<p>Systemic Arterial Stiffness in New Diagnosed Idiopathic Pulmonary Arterial Hypertension Patients</p>

Abstract

Objective: We suggested: 1) patients with idiopathic pulmonary hypertension (IPAH) have active factors which could damage not only the pulmonary but systemic arteries too as in arterial hypertensive patients; 2) if these changes were present, they might correlate with other parameters influencing on the prognosis. This study is the first attempt to use cardioankle vascular index (CAVI) for the evaluation of systemic arterial stiffness in patients with IPAH. Methods: A total of 112 patients were included in the study: group 1 consisted of 45 patients with new diagnosed IPAH, group 2 included 32 patients with arterial hypertension, and in the control group were 35 healthy persons adjusted by age. Right heart catheterization, ECG, a 6-minute walk test (6MWT), echocardiography, blood pressure (BP) measurement and ambulatory BP monitoring, pulse wave elastic artery stiffness (PWVe; segment carotid-femoral arteries) and muscular artery stiffness (PWVm; segment carotid-radial arteries), CAVI, and N-terminal pro-B-type natriuretic peptide (NT-proBNP) level were provided. The Spearman correlation, a linear regression and multivariable binary logistic analysis were performed to indicate the predictors associated with PWV and CAVI. Results: The groups were adjusted for principal characteristics influenced on arterial stiffness. IPAH patients had significantly (P<0.001 for all) shorter 6MWT distance and higher Borg dyspnea score than the patients with arterial hypertension (systolic/diastolic BP = 146.1 ±10.7/94.2±9.8 mmHg) and the control group = 330.2±14.6 vs 523.8±35.3 and 560.9±30.2 m respectively and 6.2±1.8 vs 1.2±2.1 and 0.9±2.8 points. The PWVm and PWVe were the highest in hypertensive patients (10.3±1.5 and 11.42±1.70 m/s). The control group and IPAH did not have significant differences in aorta BP, but PWVm/PWVe values were significantly (P<0.003/0.008) higher in IPAH patients than in the control group (8.1±1.9/8.49±1.92 vs 6.63±1.34/7.29±0.87 m/s). The CAVIs on both sides were significantly lower in the healthy subjects (5.91±0.99/5.98±0.87 right/left side). Patients with IPAH did not differ from the arterial hypertension patients by CAVIs in comparison with the control group (7.40±1.32/ 7.22±1.32 vs 7.19±0.78/7.2±1.1 PWVe) did not correlate with any parameters except uric acid. PWVm correlated with uric acid (r=0.58, P<0.001), NT-proBNP (r=0.33, P=0.03) and male gender (r=0.37, P=0.013) at Spearman analysis, but not at multifactorial linear regression analysis. The CAVI correlated with age and parameters characterized functional capacity (6MWT distance) and right ventricle function (NT-proBNP, TAPSE) at Spearman analysis and with age and TAPSE at multifactorial linear regression analysis. At binary logistic regression analysis CAVI > 8.0 at right and/or left side had a correlation with age, 6MWT distance, TAPSE, but an independent correlation was only with age (β=1.104, P=0.008, CI 1.026-1.189) and TAPSE (β=0.66, P=0.016, CI 0.474-0.925). Conclusion: In spite of equal and at normal range BP level, the age-adjuste...

Peripheral Arterial Stiffness in Acute Pulmonary Embolism and Pulmonary Hypertension at Short-Term Follow-Up

“…In our study, patients with acute PE showed significantly increased echo-derived arterial stiffness compared with normal subjects and hypertensive patients, as already reported in PAH patients [ 39 ]. The increased CAVI found in our PE cohort was not statistically different from our IPAH cohort, although a trend to higher values was observed in the latter population.…”

Prognostic Significance of Systemic Arterial Stiffness Evaluated by Cardio-Ankle Vascular Index in Patients with Idiopathic Pulmonary Hypertension

“…Recently we published the results of our study on the comparison of arterial stiffness parameters in patients with IPAH, systemic hypertension, and healthy people who were adjusted to age. 44 We established that mean CAVI was the highest in the group with systemic hypertension, but did not differ significantly from mean CAVI in the group newly diagnosed with IPAH. The healthy persons had significantly reduced CAVI, PWVm and PWVe values than patients with IPAH, despite the comparable office and aorta blood pressure.…”

“…We evaluated the systemic artery stiffness parameters in patients with newly diagnosed IPAH and in essential hypertensive patients. 44 We found the mean cardio-ankle vascular index (CAVI), which is independent of the blood pressure characteristic of arterial stiffness, 45 was increased significantly in IPAH patients compared to the healthy group and did not much differ from one in systemic hypertensives matched to age. Also, the CAVI correlated with IPAH patient functional capacity and right ventricle function.…”

“…However, the CAVI had a significant correlation with PWV in our study and in other reports. 44 , 71 Also, we should take into consideration our PAH patients had low systolic blood pressure, which was associated with poor prognosis, and PWV might underestimate arterial stiffness at such low systemic pressure, whereas CAVI is independent from blood pressure. This might be the reason why only CAVI predicted the survival of IPAH.…”

Increased Arterial Stiffness in Chronic Thromboembolic Pulmonary Hypertension Was Improved with Riociguat and Balloon Pulmonary Angioplasty: A Case Report

“… 9 Recently, Radchenko et al reported that arterial stiffness evaluated by CAVI was significantly higher in patients with pulmonary arterial hypertension (PAH) than in healthy subjects. 10 These findings suggest that increased arterial stiffness may increase afterload of LV and may affect cardiac function in patients with pulmonary hypertension (PH) including CTEPH. Therefore, arterial stiffness may play an important role in the pathophysiology of CTEPH.…”