Pulse最新文献

{"title":"Comment on the Paper by Cauwenberghs and Kuznetsova Entitled 'Determinants and Prognostic Significance of the Renal Resistive Index'.","authors":"Yuhei Kawano, Yoshio Iwashima","doi":"10.1159/000442901","DOIUrl":"https://doi.org/10.1159/000442901","url":null,"abstract":"The clinical use of Renal Doppler ultrasonography is spreading widely because it can assess renal blood flow in a non-invasive evaluation. It is recommended as a screening examination for patients with suspected renovascular hypertension [1]. The renal resistive index (RRI) derived from intrarenal Doppler waveforms has also been drawing attention. In this issue of Pulse, Cauwenberghs and Kuznetsova [2] presented a review article that focused on the RRI with particular reference to its determinants and prognostic significance. We would like to make some comments about the clinical meanings of the RRI and the article by Cauwenberghs and Kuznetsova [2].","PeriodicalId":29774,"journal":{"name":"Pulse","volume":"3 3-4","pages":"179-81"},"PeriodicalIF":2.2,"publicationDate":"2016-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1159/000442901","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"34497072","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Arterial Stiffness and Chronic Kidney Disease.","authors":"Anne-Sophie Garnier,&nbsp;Marie Briet","doi":"10.1159/000443616","DOIUrl":"https://doi.org/10.1159/000443616","url":null,"abstract":"<p><p>Chronic kidney disease (CKD) is a major public health concern due to the high prevalence of associated cardiovascular (CV) disease. CV mortality is 10-30 times higher in end-stage renal disease patients than in the age-adjusted general population. The last 20 years have been marked by a huge effort in the characterization of the vascular remodeling process associated with CKD and its consequences on the renal, CV and general prognosis. By comparison with patients with normal renal function, with or without hypertension, an increase in large artery stiffness has been described in end-stage renal disease as well as in CKD stages 2-5. Most clinical studies are consistent with the observation that damage to large arteries may contribute to the high incidence of CV disease. By contrast, the impact of large artery stiffening and remodeling on CKD progression is still a matter of debate. Concomitant exposure to other CV risk factors, including diabetes, seems to play a major role in the association between aortic stiffness and estimated GFR. The conflicting results obtained from longitudinal studies designed to evaluate the impact of baseline aortic stiffness on GFR progression are detailed in the present review. Only pulse pressure, central and peripheral, is almost constantly associated with incident CKD and GFR decline. Kidney transplantation improves patients' CV prognosis, but its impact on arterial stiffness is still controversial. Donor age, living kidney donation and mean blood pressure appear to be the main determinants of improvement in aortic stiffness after kidney transplantation. </p>","PeriodicalId":29774,"journal":{"name":"Pulse","volume":"3 3-4","pages":"229-41"},"PeriodicalIF":2.2,"publicationDate":"2016-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1159/000443616","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"34498070","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Brachial-Ankle Pulse Wave Velocity: Background, Method, and Clinical Evidence.","authors":"Masanori Munakata","doi":"10.1159/000443740","DOIUrl":"https://doi.org/10.1159/000443740","url":null,"abstract":"<p><strong>Background: </strong>The populations of many developed countries are becoming progressively older. In aged societies, assessment of total vascular risk is critically important, because old age is usually associated with multiple risks. In this regard, pulse wave velocity (PWV) could be a global cardiovascular marker, since it increases with advancing age, high blood pressure, hyperglycaemia, and other traditional risks, summating cardiovascular risks. Carotid-femoral PWV has been widely applied in Western countries and has been used as a gold-standard PWV measure. However, this measure has never been implemented by general practitioners in Japan, possibly because of methodological difficulties. The life expectancy of Japanese people is now the highest in the world, and the establishment of an adequate total vascular risk measure is an urgent need. Against this background, brachial-ankle PWV was developed at the beginning of this century.</p><p><strong>Summary: </strong>Measurement of this parameter is easy, and its reproducibility is good. Moreover, the generality of the methodology is guaranteed. Brachial-ankle PWV has been reported to consistently increase with most traditional cardiovascular risk factors except dyslipidaemia. A meta-analysis of cohort studies including various levels of risk has shown that a 1 m/s increase in brachial-ankle PWV is associated with a 12% increase in the risk of cardiovascular events. Moreover, simultaneous evaluation of the ankle-brachial index could allow further risk stratification of high-risk individuals, who are common in aged societies. This unique feature is indispensable for the management of aged populations, who usually are exposed to multiple risks and have polyvascular diseases. This evidence, however, is chiefly derived from East Asian countries. The collection of data from Caucasian populations, therefore, remains a task for the future.</p><p><strong>Key message: </strong>Brachial-ankle PWV has the potential to become a measure of arterial stiffness worldwide.</p>","PeriodicalId":29774,"journal":{"name":"Pulse","volume":"3 3-4","pages":"195-204"},"PeriodicalIF":2.2,"publicationDate":"2016-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1159/000443740","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"34497075","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Aortic Root Calcification: A Possible Imaging Biomarker of Coronary Atherosclerosis.","authors":"Hussein Nafakhi,&nbsp;Hasan A Al-Nafakh,&nbsp;Abdulameer A Al-Mosawi","doi":"10.1159/000442762","DOIUrl":"https://doi.org/10.1159/000442762","url":null,"abstract":"<p><p>It has been reported that coronary atherosclerosis risk assessment using coronary artery calcium and thoracic aorta calcium quantification may improve risk stratification as it can lead to the reclassification of persons at increased risk. The aortic root has been characterized by its close anatomical proximity to the ostial origins of the right and left coronary arteries, and it can be evaluated using multi-detector computed tomography without additional radiation exposure and the use of contrast. The correlations between aortic root calcification and coronary atherosclerotic markers as well as cardiac risk factors have been analyzed. </p>","PeriodicalId":29774,"journal":{"name":"Pulse","volume":"3 3-4","pages":"167-71"},"PeriodicalIF":2.2,"publicationDate":"2016-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1159/000442762","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"34497070","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cerebral Small Vessel Disease and Arterial Stiffness: Tsunami Effect in the Brain?","authors":"Naoki Saji,&nbsp;Kenji Toba,&nbsp;Takashi Sakurai","doi":"10.1159/000443614","DOIUrl":"https://doi.org/10.1159/000443614","url":null,"abstract":"<p><strong>Background: </strong>Cerebral small vessel diseases, including silent lacunar infarcts, white matter hyperintensities, and microbleeds, pose a risk for cerebrovascular disease, cognitive impairment, and the geriatric syndrome via effects on arterial stiffness. However, the vascular, physiological, and metabolic roles of arterial stiffness in cerebral small vessel diseases remain unclear.</p><p><strong>Summary: </strong>Arterial stiffness can be assessed using various indicators such as the ankle-brachial index, pulse wave velocity, cardio-ankle vascular index, and augmentation index. Arterial stiffness is independently associated with all components of cerebral small vessel disease including silent lacunar infarcts, white matter hyperintensities, and microbleeds, although there are some methodological differences between the various surrogate markers. Evidence of arterial stiffness indicates microvessel arteriosclerosis presenting with vascular endothelial dysfunction. Further, vascular narrowing due to atherosclerosis and vascular stiffness due to lipohyalinosis can accelerate the pulse waves. This hemodynamic stress, pulsatile pressure, or blood pressure variability can cause a 'tsunami effect' towards the cerebral parenchyma and lead to cerebral small vessel disease. Previous studies have shown that silent lacunar infarcts and white matter hyperintensities are strongly associated with arterial stiffness. However, the association between microbleeds and arterial stiffness remains controversial, as there are two vessel mechanisms related to microbleeds: cerebral amyloid angiopathy and hypertensive small vessel disease.</p><p><strong>Key messages: </strong>Cerebral small vessel disease with associated arterial stiffness is a risk factor for silent cerebral lesions, stroke, and cognitive impairment. Improvement of the living environment, management of risk factors, and innovation and development of novel drugs that improve arterial stiffness may suppress the progression of cerebral small vessel disease, and may reduce the risk for stroke and dementia.</p>","PeriodicalId":29774,"journal":{"name":"Pulse","volume":"3 3-4","pages":"182-9"},"PeriodicalIF":2.2,"publicationDate":"2016-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1159/000443614","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"34497073","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Practical Suitability of a Stand-Alone Oscillometric Central Blood Pressure Monitor: A Review of the Microlife WatchBP Office Central.","authors":"Willem J Verberk,&nbsp;Hao-Min Cheng,&nbsp;Li-Chih Huang,&nbsp;Chia-Ming Lin,&nbsp;Yao-Pin Teng,&nbsp;Chen-Huan Chen","doi":"10.1159/000443771","DOIUrl":"https://doi.org/10.1159/000443771","url":null,"abstract":"<p><p>Accumulating evidence indicates that central blood pressure (CBP) is a better cardiovascular risk predictor than brachial blood pressure (BP). Although more additional benefits of CBP-based treatment above usual hypertension treatment are to be demonstrated, the demand for implementing CBP assessment in general clinical practice is increasing. For this, the measurement procedure must be noninvasive, easy to perform, and cost- and time-efficient. Therefore, oscillometric devices with the possibility to assess CBP seem the best option. Recently, such an oscillometric BP monitor, the Microlife WatchBP Office Central, was developed, which demonstrated its high accuracy in a validation study against invasive BP measurement. Calibration errors of this device are limited because the procedure is automated, standardized, and performed at the same place of and within 30 s from pulse wave assessment. The transformation from the peripheral pulse wave to CBP is done by means of an individual-based pulse wave analysis according to a theory of arterial compliance and wave reflections. In addition, the device has demonstrated to enable a more reliable diagnosis of hypertension by CBP than by peripheral BP, with a lower frequency of over- and underdiagnosis. Altogether, the available clinical evidence suggests that the Microlife WatchBP Office Central fulfills the criteria for general clinical use. </p>","PeriodicalId":29774,"journal":{"name":"Pulse","volume":"3 3-4","pages":"205-16"},"PeriodicalIF":2.2,"publicationDate":"2016-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1159/000443771","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"34497076","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Hyperuricemia, Cardiovascular Disease, and Hypertension.","authors":"Masanari Kuwabara","doi":"10.1159/000443769","DOIUrl":"https://doi.org/10.1159/000443769","url":null,"abstract":"<p><p>In recent years, there has been an increase in the prevalence of hyperuricemia, and the latter has attracted attention as an adult lifestyle-associated disease, together with hypertension, diabetes, and dyslipidemia. Although hyperuricemia is known to be an independent risk factor for hypertension, whether it is an independent risk factor for cardiovascular disease remains controversial. Recently, some small-scale interventional studies on antihyperuricemic medications showed that the latter improved angina symptoms and prevented cardiovascular disease. Here, we will mainly explain the cause of hyperuricemia and the associations between hyperuricemia, hypertension, and cardiovascular disease based on the latest published evidence. </p>","PeriodicalId":29774,"journal":{"name":"Pulse","volume":"3 3-4","pages":"242-52"},"PeriodicalIF":2.2,"publicationDate":"2016-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1159/000443769","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"34498069","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Determinants and Prognostic Significance of the Renal Resistive Index.","authors":"Nicholas Cauwenberghs,&nbsp;Tatiana Kuznetsova","doi":"10.1159/000442445","DOIUrl":"https://doi.org/10.1159/000442445","url":null,"abstract":"<p><strong>Background: </strong>The noninvasive assessment of renal hemodynamics is currently possible by assessing the renal resistive index (RRI) derived from intrarenal Doppler arterial waveforms as (peak systolic velocity - end-diastolic velocity)/peak systolic velocity. In this review, we outline the important determinants of the RRI to clarify the true identity of the RRI and highlight its potential diagnostic and prognostic value in renal and cardiovascular pathology.</p><p><strong>Summary: </strong>Although the RRI was initially considered to reflect intrarenal vascular pathological processes, this index is actually a product of a complex interaction between renal and systemic vascular wall properties and hemodynamic factors. Indeed, studies in patients and general populations consistently demonstrated a significant and direct association between the RRI and central or peripheral pulse pressure independent of other covariables. Moreover, studies in renal transplant patients also showed that the RRI mainly reflects characteristics of the recipient but not those of the graft. Thus, the major influence of the systemic hemodynamics on the intrarenal arterial waveforms excludes RRI as a specific marker of renal vascular pathology. On the other hand, because the RRI reflects pulsatility in renal arteries, it might be useful for the early detection of renal microvascular damage. Future longitudinal studies are still needed to clarify whether the detection of Doppler changes in intrarenal arteries might yield an improvement in the adverse cardiovascular and renal outcome.</p><p><strong>Conclusion: </strong>Published studies on RRI imply that the interaction between the systemic hemodynamics and peripheral circulation in the kidney is a complex physiological phenomenon. In addition to renal vascular properties, the central hemodynamic factors significantly influence the intrarenal arterial Doppler waveform patterns. Previous research also suggested an important role of the RRI for the evaluation of renal target organ damage, particularly in patients with increased pulsatility of the intrarenal blood flow.</p>","PeriodicalId":29774,"journal":{"name":"Pulse","volume":"3 3-4","pages":"172-8"},"PeriodicalIF":2.2,"publicationDate":"2016-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1159/000442445","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"34497071","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Quantification of the Interrelationship between Brachial-Ankle and Carotid-Femoral Pulse Wave Velocity in a Workplace Population.","authors":"Yi-Bang Cheng,&nbsp;Yan Li,&nbsp;Chang-Sheng Sheng,&nbsp;Qi-Fang Huang,&nbsp;Ji-Guang Wang","doi":"10.1159/000444645","DOIUrl":"https://doi.org/10.1159/000444645","url":null,"abstract":"<p><strong>Background: </strong>Brachial-ankle pulse wave velocity (PWV) is increasingly used for the measurement of arterial stiffness. In the present study, we quantified the interrelationship between brachial-ankle and carotid-femoral PWV in a workplace population, and investigated the associations with cardiovascular risk factors and carotid intima-media thickness (IMT).</p><p><strong>Methods: </strong>Brachial-ankle and carotid-femoral PWV were measured using the Omron-Colin VP1000 and SphygmoCor devices, respectively. We investigated the interrelationship by the Pearson's correlation analysis and Bland-Altman plot, and performed sensitivity and specificity analyses.</p><p><strong>Results: </strong>The 954 participants (mean ± standard deviation age 42.6 ± 14.2 years) included 630 (66.0%) men and 203 (21.3%) hypertensive patients. Brachial-ankle (13.4 ± 2.7 m/s) and carotid-femoral PWV (7.3 ± 1.6 m/s) were significantly correlated in all subjects (r = 0.75) as well as in men (r = 0.72) and women (r = 0.80) separately. For arterial stiffness defined as a carotid-femoral PWV of 10 m/s or higher, the sensitivity and specificity of brachial-ankle PWV of 16.7 m/s or higher were 72 and 94%, respectively. The area under the receiver operating characteristic curve was 0.953. In multiple stepwise regression, brachial-ankle and carotid-femoral PWV were significantly (p < 0.001) associated with age (partial r = 0.33 and 0.34, respectively) and systolic blood pressure (partial r = 0.71 and 0.66, respectively). In addition, brachial-ankle and carotid-femoral PWV were significantly (p < 0.001) associated with carotid IMT (r = 0.57 and 0.55, respectively) in unadjusted analysis, but not in analysis adjusted for cardiovascular risk factors (p ≥ 0.08).</p><p><strong>Conclusions: </strong>Brachial-ankle and carotid-femoral PWV were closely correlated, and had similar determinants. Brachial-ankle PWV can behave as an ease-of-use alternative measure of arterial stiffness for assessing cardiovascular risk.</p>","PeriodicalId":29774,"journal":{"name":"Pulse","volume":"3 3-4","pages":"253-62"},"PeriodicalIF":2.2,"publicationDate":"2016-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1159/000444645","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"34498071","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pulmonary Hypertension and Cardiopulmonary Exercise in Heart Failure.","authors":"Chul-Ho Kim,&nbsp;Sae Young Jae,&nbsp;Bruce D Johnson","doi":"10.1159/000360964","DOIUrl":"https://doi.org/10.1159/000360964","url":null,"abstract":"<p><p>In heart failure (HF), pulmonary hypertension (PH) is initially associated with a rise in the left ventricular filling pressure. PH is defined by pulmonary hemodynamic measurements including pulmonary capillary wedge pressure, mean pulmonary arterial pressure and pulmonary vascular resistance. Eventually, PH in HF may become more of a reactive process. Although the mechanism of the reactive PH development is not clearly understood, vascular dysfunction induced by remodeling, vasoactive substances and genetic variation appear to contribute significantly to this form of PH. Noninvasive cardiopulmonary exercise testing has been extensively utilized to assess disease severity in HF patients. It provides integrated information that is dependent on cardiopulmonary hemodynamics, lung mechanics, breathing pattern and strategy. In this review, we will discuss the mechanisms of PH development in HF and how noninvasive gas exchange measures obtained with submaximal exercise are influenced by PH in this population. </p>","PeriodicalId":29774,"journal":{"name":"Pulse","volume":"1 3-4","pages":"143-51"},"PeriodicalIF":2.2,"publicationDate":"2014-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1159/000360964","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"34021087","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}