Background This study sought to assess cross-sectional associations of aortic stiffness assessed by magnetic resonance imaging (MRI) with left ventricular (LV) remodeling and myocardial deformation in the Multi-Ethnic Study of Atherosclerosis (MESA). Methods and Results Aortic arch pulse wave velocity (PWV) was measured with phase contrast cine MRI. LV circumferential strain (Ecc), torsion, and early diastolic strain rate (EDSR) were determined by tagged MRI. Multivariable linear regression models were used to adjust for demographics and cardiovascular risk factors. Of 2093 participants, multivariable linear regression models demonstrated that higher arch PWV was associated with higher LV mass index (B=0.53 per 1 SD increase for log-transformed PWV, p<0.05) and LV mass to volume ratio (LVMVR) (B=0.015, p<0.01), impaired LV ejection fraction (LVEF) (B=−0.84, p<0.001), Ecc (B=0.55, p<0.001), torsion (B=−0.11, p<0.001), and EDSR (B=−0.003, p<0.05). In sex stratified analysis, higher arch PWV was associated with higher MVR (B=0.02, p<0.05), impaired Ecc (B=0.60, p<0.001) and LVEF (B=−0.45, p<0.05), but with maintained torsion in women, whereas higher PWV was associated with impaired Ecc (B=0.49, p<0.001) and LVEF (B=−1.21, p<0.001) with lower torsion (B=−0.17, p<0.001) in men. Conclusions Higher arch PWV is associated with LV remodeling and reduced LV systolic and diastolic function in a large multi-ethnic population. Greater aortic arch stiffness is associated with concentric LV remodeling, relatively preserved LVEF with maintained torsion in women, whereas greater aortic arch stiffness is associated with greater LV dysfunction demonstrated as impaired Ecc, torsion and LVEF with less concentric LV remodeling in men.

No abstract

Background Although gait speed and six-minute walk distance are used to assess functional capacity in older patients with cardiovascular disease, their prognostic capabilities have not been directly compared. Methods The study population was identified from the Kitasato University Cardiac Rehabilitation Database and consisted of 1474 patients ≥60 years old with a mean age of 72.2 ± 7.1 years that underwent evaluation of both usual gait speed and six-minute walk distance in routine geriatric assessment between 1 June 2008-30 September 2015. Both gait speed and six-minute walk distance were determined on the same day at hospital discharge. Results Mean gait speed and six-minute walk distance in the whole population were 1.04 m/s and 381 m, respectively, and were strongly positively correlated ( r = 0.80, p < 0.001). A total of 180 deaths occurred during a follow-up of 2.3 ± 1.9 years. After adjusting for confounding factors, both gait speed (adjusted hazard ratio per 0.1 m/s increase: 0.87, 95% confidence interval: 0.81-0.93, p < 0.001) and six-minute walk distance (adjusted hazard ratio per 10-metre increase: 0.96, 95% confidence interval: 0.94-0.97, p < 0.001) were independent predictors of all-cause mortality. There was no significant difference in prognostic capability between gait speed and six-minute walk distance (c-index: 0.64 (95% confidence interval: 0.60-0.69) and 0.66 (95% confidence interval: 0.61-0.70), respectively, p = 0.357). Conclusions Gait speed and six-minute walk distance showed similar prognostic predictive ability for all-cause mortality in older cardiovascular disease patients, indicating the potential utility of gait speed as a simple risk stratification tool in older cardiovascular disease patients.

A high level of quadriceps strength was strongly associated with a lower risk of both all-cause and CV mortality in patients with CAD. Evaluation of QIS offered incremental prognostic information beyond pre-existing risk factors.

SummaryThe purpose of this study was to clarify the acute effects of a single session of stretching exercises on vascular endothelial function and peripheral circulation in patients with acute myocardial infarction. This study evaluated 32 patients (mean age, 66 ± 9 years) who received phase I cardiac rehabilitation after acute myocardial infarction. Five types of stretching exercises were performed on the floor: wrist dorsiflexion, close-legged trunk flexion, open-legged trunk flexion, open-legged lateral trunk bending, and cross-legged trunk flexion. Each exercise entailed a 30-second stretching followed by a 30-second relaxation, and was repeated twice. Low-and high-frequency components (LF and HF) of heart rate variability (LF, 0.04-0.15 Hz; HF, 0.15-0.40 Hz) were analyzed, and HF and LF/HF were used as indices of parasympathetic and sympathetic nervous activities, respectively. Reactive hyperemia peripheral arterial tonometry (RH-PAT) index was measured and used as a parameter for vascular endothelial function. Transcutaneous oxygen pressure (tcPO 2 ) on the right foot and chest was also measured, and the Foot-tcPO 2 /Chest-tcPO 2 ratio was used as a parameter for peripheral circulation. The HF, RH-PAT index, and Foot-tcPO 2 /Chest-tcPO 2 ratio were significantly higher after the exercises than before (P < 0.05, P < 0.01, and P < 0.05, respectively). There was no significant difference in the LF/HF ratio measured before and after stretching exercises. These findings demonstrate that stretching exercises improve vascular endothelial function and peripheral circulation in patients with acute myocardial infarction. (Int Heart J 2013; 54: 59-63)

The predictive value of aortic arch pulse wave velocity (PWV) assessed by magnetic resonance imaging (MRI) for cardiovascular disease (CVD) events has not been fully established. The aim of the present study was to evaluate the association of arch PWV with incident CVD events in MESA. Aortic arch PWV was measured using MRI at baseline in 3,527 MESA participants (mean age = 62 ± 10 years at baseline, 47% male) free of overt CVD. Cox regression was used to evaluate the risk of incident CVD (coronary heart disease, stroke, transient ischemic attack, or heart failure) in relation to arch PWV adjusted for age, gender, race, and CVD risk factors. The median value of arch PWV was 7.4 (IQR; 5.6 to 10.2) m/s. There was significant interaction between arch PWV and age for outcomes, so analysis was stratified by age categories (45–54 and over 54 years). There were 456 CVD events over the 10-year follow-up. 45–54 year-old participants had significant association of arch PWV with incident CVD independent of CVD risk factors (HR, 1.44; 95% confidence interval, 1.07 to 1.95; p=0.018; per 1SD increase for logarithmically transformed PWV), whereas over 54 years group did not (p=0.93). Aortic arch PWV assessed by MRI is a significant predictor of CVD events among middle-aged (45 to 54 years old) individuals, whereas arch PWV is not associated with CVD among an elderly in a large multi-ethnic population.

SummaryPatients with chronic heart failure (CHF) are frequently readmitted to the hospital due to disease progression. Although a shorter 6-minute walk distance (6MWD) is correlated with poor prognosis, 6MWD is not considered a clinical indicator for predicting hospital readmission.We investigated whether 6MWD measured at the time of hospital discharge predicted readmission due to heart failure in CHF patients.Patients admitted to the hospital for the first time due to heart failure were enrolled. After 6MWD was measured at discharge, patients were followed-up for 3 years. Clinical characteristics, 6MWD and readmission due to heart failure were evaluated in 252 patients (68.5 ± 11.8 years old, 162 males). Significant factors that affected readmission were extracted and cut-off values were determined using multivariate logistic regression analysis and receiver operating characteristic curves.Of 252 CHF patients, 103 were readmitted within 3 years. 6MWD at the time of discharge was significantly shorter in readmitted patients than non-readmitted patients (P < 0.001) and was a significant predictor of readmission (P < 0.001). The odds ratio for readmission was 1.22 (P < 0.001) with each 10-meter decrease in 6MWD. The 6MWD cut-off value was determined to be 390 meters, with a sensitivity of 0.75 and a specificity of 0.77.6MWD measured at the time of discharge is an independent predictor of hospital readmission in CHF patients, with a cut-off value of 390 meters. (Int Heart J 2014; 55: 331-336)

In our longitudinal, community-based cohort study of adult individuals aged 45 years or greater, greater mean blood pressure and a history of smoking history were associated with increased aortic stiffening over 10 years as assessed by MRI.