Experimental assessment of a myocyte-based multiscale model of cardiac contractile dysfunction.

Cardiac contractile dysfunction (CD) is a multifactorial syndrome caused by different acute or progressive diseases which hamper assessing the role of the underlying mechanisms characterizing a defined pathological condition. Mathematical modeling can help to understand the processes involved in CD and analyze their relative impact in the overall response. The aim of this study was thus to use a myocyte-based multiscale model of the circulatory system to simulate the effects of halothane, a volatile anesthetic which at high doses elicits significant acute CD both in isolated myocytes and intact animals. Ventricular chambers built using a human myocyte model were incorporated into a whole circulatory system represented by resistances and capacitances. Halothane-induced decreased sarco(endo)plasmic reticulum Ca2+ (SERCA2a) reuptake pump, transient outward K+ (Ito), Na+-Ca2+ exchanger (INCX) and L-type Ca2+ channel (ICaL) currents, together with ryanodine receptor (RyR2) increased open probability (Po) and reduced myofilament Ca2+ sensitivity, reproduced equivalent decreased action potential duration at 90% repolarization and intracellular Ca2+ concentration at the myocyte level reported in the literature. In the whole circulatory system, model reduction in mean arterial pressure, cardiac output and regional wall thickening fraction was similar to experimental results in open-chest sheep subjected to acute halothane overdose. Effective model performance indicates that the model structure could be used to study other changes in myocyte targets eliciting CD.

The adventitia layer modulates the arterial wall elastic response to intra-aortic counterpulsation: in vivo studies.

There is a relationship between the intra-aortic balloon pumping (IABP) benefits and the dynamic behavior of muscular arteries, which is associated with induced changes on the vessel walls through an endothelial-dependent mechanism. The arterial wall elastic behavior is influenced by adventitial function; however, no studies were performed in order to elucidate if this layer plays a role in the changes determined by IABP. Our aim was to quantify acute IABP effects on the mechanical properties of muscular arteries in induced acute heart failure (AHF), before and after adventitia removal. Pressure and diameter were recorded in the iliac arteries (IA) of sheep (n = 7), before and during 1:2 IABP: (i) in control state (CS) with intact IA, (ii) in CS after IA adventitia removal, and (iii) in de-adventitialized IA after AHF. Conduit function, compliance and arterial distensibility were calculated in each state. During CS, IABP resulted in intact IA dilatation and in an increase in conduit function, compliance and distensibility; adventitial removal determined an increase of arterial stiffness with respect to the CS, which decreased when IABP was used; the increase in arterial stiffness observed after adventitia removal was also detected in AHF state; IABP improves conduit function and arterial stiffness in de-adventitialized arteries, both before and during AHF. However, the improvement in these properties was lower than in intact arteries. Before and after AHF induction, the improvements of conduit function and arterial distensibility determined by IABP in intact IA were significantly reduced after adventitia removal. Adventitial layer integrity would be necessary to maximize IABP-related beneficial effects on arterial system properties.

Central-to-peripheral blood pressure amplification: role of the recording site, technology, analysis approach, and calibration scheme in invasive and non-invasive data agreement.

Background: Systolic blood pressure amplification (SBPA) and pulse pressure amplification (PPA) can independently predict cardiovascular damage and mortality. A wide range of methods are used for the non-invasive estimation of SBPA and PPA. The most accurate non-invasive method for obtaining SBPA and/or PPA remains unknown. Aim: This study aims to evaluate the agreement between the SBPA and PPA values that are invasively and non-invasively obtained using different (1) measurement sites (radial, brachial, carotid), (2) measuring techniques (tonometry, oscillometry/plethysmography, ultrasound), (3) pulse waveform analysis approaches, and (4) calibration methods [systo-diastolic vs. approaches using brachial diastolic and mean blood pressure (BP)], with the latter calculated using different equations or measured by oscillometry. Methods: Invasive aortic and brachial pressure (catheterism) and non-invasive aortic and peripheral (brachial, radial) BP were simultaneously obtained from 34 subjects using different methodologies, analysis methods, measuring sites, and calibration methods. SBPA and PPA were quantified. Concordance correlation and the Bland-Altman analysis were performed. Results: (1) In general, SBPA and PPA levels obtained with non-invasive approaches were not associated with those recorded invasively. (2) The different non-invasive approaches led to (extremely) dissimilar results. In general, non-invasive measurements underestimated SBPA and PPA; the higher the invasive SBPA (or PPA), the greater the underestimation. (3) None of the calibration schemes, which considered non-invasive brachial BP to estimate SBPA or PPA, were better than the others. (4) SBPA and PPA levels obtained from radial artery waveform analysis (tonometry) (5) and common carotid artery ultrasound recordings and brachial artery waveform analysis, respectively, minimized the mean errors. Conclusions: Overall, the findings showed that (i) SBPA and PPA indices are not "synonymous" and (ii) non-invasive approaches would fail to accurately determine invasive SBPA or PPA levels, regardless of the recording site, analysis, and calibration methods. Non-invasive measurements generally underestimated SBPA and PPA, and the higher the invasive SBPA or PPA, the higher the underestimation. There was not a calibration scheme better than the others. Consequently, our study emphasizes the strong need to be critical of measurement techniques, to have methodological transparency, and to have expert consensus for non-invasive assessment of SBPA and PPA.

Aortic systolic and pulse pressure invasively and non-invasively obtained: Comparative analysis of recording techniques, arterial sites of measurement, waveform analysis algorithms and calibration methods.

Background: The non-invasive estimation of aortic systolic (aoSBP) and pulse pressure (aoPP) is achieved by a great variety of devices, which differ markedly in the: 1) principles of recording (applied technology), 2) arterial recording site, 3) model and mathematical analysis applied to signals, and/or 4) calibration scheme. The most reliable non-invasive procedure to obtain aoSBP and aoPP is not well established. Aim: To evaluate the agreement between aoSBP and aoPP values invasively and non-invasively obtained using different: 1) recording techniques (tonometry, oscilometry/plethysmography, ultrasound), 2) recording sites [radial, brachial (BA) and carotid artery (CCA)], 3) waveform analysis algorithms (e.g., direct analysis of the CCA pulse waveform vs. peripheral waveform analysis using general transfer functions, N-point moving average filters, etc.), 4) calibration schemes (systolic-diastolic calibration vs. methods using BA diastolic and mean blood pressure (bMBP); the latter calculated using different equations vs. measured directly by oscillometry, and 5) different equations to estimate bMBP (i.e., using a form factor of 33% ("033"), 41.2% ("0412") or 33% corrected for heart rate ("033HR"). Methods: The invasive aortic (aoBP) and brachial pressure (bBP) (catheterization), and the non-invasive aoBP and bBP were simultaneously obtained in 34 subjects. Non-invasive aoBP levels were obtained using different techniques, analysis methods, recording sites, and calibration schemes. Results: 1) Overall, non-invasive approaches yielded lower aoSBP and aoPP levels than those recorded invasively. 2) aoSBP and aoPP determinations based on CCA recordings, followed by BA recordings, were those that yielded values closest to those recorded invasively. 3) The "033HR" and "0412" calibration schemes ensured the lowest mean error, and the "033" method determined aoBP levels furthest from those recorded invasively. 4) Most of the non-invasive approaches considered overestimated and underestimated aoSBP at low (i.e., 80 mmHg) and high (i.e., 180 mmHg) invasive aoSBP values, respectively. 5) The higher the invasively measured aoPP, the higher the level of underestimation provided by the non-invasive methods. Conclusion: The recording method and site, the mathematical method/model used to quantify aoSBP and aoPP, and to calibrate waveforms, are essential when estimating aoBP. Our study strongly emphasizes the need for methodological transparency and consensus for the non-invasive aoBP assessment.

Brachial Blood Pressure Invasively and Non-Invasively Obtained Using Oscillometry and Applanation Tonometry: Impact of Mean Blood Pressure Equations and Calibration Schemes on Agreement Levels.

The use of oscillometric methods to determine brachial blood pressure (bBP) can lead to a systematic underestimation of the invasively measured systolic (bSBP) and pulse (bPP) pressure levels, together with a significant overestimation of diastolic pressure (bDBP). Similarly, the agreement between brachial mean blood pressure (bMBP), invasively and non-invasively measured, can be affected by inaccurate estimations/assumptions. Despite several methodologies that can be applied to estimate bMBP non-invasively, there is no consensus on which approach leads to the most accurate estimation. Aims: to evaluate the association and agreement between: (1) non-invasive (oscillometry) and invasive bBP; (2) invasive bMBP, and bMBP (i) measured by oscillometry and (ii) calculated using six different equations; and (3) bSBP and bPP invasively and non-invasively obtained by applanation tonometry and employing different calibration methods. To this end, invasive aortic blood pressure and bBP (catheterization), and non-invasive bBP (oscillometry [Mobil-O-Graph] and brachial artery applanation tonometry [SphygmoCor]) were simultaneously obtained (34 subjects, 193 records). bMBP was calculated using different approaches. Results: (i) the agreement between invasive bBP and their respective non-invasive measurements (oscillometry) showed dependence on bBP levels (proportional error); (ii) among the different approaches used to obtain bMBP, the equation that includes a form factor equal to 33% (bMBP = bDBP + bPP/3) showed the best association with the invasive bMBP; (iii) the best approach to estimate invasive bSBP and bPP from tonometry recordings is based on the calibration scheme that employs oscillometric bMBP. On the contrary, the worst association between invasive and applanation tonometry-derived bBP levels was observed when the brachial pulse waveform was calibrated to bMBP quantified as bMBP = bDBP + bPP/3. Our study strongly emphasizes the need for methodological transparency and consensus for non-invasive bMBP assessment.

Intra-aortic balloon pumping reduces the increased arterial load caused by acute cardiac depression, modifying central and peripheral load determinants in a time- and flow-related way.

The mechanisms that explain intra-aortic balloon pumping (IABP) effects are not completely understood, and attributing them only to pressure-associated changes in cardiac function would be an oversimplification. Since IABP modifies the aortic and systemic blood-flow pattern, flow-related effects could be expected. To characterize effects of acute heart failure (AHF) on the arterial biomechanics; IABP effects on the arterial biomechanics during AHF, and their potential time-dependence; the association between hemodynamics and biomechanical changes during AHF and IABP. Sheep (n = 6) aortic pressure, flow, and diameter were measured: (1) before (Basal) and (2) 1-3 (HF(1-3)) and 28-30 (HF(28-30)) min after starting halothane to induce AHF; and (3) at specific times (1-3, 14-15 and 28-30 min) during IABP assistance. Calculus: aortic characteristic impedance (Z(c)), beta stiffness (ß), incremental (E(INC)) and pressure-strain elastic modulus (E(P)); total arterial compliance (C(G)), total systemic vascular resistance and wave propagation parameters. (1) AHF resulted in an acute increase in aortic and systemic stiffness (HF(28-30) % changes with respect to Basal conditions: ß +217%, E (P) +143%, E(INC) +101%, Z(c) +52%, C(G) -13%), associated with the reduction in the aortic blood flow; (2) during AHF IABP resulted in acute beneficial changes aortic and systemic biomechanics (% changes in IABP(1-3) with respect HF(28-30): ß -62%, E(P) -68%, E (INC) -66%, Z(c) -38%, C(G) 66%), and in wave propagation parameters, (3) IABP-related changes were time-dependent and associated with changes in aortic blood flow. Aortic and systemic biomechanical and impedance properties are detrimentally modified during AHF, being the changes rapidly reverted during IABP. IABP-related beneficial changes in arterial biomechanics were time-dependent and associated with IABP capability to increase blood flow.

The endothelium modulates the arterial wall mechanical response to intra-aortic balloon counterpulsation: in vivo studies.

Intra-aortic balloon pump (IABP) benefits could depend on variations in the cardiovascular biomechanical properties associated with blood flow-induced endothelium-dependent changes. However, if IABP results in changes in the peripheral artery biomechanics and if the endothelium plays a role in these potential changes remains unknown. The aim of this study is to characterize acute IABP effects on peripheral artery biomechanics in control and acute heart failure (AHF) states and the role of the endothelium in IABP effects on peripheral artery biomechanics. Pressure and diameter were recorded in sheep (n= 7) iliac arteries (IAs), before and during 1:2 IABP, during four states: (i) control with intact IA; (ii) AHF with intact IA; (iii) control with de-endothelialized (DE) (mechanical rubbing) IA; and (iv) AHF with DE IA. Arterial distensibility, elastic modulus, and conduit function (CF) (1/characteristic impedance) were calculated. The results of this study include: (i) during control conditions, IABP resulted in intact IA dilatation, stiffness reduction, and CF increase; (ii) AHF induction determined a reduction in intact IA diameter and CF, and a stiffness increase. These changes reverted during IABP; (iii) the increase in IA stiffness observed after DE remained unchanged during IABP; (iv) in DE IA, AHF did not result in diameter or stiffness changes; and (v) IABP during AHF did not associate changes in diameter or stiffness in the DE IA. In conclusion, during control and AHF states, IABP results in IA dilatation and stiffness reduction. The integrity of the endothelial layer would be critical for the IABP-associated changes in IA biomechanics.

Smooth muscle-dependent changes in aortic wall dynamics during intra-aortic counterpulsation in an animal model of acute heart failure.

PURPOSE: Intra-aortic balloon pumping (IABP) may modify arterial biomechanics; however, its effects on arterial wall properties during acute cardio-depression have not yet been fully explored. This dynamical study was designed to characterize the effects of IABP on aortic wall mechanics in an in vivo animal model of acute heart failure. METHODS: Aortic pressure, diameter and blood flow were measured in six anesthetized sheep with acute cardio-depression by halothane (4%), before and during IABP (1:2). Aortic characteristic impedance and aortic wall stiffness indexes were calculated. RESULTS: acute experimental cardio-depression resulted in a reduction in mean aortic pressure (p<0.05) and an increase in the characteristic impedance (p<0.005), incremental elastic modulus (p<0.05), stiffness index (p<0.05) and Peterson elastic modulus (p<0.05). IABP caused an increase in the cardiac output (p<0.005) and a reduction in the systemic vascular resistances (p<0.05). In addition, the aortic impedance, incremental elastic modulus, stiffness index and Peterson modulus were significantly reduced during IABP (p<0.05). CONCLUSIONS: Our findings show that IABP caused changes in aortic wall impedance and intrinsic wall properties, improving the arterial functional capability and the left ventricular afterload by a reduction in both. Systemic vascular resistances and aortic stiffness were also improved by means of smooth muscle-dependent mechanisms.

Vascular access localization determines regional changes in arterial stiffness.

BACKGROUND: Vascular access (VA) dysfunction is a common cause of hospitalization in chronically hemodialyzed patients (CHP) limiting the improvement in health and has been largely studied in order to decrease the morbidity events that involves both the artery and the vein used in the construction of the fistula. In parallel, patients in end-stage renal failure show an increase in arterial stiffness. AIM: The aims of this work were: (a) to evaluate arterial stiffness through pulse wave velocity (PWV) measurements in the carotid-brachial pathway where the arteriovenous fistulae (AVF) was constructed, and (b) to determine possible differences in arterial stiffness between the carotid-brachial pathway with and without VA. METHODS: PWV, clinical and biochemical parameters were measured in 38 CHP. PWV was obtained in the carotid-femoral, and in the left and right carotid-brachial pathway. RESULTS: Carotid-brachial PWV determination in upper limbs with AVF (10.07 +/- ;2.43 m/s) showed significantly lower values than those observed in the contra-lateral arm without VA (11.55 +/- ;2.27 m/s). Curiously, the PWV value observed in arms with an AVF was significantly lower in diabetic than in non-diabetic hemodialyzed patients (NDHP) (8.00 +/- ;2.86 m/s and 10.38 +/- ;2.33 m/s; respectively). Measurements of PWV in the carotid-femoral pathway in CHP showed a mean value of 14.09 +/- ;3.12 m/s. Carotid-femoral PWV in NDHP (14.06 +/- ;2.44 m/s) was significantly lower than that observed in the diabetic patients (16.87 +/- ;3.42 m/s). CONCLUSIONS: Carotid-brachial PWV values obtained in the upper limbs, in which VAs were constructed, were significantly lower than that measured in intact arteries in the contra-lateral pathway in CHP.

The effects of age on pulse wave velocity in untreated hypertension.

Increased arterial stiffness is an important determinant of cardiovascular risk, able to predict morbidity and mortality, and closely associated with ageing and blood pressure. The aims of this study were: (1) To determine the age-dependent reference pulse wave velocity (PWV), and compare it with values from hypertensive patients, and (2) to evaluate the impact of isolated and untreated hypertension on arterial stiffness. A total of 1079 patients were enrolled and divided into a control group (NT) of asymptomatic normotensive patients and a group of asymptomatic hypertensive patients (HT). Blood pressure, carotid-femoral PWV, and body mass index were measured in each subject, whose blood was drawn for laboratory tests. Aortic mean PWV in the NT group was 6.85 ± 1.66 m/s, which increased linearly (R2  = 0.62; P < .05) with age. In patients over 50 years of age, PWV was significantly higher than in younger patients (8.35 vs 5.92 m/s, respectively, P < .001). This significant difference persisted when observing male and female patients separately. In the hypertensive group, mean PWV value was 8.04 ± 1.8 m/s (range 4.5-15.8 m/s) and increased (R2  = 0.243; P < .05) with age. The PWV increase in HT was significantly higher (0.93 m/s per decade, P < .001) than in NT (0.44 m/s per decade). Our study provides normal values of PVW per decade, and shows that these values increase with age, especially after 50 years of age, particularly in HT patients. This stiffness growth rate may be responsible for increased cardiovascular risk in both groups.

Increases in Peripheral Systolic Pressure Levels and Z-score Associate Gradual Aortic Pressure Increase and Functional Arterial Impairment in Children and Adolescents.

BACKGROUND: Arterial changes associated with children and adolescents high blood pressure (HBP) states would vary depending on the arterial type, arterial indexes considered and/or on blood pressure (BP) levels. AIMS: To determine in children and adolescents: 1) if there is gradual structural-functional arterial impairment associated with gradual peripheral (brachial) systolic BP (pSBP) level or z-score increases, and 2) whether subjects with HBP levels and those with normal BP differ in the profiles of arterial changes associated with pSBP deviations. METHODS: 1005 asymptomatic children and adolescents were included. Clinical, anthropometric and arterial non-invasive evaluations were performed. Heart rate, brachial BP, aortic BP and wavederived parameters (i.e. augmentation index), carotid and femoral diameters, blood velocities and elastic modulus, carotid intima-media thickness and aortic pulse wave velocity, were obtained. Two groups were assembled: Reference (without cardiovascular risk factors (CVRFs); n=379) and HBP (n=175). Additionally, subjects were ascribed to groups according to their pSBP z-scores (z-score ≤ 0, 0< z-score < 1 or z-score ≥ 1). Age and sex-related mean and standard deviation equations were obtained for each variable (Reference group). Using those equations, data (entire population) were converted into z-scores. Groups were compared (absolute and z-scored variables) before and after adjusting for cofactors (ANOVA/ANCOVA). Linear regression analyses were done considering: pSBP and z-pSBP (independent) and absolute levels and z-scores for hemodynamic and arterial indexes (dependent variables). Differences in hemodynamic and arterial levels and z-scores variations (dependent) associated with variations in pSBP and z-pSBP (independent variable) were assessed. The slopes of the models for Reference and HBP groups were compared. CONCLUSION: HBP states associate hemodynamic and arterial changes not explained by exposure to other CVRFs, anthropometric or demographic factors. The higher the pSBP deviations from ageand sex-expected mean value in the Reference group, the higher the hemodynamic and arterial indexes deviation. The pSBP-related variations in hemodynamic and arterial indexes would not differ depending on whether HBP states are present or not.

Central-To-Peripheral Arterial Stiffness Gradient in Hemodialyzed Patients Depends on the Location of the Upper-limb Vascular Access.

BACKGROUND: Pulse wave velocity ratio (PWV-ratio), a measure of central-to-peripheral arterial stiffness gradient, is calculated as a quotient between carotid-femoral and carotid-radial PWV (cf-PWV/cr-PWV). This new index has been reported to be significantly associated with increased mortality in hemodialyzed patients. Since several reports showed differences in arterial stiffness regarding the pathway where the vascular access (VA) is, the purpose of this research was: a) to compare arterial stiffness values obtained in the left and right sides of the body in hemodialyzed and non-hemodialyzed patients, and b) to analyze PWV-ratio values obtained on the side of the body where the VA was placed and compare them to its contralateral intact side. Since it is difficult to adequately measure cr-PWV in patients with a VA in the forearm, we measured the carotid- brachial PWV (cb-PWV) and used it to calculate PWV-ratio (cf-PWV/cb-PWV). METHODS: A Pearson's correlation and Bland & Altman analysis were performed in hemodialyzed (n=135) and non-hemodialyzed (n=77) patients, to quantify the equivalence between arterial stiffness parameters (cf-PWV, cb-PWV, PWV-ratio) obtained on each side of the body with respect to its contralateral side. RESULTS: We conclude that PWV-ratio values measured on the side where the VA is placed were significantly higher than those obtained in its contralateral side, in hemodialyzed patients included in this research. Moreover, cf-PWV, cb-PWV and PWV-ratio values obtained on one side of the body were always highly correlated with its contralateral side. CONCLUSION: According to this research, any research involving PWV-ratio should always consider the observed territory.

Forward and Backward Aortic Components and Reflection Indexes in Children and Adolescents: Determinants and Role in High Pressure States.

BACKGROUND: High blood pressure states (HBP) would differ in wave components and reflections indexes, which could associate clinical and prognostic implications. The study aims: 1) to characterize the association of aortic wave components and reflection parameters (backward [Pb], forward [Pf], Pb/Pf ratio and augmentation index [AIx]) with demographic, anthropometric, hemodynamic and arterial parameters in healthy children and adolescents; 2) to generate multivariate prediction models for the associations, to contribute to understand the main determinants of Pf, Pb, Pb/Pf and AIx; 3) to identify if differences in wave reflection indexes observed in HBP could be explained by differences in the analyzed parameters. METHODS: Healthy children and adolescents (n=816, females: 386; Age: 3-20 years) were studied. EVALUATIONS: central aortic pressure and wave components (Pb, Pf, Pb/Pf and AIx determination with SphygmoCor [SCOR] and Mobil-o-Graph [MOG]); anthropometric assessment; regional arterial stiffness (carotid-femoral, carotid-radial pulse wave velocity [PWV] and PWV ratio); carotid intima-media thickness; carotid and femoral distensbility; cardiac output; systemic vascular resistances (SVR). Simple and multiple regression models were constructed to determine aortic wave parameters; the main explanatory variables. Normotensive and HBP groups were compared. Differences in wave reflection indexes were analyzed before and after controlling for explanatory variables. Equivalences between SphygmoCor and Mobil-O-Graph data were assessed (correlation and Bland-Altman analyses). RESULTS AND CONCLUSION: There were systematic and proportional differences between the data obtained with SphygmoCor and Mobil-O-Graph devices. Heart rate (HR), peripheral pulse pressure, height and weight were the variables that isolated (simple associations) or combined (multiple associations), showed the major capability to explain interindividual differences in Pf, Pb, Pb/Pf and AIx. Arterial stiffness also showed explanatory capacity, being the carotid the artery with the major contribution. HBP associated higher Pf, Pb, AIx and lower Pb/Pf ratio. Those findings were observed together with higher weight, arterial stiffness and HR. After adjusting for anthropometric characteristics, HR, cardiac output and SVR, the HBP group showed greater Pf and Pb. Then, Pf and Pb characteristics associated with HBP would not be explained by anthropometric or hemodynamic factors. Evaluating wave components and reflection parameters could contribute to improve the comprehension and management of HBP states.

Comparative in vivo analysis of the role of the adventitia and the endothelium on arterial mechanical function: relevance for aortic counterpulsation.

PURPOSE: The comparative effect of the intimal and adventitial layers on arterial biomechanics control, in basal and altered conditions, remains to be elucidated. This study aimed (1) to characterize the arterial conduit (CF) and buffering (distensibility) function of the iliac arteries in in vivo animals, in which the intimal and adventitial layers were removed; (2) to determine the effects of intra-aortic ballon pumping (IABP) on simultaneously de-adventitialized (DA) and de-endothelialized (DE) iliac arteries before and after induced heart failure. METHODS: Pressure and diameter signals were measured in the iliac arteries of sheep (n = 7) in which the adventitial and intima layer were removed. Intra-aortic balloon pump (IABP) assistance was used in a control state and after heart failure induction. RESULTS: Both DE and DA determined significant changes in arterial diameter, distensibility and CF. Changes were higher after DA than after DE in terms of distensibility and CF (p<0.05). DA followed by DE (DA + DE) showed significant increases in arterial diameter and CF, accompanied by a decrease in distensibility (p<0.05) with respect to intact arteries. Heart failure induction caused significant hemodynamic changes without modifying the already impaired local biomechanical parameters. Nonsignificant improvements in the biomechanical parameters of DA + DE iliac arteries were observed during IABP before and after heart failure induction. CONCLUSIONS: Biomechanical changes caused by DA of iliac arteries were more important than those observed after DE. The DA + DE arteries showed significant differences with respect to intact arteries and with DA or DE arteries. IABP-related effects on arterial mechanics were absent in DA + DE arteries.

Hydration Status Is Associated with Aortic Stiffness, but Not with Peripheral Arterial Stiffness, in Chronically Hemodialysed Patients.

Background. Adequate fluid management could be essential to minimize high arterial stiffness observed in chronically hemodialyzed patients (CHP). Aim. To determine the association between body fluid status and central and peripheral arterial stiffness levels. Methods. Arterial stiffness was assessed in 65 CHP by measuring the pulse wave velocity (PWV) in a central arterial pathway (carotid-femoral) and in a peripheral pathway (carotid-brachial). A blood pressure-independent regional arterial stiffness index was calculated using PWV. Volume status was assessed by whole-body multiple-frequency bioimpedance. Patients were first observed as an entire group and then divided into three different fluid status-related groups: normal, overhydration, and dehydration groups. Results. Only carotid-femoral stiffness was positively associated (P < 0.05) with the hydration status evaluated through extracellular/intracellular fluid, extracellular/Total Body Fluid, and absolute and relative overhydration. Conclusion. Volume status and overload are associated with central, but not peripheral, arterial stiffness levels with independence of the blood pressure level, in CHP.

Hemodialysis decreases carotid-brachial and carotid-femoral pulse wave velocities: A 5-year follow-up study.

Aortic stiffness is a prognostic parameter associated with patient mortality. Vascular access creation has been shown to have effects on arterial stiffness both in the aorta and in the upper limb arteries in chronically hemodialyzed patients (CHPs). However, no longitudinal studies have been conducted in order to characterize the evolution of arterial stiffness in CHPs. The aims of this work were (a) to measure baseline pulse wave velocity (PWV) in the carotid-femoral and in right and left carotid-brachial pathways in a cohort of CHP and (b) to conduct a 5-year prospective study on the same cohort to determine possible time-related differences. Pulse wave velocity was measured both in the carotid-femoral and in the carotid-brachial pathways, and clinical and biochemical parameters were collected in 25 CHPs, which were followed up after a 5-year lapse. Right and left carotid-brachial pathway PWV values showed significant decreases after the 5-year follow-up, independently of the presence of the vascular access (P < 0.001). Additionally, baseline carotid-brachial PWV was significantly higher (P < 0.001) than values measured 5 years later for upper limbs with vascular access (11.97 ± 2.97 m/sec vs. 6.76 ± 1.48 m/sec, respectively) and without vascular access (12.25 ± 2.38 m/sec vs. 7.18 ± 1.88 m/sec, respectively). Similarly, PWV values in the carotid-femoral pathway decreased significantly (P < 0.001) over the same period (13.27 ± 2.96 m/sec vs. 9.75 ± 2.99 m/sec, respectively). The 5-year follow-up of PWV showed significant decreases in both carotid-brachial and carotid-femoral pathways. The general changes in arterial stiffness could be related to the vascular access creation, hemodialysis therapy, and to the improvement of arterial pressure management.

Dynamic aortomyoplasty in treating end-stage heart failure.

BACKGROUND: Dynamic aortomyoplasty is an alternative to heart transplantation. The goal of our study was to evaluate the benefits of aortic counterpulsation obtained using dynamic aortomyoplasty in patients with heart failure refractory to pharmacologic treatment and with contraindications to heart transplant. METHODS: In this study, we compared the pre-operative and post-operative data of 15 selected patients who underwent dynamic thoracic aortomyoplasty. In this surgical technique, the right latissimus dorsi muscle flap is wrapped around the ascending aorta. This muscle flap was electrically stimulated during diastole, following a muscle-conditioning protocol, to obtain diastolic augmentation. At 12-month follow-up, we evaluated invasively and non-invasively the hemodynamic, clinical, and functional effects of aortomyoplasty. RESULTS: When comparing pre-operative data with 12-month follow-up data, we observed a significant decrease in the number of hospitalizations (p < 0.001) and in the New York Heart Association functional class (p < 0.001), and we observed significant improvement in the walking test (p < 0.001) and in peak oxygen consumption (p < 0.05). CONCLUSIONS: Dynamic, biologic, chronic counterpulsation of the aorta using a latissimus dorsi flap (dynamic aortomyoplasty) in selected patients with severe heart failure significantly improved hemodynamic parameters, heart functional data, and clinical functional class. A larger clinical experience with a longer follow-up would be useful in evaluating this technique's clinical relevance.

Juxtaaortic counterpulsation: comparison with intraaortic counterpulsation in an animal model of acute heart failure.

This study was designed to compare the effects of juxtaaortic balloon counterpulsation (JABC), performed in ascending aorta and the aortic arch, with those yielded by intraaortic balloon counterpulsation (IABC) in descending aorta, in experimental animals during induced cardiac failure. JABC was achieved with a manufactured Dacron prosthesis and a balloon pump placed between the prosthesis and the wrapped aorta. JABC resulted in a significant increase of cardiac output (from 2.33+/-0.82 to 2.61+/-1.12 L/min, p < 0.05), cardiac index (from 0.071+/-0.025 to 0.080+/-0.033 L/min/kg, p < 0.05) and diastolic pressure augmentation evaluated through diastolic and systolic areas beneath the aortic pressure curve (DABAC/SABAC) index (from 0.94+/-0.21 to 1.10+/-0.33, p < 0.01). End diastolic aortic pressure showed a significant decrease with JABC (from 31.90+/-7.09 to 27.83+/-9.72 mm Hg, p < 0.05). A close association between percentage of DABAC/SABAC increases obtained with IABC and JABC was observed (r2 = 0.67; p < 0.001). Counterpulsation obtained by a juxtaaortic catheter placed in the arch and the ascending wrapped aorta results in an effective hemodynamic improvement comparable with that achieved by an intraaortic catheter in open chest sheep.

Vascular accesses for haemodialysis in the upper arm cause greater reduction in the carotid-brachial stiffness than those in the forearm: study of gender differences.

Purpose. To evaluate in chronically haemodialysed patients (CHPs), if: (1) the vascular access (VA) position (upper arm or forearm) is associated with differential changes in upper limb arterial stiffness; (2) differences in arterial stiffness exist between genders associated with the VA; (3) the vascular substitute (VS) of choice, in biomechanical terms, depends on the previous VA location and CHP gender. Methods. 38 CHPs (18 males; VA in upper arm: 18) were studied. Left and right carotid-brachial pulse wave velocity (PWV(c-b)) was measured. In in vitro studies, PWV was obtained in ePTFE prostheses and in several arterial and venous homografts obtained from donors. The biomechanical mismatch (BM) between CHP native vessel (NV) and VS was calculated. Results/Conclusions. PWV(c-b) in upper limbs with VA was lower than in the intact contralateral limbs (P < 0.05), and differences were higher (P < 0.05) when the VA was performed in the upper arm. Differences between PWV(c-b) in upper limbs with VA (in the upper arm) with respect to intact upper limbs were higher (P < 0.05) in males. Independently of the region in which the VA was performed, the homograft that ensured the minimal BM was the brachial artery. The BM was highly dependent on gender and the location in the upper limb in which the VA was performed.

La adventicia arterial: actor olvidado del sistema cardiovascular

Actualmente se acepta que la adventicia tiene: un importante rol fisiológico al determinar el nivel de nutrición, oxigenación, reparación arterial, regulación de la vasomotricidad, control de la poscarga ventricular, control de la función arterial, etcétera, a la vez que tiene una importante participación en procesos patológicos (por ejemplo, aterosclerosis, hipertensión arterial, génesis de aneurismas de aorta abdominal). Sin embargo, dado lo reciente de la mayoría de los estudios que han redefinido el rol de la adventicia, aún persiste mucho desconocimiento en la comunidad biomédica acerca de la fisiología de la capa adventicia arterial. El presente trabajo tiene como objetivo revisar el rol que actualmente se reconoce para la capa adventicia de la pared arterial.