A new method of arterial stiffness measurement in pseudoexfoliation syndrome: cardio-ankle vascular index / Um novo método para medição da rigidez arterial na síndrome de pseudoesfoliação: índice vascular cardíaco-tornozelo

ABSTRACT Purpose: To investigate whether pseudoexfoliation syndrome affects arterial stiffness by using cardio-ankle vascular index measurement. Methods: This cross-sectional case-control study included 55 patients with pseudoexfoliation syndrome and 106 age- and gender-matched healthy control subjects. All subjects underwent a complete ophthalmic exa mination of both eyes and cardio-ankle vascular index measu rements. Echocardiographic and body mass index measurements were performed in all patients, and the results were recorded. A binary regression model was used to determine the relationship between cardio-ankle vascular index and pseudoexfoliation. Results: There were no significant differences between the pseudoexfoliation and control groups in baseline clinical and demographic characteristics, echocardiographic measurements of left ventricular ejection fraction, and body mass index. The mean cardio-ankle vascular index value was significantly higher in the pseudoexfoliation group than in the controls (9.47 ± 1.23 vs. 8.33 ± 1.50, p<0.001). Intraocular pressure was significantly higher in the pseudoexfoliation group than in the controls (18.31 ± 1.78 vs. 15.24 ± 2.42 mm Hg, p<0.05). Although the logistic regression analysis showed that mean cardio-ankle vascular index and IOP values were positively associated with pseudoexfoliation syndrome (Odds ratios (OR) = 1.973, 95% CI, 1.051-3.706, p=0.035; OR=3.322, 95% CI = 2.000-5.520, p<0.001, respectively), the Pearson correlation analysis revealed a borderline significant positive correlation between age and mean cardio-ankle vascular index and a significant positive correlation between dyslipidemia and intraocular pressure and mean cardio-ankle vascular index (r=0.265, p=0.050; r=0.337, p=0.012; r=0.433, p=0.001, respectively). Conclusion: Our findings demonstrated that cardio-ankle vascular index values increased in patients with pseudoexfoliation syndrome.

RESUMO Objetivo: Investigar se a síndrome de pseudoesfoliação afeta a rigidez arterial, usando a medição do índice vascular cardíaco-tornozelo. Métodos: Este estudo transversal caso-controle incluiu 55 pacientes com síndrome de pseudoesfoliação e 106 controles saudáveis, pareados por idade e gênero. Todos os indivíduos foram submetidos a um exame oftalmológico completo de ambos os olhos e à medição do índice vascular cardíaco-tornozelo. Medidas ecocardiográficas e do índice de massa corporal também foram feitas em todos os pacientes, e os resultados foram registrados. Usou-se um modelo de regressão binária para avaliar uma possível relação entre o índice vascular cardíaco-tornozelo e a pseudoesfoliação. Resultados: Não houve diferença significativa entre os grupos com pseudoesfoliação e de controle em relação às características clínicas e demográficas basais, às medidas ecocardiográficas da fração de ejeção do ventrículo esquerdo e ao índice de massa corporal. Os valores médios do índice vascular cardíaco-tornozelo foram significativamente maiores no grupo com pseudoesfoliação do que no de controle (9,47 ± 1,23 contra 8,33 ± 1,50, p<0,001). Os valores da pressão intraocular no grupo com pseudoesfoliação excederam significativamente os do grupo de controle (18,31 ± 1,78 mmHg contra 15.24 ± 2.42 mmHg, p<0.05). A análise de regressão logística demonstrou uma associação positiva das médias do índice vascular cardíaco-tornozelo e da pressão intraocular com a síndrome de pseudoesfoliação (respectivamente, OR=1,973, IC 95%: 1,051-3,706, p=0,035 e OR=3,322, IC 95%: 2,000-5,520, p<0,001). Já a análise de correlação de Pearson revelou uma correlação positiva de significância limítrofe entre a idade e a média do índice vascular cardíaco-tornozelo, e uma correlação positiva significativa entre a dislipidemia, a pressão intraocular e a média do índice vascular cardíaco-tornozelo (respectivamente, r=0,265, p=0,050; r=0,337, p=0,012; e r=0,433, p=0,001). Conclusão: Nossos achados demonstraram que os valores do índice vascular cardíaco-tornozelo se encontram aumentados em pacientes com síndrome de pseudoesfoliação.

Evaluation of the cardio-ankle vascular index in COVID-19 patients

SUMMARY OBJECTIVE: This study aimed to investigate the relationship and prognostic significance of cardio-ankle vascular index, which is a measure of arterial stiffness that can lead to endothelial dysfunction and poor cardiovascular issues in COVID-19 patients, with COVID-19. METHODS: The study included 115 patients, of which 65 patients in the case group with Real time reversetranscription-polymerasechainreaction test positive and diagnosed for COVID-19 and 50 volunteers in the control group. Patients with COVID-19 were classified as moderate/severe or mild COVID-19 in the subgroup analysis based on the severity of the disease. We investigated the relationship between cardio-ankle vascular index and COVID-19 by using the VaSera VS-1000 device to automatically measure each patient's cardio-ankle vascular index and ankle-brachial pressure index. RESULTS: The mean age of participants included in the study was 65.7±10.7 years. Patients and volunteers were statistically similar in terms of age, gender, comorbidities, Charlson comorbidity index scores, and body mass index values (p>0.05). The right-cardio-ankle vascular index value was 9.6±2.4 in the case group and 8.5±1.1 in the control group (p=0.004). The left-cardio-ankle vascular index value was 9.4±2.7 in the case group and 8.5±1.2 in the control group (p=0.01). The right-cardio-ankle vascular index value was 10.8±3.4 in the moderate/severe disease group and 8.8±0.9 in the mild disease group (p=0.008). The left-cardio-ankle vascular index value was 10.7±3.6 in the moderate/severe disease group and 8.5±1.5 in the mild disease group (p<0.001). The right-cardio-ankle vascular index and left-cardio-ankle vascular index values were found to be significantly higher in COVID-19 patients in our study. When receiver operating characteristic analysis was performed to distinguish moderate/severe COVID-19 patients from mild patients, right-cardio-ankle vascular index was area under the curve 0.757 (0.630-0.884), and left-cardio-ankle vascular index was area under the curve 0.782 (0.661-0.902). CONCLUSION: The right-cardio-ankle vascular index and left-cardio-ankle vascular index values increased in COVID-19 patients in our study, and this was thought to be prognostically significant.

Exploring the relationship between blood glucose and arteriosclerosis based on propensity score matching / 上海交通大学学报（医学版）

Objective : To explore the relationship between blood glucose and arteriosclerosis with cardio-ankle vascular index (CAVI) as the indicator of arteriosclerosis. Methods ¡¤ From 2016 to 2018, a total of 8 547 participants aged 18 years and above who completed physical examinations in the Physical Examination Center of the First Affiliated Hospital of Chongqing Medical University were selected to collect CAVI and other relevant biochemical indicators. Based on fast blood glucose (FBG) and history of diabetes, the subjects were divided into normal blood glucose group and hyperglycemia group. The 1:1 propensity score matching was used to match the gender, age, blood pressure, blood li-pids, and body mass index to balance the covariates between the groups. The matched data were analyzed by Logistic regression and restricted cubic spline (RCS) to explore the relationship and the dose-effect relationship between FBG and CAVI. Results ¡¤ A total of 1 463 pairs com-pleted propensity score matching, and the covariates between the two groups were balanced after matching. Logistic regression analysis showed that hyperglycemia was a risk factor of CAVI (OR=1.63, 95% CI 1.36-1.95). The RCS curve of FBG and CAVI abnormal risk showed an up-ward trend, i.e., as FBG increased, the risk of CAVI abnormalities increased. Conclusion ¡¤ As the fasting blood glucose increases, the risk of arteriosclerosis also increases.

Study on cardio-ankle vascular index among female residents in high radiation background area in Yangjiang City / 中国职业医学

OBJECTIVE: To explore the effect of long-term low-dose ionizing radiation exposure on arterial vascular elasticity in female residents. METHODS: A cluster random sampling method was used,95 female residents in 2 regions with high external γ radiation dose rate in the high radiation background area( HBRA) in Yangjiang City were selected as the HBRA group,and 96 female residents from the control area( CA) in Enping City were chosen as the CA group. The height,body mass,waist circumference,hip circumference and blood pressure were measured in individuals of these two groups. The fasting blood samples of elbow vein were collected to measure high-density lipoprotein cholesterol( HDL-C),low-density lipoprotein cholesterol( LDL-C),triglycerides( TG) and blood glucose. The cardio-ankle vascular index( CAVI) was measured using the blood pressure and pulse check device. RESULTS: The CAVI of the CA and HBRA groups were( 8. 09 ±1. 03) and( 8. 35 ± 1. 60) m/s,respectively. The abnormal rates of CAVI were 25. 00% and 29. 47%,respectively. The results of multiple linear regression analysis showed that after adjustment for age,HDL-C,LDL-C,TG,hypertension,abnormal glucose metabolism and abdominal obesity,the CAVI adjustment mean values of the CA and HBRA groups were8. 19 and 8. 25 m/s,respectively. The HBRA group was about 0. 73% higher than the CA group,but the difference was not statistically significant( standardized partial regression coefficient = 0. 021,P > 0. 05). After matching age of both groups,the difference of the adjusted mean of CAVI between the two groups was not statistically significant( P > 0. 05).CONCLUSION: Long-term low-dose radiation exposure is not associated with atherosclerosis in female population.

The effects of enhanced external counterpulsation on arterial elasticity in patients with cerebral ischemic stroke / 中国神经精神疾病杂志

Objectives To examine the effects of enhanced external counterpulsation on arterial elasticity in stroke patients to provide clinical evidence for secondary prevention of patients with cerebral ischemic stroke. Methods Total 192 patients with ischemic stroke were enrolled and then divided into the EECP (n=107) and control (n=85) group. Auto-matic measurement synchronous atherosclerosis detector was use to measure brachial-ankle pulse wave velocity (BaP-WV) and cardio-ankle vascular index (CAVI). The difference of BaPWV and CAVI were evaluated before, at 36 hours and one month after EECP. Results The BaPWV and CAVI significantly decreased at 36 hours and 1 month after treat-ment in EECP groups compared to either pre-therapy or control groups (all P<0.05). Conclusions EECP can signifi-cantly reduce the BaPWV and CAVI and improve the arterial elasticity in patients with cerebral ischemic stroke. Thus, arterial elasticity may be an important index to evaluate the effects of EECP on cerebral ischemic stroke.

The relationship between left ventricular diastolic function and arterial stiffness of diabetes patients / 中国综合临床

Objective To investigate the association between left ventricular diastolic function and arterial stiffness in patients with type 2 diabetes mellitus. Methods One hundred and two patients with type 2 diabetes( diabetic group),and 126 non-diabetic patients( control group) were selected from Jan. 2012 to Dec. 2013 in the Beijing Military General Hospital. The clinical features were recorded and free blood glucose (FBG ),blood lipids were measured. Cardio ankle vascular index( CAVI ) was measured by VS-1000 arteriosclerosis detector. Ultrasound heartbeat diagram was used to determine the left ventricular diastolic function indexes including the left atrial diameter(LAD),left ventricular early diastolicpeak velocity(E),left ventricular diastolic peak velocity(A),E/ A ratio and E peak deceleration time(EDT). Results The level of LAD,A, EDT,CAVI in diabetic patients were(39. 5 ± 5. 3)mm,(76. 6 ± 13. 5)cm/ s,(206. 6 ± 56. 3)ms,(9. 6 ± 1. 1)respectively,higher than those in control group((34. 4 ± 4. 2)mm,(71. 3 ± 13. 4)cm/ s,(185. 5 ± 34. 4)ms,(8. 5 ± 0. 9)). And E,E/ A level in diabetic group were(56. 6 ± 20. 4)cm/ s and(0. 73 ± 0. 21),significantly lower than the control group((67. 5 ± 16. 4)cm/ s and(0. 96 ± 0. 26)). The differences between the two groups were significant(P = 0. 001,0. 004,0. 002,0. 001,0. 001,0. 001). After adjusting the factors including body mass index and triglyceride,CAVI was negatively correlated with E/ A(r = - 0. 339,P< 0. 05))and positively correlated with EDT(r = 0. 314,P < 0. 05). Conclusion The diabetic patients with lower diastolic function and higher arterial stiffness,and the two factors are negatively correlation.

Assessing the cardio-ankle-vascular index, its influnencing factors and framingham heart scores in comparatively healthy 20-40 age adults of Ulaanbaatar city / Монголын Анагаах Ухаан

BackgroundOut of total 209550 cases of cardiovascular diseases in 2011, 66,7% were newly registered cases.Cardiovascular diseases are the number one cause of mortality in Mongolia; an estimated 6291 peopledied from CVDs in 2011, representing 36.7% of all deaths. It shows that CVD mortality level is higherthan in other countries.Materials and MethodsOur survey is a cross sectional study. We have investigated 600 people of the age of 20-40 whowere randomly selected from 6 urban districts of Ulaanbaatar city. With a permission #4 issued bythe Medical Ethics Control Committee of the Ministry of Health on 25th March 2011, our survey wascarried out between the 1st of July 2011 and the 1st of January 2012 based on the Functional DiagnosticLaboratory, Department of Physiology and Pathophysiology, School of Biomedicine, Health SciencesUniversity of Mongolia.ResultsThe CAVI was significantly higher (p<0.001) in 30-40 aged adults (6.68, 95% CI 6.58-6.78) than 20-29 aged adults (6.42, 95% CI 6.32-6.52). Also CAVI has a direct correlation with the cholesterol level(p<0.05, R2=0,011). Serum cholesterol, triglycerides and LDL levels were significantly higher (p<0.05)in men than women. Framingham Heart Score was in the normal range in 99.2% of the participantswith 4 cases having the score of 10% or higher representing a risk score.ConclusionsDislipidemia, overweight and obesity in young adults are the main causes of vascular dysfunctionsleading to cardiovascular diseases. Thus, the findings of the study demonstrate that helping youths todevelop healthy lifestyles including healthy eating and physical activities shall play a critical role for theprevention and intervention programs designed for development of healthy behavior and lifestyle fromchildhood, especially for the male population, are vital for fulfillment of this role.

Arterial stiffness of elderly population in ulaanbaatar, Khangai, Baruun regions of Mongolia / Шинэ санаа Шинэ нээлт

Human aging, the process of arterial stiffness occurs rapidly, which later results in structure change and dysfunction in blood circulation. The purpose of this study was to determine the cardio-ankle vascular index (CAVI) of elderly population in different regions of Mongolia and compare the result. In accordance with Mongolian nationwide Human Longevity Study, 1114 elderly subjects (male over 60 age, female over 55 age) were examined in Ulaanbaatar city, Baruun, Khangai area. CAVI was calculated automatically from the pulse volume record, blood pressure and the vascular length from heart to the ankle. Cardio-ankle vascular index were evaluated by VaSera VS-1000 (FUKUDA DENSHI, JAPAN). Average decline of CAVI was about 8.88±1.44 in a per decade. CAVI was correlated with age (r=0.415, p<0.01). CAVI was significantly correlated with age, and Ulaanbaatar city’s elderly people arterial stiffness is more changed other areas. Arterial stiffness male elderly people was changed more than female people.

Risk factors and association between cardio-ankle vascular index and carotid atherosclerosis in the patients with type 2 diabetes mellitus / 中国综合临床

ObjectiveTo study the association between cardio-ankle vascular index (CAVI) and carotid atherosclerosis as well as the risk factors in patients with type 2 diabetes mellitus.MethodsSixty type2 diabetic patients and 60 non-diabetic patients at the same hospitalization period were selected.The clinical features,laboratory test results such as free blood glucose ( FBG),blood lipids and other biochemical markers were recorded.Carotid intima-media thickness (IMT) and CAVI were measured.The relationship between CAVI and carotid atherosclerosis were analyzed; a multivariate linear regression analysis was performed between CAVI and risk factors of type 2 diabetes mellitus.ResultsThe body mass index,triglycerides,FBG,HbA1 c,IMT,the incidence of carotid artery plaque and CAVI values of diabetic group were significantly higher than that of nondiabetic group.Difference between the two groups was statistically significant ( all P ＜ 0.05 ) ; CAVI and carotid IMT was significantly correlated to each other( r =0.435,P ＜ 0.01 ) ; Multiple linear regression analysis showed that CAVI was significantly correlated to age (β =0.458,P ＜0.01 ),triglycerides (β =0.058,P =0.012),FBG (β =0.168,P =0.002) and HbAlc (β =0.228,P =0.003).ConclusionCAVI inpatients with diabetes was positively correlated with carotid IMT.Age,diabetes,triglycerides,FBG and HbAlc are independent risk factors for arterial stiffness.

Relationship of leptin-to-adiponectin ratio with cardio ankle vascular index in maintenance hemodialysis patients / 中国综合临床

Objective To investigate the association of serum leptin(LEP),adiponectin(ADPN)and leptin-to-adiponectin(L/A)ratio with cardio ankle vascular index(CAVI)in the patients maintaining hemodialysis(MHD).Methods Sixty MHD patients and thirty healthy volunteers were involved in the study.The levels of LEP and ADPN were determined by ELISA.Atherosclerosis was evaluated by the cardio ankle vascular index which was measured by using a VaSera VS-1000 machine.Results The levels of serum LEP and ADPN in hemodialysis patients were significantly higher than those in healthy controls([7.99 ± 1.21]μg/L vs.[4.18 ± 1.10]pg/L)and([15.12 ± 4.68]mg/L vs.[8.58 ± 2.23]mg/L),respectively,P ＜ 0.01].With the progression of atherosclerosis,the levels of serum LEP increased significantly,while the levels of serum ADPN decreased significantly.The L/A ratio was dramatically increased in patients with atherosclerosis.Multiple stepwise regression analysis showed that independent risk factors associated with CAVI include age,diabetes,levels of LEP and L/A ratio.Conclusion The increased serum LEP level and decreased serum ADPN level may be involved in the progression of atherosclerosis in MHD patients.The L/A ratio may be a powerful independentpredictor for CAVI in MHD patients.

Association of serum albumin and homocysteine levels and cardio-ankle vascular index in patients with continuous ambulatory peritoneal dialysis

BACKGROUND: The cardio-ankle vascular index (CAVI) is a newly developed arteriosclerotic measurement that has been proposed as an alternative to aortic pulse-wave velocity (PWV). The present study used the CAVI to identify the main factors associated with arteriosclerosis in continuous ambulatory peritoneal dialysis (CAPD) patients. METHODS: Fifteen CAPD patients were enrolled in the study. The CAVI is independent of the pressure and vascular reflection between the heart valve and the ankle. Serum albumin, uric acid, total calcium, phosphorus, lipid levels, high-sensitivity C-reactive protein and homocysteine concentrations in CAPD patients were measured using standard methods. Total body fat mass, truncal and non-truncal fat mass and lean body mass were measured using dual energy X-ray absorptiometry with a Lunar DPX-L scanner. RESULTS: CAPD patients had a mean CAVI of 9.37+/-3.16 m/sec, which was higher than the general population. The CAVI was negatively correlated with the serum albumin concentration (r=-0.548; p=0.034). Stepwise regression analysis showed that both the serum albumin concentration (beta=-0.643, p=0.013) and the serum homocysteine level (beta=0.486, p=0.004) were independently associated with the CAVI. CONCLUSIONS: An increase in CAVI was independently associated with both serum albumin and homocysteine level.

Change of CAVI in Maintenance Hemodialysis Patients / 대한신장학회잡지

BACKGROUND:CAVI, Cardio Ankle Vascular Index, has been proposed as an independent marker of arterial stiffness regardless of the blood pressure. We measured the CAVI of hemodynamically unstable patients on maintenance hemodialysis and at the same time measured other pulse pressure-related parameters in order to study their correlations with each other. METHODS:We studied 85 patients undergoing maintenance hemodialysis over 3 months. We categorized patients into 4 subgroups: Diabetes+Hypotension (N= 12), Diabetes+Normal blood pressure (N=16), Non- diabetes+Hypotension (N=15), and Non-diabetes+Normal blood pressure (N=42). Using automatic waveform analyzer, we measured CAVI and pulse pressure- related markers twice, before and after the hemodialysis session, and observed the change. RESULTS:After the dialysis, CAVI did not change despite the decreased mean blood pressure. Yet both brachial and ankle pulse pressure dropped significantly (4.34+/-15.22 mmHg, 11.50+/-20.65 mmHg, p<0.01). PEP (Pre-Ejection Period) on the other hand, remarkably increased (12. 13+/-22.18 msec) while ET (Ejection Time) showed considerable decrease (35.86+/-45.68 msec), and PEP/ ET ratio increased as well. Predialysis CAVI was significantly higher in Diabetes group than in Non-diabetes (11.02+/-2.33 vs. 8.20+/-1.87, p<0.001). However, no significant difference of CAVI was observed between Hypotension and Normal blood pressure groups. Diabetes+Hypotension Group displayed reduction in CAVI after dialysis with marginal significance (0.68+/-1.07, p=0.05) whilst PEP, ET and PEP/ET ratio showed no significant change compared to other groups. CONCLUSION:CAVI, a newly developed marker of arterial stiffness, is expected to be useful in prediction of the cardio-vascular risk and prognosis of patients undergoing hemodialysis.