Aortic-to-brachial stiffness gradient and kidney function in type 2 diabetes

Picone, Dean; Schultz, Martin; Climie, Rachel E.; Srikanth, Velandai; Sharman, James E.

doi:10.1097/hjh.0000000000000916

Cited by 8 publications

(30 citation statements)

References 33 publications

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“…Similar results have also been observed by other investigators [37,39]. Picone et al [37] assessed the determinants of PWV ratio in a diabetic group and a nondiabetic control group.…”

Section: Pwv Ratio and Its Relation To Blood Pressuresupporting

confidence: 85%

“…Moreover, other studies tend to support that arterial stiffness gradient may be better associated with target-organ damage than aortic stiffness. For example, in a cross-sectional analysis of patients with type 2 diabetes ( n = 60) and age-matched controls ( n = 60), aortic-brachial stiffness gradient predicted estimated glomerular filtration rate independently of age, sex, diabetes status, and cardiovascular risk factors, whereas aortic stiffness did not [37]. In addition, Lee et al [38] observed that PWV ratio was independently associated with history of stroke and coronary artery disease in patients with a known medical history of cardiovascular disease ( n = 142), while aortic stiffness did not reach a statistical level of significance.…”

Section: Aortic-brachial Pwv Ratio: a Measure Of Arterial Stiffness Gmentioning

confidence: 99%

“…Picone et al [37] assessed the determinants of PWV ratio in a diabetic group and a nondiabetic control group. They found that PWV ratio was not associated with MAP in their diabetic group, but it was associated with brachial and central pulse pressure, central augmentation pressure and augmentation index.…”

Section: Pwv Ratio and Its Relation To Blood Pressurementioning

confidence: 99%

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Aortic-Brachial Pulse Wave Velocity Ratio: A Measure of Arterial Stiffness Gradient Not Affected by Mean Arterial Pressure

Fortier

Desjardins

Agharazii³

2017

Pulse

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Background: Aortic stiffness, measured by carotid-femoral pulse wave velocity (cf-PWV), is used for the prediction of cardiovascular risk. This mini-review describes the nonlinear relationship between cf-PWV and operational blood pressure, presents the proposed methods to adjust for this relationship, and discusses a potential place for aortic-brachial PWV ratio (a measure of arterial stiffness gradient) as a blood pressure-independent measure of vascular aging. Summary: PWV is inherently dependent on the operational blood pressure. In cross-sectional studies, PWV adjustment for mean arterial pressure (MAP) is preferred, but still remains a nonoptimal approach, as the relationship between PWV and blood pressure is nonlinear and varies considerably among individuals due to heterogeneity in genetic background, vascular tone, and vascular remodeling. Extrapolations from the blood pressure-independent stiffness parameter β (β₀) have led to the creation of stiffness index β, which can be used for local stiffness. A similar approach has been used for cardio-ankle PWV to generate a blood pressure-independent cardio-ankle vascular index (CAVI). It was recently demonstrated that stiffness index β and CAVI remain slightly blood pressure-dependent, and a more appropriate formula has been proposed to make the proper adjustments. On the other hand, the negative impact of aortic stiffness on clinical outcomes is thought to be mediated through attenuation or reversal of the arterial stiffness gradient, which can also be influenced by a reduction in peripheral medium-sized muscular arteries in conditions that predispose to accelerate vascular aging. Arterial stiffness gradient, assessed by aortic-brachial PWV ratio, is emerging to be at least as good as cf-PWV for risk prediction, but has the advantage of not being affected by operating MAP. Key Messages: The negative impacts of aortic stiffness on clinical outcomes are proposed to be mediated through attenuation or reversal of arterial stiffness gradient. Aortic-brachial PWV ratio, a measure of arterial stiffness gradient, is independent of MAP.

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“…Similar results have also been observed by other investigators [37,39]. Picone et al [37] assessed the determinants of PWV ratio in a diabetic group and a nondiabetic control group.…”

Section: Pwv Ratio and Its Relation To Blood Pressuresupporting

confidence: 85%

Section: Aortic-brachial Pwv Ratio: a Measure Of Arterial Stiffness Gmentioning

confidence: 99%

See 1 more Smart Citation

Aortic-Brachial Pulse Wave Velocity Ratio: A Measure of Arterial Stiffness Gradient Not Affected by Mean Arterial Pressure

Fortier

Desjardins

Agharazii³

2017

Pulse

View full text Add to dashboard Cite

show abstract

“…This hypothesis was supported by a prospective study in dialysis patients and demonstrated that a reduced stiffness gradient is associated with increased cardiovascular events (80). Furthermore, a reduced stiffness gradient was observed in patients with T2D (81). However, others have shown that aortic-brachial stiffness gradient had little or no impact on wave reflection (evaluated as augmentation index) and left ventricular hypertrophy (82).…”

Section: The Macrovasculature and Pulsatile Hemodynamicsmentioning

confidence: 99%

Measuring the Interaction Between the Macro- and Micro-Vasculature

Climie

Gallo

Picone

et al. 2019

Front. Cardiovasc. Med.

Self Cite

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Structural and functional dysfunction in both the macro- and microvasculature are a feature of essential hypertension. In a healthy cardiovascular system, the elastic properties of the large arteries ensure that pulsations in pressure and flow generated by cyclic left ventricular contraction are dampened, so that less pulsatile pressure and flow are delivered at the microvascular level. However, in response to aging, hypertension, and other disease states, arterial stiffening limits the buffering capacity of the elastic arteries, thus exposing the microvasculature to increased pulsatile stress. This is thought to be particularly pertinent to high flow/low resistance organs such as the brain and kidney, which may be sensitive to excess pressure and flow pulsatility, damaging capillary networks, and resulting in target organ damage. In this review, we describe the clinical relevance of the pulsatile interaction between the macro- and microvasculature and summarize current methods for measuring the transmission of pulsatility between the two sites.

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“…and in the way BP is transmitted from central-to-peripheral vasculature (e.g. increased SBP amplification in some, but not in others) [7][8][9][10]. Therefore, measuring BP at an isolated arterial point may overlook these fine phenotypic differences.…”

Section: Introductionmentioning

confidence: 99%

Central-to-peripheral systolic blood pressure different phenotypes and relation to accuracy of daily used cuff devices

Bendary

Magdy

Aal

et al. 2019

Arterial Hypertension

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Background. Cuff blood pressure (BP) measurement has been the standard method for taking BP in routine daily practice for more than a century. However, some concerns were raised about the accuracy of this method which could lead to misclassification of BP in many situations. We aimed primarily to confirm a recent major discovery that distinct BP phenotypes based on central-to-peripheral systolic blood pressure (SBP) amplification do exist, and whether application of a validated cuff BP method (e.g. oscillometric) could accurately discriminate these differences. Material and methods. Among 106 participants (mean age 62 ± 11; 58% males) undergoing coronary angiography, intra-arterial BP was measured at 3 points (ascending aorta, brachial and radial arteries). Central-to-peripheral SBP amplification (SBPamp) was defined as ≥ 5 mm Hg SBP increased from aorta-to-brachial and/or from brachial-to-radial arteries. A validated cuff BP device (oscillometric) was used to measure BP at 4 different time points. Results. Four different BP phenotypes were confirmed based on the magnitude of SBPamp; phenotype I, both aortic-to brachial and brachial-to radial SBPamp; phenotype II, only aortic-to-brachial SBPamp; phenotype III, only brachial-to-radial SBPamp; and phenotype IV, no SBPamp at all. Aortic SBP was significantly higher in phenotypes-III and IV compared to phenotypes-I and II (p = 0.001). This was not discriminated using a validated cuff BP device measurement (p = 0.996). Results for the pulse pressure (PP) followed the same pattern. Conclusion. Distinct BP phenotypes do exist based on SBPamp. A validated cuff BP method failed to discriminate this. Improving quality of BP measurements in daily practice is a priority.

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Aortic-to-brachial stiffness gradient and kidney function in type 2 diabetes

Abstract: Patients with T2DM have a reversed ab-SG during rest and exercise. Resting ab-SG predicts kidney function independent of aPWV, implying a reversed ab-SG may have a pathophysiological function.

Cited by 8 publications

References 33 publications

Aortic-Brachial Pulse Wave Velocity Ratio: A Measure of Arterial Stiffness Gradient Not Affected by Mean Arterial Pressure

Aortic-Brachial Pulse Wave Velocity Ratio: A Measure of Arterial Stiffness Gradient Not Affected by Mean Arterial Pressure

Measuring the Interaction Between the Macro- and Micro-Vasculature

Central-to-peripheral systolic blood pressure different phenotypes and relation to accuracy of daily used cuff devices

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