Pulse最新文献

Introduction: Chronic kidney disease (CKD) raises cardiovascular risk, but its link with the cardio-ankle vascular index (CAVI) in diabetic and non-diabetic patients remains unclear. The aim of this study was to clarify the relationships between CAVI values and an aspect of renal function.

Methods: We investigated the relationships among CAVI values, proteinuria, and the estimated glomerular filtration rate (eGFR) in 4,682 patients enrolled in a multicenter prospective coupling study (patients aged ≥30 years with at least one cardiovascular risk factor) and both eGFR and proteinuria data available. Based on vascular insufficiency guidelines, we classified the patients as having low (<8) or high (≥8) CAVI values.

Results: The proteinuria positivity rate differed significantly between the low- and high-CAVI groups, and the difference was significant even after adjusting for age, gender, and other factors. Although direct comparisons showed a higher proportion of CKD (eGFR <60 mL/min/1.73 m²) in the high-CAVI group, this difference disappeared after adjustment. We further divided the low- and high-CAVI groups into diabetes mellitus (DM) and no diabetes mellitus (non-DM) subgroups to examine the rate of proteinuria positivity and the percentage of patients with eGFRs <60 mL/min/1.73 m². After the multivariate analysis adjustment, the odds ratios for positive proteinuria the high-CAVI group were 1.69 (confidence interval [CI]: 1.08-2.63, p = 0.021) for the non-DM subgroup and 0.91 (95% CI: 0.56-1.47, p = 0.705) for the DM subgroup. The percentage of patients with eGFRs <60 mL/min/1.73 m² was not significantly different between the low- and high-CAVI groups in both the DM and non-DM subgroups after the multivariate analysis adjustment (p = 0.088 for non-DM and p = 0.135 for DM).

Conclusions: Proteinuria was associated with a CAVI ≥8 in patients without DM. High arterial stiffness may serve as a surrogate marker for renal damage in non-diabetic patients.

Introduction: While insulin resistance (IR) is an established risk factor for cardiovascular disease, vascular dysfunction represents a critical early pathological link. Although prior studies support the association between IR and vascular dysfunction, it remains unknown whether IR assessed by homeostasis model assessment of IR (HOMA-IR) or the triglyceride-glucose index (TyG index) is more closely related to specific markers of vascular dysfunction.

Methods: A total of 2,278 participants (59.3% women; average age, 56.7 ± 11.0 years) were recruited in this study. The HOMA-IR and TyG index was calculated using (fasting insulin [μIU/mL] × fasting glucose [mmol/L]/22.5) and ln (fasting triglyceride [mg/dL] × fasting glucose [mg/dL]/2), respectively. Vascular measurements included brachial-ankle pulse wave velocity (baPWV), cardio-ankle vascular index (CAVI), and urinary albumin-to-creatinine ratio (UACR), representing macro- and microvascular dysfunction, respectively.

Results: Irrespective of the assessment methods of IR, both the TyG index and HOMA-IR were all significantly associated with the vascular indices before (p < 0.001) and after full adjustment (p ≤ 0.041). The standardized regression coefficients of the vascular dysfunction with the TyG index were comparable to those with the HOMA-IR after adjustment for various confounders (0.07-15.8 versus 0.05-18.2; P _compare ≥ 0.108). In multivariable logistic regression analysis, the TyG index was significantly associated with higher risk of arterial stiffness (odds ratio [OR] = 1.37 and 1.26 for abnormal baPWV and CAVI, respectively; p ≤ 0.035), while the HOMA-IR was tightly associated with higher risk of abnormal CAVI (OR = 1.54; p < 0.001) and albuminuria (OR = 1.40; p = 0.006). Further subgroup analyses showed that a more significant association between the TyG index and the prevalence of increased arterial stiffness was observed in women and nondiabetic participants, and participants without chronic kidney disease (CKD) (p ≤ 0.025), while a more significant association between the HOMA-IR and the prevalence of abnormal CAVI and albuminuria was detected in younger individuals, females, normotensive, or normoglycemic subjects (p ≤ 0.035).

Conclusion: The TyG index demonstrated a stronger association with arterial stiffness (baPWV) than HOMA-IR, whereas the HOMA-IR showed a more pronounced association with albuminuria, especially in women.

Introduction: The pulse wave analysis technology in the specialist SphygmoCor XCEL device has now been implemented in the CONNEQT Pulse device, which is a conventional sphygmomanometer suitable for home blood pressure (BP) monitoring. The aim of this study was to compare the correlation and consistency of measurements between the two devices.

Methods: The study was conducted in participants admitted to the Department of Geriatrics, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine. Brachial BP (bBP), central BP (cBP), augmentation pressure (AP), augmentation index (AIx), and subendocardial viability ratio (SEVR) were measured with the CONNEQT Pulse and the SphygmoCor XCEL devices, both using a calibrated cuff-based brachial waveform.

Results: A total of 367 eligible subjects, aged 23-92 (57.6 ± 13.0) years, of whom 254 (69.2%) were male, was enrolled in this study. Paired t tests showed relatively low bias and elevated standard deviation: cSBP mm Hg ([121.7 ± 17.2] vs. [117.5 ± 14.5], p < 0.001), cDBP ([80.6 ± 11.0] vs. [78.3 ± 11.4], p < 0.001), cPP ([41.0 ± 12.7] vs. [39.2 ± 9.5], p < 0.001), AP mm Hg ([11.5 ± 6.2] vs. [12.8 ± 6.6], p < 0.001), AI ([26.4 ± 9.0]% vs. [31.9 ± 14.0]%, p < 0.01), and SEVR ([135.6 ± 25.5]% vs. [137.8 ± 26.4]%, p = 0.02). cDBP (r = 0.812) measured by both devices was strongly correlated, cSBP (r = 0.762), cPP (r = 0.702) and SEVR (r = 0.778) were strongly correlated, whereas AP (r = 0.587) and AIx (r = 0.522) were moderately correlated (all p < 0.001). For intraclass correlation coefficient (ICC) for both devices, cDBP (ICC = 0.794) and SEVR (ICC = 0.776) showed good reproducibility, while cSBP (ICC = 0.727), cPP (ICC = 0.666), AIx (ICC = 0.428), and AP (ICC = 0.575) showed good to modest reproducibility. The differences between cSBP, cDBP, cPP, AP, AIx, and SEVR measured by the two devices were 4.2 ± 11.2 mm Hg, 2.3 ± 6.9 mm Hg, -1.8 ± 9.0 mm Hg, -1.3 ± 5.8 mm Hg, -5.6 ± 12.0%, and 2.1 ± 17.3%, respectively.

Conclusion: Both devices show strong cBP-bBP correlations and low bias, suggesting that the new CONNEQT Pulse provides similar measurements of cBP to the original SphygmoCor XCEL. Although there is greater variability in waveform parameters, the magnitude of differences is within acceptable limits for meaningful use in conventional home BP monitoring. The relatively elevated variability in measurement precision (standard deviation), most likely due to sequential measurements with both devices in the same arm, needs to be further evaluated using simultaneous measurements in both arms.

Introduction: Lower extremity peripheral arterial disease (LEPAD), causing reduced limb blood flow and significant morbidity, is a major global health concern. Understanding its burden and attributable risk factors is crucial for public health planning. The aim of this study was to quantify the global, regional, and national burden of LEPAD and disability-adjusted life years (DALYs) lost attributable to key risk factors from 1990 to 2021.

Methods: This analysis utilized data from the Global Burden of Disease Study 2021. It employed multisource data and advanced statistical modeling to estimate LEPAD prevalence, incidence, mortality, DALYs, and risk factor attribution across 204 countries and territories.

Results: In 2021, there were 113.7 million LEPAD survivors and 10.0 million new cases globally, with females comprising 67.0% of prevalent cases. LEPAD caused 67,000 deaths and 1.5 million DALYs. Six key risk factors accounted for most attributable DALYs: high fasting plasma glucose (36.06%), kidney dysfunction (28.64%), smoking (25.04%), hypertension (21.72%), lead exposure (15.05%), and high body mass index (BMI, 8.75%). Low- and middle-income countries bore a disproportionate burden (68.8% of incident cases, 60.9% of DALYs). While global incidence and mortality modestly declined since 1990, increases occurred in lower-middle and low socio-demographic index regions.

Conclusion: LEPAD imposes a substantial global burden, disproportionately affecting females and populations in low-resource settings. Modifiable metabolic (glucose, kidney function, BMI, hypertension) and behavioral (smoking) risks dominate. Targeted interventions, especially in high-burden regions experiencing increasing trends, are urgently needed to mitigate LEPAD-related morbidity and mortality. Future research should focus on effective interventions and healthcare access barriers.

Background: The aorta plays a crucial role in the blood circulation through its Windkessel function, buffering blood volume and regulating blood pressure. While traditionally viewed as primarily passive, this function may be actively regulated by vascular smooth muscle cells in the aortic wall through vasoconstriction or -dilation. Despite the widespread use of antihypertensive drugs that target vascular tone, our understanding of human aortic vasoreactivity remains limited. This review therefore aimed to evaluate the vasoreactivity of the human aorta in response to various pharmacological and non-pharmacological stimuli.

Summary: A systematic search of the PubMed database was conducted for articles published before January 1, 2024. Of the 1,179 articles that were screened for inclusion, 30 articles met the inclusion criteria. Ten studies involved ex vivo examinations, while 20 studies involved in vivo measurements. Ex vivo pharmacological testing revealed vasoconstriction induced by adrenergic and endothelin-A receptor agonists and prostanoids. Pharmacological vasodilation was observed following in vivo or ex vivo administration of nitrates and calcium channel blockers, although acetylcholine did not induce vasodilation ex vivo. Additionally, tobacco smoking and intravenous cocaine use were associated with vasoconstriction, whereas anesthetic agents were involved in potential aortic vasodilation.

Key messages: These findings challenge the traditional view of the aorta as a passive conduit, highlighting its vasoconstrictive and vasodilative properties in response to vasoactive stimuli. This revised understanding has significant implications for prescribing antihypertensive drugs, which commonly have vasodilatory effects. The potential impact of these vasoactive therapies on the aorta's Windkessel function warrants careful consideration, particularly in patients with aortic pathologies.

Introduction: The aim of this study was to assess the association of office arterial stiffness and 24 h arterial stiffness as measured by pulse wave velocity (PWV) with subclinical target organ damage (TOD) in a hypertensive cohort.

Methods: We evaluated associations of TOD with office carotid-femoral PWV (cf-PWV) by radial tonometry (SphygmoCor) and 24-h ambulatory PWV measurements by brachial oscillometry (Mobil-O-Graph 24-h PWA Monitor) in 636 hospital inpatients (age 54 ± 13 years, 465 males) with primary hypertension. Subclinical TOD was assessed as left ventricular hypertrophy (LVH) obtained by echocardiography quantified by LV mass index (LVMI), carotid intima-media thickness (CIMT) >0.9 mm and chronic kidney disease including urine albumin-creatinine ratio (ACR) >3.5 mg/mmol in females and >2.5 mg/mmol in males or estimated glomerular filtration rate (eGFR) <60 mL/min per 1.73 m².

Results: After adjusting for confounding factors, both cf-PWV and 24-h PWV or night-PWV showed significant association with LVMI (p < 0.05). Only day-PWV was associated with eGFR (p = 0.037). When cf-PWV, 24-h PWV, day- and night-PWV including confounding factors were forced into the same logistic regression model, only cf-PWV (OR = 1.109 [1.001-1.228], p = 0.033) remained a significant determinant of increased LVH. Day-PWV (OR = 0.538 [0.415-0.696], p < 0.001) was significantly correlated with eGFR. For ACR, each 1 m/s increase in day-PWV was associated with risk of increased ACR (OR = 1.685 [1.178-2.410], p = 0.004). For CIMT >0.9 mm, neither ambulatory PWV nor cf-PWV was significant.

Conclusion: Compared with 24-h ambulatory PWV, cf-PWV has a better correlation with LVH, while ambulatory PWV has a greater correlation with the decline in renal function.

Background: Pericardial adipose tissue (PAT), an ectopic fat depot surrounding the coronary arteries, is a significant pathogenic risk factor for cardiometabolic diseases. Due to its anatomical proximity to the heart, PAT is considered a more potent risk factor for cardiovascular conditions compared to other visceral adipose tissues located in other parts of body. Modifiable lifestyle factors such as physical activity (PA), sedentary behavior (SB), exercise interventions, and cardiorespiratory fitness (CRF) have been associated with various health outcomes, but their relationship with PAT remains less understood.

Summary: This review synthesizes current evidence on the associations of PA, SB, exercise interventions, and CRF with PAT. Increasing PA and CRF while reducing SB appears to be associated with lower PAT accumulation with age, independent of key health characteristics across diverse populations. Also, exercise interventions may be effective in reducing PAT. PAT is emerging as a critical cardiovascular disease and cardiometabolic risk factor. The review highlights the importance of PA, SB, exercise participations, and CRF as modifiable strategies to potentially mitigate this risk. Despite the documented benefits of PA, exercise interventions, and CRF and the negative impacts of SB on health, further research is warranted to explore these associations more comprehensively. Most existing studies are limited by small sample sizes, cross-sectional designs, and reliance on self-reported measures. Recent longitudinal studies suggest that PA, SB, and CRF may influence PAT volumes over time, though findings are often affected by baseline abdominal adiposity and the use of indirect measures.

Key messages: (i) Increasing PA, exercise participation, and CRF while reducing SB may prevent PAT accumulation with age, independent of other health factors. (ii) PAT is a significant, emerging risk factor for cardiovascular and metabolic diseases, underscoring the need for effective lifestyle interventions. (iii) Future research should focus on larger, more diverse cohorts using objective measures to better understand the complex relationships between PA, SB, CRF, and PAT. (iv) Comprehensive exploration of these associations will aid in developing interventions to reduce cardiac adiposity and enhance cardiovascular health outcomes.

Background: In part one of this two-part series, we performed a detailed analysis of the hemodynamic signature produced during resistance exercise (RE) and discussed the subacute effects on short-term modulation of large artery stiffness and central pulsatile hemodynamics. In this second part of our two-part series, we consider the subacute recovery window as the driver of resistance exercise training (RET) adaptations. We then discuss the results of RET interventions and corroborate these findings against the information gleaned from cross-sectional studies in habitually strength-trained athletes. Finally, we explore associations between muscular strength and arterial stiffness.

Summary: Our reanalysis of key studies assessing arterial stiffness in the hour post-RE suggests changes in both load-dependent and load-independent indices of arterial (aortic) stiffness. Regarding adaptations to habitual RET, a growing body of evidence contradicts earlier findings that suggested RET increases large artery stiffness. Recent meta-analyses conclude that longitudinal RET has no effect or may even reduce large artery stiffness. However, cross-sectional studies continue to support early RET intervention studies and note that habitual RET may increase large artery stiffness and central pulsatile hemodynamics. Complex interactions between vascular smooth muscle cells and the extracellular matrix may offer insight into inter-individual heterogeneity in subacute responses and chronic adaptations to acute RE and habitual RET.

Key messages: Habitual RET is fundamentally important for skeletal muscle quality and quantity as well as cardiovascular function. Recent literature suggests that habitual RET has negligible effects on large artery stiffness and central hemodynamic pressure pulsatility, but cross-sectional observations still raise questions about the chronic large artery effects of habitual RET.