Simultaneous non-invasive assessment of arterial stiffness and haemodynamics - a validation study

The purpose of the study was to estimate the reliability of whole-body impedance cardiography (ICGWB)-derived pulse wave velocity (PWV) and stroke volume index to pulse pressure (SI/PP) measurements. The repeatability and reproducibility of ICGWB parameters were also determined. Agreement between the impedance and Doppler ultrasound-based PWV measurements was estimated in 25 healthy subjects in two consecutive measurements. Impedance-derived SI/PP (SIICG/PP) estimates were compared with simultaneously measured SI/PP based on thermodilution (SITD/PP) and direct Fick (SIFICK/PP) methods in 30 surgical patients. PWV measured between the aortic arch and popliteal artery using the impedance technique with selective electrode configuration (PWVIS) agreed well with the Doppler ultrasound method (PWVDOPP), the bias (PWVDOPP - PWVIS) and precision (+/- SD of differences) being 0.00 and 0.79 m s-1, respectively. PWV derived from the whole-body and popliteal impedance plethysmograms (PWVICG) overestimated slightly PWVDOPP values. The repeatability value for PWVIS was excellent, being 0.54 m s-1. The reproducibility values for PWVDOPP and PWVIS were very similar (2.17 and 2.42 m s-1, respectively). Changes in PWVIS correlated strongly with changes in PWVDOPP (r=0.74; P<0.0001), indicating that both methods reflected the true physiological variation in PWV. The agreement between SIICG/PP and SITD/PP or SIFICK was almost identical to the agreement between the SITD/PP and SIFICK/PP. In conclusion,whole-body impedance cardiography provides handy and reliable means of evaluating arterial stiffness on the basis of PWV and SI/PP simultaneously with conventional haemodynamic parameters. The method is highly repeatable and reproducible.     

Segmental composition of whole‐body impedance cardiogram estimated by computer simulations and clinical experiments

Whole‐body impedance cardiography (ICG_WB) has been proposed as a feasible means of measuring cardiac output (CO). However, the source distribution of heart‐related impedance variations in the whole body is not known. To establish how much of a signal originates in each segment of the body and what the contribution of each is to stroke volume (SV) in ICG_WB, impedance in the extremities and trunk were investigated in 15 healthy volunteers. In addition, the theoretical measurement properties of ICG_WB were studied using a computer model of the whole‐body anatomy as a volume conductor. The model confirmed the expected result that most of the basal impedance originates from the extremities. Clinical experiments revealed that the heart‐related amplitude variations in the ICG_WB signal originate more evenly from various body segments, the trunk slightly more than the arms or legs. The heart‐related ICG_WB signal represents a weighted sum of segmental pulsatile events in the body yielding physiologically meaningful data on almost the whole circulatory system.     

Metabolic syndrome,cardiovascular risk and screening for subclinical atherosclerosis

The metabolic syndrome is a clustering of risk factors known to promote or increase the risk of diabetes development and subsequent cardiovascular disease. Screening for subclinical atherosclerosis using new imaging technologies or novel biomarkers could help to further risk-stratify patients with metabolic syndrome. In particular, noninvasive imaging of carotid intima-media thickness and coronary artery calcium scoring seem to have promising prognostic value in identifying patients at high risk. Early identification could lead to improved patient or physician adherence to risk-reducing behaviors or interventions and improve clinical outcomes.     

The effect of age and gender on arterial stiffness in healthy Caucasian Canadians

Aims and objectives. We aimed to investigate age and gender differences in arterial stiffness, and whether this cardiovascular risk factor was detectable in healthy Caucasians before established disease was manifest. Background. A growing number of risk factors including diabetes, obesity, hypertension, hyperlipidaemia, smoking and age have been linked to the adverse cardiovascular end‐points of myocardial infarction, stroke and heart failure. These risk factors lead to an increase in arterial stiffness. Measuring this stiffness at an early age may identify candidates for primary preventative intervention strategies by nurses. Methods. Caucasian Canadians (n = 176) were recruited. Peripheral and central blood pressure, pulse pressure, augmentation pressure, arterial compliance (augmentation index and pulse wave velocity) and sub‐endocardial viability ratio (SEVR), were assessed using applanation tonometry (SphygmoCor^® system). Blood was drawn for fasting lipid and glucose profiling. Results. Women participants had significantly stiffer arteries than men (augmentation index: 28 SEM = 1% vs. 18 SEM = 2% respectively; p < 0·001). Pulse wave velocity, however, was not different (7·7 SEM = 0·2 m/s vs. 8·3 SEM = 0·1 m/s respectively; p < 0·001). Age was a strong predictor of arterial stiffening in both genders, but the effect was greater in women. Conclusions. Women having stiffer arteries than men, thus at greater cardiovascular risk, may require earlier screening. The effect might be postmenopausal, and mechanisms require further investigation. However, both middle‐aged men and women considering themselves ‘healthy’ may benefit from more proactive primary prevention. Relevance to clinical practice. Applanation tonometry, used extensively by nurses, provides early detection of central haemodynamic changes and vascular compliance at all ages. Knowledge of arterial stiffness could guide the management of primary prevention in the nursing cardiovascular risk reduction clinic.     

Fibrinogen and d-dimer in contrasting relation with measures of wave reflection and arterial stiffness

Introduction. The relationship between the results of coagulation tests and measures of arterial stiffness or wave reflection has been investigated in different diseases. This exploratory study aimed at the evaluation of similar associations in healthy individuals. Material and methods. Pulse wave analysis of reconstructed aortic pressure waveform for the central augmentation index, augmentation pressure and pulse pressure, and digital volume pulse for the stiffness index were measured at supine rest in 91 healthy volunteers (54.1 ± 8.5 years; 56 female). Standard coagulation tests for the d-dimer and fibrinogen concentrations were performed in fasting venous blood. Results. In univariate linear regression d-dimer and fibrinogen concentrations were significantly and positively, although weakly, associated with measures related to pulse wave analysis. Multivariate linear regression adjusted to subjects’ age, resting pulse rate and mean blood pressure showed that the d-dimer concentration was significantly related to central augmentation index (p?=?0.014), augmentation pressure (p?=?0.003) and pulse pressure (p?=?0.029) whereas fibrinogen was linked to the stiffness index (p?=?0.04). Higher concentrations of d-dimers and fibrinogen are associated with increased arterial stiffness and faster pulse wave propagation in healthy people and the observed associations are independent of typical determinants of the shapes of pulse pressure waveforms like age, pulse rate and mean blood pressure. Conclusions. The independent relationships between the results of the coagulation tests and pulse wave analysis suggest that the existence of such associations may indicate a biologically plausible phenomenon.     

Association of lipoprotein subfractions with endothelial function and arterial stiffness in acute ischemic stroke

Hypercholesterolemia represents a risk factor for the development of atherosclerosis. Lipoprotein research has recently been focused on the phenomenon of atherogenic and non-atherogenic lipoproteins. The aim of this study was to explore the association of lipoprotein subfractions with a measure for endothelial function (represented by reactive hyperemia index [RHI]) and arterial stiffness (represented by augmentation index [AI]) in patients with acute ischemic stroke. We enrolled 51 patients with acute ischemic stroke. Blood samples were obtained within 24?h after the stroke onset in a fasting condition. Electrophoresis method on polyacrylamide gel was used for the analysis of plasma lipoproteins. RHI and AI was measured by peripheral arterial tonometry (EndoPAT2000 device). We failed to find any significant correlation between RHI and baseline characteristics of the population. Significant correlation was found between AI and age, hypertension, low density lipoprotein cholesterol (LDL) 1, LDL 3–7, score for anti-atherogenic risk and atherogenic profile. Age (beta?=?.362, p?=?.006) and LDL1 (beta?=??0.283, p?=?.031) were the only independent variables significantly associated with AI in regression analysis. Significantly higher AI was found in an atherogenic lipoprotein profile compared to a non-atherogenic profile population (median 25% vs. median 11.5%, p?=?.043). In conclusion, our results suggest significant inverse correlation between levels of LDL 1 subfraction and measures of AI in patients with acute ischemic stroke. Significantly higher values of AI were observed in the population with an atherogenic lipoprotein profile.     

Leptin, leptin soluble receptor and coronary atherosclerosis

BACKGROUND: The adipose tissue-related hormone leptin plays an important role in the regulation of body weight. The associations of leptin and leptin soluble receptor (sOb-R) with coronary artery disease (CAD) are not clear. DESIGN: We measured leptin and sOb-R in 543 consecutive patients (379 men, 164 women) referred for coronary angiography for the evaluation of CAD. Coronary artery stenoses with lumen narrowing > or = 50% were considered significant. RESULTS: Serum leptin correlated significantly with body mass index (r(s) = 0.443), with insulin resistance as assessed by the homeostasis model for the assessment of insulin resistance (r(s) = 0.339), with serum triglycerides (r(s) = 0.181), with systolic as well as diastolic blood pressure (r(s) = 0.170 and r(s) = 0.133, respectively) and, inversely, with sOb-R (r(s) = -0.346; P < 0.01 for all correlations). Coronary angiography revealed significant coronary artery stenoses in 331 (61%) of our patients. Serum leptin was significantly lower in patients with significant coronary artery stenoses than in patients without such lesions (8.5 +/- 7.8 vs. 13.2 +/- 12.2 ng mL(-1); P < 0.001). Multivariate logistic regression analysis proved serum leptin inversely and independently associated with the presence of significant coronary artery stenoses (standardized adjusted odds ratio 0.746, 95% confidence interval 0.566-0.983, P = 0.038). In contrast to serum concentrations of leptin, serum concentrations of sOb-R did not significantly differ between patients with significant stenoses and those without such lesions (22.4 +/- 8.3 vs. 23.1 +/- 12.1 ng mL(-1); P = 0.655). CONCLUSIONS: Serum leptin but not sOb-R is significantly lower in patients with angiographically determined CAD. Despite its association with cardiovascular risk factors, leptin should not be simply regarded as a promoter of atherosclerosis.     

Risk stratification in cardiovascular disease primary prevention - scoring systems, novel markers, and imaging techniques

The aim of this paper is to review and discuss current methods of risk stratification for cardiovascular disease (CVD) prevention, emerging biomarkers, and imaging techniques, and their relative merits and limitations. This report is based on discussions that took place among experts in the area during a special CardioVascular Clinical Trialists workshop organized by the European Society of Cardiology Working Group on Cardiovascular Pharmacology and Drug Therapy in September 2009. Classical risk factors such as blood pressure and low-density lipoprotein cholesterol levels remain the cornerstone of risk estimation in primary prevention but their use as a guide to management is limited by several factors: (i) thresholds for drug treatment vary with the available evidence for cost-effectiveness and benefit-to-risk ratios; (ii) assessment may be imprecise; (iii) residual risk may remain, even with effective control of dyslipidemia and hypertension. Novel measures include C-reactive protein, lipoprotein-associated phospholipase A(2) , genetic markers, and markers of subclinical organ damage, for which there are varying levels of evidence. High-resolution ultrasound and magnetic resonance imaging to assess carotid atherosclerotic lesions have potential but require further validation, standardization, and proof of clinical usefulness in the general population. In conclusion, classical risk scoring systems are available and inexpensive but have a number of limitations. Novel risk markers and imaging techniques may have a place in drug development and clinical trial design. However, their additional value above and beyond classical risk factors has yet to be determined for risk-guided therapy in CVD prevention.     

The Link Between Reproductive History,Cardiovascular Disease,and Peripheral Arterial Disease in Women: Implications for Practice

The average life expectancy in the United States fell for the second straight year. Attributed mostly to COVID-19 and unintentional injuries (driven by drug overdoses), the third most prevalent cause of death is heart disease. Peripheral arterial disease (PAD) is an often-unrecognized global pandemic affecting more than 220 million. Since early 2000, the incidence of PAD has increased by 25% globally, Once considered a male-dominated disease, PAD is a significant cause of morbidity and mortality among women. This article provides a comprehensive review of the sex-linked risk factors for PAD that pose additional threats for women. Implications for practice are provided.     

湖北和河南地区汉族人群NEIL3 rs12645561多态性与冠状动脉硬化严重程度的相关性研究

目的评估湖北和河南两地区汉族人群Nei核酸内切酶VIII样蛋白3(NEIL3)基因rs12645561多态性位点与冠状动脉硬化严重程度的相关性。方法以947例经冠状动脉造影病例为研究对象,采用病变支数得分和Gensini得分评估冠状动脉硬化严重程度;采用高分辨率熔解曲线进行rs12645561基因分型;ELISA法检测血浆NEIL3蛋白水平。结果 rs12645561 T风险等位可增加冠心病风险(χ2=12.165,P0.05),并与病变支数得分和Gensini得分明显相关(χ2分别为14.745和15.615,P0.05);rs12645561 CT+TT风险基因型、体重指数25 kg/m2、高脂血症和吸烟是Gensini得分增高的独立危险因素(OR分别为1.50、1.54、2.01、1.42,P0.05);血浆NEIL3蛋白表达水平与rs12645561基因型分布、病变支数得分和Gensini得分呈负相关(P0.05)。结论 rs12645561与湖北和河南地区冠状动脉硬化严重程度密切相关,并可影响NEIL3蛋白表达。     

Tea drinking,diet and ischemic stroke prevention in China: a future perspective

Stroke is a life-changing event. It has been estimated that 15–30% of stroke patients become permanently disabled. Ischemic stroke accounts for approximately 60% of all stroke cases in China and will significantly increase the health burden because of the aging population. Effective primary prevention strategies are clearly required. In this article, dietary modifications that could play an important role in ischemic stroke prevention for the Chinese population are reviewed. These factors include the promotion of tea drinking, increasing consumption of soy foods, dairy products and fruits, as well as smoking cessation and reductions in salt intake and rice-based foods.     

Hemostatic cardiovascular risk factors,common carotid–intima medial thickness and peripheral arterial disease in South Asians and African Caribbeans: a substudy to the Ethnic‐Echocardiographic Heart of England Screening (E‐ECHOES) Study

Summary. Objective: To determine whether ethnic differences exist in inflammatory (interleukin‐6 and C‐reactive protein) and hemostatic biomarkers (soluble P‐selectin [sP‐sel], von Willebrand factor [VWF], and fibrin D‐dimer) between South Asian (people originating from India, Pakistan, and Bangladesh) and African Caribbean (Black Caribbean and Black African) groups, the two largest minority ethnic groups in the UK; and to determine associations between these biomarkers and common carotid intima–media thickness and peripheral artery disease (PAD). Patients and methods: We recruited 572 subjects (356 South Asian and 216 Black) aged ≥ 45 years as a substudy to a community screening project, the Ethnic‐Echocardiographic Heart of England Screening (E‐ECHOES) study. All subjects completed an interviewer‐led questionnaire, anthropometric measurements were taken, and blood sampling was performed if consent was granted. Ankle brachial pressure index (ABPI) was calculated, and the common carotid intima–media thickness (CCIMT) was measured. PAD was defined as ABPI < 0.9. ELISA was used to quantify inflammatory and hemostatic biomarkers. Results: The incidence of hypertension (> 70%) and diabetes (> 27%) was high, but non‐significantly different between the two ethnic groups. South Asians had higher platelet count and sP‐sel levels than African Caribbeans (P < 0.0001 for both), despite there being no significant difference in antiplatelet medication. African Caribbeans had higher D‐dimer levels (P = 0.0052). Among South Asians, VWF correlated with ABPI (P = 0.047) and mean (P = 0.002) and maximum CCIMT (P = 0.011) on univariate analysis, and remained an independent predictor of mean and maximum CCIMT on multivariate analysis with traditional cardiovascular risk factors (P = 0.034 and P = 0.046, respectively). In African Caribbeans, D‐dimer levels were was higher in PAD than in normal ABPI participants (P = 0.04), and was associated with ABPI in both univariate analysis (P = 0.014) and multivariate analysis (P < 0.0001) with traditional cardiovascular risk factors. Conclusion: Ethnic differences are evident in inflammatory and hemostatic factors, as well as in their associations with CCIMT and PAD. These may reflect differences in cardiovascular risk factors or pathophysiologic processes that characterize each ethnic group.     

Shift Work,Genetic Factors,and the Risk of Heart Failure: A Prospective Study of the UK Biobank

ObjectiveTo quantify the association of combined shift work and genetic factors with the incidence of heart failure (HF).Participants and MethodsThis study included 242,754 participants with complete shift work information in the UK Biobank. Participants were followed from baseline (2006 to 2010) through January 31, 2018. The association between shift work and HF incidence was investigated separately in males and females using a Cox proportional hazards model adjusted for covariates. In addition, we established a polygenic risk score and assessed whether shift work alters genetic susceptibility to HF.ResultsThe results showed a significant association of permanent night shift work with incident HF among females (hazard ratio, 2.25; 95% CI, 1.34 to 3.76; P=.002) after adjusting for age, and the association was attenuated in the fully adjusted model. Among men, we did not detect an association between shift work and HF. In addition, we observed that the association between the risk of HF and shift work was strengthened by high genetic risk. Permanent night shift work paired with high genetic risk, compared with low genetic risk, was suggested to be associated with the risk of HF in females (hazard ratio, 2.89; 95% CI, 1.05 to 7.94) but not in males.ConclusionShift work, particularly permanent night shift work, may increase the risk of HF in females, especially in those with high genetic risk.