Textbook of Arterial Stiffness and Pulsatile Hemodynamics in Health and Disease, 2 Volume Set

9780323916486v1_WEB
Front Matter
Textbook of Arterial Stiffness and Pulsatile Hemodynamics in Health and Disease
Textbook of Arterial Stiffness and Pulsatile Hemodynamics in Health and Disease
Copyright
Contents of Volume 1
Contributors
Foreword
Preface
Acknowledgments
I - Biophysical and technical principles
1 - Basic principles that determine relationships between pulsatile hemodynamic phenomena and function of elastic v ...
Introduction
Pulsatile phenomena
Pulsatility as an evolutionary requirement for self-sustaining circulatory systems
Fundamental association of pulsatility and vascular structure and function
Elastic vessels
Hemodynamic pulsatility and structure of the arterial wall
Pressure dependence of arterial stiffness: an essential ingredient for optimal arterial design
Fundamental importance of pressure-dependent arterial stiffness (nonlinear elasticity) for arteries
Influence of pressure-dependent arterial stiffness on hemodynamic pulsatility
The arterial vasculature as a distributed system of branching distensible tubes
Structural implications of arterial branching
Structural and functional effects of arterial branching on pulsatility phenomena-implications for measurement of blood pressure
Wave propagation phenomena-pulse wave velocity and arterial stiffness
Wave speed and pulse wave velocity
Wave speed
Pulse wave velocity
Pulse wave velocity and pressure-independent arterial stiffness index beta (β)
Pulse wave propagation and oscillatory phenomena
Forward and backward waves
Vascular impedance
Steady pressure and flow: resistance
Arterial properties that determine relationship of steady pressure and flow
Oscillatory pressure and flow: impedance
Arterial properties that determine relationship of pulsatile pressure and flow
Effects of blood viscosity and pulsatile flow: Womersley's alpha
Input impedance
System linearity
Intermodulation: justification for assumptions of system linearity
Nonlinearity in arterial models
Relation between characteristic impedance and pulse wave velocity
Pressure and flow relationship in the time domain
Summary
References
2 - Measurements of arterial pressure and flow in vivo
Introduction
Cuff mercury sphygmomanometry
Cuff ``oscillometric'' blood pressure
Radial artery applanation tonometry
Cuff central aortic blood pressure
Cuffless blood pressure wearables
Invasive, intra-arterial blood pressure
Summary of blood pressure measurement methods
Measurements of arterial flow
Pulsed wave-Doppler
Phase-contrast magnetic resonance imaging
Supplementary material
References
3 - Essential principles of pulsatile pressure-flow relations in the arterial tree
Introduction
Arterial input impedance: a frequency-domain characterization
Impedance: generalizing resistance for sinusoidal signals
Calculating impedance at the inlet of the arterial tree
Interpreting input impedance: the windkessel perspective
Estimating total arterial compliance by use of windkessel models
The decay-time and area method
The pulse pressure method
Interpreting input impedance: the wave-system perspective
Characteristic impedance revisited: inertia and compliance combined
Input impedance: fingerprint of arterial wave reflections
The arterial system: a network of tubes with distributed reflection sites
The tube model-too simple as a paradigm
The arterial tree-scattered reflections
Estimating Zc from impedance
Pressure-flow relations in the time domain
Time domain formulation of wave separation equations
Estimating characteristic impedance in the time domain
Wave separation analysis in practice: an instruction manual
Wave power analysis: energizing hemodynamics
Wave power to assess the nature and timing of wave reflection
Energetics in the arterial circulation
The reservoir-wave concept-overarching paradigm or misleading enigma?
Concluding remarks
References
4 - MRI for the assessment of aortic stiffness and pulsatile hemodynamics
Introduction
Aortic stiffness assessed by MRI
Aortic strain and distensibility
Aortic pulse wave velocity
Aging and aortic stiffness measurements in MRI
Cardiovascular risk factors, left ventricular function, and aortic stiffness
Prognostic value of proximal aortic stiffness measures
Advanced methodology to assess pulsatile aortic properties using MRI
Flow analysis
Combining pressure and flow
4D flow
Conclusions
Disclosures
References
5 - Computed tomography of the aorta
Introduction
Basics of CT and physics
Spatial resolution
Temporal resolution
ECG-gated versus non‒ECG-gated CTA
Contrast resolution
3D reconstruction
Challenges
Anatomy of aorta
Aortic assessment using CT for characterizing aortic geometry, diameter, centerline length, and shape
Changes in aortic geometry with aging
Aortic calcification
Quantification of aortic calcification
Progression of aortic calcification
The importance of aortic calcification detection
References
6 - Radionuclide-based imaging of the aortic wall
Introduction
Positron emission tomography imaging
Positron emission tomography radionuclides
Positron emission tomography/computed tomography fusion imaging
18F-fluorodeoxyglucose positron emission tomography
Historical background and mechanisms
Interpretation of 18F-fluorodeoxyglucose signal
Practical considerations in 18F-fluorodeoxyglucose imaging
18F-fluorodeoxyglucose positron emission tomography imaging of the arterial wall
18F-fluorodeoxyglucose positron emission tomography imaging in prognostic assessment
18F-fluorodeoxyglucose positron emission tomography in translational research and clinical trials
18F-fluorodeoxyglucose uptake in aortic aneurysms and large vessel vasculitis
18F-sodium fluoride positron emission tomography
Historical background and mechanisms
Interpretation of 18F-sodium fluoride- signal
18F-sodium fluoride- positron emission tomography imaging of the aortic calcification activity
Intimal calcification activity
Medial arterial calcification activity
18F-sodium fluoride- positron emission tomography in aortic aneurysms, large vessel vasculitis, and other aortic pathologies
Methods of analysis and limitations of positron emission tomography imaging
Future directions
Conclusion
Acknowledgments
References
7 - Arterial wall stiffness: basic principles and methods of measurement in vivo
Introduction
Arteries-what's inside?
Large artery stiffness and stiffening-a tale of elastin and collagen
Mechanics of arterial tissues: bioengineering principles and perspective
Stress and strain-what's in a name?
Stresses acting on the arterial wall
Arteries consist of anisotropic, viscoelastic, nonlinear tissue
A glimpse on strain energy functions
Mechanics of arterial tissues: clinical/in vivo perspective
Local functional indices from pressure-area data: compliance and distensibility
(Area) compliance and distensibility
Compliance coefficient and distensibility coefficient
Stiffness moduli
Shear wave elastography-an in-vivo bioengineering perspective?
From local pressure-diameter to pulse wave velocity
Measuring (aortic) pulse wave velocity in vivo
Transit-time methods
Loop-based methods to measure local pulse wave velocity
Pulse wave imaging
Total arterial compliance
Total arterial compliance versus arterial stiffness and pulse wave velocity
Total arterial compliance versus effective arterial elastance
Concluding remarks
References
8 - Ambulatory measurement of pulsatile hemodynamics
Ambulatory 24-h measurement of brachial blood pressure and heart rate
Pulsatile and steady state hemodynamics
Techniques and devices for 24-h ambulatory measurement of pulsatile (and steady state) hemodynamics
24-h variability (``dipping'') of pulsatile and steady state hemodynamics
24-h ambulatory measurement of pulsatile (and steady state) hemodynamics-clinical studies
24-h ambulatory measurement of pulsatile (and steady state) hemodynamics-drug trials
Summary and outlook
References
9 - Animal models and methods to study arterial stiffness
Introduction
Mechanical concepts
In vivo methods to study arterial stiffness
Blood pressure measurements
Invasive blood pressure to measure arterial stiffness by transit time
High-resolution ultrasound
Applanation tonometry
Ex vivo methods to study arterial stiffness
Atomic force microscopy
Wire myography
Pressure myography
Biaxial biomechanical testing
Digital image correlation
Mouse models to study arterial stiffness
Aging
Connective tissue disorders
Diabetes and obesity
Hypertension
Comparison of methods
Recommendations
References
II - Basic and applied physiology
10 - Hemodynamic role of the aorta
Introduction
Hemodynamic consequences of large artery stiffness
Effect on the early systolic aortic pulse pressure rise
Effect on wave speed (Fig. 10.2)
Effect of aortic stiffness on wave reflections in first-order bifurcations
Aortic stiffening and its role in target organ damage
Arterial stiffness and the heart
Arterial stiffness and the kidney
Arterial stiffness and the brain
Arterial stiffness and the placental circulation
Aortic stiffness, metabolic dysfunction, and diabetes mellitus
Arterial stiffness and testicular dysfunction
Mechanisms of arterial stiffening and therapeutic approaches
Conclusions
Acknowledgments
References
11 - Wave reflection in the arterial tree
Introduction
Pressure and flow in the absence of wave reflection
The basis of wave reflection: impedance mismatching
Impact of wave reflection on arterial pressure and flow
Reflection and transmission coefficients
Arterial junctions
Tapering
Resistance vessels
Stenosis
Aneurysms
Stents
Models of arterial wave reflection
Single tube model
Asymmetric T-tube model
Tapered tube models
Branching network models
Synthesis
Re-reflections and the horizon effect
Ventricular wave re-reflection
Wave reflection, windkessel function, and diastolic pressure decay
Methods for assessing the magnitude and timing of arterial wave reflection
Pulse wave analysis
Wave separation
Frequency domain analysis
Wave intensity
Summary
References
12 - Linking arterial stiffness to microvascular remodeling
Motivation
A microvascular remodeling view of large arterial stiffening
Cell dynamics involved in microvascular growth and remodeling
Endothelial cells
Pericytes
Smooth muscle cells
Macrophages
Lymphatic endothelial cells
Consideration of microvascular patterning alterations associated with hypertension and aging
Circulating factors and hemodynamics as putative links between arterial stiffness and the microcirculation
Conclusions and future opportunities
Acknowledgments
References
13 - Myocardial function: from myofilaments to cardiac pump
The heart is an adaptive pump
Cardiac structure is tightly coupled to function
The cardiac cycle
Electromechanical coupling
Mechanisms of myocardial contraction
Mechanisms of myocardial relaxation and ventricular filling
Cardiac metabolism
Cardiac performance is governed by heart rate and loading conditions
Functional assessment of the cardiovascular system
Assessing intrinsic cardiac performance: contractility, relaxation, and compliance
The pressure-volume loop
Deriving performance indexes from acute load manipulation
Time-varying afterload, wave reflection, and their toll in the heart
Conclusions
References
14 - Systolic-diastolic coupling
Historical background
Gross cardiac anatomy, ventricular myocyte orientation, and mechanism of contraction
Anatomy of the heart
Contractile function of myocytes
Ventricular myocyte orientation and function
The cardiac cycle
Atrioventricular valve plane displacement: give and take
Locked and loaded: recovering elastic energy during diastole
Summary
Supplementary data
References
15 - Ventricular-arterial coupling: the pressure-volume plane
Introduction
The pressure volume plane
The LV chamber as a time-varying elastance
Relationship between the pressure-volume area and LV energetics
The concept of effective arterial elastance and assessment of ventricular-arterial coupling in the pressure-volume plane
Assessing the consequences of primary LV dysfunction, changes in arterial load and their consequences in the pressure-volum ...
Strengths and limitations of the pressure-volume plane
Conclusions
Acknowledgments
References
16 - Myocardial wall stress and the systolic loading sequence
Introduction
Myocardial afterload versus ventricular afterload
Quantification of myocardial wall stress
The time course of ejection-phase MW
Arterial wave reflection
LV loading sequence and its role in LV hypertrophy
LV loading sequence and its role in LV fibrosis
Effect of mid-to-late systolic load on LV diastolic dysfunction
Myocardial loading sequence and atrial dysfunction
Late systolic load and heart failure risk
Cellular processes in the myocardium
Conclusions
Acknowledgments
References
17 - Assessment of ventricular arterial interactions via arterial pressure-flow relations in humans
Overview of arterial pressure-flow relations
Noninvasive assessment of aortic pressure-flow relations
Age relations of pressure-flow variables across the lifespan
Aortic pressure-flow measures and the heart
Pressure-flow measures and cardiovascular disease events
Summary
References
18 - Hemodynamic determinants of myocardial oxygen demand and supply
Myocardial O2 demand
Left ventricular afterload
Systolic wall stress
Heart rate
Contractility
Depolarization
Shortening against load (Fenn effect)
Supporting the state of activity
Maintenance of cell viability in basal conditions
Myocardial O2 supply
Diastolic pressure decay
Coronary blood flow regulation
Coronary self-regulation
Endothelial vasoactive mediators
Metabolic regulation
Arterial oxygen content
Aortic stiffness
Increase in systolic blood pressure
Decrease in diastolic blood pressure
Increase in pulse wave velocity
The myocardial oxygen supply: demand index
Buckberg index corrected for cardiac mass
Buckberg index corrected for arterial O2 content
Reference values for the Buckberg index
Buckberg index estimated by arterial tonometry
Limits in Buckberg index estimation by arterial tonometry
Buckberg index estimated by arterial tonometry and echocardiography
New perspectives in Buckberg index estimated by arterial tonometry
References
III - Biologic pathways leading to arterial stiffness and dysfunctional pulsatile hemodynamics
19 - Role of elastin and elastin-derived peptides in arterial stiffness: from synthesis to potential therapeutic in ...
Elastic fibers and elastin
Function and composition
Elastogenesis
Microfibrils deposition
Synthesis and secretion of tropoelastin
Microassembly
Cross-linking and macromolecular assembly
Elastin role in arterial function
Elastin: a major functional vascular wall component of vertebrate's arteries
Elastin role in normal hemodynamics
Elastin modifications during aging and pathophysiological consequences
Nonenzymatic posttranslational modifications of elastin
Mechanical fatigue and enzymatic fracture of elastin
Pathophysiological consequences of elastin modifications
Elastin-derived peptides signaling, elastin receptor complex, and pathophysiological consequences
Elastin-derived peptides
Elastin receptor complex-dependent cell signaling
Pathophysiological roles of elastin-derived peptides
Elastin biology-derived therapeutic options
Targeting elastin synthesis
Targeting proteolysis and nonenzymatic posttranslational modifications
Elastin-derived peptides and elastin receptor complex modulators
Conclusion
References
20 - Inflammation and arterial stiffness
Introduction
Arterial stiffness and low-grade inflammation
Cross-sectional studies
Prospective studies
Experimental models of inflammation
Arterial stiffness in patients with primary vasculitides
Arterial stiffness in chronic inflammatory diseases
Rheumatoid arthritis
Inflammatory bowel disease
Systemic lupus erythematosus
Systemic sclerosis
Chronic obstructive pulmonary disease
Human immunodeficiency virus infection
Antiinflammatory treatment for arterial stiffness
Antilipidemic drugs
Mechanisms of inflammation-induced arterial stiffening
Endothelial dysfunction
Increased synthesis of matrix metalloproteinases
Calcification
Smooth muscle proliferation and changes in the composition of extracellular matrix
Direct vascular inflammation
Conclusion
References
21 - Mechanisms of calcification in the aortic wall and aortic valve
Cardiovascular events associated with calcification in the aortic wall and aortic valve
Calcification is a result of multiple synergistic pathogenic processes
Atherosclerosis and intimal calcification of the aortic wall
Nonatherosclerotic medial aortic wall calcification
Calcific aortic valve disease
The role of hemodynamic shear stress in vascular calcification
Synergistic effects of risk factors in vascular endothelial dysfunction
Experimental approaches in cardiovascular calcification
Therapeutic target discovery in cardiovascular calcification
Final considerations
Funding
References
22 - Vascular smooth muscle cell dysfunction: role in arterial stiffening and cardiovascular disease
Contractile tone of vascular smooth muscle cells
Vascular tone
Myogenic tone
Vascular smooth muscle cell relaxation
Endocytosis and phagocytosis abilities of vascular smooth muscle cells
Endocytosis
Phagocytosis
Scavenger receptors and eat me signaling
Integrin-mediated and nuclear mechanotransduction in vascular smooth muscle cells
Membrane mechanotransduction
Nuclear mechanotransduction
Vascular smooth muscle cell plasticity
Regulation of vascular smooth muscle cell differentiation by growth factors and transcriptional factors
Epigenetic determinants of vascular smooth muscle cell plasticity
Cell senescence
Participation of inflammation and immunity in vascular smooth muscle cell functions
Cytokines et chemokines
Innate immunity and extracellular vesicles
Failure in the resolution of inflammation
Conclusion
References
23 - Endothelial cell dysfunction and senescence: biologic mechanisms and hemodynamic consequences
Introduction
In vivo evidence of cellular senescence in age-related diseases
Molecular mechanism of cellular senescence
Endothelial cell senescence in age-related disorders
Antisenescence therapy
Inhibition of cellular senescence
Inhibition of senescence-associated secretory phenotype
Elimination of senescent cells (senolysis)
Conclusion
References
24 - Autonomic and neuroendocrine modulation of arterial stiffness and hemodynamics
Autonomic control of the cardiovascular system
Parasympathetic nervous system
Sympathetic nervous system
Assessing autonomic modulation of large-artery stiffness: methodological considerations
Parasympathetic modulation of large-artery stiffness
Sympathetic modulation of large-artery stiffness
Relationships between sympathetic activity and arterial stiffness: cross-sectional studies
Can acute modulation of sympathetic activity alter large-artery stiffness?
Evidence from muscular arteries
Evidence from elastic arteries
Does chronic sympathetic modulation contribute to large-artery stiffness?
Evidence from muscular arteries
Evidence from elastic arteries
Neuroendocrine modulation of arterial stiffness
Renin-angiotensin-aldosterone system
Endothelin-1
Insulin
Testosterone
Estrogen
Do sex hormones modify the relationship between muscle sympathetic nerve activity and arterial stiffness?
Summary
References
25 - Cellular mechanisms of aging and their impact on the aortic/arterial wall
Introduction
Effects of aging on the arterial tree
Endothelial dysfunction
Elastic arteries
Muscular arteries
Small arteries
The role of the adventitia in vascular remodeling
Cellular and molecular mechanisms of vascular aging
Vascular inflammation
Oxidative stress
Adaptation to oxidative stresses: role of Nrf2 and sirtuins
Senescence
Chronic kidney disease as a model of early vascular aging and role of calcification
Summary
References
Back Matter
9780323916486v2_WEB
Front Matter
Textbook of Arterial Stiffness and Pulsatile Hemodynamics in Health and Disease
Textbook of Arterial Stiffness and Pulsatile Hemodynamics in Health and Disease
Copyright
Contents of Volume 2
Contributors
Foreword
Preface
Acknowledgments
IV - Clinical significance of arterial stiffness and pulsatile hemodynamics
26 - Normal aging: arterial stiffness and remodeling over the life course
Preamble
Insights from cross-sectional epidemiological and cohort data
Blood pressure and pulse wave velocity
Cross-sectional wave reflection data
Insights from longitudinal cohort data: the early life trajectory
Insights from longitudinal cohort data: the adult life trajectory
Manifestations in middle-aged and aged individuals
Effects of aging on wave reflections
Conclusions
References
27 - Early vascular aging and supernormal vascular aging: genetics, epigenetics, and the environment
The background and characteristics of early vascular aging
Atherosclerosis versus arteriosclerosis
Structural components of arterial wall aging
Cross-talk between the micro- and macrocirculation
Vascular aging and target organ damage
Genetics and epigenetics
Low socioeconomic status and vascular aging
Intervention studies on vascular aging and early vascular aging
The concept and usefulness of supernormal vascular aging
Conclusion
Acknowledgments
References
Further reading
28 - Ethnic differences in arterial stiffness and central aortic hemodynamics
Is studying ethnic differences in vascular or any physiological feature or disease useful?
Relationships to blood pressure
Arterial stiffness through the life-course across different ethnic/geographic groups
Fetal life, infancy, childhood, and adolescence (see Table 1)14
Young adults (see Table 2)14
Middle-aged and elderly populations
Retinal vessels
Pulse wave velocity measures in AORTIC segments by Magnetic Resonance Imaging (MRI)
HIV
Ethnicity and the menopausal transition
The elderly
Renal impairment/failure (end-stage renal disease)
Summary and conclusions
References
29 - Arterial stiffness and pulsatile hemodynamics in systemic hypertension
Introduction
Consequence of arterial stiffness on pressure pulsatility
Arterial stiffness and wave reflection in systemic hypertension
Influence of lumen area on compliance, wave reflection, and pressure pulsatility
Peripheral and central blood pressure in aging hypertensives
Interaction between hypertension and arterial stiffness
High central blood pressure, hypertension-mediated organ damage, and cardiovascular complication
Cardiac damage
Brain damage
Renal damage
Cardiovascular and renal outcome
Predictive value of arterial stiffness and wave reflection in hypertensives
The particular case of very elderly hypertensives
Conclusion
Acknowledgments
References
30 - Arterial stiffness and pulsatile hemodynamics in diabetes and obesity
Introduction
Pathophysiologic role of diabetes mellitus in the development of increased arterial stiffness
The role of advanced glycation end-products in the development of arterial stiffness
Nitric oxide, oxidative stress, and arterial stiffness
Epidemiologic association of diabetes mellitus with the development of increased arterial stiffness
Risk of increased arterial stiffness and adverse cardiovascular events in patients with diabetes mellitus type 2
Risk of increased arterial stiffness and adverse cardiovascular events in patients with diabetes mellitus type 1
Risk of increased arterial stiffness and adverse cardiovascular events in patients with prediabetes
The role of arterial stiffness in the promotion of diabetic microvascular disease
Arterial stiffness and diabetic retinopathy
Arterial stiffness and diabetic nephropathy
Arterial stiffness and diabetic neuropathy and autonomic dysfunction
Arterial stiffness and cognitive dysfunction in patients with diabetes mellitus
Epidemiologic association of obesity and the metabolic syndrome with the development of increased arterial stiffness
Increased arterial stiffness as a potential contributor to the development of diabetes mellitus
Conclusions and future directions
Acknowledgments
References
31 - Cardiovascular risk prevention in clinical medicine: current guidelines in the United States and in Europe
Epidemiology of hypertension
Definition and classification of hypertension
Cardiovascular risk assessment in the management of hypertension
Blood pressure measurement
Risk assessment tools
Hypertension-mediated organ damage and risk modifiers
Arterial stiffness and cardiovascular risk
Therapeutic goals in the management of hypertension
Blood pressure treatment thresholds and targets in US/EU guidelines
Blood pressure goals in older adults
Chronic kidney disease
Diabetes
Blood pressure J-curve: role of large artery stiffness and implications for treatment targets
Additional therapeutic considerations for hypertension management in current guidelines
Nonpharmacologic and pharmacologic interventions
Other considerations in the approach to hypertension management
How do isolated systolic hypertension, pulse pressure, and LAS factor into current guideline recommendations for the treatm ...
How do large artery stiffness and pulsatile hemodynamics factor into guideline recommendations for the treatment of other c ...
Risk enhancers
Risk groups
Summary
References
32 - Cardiovascular risk prevention in clinical medicine: current guidelines in Asia
Cardiovascular risk prevention in clinical practice: current guidelines in Asia
Characteristics of cardiovascular risks in Asia, in comparison to the United States, Europe, and other populations
Current Asian guidelines on cardiovascular prevention
Hypertension
Dyslipidemia
Diabetes mellitus
Life style modification
Role of vascular markers in Asian cardiovascular prevention guidelines
Perspective for the prevention of cardiovascular risk in Asia
References
33 - Arterial stiffness for cardiovascular risk stratification in clinical practice
Introduction
Arterial stiffness
Central pressure and wave reflection indices
Conclusions/future perspectives
References
34 - Role of the heart and arterial tree in physiologic adjustments during exercise
Cardiac output
Heart rate response during exercise
Stroke volume response during exercise
Ventricular-vascular coupling
Exercise hemodynamics
Pulmonary hemodynamics during exercise
Pulmonary arterial pressure and resistance during exercise
Pulmonary blood volume expansion, diffusion capacity, and pulmonary artery distensibility during exercise
Central hemodynamics during exercise
Mean arterial pressure
Central pressure and pulse wave dynamics
Pulse pressure amplification
Blood flow pulsatility
Large artery stiffness and characteristic impedance
Blood flow redistribution
Total peripheral resistance and functional sympatholysis
Exercise hyperemia
Vasoactive substances
Conducted vasodilation
Flow-mediated vasodilation
Mechanical actions of the muscle
Cardiovascular limitations to exercise
Summary
References
35 - Invasive hemodynamic assessments during exercise: normal patterns and clinical value
Introduction
Role for invasive hemodynamics in diagnostic ambiguity
Physiology of invasive hemodynamic assessment
Assessment of left-sided filling pressures
Right atrial pressure
Concept of pericardial restraint
Measurement of flow
The Fick principle
CO assessment using VO2 measured versus assumed
Thermodilution CO
Vascular load
Systemic vascular load
Pulmonary vascular load
Assessment during exercise
Normal range of resting and exercise value
Preforming an exercise hemodynamic study
Setup
Supine versus upright
Measurement of pressures
End-expiration versus respiratory averaged
Cardiac output reserve
Added value of simultaneous exercise echocardiography
Clinical utility in the evaluation of suspected heart failure
HFpEF
Diagnostic uncertainty
Evaluation of specific phenotypes
Bayesian approach can guide decision to refer for invasive assessment
HFrEF
Value in determining cardiac component of limitation
Degree of pulmonary hypertension, RV dysfunction
PAH
Utility in atypical PAH
Valve disease
Paradoxical LG AS
Severe TR with pericardial restraint
More advanced assessment
Peripheral O2 utilization
Ventilation and expired gas analysis
Conclusion
References
36 - Arterial stiffness and pulsatile hemodynamics in heart failure
Introduction
Heart failure: definition and classification
The arterial tree in HF
The aorta in HF
The aorta in HFpEF
The aorta in HFrEF
Large artery stiffness as a predictor of incident HF
Large artery stiffness as a predictor of outcomes in established HF
Arterial wave reflection in heart failure
Wave reflection and LV hypertrophy
Effect of mid-to-late systolic load on LV diastolic dysfunction
Arterial wave reflection and the risk of incident HF
Hemodynamic role of the microvasculature in HF
The microvasculature as a determinant of LV load
Effects of peripheral microvascular function on exercise capacity
Role of the coronary microcirculation
Macrovascular-microvascular cross-talk: role of large arterial pulsatile hemodynamics in microvascular dysfunction and HFpE ...
Therapeutic implications
Spironolactone
Vasodilators
NO donors
Soluble guanylate cyclase stimulators/activators
Neprilysin inhibitors
The matrix gla protein pathway
Conclusions
Acknowledgments
References
37 - Ventricular-arterial coupling and arterial load in aortic valve disease
Introduction
Anatomical interaction between the LV, aortic valve, and aortic root
Anatomical interrelation between the LV outflow tract, aortic valve, and aortic root
Bicuspid aortic valve and aortopathy
Functional interaction between the left ventricle, aortic valve, and aorta
Ventriculo-valvulo-arterial coupling
Impact of aortic stenosis on ventriculo-arterial coupling
Impact of aortic regurgitation on ventriculo-arterial coupling
Interaction between LV outflow tract and aortic valve
Interaction between aorta and aortic valve in aortic valve disease
Aortic stenosis
Effacement of sinotubular junction
Pressure recovery
Interaction between hypertension and AS
Aortic regurgitation
Interaction between aorta, aortic valve, and LV in AS
Impact of arterial load following aortic valve replacement
Conclusion
References
38 - Arterial stiffness and atherosclerosis: mechanistic and pathophysiologic interactions
Introduction
Vascular failure: interaction between atherosclerosis and arterial stiffness
Pulse wave velocity and atherosclerosis
In coronary arteries
In cerebral arteries
In the carotid artery
Cardio-ankle vascular index and atherosclerosis
Other arterial stiffness parameters
Interaction between vascular disease and hemodynamic stress
SHATS: a proposed novel clinical entity
Mechanisms and evidence
BP variability
Hemodynamic factors
Vascular component
Role in organ damage and cardiovascular events
Proposed diagnostic score
Potential treatment strategies
Conclusion
Acknowledgments
References
39 - Arterial stiffness and pulsatile hemodynamics in coronary artery disease and other forms of atherosclerotic va ...
Introduction
Coronary artery disease
Clinical evidence
Mechanism
Peripheral artery disease
Clinical evidence
Mechanism
Aortic calcification
Clinical evidence
Mechanism
Stroke and cerebrovascular disease
Clinical evidence
Mechanism
Perspectives
References
40 - Arterial stiffness and pulsatile hemodynamics in renal disease
Importance of kidney disease
Unique features of the kidney circulation
Role of known factors for chronic kidney disease progression
Clinical epidemiology of large artery stiffness in chronic kidney disease
Cross-sectional findings
General populations with kidney measurements
Chronic kidney disease-not on dialysis
Chronic kidney disease-on dialysis (end-stage kidney disease/end-stage renal disease)
Longitudinal studies (see Table 40.1)
Clinical pulsatility indices and kidney function
Pulsatility index
Resistive index
Mechanisms of increased arterial stiffness in chronic kidney disease
Vascular calcification
Renin system activation
Changes in vessel wall proteins
Advanced glycation endproducts
Endothelial dysfunction
Inflammation/oxidative stress
Therapies
References
41 - Arterial stiffness, pulsatile hemodynamics, and the vascular contributions to dementia
Introduction
Review of studies linking arterial stiffness to Alzheimer's disease and related dementias
Arterial stiffness and cognitive impairment
Arterial stiffness and cognitive function
Arterial stiffness and brain structural abnormalities on magnetic resonance imaging
Association of arterial stiffness and Alzheimer's disease biomarkers
Assessing evidence of the association between arterial stiffness and dementia
Conclusions
References
42 - Arterial stiffness and pulsatile hemodynamics in pregnancy and pregnancy-related vascular complications
Healthy pregnancy
Blood volume and hematological changes
Cardiac output
Vascular remodeling and vascular resistance
Blood pressure
Arterial stiffness
Pregnancy complications
Blood volume
Cardiac output
Vascular remodeling and vascular resistance
Blood pressure
Arterial stiffness
Fetal growth restriction
Exercise in pregnancy
Concluding remarks
References
43 - Arterial stiffness and pulsatile hemodynamics in pediatric populations
Introduction
Vascular effects of various disease states
Obesity
Pulse wave velocity
Pulse wave analysis
Distensibility
Global measures
Dyslipidemia
Pulse wave velocity
Pulse wave analysis
Distensibility
Global measures
Hypertension
Pulse wave velocity
Pulse wave analysis
Distensibility
Global measures
Diabetes
Pulse wave velocity
Pulse wave analysis
Global measures
Other conditions
Methods and normal values in children
Pulse wave velocity
Applanation tonometry
Oscillometric devices
Cardiac magnetic resonance imaging
Sex-specific differences in pulse wave velocity
Race-specific differences in pulse wave velocity
Conclusions about pulse wave velocity normal values
Pulse wave analysis
Distensibility
Future directions
References
44 - Aortopathies and arteriopathies
Introduction
Approaches to defining the genetic contributions to arterial and aortic disease
Pathogenic mechanisms
Arteriopathies with limited aortic involvement
Disorders that primarily involve the aorta with arterial involvement
Disorders that primarily affect the aorta
Precision medicine
References
45 - Arterial stiffness and pulsatile hemodynamics in thoracic aortopathies
Epidemiology and sex differences of thoracic aortic disease
Clinical management of thoracic aortic aneurysm
Histopathological links between thoracic aortic aneurysms and arterial aging
Aortic wall structure, aortic stiffness, and arterial biomechanics in thoracic aortic aneurysm
Marfan syndrome
Loeys-Dietz syndrome
Familial thoracic aortic aneurysms and dissections
Bicuspid aortic valve
Turner's syndrome
Ehlers-Danlos syndrome
Degenerative aortopathy
Measures of aortic stiffness and pulsatile hemodynamic as markers of disease activity and thoracic aortic aneurysm-related risk
Conclusions and future directions
References
46 - Arterial stiffness and pulsatile hemodynamics in congenital heart disease
Background
Normal aortic morphology
Aortic development
Coarctation of the aorta and interrupted aortic arch
Hypertension after coarctation repair
Cardiovascular morbidity
Abnormalities of pulsatile hemodynamics
Arterial stiffness-regional effects
Central pressure and total arterial compliance
Aortic wave reflections
Geometric considerations
Aortic arch obstruction
Types of repair
Three-dimensional shape and hemodynamics
What causes the arterial abnormalities arise in coarctation?
Congenital stiffness or control of systemic vascular resistance?
Evolution to vasculopathy-inflammation and biomechanics
Vascular abnormalities in other forms of congenital heart disease
Tetralogy of fallot
Other forms of congenital heart disease
Conclusions
References
47 - Infection and arterial stiffness
Introduction
Arterial stiffness and sepsis
Effect of sepsis on the circulatory system
Short term
Intermediate and long term
Sepsis and arterial stiffness
Animal studies on sepsis and arterial stiffness
Human studies on sepsis and arterial stiffness
Potential mechanisms for an effect of sepsis on arterial stiffness
Can alterations of the human microbiome by antibiotics used to treat acute infections affect the associations between sepsi ...
Arterial stiffness and human immunodeficiency virus infection
Myocardial infarction in people living with human immunodeficiency virus
Heart failure in people living with human immunodeficiency virus
Human immunodeficiency virus infection and arterial stiffness
Conclusion
References
48 - Arterial stiffness, hemodynamics, and microvascular complications in conditions characterized by low arterial ...
Introduction
Low pulsatile hemodynamics in continuous-flow left ventricular assist device therapy
Effects of low pressure and flow pulsatility on the macrocirculation
Sympathetic nerve activity, vascular remodeling, and aortic stiffness
Endothelial dysfunction
Blood pressure
Consequences of low pressure and flow pulsatility on the microcirculation
Right heart failure and respiratory complications
Cerebrovascular complications
Gastrointestinal bleeding
Pharmacological decision-making in relation to PP and PI in LVAD patients
Left ventricular assist device therapy and exercise capacity
Conclusions
References
V - Therapeutic approaches to improve arterial stiffness and pulsatile hemodynamics
49 - Effects of common antihypertensive treatments on pulsatile arterial hemodynamics
Introduction
Antihypertensive drug classes and their mechanisms of action
Data acquisition, extraction, and analysis
Antihypertensive drugs versus placebo or no-treatment
Renin-angiotensin-aldosterone inhibitors and calcium-channel blockers versus diuretics, β-blockers, and α-blockers
Vasodilating versus nonvasodilating β-blockers
Angiotensin receptor neprilysin inhibitor versus angiotensin receptor blocker
Organic and inorganic nitrates, soluble guanylyl cyclase stimulators and cyclic guanosine monophosphate (cGMP)-binding phos ...
Device-based antihypertensive therapy
Conclusions and perspectives
References
50 - Pharmacologic approaches to reduce arterial stiffness
Introduction
Potential therapeutic targets for arterial destiffening: preclinical studies
Inflammation and oxidative stress
Vascular calcification
Elastase inhibitors and extracellular matrix metalloproteases
Micro-RNAs
Mineralocorticoid receptor antagonism
Amyloid-β and arterial stiffness
Clinical studies on aortic and large artery destiffening
Drugs inhibiting the renin-angiotensin-aldosterone system and mineralocorticoid antagonists
Statins and other lipid lowering therapy
Antioxidant vitamins and vitamin B12/folate supplementation
Antidiabetic drugs and advanced glycosylation end-product breakers
Antiinflammatory drugs
Drugs targeting arterial calcification and bone mineral metabolism
Summary
Conclusion
References
51 - Organic and dietary nitrates, inorganic nitrite, nitric oxide donors, and soluble guanylate cyclase stimulation
Part 1: introduction
Nitric oxide signaling in the vasculature and vasodilatation
The effect of nitric oxide on cardiac function
Endothelial paracrine regulation of left ventricular function
Effects of nitric oxide signaling at the myocardial level
Interaction with phosphodiesterase
Part 2: organic nitrates
Pulsatile hemodynamic effects of organic nitrates
Part 3: inorganic nitrite
Early pharmacological studies of nitrite on arterial tension/waveform
Reevaluation of nitrite in the ``nitric oxide era''
Recent assessment of vascular effects of nitrite
The effect of inorganic nitrite on the cardiovascular system-ventricular hemodynamics
Clinical applications of inorganic nitrite
Part 4: inorganic (dietary) nitrate
Discovery of the inorganic nitrate-nitrite-NO pathway and its cardiovascular relevance
Dietary nitrate and blood pressure
Dietary nitrate and arterial stiffness/pulse wave velocity
Inorganic nitrate and angina
Limitations of organic and dietary/inorganic nitrates
Safety concerns regarding dietary nitrate and inorganic nitrite
Part 5: nitric oxide donors
Sodium nitroprusside
Part 6: soluble guanylate cyclase
The role of soluble guanylate cyclase in the cardiovascular system
Dysfunctional soluble guanylate cyclase signaling
Drugs that target soluble guanylate cyclase
Soluble guanylate cyclase stimulators
Soluble guanylate cyclase activators
Nitroxyl
Conclusions and future directions
References
Further reading
52 - Effect of exercise training and weight loss on arterial stiffness and pulsatile hemodynamics
Introduction
Effect of high cardiorespiratory fitness and habitual aerobic PA on central artery stiffness and pulsatile hemodynamics wit ...
Effect of aerobic exercise interventions on central artery stiffness and pulsatile hemodynamics in young and MA/O adults wi ...
Effect of resistance exercise training on large central artery stiffness and central pulsatile hemodynamics
Effect of obesity, weight loss, and weight gain on central arterial stiffness
References
53 - Dietary salt and arterial stiffness
Introduction
Dietary salt and blood pressure
Dietary salt and cardiovascular outcomes
Blood pressure independent effects of dieatary salt
Heart
Inflammation
Arteries
Endothelial function
Potential mechanisms of reduced endothelial function by high salt (Fig. 53.2)
Oxidative stress
Endothelial cell stiffening
Brain and sympathetic outflow
Dietary salt and arterial stiffness
Potential mechanisms of increased arterial stiffness by high salt
Dietary salt and pulsatile load
Lifestyle and dietary salt
Potassium
Exercise/physical activity
Conclusion
References
54 - Role of arterial stiffness and central hemodynamics in personalized medicine in hypertension
Introduction
Isolated systolic hypertension in the elderly
Arterial stiffness and central pulsatile hemodynamics in ISH in the elderly
Usefulness of noninvasive measurement of arterial stiffness and central pulsatile hemodynamics in the diagnosis of ISH in t ...
Usefulness of noninvasive measurement of arterial stiffness and central pulsatile hemodynamics in the treatment of ISH in t ...
Prognostic value of noninvasive measurements of arterial stiffness and central pulsatile hemodynamics in ISH in the elderly
Isolated systolic hypertension in the young
Arterial stiffness and central pulsatile hemodynamics in ISH in the young
Usefulness of noninvasive measurements of arterial stiffness and central pulsatile hemodynamics in the diagnosis of ISH in ...
Usefulness of noninvasive measurements of arterial stiffness and central pulsatile hemodynamics in the treatment of ISH in ...
Prognostic value of noninvasive measurement of arterial stiffness and central pulsatile hemodynamics in ISH in the young
Isolated diastolic hypertension
Arterial stiffness and central pulsatile hemodynamics in IDH
Usefulness of arterial stiffness and central pulsatile hemodynamics in the diagnosis of IDH
Usefulness of arterial stiffness and central pulsatile hemodynamics in the treatment of IDH
Prognostic value of arterial stiffness and central pulsatile hemodynamics in IDH
Isolated central hypertension and isolated brachial hypertension
Arterial stiffness and central pulsatile hemodynamics in ICH and IBH
Usefulness of arterial stiffness and central pulsatile hemodynamics in the diagnosis of ICH and IBH
Usefulness of arterial stiffness and central pulsatile hemodynamics in the treatment of ICH and IBH
Prognostic value of arterial stiffness and central pulsatile hemodynamics in ICH and IBH
White coat hypertension
Arterial stiffness and central pulsatile hemodynamics in white coat hypertension
Usefulness of noninvasive measurements of arterial stiffness and central pulsatile hemodynamics in the diagnosis of white c ...
Usefulness of noninvasive measurement of arterial stiffness and central pulsatile hemodynamics in the treatment of white co ...
Prognostic value of noninvasive measurements of arterial stiffness and central pulsatile hemodynamics in white coat hyperte ...
Masked hypertension
Arterial stiffness and central pulsatile hemodynamics in masked hypertension
Usefulness of noninvasive measurements of arterial stiffness and central pulsatile hemodynamics in the diagnosis of masked ...
Usefulness of noninvasive measurements of arterial stiffness and central pulsatile hemodynamics in the treatment of masked ...
Prognostic value of noninvasive measurements of arterial stiffness and central pulsatile hemodynamics in masked hypertension
Isolated nocturnal hypertension
Arterial stiffness and central pulsatile hemodynamics in INH
Usefulness of noninvasive measurements of arterial stiffness and central pulsatile hemodynamics in the diagnosis of INH
Prognostic value of noninvasive measurements of arterial stiffness and central pulsatile hemodynamics in INH
Exaggerated blood pressure variability
Arterial stiffness and central pulsatile hemodynamics in exaggerated BPV
Usefulness of noninvasive measurement of arterial stiffness and central pulsatile hemodynamics in the diagnosis of exaggera ...
Prognostic value of noninvasive measurement of arterial stiffness and central pulsatile hemodynamics in exaggerated BP vari ...
Summary and conclusion
References
VI - Arterial stiffness and pulsatile hemodynamics in the pulmonary circulation
55 - Pulsatile hemodynamics and ventricular-arterial interactions in the pulmonary circulation: physiologic concepts
Introduction
Measurements in the pulmonary circulation
Pressures in the pulmonary system
Right atrial pressure as a function of time
Right ventricular pressure as a function of time
Pulmonary artery pressure as a function of time
Pulmonary artery wedge pressure
Pulmonary capillary pressure
Flow measurements in the pulmonary system
Cardiac output
Pulmonary artery flow
Volume measurements of the right heart
Echocardiography
Cardiac MRI
Conductance catheter
Right atrial volume as a function of time
Right ventricular volume as a function of time
The pulmonary vasculature
Anatomy and function of the pulmonary vasculature
Descriptions of the pulmonary vascular load
Frequency domain
Windkessel description
Pulmonary vascular resistance
Pulmonary arterial compliance
Characteristic impedance
Wave reflection
Relation of pressure levels
Arterial time constant
The right ventricle
Anatomy and function of the right ventricle
Ventricular anatomy
Ventricular function
Descriptions of the right ventricular function
Ventricular pressure-volume relation
End-systolic elastance
Arterial elastance
End-diastolic elastance
Ventricular interaction
Ventriculoarterial coupling
Maximal power or efficiency: energetic coupling
Ventriculoarterial coupling determined from the pressure-volume relation
Surrogate measures of ventriculoarterial coupling in the pressure-volume plane
Differences between the systemic and pulmonary circulation
Normal values in the pulmonary circulation
Summary
References
56 - Pulmonary arterial load and ventricular-arterial coupling in pulmonary hypertension
Introduction
Definition of pulmonary hypertension
The properties of pulmonary arterial load and right ventricular function
Pulmonary arterial load in pulmonary hypertension
Heart-independent arterial load
Nonpulsatile arterial load: pulmonary vascular resistance
Pulsatile arterial load
Pulmonary arterial input impedance
Pulmonary arterial compliance
Time constant of the pulmonary circulation
Characteristic impedance of the proximal arteries
Effective arterial elastance
Heart-dependent arterial load
Pulmonary artery pressure (mean, systolic, and diastolic pressure)
Wave reflection: wave separation analysis and wave intensity analysis
Right ventricular wall stress/tension
The right ventricular function in pulmonary hypertension
Load-independent right ventricular function
Right ventricular contractility: end-systolic elastance
Right ventricular diastolic stiffness: end-diastolic elastance
Load-dependent right ventricular function
Cardiac output and stroke volume
Right ventricular volume and ejection fraction
Echocardiographic measures
The cardiovascular interaction in pulmonary hypertension
The right ventricle-pulmonary artery coupling: Ees/Ea
Right ventricle volumetric adaptation and wall stress
Left ventricle-right ventricle interaction
Summary
References
57 - Biologic mechanisms and consequences of pulmonary artery stiffening in pulmonary hypertension
Pulmonary vascular stiffening and mechanobiological feedback in PH pathogenesis
Pulmonary hypertension
Pulmonary vascular stiffening in clinical studies
Pathophysiology of pulmonary vascular stiffening in disease progression
Regulation of smooth muscle contractility and tone
Proliferation
Inflammation and endothelial dysfunction
Endothelial to mesenchymal transition
Angiogenesis
Metabolic reprogramming and mitochondrial dysregulation
Targeting PA stiffness and mechanotransduction in PH
Conclusion
References
58 - Therapeutic approaches to improve pulmonary arterial load and right ventricular-pulmonary arterial coupling
Introduction
Right ventricular dysfunction and failure
Response to normal loading conditions
Pathophysiology of acute right heart failure
Pathophysiology of chronic right heart failure
The components of right ventricular afterload
Approach to the management of right ventricular failure
Optimization of preload and volume status
Maintaining myocardial perfusion
Improving contractility
Neurohormonal modulation
Therapies targeting right ventricular afterload
Relationship between resistance and compliance
Ventricular-vascular coupling
Therapeutic agents for treatment of pulmonary arterial hypertension
Approach to the treatment of pulmonary arterial hypertension
Creation of palliative right-to-left shunts
Approach to treatment of group 2 pulmonary hypertension
Advanced therapeutic options for treatment of right venrticular failure
Emerging therapeutic options
Conclusion
References
Index
A
B
C
D
E
F
G
H
I
J
K
L
M
N
O
P
Q
R
S
T
U
V
W
X
Y
Z
Back Matter