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Resumen Existen cambios estructurales importantes de la pared arterial en, prácticamente, todas las etapas clínicas de la enfermedad renal crónica. Son un marcador pronóstico y, al mismo tiempo, un factor de progresión y de eventos, tanto cardiovasculares como renales. Es por ello que tener una estimación del daño vascular y, mejor aún, un diagnóstico adecuado es esencial. La evaluación vascular en la consulta clínica, mediante la determinación de la presión del pulso y el índice de presión arterial sistólica tobillo-brazo, sirven como una orientación inicial del daño arterial de estos pacientes. Hoy podemos valorar, de manera accesible, las lesiones estructurales de las arterias mediante la cuantificación y caracterización, por ecografía vascular, de las placas ateroscleróticas de carótidas y femorales y por la velocidad de onda del pulso. En la gran mayoría de los pacientes renales la velocidad de onda del pulso está muy aumentada, comparada con poblaciones sanas, como consecuencia de múltiples mecanismos patogénicos. Las alteraciones vasculares, tanto de los grandes vasos como de la microcirculación, están fuertemente vinculados con la progresión de la enfermedad renal crónica, así como con complicaciones y eventos renales, cardiacos y cerebrales. En conclusión, en individuos con riesgo de desarrollar enfermedad renal crónica, o en quienes ya la padecen, la medición de la rigidez arterial y de los daños ateroscleróticos de la pared vascular serían parámetros centrales para su evaluación y uno de los objetivos a considerar al diseñar estrategias preventivas del deterioro de los órganos blanco y eventos.
Abstract There exist significant structural changes in the artery wall in almost all clinical stages of chronic kidney disease. They constitute a prognostic marker and, at the same time, a progression factor and an event factor, both cardiovascular and renal. For that reason, it is essential to have an estimation of vascular damage and, even better, an accurate diagnosis. Vascular evaluation during clinical consultation by means of determining pulse pressure and ankle-brachial pressure index are a helpful initial orientation of these patient´s artery damage. Today we can assess, in an accessible way, the structural lesions of the arteries by means of quantification and characterization, through vascular ultrasound, of carotid and femoral atherosclerotic plaques and through the pulse wave velocity. The vast majority of renal patients show increased pulse wave velocity, compared to healthy populations, as a result of multiple pathogenic mechanisms. Vascular alterations, both of large arteries and at the microcirculation level, are strongly linked to the progression of chronic kidney disease, as well as renal, cardiac and cerebral complications and events. In individuals at risk of developing chronic kidney disease, or in those who already suffer from it, the measurement of arterial stiffness and of atherosclerotic damage to the vascular wall is a central parameter for evaluation and one of the objectives to consider when designing preventive strategies against deterioration of target organs and events.
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Background: Hypertensive disease in pregnancy continues to be one of the leading causes of maternal death. Pregnancy induced hypertension (PIH) is said to be accompanied by several cardiovascular pathophysiological changes including increases in arterial stiffness. Pulse wave velocity (PWV) is a method for measuring arterial stiffness. Both the pulse wave form and the velocity are said to change in PIH. However, studies documenting these characteristics of the pulse wave have mainly been in the Caucasian population. Aims and Objectives: To establish the characteristics of the carotid-radial (cr) pulse wave in normotensive (NTN) and hypertensive (HTN) pregnant black African women at the UTH in Lusaka, Zambia. Methodology: This cross-sectional study comprised of 26 systemically selected pregnant women between the ages 18-45 years old who met the criteria. A structured interview was used to collect socio demographic data. Anthropometric measurements were taken. After a 15 minute rest, peripheral systolic and diastolic blood pressures (BP) were measured. The PWV measurement involved applying non-invasive piezoelectric sensors on the skin over the carotid artery in the neck and the radial artery on the wrist (carotid-radial segment crPWV). Using IBM® SPSS® version 20.0 analyses were made using mann - whitney and spearman correlation tests. A 95% confidence interval (CI) and P-value of <0.05 were set. Quality recordings were obtained from the crPWV recording processes showing the wave forms and specific measurements were made. Results: The anthropometric measurements were comparable between the 2 groups. There were significant changes in the pulse wave forms. While the normotensive participants had the type C wave form, the type A wave form was recorded from hypertensive participants. The augmentation pressure (AP) in NTN was 4±5 mmHg while it was 9±8 mmHg in HTN, indicating an increase in pressure difference from the systolic shoulder to the peak of the pulse wave (p <0.05). There was also a significant increase in the augmentation index (Aix) (1±22% vs 16±23%) (p<0.05). The hypertensive pregnant women also had a significantly higher PWV (9±4 m/s vs 13±7 m/s) (p<0.05). Conclusion: Distinct differences were seen in the cr pulse wave forms and velocity between normotensive and hypertensive individuals with PIH indicating an increase in arterial stiffness. These findings suggest the presence of significant peripheral vascular changes that may underly the pathophysiology of PIH.
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Background: Tobacco smoke is harmful to health. In the acute phase it causes changes in the cardiovascular system that result in increase in blood pressure (BP). An increase in arterial stiffness due to arteriolar endothelial dysfunction has been cited among the causes. Pulse Wave Velocity (PWV) and Arterial Stiffness Index (ASI) are used as measures of arterial stiffness in the adult population. Aim: To determine the acute effects of tobacco smoke on arterial stiffness in black male adolescents in Lusaka, Zambia. Study Design: This was an observational study done at the University of Zambia School of Medicine Cardiovascular Research Laboratory in the month of December 2014. Methodology: Twenty-two (22) black, male-adolescent (age range 19-25 years), active-smokers, consented to participate in the study. The Complior Analyse Unit (V1.9 Beta Version 2013; ALAMMedical, France) protocol was used to obtain the carotid-femoral PWV (cfPWV) and carotid-femoral ASI (cfASI) starting 15 minutes before smoking, on immediate cessation of smoking and thereafter every 15 minutes up to an hour after smoking. ASI was a surrogate measure of the loss of elasticity in the arteries. Results: The mean baseline cfPWV was 7.9±1.94 m/s and cfASI was 26.1±6.0 m/s. Smoking two tobacco cigarettes (2.8 mg Nicotine) in 15 minutes caused an increase in mean cfPWV and cfASI from their baseline values to cfPWV of 8.5±1.87 m/s and cfASI of 28.6±6.19 m/s respectively. These values reverted to baseline within 15 minutes post-smoking cessation. There was further reduction in both cfPWV and cfASI to more stable values at 45th and 60th minutes which were statistically significantly lower than the peak values recorded. Conclusion: The mean baseline cfPWV and cfASI in these late adolescents were comparatively higher than those recorded in non-smoking black adolescents and smoking white men and women (see Lemogoum, 2006). These recordings were also much higher than the values recorded 60 minutes after cessation of smoking. Compared to these values, we conclude that tobacco smoke may be the cause of the significant acute increase in cfPWV and cfASI in African male adolescents presumably signifying an increase in arterial stiffness probably due to endothelial dysfunction in elastic arteries. These alterations in vascular compliance may predispose these individuals to developing hypertension and other cardiovascular complications. There is need for further investigation of this phenomenon.
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Background: Arterial stiffness assessed noninvasively with aortic pulse wave velocity (PWV) has been associated with atherosclerosis in the coronary arteries and also cardiovascular mortality. The aim of this study was to evaluate the association between aortic PWV and severity of coronary artery disease (CAD) in patients with acute ST elevation myocardial infarction (STEMI). Methods: This cross sectional analytical study was conducted over 200 acute STEMI patients who were purposively selected and agreed to do coronary angiogram during index hospital admission. Assessment of aortic PWV was performed noninvasively with the commercially available SphygmoCor system using applanation tonometry with high fidelity micromanometer on the day before angiogram. Study subjects were subdivided into two groups on the basis of PWV. In group I: aortic PWV was d” 10 m/sec and in group II: aortic PWV was> 10 m/sec. One hundred patients were included in each group. Angiographic severity of CAD was assessed by vessel score, Friesinger score and Leaman score. Results: Vessel score 0 and 1 were significantly higher in group I (p<0.05) where vessel score 2 and 3 were significantly higher in group II (p<0.05).The mean PWV in the group with normal angiographic result was 8.10±2.9 m/sec, and in patients with single vessel disease it was 11.65±3.46m/sec. In those with double and triple vessel disease the mean value of PWV was found 13.85±3.80 and 15.70±4.66 m/sec respectively. The mean value of PWV increased in proportion with the number of vessel involved by CAD and the differences were statistically significant(p=0.001).The mean value of PWV was observed 8.5±2.3 and 12.5±3.7m/sec in insignificant and significant CAD respectively using Friesinger score and the difference was statistically significant (p<0.05).There was statistically significant positive linear relation between the values of PWV and vessel score(r=.62, p=0.01), Friesinger score(r=.64, p=0.01) and Leaman score(r=.45, p=0.01). Conclusion: Aortic PWV is associated with the extent and severity of CAD. This noninvasive, cheap, radiation free method may be considered as risk stratification tool beyond other investigations.
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[Objective]It seems that in Japan’s aging society, investigating the position of acupuncture and moxibustion for the treatment of arteriosclerotic diseases is important. In this report we evaluated the effects of electroacupuncture (EA) on stroke patients by measuring changes in pulse wave velocity (PWV), brachial-ankle PWV (baPWV), ankle brachial pressure index (ABI), blood pressure (BP) and heart rate (HR). <BR>[Method]The subjects were 210 initial stroke patients. Stroke patients were randomly allocated to three groups, those only taking drug therapy (drug group), those taking drug therapy combined with rehabilitation (rehab group), and those taking drug therapy and rehabilitation combined with EA (EA group). 81 cerebral thrombosis patients (drug group n = 25, rehab group n = 28, EA group n = 28), 68 cerebral embolus patients (drug group n = 24, rehab group n = 20, EA group n = 24) and 61 cerebral hemorrhage patients (drug group n = 20, rehab group n = 21, EA group n = 20) were examined. For the evaluation method blood pressure pulse wave measuring equipment was used to measure PWV, baPWV, ABI, BP, and HR after two months, four months, and six months from the onset of treatment. <BR>[Results]After two months and four months there was no significant difference in blood vessel elasticity of the three cerebral thrombosis groups. Whereas after six months, compared to the drug group, the baPWV in cerebral thrombosis patients significantly decreased for the rehab group (p < 0.05) and EA group (p < 0.01). There were no significant differences in ABI, BP, or HR. Cerebral hemorrhage and cerebral embolism patients showed no significant difference in baPWV, ABI, BP, and HR.<BR>[Conclusion]We examined the effects of adding EA to the treatment of patients who suffered cerebral thrombosis, cerebral embolism, or cerebral hemorrhage. These results show that adding EA to drug treatment and rehabilitation significantly improves blood vessel elasticity and suggests that using EA would reduce the risk of cerebral thrombosis and its reoccurrence.
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[Objective]We researched the effect on three acupuncture stimulation groups and a non-stimulation group used for arterial compliance. <BR>[Methods]This study was conducted on 70 healthy volunteers divided randomly into four groups. We observed the effects of arterial compliance by measuring the brachial-ankle pulse wave velocity score (baPWVs), ankle brachial pressure index (ABI), Systolic blood pressure (SBP), diastolic blood pressure (DBP) and heart rate (HR) using form PWV/ABI®. Acupuncture stimulation groups were divided into LI10 (Shousanli, Te no Sanri n = 23) group, ST36 (Zusanli, Ashi no Sanri n = 18) group, and CV12 (Zhongwan, Chukan n = 19) groups.<BR>[Results]We found that baPWVs significantly decreased in both the LI10 (before 1222 ± 203cm/s vs after 986 ± 143cm/s) and ST36 (before 1245 ± 126 cm/s vs after 1014 ± 120 cm/s) groups (p < 0.05), but not significantly in the CV12 group (before 1264 ± 222 cm/s vs 1287 ± 226 cm/s) and non-stimulation groups (before 1228 ± 144 cm/s vs after 1222 ± 150 cm/s). ABI, SBP, DBP and HR were not significant in the all groups. <BR>[Conclusion]These results suggest that upper and lower extremities or the abdomen in acupuncture stimulation may influence the activity of arterial compliance.
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@#: In recent years, more attention has been attracted by non-invasive measurement of the arterial elasticity function. Pulse wave velocity (PWV) assay is one of the commonly used Methods . The PWV measured on different sites of the artery system indicates the elasticity characteristics of the arterial segment and may have different pathophysiology bases and clinical significance.
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Increased intima-media thickness (IMT) and pulse wave velocity (PWV) are noninvasive markers of early arterial wall alteration and are more widely used in adult clinical research. We investigated whether IMT and PWV are useful predictors of cardiovascular risk in hypertensive adolescents. Fifteen hypertensive adolescents (13-18 yr old, systolic BP > or = 140 mmHg, diastolic BP > or = 90 mmHg) and seventeen normotensive subjects were included. Height, weight, obesity index, body mass index (BMI), and fat distribution were obtained from each group. Serum lipid, insulin, vitamine B12, folate, renin, aldosterone, angiotensin-converting enzyme (ACE), and homocysteine levels were compared. The carotid IMT and PWV were measured. Arterial wall compliance and distensibility were calculated with the equation. High systolic blood pressure significantly correlated with height, weight, BMI, obesity index, arm circumference, fat mass, and fat distribution. Hypertensive adolescents had significantly greater cIMT (carotid intima-media thickness) and lower elastic properties such as cross-sectional compliance and distensibility of the carotid artery. The carotid IMT significantly correlated with brachial-ankle PWV. In conclusion, the measurement of carotid IMT and brachial-ankle PWV might be useful to predict the development of atherosclerosis in hypertensive adolescents.
Subject(s)
Adolescent , Female , Humans , Male , Arteries/pathology , Body Mass Index , Elasticity , Hypertension/pathology , Tunica Intima/pathology , Tunica Media/pathologyABSTRACT
Introduction: Recent researches have determined that decreased arterial elasticity by age is one of the Cardiovascular risk factors. The modification of arterial elasticity can be evaluated accurately by measuring PWV.\r\n', u'Objectives: To determine the age - related change in the arterial stiffness in healthy people and factors that change the arterial stiffness. \r\n', u'Subjects and methods: The study group consisted of 123 normotensive subjects, including 65 men and 58 women (mean age 51.2 \xb1 13.9 years). Aortic elasticity was assessed by measuring carotid - femoral pulse PWV using a Complior Colson device with 2 pressure transducers.\r\n', u'Results: The mean PWV in both gender groups was 10.2 \xb1 1.6 m/s. There was no significant difference in both the right and the left side of the body, as well as genders regarding PWV calculation. PWV was correlated with age (r = 0.56) and mean blood pressure index (r = 0.6). If PWV was measured on the left side, subjects with plaques in common carotid artery (proved by echo) had a higher PWV than those without carotid plaque presence. In returns, there was no significant difference in terms of PWV, if it was measured on the right side. The arterial PWV in normal subjects with CT/HDL index of more than 5 is higher than those with CT/HDL index of less than 5. There was no correlation between arterial PWV and hyper - cholesterolemia. \r\n', u'Conclusions: 1. Mean arterial PWV in the healthy subjects was. 10.2 \xb1 1.6 m/s. 2. Arterial PWV had a positive correlation with age, mean blood pressure index and CT/HDL index.\r\n', u'