cIMT nor distensibility differed between the groups; however, older age and high level of FGF23 were independent predictors of β stiffness index in patients (β=0.507, p=0.005, R 2=0.461 and β=0.502, p=0.005, R 2=0.461, respectively). As compared to controls, patients had worse left ventricular diastolic function [lower E/A ratio p=0.006) and increased left atrial dimension (p<0.001)]. Cardiovascular deteriorations appear in children with stage-2 CKD. Good control of BP and decreasing the level of FGF23 may be useful to slow down the progression of cardiovascular complications.

Evaluation of the ambulatory arterial stiffness index in patients with rheumatoid arthritis.

Patients with rheumatoid arthritis (RA) are at a higher risk of arterial disease, endothelial dysfunction, and vascular inflammation than the general population. Therefore, these patients are prone to decreased arterial compliance and increased arterial stiffness. Ambulatory arterial stiffness index (AASI) was introduced as an index that predicts cardiovascular risk. In this study, the AASI was evaluated in RA patients. Thirty-three RA patients and 33 healthy age-matched and sex-matched individuals were evaluated according to the 24 h blood pressure (BP) profiles. The regression slope of diastolic over systolic BP was computed for each participant. AASI was defined as 1- regression slope. There was no significant difference in terms of the basic demographic characteristics, and average day, average night, and total average BP profiles as well as dipper status among the two groups. AASI was 0.45±0.12 and 0.38±0.10 in the RA patients and the healthy controls, respectively (P=0.019). AASI was not significantly different in women and men in both the groups. AASI was significantly higher in nondippers compared with dippers in the entire group and the RA group, but not in the control group. Independent predictors that were found to affect AASI in RA patients were age, nondipper status, VAS score, DAS28 score, and rheumatoid factor positivity. AASI is higher in RA patients compared with healthy individuals. When the prognostic significance of AASI is considered, RA patients with higher AASI should be followed closely for future adverse cardiovascular outcomes.

Left Atrial Longitudinal Strain: Early Alterations in Young Patients with Mild Hypertension

mtsAc Objectives The aim of this study was to evaluate early changes in left atrial longitudinal strain based on speckle tracking and the atrial stiffness index in patients with mild hyper- tension. Methods One hundred and one patients, between 30 to 50 years of age, were prospectively enrolled in the study: 32 healthy sedentary patients (Group 1), 35 healthy recrea- tional athletes (Group 2) and 34 controlled hypertensive patients (Group 3). Sixty eight patients were men (67.3%). Conventional echocardiographic assessments were performed, color tissue Doppler and lateral and septal pulsed tissue Doppler were re- corded and atrial volume was calculated. Left ventricular strain and strain rate and left atrial peak strain during the reservoir period were obtained by speckle tracking. The atrial stiffness index was calculated based on the (E/e)/ peak atrial strain ratio. Data was analyzed using ANOVA followed by the Bonferroni test. A p value <0.01 was considered statistically significant. Results The E/A ratio and the tissue e wave velocity were higher and the E/e ratio was low- er in the athlete group. Left ventricular mass index did not show statistical differ- ences among groups. Left atrial volume was higher in athletes without attaining significant difference. In hypertensive patients, atrial strain was lower (36.94 ± 7.71 vs. 46.17 ± 10.05 in Group1 and 46.80 ± 8.44 in Group 2; 95% CI 3.96-14.47; p < 0.0001) and the stiffness index was higher (30.49 ± 11.93 vs. 19.94 ± 8.12 in Group 1 and 18.99 ± 5.88 in Group 2; 95% CI 5.05-16.05; p < 0.0001). Conclusions Left atrial longitudinal strain during the reservoir period and the atrial stiffness index are altered in patients with mild controlled hypertension before the detection of other echocardiographic changes.

Arterial stiffness of peripheral vasculature in patients with chronic obstructive pulmonary disease and its association with arterial hypertension

Aim. To study the structural and functional state of vascular wall, arterial stiffness of large peripheral arteries (common carotid arteries, renal arteries) in patients with severe chronic obstructive pulmonary disease and its association with arterial hypertension. Methods. The study included 67 patients of working age, mainly males, having chronic obstructive pulmonary disease. Among them, 52 patients had severe chronic obstructive pulmonary disease (defined by GOLD III, 2011), 15 had concomitant arterial hypertension of I and II stage. Structural and functional status of common carotid arteries, renal arteries was assessed by measurement of intima-media thickness, arterial stiffness indexes were calculated. Arterial elasticity indices: arterial compliance, elastic index, Young’s elastic modulus were calculated based on the results of ultrasonography of main arterial wall parameters (diameter, arterial wall thickness) and blood pressure measurement. Results. A decrease in common carotid arteries and renal arteries wall elasticity was revealed in patients with chronic obstructive pulmonary disease. Increase of stiffness index in patients with severe chronic obstructive pulmonary disease associated with arterial hypertension, marking the decreased arterial wall elasticity, was registered both in common carotid arteries and renal arteries. Conclusion. In common carotid arteries vascular wall thickness contribute the most in vascular wall stiffness increase, compared to altered hemodynamics in renal arteries. Development of arterial hypertension in these patients is a predicting factor for further large vessel remodeling associated with hypoxia.

Macrophage migration inhibitory factor is associated with vascular dysfunction in patients with end-stage renal disease

BackgroundPatients with end-stage renal disease (ESRD) show a high prevalence of cardiovascular disease with arterial stiffness, atherosclerosis and endothelial dysfunction, leading to increased morbidity and mortality. The cytokine macrophage migration inhibitory factor (MIF) exhibits proinflammatory and proatherogenic functions and has recently emerged as a major regulator of atherogenesis. Studies examining the relationship between circulating MIF levels and vascular dysfunction in this high-risk population do not exist. MethodsIn patients with ESRD (n=39) and healthy controls (n=16) we assessed endothelial function by flow-mediated dilation of the brachial artery and arterial stiffness (augmentation pressure, augmentation index and pulse pressure) using applanation tonometry. High-sensitive Troponin and subendocardial viability ratio were determined to assess myocardial injury. ResultsPatients with ESRD had impaired endothelial function and higher plasma MIF levels. MIF levels negatively correlated with endothelial function (r=−0.345, P=0.031) and positively with arterial stiffness indices in patients with ESRD (pulse pressure r=−0.374, P=0.019 and augmentation pressure r=−0.423, P=0.025). In multivariate regression models besides age, gender, weight, and heart rate, MIF was an independent predictor for arterial stiffness. Impact on myocardial end-organ damage was reflected by correlation with high-sensitive Troponin I (r=0.43, P=0.009). ConclusionOur findings show that high MIF plasma levels are associated with diminished endothelial function and arterial stiffness and are correlated with myocardial injury. Further studies are necessary to investigate whether modulation of MIF might have an impact on atherosclerotic disease in this high-risk population.