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      Consistency of aortic distensibility and pulse wave velocity estimates with respect to the Bramwell-Hill theoretical model: a cardiovascular magnetic resonance study

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          Abstract

          Background

          Arterial stiffness is considered as an independent predictor of cardiovascular mortality, and is increasingly used in clinical practice. This study aimed at evaluating the consistency of the automated estimation of regional and local aortic stiffness indices from cardiovascular magnetic resonance (CMR) data.

          Results

          Forty-six healthy subjects underwent carotid-femoral pulse wave velocity measurements ( CF_PWV) by applanation tonometry and CMR with steady-state free-precession and phase contrast acquisitions at the level of the aortic arch. These data were used for the automated evaluation of the aortic arch pulse wave velocity ( Arch_PWV), and the ascending aorta distensibility ( AA_Distc, AA_Distb), which were estimated from ascending aorta strain ( AA_Strain) combined with either carotid or brachial pulse pressure. The local ascending aorta pulse wave velocity AA_PWVc and AA_PWVb were estimated respectively from these carotid and brachial derived distensibility indices according to the Bramwell-Hill theoretical model, and were compared with the Arch_PWV. In addition, a reproducibility analysis of AA_PWV measurement and its comparison with the standard CF_PWV was performed. Characterization according to the Bramwell-Hill equation resulted in good correlations between Arch_PWV and both local distensibility indices AA_Distc (r = 0.71, p < 0.001) and AA_Distb (r = 0.60, p < 0.001); and between Arch_PWV and both theoretical local indices AA_PWVc (r = 0.78, p < 0.001) and AA_PWVb (r = 0.78, p < 0.001). Furthermore, the Arch_PWV was well related to CF_PWV (r = 0.69, p < 0.001) and its estimation was highly reproducible (inter-operator variability: 7.1%).

          Conclusions

          The present work confirmed the consistency and robustness of the regional index Arch_PWV and the local indices AA_Distc and AA_Distb according to the theoretical model, as well as to the well established measurement of CF_PWV, demonstrating the relevance of the regional and local CMR indices.

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          Aortic stiffness is an independent predictor of primary coronary events in hypertensive patients: a longitudinal study.

          Stephane Laurent, Athanase Benetos, Pierre Boutouyrie … (2001)
          Arterial stiffness may predict coronary heart disease beyond classic risk factors. In a longitudinal study, we assessed the predictive value of arterial stiffness on coronary heart disease in patients with essential hypertension and without known clinical cardiovascular disease. Aortic stiffness was determined from carotid-femoral pulse wave velocity at baseline in 1045 hypertensives. The risk assessment of coronary heart disease was made by calculating the Framingham risk score according to the categories of gender, age, blood pressure, cholesterol, diabetes, and smoking. Mean age at entry was 51 years, and mean follow-up was 5.7 years. Coronary events (fatal and nonfatal myocardial infarction, coronary revascularization, and angina pectoris) and all cardiovascular events served as outcome variables in Cox proportional-hazard regression models. Fifty-three coronary events and 97 total cardiovascular events occurred. In univariate analysis, the relative risk of follow-up coronary event or any cardiovascular event increased with increasing level of pulse wave velocity; for 1 SD, ie, 3.5 m/s, relatives risks were 1.42 (95% confidence interval [CI], 1.10 to 1.82; P<0.01) and 1.41 (95% CI, 1.17 to 1.70; P<0.001), respectively. Framingham score significantly predicted the occurrence of coronary and all cardiovascular events in this population (P<0.01 and P<0.0001, respectively). In multivariate analysis, pulse wave velocity remained significantly associated with the occurrence of coronary event after adjustment either of Framingham score (for 3.5 m/s: relative risk, 1.34; 95% CI, 1.01 to 1.79; P=0.039) or classic risk factors (for 3.5 m/s: relative risk, 1.39; 95% CI, 1.08 to 1.79; P=0.01). Parallel results were observed for all cardiovascular events. This study provides the first direct evidence in a longitudinal study that aortic stiffness is an independent predictor of primary coronary events in patients with essential hypertension.
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            Aortic pulse wave velocity index and mortality in end-stage renal disease.

            Jacques Blacher, Michel E. Safar, Alain P Guerin … (2003)
            Aortic pulse wave velocity (PWV) is a strong independent predictor of overall and cardiovascular mortality in patients with end-stage renal disease (ESRD). Nevertheless, because age, blood pressure, heart rate, and gender are strong determinants of both arterial stiffness and mortality, the individual relevance of PWV measurements remains controversial. A cohort of 242 patients with ESRD undergoing hemodialysis was studied for a mean (+/- SD) duration of 78 +/- 46 months. At entry, together with standard clinical and biochemical analyses, PWV was measured using Doppler ultrasonography. On the basis of a nomogram established on 469 nonuremic subjects, a theoretical value of PWV was determined in ESRD patients according to their age, blood pressure, gender, and heart period. The PWV index (measured PWV - theoretical PWV) was then calculated for each individual ESRD patient. Based on Cox analysis, the PWV index, but neither pulse pressure nor cardiac mass, was a strong and independent predictor of both cardiovascular and overall mortality, together with age and time on dialysis before inclusion. Patients with positive (versus negative) PWV index had a twofold adjusted risk of mortality during the follow-up. Per each 1 meter/second PWV index increment, we observed a 34% (crude) and a 14% (adjusted) increase in both cardiovascular and overall mortality (P < 0.02 for all). In ESRD patients, the calculation of a PWV index provides information about cardiovascular and overall mortality risk with high predictive power, showing that PWV measurements provide discriminatory prognostic power over and above conventional cardiovascular risk factors.
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              Validation and reproducibility of aortic pulse wave velocity as assessed with velocity-encoded MRI.

              Albert de Roos, Heynric B Grotenhuis, Paul Steendijk … (2009)
              To validate magnetic resonance imaging (MRI) assessment of aortic pulse wave velocity (PWV(MRI)) with PWV determined from invasive intra-aortic pressure measurements (PWV(INV)) and to test the reproducibility of the measurement by MRI. PWV(MRI) was compared with PWV(INV) in 18 nonconsecutive patients scheduled for catheterization for suspected coronary artery disease. Reproducibility of PWV(MRI) was tested in 10 healthy volunteers who underwent repeated measurement of PWV(MRI) at a single occasion. Velocity-encoded MRI was performed on all participants to assess PWV(MRI) in the total aorta (Ao(total)), the proximal aorta (Ao(prox)), and the distal aorta (Ao(dist)). The results are expressed as mean +/- SD, Pearson correlation coefficient (PCC), and intraclass correlation (ICC). Good agreement between PWV(MRI) and PWV(INV) was found for Ao(total) (6.5 +/- 1.1 m/s vs. 6.1 +/- 0.8 m/s; PCC = 0.53), Ao(prox) (6.5 +/- 1.3 m/s vs. 6.2 +/- 1.1 m/s; PCC = 0.69), and for Ao(dist) (6.9 +/- 1.1 m/s vs. 6.1 +/- 1.0 m/s; PCC = 0.71). Reproducibility of PWV(MRI) was high for Ao(total) (4.3 +/- 0.5 m/s vs. 4.6 +/- 0.7 m/s; ICC = 0.90, P < 0.01), Ao(prox) (4.3 +/- 0.9 m/s vs. 4.7 +/- 1.0 m/s; ICC = 0.87, P < 0.01), and Ao(dist) (4.3 +/- 0.6 m/s vs. 4.4 +/- 0.8 m/s; ICC = 0.92, P < 0.01). MRI assessment of aortic pulse wave velocity shows good agreement with invasive pressure measurements and can be determined with high reproducibility.
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                Author and article information

                Journal
                Journal ID (nlm-ta): J Cardiovasc Magn Reson
                Title: Journal of Cardiovascular Magnetic Resonance
                Publisher: BioMed Central
                ISSN (Print): 1097-6647
                ISSN (Electronic): 1532-429X
                Publication date Collection: 2011
                Publication date (Electronic): 27 January 2011
                Volume: 13
                Issue: 1
                Page: 11
                Affiliations
                [1 ]Inserm U678, 91 boulevard de l'Hôpital, 75634 Paris cedex 13, France
                [2 ]AP-HP, Service de Radiologie Cardiovasculaire, Hôpital Européen Georges Pompidou, 20 rue Leblanc, Paris, 75015, France
                Article
                Publisher ID: 1532-429X-13-11
                DOI: 10.1186/1532-429X-13-11
                PMC ID: 3038969
                PubMed ID: 21272312
                SO-VID: 8ab036c1-d931-4903-b995-fbf75590e478
                Copyright © Copyright ©2011 Dogui et al; licensee BioMed Central Ltd.
                License:

                This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                Date received : 7 September 2010
                Date accepted : 27 January 2011
                Categories
                Subject: Research

                ScienceOpen disciplines: Cardiovascular Medicine
                Data availability:
                ScienceOpen disciplines: Cardiovascular Medicine

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