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Abstract Background Carotid-femoral pulse wave velocity (c–f PWV) is a gold standard for the arterial stiffness measurement and important biomarker for the assessment of the cardiovascular (CV) risk. Recent studies have focused on 24-h measurements of arterial stiffness and estimated PWV (ePWV). The aim of this study is to analyze agreement of office c–f PWV measurements (SphygmoCor) with 24-h oscillometric measurements (Mobil-O-Graph and Arteriograph), and with ePWV. Results This study included 154 patients with primary hypertension (average age 38.75 ± 12.65). Arterial stiffness has been measured in the office with SphygmoCor and 24 h with two oscillometric methods (Mobil-O-Graph and Arteriograph). ePWV was calculated using validated equation. PWV values obtained in office (SphygmoCor) showed higher average values compared to both 24-h oscillometric measurements of PWV and ePWV. The mean values of 24-h PWV measured by Arteriograph were higher compared to values obtained with Mobil-O-Graph. The measurement of PWV over 24 h using the Arteriograph is the most accurate among the methods that were compared with the office PWV measurements (accuracy of 0.989). However, the most precise method was the Mobil-O-Graph (0.631), and the highest degree of agreement also was shown with the Mobil-O-Graph (concordance coefficient correlation (CCC) = 0.447). The smallest deviation (TDI) and the highest probability of overlapping (CP) were observed with ePWV (TDI = 45.524, CP = 0.322, respectively). Conclusion In our group of young treated mild hypertensive patients with low CV risk, we found weak agreements between cfPWV and 24-h PWV. These methods are not interchangeable.

Abstract The authors present a short review of the personality, clinical and scientific contributions of a distinguished member of our Academy, the Artery Society and so many others, where he contributed landmark advances in many fields of arterial function and cardiovascular risk. The Editorial Board of the Artery Research Journal and the Executive Committee of the Artery Society present their due respects to Prof. Michel Safar.

Abstract The mechanism behind the acute reduction in peripheral arterial stiffness with reactive hyperemia is presumed to be flow-mediated; however, this has not been clearly demonstrated. We hypothesized that a larger reactive hyperemia magnitude would result in a greater reduction in peripheral arterial stiffness. Fourteen healthy young adults (5 females, 25 ± 5 yrs, mean ± SD) underwent reactive hyperemia with a rapid-release cuff on the upper arm inflated to 220 mmHg for 5 min: once with the arm positioned ~ 50ο above heart level and once with the arm positioned ~ 50ο below heart level. Brachial-radial pulse wave velocity (PWV) was measured with tonometers over brachial and radial arteries before cuff inflation and at 5, 15, and 30 min after release. Brachial blood flow was monitored with doppler ultrasound. At 5 min after reactive hyperemia, both the absolute (2.31 ± 1.22 vs 1.19 ± 1.19 m/sec, p = 0.007) and relative (24% vs 15%; p = 0.043) changes in brachial to radial PWV were greater with the arm below the heart compared to above the heart. The peak brachial blood flow was higher when the arm was below the heart compared to above the heart (477 $$\pm$$ ± 145 vs 369 $$\pm$$ ± 137 ml/min; p

Abstract Background Arteriosclerosis significantly impacts cardiovascular health. Pulse wave velocity has emerged as a valuable non-invasive method for assessing arterial stiffness. A negative association between carotid-femoral pulse wave velocity (cfPWV) and cerebral blood flow has been reported, suggesting a link between arterial stiffness and reduced cerebral blood flow. We aimed to determine whether a correlation exists between cfPWV and blood flow in the internal carotid artery (ICA) and to assess the influence of age and body mass index (BMI) on cfPWV in healthy individuals. Methods Thirty-six healthy subjects (23 males and 13 females) with no underlying medical conditions and who were not on regular medications were enrolled in the study. Arterial stiffness was assessed by measuring the cfPWV using Vicorder® software. ICA blood flow parameters were measured using high-resolution ultrasound. ICA diameter was measured using automated edge-detection software. Results Significant positive correlations were found between cfPWV and age (Spearman’s rho coefficient 0.33, p = 0.04), BMI (Spearman’s rho coefficient 0.32, p = 0.05), and ICA diameter (Pearson’s coefficient 0.35, p = 0.03). No significant correlations were observed between cfPWV and ICA peak systolic velocities (PSV; p = 0.22), or resistive index (RI; p = 0.76), nor between age and ICA diameter (p = 0.42), PSV (p = 0.09), or RI (p = 0.89). Conclusion Our findings demonstrate a positive correlation between arterial stiffness, age, and BMI in a healthy population, along with an association between increased ICA diameter and arterial stiffness. The lack of correlation between cfPWV and ICA blood flow parameters suggests that the ICA may dilate as a compensatory mechanism to mitigate the effects of increased arterial stiffness, ensuring optimal cerebral blood flow in healthy individuals.

Background: Carotid-femoral pulse wave velocity (c–f PWV) is a gold standard for the arterial stiffness measurement and important biomarker for the assessment of the cardiovascular (CV) risk. Recent studies have focused on 24-h measurements of arterial stiffness and estimated PWV (ePWV). The aim of this study is to analyze agreement of office c–f PWV measurements (SphygmoCor) with 24-h oscillometric measurements (Mobil-O-Graph and Arteriograph), and with ePWV. Results: This study included 154 patients with primary hypertension (average age 38.75 ± 12.65). Arterial stiffness has been measured in the office with SphygmoCor and 24 h with two oscillometric methods (Mobil-O-Graph and Arteriograph). ePWV was calculated using validated equation. PWV values obtained in office (SphygmoCor) showed higher average values compared to both 24-h oscillometric measurements of PWV and ePWV. The mean values of 24-h PWV measured by Arteriograph were higher compared to values obtained with Mobil-O-Graph. The measurement of PWV over 24 h using the Arteriograph is the most accurate among the methods that were compared with the office PWV measurements (accuracy of 0.989). However, the most precise method was the Mobil-O-Graph (0.631), and the highest degree of agreement also was shown with the Mobil-O-Graph (concordance coefficient correlation (CCC) = 0.447). The smallest deviation (TDI) and the highest probability of overlapping (CP) were observed with ePWV (TDI = 45.524, CP = 0.322, respectively). Conclusion: In our group of young treated mild hypertensive patients with low CV risk, we found weak agreements between cfPWV and 24-h PWV. These methods are not interchangeable. [ABSTRACT FROM AUTHOR]

The authors present a short review of the personality, clinical and scientific contributions of a distinguished member of our Academy, the Artery Society and so many others, where he contributed landmark advances in many fields of arterial function and cardiovascular risk. The Editorial Board of the Artery Research Journal and the Executive Committee of the Artery Society present their due respects to Prof. Michel Safar. [ABSTRACT FROM AUTHOR]

Background: Arteriosclerosis significantly impacts cardiovascular health. Pulse wave velocity has emerged as a valuable non-invasive method for assessing arterial stiffness. A negative association between carotid-femoral pulse wave velocity (cfPWV) and cerebral blood flow has been reported, suggesting a link between arterial stiffness and reduced cerebral blood flow. We aimed to determine whether a correlation exists between cfPWV and blood flow in the internal carotid artery (ICA) and to assess the influence of age and body mass index (BMI) on cfPWV in healthy individuals. Methods: Thirty-six healthy subjects (23 males and 13 females) with no underlying medical conditions and who were not on regular medications were enrolled in the study. Arterial stiffness was assessed by measuring the cfPWV using Vicorder® software. ICA blood flow parameters were measured using high-resolution ultrasound. ICA diameter was measured using automated edge-detection software. Results: Significant positive correlations were found between cfPWV and age (Spearman's rho coefficient 0.33, p = 0.04), BMI (Spearman's rho coefficient 0.32, p = 0.05), and ICA diameter (Pearson's coefficient 0.35, p = 0.03). No significant correlations were observed between cfPWV and ICA peak systolic velocities (PSV; p = 0.22), or resistive index (RI; p = 0.76), nor between age and ICA diameter (p = 0.42), PSV (p = 0.09), or RI (p = 0.89). Conclusion: Our findings demonstrate a positive correlation between arterial stiffness, age, and BMI in a healthy population, along with an association between increased ICA diameter and arterial stiffness. The lack of correlation between cfPWV and ICA blood flow parameters suggests that the ICA may dilate as a compensatory mechanism to mitigate the effects of increased arterial stiffness, ensuring optimal cerebral blood flow in healthy individuals. [ABSTRACT FROM AUTHOR]

The mechanism behind the acute reduction in peripheral arterial stiffness with reactive hyperemia is presumed to be flow-mediated; however, this has not been clearly demonstrated. We hypothesized that a larger reactive hyperemia magnitude would result in a greater reduction in peripheral arterial stiffness. Fourteen healthy young adults (5 females, 25 ± 5 yrs, mean ± SD) underwent reactive hyperemia with a rapid-release cuff on the upper arm inflated to 220 mmHg for 5 min: once with the arm positioned ~ 50ο above heart level and once with the arm positioned ~ 50ο below heart level. Brachial-radial pulse wave velocity (PWV) was measured with tonometers over brachial and radial arteries before cuff inflation and at 5, 15, and 30 min after release. Brachial blood flow was monitored with doppler ultrasound. At 5 min after reactive hyperemia, both the absolute (2.31 ± 1.22 vs 1.19 ± 1.19 m/sec, p = 0.007) and relative (24% vs 15%; p = 0.043) changes in brachial to radial PWV were greater with the arm below the heart compared to above the heart. The peak brachial blood flow was higher when the arm was below the heart compared to above the heart (477 ± 145 vs 369 ± 137 ml/min; p < 0.001). Reactive hyperemia acutely reduced peripheral arterial stiffness above and below heart level, with a greater decrease observed when the arm was positioned below the heart. These results demonstrate the contribution of conduit artery blood flow to the reduction of peripheral arterial stiffness after reactive hyperemia. [ABSTRACT FROM AUTHOR]

Background: We evaluated the independent associations of body composition measures on left ventricular ejection fraction (LVEF) and pulse wave arterial stiffness index (PWASI). Methods: The present analysis included 23,258 individuals (mean age 63 years, 53% women) who participated in the whole body imaging sub-study of the UK Biobank. Associations of body composition measures with each of LVEF and PWASI, after mutual adjustment for one another and potential confounders, were determined using multivariable linear regression. Results: Among regional body fat measures, higher visceral fat (VAT) was associated with lower LVEF (β = − 0.45; 95% CI − 0.60, − 0.31 per SD) and higher PWASI (β = 0.51; 95% CI 0.38–0.65 per SD). The association between VAT and LVEF was negatively linear but positively linear for PWASI throughout the range of VAT measured. Other regional fat measures and fat-free mass were not significantly associated with either LVEF or PWASI. Central adiposity measures (waist circumference [WC] and waist–hip ratio [WHR]) showed significant inverse association with LVEF (WC: β = − 0.11; 95% CI − 0.21, − 0.01 per SD; WHR β = − 0.25; 95% CI − 0.38, − 0.12 per SD) but positive association with PWASI (WC: β = 0.37; 95% CI 0.28–0.47 per SD; WHR β = 0.39; 95% CI 0.27 − 0.51 per SD) while BMI was not significantly associated with LVEF (β = 0.05; 95% CI − 0.04, 0.14 per SD) but showed weaker positive association with PWASI (β = 0.27; 95% CI 0.18–0.35 per SD). Conclusions: Excess visceral fat and central adiposity are associated with impaired LV function and increased arterial stiffness which may predispose to heart failure. [ABSTRACT FROM AUTHOR]

Abstract Background We evaluated the independent associations of body composition measures on left ventricular ejection fraction (LVEF) and pulse wave arterial stiffness index (PWASI). Methods The present analysis included 23,258 individuals (mean age 63 years, 53% women) who participated in the whole body imaging sub-study of the UK Biobank. Associations of body composition measures with each of LVEF and PWASI, after mutual adjustment for one another and potential confounders, were determined using multivariable linear regression. Results Among regional body fat measures, higher visceral fat (VAT) was associated with lower LVEF (β = − 0.45; 95% CI − 0.60, − 0.31 per SD) and higher PWASI (β = 0.51; 95% CI 0.38–0.65 per SD). The association between VAT and LVEF was negatively linear but positively linear for PWASI throughout the range of VAT measured. Other regional fat measures and fat-free mass were not significantly associated with either LVEF or PWASI. Central adiposity measures (waist circumference [WC] and waist–hip ratio [WHR]) showed significant inverse association with LVEF (WC: β = − 0.11; 95% CI − 0.21, − 0.01 per SD; WHR β = − 0.25; 95% CI − 0.38, − 0.12 per SD) but positive association with PWASI (WC: β = 0.37; 95% CI 0.28–0.47 per SD; WHR β = 0.39; 95% CI 0.27 − 0.51 per SD) while BMI was not significantly associated with LVEF (β = 0.05; 95% CI − 0.04, 0.14 per SD) but showed weaker positive association with PWASI (β = 0.27; 95% CI 0.18–0.35 per SD). Conclusions Excess visceral fat and central adiposity are associated with impaired LV function and increased arterial stiffness which may predispose to heart failure.

Abstract Objectives There is evidence that pulse wave velocity (PWV) can predict the occurrence of abdominal aortic calcification (AAC), while the association between estimated PWV (ePWV) and AAC has not been reported, so our study aimed to analyze the association between ePWV and AAC. Methods The study enrolled 3140 adults between the ages of 40 and 80 who participated in the 2013–2014 National Health and Nutrition Examination Survey. Using multivariate logistic regression analysis, multivariate linear regression and receiver operating characteristic (ROC) curve to evaluate the association between ePWV and AAC. Results The ePWV was significantly higher in participants with AAC compared with those without AAC. And ePWV had a high correlation with age and AAC (correlation coefficient = 0.906 and 0.332, both P

Objectives: There is evidence that pulse wave velocity (PWV) can predict the occurrence of abdominal aortic calcification (AAC), while the association between estimated PWV (ePWV) and AAC has not been reported, so our study aimed to analyze the association between ePWV and AAC. Methods: The study enrolled 3140 adults between the ages of 40 and 80 who participated in the 2013–2014 National Health and Nutrition Examination Survey. Using multivariate logistic regression analysis, multivariate linear regression and receiver operating characteristic (ROC) curve to evaluate the association between ePWV and AAC. Results: The ePWV was significantly higher in participants with AAC compared with those without AAC. And ePWV had a high correlation with age and AAC (correlation coefficient = 0.906 and 0.332, both P < 0.001). Individuals in high ePWV group had significantly higher percentage of AAC compared to low ePWV group (OR = 2.971, 95% CI 2.529–3.490, P < 0.001) in the crude model. After adjusting for all confounding variables, ePWV was still significantly higher (Model 3, OR = 1.962, 95% CI 1.612–2.389, P < 0.001). While after adjusting for all confounding variables plus age (Model 4), ePWV, when as a categorical variable, was no longer significantly positively associated with AAC. Additionally, the ROC curve indicated that both ePWV and age had some diagnostic value for AAC (AUC = 0.690, P < 0.001; AUC = 0.708, P < 0.001). Conclusions: In the age range of 40–80 years, ePWV did have an association with AAC but did not have predictive power beyond age. [ABSTRACT FROM AUTHOR]

Objective: Nonalcoholic fatty fiver disease (NAFLD) is a metabolic liver injury closely related to insulin resistance. Fatty liver index (FLI) can be used as a surrogate marker and is a validated index for NAFLD. This study aimed to explore the relationship between FLI and arterial stiffness in a Chinese population. Methods: From December 2017 to March 2019, 402 inpatients (mean age 51.12 ± 11.95 years) were recruited for cardiovascular disease screening at Ruijin Hospital North, Shanghai. Measurement of brachial systolic, diastolic, mean, and pulse pressure was done with cuff sphygmomanometry and carotid-femoral pulse wave velocity (cfPWV) was measured (SphygmoCor) to assess arterial stiffness. Results: Subjects were divided into three groups according to their FLI < 30, normal; 30-59, intermediate fatty liver index; ≥ 60, NAFLD. The proportion of subjects with hepatic steatosis (FLI ≥ 60), intermediate FLI (30--59), and no steatosis (FLI < 30) was 34.4%, 31.8%, and 33.8%, respectively. The male population (53.9%) had significantly higher FLI levels (p < 0.05). Subjects with FLI ≥ 60 had higher cfPWV (8.41 ± 1.77 m/s) than those with FLI < 30 (7.81 ± 1.83 m/s; p = 0.006). cfPWV was positively correlated with logFLI (r = 0.168, p = 0.001). After adjusting for age, sex, body mass index, mean arterial blood pressure, glucose, cholesterol, heart rate, and glomerular filtration rate (eGFR), FLI remained positively associated with cfPWV (β = 0.097, p = 0.024). Conclusion: cfPWV, as a measure of arterial stiffness, is higher in the NAFLD group when compared to that in normal groups. Fatty liver index is positively associated with arterial stiffness in a Chinese population. [ABSTRACT FROM AUTHOR]

Frequent assessment of vascular health (e.g., arterial stiffness) may predict the incidence of cardiovascular disease. The Second Derivative of the finger Photoplethysmogram Aging Index (SDPTGAI) may be used as an index of vascular aging and a screening tool for arteriosclerotic disease. To test its reliability as a measurement of arterial stiffness, we compared SDPTGAI with aortic Augmentation Index (AIx) at rest and during short-term mental stress (study 1). In addition, the day-to-day variability of SDPTGAI was evaluated (study 2). In study 1, a total of 31 apparently healthy adults were measured with the photoplethysmogram on the right index finger in the sitting resting condition. Simultaneously, the applanation tonometry was used to record blood pressure waveforms from the left radial artery (for aortic pressure waveform estimation via a general transfer function). Subsequently, 22 subjects underwent a 30-s arithmetic test (double-digit subtraction). In study 2, 10 young adults were measured with SDPTGAI for five consecutive days. In study 1, we found that SDPTGAI was significantly correlated with AIx (r = 0.682, p < 0.001). During the arithmetic task, heart rate and SDPTGAI were significantly increased from the baseline values (p < 0.05 for both) whereas AIx remained to be unchanged. In study 2, SDPTGAI showed 12.0 ± 9.9% of Coefficient of Variation (CV) across all subjects, which is comparable to CV of heart rate (12.5 ± 5.4%). These findings suggest that SDPTGAI has the potential for evaluating arterial stiffness and wave reflection at the resting condition, but it needs to be measured under well-rested relaxed condition because the finger photoplethysmogram may easily be affected by mental stressor. [ABSTRACT FROM AUTHOR]

Background: Brachial-Ankle Pulse Wave Velocity (baPWV) and Ankle-Brachial Index (ABI) are widely used in clinic for evaluating arterial stiffness and atherosclerosis separately. This study aimed to compare the sensitivity of baPWV and ABI for cardiovascular risk assessment in elderly Chinese. Methods: BaPWV, ABI and Carotid Intima-Media Thickness (cIMT) were assessed in 169 elderly Chinese with the mean age of 85.7 years. Results: Compared with normotensive participants, baPWV levels elevated in both limbs of hypertensive patients (2219 ± 90 cm/s vs. 1970 ± 66 cm/s, p = 0.090; 2141 ± 52 cm/s vs. 1932 ± 67 cm/s, p = 0.023, separately). Compared with non-diabetes Mellitus (DM) participants, ABI levels declined in both limbs of DM patients (0.96 ± 0.02 vs. 1.05 ± 0.02, p = 0.002 and 0.99 ± 0.03 vs. 1.03 ± 0.02, p = 0.071, separately). ABI of left limbs and ABI of right limbs were negatively correlated to cIMT (R = −0.136, p = 0.090; R = −0.196, p = 0.026, separately) after adjusted by age, systolic pressure, diastolic pressure, body mass index, triglycerides, total cholesterol and low-density lipoprotein. The regression model for predicting Cardiovascular Disease (CVD) included the factors of gender, age, hypertension, baPWV of left limbs and baPWV of right limbs (OR = 6.701, 95% CI 0.911–49.310, p = 0.062; OR = 1.181, 95% CI 1.051–1.327, p = 0.005; OR = 0.214, 95% CI 0.066–0.688, p = 0.010; OR = 1.002, 95% CI 1.000–1.003, p = 0.065; OR = 0.998, 95% CI 0.996–0.999, p = 0.006, separately). Conclusion: In elderly Chinese, baPWV was elevated in hypertensive patients while ABI was lower in DM patients compared with healthy people. Compared with baPWV, ABI is better equivalent to cIMT. But for predicting the risk of CVD, baPWV is a better biomarker. [ABSTRACT FROM AUTHOR]

In December 2019, an outbreak of pneumonia caused by a novel Coronavirus (COVID-19) spread rapidly worldwide. Although the clinical manifestations of COVID-19 are dominated by respiratory symptoms, the cardiovascular system is extensively affected at multiple levels. Due to the unprecedented consequences of the COVID-19 pandemic, the ARTERY society decided to launch the Covid-19 effects on ARTErial StIffness and vascular AgeiNg (CARTESIAN) study — the first international multicentre study into the effects of COVID-19 on non-invasive biomarkers of vascular ageing. The main study objective is to evaluate the presence of Early Vascular Ageing (EVA) 6 and 12 months after COVID-19 infection. Secondary objectives are to study the effect of COVID-19 disease severity on EVA, to investigate the role of psychosocial factors in COVID-19 induced EVA, and to investigate the potential modifying effect of comorbidities and chronic treatments. In the CARTESIAN study, a broad array of cardiovascular measurements, including carotid-femoral pulse wave velocity, central blood pressure, carotid ultrasound, brachial flow-mediated dilatation, will be performed. To date, 43 centres from 21 countries have agreed to participate, with an expected study population of >2500 individuals. To our knowledge, CARTESIAN will be the first study to provide insight into the relationship between COVID-19, its severity, and early vascular ageing in a large cohort, potentially enabling future care and diagnostics to be more focused on the most vulnerable. [ABSTRACT FROM AUTHOR]

Age-related decreases in executive function and an increase in arterial stiffness and plasma homocysteine levels are related to the risk of dementia. However, the association between executive function, arterial stiffness, and homocysteine levels remains unclear. This study aimed to investigate the relationship between executive function, arterial stiffness, and plasma homocysteine in 82 middle-aged and older women. The Stroop interference time, Brachial-ankle Pulse Wave Velocity (baPWV), and plasma homocysteine concentration were collected. The correlation analyses revealed that the Stroop interference time was significantly correlated with plasma homocysteine (r = 0.40, p < 0.001) and baPWV (r = 0.38, p = 0.001). In addition, plasma homocysteine levels were significantly correlated with baPWV (r = 0.48, p < 0.001). In the mediated analyses, the plasma homocysteine level directly (β = 0.24; p = 0.037) and indirectly (β = 0.12, 95% confidence interval [0.007, 0.238]) affected the Stroop interference time. These results suggest that higher plasma homocysteine levels are associated with a decline in executive function mediated by higher artery stiffness in middle-aged and older women. [ABSTRACT FROM AUTHOR]

Background: Increased arterial stiffness caused by elevated Blood Pressure (BP) can be indicated by the Cardio-ankle Vascular Index (CAVI). However, the relationship between arterial stiffness and BP is complex. In addition, changes in BP may contribute to increased risk of cardiovascular disease associated with abnormal lipid profiles. So far, results from published studies have been inconclusive. Objectives: To evaluate lipid profiles and BP, and their association with CAVI values in elderly participants. Methods: The study included 95 elderly Thai individuals. Anthropometric data, lipid profiles, and BP and CAVI values were established. Participants were then divided into low-CAVI (CAVI < 9, n = 50) and high-CAVI groups (CAVI ≥ 9, n = 45). Stepwise linear and logistic regression models were used. Results: The high-CAVI group had significantly higher BP and hypertension levels, than the low-CAVI group. The mean age of the high-CAVI group was also higher (≥65 years). CAVI value was positively correlated with Systolic Blood Pressure (SBP) and Pulse Pressure (PP) in the high-CAVI group. Stepwise multiple regression analysis showed SBP (β = 0.43, p < 0.01) and hip circumference (β = −0.23, p = 0.01) were associated with CAVI values. Logistic regression of the high-CAVI indices showed that the Odds Ratios (ORs) for the factors of age ≥65 years, obesity, hypertension and dyslipidemia were 7.35 (95% CI 2.42–22.36, p < 0.01), 0.20 (95% CI 0.64–0.67, p < 0.01) 4.72 (95% CI 1.67–13.32, p < 0.01), and 4.84 (95% CI 1.42–16.46, p = 0.01), respectively. Conclusion: A higher SBP level was correlated with a high-CAVI value in elderly people. [ABSTRACT FROM AUTHOR]

Obstructive Sleep Apnoea (OSA) is a breathing disorder characterized by narrowing of the upper airway that impairs normal ventilation during sleep. OSA is a highly prevalent condition which is associated with several Cardiovascular (CV) risk factors and CV diseases. Despite this clear association, Randomized Controlled Trials (RCTs) have provided equivocal data that treatment of sleep apnoea can improve CV outcomes regardless of its ability to reduce blood pressure. Here, we critically review the evidence that supports role of OSA as a risk factor for increased arterial stiffness which represents an early manifestation of vascular damage often preceding major CV events. Additionally, we examined evidence from interventional RCTs to assess if treatment of OSA by continuous positive airway pressure can affect arterial stiffness measured as carotid-femoral pulse wave velocity. Overall, a large body of evidence supports the role of OSA as a risk factor for increased arterial stiffness and several pathophysiological mechanisms, including activation of the autonomic nervous system, may help to explain the link between breathing disorders and vascular alterations (here mainly examined as functional properties). Whether the causal relationship between OSA and vascular damage exists or is mostly explained by confounders and whether OSA treatment can improve vascular stiffening is still debated. [ABSTRACT FROM AUTHOR]

Frequent assessment of vascular health (e.g., arterial stiffness) may predict the incidence of cardiovascular disease. The Second Derivative of the finger Photoplethysmogram Aging Index (SDPTGAI) may be used as an index of vascular aging and a screening tool for arteriosclerotic disease. To test its reliability as a measurement of arterial stiffness, we compared SDPTGAI with aortic Augmentation Index (AIx) at rest and during short-term mental stress (study 1). In addition, the day-to-day variability of SDPTGAI was evaluated (study 2). In study 1, a total of 31 apparently healthy adults were measured with the photoplethysmogram on the right index finger in the sitting resting condition. Simultaneously, the applanation tonometry was used to record blood pressure waveforms from the left radial artery (for aortic pressure waveform estimation via a general transfer function). Subsequently, 22 subjects underwent a 30-s arithmetic test (double-digit subtraction). In study 2, 10 young adults were measured with SDPTGAI for five consecutive days. In study 1, we found that SDPTGAI was significantly correlated with AIx (r = 0.682, p < 0.001). During the arithmetic task, heart rate and SDPTGAI were significantly increased from the baseline values (p < 0.05 for both) whereas AIx remained to be unchanged. In study 2, SDPTGAI showed 12.0 ± 9.9% of Coefficient of Variation (CV) across all subjects, which is comparable to CV of heart rate (12.5 ± 5.4%). These findings suggest that SDPTGAI has the potential for evaluating arterial stiffness and wave reflection at the resting condition, but it needs to be measured under well-rested relaxed condition because the finger photoplethysmogram may easily be affected by mental stressor.

Background: Brachial-Ankle Pulse Wave Velocity (baPWV) and Ankle-Brachial Index (ABI) are widely used in clinic for evaluating arterial stiffness and atherosclerosis separately. This study aimed to compare the sensitivity of baPWV and ABI for cardiovascular risk assessment in elderly Chinese. Methods: BaPWV, ABI and Carotid Intima-Media Thickness (cIMT) were assessed in 169 elderly Chinese with the mean age of 85.7 years. Results: Compared with normotensive participants, baPWV levels elevated in both limbs of hypertensive patients (2219 ± 90 cm/s vs. 1970 ± 66 cm/s, p = 0.090; 2141 ± 52 cm/s vs. 1932 ± 67 cm/s, p = 0.023, separately). Compared with non-diabetes Mellitus (DM) participants, ABI levels declined in both limbs of DM patients (0.96 ± 0.02 vs. 1.05 ± 0.02, p = 0.002 and 0.99 ± 0.03 vs. 1.03 ± 0.02, p = 0.071, separately). ABI of left limbs and ABI of right limbs were negatively correlated to cIMT (R = −0.136, p = 0.090; R = −0.196, p = 0.026, separately) after adjusted by age, systolic pressure, diastolic pressure, body mass index, triglycerides, total cholesterol and low-density lipoprotein. The regression model for predicting Cardiovascular Disease (CVD) included the factors of gender, age, hypertension, baPWV of left limbs and baPWV of right limbs (OR = 6.701, 95% CI 0.911–49.310, p = 0.062; OR = 1.181, 95% CI 1.051–1.327, p = 0.005; OR = 0.214, 95% CI 0.066–0.688, p = 0.010; OR = 1.002, 95% CI 1.000–1.003, p = 0.065; OR = 0.998, 95% CI 0.996–0.999, p = 0.006, separately). Conclusion: In elderly Chinese, baPWV was elevated in hypertensive patients while ABI was lower in DM patients compared with healthy people. Compared with baPWV, ABI is better equivalent to cIMT. But for predicting the risk of CVD, baPWV is a better biomarker.

Background: Advanced glycation end products (AGEs) are involved into several pathophysiologic processes in vascular diseases, including progressive loss of elasticity of vessel wall (arterial stiffness). Circulating soluble receptor for AGEs (sRAGE) act as a decoy and counterbalanced the harmful properties of AGEs as the natural protective factor [1,2]. We compared the role of circulating or skin-deposed AGEs and sRAGE regarding natural course of arterial stiffening. Methods: In a prospective cohort study, we longitudinally followed 536 general-population-based subjects (subsample of Czech post-MONICA study). Aortic pulse wave velocity (PWV) was measured twice (at baseline and after ∼8 years of follow-up) using a SphygmoCor device (AtCor Medical Ltd.), and the intraindividual change in PWV per year (ΔPWV/year) was calculated. Concentrations of sRAGE and carboxylmethyl lysine (circulating AGEs) were assessed at follow-up visit by ELISA, while skin AGEs were measured using autofluorescence-based device AGE Reader. Results: Using multiple regressions, we found significant association between ΔPWV/year as dependent variable and both, sRAGE and skin AGEs as independent ones (each on its own model). However, the closest association to ΔPWV/year were found for ratio of these two factors (skin AGEs/sRAGE) [coeff = 0.0747 (SE 0.0189), p < 0.0001]. In categorized manner, subjects with skin AGEs/sRAGE ratio ≥3.3 showed about two-fold higher risk having PWV/year ≥0.2 m/sec [adjusted odds ratio was 2.09 (95% CI: 1.35-3.22), p = 0.001]. In contrast neither circulating AGEs nor circulating AGEs/sRAGE showed any significant relation to PWV/ year. Conclusions: Skin AGEs/sRAGE ratio seems to be more sensitive biomarker of vascular ageing than these single factors themselves or circulation status of AGEs [3].

Background: Large artery stiffening, as indexed by carotid-femoral pulse wave velocity (cfPWV), may vary substantially among individuals. The present study aimed to characterize the arterial mechanical properties of the macro- and microvasculature in subjects with early or healthy vascular aging (EVA, HVA). Methods: Carotid and femoral pressure and central flow waveforms were noninvasively acquired in a total of 873 community residents (aged ≥50 years, mean age 66.9 years, 69.2% female). They were classified as EVA and HVA, according to the highest and lowest 10% of the cfPWV stratified by 5-year intervals. The remaining 80% were defined as average vascular aging (AVA). Macrovascular and microvascular functions were characterized by aortic input impedance, systemic vascular resistance and wave reflection indices. Results: EVA subjects had significantly higher prevalence of hypertension and diabetes. In multivariable analysis adjusting for sex, height, weight and mean arterial pressure (MAP), EVA had significantly increased characteristic impedance and reduced arterial compliance. By contrast, for the microvascular functions, systemic vascular resistance (not adjusted for MAP), amplitude of the reflected wave (Pb) and excess pressure integral (XSPI) derived from the reservoir-wave analysis were significantly increased in EVA when compared with HVA or AVA (all p < 0.05). Primary determinants of HVA included female, lower value of XSPI and SVR, whereas determinants of EVA included male, elevated BP, metabolic syndrome, increased Pb and SVR. Conclusions: Systemic microvasculature play an important role in interacting with macrovasculature, as evidenced from increased or reduced systemic resistance and wave reflection, in subjects with HVA and EVA.

Objectives: Carotid-femoral pulse wave velocity (cfPWV) approximates aortic stiffness and is a predictor of cardiovascular events. Despite the literature highlighting the clinical relevance of cfPWV, there is minimal integration of this parameter in clinical assessments. An underlying reason may stem from potential measurement errors. This paper investigates the potential sources of error in the measurement of cfPWV. Methods: Participants (n = 15, age 30 ± 15 years, 12 female) had supine cfPWV measured using the SphygmoCor XCEL device. Sources of error investigated included: 1) operator experience; 2) poor carotid waveform acquisition; 3) low placement of the leg cuff; and 4) tape measurement of distance. True cfPWV was obtained by averaging twenty cfPWV measurements (regression to the mean). Comparisons were made with regression analysis and Bland-Altman plots. Results: All cfPWV measurements, for both the experienced and less experienced operator, were within ± 0.5 m/s of the true cfPWV when three (but not two) measurements were averaged. cfPWV acquired with a poor carotid waveform and lower placed leg cuff did not significantly differ from the measured cfPWV (p > 0.05), however, there were some physiological meaningful errors (cfPWV error > ± 0.5 m/s). Excluding four distance measurements, three of which made by the same operator for a single individual, all distance measurements were within 5% of the true distance. Conclusions: Irrespective of the operators’ experience, with good cuff placement and carotid waveform acquisition, three measurements quantifies cfPWV accurately. Measurement error should not be a factor in the lack of clinical uptake of cfPWV.

Background and Aims: Active vitamin D [1,25(OH)2D3] deficiency is a potential modifiable risk factor for cardiovascular (CVD) and renal disease in patients with type 2 diabetes (T2DM) and stage 3/4 chronic kidney disease (CKD). Exact mechanisms are unclear. Arterial stiffness is an independent predictor of CVD. There is limited data on the effect of active vitamin D treatment on arterial haemodynamics in this patient population. Materials and Methods: We performed a 48 week duration single centre randomised double blind placebo controlled trial on the impact of calcitriol 0.25 mcg od in patients with T2DM and stage 3 CKD. Primary endpoint was change in Ao-PWV (index of arterial stiffness) measured by applanation tonometry (Sphygmocor system). Secondary endpoints included albuminuria (albumin excretion rate-AER) and changes in other indices of central haemodynamics. Results: 127 (male 70%) patients were randomised to calcitriol (n = 64) or placebo (n = 63). Baseline, mean ± SD, values were: age 64.2 ± 7.7, eGFR 43.2 ± 20.2 ml/min, SBP 146.2 ± 19.9 mmHg, Ao-PWV 11.6 ± 3.3 m/s, and AER median (IQR) 50.51 (11.5 to 188.6) mcg/min. There was no significant mean (95% CI) change in Ao-PWV as compared to placebo of 0.05 m/s (−0.68 to 0.78) vs 0.23 m/s (−0.46 to 0.93) with a between treatment mean (95% CI) difference for Ao-PWV of 0.19 (−0.81 to 1.19) m/s (p = 0.71). No significant effect of calcitriol treatment observed on augmentation index or albuminuria. Conclusion: In T2DM patients with stage 3 CKD, 48 week treatment with calcitriol as compared to placebo does not improve Ao-PWV, albuminuria or other indices of central haemodynamics.

Purpose: The adaptation process of the cardiovascular system to exercise and muscular strength in young athletes is unclear. Therefore, we investigated the influence of changes in muscular strength and weekly training load within one year on arterial stiffness in young male soccer players. Methods: 30 male soccer players were examined twice (age t0: 13.3 ± 2.0 years, age t1: 14.2 ± 2.0 years). cSBP and aPWV were measured oscillometrically (Mobil-O-Graph®) and z-scores were calculated. The MoMo physical activity questionnaire recorded the weekly training load and the hand dynamometer measured muscular strength. Height and weight were examined and body surface area (BSA) was computed. Results: The investigated parameters and the converted z-scores of cSBP and aPWV did not change over time, but handgrip strength (t0: 25.2 ± 10.2 kg, t1: 29.5 ± 10.2, p < 0.001) and training load (t0: 7.1 ± 1.5 hours/week, t1: 8.3 ± 2.4 hours/week, p = 0.005) increased significantly. 13.3% and 16.7% had cSBP >90th percentile at t0 and t1 respectively. The prevalence of aPWV >90th percentile was 26.7% at both times. Regardless of age and BSA, improvement in handgrip strength was significantly associated with higher values of cSBP (β = 1.66, p = 0.009, R2 = 0.42) and aPWV (β = 0.09, p = 0.001, R2 = 0.58) at t1. An improvement in weekly training load was not associated with cSBP and aPWV at t1. Conclusion: cSBP and aPWV are negatively influenced by an improvement in muscular strength in young male soccer players within one year. Therefore, in addition to the recommended pre-participation screening, arterial stiffness in young athletes should be monitored annually to detect possible negative outcomes of exercise on vascular health.

Purpose/Background/Objective: Cognitive decline is highly prevalent amongst end-stage renal disease (ESRD) patients and is accelerated upon initiation of hemodialysis (HD) [1]. ESRD increases aortic stiffness and blood flow pulsatility, which may damage small vessels of target organs like the brain [2]. In this pilot study, we aimed to evaluate the acute effect of HD on cerebral blood flow and its relation to arterial stiffness. Methods: Before, every hour during and after HD (T0–T4), we measured cerebral flow velocity (FV) using transcranial Doppler, blood pressure (BP) via digital finger cuff (Nexfin), cardiac activity using ECG and aortic pulse wave velocity (PWV) with Mobile-O-Graph. FV pulsatility index (PI) and transit times between ECG peak and the foot of both FV and BP waveforms (cerebral dT; digital dT) were computed using in house MATLAB-based analysis. Changes during HD were evaluated with Generalized Estimating Equation models adjusting for multiple comparisons in SPSS 26.0. Results: In eight participants aged 63 ± 17 y. old (4 diabetics, 3 women), peak FV decreased from baseline at T1 and T2 (−11.2 cm/s, p = 0.007; −12.2 cm/s, p < 0.001), PI decreased at T1 (0.81 to 0.77, p = 0.005), whilst minimum FV, mean BP and partial pressure of CO2 remained unchanged. Digital dT increased at T3 (0.19 to 0.22, p < 0.001) and cerebral dT increased throughout HD (T1–T4, p < 0.005), whereas aortic PWV did not change. Conclusions: During hemodialysis, cerebral and digital transit times increased, suggesting decreased stiffness of small peripheral vessels, without significant changes in aortic stiffness. Reduced stiffness of cerebral arteries may partially explain decreased cerebral flow pulsatility.

In December 2019, an outbreak of pneumonia caused by a novel Coronavirus (COVID-19) spread rapidly worldwide. Although the clinical manifestations of COVID-19 are dominated by respiratory symptoms, the cardiovascular system is extensively affected at multiple levels. Due to the unprecedented consequences of the COVID-19 pandemic, the ARTERY society decided to launch the Covid-19 effects on ARTErial StIffness and vascular AgeiNg (CARTESIAN) study — the first international multicentre study into the effects of COVID-19 on non-invasive biomarkers of vascular ageing. The main study objective is to evaluate the presence of Early Vascular Ageing (EVA) 6 and 12 months after COVID-19 infection. Secondary objectives are to study the effect of COVID-19 disease severity on EVA, to investigate the role of psychosocial factors in COVID-19 induced EVA, and to investigate the potential modifying effect of comorbidities and chronic treatments. In the CARTESIAN study, a broad array of cardiovascular measurements, including carotid-femoral pulse wave velocity, central blood pressure, carotid ultrasound, brachial flow-mediated dilatation, will be performed. To date, 43 centres from 21 countries have agreed to participate, with an expected study population of >2500 individuals. To our knowledge, CARTESIAN will be the first study to provide insight into the relationship between COVID-19, its severity, and early vascular ageing in a large cohort, potentially enabling future care and diagnostics to be more focused on the most vulnerable.

Purpose: Arterial stiffness is a well-established marker for cardiovascular health assessment. Current methods rely on expensive imaging systems and specialised operators to perform local stiffness evaluation from the common carotid artery (CCA) and cannot be used for ambulatory monitoring in chronic disease management. In this study, we compare the performance of a novel accelerometric system, which performs ambulatory non-invasive CCA stiffness measurement, against an ultrasound-based stiffness monitor. Methods: The accelerometric system with a wearable patch probe derives CCA’s diameter parameters from the skin surface vibrations arising out of the arterial wall displacement wave propagated to the skin surface. A subject-specific one-time calibration procedure is used to ensure accuracy, reliability and repeatability. Inbuilt pressure measurement unit of the system estimates blood pressure at CCA. Simultaneously obtained pressure and diameter parameters are used to evaluate various clinically accepted stiffness indices. An in-vivo study was performed on 36 subjects (20-50 years). Measured stiffness indices were compared against those obtained sequentially from an imaging system analysed using Carotid Studio. Results: Accelerometric-derived diameter waveform was comparable to that acquired using the reference device. Measured group-average end-diastolic diameter and distension values were 5.81 ± 0.53 mm and 0.51 ± 0.15 mm, respectively. Diameter and stiffness indices (β, Ep, AC, PWV, etc.) were repeatable over continuous cycles (variability 0.88, p < 0.001) with an acceptable agreement. The one-time calibration remained valid for more than 12 days (error

Background: Although generally assumed to be an adaptive response to increased blood pressure (BP), arterial stiffness is now recognized as an independent predictor of cardiovascular (CV) events [1]. Moreover it precedes hypertension in at least two mouse models [2,3]. Therefore, the present study aims to investigate the temporal development of aortic stiffening and peripheral blood pressure (BP) alterations in spontaneously ageing mice. Methods: A longitudinal cardiovascular characterization of spontaneously ageing C57Bl6 mice (2, 4, 6, 9, 12 and 24- month old) (male, n > 8) was performed. This includes in vivo analysis of peripheral BP (Coda) and aortic pulse wave velocity (aPWV, Vevo2100), combined with ex vivo aortic studies of isometric reactivity (organ baths) and aortic stiffness measurements (Peterson modulus, Ep) in the Rodent Oscillatory Tension set-up for Arterial Compliance (ROTSAC). Results: In vivo and ex vivo characterisation confirms that aortic stiffness precedes peripheral BP alterations in spontaneously ageing C57Bl6 mice, with significantly increased aPWV from 6 month of age (Figure A), whereas peripheral BP measurement only shows elevated pulse pressure in 24 month old mice (30% increase vs. all other ages, Figure B). Ex vivo investigation of the thoracic aorta further reveals that the aortic stiffening is both contraction-independent (Figure C) and dependent (Figure D), since older mice display increased contractions to phenylephrine (PE) (Figure E and F). Conclusion: Spontaneously ageing C57Bl6 mice present with significant aortic stiffness by 6-months of age, which is both contraction-dependent and independent in origin. Aortic stiffness thereby precedes the development of peripheral BP alterations by 18 months.

Background/Objectives: The baroreflex is a crucial mechanism acutely modulating vascular tone and heart rate response to maintain blood pressure (BP) in an optimal range. A decrease in baroreflex sensitivity (BRS) is associated with ageing, and pathological conditions such as hypertension and diabetes. Antihypertensive agents are generally known to have beneficial effect on the BRS, however it is still uncertain if the effect is mediated through a more compliant arterial wall or a sympathoinhibitory action. Methods: In the Paris Prospective Study III [1], spontaneous baroreflex, carotid stiffness and pharmacological drugs intake were available in 7967 adults (aged 55–75 years). The neural component of the baroreflex sensitivity (nBRS) was obtained with a cross-spectral analysis of variations in carotid distention rate and R-R intervals. Pharmacological classes were analysed according to the Anatomical Therapeutic Chemical (ATC) classification. Individuals with a BP lowering medication (BP-treated) were paired to non-BP treated individuals with a similar cardiovascular risk (controls) using a propensity score matching procedure (n = 1182 pairs). Results: Amongst pharmacological classes of BP lowering agents, only agents acting on the renin-angiotensin system (ACEi-ARB) were associated with nBRS (β = –0.08, p = 0.045). Compared to their matched controls, ACEi-ARB users had lower nBRS (2.79 ± 0.66 vs. 2.90 ± 0.62, p = 0.03). In multivariate analysis, ACEi-ARB remained significant (stdβ = –0.09, p = 0.025) after adjustment for carotid stiffness (stdβ = 0.25, p < 0.001) and systolic pressure (stdβ = –0.20, p < 0.001). Conclusion: In this epidemiological study, ACEi-ARB were negatively associated with nBRS. This effect is independent of BP and stiffness, which may suggest an inhibition of sympathetic activity by ACEi-ARB.

Background: In the early stages of atrial remodeling, increased aortic stiffness might indicate atrial fibrosis. Objective: This study aimed to investigate the association between left atrial (LA) mechanical function, assessed by two-dimensional speckle tracking echocardiography and aortic stiffness and whether this association is medicated by circulating biomarkers in early hypertension. Methods: We studied 34 patients, mean age 47.5 ± 11.6 years, 56% females. All parameters for arterial stiffness including 24 hour central systolic pressure, augmentation index and pulse wave velocity were measured non–invasively using Mobil-O-graph PWA. All patients underwent standard two-dimensional echocardiography with Spackle tracking analysis for left atrium (LA). Circulating biomarkers including renin, aldosterone and morning cortisol were measured using ELISA. Results: LA strain showed a significant relationship with central aortic systolic pressure; 24-hr (r = –0.46, p < 0.05), daytime (r = –50, p < 0.05) and nighttime (r = –55, p < 0.01) with no relationship with central diastolic or brachial pressures. There was a significant positive association between LA strain and aldosterone (r = 0.49, p < 0.05), aldosterone-renin ratio (r = 0.30, p < 0.05) and cortisol (r = 0.66, p < 0.01) with no relationship observed with plasma renin activity. In a stepwise regression model, central systolic pressure, aldosterone and cortisol emerged as predictors of LA strain independent of age, gender, brachial pressure and LAVi. Conclusions: In mild hypertension, central but not brachial systolic pressure determines LA remodeling which in turn may be mediated by circulating aldosterone and cortisol. This study highlights the important role of circulating biomarkers in mediating aortic stiffness and LA fibrosis in early hypertension.

Whether arterial stiffness is a surrogate end-point for cardiovascular and renal disease has never been directly demonstrated by a controlled clinical trial. Our main hypothesis is a better prevention of outcomes in high risk hypertensives with PWV normalization driven strategy than with usual blood pressure driven therapeutic strategy based on European Society of Hypertension—European Society of Cardiology (ESH—ESC) guidelines. The strategy for preventing cardiovascular and renal events based on arterial stiffness study is a multicenter open-label randomized controlled trial with blinded endpoint evaluation comparing a therapeutic strategy targeting the normalisation of Pulse Wave Velocity (PWV group) versus a classical therapeutic strategy only implementing the ESH—ESC Guidelines (conventional group), for reducing cardiovascular and renal events. Patients with primary hypertension, aged 55–75 years, and at medium-to-very high cardiovascular risk will be included and followed-up for 4 years. In the PWV group, treatment will be adjusted to carotid-femoral PWV measured every 6 months. In the conventional group, PWV will be measured at baseline and every 2 years, but its value will be blinded to the investigator in charge of the patient. In the PWV group, the therapeutic strategy will preferably use a combination of Angiotensin-converting Enzyme Inhibitor (ACEI) [or Angiotensin Receptor Blockers (ARB)] and calcium channel blockers, as well as maximal recommended doses of ACEIs and ARBs. The primary combined endpoint includes stroke and coronary events (myocardial infarction, angioplasty, bypass), fatal or not, peripheral artery disease (angioplasty, bypass, amputation), hospitalization for heart failure, aortic dissection, chronic kidney disease (doubling of creatinine, dialysis), and sudden death. Twenty-five research centers will include a total of 1500 patients, in order to show a 20% reduction in the primary combined endpoint - the incidence of which is estimated at 10% per year - in the PWV group compared to the conventional group. [ABSTRACT FROM AUTHOR]

Background: Carotid-femoral Pulse Wave Velocity (cfPWV) is the gold-standard measure of arterial stiffness. Accuracy of non-invasive cfPWV as meters per second is impeded by surface estimates of aortic length. Our aim was to compare cfPWV measured using distance estimated from surface measurements with distance traced along the length of the aorta using Magnetic Resonance Imaging (MRI) in a cohort of older women. Methods: Seventy-four women were recruited from the TwinsUK cohort. cfPWV was measured using the SphygmoCor system (SphygmoCor-PWV). The path between carotid and femoral sites was estimated from surface measurements between the sternal notch and femoral artery applanation point. Aortic distance was measured with MRI to obtain MRI-PWV. cfPWV was recalculated using MRI obtained distance. Results: Mean ± standard deviation SphygmoCor-PWV was 9.9 ± 2.1 m/s and MRI-PWV 7.63 ± 1.97 m/s (mean difference 2.2 ± 1.96 m/s, p < 0.001). Distances were considerably higher using surface measures for the SphygmoCor (55.2 ± 3.0, 95% confidence interval 54.4–55.9 cm) compared with MRI (39.9 ± 3.2, 39.2–40.7 cm) with a mean difference of 15.2 cm (14.3–16.2 cm, p < 0.001). Transit times were also marginally longer with the SphygmoCor. When SphygmoCor-PWV was Recalculated using MRI-obtained aortic distance (rec-PWV), the difference between SphygmoCor-PWV and rec-PWV reduced to 0.5 m/s (7.13 ± 1.46 vs. 7.63 ± 1.97 m/s, p = 0.08). Conclusion: In these older women, the PWV difference between SphygmoCor and MRI is substantial but reduced when using MRI length estimates. Important differences between PWV measured by Sphygmocor and MRI are mainly due to accuracy of distance measurements, which may need re-addressing in guidelines. [ABSTRACT FROM AUTHOR]

This study aimed to investigate whether a single bout of Self-myofascial Release (SMR) has a beneficial effect on peripheral and central Blood Pressure (BP) and different parameters of arterial stiffness. Twenty nine healthy male recreational athletes (26.1 ± 2.9 years, BMI 23.4 ± 1.5 kg/m2) completed an instructed SMR using a foam roller. Peripheral and central BP and different parameters of arterial stiffness were measured noninvasively before SMR and at different time points (t1, t15, t30) during a subsequent 30-min recovery phase. There was a significant decrease in both systolic (t15, −2.36 ± 4.45 mmHg, p = 0.05; t30, −4.01 ± 4.47 mmHg, p = 0.003) and diastolic (t30, −2.45 ± 5.45 mmHg, p = 0.025) peripheral pressure during the recovery phase after SMR. Regarding central BP, only systolic pressure showed a significant decrease (t30, −3.64 ± 5.83 mmHg, p = 0.003). Mean arterial pressure (t15, −1.91 ± 3.36, p = 0.03; t30, −3.05 ± 2.88 mmHg, p < 0.001), augmentation pressure (t30, −1.60 ± 2.40 mmHg, p = 0.009), peripheral resistance (t30, −0.09 ± 0.10 s* mmHg/ml, p < 0.001), and stiffness index β0 (t30, −0.33 ± 0.55, p = 0.021) were significantly reduced after SMR. No significant changes were determined for reflection coefficient, augmentation index, cardiac output, and heart rate, respectively. SMR showed effects on peripheral and central BP and different parameters of arterial stiffness in healthy young adults. A single bout of self-myofascial release confers favourable cardiovascular benefits. Self-myofascial release induces mechanical stress to the vascular system. Effects on vascular function is comparable to the effects after a bout of exercise. [ABSTRACT FROM AUTHOR]

Although the effects of smoking on hemodynamics and arterial stiffness has already been evaluated from many aspects, self-controlled and 24-h data have remained a missing area. Ten healthy light smokers were examined in a cross-sectional observational study for 48 h [smoking was prohibited during the first 24 h (non-smoking day) and allowed during the second 24 h (smoking day)] with an oscillometric device. Control group consisted of ten healthy non-smokers. Peripheral blood pressures were significantly higher on the smoking day (134.11 ± 11.02 and 77.11 ± 10.64) than on the non-smoking day (127.23 ± 8.41, p = 0.017 and 71.25 ± 10.47, p = 0.02) or among non-smokers (120.80 ± 5.77, p = 0.005 and 68.37 ± 4.87, p = 0.04). Heart rate was significantly lower on the non-smoking day (64.89 ± 9.03) than among non-smokers (74.30 ± 8.22, p = 0.03) and on the smoking day (76.09 ± 10.53, p = 0.001). Pulse Wave Velocity (PWV) was significantly higher on the smoking day (7.48 ± 1.17) than on the non-smoking day (7.00 ± 1.28, p = 0.03). Peripheral blood pressure results confirmed that smoking leads to both acute and subchronic elevation. Lower heart rate of smokers on the non-smoking day than non-smokers can be the consequence of improper heart rate adaptation to everyday activities. PWV values improved during the one-day long abstinent period suggesting that it is the most sensitive stiffness value to smoking cessation. Highlights: Systolic and diastolic blood pressure values were the highest on the smoking day. Heart rate of smokers was lower on the non-smoking day than that of non-smokers. PWV of smokers was higher on the smoking day than on the non-smoking day. There was no difference between AIX values on the non-smoking and smoking days. [ABSTRACT FROM AUTHOR]

Obstructive Sleep Apnoea (OSA) is a breathing disorder characterized by narrowing of the upper airway that impairs normal ventilation during sleep. OSA is a highly prevalent condition which is associated with several Cardiovascular (CV) risk factors and CV diseases. Despite this clear association, Randomized Controlled Trials (RCTs) have provided equivocal data that treatment of sleep apnoea can improve CV outcomes regardless of its ability to reduce blood pressure. Here, we critically review the evidence that supports role of OSA as a risk factor for increased arterial stiffness which represents an early manifestation of vascular damage often preceding major CV events. Additionally, we examined evidence from interventional RCTs to assess if treatment of OSA by continuous positive airway pressure can affect arterial stiffness measured as carotid-femoral pulse wave velocity. Overall, a large body of evidence supports the role of OSA as a risk factor for increased arterial stiffness and several pathophysiological mechanisms, including activation of the autonomic nervous system, may help to explain the link between breathing disorders and vascular alterations (here mainly examined as functional properties). Whether the causal relationship between OSA and vascular damage exists or is mostly explained by confounders and whether OSA treatment can improve vascular stiffening is still debated.

Background: Increased arterial stiffness caused by elevated Blood Pressure (BP) can be indicated by the Cardio-ankle Vascular Index (CAVI). However, the relationship between arterial stiffness and BP is complex. In addition, changes in BP may contribute to increased risk of cardiovascular disease associated with abnormal lipid profiles. So far, results from published studies have been inconclusive. Objectives: To evaluate lipid profiles and BP, and their association with CAVI values in elderly participants. Methods: The study included 95 elderly Thai individuals. Anthropometric data, lipid profiles, and BP and CAVI values were established. Participants were then divided into low-CAVI (CAVI < 9, n = 50) and high-CAVI groups (CAVI ≥ 9, n = 45). Stepwise linear and logistic regression models were used. Results: The high-CAVI group had significantly higher BP and hypertension levels, than the low-CAVI group. The mean age of the high-CAVI group was also higher (≥65 years). CAVI value was positively correlated with Systolic Blood Pressure (SBP) and Pulse Pressure (PP) in the high-CAVI group. Stepwise multiple regression analysis showed SBP (β = 0.43, p < 0.01) and hip circumference (β = −0.23, p = 0.01) were associated with CAVI values. Logistic regression of the high-CAVI indices showed that the Odds Ratios (ORs) for the factors of age ≥65 years, obesity, hypertension and dyslipidemia were 7.35 (95% CI 2.42–22.36, p < 0.01), 0.20 (95% CI 0.64–0.67, p < 0.01) 4.72 (95% CI 1.67–13.32, p < 0.01), and 4.84 (95% CI 1.42–16.46, p = 0.01), respectively. Conclusion: A higher SBP level was correlated with a high-CAVI value in elderly people.

Age-related decreases in executive function and an increase in arterial stiffness and plasma homocysteine levels are related to the risk of dementia. However, the association between executive function, arterial stiffness, and homocysteine levels remains unclear. This study aimed to investigate the relationship between executive function, arterial stiffness, and plasma homocysteine in 82 middle-aged and older women. The Stroop interference time, Brachial-ankle Pulse Wave Velocity (baPWV), and plasma homocysteine concentration were collected. The correlation analyses revealed that the Stroop interference time was significantly correlated with plasma homocysteine (r = 0.40, p < 0.001) and baPWV (r = 0.38, p = 0.001). In addition, plasma homocysteine levels were significantly correlated with baPWV (r = 0.48, p < 0.001). In the mediated analyses, the plasma homocysteine level directly (β = 0.24; p = 0.037) and indirectly (β = 0.12, 95% confidence interval [0.007, 0.238]) affected the Stroop interference time. These results suggest that higher plasma homocysteine levels are associated with a decline in executive function mediated by higher artery stiffness in middle-aged and older women.

Background: Carotid-femoral Pulse Wave Velocity (cfPWV) is the gold-standard measure of arterial stiffness. Accuracy of non-invasive cfPWV as meters per second is impeded by surface estimates of aortic length. Our aim was to compare cfPWV measured using distance estimated from surface measurements with distance traced along the length of the aorta using Magnetic Resonance Imaging (MRI) in a cohort of older women. Methods: Seventy-four women were recruited from the TwinsUK cohort. cfPWV was measured using the SphygmoCor system (SphygmoCor-PWV). The path between carotid and femoral sites was estimated from surface measurements between the sternal notch and femoral artery applanation point. Aortic distance was measured with MRI to obtain MRI-PWV. cfPWV was recalculated using MRI obtained distance. Results: Mean ± standard deviation SphygmoCor-PWV was 9.9 ± 2.1 m/s and MRI-PWV 7.63 ± 1.97 m/s (mean difference 2.2 ± 1.96 m/s, p < 0.001). Distances were considerably higher using surface measures for the SphygmoCor (55.2 ± 3.0, 95% confidence interval 54.4–55.9 cm) compared with MRI (39.9 ± 3.2, 39.2–40.7 cm) with a mean difference of 15.2 cm (14.3–16.2 cm, p < 0.001). Transit times were also marginally longer with the SphygmoCor. When SphygmoCor-PWV was Recalculated using MRI-obtained aortic distance (rec-PWV), the difference between SphygmoCor-PWV and rec-PWV reduced to 0.5 m/s (7.13 ± 1.46 vs. 7.63 ± 1.97 m/s, p = 0.08). Conclusion: In these older women, the PWV difference between SphygmoCor and MRI is substantial but reduced when using MRI length estimates. Important differences between PWV measured by Sphygmocor and MRI are mainly due to accuracy of distance measurements, which may need re-addressing in guidelines.

Although the effects of smoking on hemodynamics and arterial stiffness has already been evaluated from many aspects, self-controlled and 24-h data have remained a missing area. Ten healthy light smokers were examined in a cross-sectional observational study for 48 h [smoking was prohibited during the first 24 h (non-smoking day) and allowed during the second 24 h (smoking day)] with an oscillometric device. Control group consisted of ten healthy non-smokers. Peripheral blood pressures were significantly higher on the smoking day (134.11 ± 11.02 and 77.11 ± 10.64) than on the non-smoking day (127.23 ± 8.41, p = 0.017 and 71.25 ± 10.47, p = 0.02) or among non-smokers (120.80 ± 5.77, p = 0.005 and 68.37 ± 4.87, p = 0.04). Heart rate was significantly lower on the non-smoking day (64.89 ± 9.03) than among non-smokers (74.30 ± 8.22, p = 0.03) and on the smoking day (76.09 ± 10.53, p = 0.001). Pulse Wave Velocity (PWV) was significantly higher on the smoking day (7.48 ± 1.17) than on the non-smoking day (7.00 ± 1.28, p = 0.03). Peripheral blood pressure results confirmed that smoking leads to both acute and subchronic elevation. Lower heart rate of smokers on the non-smoking day than non-smokers can be the consequence of improper heart rate adaptation to everyday activities. PWV values improved during the one-day long abstinent period suggesting that it is the most sensitive stiffness value to smoking cessation. •Systolic and diastolic blood pressure values were the highest on the smoking day. •Heart rate of smokers was lower on the non-smoking day than that of non-smokers. •PWV of smokers was higher on the smoking day than on the non-smoking day. •There was no difference between AIX values on the non-smoking and smoking days.

Introduction: Excessive adipose tissue is associated with adverse metabolic effects and is an important risk factor for chronic diseases. According to the American Heart Association, most cardiovascular events can be prevented by adhering to healthy practices, reflecting cardiovascular health as poor, intermediate, and good. Objective: To evaluate the effect of weight loss on vascular function, metabolic profile and inflammatory markers of obese subjects with poor cardiovascular health. Methods: Obese individuals, both sexes, aged 40–70 years, will be instructed to follow a hypocaloric diet (−800 Kcal/day) for 16 weeks. Before and after intervention, participants will undergo clinical, nutritional (anthropometry and dual energy X-ray absorptiometry), biochemical, vascular and sleep evaluation. Patients will be submitted to sympathetic tone assessment using a frequency meter Polar® RS800 (Polar Electro OY, Kempele, Finland), oscillometric pulse wave analysis by Mobil-O-Graph® (IEM, Stolberg, Germany), post-occlusive microvascular reactivity by laser speckle contrast imaging, carotid ultrasound and degree of obstructive sleep apnea through the home polysomnography device (WatchPAT 200®). Serum levels of leptin, adiponectin, interleukin-6, tumor necrosis factor-alpha and C-reactive protein will be determined. Participants will be stratified in two groups according to cardiovascular health (poor vs. intermediate/ideal). Cardiovascular health is said to be ideal by the presence of optimal health behaviors (non-smokers, adequate body mass index, physical activity level and healthy eating pattern) and health factors (blood pressure, total cholesterol and blood glucose). Ideal cardiovascular health is considered for those with five or more metrics within this qualification, intermediate for presence of three or four metrics and poor for two or less metrics.

Whether arterial stiffness is a surrogate end-point for cardiovascular and renal disease has never been directly demonstrated by a controlled clinical trial. Our main hypothesis is a better prevention of outcomes in high risk hypertensives with PWV normalization driven strategy than with usual blood pressure driven therapeutic strategy based on European Society of Hypertension–European Society of Cardiology (ESH–ESC) guidelines. The strategy for preventing cardiovascular and renal events based on arterial stiffness study is a multicenter open-label randomized controlled trial with blinded endpoint evaluation comparing a therapeutic strategy targeting the normalisation of Pulse Wave Velocity (PWV group) versus a classical therapeutic strategy only implementing the ESH–ESC Guidelines (conventional group), for reducing cardiovascular and renal events. Patients with primary hypertension, aged 55–75 years, and at medium-to-very high cardiovascular risk will be included and followed-up for 4 years. In the PWV group, treatment will be adjusted to carotid-femoral PWV measured every 6 months. In the conventional group, PWV will be measured at baseline and every 2 years, but its value will be blinded to the investigator in charge of the patient. In the PWV group, the therapeutic strategy will preferably use a combination of Angiotensin-converting Enzyme Inhibitor (ACEI) [or Angiotensin Receptor Blockers (ARB)] and calcium channel blockers, as well as maximal recommended doses of ACEIs and ARBs. The primary combined endpoint includes stroke and coronary events (myocardial infarction, angioplasty, bypass), fatal or not, peripheral artery disease (angioplasty, bypass, amputation), hospitalization for heart failure, aortic dissection, chronic kidney disease (doubling of creatinine, dialysis), and sudden death. Twenty-five research centers will include a total of 1500 patients, in order to show a 20% reduction in the primary combined endpoint - the incidence of which is estimated at 10% per year - in the PWV group compared to the conventional group.

This study aimed to investigate whether a single bout of Self-myofascial Release (SMR) has a beneficial effect on peripheral and central Blood Pressure (BP) and different parameters of arterial stiffness. Twenty nine healthy male recreational athletes (26.1 ± 2.9 years, BMI 23.4 ± 1.5 k/m2) completed an instructed SMR using a foam roller. Peripheral and central BP and different parameters of arterial stiffness were measured noninvasively before SMR and at different time points (t1, t15, t30) during a subsequent 30-min recovery phase. There was a significant decrease in both systolic (t15, −2.36 ± 4.45 mmHg, p = 0.05; t30, −4.01 ± 4.47 mmHg, p = 0.003) and diastolic (t30, −2.45 ± 5.45 mmHg, p = 0.025) peripheral pressure during the recovery phase after SMR. Regarding central BP, only systolic pressure showed a significant decrease (t30, −3.64 ± 5.83 mmHg, p = 0.003). Mean arterial pressure (t15, −1.91 ± 3.36, p = 0.03; t30, −3.05 ± 2.88 mmHg, p < 0.001), augmentation pressure (t30, −1.60 ± 2.40 mmHg, p = 0.009), peripheral resistance (t30, −0.09 ± 0.10 s* mmHg/ml, p < 0.001), and stiffness index β0 (t30, −0.33 ± 0.55, p = 0.021) were significantly reduced after SMR. No significant changes were determined for reflection coefficient, augmentation index, cardiac output, and heart rate, respectively. SMR showed effects on peripheral and central BP and different parameters of arterial stiffness in healthy young adults. •A single bout of self-myofascial release confers favourable cardiovascular benefits. •Self-myofascial release induces mechanical stress to the vascular system. •Effects on vascular function is comparable to the effects after a bout of exercise.

Introduction: Malignancies are the second leading cause of death worldwide. Treatment Monoclonal Antibody (MAbs)-based treatment of cancer has been established as one of the most successful therapeutic strategies in the last 20 years; however, there is a growing concern about the effects of these agents on patients’ cardiovascular profile. Areas Covered: In this manuscript we summarize current evidence regarding MAb effects on arterial stiffness, which is an recognised biomarker of cardiovascular risk. For this purpose, we explored two bibliographic databases [PubMed, Scopus] and one full-text database (Google-Scholar) for all publications published on MAbs’ effects on arterial stiffness until December 2019. Only few of the monoclonal antibody agents used in oncology have been investigated as per their effects on arterial properties and this limited evidence suggests that cancer therapy with monoclonal antibodies demonstrates either a temporary or long-term increase in arterial stiffness. Discussion: It seems that by targeting ‘checkpoints’ in cancer genesis, anticancer MAbs also affects vascular properties causing endothelial dysfunction and arterial stiffness. Furthermore, several MAbs cause hypertension and may as a result increase pulse wave velocity. On the other hand, MAbs that target inflammatory cytokines seem to improve cardiovascular survival however, their effect on arterial stiffness is yet to be investigated. Further research is warranted in order to elucidate the biochemical pathways, clinical implications and potential reversibility of monoclonal antibody chemotherapy-induced vascular dysfunction.

Background: Endothelial Nitric Oxide Synthase (eNOS) is responsible for Nitric Oxide (NO) bioavailability at endothelial level. Aging (even in healthy people) is involved in arterial stiffness increases. Materials and Methods: We investigated (in the service of Cardiology, 4th Medical Clinic) 100 patients, 55 with metabolic syndrome (MS), mean age 56.91 ± 14.39 years, 66% women. Identification of the T786C polymorphism was performed by enzymatic digestion of the fragment obtained by polymerase chain reaction (PCR) amplification. Evaluation of arterial parameters (aortic pulse wave velocity (PWV), as a measure of arterial stiffness and aortic [AixAo] and brachial [Aixb] augmentation index) was performed with the TensioMed™ Arteriograph. Results: Regarding T786C polymorphism, the distribution was the following: 57% did not have the mutation (TT), 30% were heterozygous, 13% were homozygous (CC). Patients with MS more frequently had C allele (54.5% vs. 28.9% in those without MS) and CC state (16.4% vs. 8.9%, p-NS). Significant differences (p = 0.005) regarding PWV were found in TT patients vs. heterozygous CT vs. homozygous CC: 9.75 ± 1.75 m/s vs. 9.86 ± 1.56 m/s vs. 11.65 ± 1.87 m/s. In case of the other parameters, no significant differences were found (AixAo, p = 0.35; Aixb, p = 0.22; pulse pressure, p = 0.14), but CC patients presented higher values. Conclusion: Arterial stiffness is influenced by eNOS gene polymorphisms, being a possible link between the increase in cardiovascular risk and presence of metabolic syndrome in these patients.

Purpose: The retina provides a non-invasive window to monitor microvascular circulation. Carotid-femoral Pulse Wave Velocity (cfPWV) is an indicator of large artery stiffness and is associated with systemic cardiovascular diseases. This study investigates whether Retinal artery PWV (rPWV) reflects cfPWV changes in an elderly cohort. Methods: A total of 37 elderly participants (28 female, age 79 ± 5 years) were studied. Participants with a history of diabetes, glaucoma, and any neurological or eye-related disorders were excluded. Twenty four subjects were taking antihypertensive medication. A 60-s recording of retinal arterial diameter changes were captured (25 Hz frame rate, Dynamic Vessel Analyzer). Systolic blood pressure, Diastolic Blood Pressure (DBP), cfPWV and Intraocular Pressure (IOP) were measured. A custom-written algorithm was used to extract pulse amplitudes from retinal arterial diameters within one- and three-disc diameters from the optic disc. rPWV was designated as the ratio of the distance between two sites along the artery to the time delay between pulses. Predictors of rPWV were assessed by linear regression and parameter selection techniques. Results: There was a positive correlation between rPWV and cfPWV (Pearson’s correlation coefficient 0.82, p < 0.001). In parameter selection models, cfPWV, transmural pressure (DBP–IOP), male sex, and IOP were isolated as predictors of rPWV. Conclusion: This study found a positive correlation between rPWV and cfPWV in an elderly cohort. This indicates that microvessel remodelling that parallels large vessel remodelling is able to be detected using rPWV measurement. Further longitudinal studies are required to elucidate the predictive value of screening rPWV in systemic cardiovascular abnormalities.