Cardiopulmonary Function Assessment in Children With Pulmonary Valve Stenosis

ObjectivePulmonary valve (PV) stenosis affects cardiac pulmonary function and exercise performance. A cardiopulmonary exercise test (CPET) combined with a transthoracic echocardiogram (TTE) can measure exercise performance, disease progression, and treatment effects. We assessed the exercise capacity in children with PV stenosis by conducting CPET and TTE.MethodsFrom 2005 to 2021, 84 patients with PV stenosis aged 6–18 years were enrolled; 43 were treated with balloon pulmonary valvuloplasty (BPV) (Group A), and 41 received follow-up care (Group B), and their CPET and pulmonary function test results were compared with 84 healthy, matched individuals (Control). We also conducted TTE to compare the peak pulmonary artery pulse wave velocity and pulmonary valve (PV) area before and after catheterization and follow-up care.ResultsThere were no significant differences among the CPET parameters of the patient groups and controls in anaerobic metabolic equivalent (MET) (group A: 6.44 ± 0.58; group B: 6.28 ± 0.47, control: 6.92 ± 0.39, p = 0.110), peak MET (group A: 9.32 ± 0.74; group B: 9.13 ± 0.63; control: 9.80 ± 0.52, p = 0.263), and heart rate recovery (group A: 28.04 ± 4.70; group B: 26.44 ± 3.43, control:26.10 ± 2.42, p = 0.718). No significant differences were found in the pulmonary functions between the three groups. The pulmonary artery pulse wave velocity significantly decreased after catheterization (3.97 ± 1.50 vs. 1.95 ± 0.94, p < 0.0001), but not after follow-up care (1.67 ± 0.77 vs. 1.75 ± 0.66, p = 0.129). The pulmonary vale area significantly improved in group A (0.89 ± 0.71 vs. 1.16 ± 0.58, p < 0.0001), whereas only insignificant progression of PV stenosis was observed in group B (1.60 ± 0.64 vs. 1.57 ± 0.65, p = 0.110).ConclusionsPatients treated with BPV had a similar exercise capacity with that of patients under follow-up care and the healthy controls. Larger or multi-center studies should be conducted to confirm the physical fitness of pediatric patients with PV stenosis after management.

Effect of Acupuncture on Artery Elasticity for Atherosclerosis: A Randomized Controlled Trial

Background Atherosclerosis (AS) is a chronic arterial disease. Atherosclerosis related diseases, like myocardial infarctions (MI) and strokes have the highest mortality and disability rate. However, limited evidence verified the effects of acupuncture on arterial stiffness for subclinical atherosclerosis. We hypothesized that acupuncture could improve arterial stiffness in subclinical atherosclerosis and resist plaque progression. The aim of this study is to assess the effect of acupuncture on arterial elasticity via ultrafast pulse wave velocity (ufPWV) and explore the effect of acupuncture on lipid level and platelet function for subclinical atherosclerosis patients.MethodsThis was a randomized parallel controlled trial included 44 patients. Patients were assigned in a 1:1 ratio to acupuncture group and sham acupuncture group. Patients completed 24 treatments in total within 12 weeks of intervention. The primary outcome was ultrafast pulse wave velocity (ufPWV) assessed after every 4-weeks treatment; the secondary outcomes were carotid intima-media thickness (cIMT), blood lipid levels, fibrinogen (FIB) and blood platelet. Intention-to-treat (ITT) principle was applied and data sets were analyzed using SPSS 20.0 software.ResultsAmong the 44 randomly assigned patients, changes of right-side BS value in TA group (0.841) at week 12 were greater than SA group (-0.189), with a mean difference of 1.030 (95% CI, 0.320, 1.739; P=0.006). Similar results were observed in right-side ES, left-side BS, left-side ES at week 12. As to secondary outcomes, compared with SA group(1.08mm), the TA group(0.98mm) showed a significant decline in mean of left-side IMT at week 12. (Z= -2.118; P=0.034). There were no serious adverse events.ConclusionsAmong patients with Carotid intima-media thickening, both-side carotids arterial elasticity is significantly improved after 12-week acupuncture compared with sham acupuncture. The effects of acupuncture are more noticeable at week 12 during end-systole.Trial registrationThe trial was registered at http://www.chictr.org.cn (NO. ChiCTR1900025551, 31/08/2019)

NGHIÊN CỨU MỐI LIÊN QUAN GIỮA CHỈ SỐ ABI, TỐC ĐỘ LAN TRUYỀN SÓNG MẠCH VỚI MỨC ĐỘ TỔN THƯƠNG ĐỘNG MẠCH VÀNH THEO THANG ĐIỂM SYNTAX II Ở BỆNH NHÂN NHỒI MÁU CƠ TIM CẤP

Mục tiêu: Tìm hiểu mối liên quan giữa chỉ số huyết áp tâm thu cổ chân-cánh tay (Ankle Brachial Index – ABI), tốc độ lan truyền sóng mạch (pulse wave velocity - PWV) với mức độ tổn thương động mạch vành (ĐMV) ở bệnh nhân (BN) nhồi máu cơ tim (NMCT) cấp. Đối tượng và phương pháp nghiên cứu: Nghiên cứu mô tả cắt ngang trên 2 nhóm: nhóm bệnh gồm 60 người bị NMCT cấp và nhóm chứng gồm 33 người có cùng độ tuổi và các yếu tố nguy cơ và chụp ĐMV không tổn thương. Cả 2 nhóm đều được đo ABI, PWV, chụp ĐMV, nhóm bệnh được đánh giá mức độ tổn thương theo thang điểm SYNTAX II. Kết quả: Tuổi trung bình của nhóm bệnh và nhóm chứng tương ứng là 67,05 ± 12,04 và 67,67 ± 6,80 năm. ABI của nhóm bệnh (1,04 ± 0,10) thấp hơn nhóm chứng (1,12 ± 0,13), p<0,01. PWV của nhóm bệnh (15,90 ±1,49 m/s) cao hơn nhóm chứng (13,32 ± 1,98 m/s), p<0,01. PWV ở nhóm tổn thương 1 nhánh và ≥2 nhánh tương ứng là 15,25 ± 1,09 m/s và 16,22 ± 1,57 m/s. Có sự tương quan chặt chẽ giữa PWV với điểm SYNTAX (r = 0,477; p<0,01). Kết luận: ở nhóm NMCT cấp PWV cao hơn và ABI thấp hơn nhóm chứng có ý nghĩa. PWV tương quan chặt chẽ với mức độ tổn thương ĐMV theo thang điểm SYNTAX II.

ĐÁNH GIÁ ĐỘ CỨNG ĐỘNG MẠCH BẰNG CHỈ SỐ VẬN TỐC LAN TRUYỀN SÓNG MẠCH (PULSE WAVE VELOCITY - PWV) Ở BỆNH NHÂN BỊ BỆNH ĐỘNG MẠCH VÀNH MẠN TÍNH

Mục tiêu: Đánh giá độ cứng động mạch bằng chỉ số vận tốc lan truyền sóng mạch (pulse wave velocity - PWV) ở bệnh nhân (BN) bị bệnh động mạch vành mạn tính (BĐMVMT). Đối tượng và phương pháp: Nhóm bệnh gồm 61 người bị BĐMVMT được chẩn đoán xác định bằng phương pháp chụp động mạch vành qua da có hẹp ≥50% đường kính lòng mạch và nhóm chứng gồm 31 người nghi ngờ bị BĐMVMT nhưng chụp động mạch vành không tổn thương hoặc tổn thương <50%. Cả 2 nhóm đều được đo PWV. Kết quả: Tuổi trung bình của nhóm chứng và nhóm bệnh lần lượt là 68,26 ± 6,66 và 70,1 ± 7,15 năm. Tuổi ≥65 chiếm tỷ lệ cao (nhóm chứng và nhóm bệnh lần lượt là 74,2%; 77,0%). Nhóm bệnh nam chiếm tỷ lệ cao (60,7%) hơn nữ (39,3%). PWV tăng (≥14 m/s) ở nhóm bệnh và nhóm chứng tương ứng là: Bên phải (82,0%; 32,3%). Bên trái (67,2%; 22,6%) p<0,05. PWV ở người bị THA của nhóm bệnh và chứng tương ứng là: 15,05 ± 0,61 m/s; 11,47 ± 1,53 m/s, ở người bị ĐTĐ: 15,89 ± 2,07 m/s; 14,06 ± 1,29 m/s, người hút thuốc lá: 15,76 ± 1,97; 13,82 ± 1,45 m/s, người thừa cân: 15,69 ± 1,79 m/s; 13,59 ± 2,12m/s. Kết luận: Nhóm bệnh có PWV tăng (≥14 m/s) chiếm tỷ lệ cao hơn nhóm chứng. Ở cùng độ tuổi, giới tính và các yếu tố nguy cơ (THA, ĐTĐ, hút thuốc lá, thừa cân) thì PWV ở nhóm bệnh đều cao hơn ở nhóm chứng có ý nghĩa thống kê với p<0,05.

Utility of estimated pulse wave velocity for assessing vascular stiffness: comparison of methods

Aim. Pulse wave velocity independently predicts cardiovascular risk. Easy to use single cuff oscillometric methods are utilized in clinical practice to estimate pulse wave velocity. We applied the approach in master athletes to assess possible beneficial effects of lifelong exercise on vascular health. Furthermore, we compared single cuff measurements with a two-cuff method in another cohort. Methods. We obtained single cuff upper arm oscillometric measurements thrice in 129 master athletes aged 35 to 86 years and estimated pulse wave velocity using the ArcSolver algorithm. We applied the same method in 24 healthy persons aged 24 to 55 years participating in a head down tilt bedrest study. In the latter group, we also obtained direct pulse wave velocity measurements using a thigh cuff.Results. Estimated pulse velocity very highly correlated with age (R2 = 0.90) in master athletes. Estimated pulse wave velocity values were located on the same regression line like values obtained in participants of the head down tilt bed rest study. The modest correlation between estimated and measured PWV (r² 0.40; p<0.05) was attenuated after adjusting for age; the mean difference between pulse wave velocity measurements was 1 m/s.Conclusion. Estimated pulse wave velocity mainly reflects the entered age rather than true vascular properties and, therefore, failed detecting beneficial effects of life long exercise.Funding. The AGBRESA-Study was funded by the German Aerospace Center (DLR), the European Space Agency (ESA, contract number 4000113871/15/NL/PG) and the National Aeronautics and Space Administration (NASA, contract number 80JSC018P0078). Fabian Hoffmann received funding by the DLR and the German Federal Ministry of Economy and Technology, BMWi (50WB1816). SM, JT and JJ were supported by the Austrian Federal Ministry for Climate Action, Environment, Energy, Mobility, Innovation and Technology, BMK (SPACE4ALL Project, FFG No. 866761).

Relationship Between Brachial–Ankle Pulse Wave Velocity and Risk of New-Onset Acute Myocardial Infarction

Background To investigate the effect of brachial–ankle pulse wave velocity (baPWV) on new-onset acute myocardial infarction (AMI). Methods A retrospective cohort study was performed for the subjects who underwent baPWV examination during the follow-up of Kailuan Study Cohort from 2010 to 2017. The observation subjects were divided into 3 groups based on the levels of baPWV: &lt;14, 14 to &lt;18, and ≥18 m/s. The incidence density of AMI in 3 groups was calculated. Log-rank test was used to compare the differences of cumulative AMI incidence among 3 groups. The influence of baPWV on new-onset AMI was analyzed by Cox proportional risk model and restricted cubic spline. Results A total of 41,405 subjects were included in the study. During 2.66 (1.07–5.39) years’ follow-up, 150 new-onset AMI cases were observed. The incidence density of AMI in 3 groups was 3.69, 12.79, and 26.65 per 10,000 person-years, respectively. Log-rank test result showed the cumulative AMI incidence increased gradually from the subjects with the lowest baPWV to those with the highest baPWV (P &lt; 0.05). Compared with subjects with baPWV &lt;14 m/s, Cox model showed that hazard ratios (95% confidence interval) of AMI in those with baPWV 14 to &lt;18 m/s and baPWV ≥18 m/s were 1.77 (1.04–3.01) and 1.93 (1.03–3.60) after adjusting for age, sex, and other potential confounding factors, respectively. Restricted cubic spline analysis showed that there was a dose–response relationship between the hazard ratio of AMI and baPWV levels. Conclusions The increased baPWV is a risk factor for new-onset AMI.

Associations between estimated and measured carotid-femoral pulse wave velocity in older Black and White adults: the atherosclerosis risk in communities (ARIC) study

Introduction: Aortic stiffness offers important insight into vascular aging and cardiovascular disease (CVD) risk. The referent measure of aortic stiffness is carotid-femoral pulse wave velocity (cfPWV). cfPWV can be estimated (ePWV) from age and mean arterial pressure. Few studies have directly compared the association of ePWV to measured cfPWV, particularly in non-White adults. Moreover, whether ePWV and cfPWV correlate similarly with CVD risk remains unexplored. Aim: (1) To estimate the strength of the agreement between ePWV and cfPWV in both Black and White older adults; and (2) to compare the associations of ePWV and cfPWV with CVD risk factors and determine whether these associations were consistent across races. Methods and Results: We evaluated 4478 [75.2 (SD 5.0) years] Black and White older adults in the Atherosclerosis Risk in Communities (ARIC) Study. cfPWV was measured using an automated pulse waveform analyzer. ePWV was derived from an equation based on age and mean arterial pressure. Association and agreement between the two measurements were determined using Pearson’s correlation coefficient (r), standard error of estimate (SEE), and Bland-Altman analysis. Associations between traditional risk factors with ePWV and cfPWV were evaluated using linear mixed regression models. We observed weak correlations between ePWV and cfPWV within White adults (r = 0.36) and Black adults (r = 0.31). The mean bias for Bland-Altman analysis was low at -0.17 m/s (95%CI: -0.25 to -0.09). However, the inspection of the Bland-Altman plots indicated systematic bias (P < 0.001), which was consistent across race strata. The SEE, or typical absolute error, was 2.8 m/s suggesting high variability across measures. In models adjusted for sex, prevalent diabetes, the number of prevalent cardiovascular diseases, and medication count, both cfPWV and ePWV were positively associated with heart rate, triglycerides, and fasting glucose, and negatively associated with body mass index (BMI) and smoking status in White adults (P < 0.05). cfPWV and ePWV were not associated with heart rate, triglycerides, and fasting glucose in Black adults, while both measures were negatively associated with BMI in Black adults. Conclusions: Findings suggest a weak association between ePWV and cfPWV in older White and Black adults from ARIC. There were similar weak associations between CVD risk factors with ePWV and cfPWV in White adults with subtle differences in associations in Black adults. One sentence summary: Estimated pulse wave velocity is weakly associated with measured carotid-femoral pulse wave velocity in older Black and White adults in ARIC.