Cardiac magnetic resonance imaging-derived pulmonary artery distensibility index correlates with pulmonary artery stiffness and predicts functional capacity in patients with pulmonary arterial hypertension
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Pulmonary wedge pressure
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The aim was to assess if computed tomography is able to measure pulmonary artery pulsatility in patients affected by chronic obstructive pulmonary disease and to ascertain whether pulsatility is different in patients with and without pulmonary hypertension and whether it is related to haemodynamics. We selected two groups of patients, the first one with pulmonary hypertension and the second one without. In patient with hypertension, pulmonary artery pressure and resistance were increased with the increased diameters (transverse 36 ± 5 mm and axial 38 ± 4 mm versus 22 ± 3 and 25 ± 5, resp.), the increased cross-sectional area (10 ± 08 versus 4 ± 1 cm 2 ), and the reduced pulsatility (21 ± 7 versus 10% ± 5%). Arterial stretching was decreased in patients with hypertension (10 ± 5 versus 21% ± 7%) and significantly related to pulmonary vascular resistances and pressure. Cardiac output measured by tomography was significantly related to that obtained by Fick method and was not different in the two groups. The diameters allow to identify patients with PH, assuming a cut-off of 28 mm and assuming a pulsatility of right branch of 26% as well. These preliminary observations indicate tomography as a suitable technique, being able to measure the pulsatility and the dimensions of the arteries and the right ventricular functional parameters.
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Primary Aldosteronism
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Background: In contrast to systemic artery, much less is known about age-related change in pulmonary artery stiffness. Pulse wave velocity (PWV) is an index for vascular stiffness. The purpose of this study is to assess pulmonary artery PWV and investigate their relations to age, body mass index (BMI), pulmonary artery systolic pressure, left ventricular (LV) diastolic pressure, and systemic artery PWV in normal subjects. Methods: Echocardiography with tissue Doppler imaging was performed in 92 normal subjects from 6 to 80 years. To measure pulmonary artery PWV, pulsed Doppler flow wave transmission time (T) between main pulmonary artery proximal (pulmonary valve) and distal point (pulmonary artery bifurcation) were measured. The distance (D) from the pulsed Doppler sample volume in the pulmonary valve to the pulmonary artery bifurcation was measured. The pulmonary artery PWV was defined as T/D. Pulmonary artery systolic pressure was calculated by use of the modified Bernoulli equation, with right atrial pressure assumed to be 10 mmHg. The ratio of early transmitral flow velocity (E) to early mitral annular myocardial velocity (Em) was used as an echocardiography-derived estimate of LV diastolic pressure. Results: Average value of pulmonary artery PWV was 179±58 cm/sec (range: 78 to 450cm/sec), in good agreement with literature values measured using invasive means. Pulmonary artery PWV did not correlate with heart rate. There were significant relationships between pulmonary artery PWV and age (r = 0.69, p < 0.01), body mass index (r = 0.46, p < 0.01), and pulmonary artery systolic pressure (r = 0.54, p < 0.01). A weak but significant relationship between systemic arterial PWV and pulmonary artery PWV was observed (r = 0.38, p < 0.01). There was no significant relationship between pulmonary artery PWV and mitral E/Em. Conclusions: We provide the first evidence of age-related increase in pulmonary artery pulse wave velocity, its association with increasing pulmonary artery systolic pressure and systemic vascular stiffening, and its negative impact on body mass index. Pulmonary artery pulse wave velocity may serve as a novel cardiovascular risk factor.
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Distensibility of large and middle size arteries is a function of major significance for the cardiovascular system. This paper will describe data obtained by measurements of local discensibihty in hypertension and other cardiovascular diseases. Isolated systolic hypertension is characterized by a diffuse reduction of arterial distensibility, while essential hypertension by a reduced distensibility in large elastic arteries, but an unchanged distensibility of middle size arteries. Other conditions associated with a marked reduction of arterial mechanical functions are familial hypercholesterolemia, the association of mild hypertension and mild hypercholesterolemia, congestive heart failure and type 1 diabetes mellitus. In most of these conditions, however, appropriate therapy is able to reverse the deranged arterial distensibility. Finally, epidemiological data suggest that it is justified to focus on pulse pressure, i. e. on an indirect indicator of a reduced arterial distensibility, when assessing the overall cardiovascular risk.
Pulse pressure
Isolated systolic hypertension
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Abstract Background and aim Spontaneous coronary artery dissection (SCAD) is a major cause of acute coronary syndrome in women aged 50 years or less (22–43%). Its etiology is still unknown, though an association with systemic diseases such as fibromuscular dysplasia and collagenopathies has been found. This study is aimed at investigating the presence of subclinical structural and functional alterations in extracoronary districts in SCAD patients. Methods The design was a case-control study. Carotid, radial and digital arteries were scanned by standard or ultrahigh frequency ultrasound; clips were analyzed by automated image analysis software for diameter, intima-media thickness (IMT) and local distensibility. Applanation tonometry was used to obtain carotid-femoral pulse wave velocity, a measure of regional, aortic stiffness, and carotid pressure waveform. Results 30 patients previously diagnosed with SCAD (27 women, age 51±10 years, 8 treated hypertensives, 4 smokers, mean BP 83±11mmHg, BMI 25±5kg/mq) and 30 controls, matched for age, sex and CV risk factors by propensity score, were enrolled. 18 SCAD patients underwent PTCA and 6 had a diagnosis of extracoronary fibromuscular dysplasia. In the left radial artery, wall thickness, cross-sectional area (2.96±1.07 vs 1.79±1.41mm2, p=0.008), and wall inhomogeneity were increased, especially in the outer layer, whereas diameter, wall/lumen ratio and distensibility were comparable to controls. In the left common carotid artery, an increased carotid stiffness was shown in SCAD (5.99±0.89 m/s vs 5.6±0.85, 0.03), while IMT tended to be increased bilaterally (0.63±0.12 vs 0.59±0.10mm, p=0.08). Aortic stiffness was similar in the two groups (7.0±1.9 vs 6.7±1.7m/s, p=0.60). Carotid (20.4±14.2 vs 11.9±15.0%, p=0.03), but not aortic augmentation index, was increased bilaterally. Conclusions SCAD patients showed a peculiar pattern of alterations in vascular remodeling and stiffness in extracoronary arterial segments such as the carotid and radial arteries, supporting the hypothesis that a systemic susceptibility is present even in the absence of systemic diseases.
Fibromuscular Dysplasia
Scad
Intima-media thickness
Subclinical infection
Lumen (anatomy)
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Introduction Both pulmonary and systemic arterial stiffening have been described in COPD. It is not currently clear whether these reflect separate disease processes within the pulmonary and systemic circulation or whether they are both due to a global arteriosclerosis. The aim of the current study is to assess arterial stiffness using pulse wave velocity (PWV) within these two arterial beds to determine whether they are separate or linked processes. Methods 58 participants with COPD underwent pulmonary function tests, six-minute walk test, and cardiac MRI (CMR), while 21 age and sex matched non-smoking healthy volunteers underwent CMR. CMR was used to quantify right and left ventricular mass and volumes, with phase contrast imaging of the main pulmonary artery and ascending and abdominal aortic aorta performed in order to calculate pulmonary (pPWV) and systemic (sPWV) arterial stiffness using pulse wave velocity (PWV). Results Compared with controls, pPWV (COPD: 2.63±1.3 ms−1 vs. HC: 1.76±0.7ms−1, p=0.006) was significantly elevated with a trend towards higher sPWV (COPD: 8.67±2.7ms−1 vs. HC: 7.35±2.1ms−1, p=0.06). pPWV showed a trend towards an association with smoking pack years (rho=0.22, p=0.053), while sPWV showed a significant association with age (rho=0.47, p Conclusion Pulmonary and systemic arterial stiffening were associated with different risk factors and are independent processes in COPD. Further work is warranted to determine if both can be targeted by similar pharmacological therapy or whether different strategies are required for both.
Arteriosclerosis
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Background: Previous studies have found interaction between lower extremity artery disease (LEAD) and systemic vascular effects. 1-3Little is known about association of LEAD and carotid artery stiffness (AS).The aim of this study is to investigate the correlation between carotid stiffness parameters, intima-media thickness (IMT) and severity of LEAD.Patients and Methods: Cross-sectional study of 120 patients with LEAD was performed (mean age 64.6 ± 8.6 years, 85 males, mean ABI 0.65 ± 0.15).The diagnosis of LEAD was defined as ABI ≤ 0.9.Patients were divided into two groups: mild LEAD (ABI from 0.9 to 0.71) and advanced LEAD (ABI ≤ 0.7).Local stiffness ß index, one-point pulse wave velocity (PWV-ß), elastic modulus (Ep), arterial compliance (AC), augmentation index (AI) and IMT were measured on common carotid artery by high-resolution ultrasonography and Echo-tracking technology.Patients with severe renal impairment and those with moderate and severe heart valve disease or reduced left ventricular ejection fraction (< 40%) were excluded from this study.
Carotid artery disease
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Objective: We suggested: 1) patients with idiopathic pulmonary hypertension (IPAH) have active factors which could damage not only the pulmonary but systemic arteries too as in arterial hypertensive patients; 2) if these changes were present, they might correlate with other parameters influencing on the prognosis. This study is the first attempt to use cardio-ankle vascular index (CAVI) for the evaluation of systemic arterial stiffness in patients with IPAH. Methods: A total of 112 patients were included in the study: group 1 consisted of 45 patients with new diagnosed IPAH, group 2 included 32 patients with arterial hypertension, and in the control group were 35 healthy persons adjusted by age. Right heart catheterization, ECG, a 6-minute walk test (6MWT), echocardiography, blood pressure (BP) measurement and ambulatory BP monitoring, pulse wave elastic artery stiffness (PWVe; segment carotid-femoral arteries) and muscular artery stiffness (PWVm; segment carotid-radial arteries), CAVI, and N-terminal pro-B-type natriuretic peptide (NT-proBNP) level were provided. The Spearman correlation, a linear regression and multivariable binary logistic analysis were performed to indicate the predictors associated with PWV and CAVI. Results: The groups were adjusted for principal characteristics influenced on arterial stiffness. IPAH patients had significantly (P< 0.001 for all) shorter 6MWT distance and higher Borg dyspnea score than the patients with arterial hypertension (systolic/diastolic BP = 146.1± 10.7/94.2± 9.8 mmHg) and the control group = 330.2± 14.6 vs 523.8± 35.3 and 560.9± 30.2 m respectively and 6.2± 1.8 vs 1.2± 2.1 and 0.9± 2.8 points. The PWVm and PWVe were the highest in hypertensive patients (10.3± 1.5 and 11.42± 1.70 m/s). The control group and IPAH did not have significant differences in aorta BP, but PWVm/PWVe values were significantly (P< 0.003/0.008) higher in IPAH patients than in the control group (8.1± 1.9/8.49± 1.92 vs 6.63± 1.34/7.29± 0.87 m/s). The CAVIs on both sides were significantly lower in the healthy subjects (5.91± 0.99/5.98± 0.87 right/left side). Patients with IPAH did not differ from the arterial hypertension patients by CAVIs in comparison with the control group (7.40± 1.32/7.22± 1.32 vs 7.19± 0.78/7.2± 1.1 PWVe) did not correlate with any parameters except uric acid. PWVm correlated with uric acid (r=0.58, P< 0.001), NT-proBNP (r=0.33, P=0.03) and male gender (r=0.37, P=0.013) at Spearman analysis, but not at multifactorial linear regression analysis. The CAVI correlated with age and parameters characterized functional capacity (6MWT distance) and right ventricle function (NT-proBNP, TAPSE) at Spearman analysis and with age and TAPSE at multifactorial linear regression analysis. At binary logistic regression analysis CAVI > 8.0 at right and/or left side had a correlation with age, 6MWT distance, TAPSE, but an independent correlation was only with age (β=1.104, P=0.008, CI 1.026– 1.189) and TAPSE (β=0.66, P=0.016, CI 0.474– 0.925). Conclusion: In spite of equal and at normal range BP level, the age-adjusted patients with IPAH had significantly stiffer arteries than the healthy persons and they were comparable with the arterial hypertensive patients. Arterial stiffness evaluated by CAVI correlated with age and TAPSE in IPAH patients. Based on our results it is impossible to conclude the pathogenesis of arterial stiffening in IPAH patients, but the discovered changes and correlations suggest new directions for further studies, including pathogenesis and prognosis researches. Keywords: idiopathic pulmonary arterial hypertension, systemic arterial stiffness, functional capacity, pulse wave velocity, cardio-ankle vascular index
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Aim. To investigate the relationship between changes in indicators of arterial stiffness of various types of vessels, hemodynamic pulsatility, renal function and renal blood flow in patients with coronary artery disease (CAD) and arterial hypertension in the presence or absence of type 2 diabetes mellitus (T2DM). Materials and Methods. The study included 96 patients with CAD and arterial hypertension; among them, 54 subjects had T2DM and 42 did not. Сarbohydrate and lipid metabolism, renal function, stiffness of various types of arteries, parameters of hemodynamic pulsatility and renal blood flow were investigated. Results. Arterial stiffness of various types of vessels was increased in the T2DM group: carotid?femoral pulse wave velocity as a marker of aortic stiffness (a vessel of the elastic type) was increased by 16% (p
Essential hypertension
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