Coronary circulation in dogs with an experimental decrease in aortic compliance

Watanabe, Hideki; Ohtsuka, Sadanori; Kakihana, Masatoshi; Sugishita, Yasuro

doi:10.1016/0735-1097(93)90330-4

Cited by 270 publications

(178 citation statements)

References 29 publications

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“…There was a modest reduction in extracellular water with drug introduction, and a potential reduction in venous congestion may have played a role, but the patients with established CHF were specifically excluded from study, and the absolute change in extracellular water was small. PWV and augmentation index both improved with reintroduction of antihypertensive medication; reduction in arterial stiffness is known to reduce demand ischemia (29). There was a correlation between augmentation index (as a composite measure of cardiac performance and peripheral arterial structure and function) and the degree of endotoxemia, but not with PWV as measure of arterial compliance itself.…”

Section: Discussionmentioning

confidence: 75%

The Impact of Antihypertensive Drug Therapy on Endotoxemia in Elderly Patients with Chronic Kidney Disease

John¹,

Owen²,

Harrison³

et al. 2011

Clinical Journal of the American Society of Nephrology

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SummaryBackground and objectives Endotoxin (ET) is recognized to cause adverse effects on cardiovascular (CV) structure. Circulatory translocation of gut bacterial ET is described in heart failure. Chronic kidney disease (CKD) is common in older people and aggressive BP control is the cornerstone of management. We therefore studied ET after improvement of the overall CV milieu with introduction of optimized antihypertensive therapy (AHT).Design, setting, participants, & measurements We recruited 40 hypertensive nondiabetic patients (Ն70 years) with CKD stages 3 and 4 and hypertensive non-CKD matched controls. Assessment was performed after complete AHT washout and repeated after AHT reintroduction to target BP 130/80 mmHg. Pulse wave velocity (PWV) and analysis were assessed by applanation tonometry, central hemodynamics by continuous digital pulse wave analysis, vascular calcification (VC) by superficial femoral artery CT, and serum ET by Limulus Amebocyte assay.Results Mean age was 76 Ϯ 5 years, estimated GFR (eGFR) (CKD group) was 40 Ϯ 14 ml/min per 1.73 m 2 , and achieved BP was 128/69 mmHg. Washout ET was 0.042 Ϯ 0.011 EU/ml and was independent of renal function, gender, age, BP, VC, arterial stiffness, and high-sensitivity C-reactive protein. ET significantly decreased with AHT (to 0.020 Ϯ 0.028 EU/ml; P Ͻ 0.001) and was associated with eGFR (R ϭ Ϫ0.38; P ϭ 0.02), arterial wave reflection (Augmentation Index R ϭ Ϫ0.42; P ϭ 0.01), and degree of tonic vasodilatation (total peripheral resistance R ϭ Ϫ0.37; P ϭ 0.03), but not VC, PWV, gender, age, BP, or high-sensitivity C-reactive protein.Conclusions Elderly patients with hypertension have elevated serum ET. Improvement of their CV status with optimized AHT is associated with a significant reduction in endotoxemia. Further investigation of the potential pathophysiological mechanisms linking CV disease and CKD with this previously unappreciated effect of AHT appears warranted.

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Section: Discussionmentioning

confidence: 75%

The Impact of Antihypertensive Drug Therapy on Endotoxemia in Elderly Patients with Chronic Kidney Disease

John¹,

Owen²,

Harrison³

et al. 2011

Clinical Journal of the American Society of Nephrology

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“…Furthermore, there are important interactions between the left ventricle and aortic function (so-called ventriculovascular coupling). Prior data showed reduced aortic distensibility or LV hypertrophy increased myocardial oxygen demand or reduced diastolic coronary artery perfusion (42). Therefore, patients with lesser aortic distensibility or increasing LV mass are more vulnerable to repetitive HD-induced cardiac ischemia (43,44).…”

Section: Discussionmentioning

confidence: 99%

Randomized Controlled Trial of Individualized Dialysate Cooling for Cardiac Protection in Hemodialysis Patients

Odudu

Eldehni

McCann

et al. 2015

Clinical Journal of the American Society of Nephrology

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Background and objectives Cardiovascular disease is the most common cause of death in patients on hemodialysis (HD). HD-associated cardiomyopathy is appreciated to be driven by exposure to recurrent and cumulative ischemic insults resulting from hemodynamic instability of conventionally performed intermittent HD treatment itself. Cooled dialysate reduces HD-induced recurrent ischemic injury, but whether this confers long-term protection of the heart in terms of cardiac structure and function is not known.Design, setting, participants, & measurements Between September 2009 and January 2013, 73 incident HD patients were randomly assigned to a dialysate temperature of 37°C (control) or individualized cooling at 0.5°C below body temperature (intervention) for 12 months. Cardiac structure, function, and aortic distensibility were assessed by cardiac magnetic resonance imaging. Mean between-group difference in delivered dialysate temperature was 1.2°C60.3°C. Treatment effects were determined by the interaction of treatment group with time in linear mixed models.Results There was no between-group difference in the primary outcome of left ventricular ejection fraction (1.5%; 95% confidence interval, -4.3% to 7.3%). However, left ventricular function assessed by peak systolic strain was preserved by the intervention (-3.3%; 95% confidence interval, -6.5% to -0.2%) as was diastolic function (measured as peak diastolic strain rate, 0.18 s 21 ; 95% confidence interval, 0.02 to 0.34 s 21 ). Reduction of left ventricular dilation was demonstrated by significant reduction in left ventricular end-diastolic volume (-23.8 ml; 95% confidence interval, -44.7 to -2.9 ml). The intervention was associated with reduced left ventricular mass (-15.6 g; 95% confidence interval, -29.4 to -1.9 g). Aortic distensibility was preserved in the intervention group (1.8 mmHg 21 310 23 ; 95% confidence interval, 0.1 to 3.6 mmHg 21 310 23 ). There were no intervention-related withdrawals or adverse events.

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“…31 Thus, enhanced wave reflections exert a negative impact on LV myocardial relaxation 32,33 and may cause subendocardial ischaemia. 11,32,34,35 Chronic subendocardial ischaemia has been associated with myocardial fibrosis and LV diastolic dysfunction. 11 Therefore, impaired myocardial relaxation and coronary blood flow may be the link between increased wave reflections and LV diastolic dysfunction in newly diagnosed hypertensive patients.…”

Section: Association Of Cai and Aos With LV Diastolic Dysfunctionmentioning

confidence: 99%

“…The increased cardiac workload and reduced diastolic period caused by the early arrival of high amplitude wave reflections is reflected by an increased CAI and may have contributed to the impairment of LV diastolic function as shown in Figure 1. 34 Studies have shown an association between increased indices of aortic stiffness and LV diastolic dysfunction in animal models, 12,27,34,35 in patients with CAD, 26 diabetes, 16 in obese subjects, 36 in treated hypertensive patients 13 and in patients with Adamantiades-Behcet syndrome. 10 However, to the best of our knowledge, we are the first to describe that in untreated patients with newly diagnosed hypertension, wave reflections are associated with LV diastolic dysfunction independently of age, gender, LVMI, AoS and BP parameters.…”

Section: Association Of Cai and Aos With LV Diastolic Dysfunctionmentioning

confidence: 99%

Incremental value of arterial wave reflections in the determination of left ventricular diastolic dysfunction in untreated patients with essential hypertension

et al. 2008

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Systemic arterial stiffness is an indicator of cardiovascular disease and an independent marker of morbidity and cardiovascular mortality. We investigated the association of arterial wave reflections with left ventricular (LV) diastolic dysfunction and their incremental value to other determinants of LV diastolic dysfunction in patients with essential hypertension. In total 143 patients and 20 controls with similar atherosclerotic risk factors were examined by applanation tonometry of the radial artery (Sphygmocor) and echocardiography. Central augmentation index (CAI%) of reflected arterial waves as well as aortic strain (AoS) assessed by echocardiography were estimated. Doppler diastolic abnormalities were defined as proposed by the European Study Group on diastolic heart failure by measurement of E/A ratio (the ratio of the mitral inflow velocities), isovolumic relaxation time, deceleration time and flow propagation velocity. AoS and CAI were impaired in patients compared with controls (4.67 ± 2.94 vs 6.06 ± 4.91% and 145.8 ± 22.7 vs 135.7 ± 20.3%, Po0.01) as well as in patients with LV diastolic dysfunction compared to patients without, (5.52 ± 4.29 vs 10.73 ± 5.77% and 139.5 ± 21.7 vs 124.5 ± 17.0%, Po0.05). The odds ratio (OR) of AoS and CAI for diastolic dysfunction was OR:0.918, 95% confidence interval (CI):0.837-0.99, P ¼ 0.04 and OR:1.023, 95%CI: 1.023-1.040 P ¼ 0.010, respectively. The addition of CAI to the multivariable model including age, LV mass index, AoS and mean arterial pressure increased the power of the model for determination of LV diastolic dysfunction (À2 log likelihood ¼ 139.368, change of v 2 ¼ 4.2, P-value for change ¼ 0.04). In untreated patients with newly diagnosed essential hypertension, wave reflections are independent and additive determinants of LV diastolic dysfunction.

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Coronary circulation in dogs with an experimental decrease in aortic compliance

Cited by 270 publications

References 29 publications

The Impact of Antihypertensive Drug Therapy on Endotoxemia in Elderly Patients with Chronic Kidney Disease

The Impact of Antihypertensive Drug Therapy on Endotoxemia in Elderly Patients with Chronic Kidney Disease

Randomized Controlled Trial of Individualized Dialysate Cooling for Cardiac Protection in Hemodialysis Patients

Incremental value of arterial wave reflections in the determination of left ventricular diastolic dysfunction in untreated patients with essential hypertension

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