Different circadian patterns of arterial stiffness are responsible for increased cardiovascular mortality in hemodialyzed patients

Abstract Background and Aims The mortality rate is extremely high in chronic kidney disease (CKD), primarily due to the high prevalence of cardiovascular disease (CVD). Increased pulse pressure (PP), defined as the difference between inappropriately elevated systolic blood pressure (SBP) and reduced diastolic blood pressure (DBP) at any value of mean arterial pressure (MAP), is a surrogate measure of increased arterial stiffness of central elastic arteries (aorta and its major branches). CKD-MBD anomalies leading to calcification contribute to increased arterial stiffness and pulse pressure. This study aimed to evaluate the relationship of pulse pressure parameter with valve calcification and abdominal aortic calcification in hemodialysis patients and its impact on cardiovascular mortality. Method We performed a prospective case series study with 3 years follow- up. Plain X-ray images of the lateral lumbar spine from all subjects were studied to obtain images of the lower abdominal aorta using semiquantitative scores as described by Kauppila et al. Cardiac valve calcifications were evaluated by two-dimensional echocardiography with an HDI 5000 Sono CT echocardiographic machine with a 3.3-MHz multiphase array probe in subjects lying in the left decubitus position an according to the recommendations of the European Association of Echocardiography. The patient was evaluated as having vascular calcification if he had the presence of calcification in at least one of the site examined: a mitral valve, aortic valve or abdominal aorta. Results We studied 85 chronic stable hemodialysis patients. Mean age and meantime is therapy was 49.9±12.4 years and 51.5±28.7 months, respectively. Mean pulse pressure was 55.72±14.2 mmHg. Fifty-nine patients (69.4%) were identified with aortic abdominal calcification, and the mean Kauppila score was 4.91 ± 4.05. Sixty patients (70.5%) had at least one valve calcified, while thirty-three patients (38.8%) had both valves calcified. Univariate analysis revealed that every 1 mmHg increase in pulse pressure was associated with increased cardiovascular calcification risk p=0.020. In multivariate analysis, after adjustment for age, gender, diabetes mellitus, cholesterol, and triglyceride serum levels, the association also remained strong, where every increase of 1 mm Hg in pulse pressure was associated with increased risk for cardiovascular calcification (HR 1.02, 95% CI (1.00-1.03), p= 0.038). Besides, pulse pressure was an independent predictor for cardiovascular mortality (HR 1.03, 95% CI (1.02-1.05), p=0.002). Conclusion Pulse pressure may identify hemodialysis patients with subclinical cardiovascular calcification who need further evaluation. Wide pulse pressure is associated with increased cardiovascular mortality.

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The consequence of arterial stiffness parameters to predict the cardiovascular mortality in hemodialysis patients: a prospective cohort study

Orvosi Hetilap ◽

10.1556/oh.2010.28861 ◽

2010 ◽

Vol 151 (18) ◽

pp. 741-748

Author(s):

Taha El Hadj Othmane ◽

István Kiss ◽

János Nemcsik ◽

Cs. Bertalan Fekete ◽

György Deák ◽

...

Keyword(s):

Cohort Study ◽

Arterial Stiffness ◽

Prospective Cohort Study ◽

Cardiovascular Mortality ◽

Prospective Cohort ◽

Hemodialysis Patients

Korábbi vizsgálatok eredményei alapján az érfali tágulékonyság paraméterei összefüggést mutatnak a cardiovascularis mortalitással hemodializált betegekben. A különböző paraméterek relatív prognosztikus értékét ugyanakkor egy közös kohorszban eddig nem vizsgálták. Módszer: Dialízis előtt és után 98 betegnél mértük a carotis-femoralis pulzushullám terjedési sebességét, a carotis augmentációs indexét, a carotis pulzusnyomását és a carotis-brachialis pulzusnyomás amplifikációját. A betegeket 29 hónapig (medián) (tartomány 1–35) követtük, majd a cardiovascularis mortalitás és a kiinduláskor mért tágulékonysági paraméterek közötti összefüggést vizsgáltuk log-rank tesztek, illetve a korhoz, diabeteshez és korábban meglévő cardiovascularis megbetegedéshez illesztett Cox-féle regressziós modellek alkalmazásával. Eredmények: A követés alatt 40 beteg halt meg (mortalitási ráta 20,7/100 betegév), köztük 25-en cardiovascularis ok következtében. A dialízis előtt és után mért pulzushullám-terjedési sebességet tercilisei, illetve a dialízis előtt mért pulzusnyomás-amplifikáció tercilise szignifikáns összefüggést mutattak a cardiovascularis mortalitással (log-rank p-értékek 0,012 és 0,011 a pre- és posztdialízis pulzushullám-terjedési sebesség, illetve <0,001 és 0,321 a pre- és posztdialízis pulzusnyomás-amplifikáció esetén). Az augmentációs indexek, illetve a carotispulzusnyomás-értékek nem álltak összefüggésben a cardiovascularis mortalitással. Cox-modellben az 1 m/s-mal gyorsabb pre- és posztdialízis pulzushullám-terjedési sebességéhez tartozó relatív rizikó 1,24 (1,07–1,44) és 1,17 (1,06–1,28) volt. 10%-kal kisebb predialízispulzusnyomás-amplifikációval járó rizikónövekedés 41% (3–92%) volt. Egy közös modellben vizsgálva mind a predialízispulzushullám-terjedési sebesség, mind a pulzusnyomás-amplifikáció szignifikáns összefüggést mutatott a cardiovascularis túléléssel [relatív rizikó: 1,23 (1,07–1,42) és 1,39 (1,02–1,89)]. Következtetés: Hemodializált betegekben az érfali tágulékonyságot leíró különböző paraméterek közül a pulzushullám-terjedési sebesség a mérés idejétől független, konzekvens összefüggést mutat a cardiovascularis mortalitással. Ugyanakkor a predialízispulzusnyomás-amplifikációs érték további prognosztikus információt hordoz.

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Arterial Stiffness in Hemodialysis: Which Parameter to Measure to Predict Cardiovascular Mortality?

Kidney & Blood Pressure Research ◽

10.1159/000238822 ◽

2009 ◽

Vol 32 (4) ◽

pp. 250-257 ◽

Cited By ~ 7

Author(s):

Taha El Hadj Othmane ◽

János Nemcsik ◽

Bertalan Cs. Fekete ◽

György Deák ◽

József Egresits ◽

...

Keyword(s):

Arterial Stiffness ◽

Cardiovascular Mortality

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Ambulatory Arterial Stiffness Index as a Predictor of Cardiovascular Mortality in the Dublin Outcome Study

Hypertension ◽

10.1161/01.hyp.0000200699.74641.c5 ◽

2006 ◽

Vol 47 (3) ◽

pp. 365-370 ◽

Cited By ~ 263

Author(s):

Eamon Dolan ◽

Lutgarde Thijs ◽

Yan Li ◽

Neil Atkins ◽

Patricia McCormack ◽

...

Keyword(s):

Arterial Stiffness ◽

Cardiovascular Mortality ◽

Stiffness Index ◽

Outcome Study ◽

Arterial Stiffness Index

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Endovascular treatment of peripheral artery disease is associated with improved central hemodynamics and ventricular function

European Heart Journal ◽

10.1093/ehjci/ehaa946.2381 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

D Messiha ◽

L Halfmann ◽

O Azizy ◽

M Steinmetz ◽

T Rassaf ◽

...

Keyword(s):

Arterial Stiffness ◽

Left Ventricular Function ◽

Endovascular Treatment ◽

Ventricular Function ◽

Peripheral Artery Disease ◽

Cardiovascular Mortality ◽

Left Ventricular ◽

Central Hemodynamics ◽

Peripheral Artery ◽

Artery Disease

Abstract Background Peripheral artery disease (PAD) is a major manifestation of atherosclerosis and a risk factor for morbidity and mortality. PAD itself is associated with increased arterial stiffness with impact on cardiac functions. Previous studies have demonstrated that augmentation index (AIx) and central blood pressure (CBP) correlate with increased cardiovascular mortality. This mechanism has been described as arterio-ventricular (AV) coupling with altered ventricular afterload and a depressed ventricular function, measured by global longitudinal strain (GLS). The impact of PAD-related endovascular treatment on arterial stiffness, central hemodynamics and potential impact on AV coupling has not been elucidated until now. Purpose Aim of the study was to investigate, if endovascular treatment of PAD improves cardiac function via enhanced central hemodynamics and AV coupling. Methods To this aim 77 patients with known symptomatic PAD who underwent interventions in the iliac and femoropopliteal arteries were included in a cross-sectional study. AIx, CBP and GLS were determined using dedicated waveform analysis and echocardiography before and after endovascular treatment. Results Mean age was 65.1±10.4 years with 66.2% male patients. Symptoms were classified by Fontaine classification (stage IIb 80.7%, stage III 5.8% and stage IV 13.5%). Iliac vessel intervention was performed in 16 and femoropopliteal intervention in 61 cases. A stentless approach was feasible in 55 patients with DCB treatment and atherectomy. After endovascular treatment, peripheral perfusion was enhanced (ABI 0.45±0.6 vs 0.81±0.5, p<0.0001). Moreover, central hemodynamics were improved (AIX 33.7±3% vs 27.9±2%, p=0.0008; AP 17.8±2 mmHg vs 14.0±2 mmHg, p=0.0004; central PP 52.4±6 mmHg vs 46.4±6 mmHg, p=0.0001). Impressively, left ventricular function was also significantly improved (GLS −15.7±2.3% vs −17.1±2.8%, p=0.005) with an improvement in AV coupling (PWV/GLS ratio −0.58m/sec% vs −0.56m/sec%, p<0.01). Conclusion Our results demonstrate that endovascular treatment of the peripheral vessels is associated with an improvement of central hemodynamics and left ventricular function via enhanced AV coupling. These prognostic relevant markers of cardiovascular disease could point to an overall potential mortality benefit through PAD treatment. Further investigation of the underlying mechanisms of AV coupling in the setting of endovascular treatment of PAD with impact on cardiovascular mortality is needed in this high-risk population. Funding Acknowledgement Type of funding source: None

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Abstract W P135: Pulse Wave Velocity is a Predictor of Mortality in Acute Ischemic Stroke

Stroke ◽

10.1161/str.45.suppl_1.wp135 ◽

2014 ◽

Vol 45 (suppl_1) ◽

Author(s):

Jinkwon Kim ◽

Tae-Jin Song ◽

Ki-Jeong Lee ◽

Eun Hye Kim ◽

Dongbeom Song ◽

...

Keyword(s):

Ischemic Stroke ◽

Arterial Stiffness ◽

Acute Ischemic Stroke ◽

Acute Phase ◽

Cardiovascular Mortality ◽

Pulse Wave ◽

Cox Regression ◽

Surrogate Marker ◽

Cardiovascular Death ◽

Increased Risk

Introduction: Arterial stiffness increases with aging, but is also suggested as a surrogate marker of atherosclerosis and a predictor of cardiovascular events. Brachial-ankle pulse wave velosity (baPWV) is a simple and non-invasive tool for measurement of arterial stiffness. Hypothesis: Measurement of baPWV in acute phase of stroke may have a prognostic value to predict all-cause and cardiovascular death. Methods: This was a hospital-based, retrospective observational study. We included patients who had admitted for acute ischemic stroke and undergone baPWV measurement. Date and causes of death were obtained from the database of the Korean National Statistical Office. All-cause and cardiovascular mortality after stroke onset was compared across to the tertile groups of baPWV. Results: Of included 1696 patients, mean age was 64.5 ± 12.5 years and male was 60.7 %. Mean value of baPWV was 21.04 ± 6.31 m/sec. During mean follow-up period of 1.91 ± 1.27 years, there were 126 all-cause deaths including 85 cardiovascular deaths. Kaplan-Meier survival analysis demonstrated an increased risk for all-cause and cardiovascular mortality in patients with higher baPWV (Figure). In multivariate Cox regression, patients in the highest tertile of baPWV (T3; >22.54 m/sec) were at increased risks for all-cause death [HR 1.95, 95% CI 1.13-3.36, p=0.017] and cardiovascular death [HR 2.18, 95% CI 1.11-4.25, p=0.023] compared to the lowest tertile (T1; <17.78 m/sec). Conclusions: This study suggested that measurement of baPWV during acute phase of stroke might be used to identify patients at a higher risk for long-term mortality.

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Accuracy of Pulse Wave Velocity Predicting Cardiovascular and All-Cause Mortality. A Systematic Review and Meta-Analysis

Journal of Clinical Medicine ◽

10.3390/jcm9072080 ◽

2020 ◽

Vol 9 (7) ◽

pp. 2080

Author(s):

Irene Sequí-Domínguez ◽

Iván Cavero-Redondo ◽

Celia Álvarez-Bueno ◽

Diana P Pozuelo-Carrascosa ◽

Sergio Nuñez de Arenas-Arroyo ◽

...

Keyword(s):

Systematic Review ◽

Arterial Stiffness ◽

Pulse Wave Velocity ◽

Wave Velocity ◽

Reference Values ◽

Cardiovascular Mortality ◽

Pulse Wave ◽

Meta Analysis ◽

Predictive Performance ◽

All Cause Mortality

Increased arterial stiffness has been associated with an increased risk of developing cardiovascular diseases and all-cause mortality. Pulse wave velocity (PWV) is an innovative and affordable measurement of arterial stiffness which may be an accessible tool to estimate mortality risk; however, no meta-analysis has estimated its predictive performance for cardiovascular and all-cause mortality. Moreover, reference values for PWV have only been established by consensus for healthy populations. The aim of this review was to estimate PWV and especially carotid femoral PWV performance predicting cardiovascular and all-cause mortality as well as comparing the resulting cfPWV thresholds with already established values in order to increase its validity. Original studies measuring PWV thresholds and its association with cardiovascular and all-cause mortality were systematically searched. The DerSimonian and Laird method was used to compute pooled estimates of diagnostic odds ratio (dOR), and overall test performances were summarized in hierarchical summary receiver operating characteristic curves (HSROC). Six studies were included in the meta-analysis. The pooled dOR values for the predictive performance of cfPWV were 11.23 (95 % CI, 7.29–1.29) for cardiovascular mortality and 6.52 (95% CI, 4.03–10.55) for all-cause mortality. The area under the HSROC curve for cfPWV was 0.75 (95% CI, 0.69–0.81) for cardiovascular mortality and 0.78 (95% CI, 0.74–0.83) for all-cause mortality, where the closest cut-off point to the summary point was 10.7 and 11.5, respectively. This systematic review and meta-analysis demonstrates that cfPWV is a useful and accurate cardiovascular mortality predictor and that its previously estimated reference values for estimating risk may be used in high-risk populations.

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