RESUMO
Elevated blood pressure (BP) is a major risk factor for atherosclerosis. As the studies concerning vascular alterations in pediatric patients are rare, we aimed to study the relationship between hypertension and arterial stiffness in adolescence by novel method independent from BP during examination. Twenty nonobese adolescent boys (16.5 ± 0.4 years) with newly diagnosed essential hypertension, 20 adolescent boys (16.7 ± 0.4 years) with newly diagnosed white-coat hypertension, and 20 healthy controls matched to age and body mass index were examined. Cardio-ankle vascular index (CAVI), brachial-ankle pulse wave velocity (baPWV), pre-ejection period (PEP), and ejection time (ET) were evaluated. CAVI was significantly increased in essential hypertension patients compared with controls (p < 0.05) with no significant difference in white-coat hypertension patients. Significantly higher baPWV was found in essential and white-coat hypertension patients compared with controls (both p < 0.001). White-coat hypertension patients showed significantly shortened PEP and ET compared with controls (p < 0.01 and p < 0.001, respectively) and essential hypertension patients (both p < 0.05). For the first time, the arterial stiffness in adolescents with newly diagnosed essential and white-coat hypertension was studied using BP-independent index CAVI combined with conventional baPWV. Our study revealed significantly increased CAVI in adolescents with newly diagnosed essential hypertension compared with controls. Our findings could help to understand hypertension-atherosclerosis interaction.
Assuntos
Hipertensão/fisiopatologia , Rigidez Vascular/fisiologia , Hipertensão do Jaleco Branco/fisiopatologia , Adolescente , Fatores Etários , Índice Tornozelo-Braço , Arteriosclerose/diagnóstico , Arteriosclerose/fisiopatologia , Estudos de Casos e Controles , Diagnóstico Precoce , Hipertensão Essencial , Humanos , Masculino , Análise de Onda de Pulso , Volume SistólicoRESUMO
OBJECTIVES: Cardiac autonomic neuropathy (CAN) is one of the most common yet overlooked complications of type 2 diabetes mellitus (T2DM). Individuals with T2DM with CAN have a 5-fold higher rate of cardiovascular morbidity and mortality. The presence of CAN in T2DM could potentially lead to arterial stiffness. However, only sparse data are available suggesting any association between autonomic dysfunction and arterial stiffness in T2DM. METHODS: We recruited 80 people with T2DM and 74 healthy controls for our study. Heart rate variability (HRV) testing was performed to assess autonomic function. Assessment of arterial stiffness was done by measuring the brachial pulse wave velocity (baPWV) and augmentation index (AI). RESULTS: The time-domain parameters were significantly decreased (p<0.001) and frequency-domain parameters, such as total power and high-frequency band expressed as a normalized unit, were found to be significantly reduced in people with T2DM (p<0.001). Both baPWV and AI were significantly higher in people with T2DM compared with healthy controls (p<0.001). We observed a moderate correlation between standard deviation of normal to normal interval (SDNN) and baPWV (r=-0.437, p=0.002) and AI (r=-0.403, p=0.002). A multiple linear regression model showed an association between SDNN and arterial stiffness parameters, such as baPWV and AI, which were statistically significant (p<0.05) in a fully adjusted model that included the conventional risk factors for atherosclerosis. CONCLUSIONS: Impaired cardiovagal activity is an independent risk factor for the development of arterial stiffness. Incorporation of HRV testing into the diabetes management protocol would have potential benefits for identifying individuals at high risk of developing cardiovascular events. Hence, preventive measures can be taken as early as possible to improve patient outcomes.
Assuntos
Diabetes Mellitus Tipo 2 , Frequência Cardíaca , Hiperglicemia , Análise de Onda de Pulso , Rigidez Vascular , Humanos , Diabetes Mellitus Tipo 2/fisiopatologia , Diabetes Mellitus Tipo 2/complicações , Diabetes Mellitus Tipo 2/epidemiologia , Rigidez Vascular/fisiologia , Estudos Transversais , Masculino , Feminino , Pessoa de Meia-Idade , Índia/epidemiologia , Frequência Cardíaca/fisiologia , Hiperglicemia/epidemiologia , Hiperglicemia/fisiopatologia , Adulto , Estudos de Casos e ControlesRESUMO
The objective of the present study was to investigate the relationship between moderate-to-vigorous physical activity (MVPA) and arterial stiffness in pregnancy. Thirty-nine women participated in this study, resulting in 68 measurements in non-pregnant (NP; n = 21), first (TM1; n = 8), second (TM2; n = 20), and third trimesters (TM3; n = 19). Compliance, distensibility, elasticity, ß-stiffness, and carotid to femoral (central) and carotid to finger (peripheral) pulse wave velocity (PWV) were assessed. MVPA was measured using accelerometry. Multilevel linear regressions adjusted for multiple tests per participant using random effects to generate ß coefficients and 95% confidence intervals (CIs) were performed. Distensibility, elasticity, ß-stiffness, and central- and peripheral-PWV did not differ between pregnant and non-pregnant assessments. Carotid artery compliance was higher in TM2 compared with NP. Central PWV (ß coefficient: -0.14, 95% CI: -0.27, -0.02) decreased from early to mid-pregnancy and increased in late pregnancy. Meeting the MVPA guidelines was significantly associated with central-PWV (adjusted ß coefficient: -0.34, 95% CI: -0.62, -0.06, p = 0.016), peripheral-PWV (adjusted ß coefficient: -0.54, 95% CI: -0.91, -0.16, p = 0.005), and distensibility (adjusted ß coefficient: -0.001, 95% CI: -0.002, -0.0001, p = 0.018), in pregnancy. These results suggest that MVPA may be associated with improved (i.e., reduced) arterial stiffness in pregnancy. Novelty: Central PWV, distensibility, compliance, elasticity, and ß-stiffness, but not peripheral PWV, exhibited curvilinear relationships with gestational age Central and peripheral PWV were lower in pregnant women who met the physical activity guidelines of 150 minutes of moderate-to-vigorous physical activity per week.
Assuntos
Rigidez Vascular , Artérias Carótidas , Complacência (Medida de Distensibilidade) , Exercício Físico , Feminino , Humanos , Gravidez , Análise de Onda de PulsoRESUMO
We compared central and peripheral arterial stiffness response patterns between persons with and without intellectual and developmental disabilities (IDD) of different age groups at rest and following a cardiopulmonary exercise test (CPET). Fifteen young adults with and without IDD, and 15 middle-aged adults without IDD performed a CPET. Central and peripheral arterial stiffness were measured at rest and following CPET using estimates of carotid-femoral (cfPWV), carotid-radial (crPWV), and carotid-ankle (cdPWV) pulse wave velocity derived from piezoelectric mechano-transducers. cfPWV remained unchanged following CPET in adults with and without IDD but increased in middle-aged adults (d = 0.85; 95% CI: 0.27-1.42 m·s-1, p = 0.005), whereas cdPWV was similarly reduced (d = -0.77; 95% CI: -1.06 to -0.48 m·s-1, p < 0.001) in all groups. crPWV remained unchanged in all groups. These results were independent of exercise-related changes in mean arterial pressure. Overall group differences suggested that persons with IDD (d = -1.78; 95% CI: -3.20 to -0.37 m·s-1, p = 0.009) and without IDD (d = -1.84; 95% CI: -3.26 to -0.43 m·s-1, p = 0.007) had lower cfPWV than middle-aged adults. We found no evidence of early vascular aging and diminished vascular reserve following CPET in adults with IDD.
Assuntos
Rigidez Vascular , Pressão Sanguínea , Artérias Carótidas , Criança , Deficiências do Desenvolvimento , Exercício Físico , Humanos , Pessoa de Meia-Idade , Análise de Onda de Pulso , Rigidez Vascular/fisiologia , Adulto JovemRESUMO
We examined the efficacy of ankle bathing versus aerobic exercise to improve vascular function in young adults who were randomized to aerobic exercise (AE) (n = 13, 40%-60% of heart rate reserve), ankle bathing (AB) (n = 15, 43 °C), or a control condition (CON) (n = 14, ankle bathing, 36 °C) for 40 min. Conduit vessel function [brachial artery flow-mediated dilation (FMD)], carotid and femoral artery blood flow and shear rate (SR), and arterial stiffness [carotid-to-femoral pulse wave velocity (cf-PWV), augmentation index (AIx@75), ß-stiffness index, and arterial compliance] were evaluated. Compared with CON, AE and AB increased FMD at 30 min and 90 min (interaction: p < 0.05); AB decreased carotid artery blood flow and SR at 30 min, while both AE and AB increased femoral artery blood flow and SR at 30 min and 90 min (interaction: p < 0.05); AE and AB decreased cf-PWV and AIx@75 at 30 min and 90 min (interaction: p < 0.05); and AE improved both carotid and femoral ß-stiffness index and arterial compliance, while AB reduced ß-stiffness index and increased arterial compliance only in the femoral artery (interaction: p < 0.05). These findings suggest that ankle bathing may serve as an alternative strategy for enhancing vascular function. Novelty: We observed similar improvements in conduit vessel function, femoral artery blood flow and shear rate, and arterial stiffness following ankle bathing and acute aerobic exercise in young adults. These findings have identified ankle bathing as a potential therapeutic strategy for enhancing vascular function, which may be particularly relevant for those with limited ability to engage in regular aerobic exercise.
Assuntos
Análise de Onda de Pulso , Rigidez Vascular , Tornozelo , Pressão Sanguínea/fisiologia , Artéria Braquial/fisiologia , Exercício Físico/fisiologia , Humanos , Rigidez Vascular/fisiologia , Adulto JovemRESUMO
BACKGROUND: The association between arterial stiffness (AS) and stable coronary artery disease (CAD) has been previously demonstrated. Whether increased arterial stiffness is associated with severe CAD in patients with acute coronary syndrome (ACS) is less explored. AIM: We aim to investigate the relationship between AS parameters and the extent and severity of CAD in patients with ACS. METHODS: The study population consisted of 275 patients with ACS. We measured various AS parameters including pulse wave velocity (PWV), augmentation index (AIx), and central pulse pressure (cPP). CAD extent and severity was evaluated by the number of vessels with greater than 70% stenosis. RESULTS: The study population was predominantly men (77, 5%) with an average age of 56, 4±10, 6 years. One hundred and fifteen patients were diabetic and 97 were hypertensive. One hundred fifty patients were admitted for ST elevation myocardial infarction (54, 5%) and 37, 5% for non ST elevation myocardial infarction. Thirty six percent of patients had single vessel disease and 47, 6% of the study population had multivessel disease. At the multivariate analysis, a positive correlation was observed between the number of coronary vessels disease and PWV. PWV (OR=1,272; IC95% [1,090; 1,483]; p=0,002) and cPP (OR=1,071; IC95% [1,024; 1,121]; p=0,003) were also independent predictors of multivessel disease. CONCLUSION: In patient with ACS, PWV is correlated with the extent of coronary artery disease, as measured by the number of vessels disease. PWV and cPP were also independent predictors of multivessel disease.
Assuntos
Síndrome Coronariana Aguda/complicações , Doença da Artéria Coronariana/patologia , Análise de Onda de Pulso , Índice de Gravidade de Doença , Rigidez Vascular , Adulto , Idoso , Pressão Sanguínea/fisiologia , Doença da Artéria Coronariana/fisiopatologia , Vasos Coronários/patologia , Feminino , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
Prolonged sitting decreases lower limb endothelial function via sustained reductions in mean shear rate. We tested whether 30 min of sitting cross-legged differentially impacts superficial femoral artery shear rate pattern, flow-mediated dilation (FMD), and leg pulse-wave velocity (PWV) compared with sitting flat-footed. Sitting cross-legged attenuated the reduction in mean and antegrade shear rate and increased arterial pressure compared with sitting flat-footed. Superficial femoral artery FMD and leg PWV were unaltered following either sitting position.
Assuntos
Extremidade Inferior/fisiologia , Postura Sentada , Estresse Fisiológico/fisiologia , Rigidez Vascular/fisiologia , Vasodilatação/fisiologia , Feminino , Artéria Femoral/fisiologia , Humanos , Extremidade Inferior/irrigação sanguínea , Masculino , Análise de Onda de Pulso , Fluxo Sanguíneo Regional , Adulto JovemRESUMO
This study compared changes in brachial-ankle pulse wave velocity (baPWV) after concentric (CON) versus eccentric (ECC) cycling. It was hypothesized that baPWV would increase after the first ECC bout (ECC1) because of muscle damage, but not after the second ECC bout (ECC2), and would decrease after CON. Fifteen young (aged 20-30 years) men performed 2 bouts of 30-min ECC (ECC1 and ECC2) at 60% of maximal CON power output and 2 bouts of 30-min CON at the same intensity as that of ECC (CON1), and at the same oxygen consumption as that of ECC (CON2) every 2 weeks. Oxygen uptake during the cycling was recorded, and baPWV was measured before and at 0.5, 1, 24, and 48 h after each cycling bout. Maximal voluntary contraction (MVC) torque and muscle soreness of the knee extensors were assessed before and at 24 and 48 h after each cycling bout. Changes in these variables over time were compared among the 4 cycling bouts by 2-way repeated-measured ANOVA. baPWV decreased (P < 0.05) 8% from the baseline (1119 ± 116 cm/s) at 0.5 h after CON1 (1028 ± 126 cm/s), but no significant changes were evident after ECC1, ECC2, and CON2. MVC torque decreased 10% from the baseline at 24 h after ECC1, but no significant changes were evident after CON1, CON2, and ECC2. These results did not support the hypothesis, and suggest that minor muscle damage induced by eccentric cycling does not affect arterial stiffness.
Assuntos
Ciclismo/fisiologia , Rigidez Vascular , Adulto , Índice Tornozelo-Braço , Teste de Esforço , Humanos , Joelho/fisiologia , Masculino , Contração Muscular , Músculo Esquelético/fisiologia , Mialgia , Consumo de Oxigênio , Análise de Onda de Pulso , Torque , Adulto JovemRESUMO
BACKGROUND: Predictive factors associated with normal blood pressure (BP) after unilateral adrenalectomy for primary aldosteronism (PA) are not clearly identified. AIMS: To evaluate the predictive value of arterial stiffness before surgery on BP after surgery. METHODS: During 2009-2013, 96 patients with PA due to unilateral adrenal adenoma who underwent surgery were enrolled in a multicentre open-label, prospective study. Aortic pulse wave velocity (PWV) was assessed before surgery. Patients underwent ambulatory blood pressure monitoring (ABPM) before surgery and 6 and 12months after surgery. Twenty-four h SBP/DBP values were compared in subjects with PWVAssuntos
Neoplasias do Córtex Suprarrenal/cirurgia
, Adrenalectomia
, Adenoma Adrenocortical/cirurgia
, Pressão Sanguínea
, Hiperaldosteronismo/cirurgia
, Hipertensão/diagnóstico
, Análise de Onda de Pulso
, Rigidez Vascular
, Neoplasias do Córtex Suprarrenal/complicações
, Neoplasias do Córtex Suprarrenal/diagnóstico
, Neoplasias do Córtex Suprarrenal/fisiopatologia
, Adenoma Adrenocortical/complicações
, Adenoma Adrenocortical/diagnóstico
, Adenoma Adrenocortical/fisiopatologia
, Adulto
, Idoso
, Anti-Hipertensivos/uso terapêutico
, Área Sob a Curva
, Pressão Sanguínea/efeitos dos fármacos
, Monitorização Ambulatorial da Pressão Arterial
, Feminino
, França
, Humanos
, Hiperaldosteronismo/diagnóstico
, Hiperaldosteronismo/etiologia
, Hiperaldosteronismo/fisiopatologia
, Hipertensão/tratamento farmacológico
, Hipertensão/etiologia
, Hipertensão/fisiopatologia
, Masculino
, Pessoa de Meia-Idade
, Valor Preditivo dos Testes
, Estudos Prospectivos
, Curva ROC
, Reprodutibilidade dos Testes
, Fatores de Tempo
, Resultado do Tratamento
, Adulto Jovem
RESUMO
Increased aortic stiffness, measured by carotid-to-femoral pulse wave velocity (PWV), is an independent predictor of cardiovascular disease, and past data have shown that low-fat and low-energy diets, fed for 8-24 weeks, lower PWV. The purpose of this study was to determine whether a reduction in PWV would be achieved by dietary carbohydrate (CHO) restriction, shown to bring about weight loss over a shorter timeframe. Men (n = 10, age: 41.8 ± 10.2 years, BMI: 34.2 ± 3.0 kg/m2 (mean ± SD)) and women (n = 10, age: 38.6 ± 6.1 years, BMI: 33.5 ± 3.8 kg/m2) with characteristics of insulin resistance and the metabolic syndrome consumed a structured, CHO-restricted diet for 4 weeks (energy deficit, 645 kcal/day). For the whole group, subjects lost 5.4% ± 0.5% (P < 0.001) of body weight and experienced significant reductions in blood pressure (6%-8%), plasma insulin (34%), and triglycerides (34%). PWV was reduced by 6% ± 2% (7.1 ± 0.2 m/s to 6.7 ± 0.2 m/s, P = 0.008) and surprisingly, in women, it fell significantly (from 7.2 ± 0.3 m/s to 6.3 ± 0.3 m/s, P = 0.028), while no changes were observed in men (7.2 ± 0.3 vs. 7.0 ± 0.3 m/s, P = 0.144). This is the first study to demonstrate that weight loss can improve PWV in as little as 4 weeks and that dietary CHO restriction may be an effective treatment for reducing aortic stiffness in women. Future studies are needed to establish the mechanisms by which dietary CHO restriction may confer more cardiovascular benefits to women than to men.
Assuntos
Aorta/fisiologia , Dieta com Restrição de Carboidratos , Sobrepeso , Análise de Onda de Pulso , Redução de Peso/fisiologia , Adulto , Carboidratos da Dieta , Ingestão de Alimentos , Feminino , Humanos , Resistência à Insulina/fisiologia , Masculino , Pessoa de Meia-Idade , Sobrepeso/dietoterapia , Sobrepeso/epidemiologia , Sobrepeso/fisiopatologiaRESUMO
People living with human immunodeficiency virus (HIV) infection and receiving antiretroviral therapy now have the same life expectancy as the general population. However, they have a higher risk of atherosclerotic cardiovascular events because of a complex and polyfactorial vasculopathy, combining the effects of antiretroviral therapy, the HIV virus itself, immune activation, chronic inflammation and metabolic disturbances. Whether people living with HIV infection experience increased vascular aging compared with the general population remains controversial. To summarize current knowledge of the association between HIV infection and aortic stiffness as a marker of vascular aging. This review included 18 clinical studies in adult populations, published between 2009 and 2016, and identified on PubMed/MEDLINE or other databases. Search terms were aortic stiffness, arterial stiffness, vascular aging, pulse wave velocity and HIV. All 18 studies were observational, and compared groups infected (HIV+) and not infected (HIV-) with HIV. Ten studies (55%) reported no significant differences in aortic stiffness between HIV+ groups and age-matched HIV- control groups. The main reported determinants of aortic stiffness were age, blood pressure, smoking, metabolic syndrome and HIV-related variables, including CD4/CD8 ratio, current T-CD4 count < 200/mm3 and nadir T-CD4+ count < 200/mm3. We found discordant results regarding whether HIV+ patients had increased aortic stiffness compared with HIV- controls. However, HIV-related conditions were associated with vascular health. This association has been confirmed in recent prospective studies. There is emerging evidence that HIV itself and immune activity affect vascular health and the large arteries.
RESUMO
There is a delayed increase in arterial stiffness after eccentric exercise that is possibly mediated by the concurrent delayed increase in circulating oxidative stress. Taurine has anti-oxidant action, and taurine supplementation may be able to attenuate the increase in oxidative stress after exercise. The purpose of the present study was to investigate whether taurine supplementation attenuates the delayed increase in arterial stiffness after eccentric exercise. In the present double-blind, randomized, and placebo-controlled trial, we divided 29 young, healthy men into 2 groups. Subjects received either 2.0 g of placebo (n = 14) or taurine (n = 15) 3 times per day for 14 days prior to the exercise, on the day of exercise, and the following 3 days. The exercise consisted of 2 sets of 20 maximal-effort eccentric repetitions with the nondominant arm only. On the morning of exercise and for 4 days thereafter, we measured serum malondialdehyde (MDA) and carotid-femoral pulse wave velocity (cfPWV) as indices of oxidative stress and arterial stiffness, respectively. On the third and fourth days after exercise, both MDA and cfPWV significantly increased in the placebo group. However, these elevations were significantly attenuated in the taurine group. The increase in MDA was associated with an increase in cfPWV from before exercise to 4 days after exercise (r = 0.597, p < 0.05) in the placebo group, but not in the taurine group. Our results suggest that delayed increase in arterial stiffness after eccentric exercise was probably affected by the exercise-induced oxidative stress and was attenuated by the taurine supplementation.
Assuntos
Suplementos Nutricionais , Exercício Físico , Taurina/administração & dosagem , Rigidez Vascular/efeitos dos fármacos , Adulto , Biomarcadores/sangue , Método Duplo-Cego , Frequência Cardíaca/efeitos dos fármacos , Hemodinâmica/efeitos dos fármacos , Humanos , Masculino , Malondialdeído/sangue , Músculo Esquelético/efeitos dos fármacos , Músculo Esquelético/fisiologia , Estresse Oxidativo/efeitos dos fármacos , Análise de Onda de Pulso , Adulto JovemRESUMO
BACKGROUND: The finger-toe pathway could be a good alternative for assessing arterial stiffness conveniently. AIM: To evaluate the accuracy of the pOpmètre®--a new device that measures finger-toe pulse wave velocity (ft-PWV). METHODS: The pOpmètre has two photodiode sensors, positioned on the finger and the toe. Pulse waves are recorded continuously for 20 seconds, and the difference in pulse wave transit time between toe and finger (ft-TT) is calculated. The travelled distance is estimated using subject height. Study 1 compared ft-PWV with carotid-femoral PWV (cf-PWV) obtained by the reference method (SphygmoCor®) in 86 subjects (mean age 53±20 years), including 69 patients with various pathologies and 17 healthy normotensives. Study 2 compared changes in ft-PWV and cf-PWV during a cold pressor test in 10 healthy subjects. Study 3 assessed repeatability in 45 patients. RESULTS: ft-PWV correlated significantly with cf-PWV (R2=0.43; P<0.0001). A better correlation was found in terms of transit time (R2=0.61; P<0.0001). The discrepancy between transit times was related to age. The cold pressor test induced parallel changes in cf-PWV and ft-PWV, with increased aortic stiffness that was reversible during recovery. Intra-session repeatability was very good, with a coefficient of variation of 4.52%. CONCLUSION: The pOpmètre® allows measurement of arterial stiffness in routine clinical practice. The greatest advantages of ft-PWV are simplicity, rapidity, feasibility, acceptability by patients and correct agreement with the reference technique. Further studies are needed to adjust for bias and to validate the pOpmètre in larger populations.
Assuntos
Dedos/irrigação sanguínea , Análise de Onda de Pulso/instrumentação , Dedos do Pé/irrigação sanguínea , Rigidez Vascular , Adulto , Idoso , Idoso de 80 Anos ou mais , Velocidade do Fluxo Sanguíneo , Estudos de Casos e Controles , Transtornos Cognitivos/fisiopatologia , Temperatura Baixa , Desenho de Equipamento , Feminino , França , Humanos , Hipertensão/fisiopatologia , Masculino , Pessoa de Meia-Idade , Variações Dependentes do Observador , Valor Preditivo dos Testes , Fluxo Sanguíneo Regional , Reprodutibilidade dos Testes , Fatores de Tempo , Adulto JovemRESUMO
BACKGROUND: If the positive impact of cardiac rehabilitation on metabolic profile and exercise tolerance is well documented in the literature, very few studies evaluated the impact of these rehabilitation programs on arterial rigidity. PURPOSE: The main objective of this study was to determine if a short and intense 4-week cardiac rehabilitation program could yield a positive impact on arterial rigidity. METHOD: A cohort study was performed on Leopold Bellan Foundation. All patients referred for cardiac rehabilitation program after an acute event (surgery, technical gesture or acute decompensate heart failure) were included in this study. Our CR program consists of four sessions per week for five weeks (total of 20 sessions) and includes both exercise and health and nutrition education sessions. In addition to clinical and therapeutic data collection, biochemical analysis for carbohydrate and lipid metabolism and exercise capacity measurements, carotid femoral pulse wave velocity (PWV) were measured in a quiet room in the morning of their first and last day prior to any exercise. RESULTS: One hundred and ninety-eight cardiac patients have participated in this study, of which 79% were male, mean age 60 ± 10, 50 (25%) were diabetic, 103 (52%) were hypertensive, 60 (30%) were current smokers, 98 (50%) had dyslipidemia, and 140 (71%) were referred for cardiac rehabilitation after acute coronary syndrome. Arterial stiffness is defined by a VPWV value greater or equal to 10. At the beginning, 59% of our patients have rigid arteries. After 20 sessions of cardiac rehabilitation, this number is significantly reduced to 51% (P=0.12). Patients with arterial stiffness have accumulated more major cardiovascular risk factors, and have had less exercise capacity than others. However they benefit similarly from the cardiovascular rehabilitation program. CONCLUSION: In the present study, we observed that arterial stiffness, as reflected by the PWV, tends to decrease after short-term ambulatory cardiac rehabilitation program.
Assuntos
Cardiopatias/fisiopatologia , Cardiopatias/reabilitação , Rigidez Vascular , Estudos de Coortes , Feminino , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
BACKGROUND: Non-invasive methods allow the evaluation of structural and functional arterial abnormalities. So far, no study has focused on the comparison of vascular parameters by type of cardiovascular event. METHODS: In this pilot study, cardiovascular risk factors, carotid parameters, carotid-to-femoral pulse wave velocity (PWV), brachial flow-mediated dilation and ambulatory blood pressure were assessed in patients who presented with acute coronary syndromes (ACS) or ischaemic atherothrombotic stroke (IAS). Groups were matched for age and gender. RESULTS: Prevalences of hypertension, diabetes and dyslipidaemia and heredity, smoking and body mass index were similar in the ACS (n=50) and IAS (n=50) groups. Carotid intima-media thickness (IMT) and PWV were significantly higher in the IAS vs. ACS group (769±180 vs. 701±136 µm; P=0.039 and 12.5±3.5 vs. 10.7±2.4 m/s; P=0.006). Carotid distensibility was significantly lower in the IAS vs. ACS group (16.2±3.2 vs. 18.9±7.6 10(-3)/kPa; P=0.02). These differences persisted after adjustment for blood pressure for carotid distensibility but not for PWV. The prevalences of endothelial dysfunction and carotid plaques were not significantly different in the ACS and IAS groups (86% and 74%; 80% and 78%). In a multivariable model, carotid distensibility remained associated with ACS (odds ratio 1.19; 95% confidence interval 1.03-1.38; P=0.016). CONCLUSIONS: Stiffness and carotid wall thickness were higher in IAS than in ACS patients. These differences may support the interest in new therapeutic targets for cardiovascular secondary prevention. NCT NO: NCT00926874.
Assuntos
Síndrome Coronariana Aguda/diagnóstico , Aorta/fisiopatologia , Artéria Braquial/fisiopatologia , Isquemia Encefálica/diagnóstico , Artérias Carótidas/fisiopatologia , Doenças das Artérias Carótidas/diagnóstico , Hemodinâmica , Acidente Vascular Cerebral/diagnóstico , Síndrome Coronariana Aguda/epidemiologia , Síndrome Coronariana Aguda/fisiopatologia , Adulto , Idoso , Determinação da Pressão Arterial , Isquemia Encefálica/epidemiologia , Isquemia Encefálica/fisiopatologia , Artérias Carótidas/diagnóstico por imagem , Doenças das Artérias Carótidas/epidemiologia , Doenças das Artérias Carótidas/fisiopatologia , Espessura Intima-Media Carotídea , Comorbidade , Feminino , França , Predisposição Genética para Doença , Hereditariedade , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Razão de Chances , Projetos Piloto , Placa Aterosclerótica , Valor Preditivo dos Testes , Prevalência , Análise de Onda de Pulso , Fatores de Risco , Fumar/efeitos adversos , Fumar/epidemiologia , Acidente Vascular Cerebral/epidemiologia , Acidente Vascular Cerebral/fisiopatologia , Rigidez Vascular , VasodilataçãoRESUMO
PURPOSE: Aortic stiffness is a functional and structural consequence of ageing and arteriosclerosis. Regional arterial stiffness can be easily evaluated using pOpmetre(®) (Axelife SAS, France). This new technique assesses the pulse wave transit time (TT) between the finger (TTf) and the toe (TTt). Based on height chart, regional pulse wave velocity (PWV) between the toe and the finger can be estimated (PWVtf). pOpscore(®) index is also calculated as the ratio between PWVtoe and PWVfinger and can be considered as a peripheral vascular stiffness index. The aim of the study was to evaluate the relationship between pOpmetre(®) indices and the presence of carotid plaques in a population with cardiovascular risk factors. METHODS: In 77 consecutive patients recruited for a vascular screening for atherosclerosis (46 men aged 54 ± 2 years; 31 women aged 49 ± 3 years; ns), the difference between TTt and TTf (called Dt-f), the regional pulse wave velocity between the toe and the finger (PWVtf = constant × height/Dt-fm/s) and pOpscore(®) were measured by pOpmetre(®). Presence of carotid plaques was assessed using ultrasound imaging. The local aortic stiffness (AoStiff) was evaluated by the Physioflow(®) system. RESULTS: No difference was found between patients with or without carotid plaques (n=25 versus 52) for Ankle-Brachial Pressure Index (ABPI: 1.15 ± 0.04 versus 1.12 ± 0.03), nor for diastolic or systolic blood pressure (87 ± 3 versus 82 ± 2; 137 ± 3 versus 132 ± 2 mmHg). The first group was older than the second (59 ± 2 versus 49 ± 2 years, P<0.002) with a larger intimae media thickness (0.69 ± 0.02 versus 0.63 ± 0.01 mm, P<0.004), a higher AoStiff (10.4 ± 0.7 versus 8.2 ± 0.5m/s, P<0.02), and PWVtf (14.3 ± 1.0 versus 10.7 ± 0.7 m/s, P<0.004) and a shorter Dt-f (57.9 ± 5.1 versus 73.5 ± 3.5 ms, P<0.01). PWVtf (r(2)=0.49, P<0.0001) and Dt-f (r(2)=0.54, P<0.0001) correlated with age. A significant difference in pOpscore(®) index was observed between both groups (1.51 ± 0.3 versus 1.41 ± 0.2, P<0.006). CONCLUSION: Our results show a significant arterial stiffness indices measured by pOpmetre(®) in patients with and without carotid plaques.