Arterial stiffness and subendocardial viability ratio in patients with peripheral arterial disease.

Arterial stiffening is a hallmark of the aging process and atherosclerosis, including peripheral arterial disease (PAD). We investigated the associations between carotid-femoral pulse wave velocity (c-fPWV), augmentation index corrected for heart rate (Aix@HR75), ankle brachial index (ABI), and subendocardial viability ratio (SEVR), an indicator of cardiac perfusion. The c-fPWV, Aix@HR75, and SEVR was estimated using applanation tonometry. The ankle systolic pressure measurements for the calculation of the ABI were obtained using an 8-mHz Doppler probe. The study group included 555 subjects, mean age 63 ± 11 years (248 PAD (ABI < 1.0), and 307 non-PAD (ABI ≥ 1.0 ≤ 1.3). After the stepwise selection process in both PAD and non-PAD patients SEVR was not related to c-fPWV and ABI (P = .154; P = .156) and (P = .101; P = .402), respectively. In PAD patients, SEVR was negatively related to Aix@HR75 (P < .0001) and aortic PP (P = .0005). In conclusion, arterial stiffness is associated with non-invasive indices of myocardial perfusion in PAD patients, suggesting a potential pathophysiological link for increased cardiovascular events.

Aortic augmentation index in patients with peripheral arterial disease.

Aortic augmentation index (AIx) is used to investigate arterial stiffness. The authors tested the hypothesis that patients with peripheral arterial disease (PAD) demonstrate a higher AIx and also evaluated several related factors. In 97 patients with PAD, identified by ankle-brachial pressure index (ABPI ≤ 0.9), and 97 controls (ABPI ≥ 0.91< 1.4), AIx (%) was determined using tonometry of the radial artery. There was no significant difference between patients and controls in characteristics of age, sex, height, diastolic blood pressure, mean blood pressure, and heart rate. AIx was higher in patients with PAD (32 ± 9 vs 28 ± 9; P = .001). In multivariate regression analysis, AIx was independently associated with heart rate (ß = -0.40, P = .0005). This study showed that AIx increased in patients with PAD and that heart rate is a determinant of AIx. Further studies are necessary to assess the pathophysiological and clinical importance of AIx in patients with PAD.

Increased aortic stiffness and related factors in patients with peripheral arterial disease.

A number of conditions have been associated with functional changes of large arteries. The aim of this study was to evaluate the factors associated with aortic stiffness in patients with peripheral arterial disease (PAD). The authors studied 86 patients with PAD (ankle-brachial pressure index [ABPI] ≤0.9) and 86 controls. Aortic stiffness was determined by pulse wave velocity (aPWV) using applanation tonometry. In PAD patients, aPWV was higher compared with controls (11 ± 3 vs 9.8 ± 1.8; P=.002). In multiple regression analysis, aPWV was independently associated with pulse pressure (ß=0.05, P=.01) in the PAD patients and with age in the control group (ß=0.08, P=.0005). The results of this study confirm an aPWV increase in patients with PAD and emphasize the association between blood pressure and aPWV. Further studies are necessary to assess whether higher aortic stiffening adds prognostic value to ABPI, which is the most powerful prognostic indicator in PAD.

Both HIV-infection and long-term antiretroviral therapy are associated with increased common carotid intima-media thickness in HIV-infected adolescents and young adults.

OBJECTIVE: To evaluate common carotid artery intima-media thickness (CCIMT) and cardiovascular risk factors in HIV-infected adolescents on combination antiretroviral therapy (cART). METHODS: 23 HIV-infected adolescents were matched with 19 healthy subjects by gender, age and body mass index (BMI). CCIMT was measured by Echo-Doppler ultrasound. Bootstrapped multiple linear regression was used to identify potential predictors of CCIMT including HIV status, gender, age, BMI, waist circumference, HDL-cholesterol, LDL- cholesterol, triglycerides, folate, homocysteine, insulin resistance as detected by the homeostasis model assessment, mean blood pressure, and CD36 expression. RESULTS: In the pooled sample, age ranged from 17 to 23 years and BMI between 16.0 and 25.6 kg/m(2). Mean (SD) CCIMT was higher in HIV-infected than in healthy subjects [0.5 (0.1) vs. 0.1 (0.4) mm, p < 0.001]. Higher values of CCIMT were associated with HIV infection (p < 0.001) and male gender (p < 0.001). CCIMT was also associated with the duration of treatment in subjects with the longest cART exposure, i.e. those exposed to a PI-based and/or NNRTI-based regimen plus a single or double NRTI (p = 0.019). CONCLUSION: HIV infection and longer duration of cART are associated with higher CCIMT in adolescents and young adults.