Objectives. Carotid artery reactivity (CAR%), involving carotid artery diameter responses to a cold pressor test, is a non-invasive measure of conduit artery function in humans. This study examined: 1. the impact of age and cardiovascular risk factors on the CAR% and 2. The relationship between CAR% and coronary artery vasodilator responses to the cold pressor test. Methods. Ultrasound was used to measure resting and peak carotid artery diameters during the cold pressor test, with CAR% being calculated as the relative change from baseline (%). We compared CAR% between young (n=50, 24±3 years) and older participants (n=44, 61±8 years), and subsequently assessed relationships between CAR% and traditional cardiovascular risk factors in 50 participants (44±21 years). Subsequently, we compared left anterior descending (LAD) artery velocity (using transthoracic Doppler) with carotid artery diameter (i.e. CAR%) during the cold pressor test (CPT, n=33, 37±17 years). Results. A significantly larger CAR% was found in young versus older healthy participants (4.1±3.7 versus 1.8±2.6, P<0.001). Participants without cardiovascular risk factors demonstrated a higher CAR% compared to those with ≥2 risk factors (2.9±2.9 versus 0.5±2.9, P=0.019). Carotid artery diameter and LAD velocity increased during CPT (P<0.001). Carotid diameter and change in velocity correlated with LAD velocity (r=0.486 and 0.402, P<0.004 and 0.02, respectively). Conclusion. Older age and cardiovascular risk factors are related to lower CAR%, whilst CAR% shows good correlation with coronary artery responses to the CPT. Therefore, CAR% may represent a valuable technique to assess cardiovascular risk, whilst CAR% seems to reflect coronary artery vasodilator function.

Background Emerging evidence suggests that increasing dietary nitrate intake may be an effective approach to improve cardiovascular health. However, the effects of a prolonged elevation of nitrate intake through an increase in vegetable consumption are understudied. Objective Our primary aim was to determine the impact of 12 wk of increased daily consumption of nitrate-rich vegetables or nitrate supplementation on blood pressure (BP) in (pre)hypertensive middle-aged and older adults. Methods In a 12-wk randomized, controlled study (Nijmegen, The Netherlands), 77 (pre)hypertensive participants (BP: 144 ± 13/87 ± 7 mmHg, age: 65 ± 10 y) either received an intervention with personalized monitoring and feedback aiming to consume ∼250–300 g nitrate-rich vegetables/d (∼350–400 mg nitrate/d; n = 25), beetroot juice supplementation (400 mg nitrate/d; n = 26), or no intervention (control; n = 26). Before and after intervention, 24-h ambulatory BP was measured. Data were analyzed using repeated measures ANOVA (time × treatment), followed by within-group (paired t-test) and between-group analyses (1-factor ANOVA) where appropriate. Results The 24-h systolic BP (SBP) (primary outcome) changed significantly (P-interaction time × treatment = 0.017) with an increase in the control group (131 ± 8 compared with 135 ± 10 mmHg; P = 0.036); a strong tendency for a decline in the nitrate-rich vegetable group (129 ± 10 compared with 126 ± 9 mmHg; P = 0.051) which was different from control (P = 0.020); but no change in the beetroot juice group (133 ± 11 compared with 132 ± 12 mmHg; P = 0.56). A significant time × treatment interaction was also found for daytime SBP (secondary outcome, P = 0.011), with a significant decline in the nitrate-rich vegetable group (134 ± 10 compared with 129 ± 9 mmHg; P = 0.006) which was different from control (P = 0.010); but no changes in the beetroot juice (138 ± 12 compared with 137 ± 14 mmHg; P = 0.41) and control group (136 ± 10 compared with 137 ± 11 mmHg; P = 0.08). Diastolic BP (secondary outcome) did not change in any of the groups. Conclusions A prolonged dietary intervention focusing on high-nitrate vegetable intake is an effective strategy to lower SBP in (pre)hypertensive middle-aged and older adults. This trial was registered at www.trialregister.nl as NL7814.

Aortic valve replacement (AVR) leads to remodeling of the left ventricle (LV). Adopting a novel technique to examine dynamic LV function, our study explored whether post-AVR changes in dynamic LV function and/or changes in aortic valve characteristics are associated with LV mass regression during follow-up. We retrospectively analyzed 30 participants with severe aortic stenosis who underwent standard transthoracic echocardiographic assessment before AVR [88 (IQR or interquartile range: 22–143) days], post-AVR [13 (6–22) days], and during follow-up [455 (226–907) days]. We assessed standard measures of LV structure, function, and aortic valve characteristics. Novel insight into dynamic LV function was provided through a four-chamber image by examination of the temporal relation between LV longitudinal strain (ε) and volume (ε-volume loops), representing the contribution of LV mechanics to volume change. AVR resulted in immediate changes in structural valve characteristics, alongside a reduced LV longitudinal peak ε and improved coherence between the diastolic and systolic part of the ε-volume loop (all P < 0.05). Follow-up revealed a decrease in LV mass ( P < 0.05) and improvements in LV ejection fraction and LV longitudinal peak ε ( P < 0.05). A significant relationship was present between decline in LV mass during follow-up and post-AVR improvement in coherence of the ε-volume loops ( r = 0.439, P = 0.03), but not with post-AVR changes in aortic valve characteristics or LV function (all P > 0.05). We found that post-AVR improvements in dynamic LV function are related to long-term remodeling of the LV. This highlights the potential importance of assessing dynamic LV function for cardiac adaptations in vivo. NEW & NOTEWORTHY Combining temporal measures of left ventricular longitudinal strain and volume (strain-volume loop) provides novel insights in dynamic cardiac function. In patients with aortic stenosis who underwent aortic valve replacement, postsurgical changes in the strain-volume loop are associated with regression of left ventricular mass during follow-up. This provides novel insight into the relation between postsurgery changes in cardiac hemodynamics and long-term structural remodeling, but also supports the potential utility of the assessment of dynamic cardiac function.

The impact of 24 weeks of supervised endurance versus resistance exercise training on left ventricular mechanics in healthy untrained humans. http://researchonline.ljmu.ac.uk/id/eprint/9980/ Article LJMU has developed LJMU Research Online for users to access the research output of the University more effectively. ABSTRACT 29 Background: In addition to the well-known cardiac structural adaptation to exercise 30 training, little work examined changes in LV mechanics. With new regional and global 31 indices available we sought to determine the effect of 24 weeks endurance versus 32 resistance training on LV mechanics. 33 34 Methods and Results: 23 male subjects were randomly allocated to either a 24-week 35 endurance-or resistance-training program. Pre-and post-training 2D echocardiographic 36 images were acquired. Global LV mechanics (strain []) were recorded in longitudinal, 37 circumferential and radial planes. Rotation was assessed at apical and basal levels. In 38 addition, longitudinal -volume loops, across the cardiac cycle, were constructed from 39 simultaneous LV  (longitudinal and transverse strain) and volume measurements across the 40 cardiac cycle as a novel measure of LV mechanics. Marginal differences in  and rotation 41 data were found between groups. Post-training, we found no change in global peak  data. 42 Peak basal rotation significantly increased after training with changes in the endurance 43 group (-2.2±1.9 o to -4.5±3.3 o ) and the resistance group (-2.9±3.0 o to -3.4±2.9 o ). LV -volume 44 loops revealed a modest rightward shift in both groups. 45 46 Conclusions: Whilst most global and regional indices of LV mechanics were not significantly 47 altered, 24 weeks of intense supervised exercise training increased basal rotation. Further 48 studies that assess LV mechanics in larger cohorts of subjects and those with cardiovascular 49 disease and risk factors may reveal important training impacts. 50 51 52 53 3 NEW AND NOTEWORTHY 54 This study builds on previous work by our group and presents a comprehensive assessment 55 of cardiac mechanics following dichotomous exercise training programmes. We highlight 56 novel findings in addition to the inclusion of strain-volume loops, which shed light on subtle 57 differences in longitudinal and transverse contribution to volume change throughout the 58 cardiac cycle. Our findings suggest that training has an impact on basal rotation and possibly 59 strain-volume loops. 60 61 105 The utility and insight provided by this technique has already been demonstrated in acute 106 exercise [9] and clinical [6] settings, where it is apparent that -volume loops are sensitive to 107 changes in acute and/or chronic loading on the LV. With likely training-related changes in 108 LV loading, -volume loops could provide novel insights into the adaptability of LV 109 mechanics to physiological adaptation of the LV. In view of this, we sought to 110 comprehensively assess the impact of 24 weeks of closely supervised and centre-based 111 endurance and resistance tr...