Aortic Stiffness Determines Diastolic Blood Flow Reversal in the Descending Thoracic Aorta

Hashimoto, Junichiro; Ito, Sadayoshi

doi:10.1161/hypertensionaha.113.01318

Cited by 100 publications

(87 citation statements)

References 49 publications

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“…31 It is likely that arterial wave reflections from low resistance vascular beds, such as brain, may be small, thus CBF pulsatility would be determined mainly by wave reflections Mean CBFV (cm/sec) Figure 1. (A) Association between age and total cerebral blood flow (CBF) (top) and mean CBF velocity (CBFV) (bottom), and (B) the relation between total CBF and mean CBFV.…”

Section: Cerebral Hemodynamics and Central Arterial Aging T Tarumi Et Almentioning

confidence: 99%

Cerebral Hemodynamics in Normal Aging: Central Artery Stiffness, Wave Reflection, and Pressure Pulsatility

Tarumi

Khan

Liu

et al. 2014

J Cereb Blood Flow Metab

177

143

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Blood ejected from the left ventricle perfuses the brain via central elastic arteries, which stiffen with advancing age and may elevate the risk of end-organ damage. The purpose of this study was to determine the impact of central arterial aging on cerebral hemodynamics. Eighty-three healthy participants aged 22 to 80 years underwent the measurements of cerebral blood flow (CBF) and CBF velocity (CBFV) using magnetic resonance imaging (MRI) and transcranial Doppler, respectively. The CBF pulsatility was determined by the relative amplitude of CBFV to the mean value (CBFV%). Central arterial stiffness (carotid-femoral pulse wave velocity), wave reflection (carotid augmentation index), and pressure were measured using applanation tonometry. Total volume of white-matter hyperintensity (WMH) was quantified from MR images. Total CBF decreased with age while systolic and pulsatile CBFV% increased and diastolic CBFV% decreased. Women showed greater total CBF and lower cerebrovascular resistance than men. Diastolic CBFV% was lower in women than in men. Age-and sex-related differences in CBF pulsatility were independently associated with carotid pulse pressure and arterial wave reflection. In older participants, higher pulsatility of CBF was associated with the greater total volume of WMH. These findings indicate that central arterial aging has an important role in age-related differences in cerebral hemodynamics.

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Section: Cerebral Hemodynamics and Central Arterial Aging T Tarumi Et Almentioning

confidence: 99%

Cerebral Hemodynamics in Normal Aging: Central Artery Stiffness, Wave Reflection, and Pressure Pulsatility

Tarumi

Khan

Liu

et al. 2014

J Cereb Blood Flow Metab

177

143

View full text Add to dashboard Cite

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“…29,30 In view of the former considerations, retrograde embolization from complex plaques of the proximal descending aorta to all brain territories in early diastole is theoretically possible and could provide an alternative embolic source that should be taken into consideration, especially in patients with cryptogenic stroke. 6,28,30,31 However, in a small, prospective, population-based study, neither complex nor small plaques in the descending aorta were associated with an increased risk of first-ever stroke after a mean follow-up of 74.4 months. Moreover, subjects with large plaques in the descending aorta were also found to have a higher prevalence of hypertension, diabetes mellitus, and hypercholesterolemia, when compared with those without plaques.…”

Section: Discussionmentioning

confidence: 99%

“…26 Retrograde flow from the descending aorta has been found to be frequent in patients with determined or cryptogenic stroke 6 and in patients with uncomplicated hypertension. 28 Flow reversal in the descending aorta was found to increase with increasing age, 29 decreasing heart rate, 6 increasing aortic stiffness, 28 and the presence of complex plaques, 6 which also in turn affect aortic elasticity. 5 Interestingly, aortic valve insufficiency and aortic regurgitation were not found to be significant predictors of increased flow reversal.…”

Section: Discussionmentioning

confidence: 99%

Complex Atheromatous Plaques in the Descending Aorta and the Risk of Stroke

Katsanos

Giannopoulos

Kosmidou

et al. 2014

Stroke

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This meta-analysis has adopted the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines for systematic Background and Purpose-Proximal aortic plaques, especially in the aortic arch, have already been established as an important cause of stroke and peripheral embolism. However, aortic plaques situated in the descending thoracic aorta have recently been postulated as a potential embolic source in patients with cryptogenic cerebral infarction through retrograde aortic flow. The aim of the present study was to evaluate the potential association of descending aorta atheromatosis with cerebral ischemia. Methods-We conducted a systematic review and meta-analysis of all available prospective observational studies reporting the prevalence of complex atheromatous plaques in the descending aorta in patients with stroke and in unselected populations undergoing examination with transesophageal echocardiography. Results-We identified 11 eligible studies including a total of 4000 patients (667 patients with stroke and 3333 unselected individuals; mean age, 65 years; 55% men). On baseline transesophageal echocardiograpic examination, the prevalence of complex atheromatous plaques in the descending aorta was higher (P=0.001) in patients with stroke (25.4%; 95% confidence interval, 14.6-40.4%) compared with unselected individuals (6.1%; 95% confidence interval, 3.4-10%). However, no significant difference (P=0.059) in the prevalence of complex atheromatous plaques in the descending aorta was found between patients with cryptogenic (21.8%; 95% confidence interval, 17.5-26.9%) and unclassified (28.3%; 95% confidence interval, 23.9-33.1%) cerebral infarction. Conclusions-Our findings indicate that the presence of complex plaques in the descending aorta is presumably a marker of generalized atherosclerosis and high vascular risk. The present analyses do not provide any further evidence for a direct causal relationship between descending aorta atherosclerosis and cerebral embolism. (Stroke. 2014;45:1764-1770.)

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“…However, recent investigations are already suggesting the possibility that diastolic reverse flow in the proximal descending aorta causes retrograde plaque embolism leading to major stroke (Harloff et al 2009), and this aortic reverse flow increases with aortic stiffening (Hashimoto and Ito 2013).…”

Section: Central Hemodynamics and Brainmentioning

confidence: 99%

Central Hemodynamics and Target Organ Damage in Hypertension

Hashimoto

2014

Tohoku J. Exp. Med.

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Recent advances in technology have enabled the noninvasive evaluation of pulsatile hemodynamics in the central aorta; namely, central pressure and flow measurements. The central blood pressure represents the true load imposed on the heart, kidney and brain, and the central blood flow influences the local flow into these vital organs. An elevation of the central blood pressure has a direct, adverse impact on the target organ and, thus, the cardiovascular prognosis in patients with hypertension. A decrease in the central blood flow can cause organ dysfunction and failure. The central pressure and flow dynamics were conventionally regarded as unidirectional from the heart to the periphery. However, current evidence suggests that it should be recognized as a bidirectional interplay between the central and peripheral arteries. Specifically, the pressure pulse wave is not only transmitted forward to the periphery but also reflected backward to the central aorta. The flow pulse wave is also composed of the forward and reverse components. Aortic stiffening and arteriolar remodeling due to hypertension not only augment the central pressure by increasing the wave reflection but also may alter the central bidirectional flow, inducing hemodynamic damage/dysfunction in susceptible organs. Therefore, central hemodynamic monitoring has the potential to provide a diagnostic and therapeutic basis for preventing systemic target organ damage and for offering personalized therapy suitable for the arterial properties in each patient with hypertension. This brief review will summarize hypothetical mechanisms for the association between the central hemodynamics and hypertensive organ damage in the heart, kidney and brain.

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Aortic Stiffness Determines Diastolic Blood Flow Reversal in the Descending Thoracic Aorta

Cited by 100 publications

References 49 publications

Cerebral Hemodynamics in Normal Aging: Central Artery Stiffness, Wave Reflection, and Pressure Pulsatility

Cerebral Hemodynamics in Normal Aging: Central Artery Stiffness, Wave Reflection, and Pressure Pulsatility

Complex Atheromatous Plaques in the Descending Aorta and the Risk of Stroke

Central Hemodynamics and Target Organ Damage in Hypertension

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