Aortic Stiffness and Pulsatile Pressures as Potential Mediators of Chronic Kidney Disease Induced Impaired Diastolic Function.

IF 4.6 Q2 MATERIALS SCIENCE, BIOMATERIALS
ACS Applied Bio Materials Pub Date : 2022-02-15 eCollection Date: 2022-01-01 DOI:10.2147/IJNRD.S346074
Hon-Chun Hsu, Grace Tade, Gavin R Norton, Ferande Peters, Chanel Robinson, Noluntu Dlongolo, Gloria Teckie, Angela J Woodiwiss, Patrick H Dessein
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引用次数: 1

Abstract

Purpose: We assessed whether aortic stiffness and pulsatile pressures can mediate chronic kidney disease (CKD)-associated impaired diastolic function.

Participants and methods: In 276 black Africans including 46 CKD (19 non-dialysis; 27 dialysis) and 230 control subjects, pulse wave velocity (PWV) estimated aortic stiffness and pulsatile pressures (forward and backward wave pressure, central systolic blood pressure (CSBP) and pulse pressure (CPP)) were determined by applanation tonometry; e' as an index of left ventricular active relaxation and E/e' as a measure of left ventricular filling pressure or passive relaxation were evaluated by echocardiography.

Results: In age, sex, traditional cardiovascular risk factor and mean arterial pressure (MAP) adjusted regression models, CKD was inversely associated with e' (p = 0.03) and directly with E/e' (p < 0.01). The CKD-e' relationship was attenuated and no longer significant (p = 0.31) upon additional adjustment for aortic PWV but not pulsatile pressures (p = 0.03-0.05). In product of coefficient mediation analysis, PWV accounted for 47.6% of the CKD-e' association. CSBP (22.9%) and CPP (18.6%) but not PWV (11.3%) accounted for a significant and relevant proportion of the CKD-E/e' relationship. However, CKD remained strongly associated with E/e' independent of aortic function measures (p < 0.01). Treatable covariates that were or tended to be consistently associated with diastolic function included MAP (p < 0.01) and diabetes (p = 0.02-0.07) for the CKD-e' and CKD-E/e' relations, respectively.

Conclusion: Aortic stiffness rather than pulsatile pressures mediates CKD-related impaired left ventricular active relaxation. By contrast, aortic pulsatile pressures (and not stiffness) contribute to CKD-related left ventricular filling pressures but do not fully account for the respective association.

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主动脉僵硬度和脉压作为慢性肾病诱导舒张功能受损的潜在介质。
目的:我们评估了主动脉硬度和脉压是否可以介导慢性肾脏疾病(CKD)相关的舒张功能受损。参与者和方法:276名非洲黑人,包括46名慢性肾病患者(19名非透析患者;27例透析患者和230例对照患者,采用压平式血压计测定脉波速度(PWV)估计主动脉硬度和脉压(前、后波压、中心收缩压(CSBP)和脉压(CPP);超声心动图评价左室主动舒张指标e′和左室充盈压力或被动舒张指标e /e′。结果:在年龄、性别、传统心血管危险因素和平均动脉压(MAP)校正回归模型中,CKD与e′呈负相关(p = 0.03),与e /e′呈正相关(p < 0.01)。在额外调整主动脉PWV而非脉压后(p = 0.03-0.05), CKD-e的关系减弱且不再显著(p = 0.31)。在系数中介分析的结果中,PWV占CKD-e关联的47.6%。CSBP(22.9%)和CPP(18.6%)在CKD-E/e关系中占显著相关比例,PWV(11.3%)除外。然而,CKD与E/ E的相关性与主动脉功能测量无关(p < 0.01)。可治疗的协变量包括MAP (p < 0.01)和糖尿病(p = 0.02-0.07),分别与CKD-e'和CKD-e /e'相关。结论:主动脉僵硬而不是脉压介导ckd相关的左室主动舒张受损。相比之下,主动脉搏动压力(而不是僵硬度)有助于ckd相关的左心室充盈压力,但不能完全解释各自的关联。
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来源期刊
ACS Applied Bio Materials
ACS Applied Bio Materials Chemistry-Chemistry (all)
CiteScore
9.40
自引率
2.10%
发文量
464
期刊介绍: ACS Applied Bio Materials is an interdisciplinary journal publishing original research covering all aspects of biomaterials and biointerfaces including and beyond the traditional biosensing, biomedical and therapeutic applications. The journal is devoted to reports of new and original experimental and theoretical research of an applied nature that integrates knowledge in the areas of materials, engineering, physics, bioscience, and chemistry into important bio applications. The journal is specifically interested in work that addresses the relationship between structure and function and assesses the stability and degradation of materials under relevant environmental and biological conditions.
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