Takayasu's arteritis: a cause of prolonged arterial stiffness

OBJECTIVES: Cardiovascular disease is a major cause of mortality and morbidity in patients with Takayasu's arteritis (TA). Increased arterial stiffness is an independent risk factor and predictor of cardiovascular mortality in a variety of diseases. Pulse wave velocity (PWV) and the augmentation index (AI) are used as clinical measurements of arterial stiffness. METHODS: Data are presented from 10 patients with TA and 11 normal controls obtained between 2000 and 2004. Arterial compliance was assessed non-invasively by measurement of PWV, using the Complior system, and calculation of the aortic AI. RESULTS: TA patients (mean age 40.8+/-13.2 yr) were compared with a control group of healthy women from a parallel study (mean age 32.3+/-5.5 yr). The mean carotid-femoral PWV (PWV-CF) was higher in TA patients (P = 0.03). In addition, both aortic AI derived from the radial artery (P = 0.002) and carotid AI (P = 0.03) were higher in TA patients compared with controls. PWV-CF did not correlate with CRP (r = - 0.23, P = 0.23) or ESR (r = - 0.19, P = 0.27). Similar results were obtained for the correlation of carotid-radial PWV with CRP (r = 0.15, P = 0.32) and ESR (r = 0.33, P = 0.14). CONCLUSIONS: Our data show that TA is associated with elevated arterial stiffness in the central aorta, which may persist when the disease is quiescent. These data suggest that PWV represents a means by which cardiovascular risk can be detected and monitored in TA, and highlights the importance of effective management of cardiovascular risk factors in these patients.     

Arterial stiffness and osteoporosis in chronic obstructive pulmonary disease

RATIONALE: Chronic obstructive pulmonary disease (COPD) is associated with an increased risk of cardiovascular events and osteoporosis. Increased arterial stiffness is an independent predictor of cardiovascular disease. OBJECTIVES: We tested the hypothesis that patients with COPD would have increased arterial stiffness, which would be associated with osteoporosis and systemic inflammation. METHODS: We studied 75 clinically stable patients with a range of severity of airway obstruction and 42 healthy smoker or ex-smoker control subjects, free of cardiovascular disease. All subjects underwent spirometry, measurement of aortic pulse wave velocity (PWV) and augmentation index, dual-energy X-ray absorptiometry, and blood sampling for inflammatory mediators. MEASUREMENTS AND MAIN RESULTS: Mean (SD) aortic PWV was greater in patients, 11.4 (2.7) m/s, than in control subjects, 8.95 (1.7) m/s, p < 0.0001. Inflammatory mediators and augmentation index were also greater in patients. Patients with osteoporosis at the hip had a greater aortic PWV, 13.1 (1.8) m/s, than those without, 11.2 (2.7) m/s, p < 0.05. In patients, aortic PWV was related to age (r = 0.63, p < 0.0001) and log(10) IL-6 (r = 0.31, p < 0.01), and inversely to FEV(1) (r = -0.34, p < 0.01). The strongest predictors of aortic PWV in all subjects were age (p < 0.0001), percent predicted FEV(1) (p < 0.05), mean arterial pressure (p < 0.05), and log(10) IL-6 (p < 0.05). CONCLUSIONS: Increased arterial stiffness was related to the severity of airflow obstruction and may be a factor in the excess risk for cardiovascular disease in COPD. The increased aortic PWV in patients with osteoporosis and the association with systemic inflammation suggest that age-related bone and vascular changes occur prematurely in COPD.     

Arterial stiffness and wave reflections in patients with sickle cell disease

We tested the hypothesis that lower blood pressure and increased vasodilatation reported in sickle cell disease (SCD) patients with hemoglobin SS genotype (SS) are translated by lower arterial stiffness determined by pulse wave velocity (PWV) and wave reflections assessed by augmentation index (AI). We enrolled 20 SS (8 females; 12 male) patients closely matched for age, gender, height, and body mass index to 20 subjects with hemoglobin AA genotype (AA). Carotid-femoral PWV (PWV(CF)) and carotid-radial PWV (PWV(CR)) were recorded with the Complior device. Aortic AI was derived from pressure wave analysis (SphygmocoR). PWV(CF) and PWV(CR) were lower in SS than in AA (4.5+/-0.7 m/s versus 6.9+/-0.9 m/s, P<0.0001 and 6.6+/-1.2 m/s versus 9.5+/-1.4 m/s, P<0.0001, respectively). AI was lower in SS than in AA (2+/-14% versus 11+/-8%, P=0.02). Multivariate analysis revealed that both PWV(CF) and PWV(CR) were negatively associated with hemoglobin SS type and positively related to mean arterial pressure (MAP), whereas AI was positively associated with MAP and total cholesterol (all P<0.0001). Multivariate analysis restricted to SS indicated a positive association between PWV(CF) and PWV(CR) with age but a negative association with MAP (R2=0.57 and 0.51, respectively, both P<0.001), whereas MAP and heart rate were independently associated with AI (R2=0.65, P<0.001). This study provides the first evidence that SCD is associated with both lower arterial stiffness and wave reflections. SS patients have a paradoxical negative association between PWV and MAP, suggesting that low MAP does not protect them against arterial stiffness impairment.     

The relationship between aortic augmentation index and pulse wave velocity: an invasive study

OBJECTIVES : The aortic augmentation index (AI) and aortic pulse wave velocity (PWV) are known to be indicators of arterial stiffness. However, it is not clear whether aortic AI and PWV reflect aortic stiffness in similar ways. We investigated the relationship between aortic AI and PWV by measuring them directly using a catheter technique. DESIGN AND METHODS: Forty-one patients, aged 34-79 years, were studied during diagnostic cardiac catheterization. Aortic pressures were measured using a catheter-tip manometer at two points, one in the ascending aorta and one 40 cm distally in the descending aorta. Aortic AI was defined as the difference between early and late pressure peaks divided by the pulse pressure of the ascending aorta. Aortic PWV was calculated as the distance between the two measuring sites divided by the transit time. We also examined the effects of vasodilatation on AI and PWV by the intra-aortic administration of nitroglycerin in 15 patients. RESULTS: AI was significantly related to age, systolic aortic pressure, heart rate, left ventricular ejection time, and height. Aortic PWV showed an association only with age and systolic aortic pressure. There was no significant relationship between aortic AI and PWV (r = 0.28, NS). Nitroglycerin also produced different effects on aortic AI and PWV: aortic AI was significantly decreased (-0.17, P < 0.01) after nitroglycerin, but PWV remained unchanged (+0.4 m/s, NS). CONCLUSIONS: Aortic AI and PWV cannot be used interchangeably as an index of arterial stiffness. AI may not be a true indicator of arterial stiffness, but an index of wave reflection including PWV.     

Early identification of vascular damage in patients with systemic sclerosis

Vascular involvement in systemic sclerosis (SSc) plays a key role in the pathogenesis of fibrosis. We assessed arterial stiffness using a new echo-tracking technique in patients with SSc asymptomatic for cardiovascular diseases. We enrolled 22 patients (21 female, 63 ± 14 years) and 20 controls (12 female, 62 ± 3 years). Carotid intima-media thickness (IMT) was comparable between the 2 groups (1.1 ± 0.3 vs 1.0 ± 0.4 mm, P = ns), whereas the stiffness parameters were significantly increased in patients (β: 9.5 ± 4.2 vs 5.8 ± 1.1, P = .001; pulse wave velocity [PWV]: 6.5 ± 1.5 vs 5.2 ± 0.6 m/sec, P = .003). A correlation between stiffness parameters, anti-Scl-70 antibodies (β: r = .46, P = .03; PWV: r = .50, P = .02), and anticentromere antibodies (β: r = -.54, P = .020; PWV: r = -.53, P = .023) was found. Echo-tracking technique may be valuable in early identification of vascular involvement in patients with SSc.     

Augmentation index and central aortic stiffness in middle-aged to elderly individuals

BACKGROUND: Increased aortic stiffness contributes to systolic hypertension and increased cardiovascular risk. The augmentation index (AI), ie, the percentage of central pulse pressure attributed to reflected wave overlap in systole, was proposed as a noninvasive indicator of increased arterial stiffness. We evaluated this hypothesis by investigating relations between AI and other direct measures of aortic stiffness. METHODS: Tonometric carotid- and femoral-pressure waveforms, Doppler aortic flow, and aortic-root diameter were assessed in 123 individuals with uncomplicated systolic hypertension and 29 controls of comparable age and sex. Carotid-femoral pulse-wave velocity (PWV) was assessed from the carotid-femoral time delay and body-surface measurements. Aortic PWV was assessed from the ratio of the upstroke of carotid pressure and aortic flow velocity and was used to calculate proximal aortic compliance as [aortic area]/[1.06 x (aortic PWV)(2)]. RESULTS: Partial correlations (adjusted for age, sex, presence of hypertension, height, weight, and systolic ejection period) showed no association between AI and carotid-femoral PWV (R = -0.05, P = .54). The AI was significantly though weakly related directly with aortic compliance (R = 0.21, P = .012) and inversely with aortic PWV (R = -0.198, P = .017). However, higher stiffness (lower compliance and higher PWV) was associated with lower AI. CONCLUSIONS: Increased AI is not a reliable surrogate for increased aortic stiffness. Decreasing AI with decreasing compliance (increasing aortic stiffness) may be attributable to impedance matching and reduced wave reflection at the interface between the aorta and the muscular arteries.     

Arterial distensibility in Wegener's granulomatosis: a carotid-femoral pulse wave velocity study.

OBJECTIVE: The purpose of this study was to test the hypothesis; that chronic inflammation may impair vascular function and lead to an increase of arterial pulse wave velocity (PWV) in patients with Wegener's granulomatosis (WG). METHODS: We recruited 5 patients with WG and 5 healthy age and sex matched controls in this cross-sectional case-controlled study. Aortic PWV was determined by using an automatic device (Complior Colson, France), which allowed on-line pulse wave recording and automatic calculation of PWV. RESULTS: The carotid-femoral (aortic) PWV was increased in patients with WG as compared with control group (p=0.04). Although we found positive correlation between PWV and heart rate (r=0.75, p=0.01), we did not find any significant correlation between PWV and anthropometric and other hemodynamic parameters (p>0.05). In addition, we found positive correlation between PWV and erythrocyte sedimentation rate in patients with WG (r=0.90, p=0.03). CONCLUSION: Pulse wave velocity is increased and arterial distensibility decreased in patients with WG. Measurements of carotid-femoral (aortic) PWV may provide an easy and noninvasive technique to identify patients at increased risk of arterial disease.     

Validity of pulse pressure and augmentation index as surrogate measures of arterial stiffness during beta-adrenergic stimulation

OBJECTIVE: Increased arterial stiffness is a determinant of cardiovascular mortality. Pulse wave velocity (PWV) is a direct measure of arterial stiffness. Aortic augmentation index (AI) and pulse pressure (PP) are surrogate measures of arterial stiffness. Both PWV, AI and PP increase with cardiovascular risk factors. The aim of this study was to test the validity of AI and PP as surrogate measures of arterial stiffness compared with PWV, during beta-adrenergic stimulation with Isoprenaline (Iso). DESIGN AND METHODS: A total of 41 healthy volunteers entered a randomized, double-blind, placebo-controlled, cross-over study. In random order, subjects were given intravenous infusion in equal volume of Iso 8 microg/kg per min (dissolved in glucose 5%) and placebo (glucose 5%). A wash-out period of 25 min was observed between the infusions. Measurements included blood pressure (BP), heart rate (HR), PWV, and AI. PWV were determined using complior (Complior, Artech-Medical, Paris, France). AI and aortic PP were obtained from pulse wave analysis of radial applanation tonometry, using transfer function (SphygmoCor Windows software). RESULTS: Baseline AI increased (P < 0.05) with aging, a lower height and a larger diastolic BP (DBP). Iso increased (P < 0.0001) HR, brachial SBP, brachial and aortic PP as compared with placebo. In contrast, Iso decreased (P < 0.05) AI, brachial DBP, peripheral PWV, but not aortic PWV. Decrease of AI induced by Iso was not related to PWV. In stepwise multiple regression changes in HR, brachial SBP and DBP were independent determinants of AI response to Iso (r = 0.78, P < 0.0001). CONCLUSIONS: Our findings show that AI and PP fail as surrogate measures of arterial stiffness during beta-adrenergic stimulation.     

Relationship between aortic atherosclerosis and non-invasive measures of arterial stiffness

Both increased arterial stiffness and atherosclerosis are risk factors for cardiovascular morbidity and mortality. We studied the relationship between aortic atherosclerosis, assessed by measuring maximal aortic intima-media thickness (MAIMT) on transesophageal echocardiography and aortic stiffness, measured by applanation tonometry. Eighty-one patients (28 men, 53 women, mean age 61+/-13 years) referred for transesophageal echocardiography were studied. Augmentation index (AI) and carotid-radial pulse (PWV) wave velocity were measured using a SphygmoCor tonometer (Atcor Med., Australia). MAIMT was correlated with AI and age (r=0.35, p=0.002 and r=0.36, p=0.001), respectively. There were no relations between MAIMT and either aortic pulse pressure (A-PP) (r=0.10, p=0.35) or PVW (r=-0.38, p=0.76). Multivariate regression analysis revealed that AI and age were independently related to MAIMT. In this middle-aged predominantly African-American population structural aortic atherosclerosis and aortic stiffness as measured by AI are age dependent and are inter-related, independent of age.     

Vascular stiffness in chronic renal failure patients treated by hemodialysis

Cardiovascular disease is a major cause of morbidity in patients with end-stage renal failure. Arterial stiffness measured by pulse wave velocity (PWV) is an independent risk factor for morbidity in end stage renal failure patients. The aim of our study was to evaluate the arterial stiffness in patients with chronic renal failure. In 20 chronic renal failure patients treated by hemodialysis (HD) we assessed the PWV of the carotic artery as well as artery diameter and distensibility, systolic pressure (SBP), diastolic pressure (DBP), pulse pressure (PP), and basal biochemical parameters and compared them with the values determined in 20 healthy controls of comparable age. PWV and PP are significantly (p < 0.001, p < 0.05) higher and distensibility of the carotic artery was significantly lower (p < 0.001) compared to a control group SBP and DBP were < 140/90 mmHg in HD patients (high normotensive range) but were significantly (p < 0.05) higher than in a control group. In HD patients PP was correlated with arterial distensibility r = -0.600 (p < 0.005), and systolic artery rice r = -0.408 (p < 0.05). SBP was correlated with PP r = 0.689 (p < 0.0007) and with arterial distensibility r = -0.476 (p < 0.03), arterial diameter to systolic artery rice r = -0.463 (p < 0.03), systolic artery rice to arterial distensibility r = 0.885 (p < 0.00001), intima media to arterial distensibility r = 0.815 (p < 0.00001), intima media to arterial compliance r = 0.893 (p < 0.00001). Our results suggest that not only established hypertension but also high normotensive pressure could cause arterial stiffness absened in chronic renal failure patients.     

Preferential macrovasculopathy in systemic sclerosis detected by regional pulse wave velocity from wave intensity analysis: Comparisons of local and regional arterial stiffness parameters in cases and controls

Objective

To study the extent and severity of macrovasculopathy in systemic sclerosis (SSc; scleroderma) patients by comparing both local and regional arterial stiffness parameters.

Methods

The local arterial stiffness indices of the right common carotid artery, right brachial artery, right radial artery, right superficial femoral artery, and right posterior tibial artery were measured in 25 SSc patients and strictly matched healthy controls. The regional pulse wave velocity (PWV) of each arterial segment was also calculated from wave intensity analysis.

Results

There were no differences between the two groups in the stiffness index (β), Peterson's pressure modulus, arterial compliance, and local PWV derived from β (PWVβ) of all vessels except the right brachial artery, of which β, Peterson's pressure modulus, and PWVβ were markedly lower and arterial compliance was higher in SSc patients compared with controls (P < 0.05). The forearm (brachial–radial) and arm (carotid–radial) PWVs were significantly higher in SSc patients than in controls (mean ± SD 12.1 ± 7.1 meters/second versus 8.3 ± 3.5 meters/second and mean ± SD 7.9 ± 1.9 meters/second versus 6.9 ± 1.5 meters/second, respectively; P < 0.05), whereas the upper arm (carotid–brachial), aortic (carotid–femoral), and leg (femoral–ankle) PWVs were not different between groups. The aortic PWV was also higher in the diffuse cutaneous SSc subgroup than in controls (mean 6.2, 95% confidence interval [95% CI] 5.4–6.9 meters/second versus mean 5.1, 95% CI 4.7–5.6 meters/second; P < 0.05) after adjusting for potentially influential variables.

Conclusion

The macrovasculopathy occurs preferentially at the forearm and aorta in SSc, which can be sensitively and reliably detected by regional PWVs rather than commonly used local arterial stiffness indices.     

The T-allele of the C825T polymorphism is associated with higher arterial stiffness in young healthy males

Arterial stiffening is the major cause of increasing systolic blood pressure in arterial hypertension. Increased arterial stiffness is one major mechanism responsible for morbidity and mortality in hypertension. A C825T polymorphism was identified in the gene encoding the G-protein beta3 subunit (GNB3), and an association of the T-allele with hypertension was demonstrated in several studies. In order to identify a pathogenetic link between hypertension and arterial stiffness, we compared two indices of arterial stiffness, pulse wave velocity (PWV) and augmentation index, in young, healthy men with and without the 825T-allele under resting conditions. PWV was determined from pressure tracing over carotid and femoral arteries in 99 subjects (CC: n=43; CT&TT: n=56). Augmentation index was derived in 72 subjects (CC: n=30; CT&TT: n=42) by pulse wave analysis using radial applanation tonometry. Carriers of the 825T-allele exhibited a significantly higher PWV compared to subjects with the CC genotype (6.0+/-0.1 m/s (TC&TT) vs 5.7+/-0.1 m/s (CC); P=0.0251). There was also a significant difference (P = 0.0448) in augmentation index between carriers of the T-allele (CT&TT: 3.4+/-2.9%) and controls with the CC -genotype (-5.0+/-4.1 %). There was no difference in any other anthropometric (age, height, weight, body mass index) or haemodynamic (heart rate, peripheral and central blood pressure). In summary, the C825T polymorphism is associated with higher arterial stiffness in young, healthy males. Arterial stiffening may pathogenetically contribute to the development of hypertension in carriers of the T-allele.     

Arterial stiffness in a muscular artery in women with longstanding rheumatoid arthritis compared with healthy controls and patients with traditional cardiovascular risk factors

Pulse wave velocity (PWV), a marker of arterial stiffness, reflects vascular dysfunction and is associated with cardiovascular risk. Rheumatoid arthritis (RA) is associated with profound changes in vascular function and premature death, mainly caused by cardiovascular diseases. The aim of this study was to investigate arterial stiffness in the brachial artery (a muscular type of artery) as measured by PWV in women with longstanding RA and to compare the results with healthy controls and to patients with traditional cardiovascular risk factors without RA. A total of 80 female participants underwent non-invasive measurement of PWV. Participants were allocated to one of three groups: patients with longstanding RA (disease duration >5 years) without traditional cardiovascular risk factors (n = 30), patients with traditional cardiovascular risk factors (n = 20) and healthy controls (n = 30). Patients and controls were matched for age. PWV was significantly higher in RA patients (8.6 ± 0.9 m/s) as compared with healthy controls (8.1 ± 0.7 m/s; P = 0.02). PWV was virtually the same in RA patients and patients who had traditional cardiovascular risk factors (8.6 ± 1.5 m/s; NS). PWV was also higher in this group as compared with healthy controls, but this difference did not reach statistical significance (NS). RA is associated with a higher PWV as compared with healthy controls and is comparable to patients with known traditional risk factors. This reflects vascular dysfunction in patients with RA.     

Effects of hunter-gatherer subsistence mode on arterial distensibility in Cameroonian pygmies

We aimed to assess whether arterial distensibility estimated by pulse wave velocity (PWV) and augmentation index (AI) differs between Cameroon traditional pygmies (TPs) on hunter-gather subsistence mode, contemporary pygmies who migrated to semiurban area, and the Bantou farmers (BFs) sharing the same environment. For that purpose, we recorded carotid-femoral PWV (ComplioR) in age and sex carefully matched 20 TPs, 20 contemporary pygmies, and 22 BFs. Aortic AI corrected for heart rate and blood pressures were generated from pressure wave analysis (SphygmoCor). Lipid profile was determined in TP and BF participants. TPs were shorter (P=0.02) with lower body weight (P<0.01) in comparison with contemporary pygmies and BFs. TPs had lower low-density lipoprotein cholesterol but higher high-density lipoprotein cholesterol than BFs (P<0.01). Their PWV (5.81±0.21 m/s) was slower (P=0.006) than that of contemporary pygmies (6.82±0.36 m/s) or BFs (6.93±0.29 m/s); however, after its adjustment for age, mean arterial pressure, and heart rate, the difference was slightly attenuated (P=0.051). PWV adjusted for weight did not differ between groups (P=0.10). In the whole study population but not in TPs taken separately, multivariate regression analysis revealed that PWV was independently associated with mean arterial pressure, age, and TP status (P<0.001), whereas age, mean arterial pressure, and height emerged as independent determinants of aortic AI corrected for heart rate (P<0.001). Aortic AI corrected for heart rate did not differ in the 3 groups. In conclusion, hunter-gather lifestyle is associated with low atherosclerosis risk translated by lower aortic stiffness attributed at least partly to low weight and blunted effects of aging and blood pressures on TP arterial structure and function.     

Increased pulse wave velocity is not associated with elevated augmentation index in patients with diabetes

OBJECTIVE: Increased arterial stiffness is a risk factor for cardiovascular disease and is a feature associated with diabetes. Pulse wave velocity (PWV) is an accepted index of arterial stiffness and augmentation index (AI) derived from radial applanation tonometry has been advocated as a measurement of arterial stiffness. This study compares the relationship between PWV and AI in people with and without diabetes. DESIGN AND METHODS: A total of 66 people with diabetes and 66 age-matched non-diabetic controls were studied. Central aortic pressure waves were generated using applanation tonometry over the radial artery and used to calculate AI. Carotid-femoral PWV (PWVcf) was measured simultaneously. RESULTS: Relative to controls, diabetes was associated with increased pulse pressure (PP) and PWVcf (P < 0.01). In contrast, AI did not differ between groups even after adjustment for heart rate. This observation remained consistent irrespective of diabetes type, arterial site, and the presence or absence of antihypertensive therapy. Multiple regression analysis revealed diabetes to be a significant determinant of PWVcf, but not AI. CONCLUSIONS: PP and PWVcf are increased in people with diabetes, but this is not associated with increased AI. These findings conclusively demonstrate that AI is not a reliable measure of arterial stiffness in people with diabetes.     

Brachial-ankle pulse wave velocity: an index of central arterial stiffness?

Brachial-ankle pulse wave velocity (baPWV) is a promising technique to assess arterial stiffness conveniently. However, it is not known whether baPWV is associated with well-established indices of central arterial stiffness. We determined the relation of baPWV with aortic (carotid-femoral) PWV, leg (femoral-ankle) PWV, and carotid augmentation index (AI) by using both cross-sectional and interventional approaches. First, we studied 409 healthy adults aged 18-76 years. baPWV correlated significantly with aortic PWV (r = 0.76), leg PWV (r = 0.76), and carotid AI (r = 0.52). A stepwise regression analysis revealed that aortic PWV was the primary independent correlate of baPWV, explaining 58% of the total variance in baPWV. Additional 23% of the variance was explained by leg PWV. Second, 13 sedentary healthy men were studied before and after a 16-week moderate aerobic exercise intervention (brisk walking to jogging; 30-45 min/day; 4-5 days/week). Reductions in aortic PWV observed with the exercise intervention were significantly and positively associated with the corresponding changes in baPWV (r = 0.74). A stepwise regression analysis revealed that changes in aortic PWV were the only independent correlate of changes in baPWV (beta = 0.74), explaining 55% of the total variance. These results suggest that baPWV may provide qualitatively similar information to those derived from central arterial stiffness although some portions of baPWV may be determined by peripheral arterial stiffness.     

Peripheral arterial disease: an underestimated aetiology of exercise intolerance in chronic obstructive pulmonary disease patients.

OBJECTIVE: To assess the prevalence of peripheral arterial disease and its implications for exercise limitation in chronic obstructive pulmonary disease (COPD) patients. METHOD: One hundred and fifty-one moderate-to-severe COPD patients (forced expiratory volume in 1 s: 37+/-6 SD% predicted) and 73 healthy age-matched control individuals (divided into 31 smokers and 42 nonsmokers) participated in this study. All COPD patients were either exsmokers or current smokers and their tobacco-smoking history was similar to that of healthy smokers. To evaluate the existence of arterial disease, lower limb perfusion pressure impairment was assessed using the ankle brachial index, whereas arterial stiffness was assessed by the pulse wave velocity (PWV). The definition of peripheral arterial disease required an ankle brachial index value of 0.90 or less, whereas the PWV increment was considered to be a direct witness of arterial stiffness increase. A 6-min walk test was performed to assess physical exercise capacity. RESULTS: Prevalence of peripheral arterial disease was higher in COPD patients than in healthy participants (81+/-3 SD; 49+/-5 SD and 9+/-2 SD%, respectively, in COPD, healthy smokers and nonsmokers). PWV mean values were significantly higher in COPD patients compared with healthy smokers and nonsmokers (10.3+/-2.1 SD m/s; 9.2+/-1.3 SD m/s and 8.7+/-2.2 SD m/s, respectively). The distance covered during the 6-min-walk test was associated positively with the degree of peripheral arterial disease (r=0.78; P=0.05) and negatively with the PWV values (r=-0.74; P=0.05). Not only tobacco-smoking history but also COPD severity was shown to influence these associations. CONCLUSION: The effect of peripheral arterial disease on exercise intolerance in COPD seems to be considerable. Therefore, COPD patients participating in a pulmonary rehabilitation programme should profit from a systematic search for arterial disease. Arterial dysfunction has to be taken into account in the multidisciplinary treatment of these patients.     

Association between serum homocysteine and arterial stiffness in patients with Behçet’s disease

Aim of the workTo study the effects of serum homocysteine (Hcy) on arterial wall properties, as a contributing risk factor for arterial atherosclerosis and thrombosis.Patients and methodsFifty Behçet's disease (BD) patients (M/F:37/13; age:34.8 ± 8.5 years) along with 50 healthy controls (M/F:32/18; age:31.9 ± 8.1 years) matched for age, sex, blood pressure, heart rate, height, total cholesterol and glucose levels were included. All were recruited Zagazig University Hospitals between January 2018 and December 2018. Disease activity was assessed using the Behçet's Disease Current Activity Form (BDCAF). Total Hcy was assayed by the Axis-Shield Homocysteine Enzyme Immunoassay (EIA) in serum. All subjects underwent carotid Doppler ultrasound to measure carotid artery intima-media thickness (C-IMT), arterial distensibility coefficient, Beta-stiffness index (ß) and carotid- femoral pulse wave velocity (PWV).ResultsThe main findings were significantly increased C-IMT (0.75 ± 0.71 mm), beta stiffness index (3.55 ± 0.34) and PWV (6.55 ± 1.07 m/second) and decreased distensibility (23.39 ± 1.89·10⁻³ × kPa⁻¹) in patients compared to control (p < 0.001, p < 0.001, p = 0.02 and p < 0.001 respectively). The Hcy level was significantly higher in BD patients (17.3 ± 4.2 μmol/L) vs control (8.9 ± 2.3 μmol/L). The Hcy level > 15 μmol/L significantly correlated with the C-IMT (r = 0.54, p < 0.001), ß index (r = 0.78, p < 0.001), PWV (r = 0.56, p < 0.001) and distensibility (r = −0.65, p < 0.001) as well as with the presence of vascular lesions (r = 0.59, p < 0.001) with a tendency to correlate with the BDCAF (r = 0.11, p = 0.07).ConclusionsThese findings suggest higher risk for development of atherosclerosis and endothelial dysfunction in BD patients and highlights that future researches should focus on identification and prophylactic treatment of patients at risk of cardiovascular disease.     

Arterial Stiffness in Adult Patients with Cyanotic Congenital Heart Disease

Background. Increased arterial stiffness is an important predictor of cardiovascular (CVS) morbidity and mortality. Adults suffering from cyanotic congenital heart disease (CCHD) represent a population of patients at particular risk of CVS events. Erythrocytosis is a cardinal feature of CCHD but little is known about any possible interaction between hematological derangements and arterial stiffness. Methods. Fourteen CCHD patients (6 men and 8 women, mean age 32 ± 3 years) and 13 age‐matched healthy subjects were recruited. Results. Mean arterial stiffness, as estimated by stiffness index of digital volume pulse (SI_DVP) values was similar in the 2 groups (7.9 ± 0.7m/s vs. 7.2 ± 0.4 m/s, P = .38). In the control subjects arterial stiffness showed a strong correlation with age and mean arterial pressure (r = 0.64, P = .02 and r = 0.58, P = .036, respectively). In patients with CCHD, arterial stiffness correlated with mean arterial pressure but not with age (r = 0.76, P = .002 and r =?0.13, P = .65, respectively). However, SI_DVP correlated with hematocrit in CCHD patients (r = 0.69, P = .006), but not in healthy controls. The mean arterial pressure in patients with CCHD but not in controls showed a highly significant, positive correlation with the hematocrit level (r = 0.68, P = .008). Conclusions. Arterial stiffness in CCHD patients is affected by arterial pressure and hematocrit concentration but did not differ significantly from that in age‐matched healthy controls. It is unlikely that increased arterial stiffness may contribute to cardio‐ and cerebrovascular complication in adults with CCHD.     

Impact of serum parathyroid hormone concentration and its regulatory factors on arterial stiffness in patients undergoing maintenance hemodialysis

BACKGROUND: Cardiovascular mortality is extremely high in patients on hemodialysis. Among a variety of pathophysiological conditions, deranged calcium homeostasis including secondary hyperparathyroidism may be one of the factors contributing to cardiovascular disease in patients on hemodialysis. This study was designed to evaluate the role of the serum parathyroid hormone (PTH) concentration and its regulatory factors in serum on arterial stiffness in patients on maintenance hemodialysis. METHODS: Arterial stiffness was assessed by pulse wave velocity (PWV) in 73 non-diabetic patients undergoing maintenance hemodialysis. At the same time, serum concentrations of calcium, phosphate, and intact PTH were measured. RESULTS: Single regression analyses revealed that arterial PWV was positively correlated with age (r = 0.505, p < 0.0001), systolic blood pressure (r = 0.250, p = 0.043), and pulse pressure (r = 0.306, p = 0.012). It was inversely correlated with the serum phosphate concentration (r = -0.240, p = 0.041) and the duration of hemodialysis treatment (r = -0.343, p = 0.003), but not with serum concentrations of calcium and intact PTH or the calcium x phosphate product in serum. By multiple regression analysis age was found to be the most significant variable affecting arterial PWV, and the duration of hemodialysis treatment negatively influenced arterial PWV. CONCLUSION: Age is an independent risk factor for arterial stiffness in patients on maintenance hemodialysis, and the serum PTH concentration and its regulatory factors in the serum are not.