Increased systemic arterial stiffness in patients with chronic thromboembolic pulmonary hypertension

Sznajder, Monika; Dzikowska-Diduch, Olga; Kurnicka, Katarzyna; Roik, Marek; Wretowski, Dominik; Pruszczyk, Piotr; Kostrubiec, Maciej

doi:10.5603/cj.a2018.0109

Cited by 12 publications

(16 citation statements)

References 23 publications

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“…In both indicated studies, 76 , 77 it was suggested that increased systemic arterial stiffness could be associated with poor prognosis in pulmonary hypertension, but only in the present study did we test this suggestion, and confirmed that increased CAVI is associated with a higher rate of death, independent to other traditional risk factors – OR = 1.13, CI 1.001–1.871. In non-survived patients the mean CAVI was significantly higher than in patients who survived – 7.8±1.56 vs 6.8±1.2, P = 0.004, while PWVe and PWVm did not differ significantly and were not associated with the prognosis.…”

Section: Discussionsupporting

confidence: 67%

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Prognostic Significance of Systemic Arterial Stiffness Evaluated by Cardio-Ankle Vascular Index in Patients with Idiopathic Pulmonary Hypertension

Radchenko

Sіrenko

2021

VHRM

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Background In a previous study, the cardio-ankle vascular index (CAVI) was increased significantly in idiopathic pulmonary arterial hypertension (IPAH) patients compared to the healthy group and did not much differ from one in systemic hypertensives. In this study the relations between survival and CAVI was evaluated in patients with IPAH. Patients and Methods We included 89 patients with new-diagnosed IPAH without concomitant diseases. Standard examinations, including right heart catheterization (RHC) and systemic arterial stiffness evaluation, were performed. All patients were divided according to CAVI value: the group with CAVI ≥ 8 (n = 18) and the group with CAVI < 8 (n = 71). The mean follow-up was 33.8 ± 23.7 months. Kaplan–Meier and Cox regression analysis were performed for the evaluation of our cohort survival and the predictors of death. Results The group with CAVI≥8 was older and more severe compared to the group with CAVI< 8. Patients with CAVI≥8 had significantly reduced end-diastolic (73.79±18.94 vs 87.35±16.69 mL, P<0.009) and end-systolic (25.71±9.56 vs 33.55±10.33 mL, P<0.01) volumes of the left ventricle, the higher right ventricle thickness (0.77±0.12 vs 0.62±0.20 mm, P < 0.006), and the lower TAPSE (13.38±2.15 vs 15.98±4.4 mm, P<0.018). RHC data did not differ significantly between groups, except the higher level of the right atrial pressure in patients with CAVI≥ 8–11.38±7.1 vs 8.76±4.7 mmHg, P<0.08. The estimated overall survival rate was 61.2%. The CAVI≥8 increased the risk of mortality 2.34 times (CI 1.04–5.28, P = 0.041). The estimated Kaplan–Meier survival in the patients with CAVI ≥ 8 was only 46.7 ± 7.18% compared to patients with CAVI < 8 - 65.6 ± 4.2%, P = 0.035. At multifactorial regression analysis, the CAVI reduced but saved its relevance as death predictor - OR = 1.13, CI 1.001–1.871. Summary We suggested the CAVI could be a new independent predictor of death in the IPAH population and could be used to better risk stratify this patient population if CAVI is validated as a marker in a larger multicenter trial.

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Section: Discussionsupporting

confidence: 67%

“… 76 Also, in patients with chronic thromboembolic pulmonary hypertension Sznajder et al found significantly higher PWVe than in the control group which was matched to age, gender, and concomitant diseases. 77 …”

Section: Discussionmentioning

confidence: 99%

Prognostic Significance of Systemic Arterial Stiffness Evaluated by Cardio-Ankle Vascular Index in Patients with Idiopathic Pulmonary Hypertension

Radchenko

Sіrenko

2021

VHRM

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“…Thus, the authors concluded that the patients with pulmonary arterial hypertension had altered vascular function in the systemic arteries and, considering the relationship between PWV and pulmonary hypertension severity, systemic arterial stiffness might serve as a marker of the disease severity and response to a treatment. Sznajder et al 33 found the elevated PWVe was associated with older age, higher pulmonary vascular resistance and lower oxygen saturation in CTEPH.…”

Section: Discussionmentioning

confidence: 97%

“…In our study, mean PWVe values were very similar to those in Chamorro et al's study for IPAH patients (8.49±1.92 m/s) and healthy adults (7.29±0.87 m/s). Sznajder et al 33 evaluated systemic arterial stiffness in chronic thromboembolic pulmonary hypertension (CTEPH) and the control group patients were adjusted by age, gender, and concomitant diseases. They found significantly higher levels of PWVe in CTEPH patients (10.3 ± 2.5 vs 9 ± 1.3 m/s, p < 0.05).…”

Section: Discussionmentioning

confidence: 99%

“…In the literature we were able to find some observations devoted to evaluation of the pulmonary artery resistance, 11,12,[29][30][31][32] but only a few of them studied the systemic arterial stiffness. [33][34][35] Before planning this study we hypothesized the following: 1) patients with IPAH have active factors in circulation which could damage not only the pulmonary but systemic arteries too as in arterial hypertensive patients; 2) if these changes are present, they might correlate with other parameters influencing on the prognosis. That is why we evaluated systemic arterial stiffness measured as carotid-femoral pulse wave velocity (PWVe), carotid-radial PWV (PWVm) and cardio-ankle vascular index (CAVI) in IPAH patients and compared the results with those in the matched arterial hypertensive patients and the healthy people.…”

Section: Introductionmentioning

confidence: 99%

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<p>Systemic Arterial Stiffness in New Diagnosed Idiopathic Pulmonary Arterial Hypertension Patients</p>

Radchenko

Zhyvylo

Titov

et al. 2020

VHRM

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Objective: We suggested: 1) patients with idiopathic pulmonary hypertension (IPAH) have active factors which could damage not only the pulmonary but systemic arteries too as in arterial hypertensive patients; 2) if these changes were present, they might correlate with other parameters influencing on the prognosis. This study is the first attempt to use cardioankle vascular index (CAVI) for the evaluation of systemic arterial stiffness in patients with IPAH. Methods: A total of 112 patients were included in the study: group 1 consisted of 45 patients with new diagnosed IPAH, group 2 included 32 patients with arterial hypertension, and in the control group were 35 healthy persons adjusted by age. Right heart catheterization, ECG, a 6-minute walk test (6MWT), echocardiography, blood pressure (BP) measurement and ambulatory BP monitoring, pulse wave elastic artery stiffness (PWVe; segment carotid-femoral arteries) and muscular artery stiffness (PWVm; segment carotid-radial arteries), CAVI, and N-terminal pro-B-type natriuretic peptide (NT-proBNP) level were provided. The Spearman correlation, a linear regression and multivariable binary logistic analysis were performed to indicate the predictors associated with PWV and CAVI. Results: The groups were adjusted for principal characteristics influenced on arterial stiffness. IPAH patients had significantly (P<0.001 for all) shorter 6MWT distance and higher Borg dyspnea score than the patients with arterial hypertension (systolic/diastolic BP = 146.1 ±10.7/94.2±9.8 mmHg) and the control group = 330.2±14.6 vs 523.8±35.3 and 560.9±30.2 m respectively and 6.2±1.8 vs 1.2±2.1 and 0.9±2.8 points. The PWVm and PWVe were the highest in hypertensive patients (10.3±1.5 and 11.42±1.70 m/s). The control group and IPAH did not have significant differences in aorta BP, but PWVm/PWVe values were significantly (P<0.003/0.008) higher in IPAH patients than in the control group (8.1±1.9/8.49±1.92 vs 6.63±1.34/7.29±0.87 m/s). The CAVIs on both sides were significantly lower in the healthy subjects (5.91±0.99/5.98±0.87 right/left side). Patients with IPAH did not differ from the arterial hypertension patients by CAVIs in comparison with the control group (7.40±1.32/ 7.22±1.32 vs 7.19±0.78/7.2±1.1 PWVe) did not correlate with any parameters except uric acid. PWVm correlated with uric acid (r=0.58, P<0.001), NT-proBNP (r=0.33, P=0.03) and male gender (r=0.37, P=0.013) at Spearman analysis, but not at multifactorial linear regression analysis. The CAVI correlated with age and parameters characterized functional capacity (6MWT distance) and right ventricle function (NT-proBNP, TAPSE) at Spearman analysis and with age and TAPSE at multifactorial linear regression analysis. At binary logistic regression analysis CAVI > 8.0 at right and/or left side had a correlation with age, 6MWT distance, TAPSE, but an independent correlation was only with age (β=1.104, P=0.008, CI 1.026-1.189) and TAPSE (β=0.66, P=0.016, CI 0.474-0.925). Conclusion: In spite of equal and at normal range BP level, the age-adjuste...

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Vascular stiffening in aging females with a hypertension‐induced HIF2A gain‐of‐function mutation

Volkova

Procell

Kong

et al. 2022

Bioengineering & Transla Med

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Pulmonary arterial hypertension (PAH) is more prevalent in females than males; the causes of this sex difference have not been adequately explored. Gain-of-function (GOF) mutations in hypoxia-inducible factor 2α (HIF2A) lead to PAH and thrombotic consequences in patients and mice. Additionally, multiple emerging studies suggest that elevated systemic arterial stiffening (SAS) occurs in PAH; this could have critical prognostic value. Here, we utilized a HIF2A GOF mouse model to determine how SAS can be used as a prognosticator in sex-divergent PAH. We analyzed survival, vascular mechanics, and vascular phenotypes in young adult (8-16 weeks) and middle age (9-12 months) Hif2a GOF mice. We find that Hif2a heterozygous (HT) female mice, but not Hif2a HT male mice, exhibit poor survival, SAS upon aging, and decreased ability to withstand repeated physiological strain. Hif2a HT female mice also display thickening of the adventitial intima and increased collagen I and collagen III in all layers of the thoracic aorta. Our findings demonstrate differing PAH progression in female and male Hif2a GOF mice. Specifically, alterations in extracellular matrix (ECM) content led to vascular stiffening in aged females, resulting in poor survival. Moreover, we show that SAS emerges early in mice with PAH by coupling studies of vascular mechanics and analyzing vascular structure and composition.Importantly, we present a model for assessing sex differences in hereditary PAH progression and sex-specific prognosis, proposing that aortic stiffening can be used to prognosticate future poor outcomes in PAH.

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Increased systemic arterial stiffness in patients with chronic thromboembolic pulmonary hypertension

Cited by 12 publications

References 23 publications

Prognostic Significance of Systemic Arterial Stiffness Evaluated by Cardio-Ankle Vascular Index in Patients with Idiopathic Pulmonary Hypertension

Prognostic Significance of Systemic Arterial Stiffness Evaluated by Cardio-Ankle Vascular Index in Patients with Idiopathic Pulmonary Hypertension

<p>Systemic Arterial Stiffness in New Diagnosed Idiopathic Pulmonary Arterial Hypertension Patients</p>

Vascular stiffening in aging females with a hypertension‐induced HIF2A gain‐of‐function mutation

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