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1.
Medicine (Baltimore) ; 98(50): e18100, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31852069

RESUMO

INTRODUCTION: Pulse wave analysis is an emerging approach that analyzes parameters comprising strong predictors of cardiovascular (CV) events and all-cause mortality, especially in patients with high CV risk based on established risk factors. This study used the oscillometric method, provided by the Mobil-o-Graph (PWA-EMI GmbH, Stolberg, Germany) device, to compare data regarding the pulse wave analysis parameters in hypertensive nondiabetic and diabetic patients. MATERIAL AND METHODS: In this cross-sectional study, 276 individuals were examined in the academic hypertension outpatient care unit of the Federal University of the Triângulo, in Mineiro, Brazil, from January to December 2016. The pulse wave analysis was performed by oscillometry, and its parameters were acquired from all patients. RESULTS: Of the 276 patients, 99 were diabetic and 177 nondiabetic. The mean systolic and pulse central blood pressure were significantly higher in diabetic patients than in nondiabetic patients (P = .008 and.0003, respectively). The mean peripheral systolic blood pressure and pulse pressure were also significantly higher in the diabetic group (P = .001 and P < .0001, respectively). The average pulse wave velocity (PWV, m/s) was 9.4 ±â€Š1.6 and 8.8 ±â€Š1.6 in the diabetic and nondiabetic groups, respectively (P = .003). CONCLUSION: The group of hypertensive diabetic patients had significantly higher central blood pressure, peripheral blood pressure, and PWV than the hypertensive nondiabetic patients. The patients with overlapping established CV risk factors presented values of the pulse wave analysis parameters consistent with higher central pressure and greater arterial stiffness.


Assuntos
Assistência Ambulatorial , Pressão Sanguínea/fisiologia , Diabetes Mellitus/fisiopatologia , Hipertensão/fisiopatologia , Oscilometria/métodos , Análise de Onda de Pulso/métodos , Rigidez Vascular/fisiologia , Brasil/epidemiologia , Estudos Transversais , Diabetes Mellitus/diagnóstico , Diabetes Mellitus/epidemiologia , Feminino , Seguimentos , Humanos , Hipertensão/diagnóstico , Hipertensão/epidemiologia , Incidência , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Reprodutibilidade dos Testes , Fatores de Risco , Sístole
2.
Bratisl Lek Listy ; 120(12): 894-898, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31855047

RESUMO

OBJECTIVES: Central systolic blood pressure (CSBP) is the pressure in the root of aorta, which directly influences organs such as brain, heart and kidneys and is related to organ damage. Its value increases with the aortic stiffness. The aim of this study was to analyze the relationships of CSBP to aortic stiffness parameters. METHODS: Central blood pressure (BP) and related parameters were measured by Arteriograph, working based on oscillometric principle, using pulse wave analysis (PWA) approach. We examined 123 patients (69 females, 54 males) with a primary hypertension. RESULTS: Using a linear correlation analysis, we found that CSBP was correlated to aortic pulse wave velocity (PWV), aortic and brachial pulse pressure (PP), aortic augmentation index, return time of reflected pressure wave (RT) and aortic and brachial augmentation indexes. Multivariate analysis defines the aortic pulse pressure (PPao) as the most powerful parameter influencing CSBP. By an individual analysis of BP in each patient separately, we defined two different types of central hemodynamics; those with a higher CSBP than brachial SBP occur in stiffer aorta. CONCLUSION: The CSBP increases with aortic PP, the most powerful stiffness parameter of aorta. Higher CSBP than brachial SBP usually accompanies a stiffer aorta (Tab. 5, Ref. 19).


Assuntos
Pressão Sanguínea/fisiologia , Análise de Onda de Pulso/métodos , Rigidez Vascular , Pressão Arterial , Determinação da Pressão Arterial , Feminino , Humanos , Masculino
3.
Dis Markers ; 2019: 2568069, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31396293

RESUMO

Arterial stiffness and arterial age provide valuable prognostic cardiovascular information. The present study aimed at assessing the levels of vitamin D, high-sensitivity C-reactive protein (hsCRP), low-density lipoprotein cholesterol (LDL), and oxidized LDL (oxLDL) in a group of middle-aged hypertensive patients and their relationship with pulse wave velocity (PWV), central blood pressure, and early arterial aging (EAA), respectively. A total of 56 patients, aged 48 ± 6 years, 57% males, with hypertension and high normal blood pressure (HNBP), were investigated using a Mobile-O-Graph, to assess central and peripheral blood pressure, PWV, and arterial age. Additionally, hsCRP, LDL, oxLDL, and 25-hydroxy vitamin D3 were assessed. PWV, 25-hydroxy vitamin D3, hsCRP, oxLDL, and LDL levels were 7.26 ± 0.69 m/s, 25.99 ± 11.17 microg/l, 0.48 ± 0.44 mg/dl, 261.37 ± 421 ng/ml, and 145.73 ± 39.53 mg/dl, respectively. Significant correlations were obtained between oxLDL and pulse pressure amplification (rS = -0.347, p = 0.028) and between hsCRP and LDL levels with PWV and EAA, respectively. ROC curve analysis revealed that hsCRP is a sensitive and specific predictor of EAA and increased PWV values. Concluding, vitamin D deficiency and increased hsCRP and LDL values are very common, and high oxidized LDL is related to pulse pressure amplification in patients with elevated blood pressure. Vitamin D level and high-sensitivity C-reactive protein and LDL provide valuable information in middle-aged hypertensive and HNBP patients related to arterial stiffness and early arterial aging, but only hsCRP is a sensitive predictor of EAA and PWV.


Assuntos
Biomarcadores/análise , Pressão Sanguínea , Proteína C-Reativa/análise , Hipertensão/diagnóstico , Análise de Onda de Pulso/métodos , Deficiência de Vitamina D/complicações , Adolescente , Adulto , Estudos de Casos e Controles , LDL-Colesterol/sangue , Feminino , Seguimentos , Humanos , Hipertensão/sangue , Hipertensão/etiologia , Masculino , Pessoa de Meia-Idade , Prognóstico , Fatores de Risco , Rigidez Vascular , Adulto Jovem
4.
Respir Res ; 20(1): 166, 2019 Jul 24.
Artigo em Inglês | MEDLINE | ID: mdl-31340825

RESUMO

BACKGROUND: Patients with chronic obstructive pulmonary disease (COPD) have elevated cardiovascular risk, and cardiovascular disease is a major cause of death in COPD. The current literature indicates that changes in cardiovascular risk during pulmonary rehabilitation (assessed using aortic stiffness) are heterogeneous suggesting that there may be sub-groups of patients who do and do not benefit. OBJECTIVES: To investigate the characteristics of COPD patients who do and do not experience aortic stiffness reduction during pulmonary rehabilitation, examine how changes relate to physical activity and exercise capacity, and assess whether changes in aortic stiffness are maintained at 6 weeks following rehabilitation. METHODS: We prospectively measured arterial stiffness (aortic pulse-wave velocity), exercise capacity (Incremental Shuttle Walk Test) and physical activity (daily step count) in 92 COPD patients who started a six week pulmonary rehabilitation programme, 54 of whom completed rehabilitation, and 29 of whom were re-assessed six weeks later. RESULTS: Whilst on average there was no influence of pulmonary rehabilitation on aortic stiffness (pre- vs. post pulse-wave velocity 11.3 vs. 11.1 m/s p = 0.34), 56% patients responded with a significant reduction in aortic stiffness. Change in aortic stiffness (absolute and/or percentage) during rehabilitation was associated with both increased physical activity (rho = - 0.30, p = 0.042) and change in exercise capacity (rho = - 0.32, p = 0.02), but in multivariable analysis most closely with physical activity. 92% of the responders who attended maintained this response six weeks later. CONCLUSION: Elevated aortic stiffness in COPD is potentially modifiable in a subgroup of patients during pulmonary rehabilitation and is associated with increased physical activity. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT03003208. Registered 26/12/ 2016.


Assuntos
Aorta/fisiopatologia , Exercício/fisiologia , Volume Expiratório Forçado/fisiologia , Doença Pulmonar Obstrutiva Crônica/fisiopatologia , Doença Pulmonar Obstrutiva Crônica/reabilitação , Rigidez Vascular/fisiologia , Idoso , Idoso de 80 Anos ou mais , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Doença Pulmonar Obstrutiva Crônica/diagnóstico , Análise de Onda de Pulso/métodos , Teste de Caminhada/métodos
5.
Angiology ; 70(10): 929-937, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31234636

RESUMO

The morphology and function of the arteries can be directly measured using different established methods. This prospective cohort study aimed to translate 2 of these, aortic pulse wave velocity (aPWV) and carotid intima-media thickness (cIMT), into a combined Vascular Aging Index (VAI) and then evaluate the predictive power of aPWV, cIMT, and VAI. Patients (n = 2718) were included from the cardiovascular arm of the Malmö Diet and Cancer Study (median age 71.9 years, 62.2% females). Total follow-up time was 16 448 person-years and a composite cardiovascular disease (CVD) end point was used. Cox regressions yielded adjusted hazard ratios (95% confidence interval) per 1 standard deviation increment of loge aPWV, loge cIMT, and loge VAI of 1.25 (1.08-1.45, P = .003), 1.27 (1.13-1.44, P < .001), and 1.45 (1.26-1.68, P < .001), respectively. The C-statistics increased from 0.714 to 0.734 when adding aPWV and cIMT to a model of conventional risk factors. Net Reclassification Index also showed a significant (P < .001) improvement for the classification of event-free patients and no change for patients with events. A VAI based on aPWV and cIMT had a good predictive performance. Used together, aPWV and cIMT incrementally and significantly improve the prediction of CVD events by correctly down-adjusting the predicted risk for noncases.


Assuntos
Envelhecimento , Aorta/fisiopatologia , Doenças Cardiovasculares/mortalidade , Espessura Intima-Media Carotídea/mortalidade , Idoso , Doenças Cardiovasculares/etiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Modelos de Riscos Proporcionais , Estudos Prospectivos , Análise de Onda de Pulso/métodos , Fatores de Risco , População Urbana/estatística & dados numéricos
6.
J Stroke Cerebrovasc Dis ; 28(9): 2580-2584, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31239221

RESUMO

BACKGROUND: Pulse wave velocity is commonly regarded as the most effective and noninvasive indicator for evaluating arterial stiffness, while increased arterial stiffness is known to be related to atherosclerosis, which has been proved to play a significant role on the onset of acute ischemic stroke. However, it is still only used in the assessment of central and peripheral arteries. Our previous studies have found that carotid-cerebral pulse wave velocity measured using transcranial Doppler may be a promising method for the assessment of human cerebral arterial stiffness. This trial was designed to examine the association between carotid-cerebral pulse wave velocity and acute ischemic stroke. METHODS: In a single-center, single-arm, prospective clinical trial, patients with acute ischemic stroke who had anterior circulation infarcts confirmed by magnetic resonance imaging are eligible to receive measurement of carotid-cerebral pulse wave velocity, which is measured in the supine position with transcranial Doppler that using 2-MHz and 4-MHz ultrasound probes by 2 experienced operators. Subjects will be received follow-up for 1 year. Vascular and nonvascular death at follow-up will be assessed as primary outcomes. Secondary outcomes include intracerebral hemorrhage, subarachnoid hemorrhage, transient ischemic attack, recurrence or aggravation of ischemic stroke. CONCLUSION: This trial will be the first to evaluate carotid-cerebral pulse wave velocity in patients with acute ischemic stroke using transcranial Doppler. The results may provide more valuable theoretical basis for the prevention, treatment, and prognosis of acute ischemic stroke.


Assuntos
Isquemia Encefálica/diagnóstico por imagem , Artéria Carótida Primitiva/diagnóstico por imagem , Artéria Cerebral Média/diagnóstico por imagem , Análise de Onda de Pulso/métodos , Acidente Vascular Cerebral/diagnóstico por imagem , Ultrassonografia Doppler Transcraniana/métodos , Rigidez Vascular , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Isquemia Encefálica/fisiopatologia , Artéria Carótida Primitiva/fisiopatologia , China , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Artéria Cerebral Média/fisiopatologia , Posicionamento do Paciente/métodos , Valor Preditivo dos Testes , Estudos Prospectivos , Acidente Vascular Cerebral/fisiopatologia , Decúbito Dorsal , Adulto Jovem
7.
Medicine (Baltimore) ; 98(20): e15484, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31096447

RESUMO

INTRODUCTION: The purpose of this study protocol is to provide the methodology for a review to compare the effect of statins vs physical exercise interventions and the effect of different types of physical exercise, on reducing arterial stiffness associated with cardiovascular diseases and mortality. METHODS AND ANALYSIS: The literature search will be conducted in MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, and Web of Science databases from their inception until July 31, 2019. We will include randomized controlled trials, nonrandomized experimental studies, and controlled pre-post studies assessing the effect in the general population of statins and physical exercise interventions on arterial stiffness measured by pulse wave velocity. The Cochrane Collaboration's tool and the Quality Assessment Tool for Quantitative Studies will be used to assess the risk of bias for studies included in the systematic review. A Bayesian network meta-analysis will be carried out to determine the comparative effect of the different physical exercise interventions and/or statin intervention. ETHICS AND DISSEMINATION: This study will generate evidence about the effectiveness of both statins and exercise on reducing arterial stiffness that potentially can be transferred to patients and practitioners. Moreover, in light of the importance of reducing arterial stiffness for preventing cardiovascular disease, the evidence provided by this study will be potentially suitable to be included in cardiovascular clinical practice guidelines. STRENGTHS AND LIMITATIONS: This protocol describes the methods of a study examining, using network meta-analysis strategies, the efficacy of statins and different types of exercise on improving arterial stiffness, which is an early marker of atherosclerosis. The results of this study could immediately help clinicians to recommend the best evidence-based intervention to their patients to reduce arterial stiffness and, as a consequence, prevent major complications, such as heart failure, stroke, or myocardial infarction. TRIAL REGISTRATION NUMBER: PROSPERO CRD42019123120.


Assuntos
Doenças Cardiovasculares/mortalidade , Doenças Cardiovasculares/terapia , Exercício/fisiologia , Inibidores de Hidroximetilglutaril-CoA Redutases/farmacologia , Rigidez Vascular/efeitos dos fármacos , Doenças Cardiovasculares/tratamento farmacológico , Humanos , Inibidores de Hidroximetilglutaril-CoA Redutases/administração & dosagem , Meta-Análise em Rede , Ensaios Clínicos Controlados não Aleatórios como Assunto , Análise de Onda de Pulso/métodos , Ensaios Clínicos Controlados Aleatórios como Assunto , Projetos de Pesquisa , Rigidez Vascular/fisiologia
8.
Hypertension ; 74(1): 111-116, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-31132952

RESUMO

Pulse wave velocity (PWV), a measure of arterial stiffness, is an independent risk factor for cardiovascular morbidity and mortality. We investigated the relationship of ambulatory brachial cuff-based oscillometric PWV (oPWV) to 2 known correlates: age and brachial systolic blood pressure (SBP). In 234 participants in the Masked Hypertension Study, we analyzed 7284 validated hourly ambulatory SBP and oPWV readings using the Mobil-O-Graph monitor, which uses a proprietary pulse wave analysis algorithm to determine oPWV. Carotid-femoral PWV (cfPWV) was also measured. Mixed linear models were developed to estimate oPWV from age and ambulatory SBP. Participants were 34% male, with mean (SD) age 52.8 (9.9) years, SBP 123.8 (18.4) mm Hg, and oPWV 7.6 (1.3) m/s and cfPWV of 7.7 (1.7) m/s. The relationship of oPWV to age and SBP is given below: [Formula: see text] Age uniquely accounted for an estimated 75% of the total variation of oPWV, whereas SBP uniquely accounted for 20%; these findings were confirmed in an external validation dataset. Together, age and SBP accounted for 99.1% of the total variance of oPWV but (only) 40.2% of the variance of cfPWV. The correlation between oPWV and cfPWV was 0.58 but was only 0.11 after controlling for age and SBP. We conclude that the Mobil-O-Graph's oPWV is nearly completely explained by age and SBP and its relationship to cfPWV is because of their shared associations with age and SBP. Other hemodynamic variables derived from oscillometric pulse wave analysis may be useful and deserve additional scrutiny.


Assuntos
Monitorização Ambulatorial da Pressão Arterial , Doenças Cardiovasculares/fisiopatologia , Hipertensão Mascarada/diagnóstico , Hipertensão Mascarada/mortalidade , Análise de Onda de Pulso/métodos , Rigidez Vascular/fisiologia , Adulto , Fatores Etários , Idoso , Determinação da Pressão Arterial/métodos , Doenças Cardiovasculares/prevenção & controle , Estudos de Coortes , Bases de Dados Factuais , Feminino , Seguimentos , Hemodinâmica , Humanos , Masculino , Pessoa de Meia-Idade , Análise de Onda de Pulso/efeitos adversos , Reprodutibilidade dos Testes , Estudos Retrospectivos , Medição de Risco , Fatores Sexuais , Análise de Sobrevida , Fatores de Tempo
9.
Hypertension ; 74(1): 117-129, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-31132954

RESUMO

Aortic pulse wave velocity is a worldwide accepted index to evaluate aortic stiffness and can be assessed noninvasively by several methods. This study sought to determine if commonly used noninvasive devices can all accurately estimate aortic pulse wave velocity. Pulse wave velocity was estimated in 102 patients (aged 65±13 years) undergoing diagnostic coronary angiography with 7 noninvasive devices and compared with invasive aortic pulse wave velocity. Devices evaluating carotid-femoral pulse wave velocity (Complior Analyse, PulsePen ET, PulsePen ETT, and SphygmoCor) showed a strong agreement between each other ( r>0.83) and with invasive aortic pulse wave velocity. The mean difference ±SD with the invasive pulse wave velocity was -0.73±2.83 m/s ( r=0.64) for Complior-Analyse: 0.20±2.54 m/s ( r=0.71) for PulsePen-ETT: -0.04±2.33 m/s ( r=0.78) for PulsePen ET; and -0.61±2.57 m/s ( r=0.70) for SphygmoCor. The finger-toe pulse wave velocity, evaluated by pOpmètre, showed only a weak relationship with invasive aortic recording (mean difference ±SD =-0.44±4.44 m/s; r=0.41), and with noninvasive carotid-femoral pulse wave velocity measurements ( r<0.33). Pulse wave velocity estimated through a proprietary algorithm by BPLab (v.5.03 and v.6.02) and Mobil-O-Graph showed a weaker agreement with invasive pulse wave velocity compared with carotid-femoral pulse wave velocity (mean difference ±SD =-0.71±3.55 m/s, r=0.23; 1.04±2.27 m/s, r=0.77; and -1.01±2.54 m/s, r=0.71, respectively), revealing a negative proportional bias at Bland-Altman plot. Aortic pulse wave velocity values provided by BPLab and Mobil-O-Graph were entirely dependent on age-squared and peripheral systolic blood pressure (cumulative r2=0.98 and 0.99, respectively). Thus, among the methods evaluated, only those assessing carotid-femoral pulse wave velocity (Complior Analyse, PulsePen ETT, PulsePen ET, and SphygmoCor) appear to be reliable approaches for estimation of aortic stiffness.


Assuntos
Angiografia Coronária/métodos , Estenose Coronária/diagnóstico por imagem , Hemodinâmica/fisiologia , Análise de Onda de Pulso/métodos , Rigidez Vascular/fisiologia , Idoso , Velocidade do Fluxo Sanguíneo/fisiologia , Determinação da Pressão Arterial/métodos , Doenças Cardiovasculares/fisiopatologia , Estudos de Coortes , Estenose Coronária/fisiopatologia , Humanos , Itália , Modelos Lineares , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Fluxo Pulsátil/fisiologia , Sensibilidade e Especificidade , Índice de Gravidade de Doença
10.
Pregnancy Hypertens ; 15: 166-170, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30825916

RESUMO

OBJECTIVE: To describe the comparative hierarchical area ratio (CHAR), a novel parameter derived from the photoplethysmographic (PPG) pulse wave and differences in CHAR values in parturients with and without preeclampsia (PE). METHODS: A total of 59 parturients (37 without and 22 with PE) was conducted at the Women's Hospital, Zhejiang University, School of Medicine in Hangzhou, China. We calculated the CHAR values derived from the PPG pulse wave and compared them in parturients with and without PE. RESULT: The values of CHAR derived from the parturients with PE were lower compared to those without PE (p < 0.01). The ROC analysis indicated that the best threshold for the mean value of CHAR was 7.92 to predict PE with a sensitivity of 86.4% and a specificity of 87.1%, while the threshold for the standard deviation of CHAR was 0.76 with a sensitivity of 77.3% and a specificity of 77.4%. The area under the curve (AUC) was 0.91 for mean value of CHAR while 0.78 for standard deviation of CHAR. Meanwhile, a contrast of AUC between CHAR and the former parameter we proposed showed CHAR had better performance in distinguishing PE (0.908 over 0.615, p < 0.01). CONCLUSION: The novel parameter, CHAR, derived from PPG pulse wave differs in parturients with and without PE with high sensitivity and specificity, suggesting that the CHAR might be an effective tool in differentiating the presence of PE.


Assuntos
Fotopletismografia , Pré-Eclâmpsia/diagnóstico , Análise de Onda de Pulso/métodos , Adulto , Área Sob a Curva , Estudos de Casos e Controles , Diagnóstico Diferencial , Feminino , Humanos , Gravidez , Proteinúria/urina , Curva ROC , Sensibilidade e Especificidade , Estatísticas não Paramétricas
11.
Sensors (Basel) ; 19(3)2019 Jan 31.
Artigo em Inglês | MEDLINE | ID: mdl-30708934

RESUMO

Hypertension is a well-known chronic disease that causes complications such as cardiovascular diseases or stroke, and thus needs to be continuously managed by using a simple system for measuring blood pressure. The existing method for measuring blood pressure uses a wrapping cuff, which makes measuring difficult for patients. To address this problem, cuffless blood pressure measurement methods that detect the peak pressure via signals measured using photoplethysmogram (PPG) and electrocardiogram (ECG) sensors and use it to calculate the pulse transit time (PTT) or pulse wave velocity (PWV) have been studied. However, a drawback of these methods is that a user must be able to recognize and establish contact with the sensor. Furthermore, the peak of the PPG or ECG cannot be detected if the signal quality drops, leading to a decrease in accuracy. In this study, a chair-type system that can monitor blood pressure using polyvinylidene fluoride (PVDF) films in a nonintrusive manner to users was developed. The proposed method also uses instantaneous phase difference (IPD) instead of PTT as the feature value for estimating blood pressure. Experiments were conducted using a blood pressure estimation model created via an artificial neural network (ANN), which showed that IPD could estimate more accurate readings of blood pressure compared to PTT, thus demonstrating the possibility of a nonintrusive blood pressure monitoring system.


Assuntos
Balistocardiografia/métodos , Determinação da Pressão Arterial/métodos , Pressão Sanguínea/fisiologia , Monitorização Fisiológica/métodos , Adulto , Eletrocardiografia/métodos , Equipamentos e Provisões , Feminino , Monitorização Hemodinâmica/métodos , Humanos , Hipertensão/fisiopatologia , Masculino , Pessoa de Meia-Idade , Fotopletismografia/métodos , Análise de Onda de Pulso/métodos , Adulto Jovem
12.
Ultrasound Obstet Gynecol ; 54(1): 35-50, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30737852

RESUMO

Cardiac output (CO), along with blood pressure and vascular resistance, is one of the most important parameters of maternal hemodynamic function. Substantial changes in CO occur in normal pregnancy and in most obstetric complications. With the development of several non-invasive techniques for the measurement of CO, there is a growing interest in the determination of this parameter in pregnancy. These techniques were initially developed for use in critical-care settings and were subsequently adopted in obstetrics, often without appropriate validation for use in pregnancy. In this article, methods and devices for the measurement of CO are described and compared, and recommendations are formulated for their use in pregnancy, with the aim of standardizing the assessment of CO and peripheral vascular resistance in clinical practice and research studies on maternal hemodynamics. Copyright © 2019 ISUOG. Published by John Wiley & Sons Ltd.


Assuntos
Débito Cardíaco/fisiologia , Ecocardiografia/métodos , Hemodinâmica/fisiologia , Resistência Vascular/fisiologia , Adulto , Pressão Sanguínea/fisiologia , Cateterismo de Swan-Ganz/métodos , Feminino , Coração/diagnóstico por imagem , Coração/fisiologia , Humanos , Hipertensão Induzida pela Gravidez/fisiopatologia , Imagem por Ressonância Magnética/métodos , Pessoa de Meia-Idade , Gravidez , Gestantes , Análise de Onda de Pulso/métodos , Ultrassonografia Doppler/métodos
13.
Pediatr Cardiol ; 40(4): 805-812, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30759268

RESUMO

Atherosclerosis promoting cardiovascular disease risk factors (CVDrf) are highly prevalent among youth in the U.S. Determining which standard modifiable clinical measures (SMCMs) has the greatest impact on vascular structure and function is valuable for the health care provider to help identify children at highest risk. The aim of this study was to determine modifiable outpatient clinical predictors of vascular health in youth with CVDrf. Children and adolescents with CVDrf (n = 120, 13.1 ± 1.9 years, 49% female) were recruited from a pediatric preventive cardiology clinic. The SMCMs included BMI z-score, waist-to-height ratio (WTHR), lipid panel, hemoglobin A1c, blood pressure (BP), presence of tobacco smoke exposure, and presence of hypertriglyceridemic waist (HTW) phenotype (triglycerides ≥ 110 mg/dL and waist circumference ≥ 90 percentile). Vascular function and structure were measured with pulse wave velocity (PWV), central systolic BP (CSP), augmentation index (AIx), and carotid artery intima-media thickness (cIMT). Sex and height specific z-scores for PWV, CSP, and cIMT were used. Multiple linear regression with backwards selection identified SMCMs which strongly predicted vascular function and structure. Among SMCMs, WTHR and HTW were the most frequent predictors of vascular function (PWV: R2 = 0.32; CSP: R2 = 0.35; AIx R2 = 0.13). Other predictors of vascular function included hemoglobin A1C, BP, and BMI z-score. Systolic BP and LDL cholesterol were predictors of vascular structure (cIMT: R2 = 0.14). The strongest predictors of vascular health in youth with CVDrf were related to measures of central obesity. Targeting these SMCM in lieu of vascular testing in outpatient clinic setting may be practical to identify children and adolescents at greatest risk for CVD.


Assuntos
Vasos Sanguíneos/fisiopatologia , Doenças Cardiovasculares/etiologia , Dislipidemias/fisiopatologia , Adolescente , Pressão Sanguínea/fisiologia , Doenças Cardiovasculares/diagnóstico , Espessura Intima-Media Carotídea/estatística & dados numéricos , Criança , Dislipidemias/complicações , Feminino , Humanos , Lipídeos/sangue , Masculino , Análise de Onda de Pulso/métodos , Fatores de Risco
14.
Pediatr Cardiol ; 40(4): 784-791, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30770935

RESUMO

There are no previous studies on arterial stiffness and its associations with cardiorespiratory fitness in young Fontan patients. Therefore, we examined the arterial stiffness and its relationship to cardiorespiratory fitness in children and young adults with a Fontan circulation. Altogether, 17 Fontan patients and 26 healthy controls (16 females and 27 males aged 8-40 years) participated in this cross-sectional study. The cardiorespiratory fitness was assessed by cardiopulmonary exercise testing on a cycle ergometer and was defined as the standard deviation scores (SDS) of peak oxygen uptake per body mass (VO2peak/kg) based on the national reference values and assessed with cardiopulmonary exercise testing on a cycle ergometer. Aortic pulse wave velocity (PWVao) as a measure of arterial stiffness and aortic Augmentation Index (AIX) as a measure of peripheral arterial tone, were assessed by non-invasive oscillometric device from upper arm. Body adiposity was determined by body mass index SDS and the sport participation by interview. Data were analyzed using linear regression analyses and Pearson's correlations, adjusted for age and sex. Fontan patients had a lower VO2peak/kg-SDS (- 2.69 vs 0.078), higher PWVao-SDS (1.13 vs - 0.24) and higher AIX (19.26% vs 8.49%) in comparison with healthy controls. PWVao and AIX were negatively associated with VO2peak/kg (standard regression coefficient (ß) - 0.525, 95% confidence interval (CI) - 0.722 to - 0.227, p < 0.01 and ß - 0.371, 95% CI - 0.672 to - 0.080, p = 0.014). Young Fontan patients have the arterial stiffness of healthy people who are twice as old. Thereby, children and young adults with a Fontan circulation have a lower cardiorespiratory fitness and less sport participation. Arterial stiffness is inversely associated with cardiorespiratory fitness and exercise training might be an intervention to improve vascular health in this population.


Assuntos
Aorta/fisiopatologia , Aptidão Cardiorrespiratória/fisiologia , Técnica de Fontan/efeitos adversos , Cardiopatias Congênitas/cirurgia , Rigidez Vascular/fisiologia , Adolescente , Adulto , Criança , Estudos Transversais , Teste de Esforço/métodos , Feminino , Cardiopatias Congênitas/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Oscilometria , Análise de Onda de Pulso/métodos , Adulto Jovem
15.
Sensors (Basel) ; 19(4)2019 Feb 19.
Artigo em Inglês | MEDLINE | ID: mdl-30791363

RESUMO

This work describes the development of a pressure-sensing array for noninvasive continuous blood pulse-wave monitoring. The sensing elements comprise a conductive polymer film and interdigital electrodes patterned on a flexible Parylene C substrate. The polymer film was patterned with microdome structures to enhance the acuteness of pressure sensing. The proposed device uses three pressure-sensing elements in a linear array, which greatly facilitates the blood pulse-wave measurement. The device exhibits high sensitivity (-0.533 kPa-1) and a fast dynamic response. Furthermore, various machine-learning algorithms, including random forest regression (RFR), gradient-boosting regression (GBR), and adaptive boosting regression (ABR), were employed for estimating systolic blood pressure (SBP) and diastolic blood pressure (DBP) from the measured pulse-wave signals. Among these algorithms, the RFR-based method gave the best performance, with the coefficients of determination for the reference and estimated blood pressures being R² = 0.871 for SBP and R² = 0.794 for DBP, respectively.


Assuntos
Determinação da Pressão Arterial/tendências , Pressão Sanguínea/fisiologia , Aprendizado de Máquina , Análise de Onda de Pulso/métodos , Algoritmos , Diagnóstico por Computador , Frequência Cardíaca/fisiologia , Humanos
16.
Sensors (Basel) ; 19(4)2019 Feb 19.
Artigo em Inglês | MEDLINE | ID: mdl-30791368

RESUMO

In this project, we have studied the use of electrical impedance cardiography as a possible method for measuring blood pulse wave velocity, and hence be an aid in the assessment of the degree of arteriosclerosis. Using two different four-electrode setups, we measured the timing of the systolic pulse at two locations, the upper arm and the thorax, and found that the pulse wave velocity was in general higher in older volunteers and furthermore that it was also more heart rate dependent for older subjects. We attribute this to the fact that the degree of arteriosclerosis typically increases with age and that stiffening of the arterial wall will make the arteries less able to comply with increased heart rate (and corresponding blood pressure), without leading to increased pulse wave velocity. In view of these findings, we conclude that impedance cardiography seems to be well suited and practical for pulse wave velocity measurements and possibly for the assessment of the degree of arteriosclerosis. However, further studies are needed for comparison between this approach and reference methods for pulse wave velocity and assessment of arteriosclerosis before any firm conclusions can be drawn.


Assuntos
Artérias/fisiologia , Velocidade do Fluxo Sanguíneo/fisiologia , Pressão Sanguínea/fisiologia , Análise de Onda de Pulso/métodos , Adulto , Fatores Etários , Idoso , Feminino , Frequência Cardíaca/fisiologia , Humanos , Masculino , Pessoa de Meia-Idade
17.
Eur J Appl Physiol ; 119(4): 913-920, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30666411

RESUMO

PURPOSE: Weight lifting training has gained much popularity in recent years and is frequently used in non-professional and professional settings. However, little is known about the acute effects of a highly intensive weight lifting exercise (clean and jerk) on the hemodynamic reaction. METHODS: 18 non-professional experienced weight lifters were recruited. Hemodynamic parameters were obtained and measured at baseline (T1), after warming up (T2), and after a highly intensive clean and jerk exercise (90-95% of personal best; T3). Further, 15 (T4), and 30 min (T5) post-exercise measurements were conducted. Evaluated parameters were heart rate (HR) (b/min), peripheral and central systolic and diastolic blood pressure (pSysBP, pDiaBP, cSysBP, cDiaBP) (mmHg), pulse wave velocity (PWV) (m/s), and double product (DP). RESULTS: All hemodynamic values increased from T1 up to T3 with significantly higher values measured at T3 compared to T1 and T2. Values of measured parameters at T3 were as follows: HR: 94.4 ± 15.6 b/min, pSysBP: 147.1 ± 15.9 mmHg, pDiaBP: 87.4 ± 12.2 mmHg, cSysBP: 129.3 ± 13.8 mmHg, cDiaBP: 89.9 ± 12.8 mmHg, and: 5.8 ± 0.5 m/s, DP: 14053 ± 3669. Post-exercise (T4, T5), all values returned to baseline levels. CONCLUSIONS: Results indicate that a highly intensive weight lifting exercise led to an acute increase of blood pressure and an acute stiffening of the arteries. Yet, increases were moderate and did not reach disproportionately high levels and returned to baseline levels within 15 min post-exercise. Hence, no negative acute effects of a maximum weight lifting exercise on the hemodynamic system are observed.


Assuntos
Pressão Sanguínea/fisiologia , Exercício/fisiologia , Rigidez Vascular/fisiologia , Levantamento de Peso/fisiologia , Adulto , Determinação da Pressão Arterial/métodos , Teste de Esforço/métodos , Feminino , Frequência Cardíaca/fisiologia , Hemodinâmica/fisiologia , Humanos , Masculino , Análise de Onda de Pulso/métodos , Adulto Jovem
18.
Med Biol Eng Comput ; 57(5): 1151-1158, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30680662

RESUMO

The main goal of this study was to make a comparison of aortic flow timing obtained by PW Doppler in four aortic sections with timing of - dZ/dt max obtained by bioimpedance measurement in nine locations on the thorax and neck. This knowledge is essential for determination of which bioimpedance channel could be used as a proximal for evaluation of pulse wave velocity (PWV) from the beginning of the ascending aorta or another aortic section. Time intervals between the Doppler flow and bioimpedance information (- dZ/dt max) were compared. It was found that the channel located on the left part of the neck is the most suitable as a proximal bioimpedance channel which corresponds to the aortic arch. This match is obtained with regard to the value of the time difference as well as inter-subject stability. This channel can be used as a proximal for evaluation of pulse wave velocity from the aortic arch to the desired distal target place in the body when distance between measured parts is known. The data from 35 volunteers with adequate signal quality were analyzed. Graphical abstract ᅟ.


Assuntos
Aorta/fisiologia , Pletismografia de Impedância/métodos , Análise de Onda de Pulso/métodos , Ultrassonografia Doppler/métodos , Adulto , Aorta/diagnóstico por imagem , Humanos , Fatores de Tempo
19.
Ultrasound Med Biol ; 45(3): 758-772, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30642659

RESUMO

Shear wave elastography and ultrafast imaging of the carotid artery pulse wave were performed in 27 normotensive participants and 29 age- and sex-matched patients with essential hypertension, and compared with reference techniques: carotid-femoral pulse wave velocity (cfPWV) determined via arterial tonometry and carotid stiffness (carPWV) determined via echotracking. Shear wave speed in the carotid anterior (a-SWS) and posterior (p-SWS) walls were assessed throughout the cardiac cycle. Ultrafast PWV was measured in early systole (ufPWV-FW) and in end-systole (dicrotic notch, ufPWV-DN). Shear wave speed in the carotid anterior appeared to be the best candidate to evaluate arterial stiffness from ultrafast imaging. In univariate analysis, a-SWS was associated with carPWV (r = 0.56, p = 0.003) and carotid-to-femoral PWV (r = 0.66, p < 0.001). In multivariate analysis, a-SWS was independently associated with age (R²â€¯= 0.14, p = 0.02) and blood pressure (R²â€¯= 0.21, p = 0.004). Moreover, a-SWS increased with blood pressure throughout the cardiac cycle and did not differ between normotensive participants and patients with essential hypertension when compared at similar blood pressures.


Assuntos
Pressão Sanguínea/fisiologia , Artérias Carótidas/fisiopatologia , Técnicas de Imagem por Elasticidade/métodos , Hipertensão/fisiopatologia , Análise de Onda de Pulso/métodos , Rigidez Vascular/fisiologia , Adulto , Idoso , Artérias Carótidas/diagnóstico por imagem , Estudos de Casos e Controles , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Valores de Referência , Reprodutibilidade dos Testes
20.
J Clin Rheumatol ; 25(4): 171-175, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-29782425

RESUMO

BACKGROUND/OBJECTIVE: Takayasu arteritis (TA) is characterized by extensive aortic, large and midsize arterial wall inflammation. The aim of this study was to assess the morphological and elastic properties of the aorta and large arteries and the impact on left ventricular (LV) mechanics in children with TA. METHODS: Seven pediatric TA patients (6 female patients, 13.8 ± 3.2 years) were assessed with magnetic resonance imaging, vascular ultrasound, applanation tonometry, and echocardiography from February 2015 until July 2017 and compared with 7 age- and sex-matched controls. Takayasu arteritis disease activity was assessed clinically by the Pediatric Vasculitis Activity Score (PVAS). RESULTS: Pediatric TA patients showed increased carotid-to-radial artery pulse wave velocity (8.1 ± 1.8 vs. 6.4 ± 0.6 m/s, p = 0.03) and increased carotid-to-femoral artery pulse wave velocity (8.3 ± 1.9 vs. 5.1 ± 0.8 m/s, p < 0.01) when compared with controls. Patients demonstrated increased LV mass index (74.3 ± 18.8 vs. 56.3 ± 10.9 g/m, p = 0.04), altered myocardial deformation with increased basal rotation (-9.8 ± 4.5 vs. -4.0 ± 2.0 degrees, p = 0.01) and torsion (19.9 ± 8.1 vs. 9.1 ± 3.1 degrees, p = 0.01), and impaired LV diastolic function with decreased mitral valve E/A ratio (1.45 ± 0.17 vs. 2.40 ± 0.84, p = 0.01), increased mitral valve E/E' ratio (6.8 ± 1.4 vs. 4.9 ± 0.7, p < 0.01), and increased pulmonary vein A-wave velocity (26.7 ± 5.7 vs. 16.8 ± 3.3 cm/s, p = 0.03). Carotid-to-radial artery pulse wave velocity was associated with systolic (R = 0.94, p < 0.01), diastolic (R = 0.85, p = 0.02), and mean blood pressure (R = 0.91, p < 0.01), as well as disease activity by PVAS (R = 0.75, p = 0.05). The PVAS was associated with carotid-to-radial artery pulse wave velocity (R = 0.75, p = 0.05), as well as systolic (R = 0.84, p = 0.02), diastolic (R = 0.82, p = 0.03), and mean blood pressure (R = 0.84, p = 0.02). CONCLUSIONS: Increased arterial stiffness is present in pediatric TA patients and associated with increased blood pressure and TA disease activity. Pediatric TA patients demonstrate altered LV mechanics, LV hypertrophy, and impaired diastolic function.


Assuntos
Aorta , Artérias , Arterite de Takayasu , Rigidez Vascular/fisiologia , Disfunção Ventricular Esquerda , Adolescente , Aorta/diagnóstico por imagem , Aorta/fisiopatologia , Artérias/diagnóstico por imagem , Artérias/fisiopatologia , Canadá , Criança , Correlação de Dados , Ecocardiografia/métodos , Técnicas de Imagem por Elasticidade/métodos , Feminino , Humanos , Masculino , Manometria/métodos , Gravidade do Paciente , Análise de Onda de Pulso/métodos , Arterite de Takayasu/diagnóstico , Arterite de Takayasu/fisiopatologia , Disfunção Ventricular Esquerda/etiologia , Disfunção Ventricular Esquerda/patologia , Disfunção Ventricular Esquerda/fisiopatologia
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