Article

Relationship between aortic stiffness and cardiorespiratory fitness in primary and secondary cardiovascular prevention patients

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Abstract

Aortic stiffness (AS), defined as the elastic resistance to deformation resulting from complex interactions between vascular smooth muscle cells and the extracellular matrix is a marker of increased cardiovascular (CV) risk and mortality. Age, hypertension, diabetes, atherosclerosis, and chronic kidney disease may represent the most important contributors to its increase.¹ A low cardiorespiratory fitness, estimated through peak V02 value obtained during a cardiopulmonary exercise test (CPET), has been also shown to represent an independent marker of adverse CV outcome.² Nowadays, only few studies explored the correlation between arterial stiffness and cardiorespiratory fitness in patients undergoing cardiopulmonary exercise testing.3–6 The aim of the present study was to evaluate the association between two markers of AS, pulse wave velocity (PWV) and augmentation index (AI), on different CPET-derived data, such as ventilatory efficiency (VE/VCO2 slope), CV efficiency (VO2/WR slope), and oxygen uptake extraction slope (OUES). This prospective cross-sectional study included individuals who underwent CV evaluation at ‘CV Prevention Unit of Fondazione Don Gnocchi, Parma’ from 2017 to 2018. Our ethics committee on human research approved the collection of data in accordance with the Declaration of Helsinki after having obtained written informed consent from all the subjects. Incremental and maximal cardiopulmonary tests were performed with the Cosmed Quark C-PET system (COSMED, Rome, Italy) until maximal perceived exertion; cardiorespiratory fitness was evaluated as peak VO2 (mL/kg/min) (mean oxygen uptake over the last 30 s of exercise). Before CPET examination, pulse wave analysis was performed using the Vicorder (Skidmore Medical, Bristol, UK) with oscillometric technique to detect the pulse waveform between the two recording sites.⁶,⁷ Measurements were obtained by using a 10-cm-wide cuff around the right upper thigh to detect the femoral pulse and a 10-cm-wide cuff around the arm to detect the right brachial pulse. The cuffs were automatically inflated simultaneously and pulse waveform was recorded for 3–5 s, while the patient was in supine position, before freezing the display screen and obtaining the pulse wave analysis. Carotid-femoral PWV was calculated by the formula: PWV (m/s) = distance between measurement locations (m)/transit time. Augmentation index was calculated by the formula: AI (%): (Augmentation pressure/Pulse pressure) × 100.⁸,⁹ Differences among groups were tested by ANOVA, with Least-Significant Difference post-hoc analysis. The Shapiro–Wilk test was used to check the normality distribution of continuous variable. Linear regression analysis was performed and the relationship between potential predictors and main outcome measures was analysed using stepwise logistic regression models including different covariates. Statistical significance was set at P < 0.05.

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... The most informative test for patients with post-COVID-19 dyspnea is still the cardiopulmonary exercise Testing (CPET) [168]. CPET allows to assess the presence of myocardial ischemia (reduced values of VO2/WR slope, reduced oxygen pulse, and ST abnormalities), of ventilatory dysfunction (high VE/VCO2 slope values, trend anomalies, and PET-O2 and PET-CO2 values), of muscle-metabolic inefficiency (altered anaerobic threshold and reduced oxygen uptake extraction slope values) or aortic stiffness [169]. Moreover, post-COVID-19 unexplained dyspnea without cardiopulmonary abnormalities is common with PACS and may relate to deconditioning with poor cardiovascular fitness. ...
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Post-acute COVID-19 syndrome (PACS) describes the clinical condition of some SARS-CoV-2-infected patients in which a wide range of signs and symptoms that persist for several months after the acute phase of the disease. Cardiovascular symptoms including chest pain, dyspnea, elevated blood pressure, palpitations, inappropriate tachycardia, fatigue, and exercise intolerance are common in this condition. Some infected patients develop cardiovascular diseases such as myocarditis, pericarditis, new or worsening myocardial ischemia due to obstructive coronary artery disease, microvascular dysfunction, stress cardiomyopathy, thromboembolism, cardiovascular sequelae of pulmonary disease, arrhythmias, while others have cardiovascular symptoms without objective evidence of cardiovascular abnormalities. In the present chapter, definition, spectrum of manifestations, clinical scenarios, diagnosis, management, and therapy of cardiovascular PACS will be discussed.
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This study investigated the effect of age and gender on central arterial hemodynamic variables derived from noninvasive tonometric carotid pressure waveforms. Women have a greater age-related increase in left ventricular (LV) mass than do men and are more likely to experience symptomatic heart failure after infarction despite their higher ejection fraction. In studies of these changes, ventricular afterload is incompletely defined by brachial blood pressure (BP) measurements. We hypothesized that there exist gender differences in pulsatile vascular load, as revealed by pressure waveform analysis, which may produce suboptimal afterload conditions in women. Data from 350 healthy normotensive subjects (187 female) aged 2 to 81 years were analyzed in decade groups. Augmentation index (AIx, the difference between early and late pressure peaks divided by pulse pressure) was used as an index of pulsatile afterload, and the ratio of diastolic to systolic pressure-time integral gave a subendocardial viability index. Heart rate, BP, ejection duration and maximal rate of pressure rise (dP/dt(max)) were also determined. Male subjects had a slightly higher systolic pressure until age 50. Female subjects had higher systolic pressure augmentation after the 1st decade, a difference that was significant after age 30 (p < 0.005 for each decade). In both males and females there was a strong age dependence for AIx (r = 0.77, p < 0.001 for females, r = 0.66, p < 0.001 for males). Although males had a larger body size and higher systolic pressure, systolic pressure-time integral was similar in males and females across all age groups. Diastolic pressure-time integral was consistently lower in females because of their shorter diastolic period. Subendocardial viability index was lower in females across the entire group. Differences in stature and heart rate may contribute to these findings. These new data may help to explain previous findings in women of an age-related increase in LV mass and excess symptomatic heart failure that are not explained by differences in brachial BP.
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We investigated whether the aortic augmentation index (AIx), a measure of arterial wave reflection and stiffness, is associated with cardiorespiratory fitness in men without known coronary heart disease (CHD). Asymptomatic men (n = 201, mean age 51 +/- 9.2 years) referred for a screening exercise electrocardiogram (ECG) underwent applanation tonometry to obtain radial artery pulse waveforms, and an ascending aortic pressure waveform was derived by a transfer function. The AIx is the difference between the first and second systolic peak of the ascending aortic pressure waveform, expressed as a percentage of the pulse pressure. Cardiorespiratory fitness was assessed by maximal oxygen consumption (VO2max mL/min/kg) during a symptom-limited graded exercise test. Multivariable regression analyses were used to identify significant independent determinants of AIx and of VO2 max. Diabetes was present in 2.5% of subjects, 34.8% had history of smoking, and 29% were hypertensive. Mean (+/- SD) AIx was 19.9% +/- 9.0% and mean VO(2 max) was 33.9 +/- 6.4 mL/min/kg. In a multivariable linear regression model, AIx was positively associated with age, hypertension, and history of smoking and inversely with heart rate, height, and body mass index (BMI). The VO2 max was significantly inversely related to AIx after adjustment for age, heart rate, height, and BMI (r = -0.22, P = .002), after further adjustment for CHD risk factors (total cholesterol, HDL-cholesterol, history of smoking, diabetes, hypertension) (P = .006), and after additional adjustment for behavioral factors (physical activity score, alcohol intake, and percent body fat) (P = .022). These findings indicate that AIx, a measure of arterial wave reflection and stiffness, is inversely associated with cardiorespiratory fitness in men without CHD.