RESUMEN

Arterial stiffness is a major condition related to many cardiovascular diseases. Traditional approaches in the assessment of arterial stiffness supported by machine learning techniques are limited to the pulse wave velocity (PWV) estimation based on pressure signals from the peripheral arteries. Nevertheless, arterial stiffness can be assessed based on the pressure-strain relationship by analyzing its hysteresis loop. In this work, the capacity of deep learning models based on generative adversarial networks (GANs) to transfer pressure signals from the peripheral arterial region to pressure and area signals located in the central arterial region is explored. The studied signals are from a public and validated virtual database. Compared to other works in which the assessment of arterial stiffness was performed via PWV, in the present work the pressure-strain hysteresis loop is reconstructed and evaluated in terms of classical machine learning metrics and clinical parameters. Least-square GAN (LSGAN) and Wasserstein GAN with gradient penalty (WGAN-GP) adversarial losses are compared, yielding better results with LSGAN. LSGAN mean ± standard deviation of error for pressure and area pulse waveforms are 0.8 ± 0.4 mmHg and 0.1 ± 0.1 cm2, respectively. Regarding the pressure-strain elastic modulus, it is achieved a mean absolute percentage error of 6.5 ± 5.1%. GAN-based deep learning models can recover the pressure-strain loop of central arteries while observing pressure signals from peripheral arteries.

Asunto(s)

Análisis de la Onda del Pulso , Rigidez Vascular , Presión Sanguínea/fisiología , Análisis de la Onda del Pulso/métodos , Presión Arterial , Arterias , Determinación de la Presión Sanguínea/métodos , Rigidez Vascular/fisiología

RESUMEN

Arterial stiffness may be associated with glucose metabolism parameters, such as HbA1c, mainly via insulin resistance. We aimed to investigate the association between arterial stiffness and HbA1c and explore the mediator effect of insulin resistance. In this cross-sectional study, arterial stiffness (pulse-wave velocity; PWV), HbA1c, and insulin resistance (METS-IR) were determined in Hispanic adults. In addition to sex and age, various biochemical measurements (glucose, lipid profile, etc.) and adipose tissue (fat mass and visceral fat mass) were considered as potential confounding variables. A multivariate regression analysis shows that HbA1c is associated with PWV, even after adjusting for several confounding variables. Importantly, the results show that insulin resistance mediated 17.9% of the effect of HbA1c over PWV. In conclusion, HbA1c may be a potential resource for predicting arterial stiffness due to the influence of insulin resistance in Hispanic subjects.

Asunto(s)

Resistencia a la Insulina , Rigidez Vascular , Adulto , Estudios Transversales , Hemoglobina Glucada , Hispánicos o Latinos , Humanos , Análisis de la Onda del Pulso/métodos

RESUMEN

Atrial fibrillation (AF) is the most common cardiac arrhythmia, affecting 0.5%-1% of people worldwide. Hemodynamic changes due to stiffening of the arteries may cause cardiac structural and electrical remodeling that induces AF.Pulse wave velocity (PWV) is a direct non-invasive method to measure arterial stiffness (AS). Central pulse pressure (PPc) describes oscillations around the mean arterial pressure and is increased in more rigid arteries. These two central variables can be considered markers of AF. Sympathetic activity has been reported to be directly relatedto PWV even in patients without comorbidities. Therefore, in patients with more rigid arteries, sudden changes in pressure could affect the activation of arterial baroreceptors, leading to an acute imbalance between the sympathetic and parasympathetic responses in the heart. The coexistence of AF and AS is common. This critical review aims to bring information about the role of AS in the pathophysiology of AF and discuss results of clinical studies on this topic. Althuogh discussed in the literature, further studies are needed to confirm the predictive role of these variables in AF, and their use in clinical practice.

Asunto(s)

Fibrilación Atrial , Rigidez Vascular , Presión Arterial , Fibrilación Atrial/diagnóstico , Presión Sanguínea , Humanos , Análisis de la Onda del Pulso/métodos , Rigidez Vascular/fisiología

RESUMEN

To compare global endothelial function assessed by pulse wave analysis (PWA) using the ratio of endothelium dependent vasodilatation (EDV) to endothelium independent vasodilatation (EIV) in patients with hypercholesterolemia and controls. 92 subjects [46 hypercholesterolemics, 46 controls] were studied at standardized conditions. Baseline augmentation index (AIx) was assessed followed by the administration of 0.5 mg sublingual nitroglycerine, an endothelium independent vasodilator. AIx was assessed and the maximum change in AIx after nitroglycerine was recorded as EIV. After a washout period of 30 minutes, 400 µg of inhaled salbutamol, an endothelium dependent vasodilator was administered. AIx was assessed again and the maximum change in AIx after salbutamol was recorded as EDV. Global endothelial function was calculated as EDV:EIV ratio. EDV and EIV in patients with hypercholesterolemia compared to controls were 2.97 ± 3.95 and 6.65 ± 3.80 (p<0.001); and 13.41 ± 4.57 and 15.88 ± 4.78 (p=0.01) respectively. EDV:EIV ratio was significantly reduced in patients with hypercholesterolemia compared to controls; 0.21 ± 0.38 and 0.44 ± 0.24 (p<0.001) respectively. EDV:EIV ratio was significantly reduced in patients with hypercholesterolemia compared to controls. PWA is a potential clinical tool to assess global endothelial function in patients with hypercholesterole

Asunto(s)

Humanos , Masculino , Femenino , Adulto , Endotelio/metabolismo , Análisis de la Onda del Pulso/métodos , Hipercolesterolemia , Pacientes , Vasodilatadores/efectos adversos

Asunto(s)

Grosor Intima-Media Carotídeo/instrumentación , Rigidez Vascular , Medicina Basada en la Evidencia , Análisis de la Onda del Pulso/métodos , Factores de Riesgo de Enfermedad Cardiaca

RESUMEN

ABSTRACT Objective The purpose of this study was to examine arterial stiffness in elite basketball and soccer athletes by pulse wave velocity. Methods The cohort comprised 35 healthy male volunteers aged 17 to 26 years. All the subjects were either basketball players (n=9), soccer players (n=12) or sedentary controls (n=14). Arterial stiffness was measured by the Pulse Trace System (Micro Medical Ltd., Rochester, UK) and echocardiographic images were taken using a commercially available machine (Vivid 7 GE-Vingmed, Horten, Norway) with a 2.5 MHz transducer. Results The basketball players had significantly higher heights and body weights as compared to both the soccer players and the controls. The aortic elastic properties derived from the echocardiographic measurements did not differ between the groups. The peripheral pulse wave velocity measurements showed significantly lower values both in the basketball and soccer players compared to the controls, whereas the central pulse wave velocity measurement was significantly lower only in the basketball players as compared to the controls. No significant difference was seen between the basketball and soccer players. Conclusions The results of this study show that football and basketball exercises comprised of aerobic, anaerobic, endurance balance-coordination and sport-specific training play a role in reducing arterial stiffness. Level of evidence I; type of study: prognostic study.

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RESUMO Objetivo O propósito deste estudo foi examinar a rigidez arterial em atletas de basquetebol e futebol medindo a velocidade da onda do pulso. Métodos A coorte foi composta por 35 voluntários saudáveis do sexo masculino, com idade entre 17 a 26 anos. Os participantes eram jogadores de basquetebol (n = 9), jogadores de futebol (n = 12) e controles sedentários (n = 14). A rigidez arterial foi medida com o Pulse Trace System (Micro Medical Ltd., Rochester, Reino Unido) e as imagens ecocardiográficas foram obtidas com um aparelho disponível no mercado, com transdutor de 2,5 MHz (Vivid 7 GE-Vingmed, Horten, Noruega). Resultados Os jogadores de basquetebol tinham estatura e peso corporal consideravelmente superiores aos dos jogadores de futebol e aos controles. As propriedades elásticas aórticas derivadas das medicas ecocardiográficas não diferiram entre os grupos. A velocidade da onda de pulso periférico foi significativamente menor nos jogadores de basquetebol e futebol em comparação com os controles, enquanto os jogadores de basquetebol tiveram velocidade da onda do pulso central consideravelmente menor que os controles. Não se observou diferença significativa entre os jogadores de basquetebol e os de futebol. Conclusões Os resultados deste estudo mostram que os exercícios de treinamento de futebol e basquetebol: aeróbicos, anaeróbicos, de resistência, de coordenação e equilíbrio e os treinamentos específicos de cada esporte têm um papel importante na redução da rigidez arterial. Nível de Evidência I, Estudo prognóstico.

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RESUMEN Objetivo El propósito de este estudio fue examinar la rigidez arterial en atletas de básquetbol y fútbol midiendo la velocidad de onda de pulso. Métodos La cohorte fue compuesta por 35 voluntarios saludables del sexo masculino, con edad entre 17 y 26 años. Los participantes eran jugadores de básquetbol (n=9), jugadores de fútbol (n=12) y controles sedentarios (n=14). La rigidez arterial fue medida con Pulse Trace System (Micro Medical Ltd., Rochester, Reino Unido) y las imágenes ecocardiográficas fueron obtenidas con un aparato disponible en el mercado, con transductor de 2,5 MHz (Vivid 7 GE-Vingmed, Horten, Noruega). Resultados Los jugadores de básquetbol tenían estatura y peso corporal considerablemente superiores a los de los jugadores de fútbol y a los de los controles. Las propiedades elásticas aórticas derivadas de las medidas ecocardiográficas no difirieron entre los grupos. La velocidad de onda de pulso periférico fue significativamente menor en los jugadores de básquetbol y fútbol en comparación con los controles, mientras que los jugadores de básquetbol tuvieron velocidad de onda de pulso central considerablemente menor que los controles. No se observó diferencia significativa entre los jugadores de básquetbol y los de fútbol. Conclusiones Los resultados de este estudio muestran que los ejercicios de entrenamiento de fútbol y básquetbol: aeróbicos, anaeróbicos, de resistencia, de coordinación y equilibrio y los entrenamientos específicos de cada deporte tienen un papel importante en la reducción de la rigidez arterial. Nivel de Evidencia I, Estudio pronóstico.

Asunto(s)

Humanos , Masculino , Adolescente , Adulto , Adulto Joven , Fútbol/fisiología , Baloncesto/fisiología , Rigidez Vascular/fisiología , Análisis de la Onda del Pulso/métodos , Estudios de Cohortes

RESUMEN

INTRODUCTION: Pulse wave analysis is an emerging approach that analyzes parameters comprising strong predictors of cardiovascular (CV) events and all-cause mortality, especially in patients with high CV risk based on established risk factors. This study used the oscillometric method, provided by the Mobil-o-Graph (PWA-EMI GmbH, Stolberg, Germany) device, to compare data regarding the pulse wave analysis parameters in hypertensive nondiabetic and diabetic patients. MATERIAL AND METHODS: In this cross-sectional study, 276 individuals were examined in the academic hypertension outpatient care unit of the Federal University of the Triângulo, in Mineiro, Brazil, from January to December 2016. The pulse wave analysis was performed by oscillometry, and its parameters were acquired from all patients. RESULTS: Of the 276 patients, 99 were diabetic and 177 nondiabetic. The mean systolic and pulse central blood pressure were significantly higher in diabetic patients than in nondiabetic patients (P = .008 and.0003, respectively). The mean peripheral systolic blood pressure and pulse pressure were also significantly higher in the diabetic group (P = .001 and P < .0001, respectively). The average pulse wave velocity (PWV, m/s) was 9.4 ±â€Š1.6 and 8.8 ±â€Š1.6 in the diabetic and nondiabetic groups, respectively (P = .003). CONCLUSION: The group of hypertensive diabetic patients had significantly higher central blood pressure, peripheral blood pressure, and PWV than the hypertensive nondiabetic patients. The patients with overlapping established CV risk factors presented values of the pulse wave analysis parameters consistent with higher central pressure and greater arterial stiffness.

Asunto(s)

Atención Ambulatoria , Presión Sanguínea/fisiología , Diabetes Mellitus/fisiopatología , Hipertensión/fisiopatología , Oscilometría/métodos , Análisis de la Onda del Pulso/métodos , Rigidez Vascular/fisiología , Brasil/epidemiología , Estudios Transversales , Diabetes Mellitus/diagnóstico , Diabetes Mellitus/epidemiología , Femenino , Estudios de Seguimiento , Humanos , Hipertensión/diagnóstico , Hipertensión/epidemiología , Incidencia , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Reproducibilidad de los Resultados , Factores de Riesgo , Sístole

RESUMEN

Pediatric elevated blood pressure (BP) and hypertension are usually defined using traditional BP tables at the 90th and 95th percentiles, respectively, based on sex, age, and height, which are cumbersome to use in clinical practice. The authors aimed to assess the performance of the static cut-points (120/80 mm Hg and 130/80 mm Hg for defining elevated BP and hypertension for adolescents, respectively; and 110/70 mm Hg and 120/80 mm Hg for children, respectively) in predicting increased arterial stiffness. Using data from five population-based cross-sectional studies conducted in Brazil, China, Korea, and New Zealand, a total of 2546 children and adolescents aged 6-17 years were included. Increased arterial stiffness was defined as pulse wave velocity ≥sex-specific, age-specific, and study population-specific 90th percentile. Compared to youth with normal BP, those with hypertension defined using the 2017 American Academy of Pediatrics guideline (hereafter referred to as "percentile-based cut-points") and the static cut-points were at similar risk of increased arterial stiffness, with odds ratios and 95% confidence intervals of 2.35 (1.74-3.17) and 3.07 (2.20-4.28), respectively. Area under the receiver operating characteristic curve and net reclassification improvement methods confirmed the similar performance of static cut-points and percentile-based cut-points (P for difference > .05). In conclusion, the static cut-points performed similarly well when compared with the percentile-based cut-points in predicting childhood increased arterial stiffness. Use of static cut-points to define hypertension in childhood might simplify identification of children with abnormal BP in clinical practice.

Asunto(s)

Hipertensión/fisiopatología , Análisis de la Onda del Pulso/métodos , Rigidez Vascular/fisiología , Adolescente , Presión Sanguínea/fisiología , Determinación de la Presión Sanguínea/métodos , Brasil/epidemiología , Estudios de Casos y Controles , Niño , China/epidemiología , Estudios Transversales , Femenino , Humanos , Hipertensión/diagnóstico , Masculino , Nueva Zelanda/epidemiología , República de Corea/epidemiología , Factores de Riesgo

RESUMEN

Hypertension is associated with insulin resistance (IR), metabolic syndrome (MS), and arterial stiffness. Non-insulin-based IR indexes were developed as tools for metabolic screening. Here, we aimed to evaluate the novel non-insulin-based Metabolic Score for IR (METS-IR) index for the prediction of incident hypertension and arterial stiffness evaluated using pulse wave velocity (PWV) analysis, compared with other non-insulin-based IR indexes. We evaluated two populations, a cross-sectional evaluation of high-risk individuals (n = 305) with a wide range of metabolic comorbidities and dyslipidemia in whom PWV measurement was performed and a 3-year prospective cohort of normotensive individuals (N = 6850). We observed a positive correlation between METS-IR and PWV in the cross-sectional cohort, which was higher compared with other non-insulin-based fasting IR indexes; furthermore, PWV values >75th percentile were associated with the upper tercile of METS-IR values. In the prospective cohort, we observed an increased risk for incident hypertension for the upper METS-IR tercile (METS-IR ≥ 46.42; HR: 1.81, 95% CI: 1.41-2.34), adjusted for known cardiovascular risk factors, and observed that METS-IR had greater increases in the predictive capacity for hypertension along with SBP and the Framingham Hypertension Risk Prediction Model compared with other non-insulin-based IR indexes. Therefore, METS-IR is a novel non-insulin-based IR index which correlates with arterial stiffness and is a predictor of incident hypertension, complementary to previously validated risk prediction models.

Asunto(s)

Hipertensión/fisiopatología , Resistencia a la Insulina/fisiología , Síndrome Metabólico/fisiopatología , Rigidez Vascular/fisiología , Adulto , Presión Sanguínea/fisiología , Índice de Masa Corporal , Enfermedades Cardiovasculares/epidemiología , Enfermedades Cardiovasculares/etiología , Estudios de Casos y Controles , Comorbilidad , Estudios Transversales , Dislipidemias/complicaciones , Dislipidemias/diagnóstico , Ayuno/metabolismo , Femenino , Humanos , Hipertensión/epidemiología , Incidencia , Masculino , Persona de Mediana Edad , Valor Predictivo de las Pruebas , Estudios Prospectivos , Análisis de la Onda del Pulso/métodos , Factores de Riesgo

RESUMEN

OBJECTIVES: To test whether youth with Down syndrome have aortic stiffness indices, as measured by pulse wave velocity (PWV), that differ from youth without Down syndrome and to compare reference-based age-adjusted (age-PWV-Z) and height-adjusted (Ht-PWV-Z) in youth with and without Down syndrome. STUDY DESIGN: Cross-sectional study of PWV in 129 adolescents with Down syndrome and 97 youth of comparable age, sex, race/ethnicity, and body mass index (BMI). PWV, age-PWV-Z, and Ht-PWV-Z were compared. Regression models were developed to test for associations with PWV. RESULTS: Youth with Down syndrome and controls were comparable in BMI-Z (1.4 [-1.5 to 2.8] vs 1.2 [-2.0 to 2.8], P = .57) but not Ht-Z (-2.3 [-4.7 to 0.8] vs 0.4 [-2.0 to 2.6], P < .0001). PWV (m/s, 5.0 [3.1-7.9] vs 5.0 [3.6-8.0], P = .5) and mean arterial pressure (MAP, mm Hg) (78 [61-102] vs 74 [64-97], P = .09) were not different between groups. In adjusted analyses confined to Down syndrome, PWV was associated only with BMI, but not age, black race, or MAP (R2 = 0.11). In contrast, BMI, age, black race, and MAP were all positively associated with and better explained PWV in controls (R2 = 0.50). PWV was not associated with height in youth with or without Down syndrome. Although age-PWV-Z was not different in Down syndrome (-0.36 [-2.93 to 3.49]) vs -0.15 [-2.32 to 3.22]), Ht-PWV-Z was greater in Down syndrome (0.32 [-2.28 to 4.07] vs -0.08 [-2.64 to 2.64], P = .002), and Ht-PWV-Z was greater than age-PWV-Z in Down syndrome (P < .0001). CONCLUSIONS: The lack of relationship of PWV, an independent predictor of adult cardiovascular events, with its traditional determinants including MAP suggests Down syndrome-specific phenomena may alter such relationships in this population. In youth with Down syndrome, Ht-adjusted PWV may overestimate aortic stiffness. TRIAL REGISTRATION: Clinicaltrials.gov: NCT01821300.

Asunto(s)

Síndrome de Down/fisiopatología , Rigidez Vascular , Adolescente , Adulto , Estudios de Casos y Controles , Niño , Estudios Transversales , Femenino , Humanos , Masculino , Análisis de la Onda del Pulso/métodos , Adulto Joven

RESUMEN

OBJECTIVES: Pulse wave velocity (PWV) is an early marker of arterial stiffness and a strong predictor of cardiovascular disease (CVD). Body fat measures, such as body mass index (BMI), waist circumference (WC), and visceral fat, have been associated with CVD in adulthood. The aim of this study was to evaluate the association of PWV at 30 y of age using body fat measures. METHODS: In 1982, the maternity hospitals in Pelotas, Brazil, were visited daily and all live births were identified. These infants have been prospectively followed several times. At 30 y, we tried to follow the cohort; the individuals were interviewed and had PWV, anthropometric parameters, abdominal fat, and visceral fat measured. RESULTS: The present study included 1576 individuals. PWV was highly correlated with BMI, WC, visceral fat thickness, and fat mass compared with other body composition measures. In linear regression analysis, the highest regression coefficients were observed for BMI (r = 0.30; 95% confidence interval [CI], 0.25-0.35), visceral fat thickness (r = 0.30; 95% CI, 0.24-0.35), and fat mass (r = 0.30; 95% CI, 0.24-0.35), even after controlling for potential confounders (sex, race, birth weight, family income, family education, and maternal smoking during pregnancy). CONCLUSION: In the present study, BMI, visceral fat thickness, and fat mass were the strongest body fat measures related to PWV.

Asunto(s)

Tejido Adiposo , Antropometría , Índice de Masa Corporal , Análisis de la Onda del Pulso/métodos , Adulto , Brasil , Enfermedades Cardiovasculares/etiología , Femenino , Humanos , Grasa Intraabdominal , Masculino , Valor Predictivo de las Pruebas , Estudios Prospectivos , Circunferencia de la Cintura

RESUMEN

Introducción: La aplicación de métodos para la detección de puntos clínicos de interés de la onda de pulso permite la obtención de parámetros como el índice de rigidez vascular y el de reflexión que facilitan la evaluación de los efectos vasculares del envejecimiento, la hipertensión y la aterosclerosis. Por esto es necesaria la adecuada localización del inicio, pico sistólico, incisura dicrota y el pico diastólico de la onda de pulso arterial. Objetivo: Desarrollar un algoritmo para la localización del inicio, pico sistólico, incisura dicrota y el pico diastólico de la onda de pulso arterial. Método: El algoritmo presentado utiliza la primera derivada unido a condicionales móviles para eliminar puntos no deseados, al igual que intervalos no confiables. El algoritmo fue evaluado utilizando la anotación de un experto, con 5 registros de onda de pulso arterial de 5 minutos (5236 anotaciones) y contaminadas a diferente relaciones señal ruido (15, 12 and 9 dB). Resultados: Cuando se comparó con las anotaciones de un experto el algoritmo detecto estos puntos fiduciales con una sensibilidad promedio, predictividad positiva y exactitud del 100 por ciento y mostró errores menores de 10ms. En señales de onda de pulso arterial contaminadas con ruido en ambos casos el error relativo fue menor que 2 por ciento respecto a un periodo de muestreo de 800ms. Conclusiones: el algoritmo provee una simple pero precisa detección de los puntos clínicos de interés de la onda de pulso arterial, robusto a ruido y artefactos de movimiento que pudiera ser utilizado en la evaluación del índice de rigidez y de reflexión vascular(AU)

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Introduction: The application of methods for the detection of clinical points of interest of the pulse wave allows obtaining parameters such as the index of vascular rigidity and reflection that facilitate the evaluation of the vascular effects of aging, hypertension and atherosclerosis. For this reason, the appropriate localization of the onset, systolic peak, dicrotic notchs and the diastolic peak of the arterial pulse wave is necessary. Objective: To develop an algorithm for the localization of the onset, systolic peak, dicrotic notchs and the diastolic peak of the arterial pulse wave. Method: The presented algorithm uses the first derivative linked to mobile conditionals to eliminate unwanted points, as well as unreliable intervals. The algorithm was evaluated using the annotation of an expert, with 5 records of arterial pulse wave of 5 minutes (5236 annotations) and contaminated at different signal-to-noise ratios (15, 12 and 9 dB). Results: When compared with the annotations of an expert, the algorithm detected these fiducial points with an average sensitivity, positive predictivity and 100 percent accuracy and showed errors of less than 10ms. In arterial pulse wave signals contaminated with noise in both cases the relative error was less than 2 percent with respect to a sampling period of 800ms. Conclusions: the algorithm provides a simple but accurate detection of the clinical points of interest of the arterial pulse wave, robust to noise and movement artifacts that could be used in the evaluation of the stiffness index and vascular reflection(AU)

Asunto(s)

Humanos , Algoritmos , Análisis de la Onda del Pulso/métodos , Presión Sanguínea

RESUMEN

Introducción: La aplicación de métodos para la detección de puntos clínicos de interés de la onda de pulso permite la obtención de parámetros como el índice de rigidez vascular y el de reflexión que facilitan la evaluación de los efectos vasculares del envejecimiento, la hipertensión y la aterosclerosis. Por esto es necesaria la adecuada localización del inicio, pico sistólico, incisura dicrota y el pico diastólico de la onda de pulso arterial. Objetivo: Desarrollar un algoritmo para la localización del inicio, pico sistólico, incisura dicrota y el pico diastólico de la onda de pulso arterial. Método: El algoritmo presentado utiliza la primera derivada unido a condicionales móviles para eliminar puntos no deseados, al igual que intervalos no confiables. El algoritmo fue evaluado utilizando la anotación de un experto, con 5 registros de onda de pulso arterial de 5 minutos (5236 anotaciones) y contaminadas a diferente relaciones señal ruido (15, 12 and 9 dB). Resultados: Cuando se comparó con las anotaciones de un experto el algoritmo detecto estos puntos fiduciales con una sensibilidad promedio, predictividad positiva y exactitud del 100 por ciento y mostró errores menores de 10ms. En señales de onda de pulso arterial contaminadas con ruido en ambos casos el error relativo fue menor que 2 por ciento respecto a un periodo de muestreo de 800ms. Conclusiones: el algoritmo provee una simple pero precisa detección de los puntos clínicos de interés de la onda de pulso arterial, robusto a ruido y artefactos de movimiento que pudiera ser utilizado en la evaluación del índice de rigidez y de reflexión vascular(AU)

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Introduction: The application of methods for the detection of clinical points of interest of the pulse wave allows obtaining parameters such as the index of vascular rigidity and reflection that facilitate the evaluation of the vascular effects of aging, hypertension and atherosclerosis. For this reason, the appropriate localization of the onset, systolic peak, dicrotic notchs and the diastolic peak of the arterial pulse wave is necessary. Objective: To develop an algorithm for the localization of the onset, systolic peak, dicrotic notchs and the diastolic peak of the arterial pulse wave. Method: The presented algorithm uses the first derivative linked to mobile conditionals to eliminate unwanted points, as well as unreliable intervals. The algorithm was evaluated using the annotation of an expert, with 5 records of arterial pulse wave of 5 minutes (5236 annotations) and contaminated at different signal-to-noise ratios (15, 12 and 9 dB). Results: When compared with the annotations of an expert, the algorithm detected these fiducial points with an average sensitivity, positive predictivity and 100 percent accuracy and showed errors of less than 10ms. In arterial pulse wave signals contaminated with noise in both cases the relative error was less than 2 percent with respect to a sampling period of 800ms. Conclusions: the algorithm provides a simple but accurate detection of the clinical points of interest of the arterial pulse wave, robust to noise and movement artifacts that could be used in the evaluation of the stiffness index and vascular reflection(AU)

Asunto(s)

Humanos , Masculino , Femenino , Presión Sanguínea , Algoritmos , Electrocardiografía/métodos , Análisis de la Onda del Pulso/métodos

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This study aimed to evaluate the effects of glycated hemoglobin (HbA1c ) on flow-mediated dilation, intima-media thickness, pulse wave velocity, and left ventricular mass index in patients with resistant hypertension (RHTN) comparing RHTN-controlled diabetes mellitus and RHTN-uncontrolled type 2 diabetes mellitus. Two groups were formed: HbA1c <7.0% (RHTN-controlled diabetes mellitus: n = 98) and HbA1c ≥7.0% (RHTN-uncontrolled diabetes mellitus: n = 122). Intima-media thickness and flow-mediated dilation were measured by high-resolution ultrasound, left ventricular mass index by echocardiography, and arterial stiffness by carotid-femoral pulse wave velocity. No differences in blood pressure levels were found between the groups but body mass index was higher in patients with RHTN-uncontrolled diabetes mellitus. Endothelial dysfunction and arterial stiffness were worse in patients with RHTN-uncontrolled diabetes mellitus. Intima-media thickness and left ventricular mass index measurements were similar between the groups. After adjustments, multiple linear regression analyses showed that HbA1c was an independent predictor of flow-mediated dilation and pulse wave velocity in all patients with RHTN. In conclusion, HbA1c may predict the grade of arterial stiffness and endothelial dysfunction in patients with RHTN, and superimposed uncontrolled diabetes mellitus implicates further impairment of vascular function.

Asunto(s)

Diabetes Mellitus Tipo 2/metabolismo , Endotelio Vascular/metabolismo , Hemoglobina Glucada/metabolismo , Hipertensión/metabolismo , Anciano , Índice de Masa Corporal , Grosor Intima-Media Carotídeo/estadística & datos numéricos , Diabetes Mellitus Tipo 2/fisiopatología , Ecocardiografía/métodos , Endotelio Vascular/fisiopatología , Femenino , Ventrículos Cardíacos/anatomía & histología , Humanos , Hipertensión/fisiopatología , Masculino , Persona de Mediana Edad , Análisis de la Onda del Pulso/métodos , Ultrasonografía/métodos , Rigidez Vascular/efectos de los fármacos

RESUMEN

BACKGROUND: Aging declines essential physiological functions, and the vascular system is strongly affected by artery stiffening. We intended to define the age- and sex-specific reference values for carotid-to-femoral pulse wave velocity (cf-PWV) in a sample free of major risk factors. METHODS AND RESULTS: The ELSA-Brasil study enrolled 15,105 participants aged 35-74years. The healthy sample was achieved by excluding diabetics, those over the optimal and normal blood pressure levels, body mass index ≤18.5 or ≥25kg/m2, current and former smokers, and those with self-report of previous cardiovascular disease. After exclusions, the sample consisted of 2158 healthy adults (1412 women). Although cf-PWV predictors were similar between sex (age, mean arterial pressure (MAP) and heart rate), cf-PWV was higher in men (8.74±1.15 vs. 8.31±1.13m/s; adjusted for age and MAP, P<0.001) for all age intervals. When divided by MAP categories, cf-PWV was significantly higher in those which MAP ≥85mmHg, regardless of sex, and for all age intervals. Risk factors for arterial stiffening in the entire ELSA-Brasil population (n=15,105) increased by twice the age-related slope of cf-PWV growth, regardless of sex (0.0919±0.182 vs. 0.0504±0.153m/s per year for men, 0.0960±0.173 vs. 0.0606±0.139m/s per year for women). CONCLUSIONS: cf-PWV is different between men and women and even in an optimal and normal range of MAP and free of other classical risk factors for arterial stiffness, reference values for cf-PWV should take into account MAP levels. Also, the presence of major risk factors in the general population doubles the age-related rise in cf-PWV.

Asunto(s)

Arterias Carótidas/fisiología , Arteria Femoral/fisiología , Análisis de la Onda del Pulso/métodos , Caracteres Sexuales , Adulto , Anciano , Velocidad del Flujo Sanguíneo/fisiología , Brasil/epidemiología , Estudios de Cohortes , Estudios Transversales , Femenino , Voluntarios Sanos , Humanos , Masculino , Persona de Mediana Edad , Estudios Prospectivos

RESUMEN

Increased arterial stiffness is an important determinant of cardiovascular risk, able to predict morbidity and mortality, and closely associated with ageing and blood pressure. The aims of this study were: (1) To determine the age-dependent reference pulse wave velocity (PWV), and compare it with values from hypertensive patients, and (2) to evaluate the impact of isolated and untreated hypertension on arterial stiffness. A total of 1079 patients were enrolled and divided into a control group (NT) of asymptomatic normotensive patients and a group of asymptomatic hypertensive patients (HT). Blood pressure, carotid-femoral PWV, and body mass index were measured in each subject, whose blood was drawn for laboratory tests. Aortic mean PWV in the NT group was 6.85 ± 1.66 m/s, which increased linearly (R2  = 0.62; P < .05) with age. In patients over 50 years of age, PWV was significantly higher than in younger patients (8.35 vs 5.92 m/s, respectively, P < .001). This significant difference persisted when observing male and female patients separately. In the hypertensive group, mean PWV value was 8.04 ± 1.8 m/s (range 4.5-15.8 m/s) and increased (R2  = 0.243; P < .05) with age. The PWV increase in HT was significantly higher (0.93 m/s per decade, P < .001) than in NT (0.44 m/s per decade). Our study provides normal values of PVW per decade, and shows that these values increase with age, especially after 50 years of age, particularly in HT patients. This stiffness growth rate may be responsible for increased cardiovascular risk in both groups.

Asunto(s)

Envejecimiento/fisiología , Aorta/fisiopatología , Arterias Carótidas/fisiopatología , Hipertensión , Análisis de la Onda del Pulso/métodos , Rigidez Vascular , Factores de Edad , Anciano , Argentina/epidemiología , Enfermedades Asintomáticas , Presión Sanguínea/fisiología , Determinación de la Presión Sanguínea/métodos , Femenino , Humanos , Hipertensión/diagnóstico , Hipertensión/epidemiología , Hipertensión/fisiopatología , Masculino , Persona de Mediana Edad , Vigilancia de la Población , Factores Sexuales

RESUMEN

Fundamento: A Caminhada Ecológica que ocorre anualmente no Brasil, é um evento único por sua distância (310 Km) e dinâmica de realização (média de 62 km/dia por 5 dias, com ritmo médio de 7,6 km/h). Embora os efeitos benéficos de exercícios de intensidade moderada sejam bem conhecidos, os efeitos do exercício intenso e de longa duração ainda requerem estudo. Objetivo: Avaliar os efeitos da modalidade mista caminhada/corrida em vários parâmetros de pressão arterial (PA) 30 dias antes (A0) do evento, e ao final dos dias 2 (A2), 3 (A3) e 4 (A4) da caminhada. Métodos: Foram medidas PA sistólica e diastólica central (cPAS e cPAD, respectivamente), PA sistólica e diastólica periférica (pPAS e pPAD, respectivamente), pressão de pulso central (cPP), pressão de pulso periférica (pPP), pressão de pulso amplificada (aPP), augmentation index ajustado (AIx75%) e velocidade da onda de pulso (VOP) com Mobil-O-Graph ® (IEM, Stolberg, Alemanha) em 25 atletas do sexo masculino (idade média, 45,3 ± 9,1 anos). Foi considerado significativo valor de p < 0,05. Resultados: Houve redução de cPAS de A0 para A2 (109,5 para 118,1 mmHg) e de A0 para A3 (109,5 para 102,5 mmHg); redução de pPP de A0 para A2 (49,2 para 38,2 mmHg) e de A0 para A4 (49,2 para 41,2 mmHg); redução de aPP de A0 para A1 (15,6 para 9,5 mmHg), de A0 para A2 (15,6 para 8,0 mmHg) e de A0 para A3 (15,6 para 11,2 mmHg). VOP correlacionou-se com idade. Conclusões: A PA caiu nos primeiros dias da caminhada de longa distância, retornando a níveis próximos aos basais no final, e a VOP correlacionou-se fortemente com idade. Esse tipo de exercício promove efeitos na PA e na VOP similares aos vistos em esportes de longa duração e alta intensidade. Tais mudanças em indivíduos saudáveis e treinados não parecem aumentar os riscos cardiovasculares. Este foi o primeiro estudo a avaliar os efeitos desse tipo de exercício no sistema cardiovascular

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Background: An ecological hiking occurs yearly in Brazil. It is a unique event because of its distance (310 km) and dynamics (mean of 62 km/day for 5 days with mean pace of 7.6 km/h). Although beneficial effects of moderate-intensity exercises are well-known, the effects of intense and long-duration exercise still require study. Objective: To evaluate the effects of mixed walking/running race on various blood pressure (BP) parameters 30 days before (A0), on the 2 nd (A2), 3 rd (A3), and 4 th (A4) days after completing the day's stage. Methods: Central systolic (cSBP) and diastolic BP (cDBP), peripheral systolic (pSBP) and diastolic BP (pDBP), central pulse pressure (cPP), peripheral pulse pressure (pPP), amplified pulse pressure (aPP), corrected augmentation index (AIx75%) and pulse wave velocity (PWV) were measured using an oscillometric Mobil-O-Graph ® (IEM, Stolberg, Germany) in 25 male athletes (mean age of 45.3 ± 9.1 years). A p value < 0.05 was considered a statistically-significant difference. Results: cSBP decreased from A0 to A2 (109.5 to 118.1 mmHg) and from A0 to A3 (109.5 to 102.5 mmHg); pPP decrease from A0 to A2 (49.2 to 38.2 mmHg) and from A0 to A4 (49.2 to 41.2 mmHg); aPP decrease from A0 to A1 (15.6 to 9.5 mmHg), from A0 to A2 (15.6 to 8.0 mmHg) and from A0 to A3 (15.6 to 11.2 mmHg). PWV correlated with age. Conclusions: Blood pressure dropped on the first days of the race and returned to close to baseline values at the end. PWV correlates strongly with age. This type of exercise promotes effects on BP and PWV similar to those seen in long-duration, high-intensity sports. These changes in trained healthy individuals do not seem to increase cardiovascular risks. This was the first study to assess the effects of this type of exercise on the cardiovascular system

Asunto(s)

Humanos , Masculino , Persona de Mediana Edad , Presión Arterial , Hipertensión/diagnóstico , Análisis de la Onda del Pulso/métodos , Rigidez Vascular , Caminata , Factores de Edad , Análisis de Varianza , Atletas , Enfermedades Cardiovasculares , Enfermedad Coronaria/complicaciones , Factores de Riesgo

RESUMEN

Metabolic syndrome (MetS) causes autonomic alteration and vascular dysfunction. The authors investigated whether impaired fasting glucose (IFG) is the main cause of vascular dysfunction via elevated sympathetic tone in nondiabetic patients with MetS. Pulse wave velocity, muscle sympathetic nerve activity (MSNA), and forearm vascular resistance was measured in patients with MetS divided according to fasting glucose levels: (1) MetS+IFG (blood glucose ≥100 mg/dL) and (2) MetS-IFG (<100 mg/dL) compared with healthy controls. Patients with MetS+IFG had higher pulse wave velocity than patients with MetS-IFG and controls (median 8.0 [interquartile range, 7.2-8.6], 7.3 [interquartile range, 6.9-7.9], and 6.9 [interquartile range, 6.6-7.2] m/s, P=.001). Patients with MetS+IFG had higher MSNA than patients with MetS-IFG and controls, and patients with MetS-IFG had higher MSNA than controls (31±1, 26±1, and 19±1 bursts per minute; P<.001). Patients with MetS+IFG were similar to patients with MetS-IFG but had higher forearm vascular resistance than controls (P=.008). IFG was the only predictor variable of MSNA. MSNA was associated with pulse wave velocity (R=.39, P=.002) and forearm vascular resistance (R=.30, P=.034). In patients with MetS, increased plasma glucose levels leads to an adrenergic burden that can explain vascular dysfunction.

Asunto(s)

Glucemia/análisis , Intolerancia a la Glucosa/complicaciones , Síndrome Metabólico/fisiopatología , Sistema Nervioso Simpático/fisiopatología , Glucemia/metabolismo , Femenino , Intolerancia a la Glucosa/epidemiología , Intolerancia a la Glucosa/fisiopatología , Humanos , Resistencia a la Insulina , Masculino , Síndrome Metabólico/complicaciones , Síndrome Metabólico/epidemiología , Persona de Mediana Edad , Estado Prediabético/complicaciones , Estudios Prospectivos , Análisis de la Onda del Pulso/métodos , Factores de Riesgo , Resistencia Vascular/fisiología , Rigidez Vascular/fisiología , Circunferencia de la Cintura

RESUMEN

Whether sex influences the association of obstructive sleep apnea (OSA) with markers of cardiovascular risk in patients with hypertension is unknown. In this study, 95 hypertensive participants underwent carotid-femoral pulse wave velocity, 24-hour ambulatory blood pressure monitoring, echocardiogram, and polysomnography after a 30-day standardized treatment with hydrochlorothiazide plus enalapril or losartan. OSA was present in 52 patients. Compared with non-OSA patients, pulse wave velocity values were higher in the OSA group (men: 11.1±2.2 vs 12.7±2.4 m/s, P=.04; women: 11.8±2.4 vs 13.2±2.2 m/s, P=.03). The proportion of diastolic dysfunction was significant in men and women with OSA. Compared with non-OSA patients, nondipping systolic blood pressure in OSA was higher in men (14.3% vs 46.4%) and in women (41.4% vs 65.2%). OSA was independently associated with pulse wave velocity (ß=1.050; P=.025) and nondipping systolic blood pressure (odds ratio, 3.03; 95% confidence interval, 1.08-8.55; P=.035) in the regression analysis. In conclusion, OSA is independently associated with arterial stiffness and nondipping blood pressure in patients with hypertension regardless of sex.

Asunto(s)

Presión Sanguínea/fisiología , Enfermedades Cardiovasculares/epidemiología , Hipertensión/complicaciones , Apnea Obstructiva del Sueño/complicaciones , Rigidez Vascular/fisiología , Adulto , Anciano , Bloqueadores del Receptor Tipo 1 de Angiotensina II/uso terapéutico , Inhibidores de la Enzima Convertidora de Angiotensina/uso terapéutico , Monitoreo Ambulatorio de la Presión Arterial/métodos , Brasil/epidemiología , Enfermedades Cardiovasculares/fisiopatología , Diuréticos/normas , Diuréticos/uso terapéutico , Ecocardiografía/métodos , Enalapril/administración & dosificación , Enalapril/uso terapéutico , Femenino , Humanos , Hidroclorotiazida/administración & dosificación , Hidroclorotiazida/normas , Hidroclorotiazida/uso terapéutico , Hipertensión/tratamiento farmacológico , Hipertensión/epidemiología , Hipertensión/fisiopatología , Losartán/administración & dosificación , Losartán/uso terapéutico , Masculino , Persona de Mediana Edad , Polisomnografía/métodos , Análisis de la Onda del Pulso/métodos , Factores de Riesgo , Apnea Obstructiva del Sueño/epidemiología , Apnea Obstructiva del Sueño/fisiopatología

RESUMEN

AIMS: To analyze the early vascular aging (EVA) in end-stage renal disease (ESRD) patients, attempting to determine a potential association between EVA and the etiology of ESRD, and to investigate the association of hemodialysis and EVA in ESRD patients during a 5-year follow-up period. METHODS: Carotid-femoral pulse wave velocity (cfPWV) was obtained in 151 chronically hemodialyzed patients (CHP) and 283 control subjects, and in 25 CHP, who were followed-up after a 5-year lapse. RESULTS: cfPWV increased in ESRD patients compared to control subjects. The cfPWV-age relationship was found to have a steeper increase in ESRD patients. The highest cfPWV and EVA values were observed in patients with diabetic nephropathy. Regression analysis demonstrated a significant reduction of the EVA in HD patients on a 5-year follow-up. CONCLUSION: Patients in ESRD showed higher levels of EVA. cfPWV and EVA differed in ESRD patients depending on their renal failure etiology. CHP showed an EVA reduction after a 5-year follow-up period.

Asunto(s)

Fallo Renal Crónico/terapia , Diálisis Renal , Envejecimiento , Arterias Carótidas/fisiopatología , Estudios de Casos y Controles , Arteria Femoral/fisiopatología , Estudios de Seguimiento , Humanos , Fallo Renal Crónico/complicaciones , Análisis de la Onda del Pulso/métodos