OBJECTIVETo study the differences of cardiovascular system between men and women in response to exercise stress.

METHODSForty healthy youth were tested according to Bruce protocol of exercise stress. They were detected by ultrasonography during the rest, peak exercise, and recovery stages, respectively. The left ventricular diastolic elastance (Ed), effective arterial elastance (Ea), left ventricular end-systolic elatance (Ees), ventricular-vascular coupling index (VVI), and total stiffness index (TSI) were measured and calculated according to the formulas. The results of all stages were compared according to genders.

RESULTSAll stages, the Ed, TSI, and VVI of women were higher than those of men, but the Ees was lower than that of men (all P<0.05); there was no significant difference in Ea between men and women. The Ed, Ees, Ea, and TSI were closely related with left ventricular oxygen consumption and heart function, and women showed more closely. Before and after exercise, the changes were different in Ed, Ees, Ea, TSI, and VVI (all P<0.05), and VVI changed least.

CONCLUSIONSBefore and after exercise, the ventricular stiffness matched well with arterial stiffness and maintained within a narrow range. For women, the tolerance of exercise was lower than that of men.

Adult ; Diastole ; physiology ; Exercise ; physiology ; Female ; Humans ; Male ; Sex Characteristics ; Vascular Resistance ; physiology ; Vascular Stiffness ; physiology ; Ventricular Function, Left ; physiology

Increased arterial stiffness is an independent predictor of cardiovascular disease independent from blood pressure. Recent studies have shed new light on the importance of inflammation on the pathogenesis of arterial stiffness. Arterial stiffness is associated with the increased activity of angiotensin II, which results in increased NADPH oxidase activity, reduced NO bioavailability and increased production of reactive oxygen species. Angiotensin II signaling activates matrix metalloproteinases (MMPs) which degrade TGFbeta precursors to produce active TGFbeta, which then results in increased arterial fibrosis. Angiotensin II signaling also activates cytokines, including monocyte chemoattractant protein-1, TNF-alpha, interleukin-1, interleukin-17 and interleukin-6. There is also ample clinical evidence that demonstrates the association of inflammation with increased arterial stiffness. Recent studies have shown that reductions in inflammation can reduce arterial stiffness. In patients with rheumatoid arthritis, increased aortic pulse wave velocity in patients was significantly reduced by anti tumor necrosis factor-alpha therapy. Among the major classes of anti hypertensive drugs, drugs that block the activation of the RAS system may be more effective in reducing the progression of arterial stiffness. Thus, there is rationale for targeting specific inflammatory pathways involved in arterial stiffness in the development of future drugs. Understanding the role of inflammation in the pathogenesis of arterial stiffness is important to understanding the complex puzzle that is the pathophysiology of arterial stiffening and may be important for future development of novel treatments.
Angiotensin II/metabolism ; Humans ; Inflammation/drug therapy/metabolism/*physiopathology ; Matrix Metalloproteinases/metabolism ; Vascular Stiffness/drug effects/*physiology

BACKGROUNDIn the early stages of atrial remodeling, aortic stiffness might be an indication of an atrial myopathy, in particular, atrial fibrosis. This study aimed to investigate the association between left atrial (LA) mechanical function, assessed by two-dimensional speckle tracking echocardiography, and aortic stiffness in middle-aged patients with the first episode of nonvalvular atrial fibrillation (AF).

METHODSThis prospective study included 34 consecutive patients with the first episode of AF, who were admitted to Kartal Koşuyolu Research and Training Hospital between May 2013 and October 2015, and 31 age- and gender-matched healthy controls. During the 1 st month (mostly in the first 2 weeks) following their first admission, 34 patients underwent the first pulse wave measurements. Then, 21 patients were recalled for their second pulse wave measurement at 11.8 ± 6.0 months following their initial admission. Echocardiographic and pulse wave findings were compared between these 34 patients and 31 healthy controls. We also compared the pulse wave and echocardiographic findings between the first and second measurements in 21 patients.

RESULTSPulse wave analysis showed no significant differences between the AF patients and healthy controls with respect to PWV (10.2 ± 2.5 m/s vs. 9.7 ± 2.1 m/s; P = 0.370), augmentation pressure (9.6 ± 7.4 mmHg vs. 9.1 ± 5.7 mmHg; P = 0.740), and aortic pulse pressure (AoPP; 40.4 ± 14.0 mmHg vs. 42.1 ± 7.6 mmHg, P = 0.550). The first LA positive peak of strain was inversely related to the augmentation pressure (r = -0.30; P = 0.02) and aortic systolic pressure (r = -0.26, P = 0.04). Comparison between the two consecutive pulse wave measurements in 21 patients showed similar results, except for AoPP. In 21 patients, the AoPP at the second measurement (45.1 ± 14.1 mmHg) showed a significant increase compared with AoPP at the first measurement (39.0 ± 10.6 mmHg, P = 0.028), which was also higher than that of healthy controls (42.1 ± 7.6 mmHg, P = 0.000).

CONCLUSIONThe association between aortic stiffness with reduced atrial strain and the key role of AoPP in the development of AF should be considered when treating nonvalvular AF patients with normal LA sizes.

Adult ; Atrial Fibrillation ; physiopathology ; Atrial Function, Left ; physiology ; Atrial Remodeling ; physiology ; Echocardiography ; Female ; Humans ; Male ; Middle Aged ; Prospective Studies ; Vascular Stiffness ; physiology

BACKGROUNDArterial stiffness is well known as an important risk factor for coronary artery disease. In this study, we aimed to investigate the association between carotid-ankle pulse wave velocity (caPWV) and risk of coronary artery disease (CAD), and the interaction between pulse wave velocity (PWV) and other potential risk factors of CAD.

METHODSA community-based cross-sectional study was conducted for subjects living in Beijing, China. We collected 213 subjects with coronary artery disease and 1 266 subjects without CAD between September 2007 and January 2009 in a community center of Beijing. A multivariate Logistic regression analysis was carried out to assess the odds ratios of factors related to CAD.

RESULTSWe found CAD subjects were more likely to have a higher body massindex (BMI), fasting glucose, uric acid, low-density lipoprotein (LDL) cholesterol, high-sensitivity Creactive protein (hs-CRP), carotic-femoral pulse wave velocity (cfPWV) and caPWV (P < 0.05), and CAD subjects had a significantly lower HDL cholesterol levels (P < 0.05). Moreover, the proportion of hypertension in CAD subjects was significantly higher than non-CAD subjects. The multiple Logistic regression analysis showed that hypertension, higher uric acid, hs-CRP, cfPWV and caPWV levels significantly increased the risk of CAD, with ORs (CI) of 1.47 (1.25-1.74), 1.17 (1.01-1.26), 1.35 (1.10-1.67), 1.15 (1.09-1.19) and 1.07 (1.01-1.15), respectively. Higher HDL cholesterol was significantly associated with reduced risk of CAD, with ORs (CI) of 0.58 (0.40-0.83). In addition, cfPWV had significant association with age, hypertension, LDL cholesterol, with Pearson's coefficients of 0.166, 0.074, and 0.030, respectively.

CONCLUSIONScfPWV and caPWV are independently associated with significant CAD, and cfPWV has significant correlation with age and hypertension. cfPWV and caPWV may be used as a practical tool for predicting the risk of CAD.

Adult ; Aged ; Aged, 80 and over ; Coronary Artery Disease ; epidemiology ; physiopathology ; Cross-Sectional Studies ; Female ; Humans ; Logistic Models ; Male ; Middle Aged ; Risk Factors ; Vascular Stiffness ; physiology ; Young Adult

BACKGROUNDArterial stiffness increases with age and is also associated with traditional cardiovascular risk factors. Little is known about the relations of homocysteine and high-sensitivity C-reactive protein (hs-CRP) to arterial stiffness in the Chinese community. The aim of the present study was to investigate the association of plasma homocysteine and hs-CRP levels with arterial stiffness in a community-based cohort.

METHODSWe related levels of homocysteine and hs-CRP to four measures of arterial stiffness (carotid-femoral pulse wave velocity (PWV), carotid-radial PWV, carotid-ankle PWV and heart rate corrected augmentation index) in 1680 participants from two communities of Beijing, China. Arterial stiffness was measured within two days of the time of biomarker measurement.

RESULTSIn univariate analysis, homocysteine was positively associated with the carotid-femoral PWV (r = 0.211, P < 0.0001), carotid-radial PWV (r = 0.120, P < 0.0001) and carotid-ankle PWV (r = 0.148, P < 0.0001), whereas it was inversely related to the augmentation index (r = -0.052, P = 0.016). Hs-CRP was positively associated with the carotid-femoral PWV (r = 0.074, P = 0.001) and carotid-ankle PWV (r = 0.050, P = 0.02). In multiple-adjusted models (R(2) = 0.57), homocysteine levels remained a significant determinant of the carotid-femoral PWV (standardized β = 0.065, P = 0.007), whereas the association of hs-CRP with measurements of arterial stiffness was not present.

CONCLUSIONSIn the Chinese population, plasma homocysteine levels are associated with alterations of aortic stiffness, whereas plasma levels of hs-CRP are not independently related to artery stiffening.

Aged ; Asian Continental Ancestry Group ; C-Reactive Protein ; metabolism ; China ; epidemiology ; Cross-Sectional Studies ; Female ; Homocysteine ; blood ; Humans ; Male ; Middle Aged ; Vascular Stiffness ; physiology

To investigate the changes of aortic stiffness and its influencing factors in patients with chronic kidney diseases (CKD).Eightyfour patients with CKD from Department of Nephrology, Zhejiang Provincial People's Hospital were divided into the dialysis group (CKD stage 5,=48) and non-dialysis group (CKD stage 3-5,=36). Clinical data, biochemical parameters and echocardiography findings were collected. SphygmoCor pulse wave analysis system was used to obtain pulse wave analysis (PWA) parameters including central aortic systolic blood pressure (CSP), central pulse pressure (CPP), augmented pressure (AP), augmentation index (AIX), and heart rate 75-adjusted augmentation index (HR75AIX). The influencing factors of aortic stiffness were analyzed by spearman correlation analysis and multiple regression analysis.CSP, CPP, AP, AIX and HR75AIX in dialysis patients had no significant differences compared with those in non-dialysis group (all>0.05). Spearman correlation analysis showed that CSP was positively correlated with systolic blood pressure, diastolic blood pressure, cholesterol, low-density lipoprotein cholesterol, left atrial diameter (LA),left ventricular systolic diameter (LVDs), left ventricular diastolic diameter (LVDd), and negatively correlated with calcium and hemoglobin levels. CPP was positively correlated with systolic blood pressure, age, LA, LVDd, and negatively correlated with diastolic blood pressure and hemoglobin levels. AP was positively correlated with systolic blood pressure, age, LA, LVDd, and negatively correlated with hemoglobin levels. AIX was positively correlated with systolic blood pressure, age, sodium, and negatively correlated with phosphorus levels. HR75AIX was positively correlated with systolic blood pressure, sodium, cholesterol, and negatively correlated with hemoglobin and albumin levels. Multiple regression analysis showed that higher systolic blood pressure was the independent risk factor for CSP (β=0.944,<0.01); lower diastolic blood pressure (β=0.939,<0.01) and higher systolic blood pressure (β=-1.010,<0.01) were the independent risk factors for CPP; older age (β=0.237,<0.01) and higher systolic blood pressure (β=0.200,<0.01) were the independent risk factors for AP; higher systolic blood pressure (β=0.163 and 0.115,<0.05 and<0.01) and higher sodium (β=0.646 and 0.625, all<0.05) were independent risk factors for both AIX and HR75AIX.No significant correlation is observed between aortic stiffness and CKD of different stages. Control blood pressure and restrict sodium intake may be effective means of delaying arterial stiffness in patients with CKD.
Age Factors ; Aorta ; pathology ; Blood Pressure ; physiology ; Cholesterol ; Dialysis ; Female ; Heart Atria ; Humans ; Male ; Middle Aged ; Regression Analysis ; Renal Insufficiency, Chronic ; complications ; Risk Factors ; Sodium, Dietary ; adverse effects ; Vascular Stiffness ; physiology

PURPOSE: Despite technical simplicity and the low cost of brachial-ankle pulse wave velocity (BA-PWV), its use has been hampered by a lack of data supporting its usefulness and reliability. The aim of this study was to evaluate the usefulness of BA-PWV to measure aortic stiffness in comparison to using cardiovascular magnetic resonance (CMR). MATERIALS AND METHODS: A total of 124 participants without cardiovascular risk factors volunteered for this study. BA-PWV was measured using a vascular testing device. On the same day, using CMR, cross-sectional areas for distensibility and average blood flow were measured at four aortic levels: the ascending, upper thoracic descending, lower thoracic descending, and abdominal aorta. RESULTS: Compared to PWV measured by CMR, BA-PWV values were significantly higher and the differences therein were similar in all age groups (all p<0.001). There was a significant correlation between BA-PWV and PWV by CMR (r=0.697, p<0.001). Both BA-PWV and PWV by CMR were significantly and positively associated with age (r=0.652 and 0.724, p<0.001). The reciprocal of aortic distensibility also demonstrated a statistically significant positive correlation with BA-PWV (r=0.583 to 0.673, all p<0.001). CONCLUSION: BA-PWV was well correlated with central aortic PWV and distensibility, as measured by CMR, regardless of age and sex.
Adult ; Ankle Brachial Index/*methods ; Ankle Joint ; Aorta/anatomy & histology/*physiology ; *Blood Flow Velocity ; Cardiovascular Diseases ; Female ; Heart/physiopathology ; Humans ; *Magnetic Resonance Imaging, Cine ; Male ; Pulse Wave Analysis/*methods ; Regional Blood Flow ; Reproducibility of Results ; Risk Factors ; *Vascular Stiffness

PURPOSE: Elastin is a major arterial structural protein, and elastin-derived peptides are related to arterial change. We previously reported on a novel assay developed using aortic elastin peptides; however, its clinical implications remain unclear. In this study, we assessed whether anti-elastin antibody titers reflect the risk of coronary artery disease (CAD) or its characteristics. MATERIALS AND METHODS: We included 174 CAD patients and 171 age- and sex-matched controls. Anti-elastin antibody titers were quantified by enzyme-linked immunosorbent assay. Parameters of arterial stiffness, including the augmentation index (AI) and heart-to-femoral pulse wave velocity (hfPWV), were measured non-invasively. The clinical and angiographic characteristics of CAD patients were also evaluated. Associations between anti-elastin levels and vascular characteristics were examined by linear regression analysis. RESULTS: The median blood level of anti-elastin was significantly lower in the CAD group than in the controls [197 arbitrary unit (a.u.) vs. 63 a.u., p<0.001]. Levels of anti-elastin were significantly lower in men and in subjects with hypertension, diabetes mellitus, hyperlipidemia, or high hfPWV. Nevertheless, anti-elastin levels were not dependent on atherothrombotic events or the angiographic severity of CAD. In a multivariate analysis, male sex (beta=-0.38, p<0.001), diabetes mellitus (beta=-0.62, p<0.001), hyperlipidemia (beta=-0.29, p<0.001), and AI (beta=-0.006, p=0.02) were ultimately identified as determinants of anti-elastin levels. CONCLUSION: Lower levels of anti-elastin are related to CAD. The association between antibody titers and CAD is linked to arterial stiffness rather than the advancement of atherosclerosis.
Aged ; Angiography ; Antibodies/*blood ; Atherosclerosis/*blood/immunology ; Coronary Artery Disease/blood/*immunology ; Elastin/*blood/immunology ; Enzyme-Linked Immunosorbent Assay ; Female ; Humans ; Hyperlipidemias ; Hypertension/complications ; Male ; Middle Aged ; Pulse Wave Analysis ; Vascular Stiffness/*immunology/physiology

Rheumatoid arthritis (RA) is associated with significant cardiovascular (CV) morbidity and mortality. Increased urinary albumin excretion is a marker of CV risk. There are only few data on urinary albumin excretion in RA patients. Aim of the present study was to investigate urinary albumin excretion in RA patients and analyze, whether there is an association between urinary albumin excretion and vascular function as measured by the augmentation index (AIx). In a total of 341 participants (215 with RA, 126 without RA) urinary albumin-creatinine ratio (ACR) was determined and the AIx was measured. The Kolmogorov-Smirnov-test was used to cluster patient groups whose distributions of ACR can be considered to be equal. A crude analysis showed a median ACR of 6.6 mg/g in the RA group and 5.7 mg/g in patients without RA (P > 0.05). In order to account for diabetes (DM) we formed 4 distinct patient groups. Group 1: RA-/DM- (n = 74); group 2: RA+/DM- (n = 195); group 3: RA-/DM+ (n = 52); group 4: RA+/DM+ (n = 20). Clustering of these groups revealed two distinct patient groups: those without RA and DM, and those with either RA or DM or both. The latter group showed statistically significant higher ACR (median 8.1 mg/g) as the former (median 4.5 mg/g). We found no significant correlation between AIx and ACR. Urinary albumin excretion in patients with RA or DM or both is higher than in subjects without RA and DM. This can be seen as a sign of vascular alteration and increased CV risk in these patients.
Aged ; Albumins/analysis ; Albuminuria/*complications ; Arthritis, Rheumatoid/complications/*diagnosis ; Cardiovascular Diseases/etiology ; Cluster Analysis ; Creatinine/urine ; Diabetes Mellitus, Type 2/complications ; Female ; Humans ; Male ; Middle Aged ; Pulse Wave Analysis ; Risk Factors ; Vascular Stiffness/*physiology

BACKGROUNDHigh uric acid (UA) levels and metabolic syndrome (MS) are risk factors for atherosclerotic diseases. Brachial-ankle pulse wave velocity (baPWV) is a valid and reproducible measurement by which to assess arterial stiffness and a surrogate marker of atherosclerosis. However, little is known about the relationship between them, especially in elderly Chinese with MS components who are at high risk for atherosclerotic diseases.

METHODSOne thousand and twenty Chinese subjects (159 women) older than 60 years of age (mean age (70.6 ± 5.7) years) with at least one MS component underwent routine laboratory tests, and baPWV measurements were analyzed.

RESULTSParticipants were divided into four groups by MS components. The mean age did not significantly differ among the MS component groups. We found that not only the diagnostic factors (blood pressure, body mass index (BMI), lipids, glucose) of MS but also baPWV, UA, insulin, homeostasis model of assessment for insulin resistence index (HOMAIR) levels increased, and high density lipoprotein (HDL)-C decreased with an increased number of MS components (test for trend P < 0.05). The association between UA and baPWV was observed after adjustment for gender, age, blood pressure, BMI, serum creatinine and high density lipoprotein, and insulin resistance (r = 0.186, P < 0.0001). There were increases in the odds ratios for the association between the number of components of MS, UA and baPWV, even after adjustment for traditional risk factors. However, after adjustment for insulin or HOMA-IR, there were no significant differences in the multivariate odds ratios among the number of MS components for UA.

CONCLUSIONSThe UA level is positively associated with baPWV and MS, but the association between UA and MS is dependent on insulin resistance. Furthermore, baPWV is independently associated with MS in our study population.

Aged ; Aged, 80 and over ; Body Mass Index ; Brachial Artery ; physiopathology ; Cholesterol, HDL ; blood ; Female ; Humans ; Insulin Resistance ; Male ; Metabolic Syndrome ; physiopathology ; Middle Aged ; Uric Acid ; blood ; Vascular Stiffness ; physiology