Changes in segmental pulse wave velocity of the thoracic aorta with age and left ventricular remodelling. An MRI 4D flow study

Background: Ankle brachial index (ABI) has been increasingly used in general practice to identify individuals with low ABI at high cardiovascular risk. However, there has been no consensus on the clinical significance of high ABI. The aim of our study was to compare aortic stiffness as a marker of cardiovascular risk in individuals with low (<1.0), normal (1.0–1.4), and high ABI (>1.4). Methods: A total of 911 individuals from the Czech post-MONICA study (a randomly selected 1% representative population sample, aged 54 ± 13.5 years, 47% of men) were examined. ABI was measured using a handheld Doppler and aortic pulse wave velocity (aPWV) using the Sphygmocor device. Results: Of the 911 individuals, 28 (3.1%) had low ABI and 23 (2.5%) high ABI. There was a U-shaped association between aPWV and ABI. aPWV was significantly higher in individuals with low and high ABI compared with the normal ABI group (11.1 ± 2.8, 8.3 ± 2.3, p < 0.001; 10.8 ± 2.5, 8.3 ± 2.3 m/s, p < 0.001, respectively). In a model adjusted for age, sex, systolic, diastolic, mean blood pressure and examiner, aPWV remained increased in both extreme ABI groups compared with the normal ABI group. In logistic regression analysis, aPWV together with glucose level, male sex, and a history of deep venous thrombosis were independent predictors of high ABI, while cholesterol was not. Conclusion: This is the first study showing increased aortic stiffness in individuals with high ABI, presumably responsible for increased left ventricular mass described previously in this group. These findings suggest increased cardiovascular risk of high ABI individuals.

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PERFORMANCE OF THE VASCULAR STIFFNESS INDICATORS AND THE PROCESS OF LEFT VENTRICLE REMODELING IN HYPERTENSIVE PATIENTS UNDER RENAL REPLACEMENT THERAPY

The Russian Archives of Internal Medicine ◽

10.20514/2226-6704-2019-9-5-391-398 ◽

2019 ◽

Vol 9 (5) ◽

pp. 391-398

Author(s):

E. A. Praskurnichiy ◽

I. E. Minyukhina

Keyword(s):

Essential Hypertension ◽

Renal Replacement Therapy ◽

Pulse Wave Velocity ◽

Arterial Hypertension ◽

Healthy Volunteers ◽

Replacement Therapy ◽

Wave Velocity ◽

Pulse Wave ◽

Left Ventricular ◽

Vascular Stiffness

Objective. The objective of our study was to compare the performance of vascular stiffness (VS) and the left ventricular (LV) remodeling process indicators in patients with arterial hypertension (AH) under renal replacement therapy (RRT), and patients with essential hypertension.Design and methods. 158 people were included in the study, divided into 4 comparable age groups: 32 patients receiving programmed hemodialysis (PH), 37 recipients of renal transplant (RT), 69 patients with essential AH and 20 healthy volunteers. All the patients underwent 24-hour blood pressure (BP) monitoring with an assessment of VS and central BP (SBPao) and echocardiography (EchoCG).Results. The patients under PH and after RT did not have any significant differences in the values of central and peripheral BP. Comparing the groups of patients under RRT with the group of essential AH, the office systolic (SBP) and diastolic (DBP) BP values did not differ significantly. Аlthough, at night, considerably higher DBP(n) and SBPao(n) values were detected in patients under RRT, and in the patients after RT SBP(n) and PP(n) values were also increased. An increase in the SBPao values of more than 10 m/sec was detected only in the groups of patients under RRT. In all the groups with hypertension all indicators of daily VS differed significantly from the group of healthy volunteers. PTIN (Pulse Time Index of Norm) in the studied groups had more evident differences: in the healthy volunteers it was in the range of 80-90%, in the patients with essential hypertension — 50-60%, and in the patients under PH and after RT — 20-40%. In all groups of patients with AH, the average the posterior wall thickness (PWT) of the LV and the interventricular septum thickness (IVST) were close to the upper limit of the norm. In the groups of patients with AH an increase in the relative wall thickness (RWT) of the LV was also detected. Furthermore, considerably higher the values of ILVmass, IVST were found in the group of patients on PH in comparison with the patients after RT. In addition, in all the groups of patients with AH, there was a tendency to LV spherification in comparison with the healthy volunteers, and in the group of essential AH the difference was more pronounced compared with the group under RRT.Conclusion. In the patients with arterial hypertension who undergo renal replacement therapy, higher average values of central BP, higher vascular stiffness (daily pulse wave velocity in the aorta and a longer period of pulse wave velocity increase in the aorta during the day (PTIN)) and less pronounced left ventricular spherification are recorded in comparison with the patients with essential hypertension while office BP values remained consistent.

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Editorial for “Aortic Pulse Wave Velocity Evaluated by 4D Flow MRI Across the Adult Lifespan”

Journal of Magnetic Resonance Imaging ◽

10.1002/jmri.28050 ◽

2021 ◽

Author(s):

Alexander Fyrdahl

Keyword(s):

Pulse Wave Velocity ◽

Wave Velocity ◽

Pulse Wave ◽

Aortic Pulse Wave Velocity ◽

4D Flow Mri ◽

4D Flow ◽

Adult Lifespan ◽

Flow Mri

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Multicenter Randomized Controlled Trial of Vitamin K Antagonist Replacement by Rivaroxaban with or without Vitamin K2 in Hemodialysis Patients with Atrial Fibrillation: the Valkyrie Study

Journal of the American Society of Nephrology ◽

10.1681/asn.2019060579 ◽

2019 ◽

Vol 31 (1) ◽

pp. 186-196 ◽

Cited By ~ 18

Author(s):

An S. De Vriese ◽

Rogier Caluwé ◽

Lotte Pyfferoen ◽

Dirk De Bacquer ◽

Koen De Boeck ◽

...

Keyword(s):

Atrial Fibrillation ◽

Pulse Wave Velocity ◽

Thoracic Aorta ◽

Wave Velocity ◽

Vitamin K ◽

Pulse Wave ◽

Vitamin K2 ◽

Favorable Effect ◽

Bleeding Complications ◽

Multicenter Randomized Controlled Trial

BackgroundVitamin K antagonists (VKAs), although commonly used to reduce thromboembolic risk in atrial fibrillation, have been incriminated as probable cause of accelerated vascular calcification (VC) in patients on hemodialysis. Functional vitamin K deficiency may further contribute to their susceptibility for VC. We investigated the effect of vitamin K status on VC progression in 132 patients on hemodialysis with atrial fibrillation treated with VKAs or qualifying for anticoagulation.MethodsPatients were randomized to VKAs with target INR 2–3, rivaroxaban 10 mg daily, or rivaroxaban 10 mg daily plus vitamin K2 2000 µg thrice weekly during 18 months. Systemic dp-ucMGP levels were quantified to assess vascular vitamin K status. Cardiac and thoracic aorta calcium scores and pulse wave velocity were measured to evaluate VC progression.ResultsBaseline dp-ucMGP was severely elevated in all groups. Initiation or continuation of VKAs further increased dp-ucMGP, whereas levels decreased in the rivaroxaban group and to a larger extent in the rivaroxaban+vitamin K2 group, but remained nevertheless elevated. Changes in coronary artery, thoracic aorta, and cardiac valve calcium scores and pulse wave velocity were not significantly different among the treatment arms. All cause death, stroke, and cardiovascular event rates were similar between the groups. Bleeding outcomes were not significantly different, except for a lower number of life-threatening and major bleeding episodes in the rivaroxaban arms versus the VKA arm.ConclusionsWithdrawal of VKAs and high-dose vitamin K2 improve vitamin K status in patients on hemodialysis, but have no significant favorable effect on VC progression. Severe bleeding complications may be lower with rivaroxaban than with VKAs.

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Blood Pressure and Body Weight Have Different Effects on Pulse Wave Velocity and Cardiac Mass in Children

Journal of Clinical Medicine ◽

10.3390/jcm9092954 ◽

2020 ◽

Vol 9 (9) ◽

pp. 2954

Author(s):

Simonetta Genovesi ◽

Paolo Salvi ◽

Elisa Nava ◽

Elena Tassistro ◽

Marco Giussani ◽

...

Keyword(s):

Blood Pressure ◽

Pulse Wave Velocity ◽

Wave Velocity ◽

Pulse Wave ◽

Left Ventricular ◽

Cardiac Mass ◽

Excess Weight ◽

Gold Standard Method ◽

Z Scores ◽

The Impact

Background: High blood pressure (BP) and excess weight can lead to early cardiovascular organ damage already in children. Carotid-femoral pulse wave velocity (cf-PWV) is the non-invasive gold standard method for assessing aortic stiffness, while carotid-radial PWV (cr-PWV) provides information on the distensibility of the upper limb arteries. The aim of this study was to evaluate the relationship of BP and BMI z-scores with arterial stiffness and left ventricular mass index (LVMI) in a pediatric population. Methods: In 343 children (57.7% males; age ± SD 11.7 ± 2.9 years), systolic (SBP) and diastolic (DBP) BP, BMI, cf-PWV, cr-PWV and LVMI were measured. A multiple linear regression model was used to assess the impact of BMI and SBP (or DBP) z-scores on cf-PWV, cr-PWV and LVMI. Results: About 21% of children were normal weight, 34% were overweight and 45% obese. Adjusted for possible confounders, SBP and DBP z-scores were significantly associated with cf-PWV (p < 0.001), while only DBP z-scores were related to cr-PWV (p < 0.01). BMI was neither associated with cf-PWV nor with cr-PWV values but was a strong predictor of LVMI (<0.001), whereas cardiac mass and BP z-scores were not related. Conclusions: Our study suggests that, in children, elevated BP values and excess weight may have different effects on the heart and the vessels in causing early cardiovascular alterations.

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Novel method to estimate ventricular contractility using intraventricular pulse wave velocity

AJP Heart and Circulatory Physiology ◽

10.1152/ajpheart.1999.277.6.h2409 ◽

1999 ◽

Vol 277 (6) ◽

pp. H2409-H2415 ◽

Cited By ~ 2

Author(s):

Toshiaki Shishido ◽

Masaru Sugimachi ◽

Osamu Kawaguchi ◽

Hiroshi Miyano ◽

Toru Kawada ◽

...

Keyword(s):

Pulse Wave Velocity ◽

Wave Velocity ◽

Pulse Wave ◽

Volume Measurement ◽

Left Ventricular ◽

Ventricular Contractility ◽

Left Ventricular Chamber ◽

Novel Method ◽

Volume Pulse ◽

Late Systole

We developed a novel technique for estimating ventricular contractility using intraventricular pulse wave velocity (PWV). In eight isolated, cross-circulated canine hearts, we used a fast servo pump to inject a volume pulse into the base of the left ventricular chamber at late diastole and at late systole. We measured the transit time of the volume pulse wave as it traversed the distance from base to apex and calculated the intraventricular PWV. The intraventricular PWV increased from diastole (2.3 ± 0.4 m/s) to systole (11.7 ± 2.4 m/s, P < 0.0001 vs. diastole). The square of the intraventricular PWV at late systole correlated linearly with the left ventricular end-systolic elastance ( r = 0.939, P < 0.0001) and with the end-systolic Young's modulus ( r = 0.901, P < 0.0001). Moreover, the intraventricular PWV was insensitive to preload. We conclude that the intraventricular PWV at late systole reflects left ventricular end-systolic elastance reasonably well. The fact that estimation of PWV does not require volume measurement or load manipulation makes this technique an attractive means of assessing ventricular contractility.

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