Aortic-Brachial Stiffness Mismatch and Mortality in Dialysis Population

Fortier, Catherine; Mac‐Way, Fabrice; Desmeules, Simon; Marquis, Karine; Serres, Sacha A. De; Lebel, Marcel; Boutouyrie, Pierre; Agharazii, Mohsen

doi:10.1161/hypertensionaha.114.04587

Cited by 101 publications

(143 citation statements)

References 35 publications

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“…In contrast, brachial (or femoral) ( Table 1) stiffness remains almost stable throughout aging ( Figure 1B, Table 2) and cannot negate for the effect of premature aortic aging on pressure transmission. 2,28, 29 Fortier et al 30 proposed arterial stiffness gradient as an independent index of ESRD survival. In our study, the predictive value of the arterial stiffness gradient depends entirely on aortic PWV changes.…”

Section: Discussionmentioning

confidence: 99%

“…In our study, the predictive value of the arterial stiffness gradient depends entirely on aortic PWV changes. In the paper by Fortier et al, 30 the stiffness gradient was expressed as aortic PWV/brachial PWV and not in the usual way as (brachial PWV/aortic PWV) 0.5 . 2 The population in the work by Fortier et al 30 was older and included patients with diabetes, and the population was characterized principally by unusually low brachial PWV, which could account for the stiffness gradient as a better predictor.…”

Section: Discussionmentioning

confidence: 99%

“…In the paper by Fortier et al, 30 the stiffness gradient was expressed as aortic PWV/brachial PWV and not in the usual way as (brachial PWV/aortic PWV) 0.5 . 2 The population in the work by Fortier et al 30 was older and included patients with diabetes, and the population was characterized principally by unusually low brachial PWV, which could account for the stiffness gradient as a better predictor. However, the most important finding to consider in such studies is that, with aging, the aorta undergoes marked structural and geometric changes and becomes stiff and tortuous, with increased length, diameters, and wall thickness.…”

Section: Discussionmentioning

confidence: 99%

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Aortic Aging in ESRD: Structural, Hemodynamic, and Mortality Implications

London

Safar

Pannier

2015

JASN

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Aging incurs aortic stiffening and dilation, but these changes are less pronounced in peripheral arteries, resulting in stiffness and geometry gradients influencing progression of the forward and reflected pressure waves. Because premature arterial aging is observed in ESRD, we determined the respective roles of stiffness and aortic geometry gradients in 73 controls and 156 patients on hemodialysis. We measured aortic pulse wave velocity (PWV) and brachial PWV to evaluate the stiffness gradient [(brachial PWV/aortic PWV) 0.5 ] and ascending aortic and aortic bifurcation diameters to assess aortic taper (ascending aortic diameter/aortic bifurcation diameter). The global reflection coefficient was estimated from characteristic impedance and vascular resistance. Cox proportional hazard models were used to determine mortality risk. The age-associated increase in aortic PWV was higher in patients (P,0.001). In controls, aortic ascending and bifurcation diameters increased with age, with an unchanged aortic taper. In patients on hemodialysis, age did not associate with increased ascending aortic diameter but did associate with increased aortic bifurcation diameter and decreased aortic taper, both of which also associated with abdominal aortic calcifications and smaller global reflection coefficient (P,0.001). In patients, multivariate models revealed all-cause and cardiovascular mortality associated with age, aortic PWV, and aortic bifurcation diameter with high specificity and sensitivity. Using stiffness gradient, aortic taper, or global reflection coefficient in the model produced similar results. Thus, whereas aortic stiffness is a known independent predictor of mortality, these results indicate the importance of also evaluating the aortic geometry in patients on hemodialysis. 27: 183727: -184627: , 201627: . doi: 10.1681 Aging is associated with marked changes in the mechanical and geometric characteristics of the arterial tree. 1 It is characterized by markedly increased aortic stiffness (aortic pulse wave velocity [PWV]), stiffening not observed to the same degree in peripheral muscular arteries. 2 This change reduces the normal centrifugal impedance gradient between central and peripheral artery systems. 2,3 Any change of the impedance gradient generates modifications of partial local wave reflections, which can be considered a continuous phenomenon along the impedance gradient. 3,4 The partial reflections summate to form an apparently unique backward-traveling reflected wave. 5 In the presence of impedance gradient and low aortic PWV, the backward wave returns to the aorta at end systole and early diastole, thereby enhancing late diastolic pressure and coronary perfusion 4 and attenuating the transmission of pulsatile pressure to the microcirculation. 3,6 The central effect of aortic stiffness on impedance J Am Soc Nephrol

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Aortic Aging in ESRD: Structural, Hemodynamic, and Mortality Implications

London

Safar

Pannier

2015

JASN

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“…During aging, since the stiffness of the central elastic arteries increases to a greater extent than that of peripheral muscular arteries [2], the aortic/brachial stiffness gradient is first equalized (aortic stiffness = brachial artery stiffness), and then even reverted (aortic stiffness N brachial artery stiffness). This process, called aortic-brachial stiffness mismatch [3][4][5], has important hemodynamic and clinical consequences since it reduces the reflection waves, increasing the reflection site distance, causes vascular damage through the enhanced transmission of forward energy waves into the microcirculation [5], contributes to the pathogenesis of white matter lesions of the brain [6] and renal dysfunction [7,8] and, at least in patients with ESRD, is strongly and independently associated with increased mortality [9].inflammatory bowel disease (IBD) [10], we reported that aortic stiffness was increased [11] and that the aortic stiffening was reduced by antitumor necrosis factor (anti-TNF) therapy in young patients with IBD [12]. These findings were confirmed in several studies performed by independent groups, in meta-analyses performed by our group [13][14][15], and in a meta-analysis performed by an independent group that, methodologic issues aside [16], has also reported both increased intima-media thickness and reduced flow-mediated dilation in patients with IBD [17].…”

Section: Introductionmentioning

confidence: 99%

“…Both CKD and ulcerative colitis (UC) are characterized by an increase of aortic stiffness [1,9,[11][12][13][14][15]17]. However, since the causes and the mechanisms involved in the arterial stiffening seem to be different [10,20], also the arterial phenotype, the hemodynamic and the clinical consequences could be different in UC and CKD.…”

Section: Introductionmentioning

confidence: 99%

Pulse wave velocity differs between ulcerative colitis and chronic kidney disease

Zanoli

Lentini

Boutouyrie

et al. 2018

European Journal of Internal Medicine

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Ankle‐brachial index, arterial stiffness, and biomarkers in the prediction of mortality and outcomes in patients with end‐stage kidney disease

Otsuka

Nakanishi

Shimada

et al. 2019

Clinical Cardiology

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Background Although ankle‐brachial index (ABI) and brachial‐ankle pulse wave velocity (baPWV) are significant predictors of major adverse cardiovascular event (MACE), their prognostic value in association with biomarkers has not been fully evaluated in patients with end‐stage kidney disease (ESKD). Hypothesis We hypothesized that ABI/baPWV would provide better prognostic value independent of biomarkers in ESKD patients. Methods This study included 104 ESKD patients treated with maintenance hemodialysis who underwent ABI and baPWV examinations and laboratory tests, including brain‐natriuretic peptide, high‐sensitive cardiac troponin T (hs‐cTnT), and high‐sensitive C‐reactive protein (hs‐CRP). MACE was defined as a composite event of all‐cause death, acute coronary syndrome, and stroke. Results During a mean follow‐up of 3.6 ± 1.7 years, a total of 51 MACE were observed. The independent factors associated with MACE were age >75 years (adjusted hazard ratio [HR], 2.15; P < .05), abnormal ABI (adjusted HR, 2.01; P < .05), left ventricular ejection fraction (LVEF) <50% (adjusted HR, 3.33; P < .001), the upper tertile of hs‐cTnT (adjusted HR, 2.77; P < .05), and hs‐CRP (HR, 1.96; P < .05). However, baPWV did not remain as an independent predictor of MACE in the entire cohort and also in patients without abnormal ABI. The combination of predictors improves the predictive value of MACE, providing increased HR with 4.00 for abnormal ABI + hs‐CRP, 4.42 for abnormal ABI + hs‐cTnT, and 7.04 for abnormal ABI + LVEF <50% (all P < .001). Conclusion Abnormal ABI is a robust predictor of MACE independent of biomarkers and their combination provides better risk stratification compared with a single predictor in ESKD patients.

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Aortic-Brachial Stiffness Mismatch and Mortality in Dialysis Population

Cited by 101 publications

References 35 publications

Aortic Aging in ESRD: Structural, Hemodynamic, and Mortality Implications

Aortic Aging in ESRD: Structural, Hemodynamic, and Mortality Implications

Pulse wave velocity differs between ulcerative colitis and chronic kidney disease

Ankle‐brachial index, arterial stiffness, and biomarkers in the prediction of mortality and outcomes in patients with end‐stage kidney disease

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