RESUMO
BACKGROUND: Pulse wave velocity (PWV) is an indicator of aortic stiffness and a predictor of cardiovascular risk. Applanation tonometry (e.g., SphygmoCor) is a well-established method to measure aortic PWV (aPWV). The Vicorder, a new oscillometric device, has not been validated in children and adolescents. METHODS: We performed intra- and interobserver repeatability studies in 14 individuals using the Vicorder. Vicorder and SphygmoCor measurements were compared in 156 healthy children (6-18 years) using two different path length measurements. RESULTS: Intra- and interobserver repeatabilities of the Vicorder were excellent with coefficients of variation of 5.6% and 5.8% and intraclass correlation coefficients (ICCs) of 0.8 and 1.0. aPWV calculated using the distances (suprasternal notch-to-femoral recording point) - (suprasternal notch-to-carotid artery), the path length most commonly used in adults, revealed a mean of 4.8 ± 0.7 m/s for SphygmoCor and 4.9 ± 0.6 m/s for Vicorder. The percentage deviation between both devices was 13.0% and the limit of agreement (LoA) ranged from -1.0 to 1.7 m/s reflecting a good concordance. Using a path length that measured the distance from suprasternal notch to femoral recording point via the umbilicus (Umb), an even better agreement was found (percentage deviation: 11.8%, LoA: -1.0 to 1.6 m/s). CONCLUSIONS: Vicorder aPWV values are similar to those obtained by SphygmoCor applanation tonometry. The best agreement between devices was obtained with the path length that most accurately describes the aortic tree. Excellent intra- and interobserver repeatability and ease of measurements make Vicorder appropriate for large multicentre studies in children and adolescents.
Assuntos
Velocidade do Fluxo Sanguíneo , Oscilometria/instrumentação , Fluxo Pulsátil , Pulso Arterial/instrumentação , Adolescente , Criança , Feminino , Humanos , Masculino , Reprodutibilidade dos TestesRESUMO
BACKGROUND AND OBJECTIVES: Children and adolescents with chronic kidney disease (CKD) are at high risk for cardiovascular morbidity and mortality. A systemic arteriopathy and cardiomyopathy has been characterized in pediatric dialysis patients by the presence of morphologic and functional abnormalities. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: The Cardiovascular Comorbidity in Children with CKD (4C) Study is a multicenter, prospective, observational study aiming to recruit more than 600 children, aged 6 to 17 years, with initial GFR of 10 to 45 ml/min per 1.73 m(2). The prevalence, degree, and progression of cardiovascular comorbidity as well as its association with CKD progression will be explored through longitudinal follow-up. The morphology and function of the heart and large arteries will be monitored by sensitive noninvasive methods and compared with aged-matched healthy controls. Multiple clinical, anthropometric, biochemical, and pharmacologic risk factors will be monitored prospectively and related to the cardiovascular status. A whole-genome association study will be performed to identify common genetic variants associated with progression of cardiovascular alterations and/or renal failure. Monitoring will be continued as patients reach end-stage renal disease and undergo different renal replacement therapies. RESULTS: While cardiovascular morbidity in adults is related to older age and additional risk factor load (e.g., diabetes), the role of CKD-specific factors in the initiation and progression of cardiac and vascular disease are likely to be characterized with greater sensitivity in the pediatric age group. CONCLUSIONS: The 4C study is expected to provide innovative insight into cardiovascular and renal disease progression in CKD.
Assuntos
Doenças Cardiovasculares/epidemiologia , Nefropatias/epidemiologia , Adolescente , Doenças Cardiovasculares/diagnóstico , Doenças Cardiovasculares/genética , Estudos de Casos e Controles , Criança , Doença Crônica , Comorbidade , Progressão da Doença , Predisposição Genética para Doença , Estudo de Associação Genômica Ampla , Taxa de Filtração Glomerular , Humanos , Nefropatias/diagnóstico , Nefropatias/genética , Nefropatias/fisiopatologia , Prognóstico , Estudos Prospectivos , Projetos de Pesquisa , Medição de Risco , Fatores de Risco , Fatores de TempoRESUMO
Vascular dysfunction has been reported in human cases of anthrax, in mammalian models of Bacillus anthracis, and in animals injected with anthrax toxin proteins. To examine anthrax lethal toxin effects on intact blood vessels, we developed a zebrafish model that permits in vivo imaging and evaluation of vasculature and cardiovascular function. Vascular defects monitored in hundreds of embryos enabled us to define four stages of phenotypic progression leading to circulatory dysfunction. We demonstrated increased endothelial permeability as an early consequence of toxin action by tracking the extravasation of fluorescent microspheres in toxin-injected embryos. Lethal toxin did not induce a significant amount of cell death in embryonic tissues or blood vessels, as shown by staining with acridine orange, and endothelial cells in lethal toxin-injected embryos continued to divide at the normal rate. Vascular permeability is strongly affected by the VEGF/vascular permeability factor (VPF) signaling pathway, and we were able to attenuate anthrax lethal toxin effects with chemical inhibitors of VEGFR function. Our study demonstrates the importance of vascular permeability in anthrax lethal toxin action and the need for further investigation of the cardiovascular component of human anthrax disease.
