Figure - available from: Journal of Cardiovascular Translational Research
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Relationships among cardiovascular risk factors and aortic and diastolic function. Previous RA and non-RA studies revealed that traditional cardiovascular disease risk factors and systemic inflammation can impact aortic and diastolic function (dashed arrows). Non-RA investigations also documented that pulse wave velocity and wave reflection associate with diastolic function parameters but this relationship was mostly mediated by pulsatile pressure. In the present RA study (solid arrows), we found that pulse wave velocity is directly associated with increased left ventricular filling pressure, independent of pulsatile pressure as well as traditional cardiovascular risk factors and inflammatory markers. Additionally, early return of the reflected wave and forward wave pressure were related to impaired left ventricular relaxation independent of pulsatile pressure, pulse wave velocity, inflammation and traditional cardiovascular risk factors. Our results suggest that arterial dysfunction may exacerbate diastolic dysfunction directly through impaired ventricular-arterial coupling. CVD, cardiovascular disease; LV, left ventricular; RA, rheumatoid arthritis
Source publication
Rheumatoid arthritis (RA) impacts arterial and diastolic function. This study examined whether arterial properties can determine diastolic function in RA. In 173 RA patients, arterial function measures including carotid femoral pulse wave velocity (PWV), central systolic and pulse pressure, pulse pressure amplification, and the magnitude and timing...
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Study objectives
Lifestyle changes decrease blood pressure (BP) levels by 3-5 mmHg in hypertensive patients. We assessed the effect of mid-day sleep on BP levels in hypertensive patients.
Methods
We prospectively studied two hundred and twelve hypertensive patients. Mid-day sleep duration (minutes), lifestyle habits, anthropometric characteristics...
Citations
... Ikdahl et al. showed significant correlations of both cfPWV (p < 0.001) and AIx (p = 0.04) with CVD in 138 RA patients [56]. Arterial stiffness was also found to be associated with cardiac involvement in RA, as cfPWV correlated with increasing filling pressure and impaired relaxation of the left ventricle [84]. Moreover, AIx (r = 0.334, p = 0.009) and cfPWV (r = 0.360, p = 0.005) were found to correlate with a higher myocardial performance index (a marker for cardiomyopathy) in a study of 40 RA patients evaluated for left ventricle dysfunction in the context of the disease [64]. ...
The increased cardiovascular (CV) risk among patients with autoimmune rheumatic diseases, such as arthritides and connective tissue diseases, has been extensively documented. From a pathophysiological standpoint, systemic inflammation in the context of the disease can lead to endothelial dysfunction, accelerated atherosclerosis, and structural changes in vessel walls, which, in turn, are associated with exaggerated CV morbidity and mortality. In addition to these abnormalities, the increased prevalence of traditional CV risk factors, such as obesity, dyslipidemia, arterial hypertension, and impaired glucose metabolism, can further worsen the status of and overall prognosis for CV in rheumatic patients. However, data on appropriate CV screening methods for patients with systemic autoimmune diseases are scarce, and traditional algorithms may lead to an underestimation of the true CV risk. The reason for this is that these calculations were developed for the general population and thus do not take into account the effect of the inflammatory burden, as well as other chronic-disease-associated CV risk factors. In recent years, different research groups, including ours, have examined the value of different CV surrogate markers, including carotid sonography, carotid–femoral pulse wave velocity, and flow-mediated arterial dilation, in the assessment of CV risk in healthy and rheumatic populations. In particular, arterial stiffness has been thoroughly examined in a number of studies, showing high diagnostic and predictive value for the occurrence of CV events. To this end, the present narrative review showcases a series of studies examining aortic and peripheral arterial stiffness as surrogates of all-cause CV disease and atherosclerosis in patients with rheumatoid and psoriatic arthritis, as well as in systemic lupus erythematosus and systemic sclerosis. Moreover, we discuss the associations of arterial stiffness with clinical, laboratory, and disease-specific parameters.
... The accuracy of our results from the SphygmoCor XCEL PWV measurement should also be considered. The original SphygmoCor device has been widely used in research of South African populations [57][58][59], after being validated against invasive procedures [25,60]. The newer Sphygmo-Cor XCEL has been validated and compared against the original SphygmoCor [23] including youth (6-20 years) [22], but it has not, to our knowledge, been compared with invasive measures, and no clinical outcome studies using the XCEL device are yet available [18]. ...
Background
Carotid-femoral pulse wave velocity (PWV) is the gold-standard noninvasive measure of arterial stiffness. Data comparing tonometry-based devices such as the SphygmoCor XCEL to simpler brachial-cuff-based estimates of PWV, such as from the Mobil-O-Graph in African populations are sparse. We therefore aimed to compare PWV measured by the Mobil-O-Graph and the SphygmoCor XCEL device in a sample of South African women and children.
Methods
Women (n = 85) 29 years [interquartile range (IQR): 29–69] and their children/grandchildren (n = 27) 7 years (IQR: 4–11) were recruited for PWV measurement with Mobil-O-Graph and SphygmoCor XCEL on the same day. Wilcoxon signed-rank test, regression analysis, spearman correlation and Bland–Altman plots were used for PWV comparison between devices.
Results
For adults, the SphygmoCor XCEL device had a significantly higher PWV (7.3 m/s, IQR: 6.4–8.5) compared with the Mobil-O-Graph (5.9 m/s, IQR: 5.0–8.1, P = 0.001) with a correlation coefficient of 0.809 (P ≤ 0.001). Bland--Altman analysis indicated an acceptable level of agreement but significant bias (mean difference PWV: 0.90 ± 1.02 m/s; limits of agreement: −1.10 to 2.90). The odds of having a PWV difference more than 1 m/s decreased with a higher age [odds ratio (OR): 0.95, 95% confidence interval (95% CI) = 0.92–0.98] and increased with greater height (OR: 1.10, 95% CI = 1.01–1.21, P = 0.03) in multivariable analysis. In children, the Bland–Altman indicated an excellent level of agreement (−0.03 ± 0.63 m/s; limits of agreement: −1.26 to 1.21), but no correlation was found (rs = 0.08, P = 0.71).
Conclusion
Particularly in younger and taller women, the Mobil-O-Graph significantly underestimated PWV compared with the SphygmoCor. Although no correlation was found between the two devices for children, further research is required due to the small sample size. Furthermore, the clinical value of both methods in young African populations requires further investigation.
... On the other hand, it has also been reported that reflected wave increased after EVAR 6 , and caused LV diastolic dysfunction 7,8 . Thus, it is important to clarify which factors enhanced the reflected wave after EVAR. ...
... PWV correlates with vascular diameter 9,10 , and an increased PWV leads to an early reflected wave 7,11 . However, it remains unclear whether the aortic diameter, where the stent-graft is deployed, is related to the enhancement of the reflected wave after EVAR. ...
Reflected wave increases after endovascular aortic repair (EVAR) in patients with aortic aneurysm. This affects the left ventricular (LV) diastolic function and leads to a poor prognosis. This study aimed to evaluate the relationship between increased reflected wave amplitude and aortic diameter after EVAR. EVAR was performed in seven healthy goats. We assessed wave intensity (WI), aortic diameter, and stiffness parameter β. Moreover, we evaluated the relationship between negative reflected wave (NW, reflected waves toward the heart from the periphery by WI) and other parameters after EVAR. Results showed an increase in stiffness parameter β (3.5 ± 0.3 vs 15.9 ± 4.7, p = 0.018) and a decrease in the change of aortic diameter (6.9 ± 0.7 vs 2.7 ± 0.4%, p = 0.018) after EVAR. The NW was significantly amplified after EVAR from baseline (−589.8 ± 143.4 to − 1192.3 ± 303.7 mmHg-m/sec³, p = 0.043). The NW showed a significant correlation with maximum aortic diameter (R = 0.707, p = 0.038) and minimum aortic diameter (R = 0.724, p = 0.033). The reflected wave was enhanced after EVAR and was correlated to the aortic diameter at the stent-graft site. It is important to consider that patients with smaller aortic diameters in landing zone who undergo EVAR may develop LV dysfunction.
