The document discusses arterial stiffness in predicting preeclampsia. There is evidence that preeclampsia is associated with increased arterial stiffness, an important predictor of outcomes. A meta-analysis showed arterial stiffness indices are significantly higher in preeclamptic women compared to normotensive pregnant women. Arterial stiffness varies throughout normal pregnancy, reaching its lowest point in the second trimester and rising in the third trimester, while in preeclamptic women it continues to increase throughout pregnancy. Measuring arterial stiffness in early pregnancy may help identify women at risk of developing preeclampsia.
ASA/AHA 2014 guidelines for the Primary Prevention of Stroke
Hypertension and dyslipidemia impact on stroke development and prevention
SPRINT and HOPE-3
ASA/AHA 2014 guidelines for the Primary Prevention of Stroke
Hypertension and dyslipidemia impact on stroke development and prevention
SPRINT and HOPE-3
I wish to express our heartfelt gratitude to the following
individuals whose unwavering support and contributions have
played a pivotal role in the creation of this book "Innovations in
Cardiology: From Fundamentals to Frontiers – Short Notes in
Cardiology," My sincere thanks go to: Professor Sufia Rahman,
Professor Abdullah Al Shafi Majumder, Professor dr. Abduz
Zaher, Professor Syed Azizul Haque, Professor Dr Nurunnahar
Fatema Begum; Professor Md. Atahar Ali, Professor Dr. Afzalur
Rahman, Professor Fazila- Tun- Nessa Malik, Professor Kh.
Qamrul Islam; Professor Dr. GM Faruque, Professor M.
Maksumul Haq,Professo Dr. Sajal Krisna Banerjee; Professor
Dr. STM Abu Azam; Professor Mir Jamal Uddin, Professor
Mohammad Abdur Rashid, Professor Dr. AKM Fazlur Rahman,
Professor Dr. Abdul Kader Akanda, Professor Dr. AQM Reza,
Professor Dr. Saiful Islam; Dr. Shams Munwar; Professor Dr.
Chaudhury Meshkat Ahmed, Professor Dr. Khaled Mohsin,
Professor Abdul Wadud Chowdhury, Professor Razia Sultana
Mahmud,Professor Dr. M Touhidul Haque; Professor Dr. Md.
Sahabuddin, Professor Prabir Kumar Das, Professor Dr. Baren
Chakraborty, Professor Dr. Amirul Khusru, Dr. Kaiser Nasrullah
Khan, Professor Ashok Dutta, Professor Md. Khalequzzaman,
Dr. Abdullah Al Jamil, Professor Dr. Amal Kumar Choudhury,
Professor Mostafa Zaman Babul, Professor Dr Dipal Krishna
Adhikary, Professor Dr. Dipankar Chandra Nag professor Dr.
Moeen Uddin Ahmed, professor Mir nesar Uddin; Brig. Gen. Dr.
Syeda Aleya Sultana,Professor Dr Syed Nasir Uddin; Professor
Dr Mohsin Hossain; Dr. Sm Shahidul Haque; Professor Dr
Tawfiq Shahriar Huq; Dr. SM Quamrul Haque; Professor Dr.
Mamunur Rashid Sizar, Professor Dr. Mohsin Ahmed, Professor
Dr. Zillur Rahman; Professor Dr. Tanjima Parveen; Professor Dr.
Harisul hoque, Dr. Reyan Anis, Dr. Ashish Dey, Dr. Mohammad
Ullah firoz, Professor Dr. Udoy Shankar Roy; Dr. Nuruddin
Tareq; Dr. Md. Towhiduzzaman, Dr. Kh. Asaduzzaman, Dr.
AKM Monwarul Islam, Dr. Abdul Momen, Dr. Md. Shafiqur
Rahman Patwary, Dr. Md, Zulfiker Ali Lenin; Dr. Mahbub
Mansur, Dr. CM Shaheen Kabir, Dr. Rumi Alam, Dr. Farah
ii
Tasneem Mowmi, Dr. Rashid Ahmed, Dr. Mohammad Anowar
Hossain, Dr. Mohammad Nasimul Gani,Professor Dr abu Tarek
Iqbal, Dr. Husnayen Nanna, Dr. Abdul Malek, Dr, Ajoy Kumar
Datta, Dr. Nur Alam; Dr. Sahela Nasrin; Dr. Haripada sarker, Dr.
Anisul Awal, Dr. Shaila Nabi; Professor Dr. Umme Salma Khan;
Dr SM Ahsan Habib; Professor Dr Solaiman Hossain; Dr. Bijoy
Dutta,Dr. Shahana Zaman; Dr. Ishrat Jahan shimu, Dr. Ibrahim
Khalil. Dr. Chayan Kumar Singha, Dr. Kazi Nazrul Islam, Dr.
Kamal pasha; professor Dr. Liakat Hossain Tapan, Professor Dr.
Mamun Iqbal, Professor Dr. MG Azam, Dr. Lima Asrin Sayami,
Dr. Smita Kanungo; Dr. Sadequl Islam Shamol; Dr. Swadesh
chakraborty; Dr. Md. Rasul Amin Shepon; Dr. Saqif shahriar;
Your collective wisdom, expertise and commitment to the field
of cardiology have enriched the content of this book. Your
mentorship and guidance have been invaluable in shapi
I wish to express our heartfelt gratitude to the following
individuals whose unwavering support and contributions have
played a pivotal role in the creation of this book "Innovations in
Cardiology: From Fundamentals to Frontiers – Short Notes in
Cardiology," My sincere thanks go to: Professor Sufia Rahman,
Professor Abdullah Al Shafi Majumder, Professor dr. Abduz
Zaher, Professor Syed Azizul Haque, Professor Dr Nurunnahar
Fatema Begum; Professor Md. Atahar Ali, Professor Dr. Afzalur
Rahman, Professor Fazila- Tun- Nessa Malik, Professor Kh.
Qamrul Islam; Professor Dr. GM Faruque, Professor M.
Maksumul Haq,Professo Dr. Sajal Krisna Banerjee; Professor
Dr. STM Abu Azam; Professor Mir Jamal Uddin, Professor
Mohammad Abdur Rashid, Professor Dr. AKM Fazlur Rahman,
Professor Dr. Abdul Kader Akanda, Professor Dr. AQM Reza,
Professor Dr. Saiful Islam; Dr. Shams Munwar; Professor Dr.
Chaudhury Meshkat Ahmed, Professor Dr. Khaled Mohsin,
Professor Abdul Wadud Chowdhury, Professor Razia Sultana
Mahmud,Professor Dr. M Touhidul Haque; Professor Dr. Md.
Sahabuddin, Professor Prabir Kumar Das, Professor Dr. Baren
Chakraborty, Professor Dr. Amirul Khusru, Dr. Kaiser Nasrullah
Khan, Professor Ashok Dutta, Professor Md. Khalequzzaman,
Dr. Abdullah Al Jamil, Professor Dr. Amal Kumar Choudhury,
Professor Mostafa Zaman Babul, Professor Dr Dipal Krishna
Adhikary, Professor Dr. Dipankar Chandra Nag professor Dr.
Moeen Uddin Ahmed, professor Mir nesar Uddin; Brig. Gen. Dr.
Syeda Aleya Sultana,Professor Dr Syed Nasir Uddin; Professor
Dr Mohsin Hossain; Dr. Sm Shahidul Haque; Professor Dr
Tawfiq Shahriar Huq; Dr. SM Quamrul Haque; Professor Dr.
Mamunur Rashid Sizar, Professor Dr. Mohsin Ahmed, Professor
Dr. Zillur Rahman; Professor Dr. Tanjima Parveen; Professor Dr.
Harisul hoque, Dr. Reyan Anis, Dr. Ashish Dey, Dr. Mohammad
Ullah firoz, Professor Dr. Udoy Shankar Roy; Dr. Nuruddin
Tareq; Dr. Md. Towhiduzzaman, Dr. Kh. Asaduzzaman, Dr.
AKM Monwarul Islam, Dr. Abdul Momen, Dr. Md. Shafiqur
Rahman Patwary, Dr. Md, Zulfiker Ali Lenin; Dr. Mahbub
Mansur, Dr. CM Shaheen Kabir, Dr. Rumi Alam, Dr. Farah
ii
Tasneem Mowmi, Dr. Rashid Ahmed, Dr. Mohammad Anowar
Hossain, Dr. Mohammad Nasimul Gani,Professor Dr abu Tarek
Iqbal, Dr. Husnayen Nanna, Dr. Abdul Malek, Dr, Ajoy Kumar
Datta, Dr. Nur Alam; Dr. Sahela Nasrin; Dr. Haripada sarker, Dr.
Anisul Awal, Dr. Shaila Nabi; Professor Dr. Umme Salma Khan;
Dr SM Ahsan Habib; Professor Dr Solaiman Hossain; Dr. Bijoy
Dutta,Dr. Shahana Zaman; Dr. Ishrat Jahan shimu, Dr. Ibrahim
Khalil. Dr. Chayan Kumar Singha, Dr. Kazi Nazrul Islam, Dr.
Kamal pasha; professor Dr. Liakat Hossain Tapan, Professor Dr.
Mamun Iqbal, Professor Dr. MG Azam, Dr. Lima Asrin Sayami,
Dr. Smita Kanungo; Dr. Sadequl Islam Shamol; Dr. Swadesh
chakraborty; Dr. Md. Rasul Amin Shepon; Dr. Saqif shahriar;
Your collective wisdom, expertise and commitment to the field
of cardiology have enriched the content of this book. Your
mentorship and guidance have been invaluable in shapi
The Vertebral Artery Test
Luc Peeters, MSc.Ost. & Grégoire Lason, MSc.Ost.
The International Academy of Osteopathy
http://www.osteopathie.eu/en
http://www.osteopathie.eu/en/publications
info@osteopathy.eu
Aging and the Cardiovascular System; An in vivo and in vitro approach to the ...Scintica Instrumentation
Almost one third of deaths world-wide can be attributed to cardiovascular diseases (CVD). More than half of those cases are related to systemic arterial hypertension (SAH). There are several risk factors that contribute to the development of SAH. Type II diabetes causes structural and functional damage to arterial walls, which leads to stiffness of compliance vessels and eventually SAH. Some studies have also related oxidative stress, genetics, and neuroendocrine changes to increasing stiffness. Another risk factor that effects everyone is age, and this webinar will explore the effect of vascular aging and how vascular aging and arterial stiffness can be assessed.
Experimental and clinical studies have demonstrated that changes in small artery structure and function are associated with age. These changes include decreased lumen diameter, increased wall thickness and diminished vasoreactivity. Other risk factors such as hypertension and diabetes accelerate and exacerbate these changes. Quantifying these parameters using isolated and pressurized, perfused, cannulated blood vessels is an ideal way to aid in elucidating the underlying causes of these changes to the vasculature and as they relate to aging and cardiovascular health.
Measuring stiffness in progressive diseases can be challenging, but pulse wave velocity (PWV) is considered the gold standard to assess arterial stiffness in vivo. There is epidemiological evidence of the predictive value of PWV for cardiovascular events, and PWV assessment can be done non-invasively and longitudinally for monitoring the progression and improvement of arterial stiffness through different disease models and treatments. For translational researchers, the PWV measurement technique can be adapted from the traditional clinical technique to be used to assess PWV in preclinical animal research studies. As many of the models for CVD use rodents, PWV in small animals is one of the best ways to monitor treatment efficacy and disease progression for pre-clinical research.
By combining these two modalities, both in vivo and in vitro, researchers can assess arterial stiffness and resulting vascular dysfunction. In this webinar we will discuss both methodologies, the techniques and instrumentation used, and some relevant journal articles that use these techniques to assess vascular aging.
This webinar will cover the following topics:
Vascular stiffness, systemic arterial hypertension and other associated effects of aging on the cardiovascular system
Pulse Wave Velocity (PWV) and Pressure Arteriography and how they can be used to assess arterial stiffness:
PWV as the gold-standard for longitudinal, non-invasive estimates of arterial stiffness
Pressure Arteriography and why it is essential for measuring isolated vessel structure and function to assess vascular activity
A brief summary of relevant literature
Aterosclerosi il danno d'organo: vasculopatia periferica - di P. Buonamico MedOliveOil
Aterosclerosi il danno d'organo: vasculopatia periferica - di P. Buonamico. 7 giugno 2012. Corso di formazione "valore nutrizionale e salutistico di prodotti agroalimentari” - Università degli studi di Bari.
Total body sodium is the major determinant of extracellular
fluid volume. Increased total body sodium and fluid volume
is an inevitable consequence of end-stage renal failure
because kidneys have a key role in the regulation of sodium
balance
ICH Guidelines for Pharmacovigilance.pdfNEHA GUPTA
The "ICH Guidelines for Pharmacovigilance" PDF provides a comprehensive overview of the International Council for Harmonisation of Technical Requirements for Pharmaceuticals for Human Use (ICH) guidelines related to pharmacovigilance. These guidelines aim to ensure that drugs are safe and effective for patients by monitoring and assessing adverse effects, ensuring proper reporting systems, and improving risk management practices. The document is essential for professionals in the pharmaceutical industry, regulatory authorities, and healthcare providers, offering detailed procedures and standards for pharmacovigilance activities to enhance drug safety and protect public health.
The Importance of Community Nursing Care.pdfAD Healthcare
NDIS and Community 24/7 Nursing Care is a specific type of support that may be provided under the NDIS for individuals with complex medical needs who require ongoing nursing care in a community setting, such as their home or a supported accommodation facility.
R3 Stem Cells and Kidney Repair A New Horizon in Nephrology.pptxR3 Stem Cell
R3 Stem Cells and Kidney Repair: A New Horizon in Nephrology" explores groundbreaking advancements in the use of R3 stem cells for kidney disease treatment. This insightful piece delves into the potential of these cells to regenerate damaged kidney tissue, offering new hope for patients and reshaping the future of nephrology.
Deep Leg Vein Thrombosis (DVT): Meaning, Causes, Symptoms, Treatment, and Mor...The Lifesciences Magazine
Deep Leg Vein Thrombosis occurs when a blood clot forms in one or more of the deep veins in the legs. These clots can impede blood flow, leading to severe complications.
CHAPTER 1 SEMESTER V - ROLE OF PEADIATRIC NURSE.pdfSachin Sharma
Pediatric nurses play a vital role in the health and well-being of children. Their responsibilities are wide-ranging, and their objectives can be categorized into several key areas:
1. Direct Patient Care:
Objective: Provide comprehensive and compassionate care to infants, children, and adolescents in various healthcare settings (hospitals, clinics, etc.).
This includes tasks like:
Monitoring vital signs and physical condition.
Administering medications and treatments.
Performing procedures as directed by doctors.
Assisting with daily living activities (bathing, feeding).
Providing emotional support and pain management.
2. Health Promotion and Education:
Objective: Promote healthy behaviors and educate children, families, and communities about preventive healthcare.
This includes tasks like:
Administering vaccinations.
Providing education on nutrition, hygiene, and development.
Offering breastfeeding and childbirth support.
Counseling families on safety and injury prevention.
3. Collaboration and Advocacy:
Objective: Collaborate effectively with doctors, social workers, therapists, and other healthcare professionals to ensure coordinated care for children.
Objective: Advocate for the rights and best interests of their patients, especially when children cannot speak for themselves.
This includes tasks like:
Communicating effectively with healthcare teams.
Identifying and addressing potential risks to child welfare.
Educating families about their child's condition and treatment options.
4. Professional Development and Research:
Objective: Stay up-to-date on the latest advancements in pediatric healthcare through continuing education and research.
Objective: Contribute to improving the quality of care for children by participating in research initiatives.
This includes tasks like:
Attending workshops and conferences on pediatric nursing.
Participating in clinical trials related to child health.
Implementing evidence-based practices into their daily routines.
By fulfilling these objectives, pediatric nurses play a crucial role in ensuring the optimal health and well-being of children throughout all stages of their development.
India Clinical Trials Market: Industry Size and Growth Trends [2030] Analyzed...Kumar Satyam
According to TechSci Research report, "India Clinical Trials Market- By Region, Competition, Forecast & Opportunities, 2030F," the India Clinical Trials Market was valued at USD 2.05 billion in 2024 and is projected to grow at a compound annual growth rate (CAGR) of 8.64% through 2030. The market is driven by a variety of factors, making India an attractive destination for pharmaceutical companies and researchers. India's vast and diverse patient population, cost-effective operational environment, and a large pool of skilled medical professionals contribute significantly to the market's growth. Additionally, increasing government support in streamlining regulations and the growing prevalence of lifestyle diseases further propel the clinical trials market.
Growing Prevalence of Lifestyle Diseases
The rising incidence of lifestyle diseases such as diabetes, cardiovascular diseases, and cancer is a major trend driving the clinical trials market in India. These conditions necessitate the development and testing of new treatment methods, creating a robust demand for clinical trials. The increasing burden of these diseases highlights the need for innovative therapies and underscores the importance of India as a key player in global clinical research.
Leading the Way in Nephrology: Dr. David Greene's Work with Stem Cells for Ki...Dr. David Greene Arizona
As we watch Dr. Greene's continued efforts and research in Arizona, it's clear that stem cell therapy holds a promising key to unlocking new doors in the treatment of kidney disease. With each study and trial, we step closer to a world where kidney disease is no longer a life sentence but a treatable condition, thanks to pioneers like Dr. David Greene.
Medical Technology Tackles New Health Care Demand - Research Report - March 2...pchutichetpong
M Capital Group (“MCG”) predicts that with, against, despite, and even without the global pandemic, the medical technology (MedTech) industry shows signs of continuous healthy growth, driven by smaller, faster, and cheaper devices, growing demand for home-based applications, technological innovation, strategic acquisitions, investments, and SPAC listings. MCG predicts that this should reflects itself in annual growth of over 6%, well beyond 2028.
According to Chris Mouchabhani, Managing Partner at M Capital Group, “Despite all economic scenarios that one may consider, beyond overall economic shocks, medical technology should remain one of the most promising and robust sectors over the short to medium term and well beyond 2028.”
There is a movement towards home-based care for the elderly, next generation scanning and MRI devices, wearable technology, artificial intelligence incorporation, and online connectivity. Experts also see a focus on predictive, preventive, personalized, participatory, and precision medicine, with rising levels of integration of home care and technological innovation.
The average cost of treatment has been rising across the board, creating additional financial burdens to governments, healthcare providers and insurance companies. According to MCG, cost-per-inpatient-stay in the United States alone rose on average annually by over 13% between 2014 to 2021, leading MedTech to focus research efforts on optimized medical equipment at lower price points, whilst emphasizing portability and ease of use. Namely, 46% of the 1,008 medical technology companies in the 2021 MedTech Innovator (“MTI”) database are focusing on prevention, wellness, detection, or diagnosis, signaling a clear push for preventive care to also tackle costs.
In addition, there has also been a lasting impact on consumer and medical demand for home care, supported by the pandemic. Lockdowns, closure of care facilities, and healthcare systems subjected to capacity pressure, accelerated demand away from traditional inpatient care. Now, outpatient care solutions are driving industry production, with nearly 70% of recent diagnostics start-up companies producing products in areas such as ambulatory clinics, at-home care, and self-administered diagnostics.
How many patients does case series should have In comparison to case reports.pdfpubrica101
Pubrica’s team of researchers and writers create scientific and medical research articles, which may be important resources for authors and practitioners. Pubrica medical writers assist you in creating and revising the introduction by alerting the reader to gaps in the chosen study subject. Our professionals understand the order in which the hypothesis topic is followed by the broad subject, the issue, and the backdrop.
https://pubrica.com/academy/case-study-or-series/how-many-patients-does-case-series-should-have-in-comparison-to-case-reports/
Empowering ACOs: Leveraging Quality Management Tools for MIPS and BeyondHealth Catalyst
Join us as we delve into the crucial realm of quality reporting for MSSP (Medicare Shared Savings Program) Accountable Care Organizations (ACOs).
In this session, we will explore how a robust quality management solution can empower your organization to meet regulatory requirements and improve processes for MIPS reporting and internal quality programs. Learn how our MeasureAble application enables compliance and fosters continuous improvement.
2. • There is emerging evidence that PE is associated
with increased arterial stiffness (AS), which is
itself an important predictor of outcome.
• A recent meta- analysis of 23 relevant studies
showed a significant increase in all AS indices
measured in pre-eclamptic compared with
normotensive pregnant women.
• Aortic stiffness
– reportedly varies throughout normal pregnancy,
reaching its nadir in the second trimester and rising
again in the third
– in pre-eclamptic women it continues to increase
throughout pregnancy.
4. Definition
• Arterial Stiffness
–The elasticity (or compliance) of the arteries.
• Arteriosclerosis
–The hardening or stiffening of the arteries.
• The stiffness of arteries influences how hard the
heart has to work to pump blood through the
body.
11. Peter M. Nilsson, Pierre Boutouyrie, Stéphane Laurent
Hypertension. 2009;54:3-10
Arterial stiffness is a cumulative measure of the damaging effects of CV risk factors on the arterial wall
with aging.
Arterial stiffness, which reflects the true arterial wall damage of CV risk factors, increases with aging, whereas
blood pressure (MBP), glycemia, and lipids which are fluctuating along the follow-up of patients, may give a
constant value when combined into a CV risk score if their fluctuations occur in opposite directions.
Thus, measuring “circulating” biomarkers at a certain time may give only a “snapshot” and not the whole history of
arterial wall damage.
12. Conclusion
Women who had iatrogenic PTB, but not those who had
spontaneous PTB, have increased SBPAo and arterial
stiffness that is apparent from as early as the first trimester
of pregnancy.
13. Conclusion
Woman who develop GDM have increased SBP(Ao) and
Arterial stiffness from the 1st TM of pregnancy before the
clinical onset of GDM
14. • The aim of this study was to examine the potential value of assessment of SBPAo,
PWV and AIx at 11–13weeks’ gestation in identifying women who subsequently
develop pre-eclampsia.
• Results :
– In the pre-eclampsia group vs unaffected controls, there was an increase in
Aix-75 (1.13 vs. 1.00 multiples of the median (MoM); P<0.0001), PWV (1.06
vs. 1.00 MoM; P<0.0001) and SBPAo (1.09 vs. 1.00 MoM; P<0.0001)
Conclusion :
Compared with women who remain normotensive,
women who develop pre-eclampsia have higher
SBPAo and arterial stiffness, which is apparent from
the first trimester of pregnancy
17. • Augmentation index (Aix) :
– Using the shape of the pulse wave to provide measures of
endothelial function
– Primarily reated to the endotheliaal function modulated
vascular tone of the arterioles and small arteries
• Pulse Wave Velocity (PWF) :
– Measuring the time it take for a pressure pulse to travel
between two points in the arterial system, usually the carotid
artery (neck) and femoral artery (groin), and estimating the
length of the artery between these two points.
– Related to the peripherial (brachial) Related to peripheral
(brachial) BP and the Aix (wafe reflection)
18. • Central blood pressure :
–The pressure that the heart acts against, tends
to increase with higher arterial stiffness.
–Related to the peripheral (brachial) BP and the
Aix (wave reflection).
• Carotid, intima-media thickness :
–using an ultrasound scan to gauge the
thickness of the inner distance of the wall of
the carotid artery.
19. • Carotid-femoral pulse wave velocity (cf-PWV),
the most widely validated and universally
accepted measure of AS, is considered the
‘gold-standard’ measurement of AS.
• PWV has not been adequately examined
during pregnancy, and the potential utility of
PWV as a predictor of PE has not yet been
determined.
21. • A simple method to assess arterial stiffness and
distensibility.
• A long-established and widely used technique.
• Non-invasive, accurate and reproducible.
22. Principles
L.V.Ejection generates a pulse wave which will propagate
along the arterial walls at a certain speed.
Propagation along the arterial tree
Systole
L.V.
Blood = incompressible fluid
Artery = elastic conduit }
The propagation velocity is determined by:
• the elastic and geometric properties of
the arterial wall
• the characteristics of the arterial wall
structure.
Higher velocity = higher stiffness
= lower distensibility.
23. PULSE WAVE VELOCITY
Intermittent cardiac output
Systole Diastole
Large arteries store a part of the ejection volume
during systole and restore it during diastole.
Arterial Buffering function
Continuous peripheral flow
26. Speed of the wave is related to
the stiffness of the artery it is
traveling in
The stiffer the artery;
the higher the wave speed
Wave speed is proportional to the square
root of arterial stiffness
27. WHAT ARE THE TOOLS to measure PWV?
• Doppler Ultrasound
• Oscillometric
– Measure the fluctuations observed in an occluding cuff as
the pressure is initially raised and then gradually dropped.
– Mathematically estimates the oscillation
• Tonometric
– Using measurement at radial artery by applanation
tonometry
• Piezo-electronic
– Measuring changes in pressure, acceleration, or force by
converting to an electrical charge
28. Pros and CONS?
• Oscillometric
– Easy to measure
– Non invasive
– Fast & Economic
– Indirect calculation
• Tonometric and Piezoelectric
– Real calculation of the formula
– Non invasive
– Training needed
– Expensive
29. Although the complex pathophysiology underlying the arterial stiffening process is beyond the scope of this review, knowledge of its basic mechanisms
is relevant for better un- derstanding its relationship to sex. The stability and compli- ance of the arterial wall is maintained by a well-regulated balance
between its 2 main extracellular matrix proteins, collagen and elastin. With aging, there is fatigue of the elastin fibres and dysregulation of this balance,
with excessive degradation of its elastic component, elastin, and replacement with tensile collagen fibres, leading to stiffening of the arterial wall. In the
presence of cardiovascular risk factors, an adverse inflammatory and hormonal milieu further exacerbates this process.18 Estrogen has been shown to
directly affect arterial wall remodelling by increasing elastin production and decreasing collagen deposition in human arteries.19
There is compelling evidence suggesting that sex differ- ences in vascular biology are related not only to the type and levels of sex hormones, but also to
tissue and cellular differ- ences responsible for sex-specific responses to various stimuli. For instance, the human aorta has estrogen20 and progester-
one21 receptors, and women have more arterial estrogen re- ceptors than men.22 Although androgen receptors have been identified in primate
vascular tissues,23 there have been no reports of the localization or distribution of androgen re- ceptors in human blood vessels. In addition, it has
been demonstrated that production of the potent vasodilator nitric oxide (NO) is greater in premenopausal women than in men,24 and the endothelial-
dependent, NO-mediated vaso- dilatory effects of estrogen differ between men and women, because intracoronary injections of estradiol improve
endo- thelial function and coronary flow in women with coronary artery disease, but not in men.25 Such vasodilatory effects of estrogen in women
appear to be time-dependent, because they vary inversely with the length of estrogen deprivation.26 Thus, sex differences in arterial estrogen
receptors coupled with a direct effect of endogenous estrogens on endothelial function and arterial stiffness via NO might at least partially underlie the
favourable hemodynamic and risk profile attributed to women of reproductive age; and help explain the adverse hemodynamic and cardiovascular
transitions that often follow menopause.
A potential role for sex hormones in the regulation of arterial function, tone, and elasticity is further suggested by studies that evaluated measures of
arterial stiffness during hormonal transition periods, such as before and after puberty, or throughout the menstrual cycle. Ahimastos and col- leagues27
studied 58 prepubertal and 52 postpubertal healthy children and found that in the prepuberty period, girls had greater cfPWV (a measure of aortic
stiffness) and PP (a global marker of arterial stiffness), than age-matched boys. After puberty, girls’ cfPWV decreased, boys’ cfPWV increased, thereby
dissipating the prepubertal differences; and PP was lower in postpubertal girls than in boys. In addition, stiffness has been shown to vary during the
menstrual cycle in young, healthy women of reproductive age,28-30 although this matter remains debatable because a recent study has challenged this
Canadian Journal of Cardiology Volume 30 2014
concept.31 Use of oral contraceptives among women of reproductive age has been shown to be associated with greater PP and cfPWV,32 corroborating
the notion that suppression of female endogenous sex hormones might have an effect on arterial health and compliance.
In the postmenopausal period, age-related increases in arterial stiffness are observed,33 however, several studies have shown that arterial stiffness is
ameliorated by administration of hormonal therapy (HT) in postmenopausal women,34-40 worsening again after HT withdrawal.41 The aforemen-
tioned findings suggest that female sex hormones (and/or the additional hormonal and metabolic milieu that accompany them) might have a role in the
regulation of large artery compliance. However, the results of the HT studies deserve special interpretation in the context of the Heart and Estro-
gen/Progestin Replacement Study (HERS),42 which showed no difference in the incidence of cardiovascular events in women taking HT vs placebo, and
the Women’s Health Initiative,43 which showed greater risk of nonfatal myocardial infarction and stroke among women taking HT (although absolute
rates of events were low). Interestingly, despite the lack of protection against cardiovascular events, both studies showed a beneficial effect of HT on
cardiovascular risk factors such as blood pressure and lipids, which mirrors the afore- mentioned results of HT in arterial stiffness. Whether these
divergent effects of HT on arterial stiffness/risk factors and cardiovascular events are related to timing of HT adminis- tration, lack of enough follow-up
time for improvement in hard outcomes, or additional thrombogenic mechanisms that are independent of arterial compliance and risk factors is not
the focus of the present review, but remain amenable to further testing and discussion.
30. Hypertensive Complications of Pregnancy
It is estimated that approximately 10% of pregnant women experience hypertensive complications,80 including
gestational hypertension, pre-eclampsia and eclampsia. Hypertensive complications can have devastating
consequences to women and their families, including fetal loss and maternal death.81,82 Moreover, women who
develop pre-eclampsia or eclampsia during gestation have a significantly greater risk of developing CVD later in
life,83-85 with hazard ratios as high as 5.36 for women with severe pre-eclampsia/eclampsia.84
Because of the significant health burden associated with hypertensive complications of pregnancy, increasing
efforts have been devoted to understanding its pathophysiology and identifying markers for risk stratification. It
is well recognized that greater arterial stiffness is a common characteristic of women who develop
hypertensive emergencies of pregnancy.86-90 In a meta-analysis of 9 studies, Hausvater and colleagues at McGill
University found that cfPWV and AIx were significantly greater among women who had a history of pre-
eclampsia than women with normotensive pregnancies.88 What remains unclear is whether arterial stiffness is
implicated in the pathogenesis of hypertensive complications of pregnancy, or is simply a marker of increased
risk. Endothelial dysfunction, inflammation, and changes in the renin-angiotensin-aldosterone system are
abnormalities described in arterial stiffness and pre-eclampsia,88 and as such, increased arterial stiffness might
be a simple marker of the physiologic and metabolic derangements that lead to hypertensive complications of
pregnancy. By leading to the delivery of (deleterious) highly pulsatile energy to the end organs, it is also
possible that arterial stiffness might promote endothelial dysfunction and vascular damage, which in turn
trigger the cascade that culminates in pre-eclampsia or eclampsia. Further basic science and prospective
studies are needed to disentangle the complex associations of arterial stiffness and hypertensive complications
of pregnancy.
Although measures of arterial stiffness appear to have a role in predicting future development of pre-
eclampsia/eclampsia, its role as a therapeutic or preventative target remains unknown. Khalil et al.
demonstrated that, among women with pre-eclampsia, arterial stiffness was significantly decreased by
treatment with a-methyldopa.91 However, clinical trials are needed to determine whether therapeutically
decreasing arterial stiffness will be efficacious in preventing hypertensive emergencies in pregnant women
identified as having high risk of developing pre-eclampsia/eclampsia (Fig. 3).
31. • Augmentation Index
• The augmentation index (A-Ix) is defined as the difference
between the second and first systolic peaks expressed as a
percentage of the pulse pressure, is a measure of systemic
arterial stiffness and wave reflection.
• Pulse wave velocity
• The carotid-femoral PWV (cf-PWV) is calculated as the
quotient of the distance traveled by the pulse wave and the
foot-to-foot time delay between the pulse waves.
• The carotid-radial PWV (cr-PWV), the method of calculation
was the same; however the distal distance was measured
from the sternal notch to the radial artery
39. Objective:
• To assess arterial stiffness in pregnancies complicated by
hypertensive disorders: preeclampsia and chronic hypertension.
Results:
• Significantly higher PP and PWV and lower SI/PP were observed
in preeclamptic compared to uncomplicated pregnancies.
Preeclamptic pregnancies also differed from chronic
hypertensive pregnancies by higher PP and lower SI/PP. Women
with chronic hypertension had significantly higher PWV than the
control group, but PP and SI/PP were not different. In both
hypertensive groups SVRI was exceptionally high.
40.
41. Objective :
• To evaluate the effect of the menstrual cycle, normal pregnancy, and
preeclampsia on central and systemic arterial stiffness.
Result :
• In normal pregnancy, pulse wave velocity and augmentation index
increased from 24 weeks over the third trimester (P 0.01 for both).
• All of the measures were increased in women with preeclampsia (P
0.01), with augmentation index and carotid-femoral pulse wave
velocity remaining elevated 7 weeks postpartum (P 0.02).
42. Objective :
• To compare the maternal wave reflections and arterial stiffness in women
with established PE and those with normotensive pregnancies, after
systematic adjustment for known confounders.
Result :
• In the PE group, compared with controls, there was an increase in the
median pulse wave velocity of both the carotid to femoral [1.1,
interquartile rage (IQR) 1.0–1.3 MoM vs. 0.9, IQR 0.9–1.0 MoM; P 0.0001]
and carotid to radial (1.0, IQR 0.9 –1.1 MoM vs. 0.9, IQR 0.9 –1.0 MoM; P
0.01) parts of the arterial tree.
• In contrast, there were no significant differences between the two groups
in the median augmentation index (0.9, IQR 0.7–1.1 MoM vs. 1.0, IQR
0.5–1.8 MoM; P 0.46).
43.
44.
45. Objective:
• Investigate the association between PE and arterial stiffness. 23 relevant
studies were included.
Results:
• A significant increase in all arterial stiffness indices combined was
observed in PE vs. control [SD 1.62, 95% CI : 0.73–2.50]
• cfPWV and AIx were also significantly increased (weighted mean
difference, WMD cfPWV 1.04, 95% CI 0.34–1.74; WMDAIx 15.10, 95% CI
5.08–25.11), whereas crPWV increase did not reach significance (WMD
crPWV 0.99, 95% CI S0.07 to 2.05).
• Significant increases in arterial stiffness measurements were noted in
women with preeclampsia compared with those with gestational
hypertension. Arterial stiffness measurements may also be useful in
predicting preeclampsia and may play a role in the increased risk of future
cardiovascular complications seen in women with a history of PE
A systematic review and meta-analysis was conducted using MEDLINE, EMBASE, and
the Cochrane Library
46.
47.
48.
49.
50.
51.
52.
53. Objective:
• To evaluated the diagnostic utility of pulse wave velocity (PWV) alone or in combination with other
diagnostic markers in predicting pre-eclampsia (PE) in high-risk women.
Result:
• Of 118 women recruited, 11 and 10 women developed early-onset PE (<34 weeks) and late-onset PE (>34
weeks), respectively.
• Of the five diagnostic markers tested, PWV showed the highest detection rate for all cases (21) of PE (81%)
and for early-onset PE (82%) at a fixed 10% false-positive rate (FPR), and when combined with sFlt-1, these
figures increased to 90% and 92%, respectively.
• Despite the reduced ability of PWV to predict late-onset PE (detection rate 20%), the combination of PWV
with sFlt-1 achieved a detection rate of 50% at a fixed 10% FPR.
• A suggested cutoff value of 9 m/s for PWV resulted in optimal sensitivity (91%) and specificity (86%) for
predicting early-onset PE.
• This study is the first to show that PWV may be a potentially promising predictor of early-onset PE in
women at high risk for PE. The combination of PWV with sFlt-1 may further improve the screening efficacy
for predicting PE.
54. Figure 2. PWV (m s 1) and sFlt-1 (pg ml 1) the non-PE and PE
groups. at 22–26 weeks of gestation in
55.
56.
57.
58.
59. DISCUSSION
• These findings suggest that pre-existing maternal
subclinical endothelial dysfunction and atherosclerosis
may render pregnant women more sensitive to
maladaptive hemodynamic responses including
increased AS, and thus placing them at high risk for
developing PE.
• PWV was significantly higher in the early-onset PE
group compared with the late-onset, and that are
compatible with the concept that early- and late-onset
PE may be two different disorders where early-onset
PE is related to reduced placental perfusion and late-
onset PE is associated with maternal factors.
60. • Screening for PE is believed to be most relevant during
the first trimester because preventive interventions are
more likely to be effective if initiated early in
pregnancy when pathogenic mechanisms may be
modified.
• PWV, a simple, low-cost noninvasive method for
assessing AS, measured during the second trimester,
may prove useful in predicting PE, particularly early-
onset PE, in high-risk women.
• The predictive characteristics of PWV were further
improved when it was used in concert with sFlt-1. T