Determinants of Progression of Aortic Stiffness in Hemodialysis Patients

Utescu, Mihai Silviu; Couture, Véronique; Mac‐Way, Fabrice; Serres, Sacha A. De; Marquis, Karine; Lariviere, Richard W.; Desmeules, Simon; Lebel, Marcel; Boutouyrie, Pierre; Agharazii, Mohsen

doi:10.1161/hypertensionaha.113.01200

Cited by 85 publications

(71 citation statements)

References 41 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…6,7,22,23 In a longitudinal study with repeated measures of PWV in hemodialysis patients, we observed that the reduction of brachial stiffness was inversely associated to baseline degree of aortic stiffness. 11 This finding along with others, 9,24 have led to propose that regression of brachial stiffness could be an adaptation to an increased central aortic stiffness. Indeed, the reduction in the stiffness of peripheral muscular arteries in the presence of high aortic stiffness will attenuate wave reflection, contributing to the shifting of the reflecting sites distally, potentially reducing the negative effect of wave reflection on central blood pressure and cardiac workload (ie, adaptation) and explaining the discordance between augmentation index and aortic stiffness.…”

Section: Discussionmentioning

confidence: 72%

“…11 The regression of brachial stiffness was associated to higher degree of aortic stiffness, therefore, leading to an enhanced aortic-brachial stiffness mismatch. In the context of this study, we hypothesized that aortic-brachial stiffness mismatch, as evaluated by the ratio of aortic and brachial pulse wave velocity (PWV) ratio, may prove to be a better prognostic predictor of mortality in dialysis population than aortic PWV.…”

Section: 10mentioning

confidence: 99%

“…12 We determined carotid-femoral pulse wave velocity (cf-PWV) and carotid-radial pulse wave velocity (cr-PWV) using Complior SP (Artech Medical, Pantin, France) as described previously. 11,13 PWV ratio was calculated from the average cf-PWV and cr-PWV (PWV ratio=cf-PWV/cr-PWV). For the purpose of comparison to the reference values published, standard cf-PWV was obtained as previously reported.…”

Section: Hemodynamic Parametersmentioning

confidence: 99%

See 2 more Smart Citations

Aortic-Brachial Stiffness Mismatch and Mortality in Dialysis Population

et al. 2015

Self Cite

View full text Add to dashboard Cite

C ardiovascular disease is the leading cause of mortality in patients with chronic kidney disease. 1,2 Aortic stiffness, which results in increased pulse pressure (PP), cardiac overload, and left ventricular hypertrophy, is an established predictor for cardiovascular morbidity and mortality in chronic kidney disease. [3][4][5] Physiologically, the aorta is much more elastic than peripheral muscular arteries providing a physiological stiffness gradient. This physiological gradient of stiffness generates reflecting sites, which dampens the transmission of forward travelling pressure into the microcirculation. In normal aging, aortic stiffness increases to a greater extent than peripheral muscular arteries, resulting in equalization or even reversal of stiffness gradient (aortic stiffness>muscular artery stiffness), referred to as stiffness mismatch. 6-9 Attenuation or reversal of physiological stiffness gradient has been proposed to cause vascular damage through enhanced transmission of forward travelling wave energy into the microcirculation. 9,10In a longitudinal study with repeated measures of aortic and brachial stiffness in hemodialysis patients, we observed an accelerated progression of aortic stiffness and a significant reduction in brachial stiffness. 11 The regression of brachial stiffness was associated to higher degree of aortic stiffness, therefore, leading to an enhanced aortic-brachial stiffness mismatch. In the context of this study, we hypothesized that aortic-brachial stiffness mismatch, as evaluated by the ratio of aortic and brachial pulse wave velocity (PWV) ratio, may prove to be a better prognostic predictor of mortality in dialysis population than aortic PWV. Therefore, the objectives of this study were to examine the nonadjusted and adjusted effect of the PWV ratio on overall mortality and to study its relative predictive value as compared with well-known central and peripheral hemodynamic parameters.Abstract-We hypothesized that increased aortic stiffness (central elastic artery) combined with a decrease in brachial stiffness (peripheral muscular artery) leads to the reversal of the physiological stiffness gradient (ie, mismatch), promoting end-organ damages through increased forward pressure wave transmission into the microcirculation. We, therefore, examined the effect of aortic-brachial stiffness mismatch on mortality in patients in need of dialysis. In a prospective observational study, aortic-brachial arterial stiffness mismatch (pulse wave velocity ratio) was assessed using carotid-femoral pulse wave velocity divided by carotid-radial pulse wave velocity in 310 adult patients on dialysis. After a median follow-up of 29 months, 146 (47%) deaths occurred. The hazard ratio (HR) for mortality related to PWV ratio in a Cox regression analysis was 1.43 (95% confidence interval [CI], 1.24-1.64; P<0.001 per 1 SD) and was still significant after adjustments for confounding factors, such as age, dialysis vintage, sex, cardiovascular disease, diabetes mellitus, smoking status, and weight (HR...

show abstract

Section: Discussionmentioning

confidence: 72%

Section: 10mentioning

confidence: 99%

Section: Hemodynamic Parametersmentioning

confidence: 99%

See 1 more Smart Citation

Aortic-Brachial Stiffness Mismatch and Mortality in Dialysis Population

et al. 2015

Self Cite

View full text Add to dashboard Cite

show abstract

“…Aortic stiffness is known to progress faster in CKD patients (31), although not all studies found this (32). Progression in APWV varies from 0.08 m/s per year in healthy normotensive persons and 0.15 m/s per year in treated hypertensive persons (31) to 0.84 m/s per year in hemodialysis patients (33). Considerable variability existed in APWV progression in our cohort, and 26.4% of patients increased by >1 m/s, a proportion of progressors similar to the study in CKD (22).…”

Section: Discussionmentioning

confidence: 99%

Serum Calcification Propensity Is a Strong and Independent Determinant of Cardiac and All-Cause Mortality in Kidney Transplant Recipients

Dahle

Åsberg

Hartmann

et al. 2016

American Journal of Transplantation

View full text Add to dashboard Cite

“…12 Immediately after BP measurements, we determined cf-PWV and carotid-radial pulse wave velocity (cr-PWV) in triplicates. 13,14 Aortic-brachial PWV ratio was calculated by the ratio of cf-PWV and cr-PWV (PWV ratio=cf-PWV/cr-PWV). For comparison, we also reported the standard cf-PWV, which was obtained taking into account differences in the transit time using the maximal upstroke algorithm and the overestimation of true distance by multiplying direct distance by 0.8.…”

Section: Hemodynamic Measurementsmentioning

confidence: 99%

Aortic–Brachial Pulse Wave Velocity Ratio

et al. 2017

Self Cite

View full text Add to dashboard Cite

A ortic stiffness, as measured by carotid-femoral pulse wave velocity (cf-PWV), has been associated with increased risk of cardiovascular events, mortality, and overall mortality in various groups of subjects.1-5 From a mechanistic point of view, although the impact of aortic stiffness on the myocardium is explained by increased cardiac workload and reduced coronary perfusion, the peripheral target organ damage is best explained by the arterial stiffness gradient hypothesis.6 Indeed, because of the heterogeneity of vascular wall composition and diameter, there is an increase in arterial stiffness (stiffness gradient) from the heart to the periphery. This gradient in arterial stiffness results in a gradual attenuation of forward pressure wave throughout its passage along the arterial tree down to the microcirculation, where the pulsatility is minimal. As aorta stiffens, there is attenuation and then reversal of the stiffness gradient, resulting in the lack of attenuation of the forward travelling wave pressure, and higher pulse pressure transmission into the microcirculation. This leads to vascular myogenic response, endothelial dysfunction, hypoperfusion, and organ damage.6,7 Indeed, recent studies underline the importance of vascular stiffness gradient on both blood flow and clinical outcomes. 8-10One of the limitations of aortic stiffness is that it is highly related to the operational mean arterial pressure (MAP). Although cf-PWV of a cohort could be adjusted for the group's MAP by use of linear regression, there are limitations to such approach. First, the pressure-diameter relationship is curvilinear. Second, the pressure-diameter curve differs among individuals because of variations in genetic background and exposure to environmental risk factors, which contribute to the cumulative changes in the arterial wall structure.To study the impact of arterial stiffness gradient on mortality, we examined and found that aortic-brachial pulse wave velocity ratio (aortic-brachial PWV ratio) was better than cf-PWV in predicting mortality in a multivariable adjusted model in a dialysis population.11 Because both aortic and brachial stiffness are influenced in a similar manner with MAP, we hypothesized that aortic-brachial PWV ratio is not significantly affected by MAP and hence could be of additional value in clinical practice. Therefore, the Abstract-Aortic stiffness, a cardiovascular risk factor, depends on the operating mean arterial pressure (MAP). The impact of aortic stiffness on cardiovascular outcomes is proposed to be mediated by the attenuation or the reversal of the arterial stiffness gradient. We hypothesized that arterial stiffness gradient is less influenced by changes in MAP. We aimed to study the relationship between MAP and aortic stiffness, brachial stiffness, and arterial stiffness gradient. In a crosssectional study of a dialysis cohort (group A, n=304) and a cohort of hypertensive or kidney transplant recipient with an estimated glomerular filtration rate of >45 mL/min/1.73 m 2 (group B, n=114), we ...

show abstract

Determinants of Progression of Aortic Stiffness in Hemodialysis Patients

Cited by 85 publications

References 41 publications

Aortic-Brachial Stiffness Mismatch and Mortality in Dialysis Population

Aortic-Brachial Stiffness Mismatch and Mortality in Dialysis Population

Serum Calcification Propensity Is a Strong and Independent Determinant of Cardiac and All-Cause Mortality in Kidney Transplant Recipients

Aortic–Brachial Pulse Wave Velocity Ratio

Contact Info

Product

Resources

About