Abstract Book from Artery 2023

1 1.01 Ethnic difference in reservoir-excess pressure parameters in a tri-ethnic population-based cohort: The SABRE Study

1.1 Aizawa K ^1,2, Park C³, Parker K⁴, Shore A^1,2, Chaturvedi N³, Hughes A³

1.1.1 ¹University of Exeter Medical School, Exeter, United Kingdom, ²NIHR Exeter Clinical Research Facility, Exeter, United Kingdom, ³MRC Unit for Lifelong Health & Ageing, Institute of Cardiovascular Science, University College London, London, United Kingdom, ⁴Department of Bioengineering, Imperial College, London, United Kingdom

Background: Arterial haemodynamics may contribute to marked ethnic differences in coronary heart disease (CHD) risk [1]. However, the evidence using reservoir-excess pressure analysis is scarce. We determined in a tri-ethnic population-based cohort whether reservoir-excess pressure parameters would differ by ethnicity.

Methods: 1138 participants [Europeans n = 549, 69.6 ± 6.2 yrs, 116F; South Asians (SA) n = 409, 69.1 ± 6.3 yrs, 62F; African Caribbeans (AC) 70.5 ± 6.0 yrs, 82F] were studied. Radial artery tonometry was performed using a SphygmoCor system, and reservoir-excess pressure parameters were calculated from an ensemble-averaged radial pressure waveform including reservoir pressure integral (INTPR), peak reservoir pressure, excess pressure integral (INTXSP), systolic rate constant and diastolic rate constant (DRC).

Results: INTPR was greater in AC [96.6 (93.9–99.3) mmHg·s] than Europeans [89.5 (88.0–91.0) mmHg·s] and SA [91.8 (90.1–93.6) mmHg·s] after accounting for age and sex. INTXSP and DRC were both greater in SA [7.2 (7.0–7.4) mmHg·s and 2.7 (2.6–2.8) 1/s] than Europeans [6.6 (6.4–6.8) mmHg·s and 2.5 (2.3–2.6) 1/s] and AC [6.4 (6.0–6.7) mmHg·s and 2.4 (2.2–2.6) 1/s] after accounting for age and sex. These differences remained after multivariate adjustment except INTXSP where it was attenuated in AC [6.2 (5.9–6.6) mmHg·s] compared with Europeans and SA [6.8 (6.6–6.9 mmHg·s and 7.0 (6.8–7.2) mmHg·s]. When each ethnic group was stratified by diabetes, INTPR in all ethnic groups was significantly lower in those with diabetes than those without after accounting for age and sex. This difference persisted even after multivariate adjustment.

Conclusions: AC have a more favourable reservoir-excess pressure profile compared to Europeans and SA. Diabetes adversely affects INTPR in all ethnic groups. These observations may partly explain ethnic difference in CHD risk.

References

[1] Park CM, Tillin T, March K, Jones S, Whincup PH, Mayet J, Chaturvedi N, Hughes AD. Adverse effect of diabetes and hyperglycaemia on arterial stiffness in Europeans, South Asians, and African Caribbeans in the SABRE study. J Hypertens. 2016 Feb;34 (2):282–9. https://doiorg.publicaciones.saludcastillayleon.es/10.1097/HJH.0000000000000789. PMID: 26628109; PMCID: PMC4841389

2 1.02 Lifelong heterogeneous contribution of cardiovascular risk factors to slow and fast progression of arterial stiffness

2.1 Tomiyama H ¹, Shiina K, Nakano H, Fujii M, Takahashi T, Kani J, Matsumoto C

2.1.1 ¹Tokyo Medical University, Tokyo, Japan

Full article has been published.

3 1.03 Air pollutants and arterial function in young London adults of 6 ethnic groups

3.1 Cruickshank J ¹, Karamanos A¹, Lu Y⁶, Mudway I², Kelly F², Beevers S², Dajnak D², Elia C¹, Webb A¹, Malaodi O⁴, Enayat Z³, Maynard M⁵, Harding S¹

3.1.1 ¹King's College, LONDON, United Kingdom, ²Imperial College, London, United Kingdom, ³University College, London, United Kingdom, ⁴University of Glasgow, Glasgow, Scotland, ⁵Leeds Beckett University, Leeds, United Kingdom, ⁶Central South University, Changsha, China

We tested whether exposures to air pollutant particulate matter ≤ 2.5 µm (PM2.5) and nitrogen dioxide (NO₂) in school children at 11–13 y and 14–16 y were implicated in aPWV at 21–23 y independent of mean blood pressure (BP) and its change over time.

Methods: Cross-sectional and longitudinal data were analysed from 426 participants aged 21–23 years with data at those previous ages. Contemporary and previous PM2.5 and NO₂ air levels within a 20-m radius buffer zone around participants’ residential postcode centroid, from long-validated monitors across London, were utilised to estimate whether these air pollutants were independently linked to aPWV, via a least squares model, adjusting for age, sex, ethnicity, waist/height ratio, mean BP, racism and prior such measures.

Results: Higher PM2.5 concentrations were significantly associated cross-sectionally with higher aPWV (β = 0.2 (95% CI 0.05–0.39) m/s t = 2.42, p = 0.009) and longitudinally (β = 0.26 (0.05–0.46) m/s, t = 2.42, p = 0.016), independently of current (0.03 (0.02–0.04) mmHg, t = 3.08, p = 0.001) or previous mean BPs (NS), racism the only other effect persisting (0.36 (0.11–0.61), t = 2.84, p = 0.005). Conversely, simultaneous higher ambient NO₂ air levels were independent if weakly associated with lower aPWV (β = − 0.03 (− 0.05–0.00) m/s p = 0.037 and longitudinal, − 0.35 (− 0.0008 to − 0.068, t = − 2.01 p = 0.045). No significant interactions between air pollutants, ethnicity or other variables were found; adjusted for cross-sectional MAP, Black Caribbean had lower PWV than White British participants (− 0.35 m/s, p = 0.04) but not with earlier BPs included.

Conclusions: Exposure to air pollutants PM2.5 was associated strongly and NO2 inversely if weakly with arterial stiffening, independently of current or previous childhood mean BP and other risk factors; racism effects remain.

Disclosures: Funded by the MRC.

4 1.04 Effects of weight loss on vascular function, autonomic nervous system and metabolic biomarkers in obese subjects with moderate and low cardiovascular health

4.1 Cunha M¹, Mattos S¹, Klein M¹, Neves M ¹

4.1.1 ¹State University Of Rio De Janeiro, Rio De Janeiro, Brazil

According to the American Heart Association, most cardiovascular events can be prevented through adherence to eight behavior and health factors, reflecting the classification of cardiovascular health (CVH) as high, moderate and low. This study aimed to evaluate the effects of weight loss on vascular function, sympathetic tone, metabolic and inflammatory biomarkers in obese subjects with moderate and low CVH. A prospective intervention study was conducted with patients aged 40–70 years, BMI ≥ 30 and < 40 kg/m², instructed to follow a low-calorie diet. At baseline and after 16 weeks of nutritional intervention, patients underwent assessment of central hemodynamics and arterial stiffness by oscillometry (Mobil-O-Graph^®), autonomic system by heart rate variability, and brachial artery flow-mediated dilation (FMD). Patients (n = 82) were divided into two groups based on the CVH classification at baseline: moderate CVH (CVH score ≥ 50 ≤ 79 points, n = 47); and low CVH (CVH score ≤ 49, n = 35). Peripheral (119 ± 10 vs 125 ± 15 mmHg, p = 0.048) and central (111 ± 10 vs 118 ± 15 mmHg; p = 0.016) systolic pressures were significantly higher in the low CVH group, which also had lower FMD (9.24 ± 5.41 vs 6.79 ± 4.74%, p = 0.043) compared to the moderate CVH group. After 16 weeks, the low CVH group, with a 5.1% weight loss, showed a decrease in vascular age (62 ± 13 vs 58 ± 14 years, p = 0.023) and HOMA-IR (4.4 ± 2.4 vs 3.1 ± 2.0, p = 0.002). Both groups significantly reduced C-reactive protein (− 0.18 vs − 0.25 mg/dl). In conclusion, the greatest benefits of the nutritional intervention occurred in the low cardiovascular health group, which showed metabolic improvement and attenuation of vascular aging.

References

1. Lloyd-Jones DM, Allen NB, Anderson CAM, Black T, Brewer LC, Foraker RE, Grandner MA, Lavretsky H, Perak AM, Sharma G, Rosamond W; American Heart Association. Life's Essential 8: Updating and Enhancing the American Heart Association's Construct of Cardiovascular Health: A Presidential Advisory From the American Heart Association. Circulation. 2022 Aug 2;146 (5):e18-e43. https://doiorg.publicaciones.saludcastillayleon.es/10.1161/CIR.0000000000001078. Epub 2022 Jun 29. PMID: 35766027; PMCID: PMC10503546.

2. Lloyd-Jones DM, Hong Y, Labarthe D, Mozaffarian D, Appel LJ, Van Horn L, Greenlund K, Daniels S, Nichol G, Tomaselli GF, Arnett DK, Fonarow GC, Ho PM, Lauer MS, Masoudi FA, Robertson RM, Roger V, Schwamm LH, Sorlie P, Yancy CW, Rosamond WD; American Heart Association Strategic Planning Task Force and Statistics Committee. Defining and setting national goals for cardiovascular health promotion and disease reduction: the American Heart Association's strategic Impact Goal through 2020 and beyond. Circulation. 2010 Feb 2;121 (4):586–613. https://doiorg.publicaciones.saludcastillayleon.es/10.1161/CIRCULATIONAHA.109.192703. Epub 2010 Jan 20. PMID: 20089546.

5 1.05 SPARTE study: Results revisited using a preliminary Bayesian analysis approach

5.1 Spronck B ^1,2, Giudici A^1,3

5.1.1 ¹Department of Biomedical Engineering, CARIM School for Cardiovascular Diseases, Maastricht University, Maastricht, Netherlands, ²Macquarie Medical School, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, Australia, ³GROW School for Oncology and Reproduction, Maastricht University, Maastricht, Netherlands

Background: The SPARTE (Strategy for Preventing cardiovascular and renal events based on ARTErial stiffness) randomised controlled trial [1] investigated the benefit of a therapeutic strategy targeting the normalisation of carotid–femoral pulse wave velocity (PWV group, n = 264), compared to standard therapy (conventional group, n = 272). After four years of follow-up, SPARTE did not show a significant benefit of PWV-based treatment using “traditional” frequentist analysis [2], likely due to small sample size and/or low event rate [1, 2]. Rather than dismissing SPARTE as a “negative” study, we aimed to assess what statements can be made based on SPARTE’s results using Bayesian analyses.

Methods: Bayesian analysis was performed using the Markov chain Monte Carlo method [3]. Since SPARTE was the first study of its kind, an uninformative prior was assumed.

Results: n = 17 (6.4%) in the PWV group had a primary outcome (combined end point including particularly stroke/coronary events), as compared to n = 24 (8.8%) in the conventional group (frequentist risk ratio (RR) 0.73 [0.38–1.33], estimate [95% confidence interval]; p = 0.38, (Fisher exact)). Bayesian analysis, however, showed that it is 85% probable that the PWV group has a lower event rate than the conventional group (RR < 1; Figure). Among patients with very high cardiovascular risk (n = 73/n = 74 in PWV/conventional groups), n = 6/n = 12 had a primary outcome (frequentist RR 0.51 [0.14–1.24], p = 0.21). However (Bayesian), it is 93% probable that RR < 1 (Figure).

Conclusions: Bayesian analyses can be used to give meaning and context to a study’s results. Further, more detailed Bayesian analyses of SPARTE taking into account individual events and censoring is warranted.

Figure legend

References

1. Laurent S, Chatellier G, Azizi M, Calvet D, Choukroun G, Danchin N, Delsart P, Gosse P, London G, Mourad JJ, Pannier B, Pereira H, Stephan D, Boutouyrie P, SPARTE Investigators. Artery Res. 2020;26:250–260.

2. Laurent S, Chatellier G, Azizi M, Calvet D, Choukroun G, Danchin N, Delsart P, Girerd X, Gosse P, Khettab H, London G, Mourad JJ, Pannier B, Pereira H, Stephan D, Valensi P, Cunha P, Narkiewicz K, Bruno RM, Boutouyrie P; SPARTE Investigators. SPARTE Study: Normalization of Arterial Stiffness and Cardiovascular Events in Patients With Hypertension at Medium to Very High Risk. Hypertension. 2021 Sep;78 (4):983–995. https://doiorg.publicaciones.saludcastillayleon.es/10.1161/HYPERTENSIONAHA.121.17579. Epub 2021 Aug 30. PMID: 34455813; PMCID: PMC8415523.

3. Kruschke J. Doing Bayesian data analysis (2nd edition, 2014).

6 1.06 Critical limb ischemia, arterial stiffness and sarcopenia

6.1 Ferreira J^1,2,3,4,5, Longatto-Filho A^2,3,6,7, Cunha C^4,8,9, Silva C^4,8,9, Gonçalves F ^4,8,9, Carneiro A¹⁰, Vila I^4,8,9, Cotter J^2,3,4,8,9, Mesquita A¹¹, Correia-Neves M^2,3, Mansilha A^1,12,13, Guimarães Cunha P^2,3,4,8,9

6.1.1 ¹Vascular Surgery Department – Physiology and Surgery, University Hospital Center of São João, Porto, Portugal, ²Life and Health Science Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal, ³ICVS/3B’s—PT Government Associated Laboratory, Braga, Portugal, ⁴Academic Center Hospital da Senhora da Oliveira, Guimarães, Portugal, ⁵Clinical Academic Center Hospital de Trás-os-Montes e Alto Douro—Professor Doutor Nuno Grande—CACTMAD, Vila Real, Portugal, Vila Real, Portugal, ⁶Faculty of Medicine, Department of Pathology, University of São Paulo, São Paulo, Brazil, ⁷Molecular Oncology Research Center, Barretos Cancer Hospital, Barretos, São Paulo, Brazil, ⁸Medicine Department, Hospital da Senhora da Oliveira, Guimarães, Portugal, ⁹Center for the Research and Treatment of Arterial Hypertension and Cardiovascular Risk, Internal Medicine Department, Hospital da Senhora da Oliveira, Guimarães, Portugal, ¹⁰Radiology Department, Unidade Local de Saúde Alto Minho, Viana do Castelo, Portugal, ¹¹Vascular Surgery Department, Hospital da Senhora da Oliveira, Guimarães, Portugal, ¹²Faculty of Medicine, University of Porto, Porto, Portugal, ¹³Department of Angiology and Vascular Surgery, University Hospital Center of São João, Porto, Portugal

Background: We aim to compare arterial stiffness and skeletal muscle characteristics in claudication versus critical limb threatening ischemia (CLTI) patients.

Methods: An observational, single-centre and prospective study (January 2018-July 2022) enrolling peripheral arterial disease patients was conducted. SphygmoCor^® was used to measure carotid–femoral pulse wave velocity (cfPWV). CT scan assessed skeletal muscle area/mass. In patients with surgical indication, samples of sartorius muscle were collected and submitted to histological characterization. Serum levels of myokines: irisin, myostatin, IL-8 and IL-6 were determined with ELISA.

Results: We enrolled 119 subjects (mean age: 67.58 ± 9.60 years old; 79.80% males), 65 claudication and 54 CLTI (Table 1). CLTI exhibited higher cfPWV (13.64 ± 4.31 m/s vs 10.37 ± 3.03 m/s p = 0.00). CLTI showed lower muscle area and density [area (mm²): 13601.00; IQR = 20.13 vs 20.80; IQR = 17.005 p = 0.044; density (mm²): 11.25; IQR = 20.13 vs 20.80; IQR = 17.05 p = 0.007]. Histology revealed similar muscle fibers' preservation, areas of trauma or haemorrhage. On immunohistochemistry, we found more inflammatory CD 45+ leucocytes in CLTI when compared to claudicants [CD 45+ > moderate (2;3;4): claudication (n = 14):4; 28.57%; CLTI (n = 25):16; 64.00%; p = 0.034]. No differences were registered on CD 163+ macrophages [CD 163+ > moderate (2;3;4): claudication (n = 13): 7; 53.85%; CLTI (n = 27): 21; 77.78%; p = 0.122]. No differences were registered in serum levels of the myokines irisin and myostatin between patients, but CLTI had a higher serum level of IL-6 and IL-8.

Conclusions: CLTI displayed higher arterial stiffness, lower skeletal muscle density and area, more number of intramuscular inflammatory cells, and higher pro-sarcopenic myokines. In patients with CLTI sarcopenia, inflammation and arterial stiffness might be intricately linked.

Figure legend

References

[1] Simon F, Oberhuber A, Floros N, Düppers P, Schelzig H, Duran M. Pathophysiology of chronic limb ischemia. Gefässchirurgie 2018;23:13–8

[2] Aday AW, Matsushita K. Epidemiology of Peripheral Artery Disease and Polyvascular Disease. Circ Res. 2021 Jun 11;128 (12):1818–1832. https://doiorg.publicaciones.saludcastillayleon.es/10.1161/CIRCRESAHA.121.318535. Epub 2021 Jun 10. PMID: 34110907; PMCID: PMC8202714.

[3] Mendes-Pinto D, Rodrigues-Machado MDG, Navarro TP, Dardik A. Association Between Critical Limb Ischemia, the Society for Vascular Surgery Wound, Ischemia and Foot Infection (WIfI) Classification System and Arterial Stiffness. Ann Vasc Surg. 2020 Feb;63:250–258.e2. https://doiorg.publicaciones.saludcastillayleon.es/10.1016/j.avsg.2019.07.017. Epub 2019 Oct 15. PMID: 31626931.

7 2.01 The aortic‐femoral arterial stiffness gradient predicts incident cardiovascular disease in older adults: an atherosclerosis risk in communities (ARIC) study.

7.1 Stone K ¹, Stoner L^3,4,5, Meyer M⁶, Faulkner J⁷, McDonnell B^1,2, Pugh C^1,2, Williams J^1,2, Paterson C³, Zieff G³, Pomeroy A³, Kucharska-Newton A⁸, Fryer S⁹

7.1.1 ¹Centre for Cardiovascular Health and Ageing, Cardiff Metropolitan University, Cardiff, United Kingdom, ²National Cardiovascular Research Network, Wales,,, ³Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, USA, ⁴Department of Epidemiology, The Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, USA, ⁵Center for Health Promotion and Disease Prevention, University of North Carolina at Chapel Hill, Chapel Hill, USA, ⁶Department of Emergency Medicine, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, USA, ⁷Department of Sport, Exercise & Health, University of Winchester, Winchester, UK, ⁸Department of Epidemiology, College of Public Health, University of Kentucky, Lexington, USA, ⁹School of Sport and Exercise Sciences, University of Gloucestershire, Gloucester, UK

Background: Central arterial stiffness, represented as carotid–femoral pulse wave velocity (cfPWV), predicts cardiovascular disease (CVD); however, this association is attenuated in older adults [1]. The aortic–femoral arterial stiffness gradient, a ratio of cfPWV or heart–femoral PWV (hfPWV) and femoral–ankle PWV (faPWV), is a promising alternative [2, 3], but its prognostic utility is unknown. The aim of this study was to examine whether the aortic–femoral arterial stiffness gradient predicts incident CVD and all-cause mortality in community dwelling older adults.

Methods: In 3,109 Atherosclerosis Risk in Communities study participants (66–90 years) without CVD, we examined the associations of cfPWV, faPWV, hfPWV, carotid–femoral stiffness gradient (cfSG; faPWV/cfPWV) and heart–femoral stiffness gradient (hfSG; faPWV/hfPWV) with incident CVD (coronary disease, stroke, and heart failure) and all-cause mortality. Exposures were categorised into quartiles, with quartile 2 as the referent due to J-shaped associations with outcomes. Cox regression was used to estimate hazard ratios (HR) and 95% confidence intervals (CI).

Results: Over a median follow-up of 7.4 years, there were 322 incident CVD events and 410 deaths. In risk factor-adjusted models, cfSG quartiles 3 (0.83–0.99) and 4 (< 0.82) were associated with a 43% and 49% greater risk of incident CVD, and hfSG quartiles 3 (0.83–0.97) and 4 (< 0.83) were associated with a 41% and 77% greater risk of incident CVD, compared to quartile 2 (Fig. 1). Standalone PWVs were not associated with incident CVD. There were no associations with all-cause mortality.

Conclusion: Unlike central arterial stiffness, the aortic–femoral arterial stiffness gradient independently predicts incident CVD in older adults.

References

1. Ben-Shlomo Y, Spears M, Boustred C, May M, Anderson SG, Benjamin EJ, Boutouyrie P, Cameron J, Chen CH, Cruickshank JK, Hwang SJ, Lakatta EG, Laurent S, Maldonado J, Mitchell GF, Najjar SS, Newman AB, Ohishi M, Pannier B, Pereira T, Vasan RS, Shokawa T, Sutton-Tyrell K, Verbeke F, Wang KL, Webb DJ, Willum Hansen T, Zoungas S, McEniery CM, Cockcroft JR, Wilkinson IB. Aortic pulse wave velocity improves cardiovascular event prediction: an individual participant meta-analysis of prospective observational data from 17,635 subjects. J Am Coll Cardiol. 2014 Feb 25;63 (7):636–646. https://doiorg.publicaciones.saludcastillayleon.es/10.1016/j.jacc.2013.09.063. Epub 2013 Nov 13. PMID: 24239664; PMCID: PMC4401072.

2. Stone K, Fryer S, Meyer ML, Kucharska-Newton A, Faulkner J, Zieff G, Paterson C, Credeur D, Matsushita K, Hughes TM, Tanaka H, Stoner L. The aortic-femoral arterial stiffness gradient: an atherosclerosis risk in communities (ARIC) study. J Hypertens. 2021 Jul 1;39 (7):1370–1377. https://doiorg.publicaciones.saludcastillayleon.es/10.1097/HJH.0000000000002808. PMID: 33560059; PMCID: PMC8217898.

3. Stone K, Fryer S, Faulkner J, Meyer ML, Heffernan K, Kucharska-Newton A, Zieff G, Paterson C, Matsushita K, Hughes TM, Tanaka H, Stoner L. The aortic-femoral arterial stiffness gradient is blood pressure independent in older adults: the atherosclerosis risk in communities (ARIC) study. J Hypertens. 2021 Dec 1;39 (12):2361–2369. https://doiorg.publicaciones.saludcastillayleon.es/10.1097/HJH.0000000000002937. PMID: 34343145; PMCID: PMC8570989.

8 2.02 Mechanisms limiting stroke volume reserve in Heart Failure with Preserved Ejection Fraction: is there a role for mid-late systolic afterload?

8.1 Wakeham D ¹, Howrey M², Pellegrom I², Bagga J¹, Brazile T¹, Balmain B¹, Tomlinson A¹, MacNamara J¹, Babb T¹, Levine B¹, Hearon C¹, Sarma S¹

8.1.1 ¹Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas and UT Southwestern Medical Center, Dallas, United States, ²Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, Dallas, United States

Background: Stroke volume (SV) reserve (exercise–rest % difference) is often low (< 50%) in patients with heart failure with preserved ejection fraction (HFpEF), but marked variability exists (1). One potential mediator of such variability is differences in mid-late systolic afterload during exercise quantified as aortic augmentation pressure (aAP). Therefore, we compared the change in SV from rest to exercise between patients with HFpEF who had a fall (aAP-) or increase (aAP +) in aAP from rest to exercise.

Methods: We calculated SV (direct Fick) and estimated ascending aortic blood pressure (transfer function applied to radial catheter waveforms; SphygmoCor) in 29 patients with HFpEF (62% female; age: 71 ± 8 years; BMI: 37.6 ± 6.7 kg/m²) at rest and during upright cycle ergometry (20 Watts; 30 ± 12% of maximum). Data were compared via unpaired t-tests and two-way (group*time) ANOVA.

Results: SV reserve was highly variable (58 ± 37 [7–160] %). On average ,aAP did not change with exercise, but there was marked variability (∆2 ± 7 [− 12–15] mmHg, P = 0.492; Panel A). Absolute (AP −: ∆27 ± 14 vs AP +: ∆28 ± 12 ml, P = 0.796; Panel B) and relative (∆49 ± 30 vs ∆63 ± 42%, P = 0.293) changes in SV were not different between groups. Aortic systolic blood pressure (aSBP; Panel C) and aortic systolic pressure-time integral (aSPTI; Panel D) were higher at rest in AP- but were not different between groups during exercise.

Conclusions: The variability in SV reserve in patients with HFpEF is not influenced by the magnitude or directional change of aAP suggesting that such patients are not sensitive to changes in mid-late systolic afterload with exercise.

Figure legend

References

1. Pandey A, Khera R, Park B, Haykowsky M, Borlaug BA, Lewis GD, Kitzman DW, Butler J, Berry JD. Relative Impairments in Hemodynamic Exercise Reserve Parameters in Heart Failure With Preserved Ejection Fraction: A Study-Level Pooled Analysis. JACC Heart Fail. 2018 Feb;6 (2):117–126. https://doiorg.publicaciones.saludcastillayleon.es/10.1016/j.jchf.2017.10.014. PMID: 29413366; PMCID: PMC8135913.

9 2.03 Estimating central arterial stiffness from photoplethysmogram using machine learning

9.1 Hong J ¹, Nandi M², Alastruey J¹

9.1.1 ¹Division of Imaging Sciences and Biomedical Engineering, King's College London, London, United Kingdom, ²School of Cancer and Pharmaceutical Science, King’s College London, London, United Kingdom

Background: Central arterial stiffness, a key cardiovascular disease indicator, can be assessed through carotid–femoral pulse wave velocity (cfPWV) in specialised clinics (1, 2). We investigated the potential of machine learning (ML) models to estimate cfPWV from peripheral photoplethysmogram (PPG) signals, aiming to simplify measurements.

Methods: The carotid–femoral pulse transit time was calculated in 4,374 virtual subjects (ages 25–75) (3), using a foot-to-foot algorithm, enabling cfPWV computation with the exact arterial distance (Fig. 1A). In addition, digital and toe PPG signals were collected from the same database (Fig. 1B). The ML model, comprising a gated recurrent unit (GRU) layer and two fully connected layers, regressed PPG signals to cfPWV (Fig. 1C). Subjects were partitioned into training (80%), validation (10%), and testing (10%) sets.

Results: Using both digital and toe PPG signals as a two-channel input showed narrower limits of agreement (mean ± 1.96SD = − 0.06 ± 0.43) along with a lower root-mean-square error (RMSE) of 0.23 m/s, compared to toe-only input (mean ± 1.96SD: − 0.05 ± 0.60, RMSE: 0.31 m/s) or finger-only input (mean ± 1.96SD: − 0.02 ± 0.63, RMSE: 0.32 m/s).

Conclusion: Peripheral PPG signals, from finger and/or toe, contain sufficient information to estimate cfPWV. Wearable devices measuring PPG signals offer potential for aortic stiffness assessment outside clinical settings and in daily life. We are currently testing several traditional ML models (e.g., Gaussian process regression) using diverse PPG-based features (e.g., stiffness index) as inputs, enabling comprehensive comparisons with the current model.

Figure legend

References

1. Reference Values for Arterial Stiffness' Collaboration. Determinants of pulse wave velocity in healthy people and in the presence of cardiovascular risk factors: 'establishing normal and reference values'. Eur Heart J. 2010 Oct; 31 (19):2338–50. https://doiorg.publicaciones.saludcastillayleon.es/10.1093/eurheartj/ehq165. Epub 2010 Jun 7. PMID: 20530030; PMCID: PMC2948201.

2. Reusz GS, Cseprekal O, Temmar M, Kis E, Cherif AB, Thaleb A, Fekete A, Szabó AJ, Benetos A, Salvi P. Reference values of pulse wave velocity in healthy children and teenagers. Hypertension. 2010 Aug;56 (2):217–24. https://doiorg.publicaciones.saludcastillayleon.es/10.1161/HYPERTENSIONAHA.110.152686. Epub 2010 Jun 21. PMID: 20566959.

3. Charlton PH, Mariscal Harana J, Vennin S, Li Y, Chowienczyk P, Alastruey J. Modeling arterial pulse waves in healthy aging: a database for in silico evaluation of hemodynamics and pulse wave indexes. Am J Physiol Heart Circ Physiol. 2019 Nov 1;317 (5):H1062–H1085. https://doiorg.publicaciones.saludcastillayleon.es/10.1152/ajpheart.00218.2019. Epub 2019 Aug 23. PMID: 31442381; PMCID: PMC6879924.

10 2.04 Investigation and clinical based validation of real world DVP shape clusters

10.1 Zanelli S ^1,2, El Yacoubi M², Ammi M¹

10.1.1 ¹University Paris Sorbonne Nord, Villetaneuse, France, ²TelecomSud Paris, Institut Polytechnique de Paris, Paris, France

Full article has been published

11 2.05 Is there an antihypertensive class-specific effect on pulse wave velocity reduction? A systematic review and meta-analysis of the influence of blood pressure reduction on pulse wave velocity in hypertension

11.1 McNally R ¹, Boguslavskyi A², Malek R³, Floyd C¹, Cecelja M¹, Douiri A³, Bruno R⁴, Chowienczyk P¹, Faconti L¹

11.1.1 ¹Department of Vascular Risk and Surgery, King's College London, London, United Kingdom, ²Clinical Research Facilities, Guy’s and St Thomas’ Hospital, London, United Kingdom, ³School of Life Course and Population Sciences, King's College London, London, United Kingdom, ⁴Université Paris Cité, INSERM U970 Team 7, Paris Cardiovascular Research Centre, Paris, France

Background: Arterial stiffness estimated non-invasively as carotid–femoral PWV [1] is a predictor of hypertension and adverse cardiovascular events [2], an association that is thought to be causally related to the hemodynamic load generated by a stiffened aorta. The only intervention that has been consistently shown to do this is a reduction in BP [3]. However, it is not clear whether the “de-stiffening” differs according to drug class and/or duration of treatment.

Methods: We performed a systematic review and meta-analysis of the effects of antihypertensive interventions on aortic PWV, to explore if reduction in PWV would differ between drug classes independently of BP-reduction. PubMed, MEDLINE, Embase and CENTRAL databases were searched to 1st February 2023 for studies investigating the effects of antihypertensive drugs on PWV.

Results: 83 studies involving 6,200 subjects were identified. Change in PWV was strongly related with change in MAP (P < 0.001). The estimated change in PWV per 10 mmHg fall in MAP was 0.65 [95% CI 0.46–0.83] m/s. The magnitude of PWV decrease varied significantly between drug classes (Q = 14.38, P = 0.002) and after adjustment for change in MAP, PWV decreased significantly with the four classes of antihypertensive drugs (ACEI, beta-blockers CCB and diuretics) by − 1.21 [− 1.43, − 0.98], − 0.78 [− 1.09, − 0.48], − 1.24 [− 1.54, − 0.94] and − 0.74 [− 1.12, − 0.37] m/s, respectively, within significant between-class difference (P < 0.05).

Conclusion: Effects of drug classes on PWV and MAP vary, thus raising the hypothesis that the degree to which the reduction in PWV can be explained by the reduction in MAP is class-specific.

References

[1] Van Bortel LM, Laurent S, Boutouyrie P, Chowienczyk P, Cruickshank JK, De Backer T, Filipovsky J, Huybrechts S, Mattace-Raso FU, Protogerou AD, Schillaci G, Segers P, Vermeersch S, Weber T; Artery Society; European Society of Hypertension Working Group on Vascular Structure and Function; European Network for Noninvasive Investigation of Large Arteries. Expert consensus document on the measurement of aortic stiffness in daily practice using carotid-femoral pulse wave velocity. J Hypertens. 2012 Mar;30 (3):445–8. https://doiorg.publicaciones.saludcastillayleon.es/10.1097/HJH.0b013e32834fa8b0. PMID: 22278144.

[2] Ben-Shlomo Y, Spears M, Boustred C, May M, Anderson SG, Benjamin EJ, Boutouyrie P, Cameron J, Chen CH, Cruickshank JK, Hwang SJ, Lakatta EG, Laurent S, Maldonado J, Mitchell GF, Najjar SS, Newman AB, Ohishi M, Pannier B, Pereira T, Vasan RS, Shokawa T, Sutton-Tyrell K, Verbeke F, Wang KL, Webb DJ, Willum Hansen T, Zoungas S, McEniery CM, Cockcroft JR, Wilkinson IB. Aortic pulse wave velocity improves cardiovascular event prediction: an individual participant meta-analysis of prospective observational data from 17,635 subjects. J Am Coll Cardiol. 2014 Feb 25;63 (7):636–646. https://doiorg.publicaciones.saludcastillayleon.es/10.1016/j.jacc.2013.09.063. Epub 2013 Nov 13. PMID: 24239664; PMCID: PMC4401072.

[3] Janić M, Lunder M, Sabovič M. Arterial stiffness and cardiovascular therapy. Biomed Res Int. 2014;2014:621437. https://doiorg.publicaciones.saludcastillayleon.es/10.1155/2014/621437. Epub 2014 Aug 7. PMID: 25170513; PMCID: PMC4142148.

12 3.01 Invasive and estimated central blood pressure using the oscillometric algorithm Antares in patients with obesity

12.1 Dörr M ^1,2, Stäuber A³, Piper C⁴, Köster M⁴, Lapp H⁵, Richter S⁶, Ohlow M⁷, Eckert S⁴, Hoppe M³, Barroso M⁸, Baulmann J⁹

12.1.1 ¹Department of Internal Medicine B, University Medicine Greifswald, Greifswald, Germany, ²German Centre for Cardiovascular Research (DZHK), Partner Site Greifswald, Greifswald, Germany, ³Movement and Training Science, Leipzig University, Leipzig, Germany, ⁴Klinik für Allgemeine und Interventionelle Kardiologie/Angiologie, Universitätsklinik der Ruhr-Universität Bochum, Bochum, Germany, ⁵Department of Cardiology, Zentralklinik Bad Berka GmbH, Bad Berka, Germany, ⁶Department of Cardiology, SRH Klinikum Burgenlandkreis GmbH, Naumburg, Germany, ⁷Department of Cardiology, SRH Wald-Klinikum GmbH, Gera, Germany, ⁸Fliedner Fachhochschule gGmbH, Düsseldorf, Germany, ⁹Praxis Dres. Gille/Baulmann, Rheinbach, Germany

Background: Obesity is a global health concern and risk factor for cardiovascular disease. The assessment of central blood pressure (cBP) has been shown to improve prediction of cardiovascular events. However, few studies have investigated the impact of obesity on cBP in adults, and invasive data on this issue are lacking. The objective of this study was to evaluate the accuracy of the oscillometric algorithm Antares in estimating non-invasive central blood pressure (cBP) compared to invasive cBP in obese patients.

Methods: A total of 75 obese patients (66 ± 12 years, 77% male, obesity class I: n = 55, class II: n = 18, class III: n = 2) undergoing elective cardiac catheterization were included in the study. cBP was measured invasively and simultaneously estimated non-invasively using the custo screen 400 device (custo med GmbH, Ottobrunn, Germany) with the integrated Antares algorithm (Redwave Medical GmbH, Jena, Germany).

Results: The estimated cBP displayed strong correlations and excellent accuracy with invasive cBP for systolic blood pressure (r = 0.89, P < 0.001; mean difference ± standard deviation: − 0.4 ± 6.0 mmHg), mean arterial pressure (r = 0.84, P < 0.001; − 0.4 ± 4.2 mmHg), and diastolic blood pressure (r = 0.74, P < 0.001; − 3.1 ± 5.7 mmHg).

Conclusions: The study demonstrates the effectiveness of Antares algorithm in precisely and non-invasively estimating central blood pressure (cBP) in individuals with obesity. These findings hold promising implications for enhancing the diagnosis and treatment of hypertension in this specific group of patients.

References

[1] Kollias A, Lagou S, Zeniodi ME, Boubouchairopoulou N, Stergiou GS. Association of Central Versus Brachial Blood Pressure With Target-Organ Damage: Systematic Review and Meta-Analysis. Hypertension. 2016 Jan;67 (1):183–90. https://doiorg.publicaciones.saludcastillayleon.es/10.1161/HYPERTENSIONAHA.115.06066. Epub 2015 Nov 23. PMID: 26597821.

[2] Dörr M, Richter S, Eckert S, Ohlow MA, Hammer F, Hummel A, Dornberger V, Genzel E, Baulmann J. Invasive Validation of Antares, a New Algorithm to Calculate Central Blood Pressure from Oscillometric Upper Arm Pulse Waves. J Clin Med. 2019 Jul 22;8 (7):1073. https://doiorg.publicaciones.saludcastillayleon.es/10.3390/jcm8071073. PMID: 31336569; PMCID: PMC6678985.

[3] Stäuber A, Piper C, Köster M, Dörr M, Richter S, Ohlow MA, Eckert S, Baulmann J. Invasive validation of the Antares algorithm for determining central blood pressure based on upper arm oscillometric pulse waves in patients with type 2 diabetes. BMJ Open Diabetes Res Care. 2023 Jan;11 (1):e003119. https://doiorg.publicaciones.saludcastillayleon.es/10.1136/bmjdrc-2022-003119. PMID: 36707104; PMCID: PMC9884863.

13 3.02 The association between age and photoplethysmography pulse waveform morphology: The first large-scale study using a commercially available wearable device

13.1 Rantanen A ¹, Koskimäki H¹, Ohukainen P¹

13.1.1 ¹Oura Health, Oulu, Finland

Background: Photoplethysmography (PPG) is a non-invasive optical method widely used for assessing physiological parameters including heart rate, heart rate variability and oxygen saturation. It is well established that the shape and characteristics of the PPG pulse waveform contain valuable information about the cardiovascular system and can serve as an indicator of its health and function [1]. PPG offers convenient and accessible means for self-monitoring cardiovascular changes associated with ageing. However, the accuracy of commercial devices remains unknown.

Methods: Commercially available Oura Ring (Oura Health, Finland) was used to measure two 30-s segments of PPG signal during sleep from a free-living global sample of users (N = 110,000). For morphological comparisons, individuals were divided into 11 age groups between 20 and 99. The PPG segments underwent bandpass filtering using a Butterworth filter and individual pulses were detected from each segment. For consistency, individual pulses were normalized by heart rate, ensuring an equal length and by amplitudes to have uniform height. The PPG pulses collected from each individual were then utilised to derive the average pulse waveform specific to their corresponding age group.

Results: The results illustrated in Fig. 1, indicate quantifiable changes in the pulse waveform with age. Specifically, the dicrotic notch diminishes, and the location of the systolic peak shifts with increasing age.

Conclusion: Our large-scale population analysis confirms age-associated variation in the PPG pulse waveform consistent with the previous studies [1, 2]. Tracking PPG pulse waveform morphology using a commercial device may hold valuable insights into cardiovascular ageing and has potential in the self-care sector.

References

1. Charlton PH, Paliakaitė B, Pilt K, Bachler M, Zanelli S, Kulin D, Allen J, Hallab M, Bianchini E, Mayer CC, Terentes-Printzios D, Dittrich V, Hametner B, Veerasingam D, Žikić D, Marozas V. Assessing hemodynamics from the photoplethysmogram to gain insights into vascular age: a review from VascAgeNet. Am J Physiol Heart Circ Physiol. 2022 Apr 1;322 (4):H493-H522. https://doiorg.publicaciones.saludcastillayleon.es/10.1152/ajpheart.00392.2021. Epub 2021 Dec 24. PMID: 34951543; PMCID: PMC8917928.

2. Allen J, Murray A. Age-related changes in the characteristics of the photoplethysmographic pulse shape at various body sites. Physiol Meas. 2003 May;24 (2):297–307. https://doiorg.publicaciones.saludcastillayleon.es/10.1088/0967-3334/24/2/306. PMID: 12812416.

14 3.03 Ultrasonic Imaging of the Origins of Photoplethysmography Waveforms in the Lower Wrist Tissues

14.1 Jurkonis R ¹, Rinkevičius M¹, Marozas V¹

14.1.1 ¹Biomedical Engineering Institute, Kaunas University of Technology, Kaunas, Lithuania

Background: Recent research renewed interest in unraveling the origin and significance of the photoplethysmogram (PPG) signal, driven by its growing use [1] in wearable technologies.

Methods: Sonography was conducted using an ArtUS (Telemed, Vilnius, Lithuania) module equipped with a 7–15 MHz linear array. PPG was acquired using MAX86916 optical sensor capable of multiwavelength (R, IR, G, and B) measurements. Sonography was performed by immersing the arm in a water bath, allowing for determination and annotation of the artery axis on the skin (Fig. A). Artery sonography images were captured with color Doppler to visualize the bloodstream (B and C). The PPG sensor was oriented on the artery (B) so that LEDs and photodiode (pd) were at opposite sides of artery axis. The PPG sensor was repositioned at a few positions (1–6 C). Displacement waveforms (D) of the artery surface were detected through offline analysis of the Bscan sequences.

Results: Ultrasound imaging revealed varying artery displacement morphologies and magnitudes (9–66 µm) at specific locations 1–6 (D). Opposite phasicity [2, 3] of waveforms was observed at locations separated by just 7 mm (#5 and #6). Blood perfusion in capillary-scattered G and B light waveforms were independent of the location (E and F). Deep penetrating R and IR light waveforms resembled the results of ultrasound artery imaging.

Conclusions: The phasicity of the PPG waveform is related to diameter pulsations and off-axis displacements of artery observed in vivo using ultrasound. To our knowledge, this is the first investigation using ultrasound imaging to understand counter-phase PPG waveforms.

Figure legend

References

[1] Park J, Park B, Ahn J, Kim D, Kim JY, Kim HH, Kim C. Opto-ultrasound biosensor for wearable and mobile devices: realization with a transparent ultrasound transducer. Biomed Opt Express. 2022 Aug 11;13 (9):4684–4692. https://doiorg.publicaciones.saludcastillayleon.es/10.1364/BOE.468969. PMID: 36187254; PMCID: PMC9484414.

[2] Kim ES, Sharma AM, Scissons R, Dawson D, Eberhardt RT, Gerhard-Herman M, Hughes JP, Knight S, Marie Kupinski A, Mahe G, Neumyer M, Poe P, Shugart R, Wennberg P, Williams DM, Zierler RE. Interpretation of peripheral arterial and venous Doppler waveforms: A consensus statement from the Society for Vascular Medicine and Society for Vascular Ultrasound. Vasc Med. 2020 Oct;25 (5):484–506. https://doiorg.publicaciones.saludcastillayleon.es/10.1177/1358863X20937665. Epub 2020 Jul 15. PMID: 32667274.

[3] Moço AV, Stuijk S, de Haan G. New insights into the origin of remote PPG signals in visible light and infrared. Sci Rep. 2018 May 31;8 (1):8501. https://doiorg.publicaciones.saludcastillayleon.es/10.1038/s41598-018-26068-2. PMID: 29855610; PMCID: PMC5981460.

15 3.04 Unfavourable 24 h hemodynamic changes with declining kidney function

15.1 Danninger K ¹, Weber T¹, Aoun Bahous S², Wassertheurer S³, Protogerou A⁴, Sharman J⁵, Agharazii M⁶, Argyris A⁴, Ramon Banegas J⁷, Blacher J⁸, Giannattasio C⁹, Gkaliagkousi E¹⁰, Haddad C², Hametner B³, Jankowski P¹¹, Kario K¹², Li Y¹³, Maloberti A⁹, Antonia Mota Gomes M¹⁴, Lorenza Muiesan M¹⁵, Nemcsik J¹⁶, Orter S³, Pascual J¹⁷, Perl S¹⁸, Pierce G¹⁹, Piskorz D²⁰, Pucci G²¹, Rodilla Sala E¹⁷, Salameh P², de la Sierra A²², Stergiou G²³, Terentes-Printzios D²⁴, Vlachopoulos C²⁴, Zhang Y²⁵

15.1.1 ¹Department of Cardiology, Klinikum Wels-Grieskirchen, Linz, Austria, ²Lebanese American University School of Medicine, Beirut, Lebanon, ³Center for Health & Bioresources, Biomedical systems, Austrian Institute of Technology, Vienna, Austria, ⁴Cardiovascular Prevention & Research Unit, Department of Pathophysiology, Medical School, Laiko Hospital, National and Kapodistrian University of Athens, Athens, Greece, ⁵Menzies Institute for Medical Research, College of Health and Medicine, University of Tasmania, Tasmania, Austria, ⁶CHU de Quebec, Universite Laval, Quebec, Canada, ⁷Universidad autonoma de Madrid, Departamento de medicina preventiva y saludad publica, Madrid, Spain, ⁸AP-HP Centre-Universite de Paris, Hopital Hotel-Dieu, Centre de diagnostic et de therapeutique, Paris, France, ⁹Cardiology IV, 'A. De Gasperis' Department, ASTT Ospedale Niguarda Ca' Granda, School of Medicine and Surgery Department, Milano-Bicocca University, Milan, Italy, ¹⁰3rd Department of Internal Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece, ¹¹1st Department of Cardiology, Interventional Electrocardiology and Hypertension, Jagiellonian University, Medical College, Krakow, Poland, ¹²Jichi Medical University School of Medicine,, Japan, ¹³Shanghai Institute of Hypertension, Shanghai Jiaotong University School of Medicine, Shanghai, China, ¹⁴Centro Universitario CESMAC, Alagoas, Brasil, ¹⁵Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy, ¹⁶Semmelweis University, Department of Family Medicine, Budapest, Hungary, ¹⁷Department of Medicina Interna, Hospital de Sagunto, Universidad Cardenal Herrera-CEU, CEU Universities, Valencia, Spain, ¹⁸Cardiology Department, Medical University Graz, Graz, Austria, ¹⁹University of Iowa, Iowa, USA, ²⁰Cardiovascular Research Center, Rosario British Sanatorium,, Argentina, ²¹Unit of Internal Medicine, Terni University Hospital, Department of Medicine, University of Perugia, Perugia, Italy, ²²Internal Medicine Department, Hospital Mutua Terrassa, University of Barcelona, Barcelona, Spain, ²³Hypertension Center STRIDE-7, National and Kapodistrian University of Athens, School of Medicine, Third Department of Medicine, Athens, Greece, ²⁴Hippokration Hospital, University of Athens, Athens, Greece, ²⁵Department of Cardiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China

Background: Cardiovascular diseases are the leading cause of mortality in chronic kidney disease (CKD). We investigated the relationship between steady-state as well as pulsatile hemodynamics, measured during 24-h ambulatory blood pressure monitoring (ABPM), and kidney function.

Methods: 24-h ABPM recordings, obtained with the mobilograph device (iem, Stolberg, Germany), were collected centrally. Pulse waveforms were obtained at the level of diastolic BP, and processed with validated ARCSolver algorithms (Austrian Institute of Technology, Vienna, Austria) to obtain measures of central BPs, antegrade and reflected waves, peripheral resistance (PR), cardiac output (CO), and an estimate of pulse wave velocity (ePWV). Renal function was determined using the creatinine-based CKD-EPI (Chronic Kidney Disease Epidemiology) equation for the calculation of eGFR (estimated glomerular filtration rate).

Results: We included 5033 patients (2334 women) from 24 centers in 15 countries. Mean age was 61.4 years, and 59.5% had hypertension. CKD stages 1, 2, 3, 4, and 5/6 were present in 56.5, 36.2, 4.0, 1.4 and 1.7% of the patients, respectively. There were no significant differences in brachial systolic BP across CKD stages, whereas diastolic BP decreased. In contrast, in age- and sex-adjusted models, there was a consistent significant increase in 24-h/daytime/nighttime central systolic and pulse pressure, antegrade wave amplitude, wave reflections, and ePWV, accompanied by unfavourable nighttime/daytime changes (dipping) with declining eGFR. PR remained stable, and CO changes were due to changes in heart rate.

Conclusion: Unfavourable pulsatile—rather than steady—hemodynamic changes with declining kidney function may contribute to the high cardiovascular risk in CKD patients.

16 3.05 Ultrasound-Based Pulse Wave Analysis for Enhanced Diagnosis of Fetal Growth Restriction and Aortic Stiffness

16.1 Alimahomed F ¹, Charakida M, Tang M, Charlton P, Christensen-Jeffries K, Alastruey J

16.1.1 ¹King's College London, London, United Kingdom

Background: High stillbirth rates in England and Wales are primarily attributed to foetal growth restriction (FGR) [1]. Hence, it is important to detect FGR early, but current approaches have low diagnostic sensitivity (< 40%) [2]. Aortic stiffness shows potential as an early FGR diagnostic marker but no established clinical procedure assesses aortic elasticity during pregnancy. This study aims to develop and validate pulse wave (PW) analysis techniques for improved FGR diagnosis using luminal diameter B-mode ultrasound to assess aortic stiffness.

Methods: An edge-detection algorithm (Fig. 1A) extracted diameter PWs (Fig. 1B) from a clinical dataset of 12 healthy and 10 FGR fetuses (33–38 weeks gestation) and produced representative diameter PWs for each subject. Combining this dataset with the literature data, a one-dimensional model of fetal aortic blood flow (Fig. 1C) was calibrated, generating an Insilco dataset of diameter PWs (Fig. 1D) for hundreds of virtual aortas with distinct cardiovascular parameters. The in-silico PW dataset was used to assess PW indices proposed as markers of aortic stiffness in adults [3], as well as technical ultrasound parameters. Indices strongly correlated with the theoretical aortic Young’s modulus were examined to identify FGR fetuses using the clinical dataset.

Results: Simulated and in vivo data aligned with the literature measurements (Fig. 1B–E). Several fetal aortic stiffness indices were identified for enhanced fetal vascular assessment and improved FGR diagnosis.

Conclusion: Integration of in vivo and in silico data enhances the development of a robust PW analysis technique for assessing fetal aortic stiffness and improving FGR diagnosis sensitivity.

Figure. (A) Edge detection of the luminal diameter B-mode ultrasound. (B) Extraction of diameter pulse wave through edge detection. (C) The one-dimensional (1D) model of pulse wave propagation consisting of a prescribed inflow wave (Q), a single compliant vessel of length L, diameter D, and Young’s modulus E, and an outflow Windkessel model with a proximal resistance (r), compliance (C), and distal resistance (R). (D) Simulated pulse waves. (E) Morphology of pulse waves found from the literature [4].

Figure Legend

References

[1] Flenady V, Wojcieszek AM, Middleton P, Ellwood D, Erwich JJ, Coory M, Khong TY, Silver RM, Smith GCS, Boyle FM, Lawn JE, Blencowe H, Leisher SH, Gross MM, Horey D, Farrales L, Bloomfield F, McCowan L, Brown SJ, Joseph KS, Zeitlin J, Reinebrant HE, Cacciatore J, Ravaldi C, Vannacci A, Cassidy J, Cassidy P, Farquhar C, Wallace E, Siassakos D, Heazell AEP, Storey C, Sadler L, Petersen S, Frøen JF, Goldenberg RL; Lancet Ending Preventable Stillbirths study group; Lancet Stillbirths In High-Income Countries Investigator Group. Stillbirths: recall to action in high-income countries. Lancet. 2016 Feb 13;387 (10019):691–702. https://doiorg.publicaciones.saludcastillayleon.es/10.1016/S0140-6736(15)01020-X. Epub 2016 Jan 19. Erratum in: Lancet. 2021 Sep 25;398 (10306):1132. https://doiorg.publicaciones.saludcastillayleon.es/10.1016/S0140-6736(21)02091-2. PMID: 26794070.

[2] Roma E, Arnau A, Berdala R, Bergos C, Montesinos J, Figueras F. Ultrasound screening for fetal growth restriction at 36 vs 32 weeks' gestation: a randomized trial (ROUTE). Ultrasound Obstet Gynecol. 2015 Oct;46 (4):391–7. https://doiorg.publicaciones.saludcastillayleon.es/10.1002/uog.14915. PMID: 26031399.

[3] Charlton PH, Mariscal Harana J, Vennin S, Li Y, Chowienczyk P, Alastruey J. Modeling arterial pulse waves in healthy aging: a database for in silico evaluation of hemodynamics and pulse wave indexes. Am J Physiol Heart Circ Physiol. 2019 Nov 1;317 (5):H1062–H1085. https://doiorg.publicaciones.saludcastillayleon.es/10.1152/ajpheart.00218.2019. Epub 2019 Aug 23. PMID: 31442381; PMCID: PMC6879924.

[4] Tonge, Hilda Margaret, Struijk, Peter Cornelis, van Kooten, Cornelis, Wladimiroff, Juriy Wybe and Born, Nicolas. "The first derivative as a means of synchronizing pulsatile flow velocity and vessel diameter waveforms in the fetal descending aorta" Journal of Perinatal Medicine, vol. 16, no. 4, 1988, pp. 299–304. https://doiorg.publicaciones.saludcastillayleon.es/10.1515/jpme.1988.16.4.299

17 4.01 Mechanobiological adaptation after the Ross procedure: an ovine model

17.1 Hendrickx A ¹, Van Hoof L¹, Verbrugghe P¹, Vervenne T², Maes L², Hellings P², Dahmani N¹, Grootaert M³, Fehervary H², Meuris B¹, Claus P⁴, Jones E³, Famaey N², Rega F¹

17.1.1 ¹Department of Cardiac Surgery, KU Leuven, Leuven, Belgium, ²Biomechanics section, KU Leuven, Leuven, Belgium, ³Center of Molecular and Vascular Biology, KU Leuven, Leuven, Belgium, ⁴Cardiovascular Imaging, KU Leuven, Leuven, Belgium

The Ross procedure is an alternative surgical technique for aortic valve replacement. During the procedure, the patient’s own pulmonary valve is used as a so-called autograft to replace the diseased aortic valve. The technique is promising since it involves a body’s own, living valve with excellent hemodynamics. Autografts are observed to adapt well to its new environment, resulting in a well-functioning valve for several decades. Nevertheless, progressive dilatation of the autograft is sometimes observed due to the inability to adapt to the new environment, requiring reoperation. To improve the outcomes after the Ross procedure, a better understanding of the underlying mechanical and biological adaptation mechanisms is essential. A study was set up in which the Ross procedure was performed in nineteen sheep with a six month follow-up time. In five sheep, the autograft was reinforced with a macroscopic mesh to promote benign adaptation. MRI imaging was performed preoperatively and regularly during the follow-up period, showing a progressive autograft dilatation and decreased pulsatility for both unreinforced and reinforced autografts. Furthermore, macroscopic evaluation at explantation indicated a clearly visible decreased wall thickness of the reinforced autografts. Mechanical analysis showed increased stiffness. Increased adventitial collagen and elastin fragmentation was visualized through histological examination for both unreinforced and reinforced autografts. In addition, wall thinning and smooth muscle cell atrophy was observed for the reinforced grafts. Gene transcription analysis indicated an important role for inflammation and a loss of SMC contractility.

References

Van Hoof L, Claus P, Jones EAV, Meuris B, Famaey N, Verbrugghe P, Rega F. Back to the root: a large animal model of the Ross procedure. Ann Cardiothorac Surg. 2021 Jul;10 (4):444–453. https://doiorg.publicaciones.saludcastillayleon.es/10.21037/acs-2020-rp-21. PMID: 34422556; PMCID: PMC8339627.

18 4.02 Investigating vascular ageing in C57Bl/6J mice: Impaired modulation of aortic stiffness by smooth muscle cells

18.1 Van Der Laan K ¹, Neutel C², Pencheva M^1,3, Wesley C², Kruger D², Schalkwijk C³, Martinet W², Reesink K¹, Delhaas T¹, Giudici A^1,4, Spronck B^1,5, Guns P²

18.1.1 ¹Department of Biomedical Engineering, CARIM School for Cardiovascular Diseases, Maastricht University, Maastricht, Netherlands, ²Laboratory of Physiopharmacology, University of Antwerp, Antwerp, Belgium, ³Department of Internal Medicine, CARIM School for Cardiovascular Diseases, Maastricht University, Maastricht, Netherlands, ⁴GROW School for Oncology and Reproduction, Maastricht University, Maastricht, Netherlands, ⁵Macquarie Medical School, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, Australia

Background: Arterial viscoelastic properties and contractile behaviour change with ageing, thereby increasing arterial stiffness and risk of cardiovascular events. While changes in contractile function have been investigated using isometric vasoreactivity studies [1, 2], their direct effect on viscoelastic properties under physiological loading conditions remains unexplored. Therefore, this study investigated how ageing-induced changes in contractility, extracellular matrix (ECM) microstructure, and vascular smooth muscle cell (VSMC) phenotype-related structural metrics [3] affected arterial viscoelastic behaviour.

Methods: Descending thoracic aortas were excised from five adult (5-month-old) and five old (24-month-old) male C57Bl/6J mice. Using a custom-built biaxial tester [4], viscoelastic properties were characterised under dynamic loading conditions. In HEPES buffer, contraction was induced using 2 µM phenylephrine combined with 300 µM N-Ω-Nitro-L-arginine methyl ester (L-NAME); dilatation was induced using 10 µM sodium nitroprusside. Passive viscoelastic behaviour was investigated by switching to calcium-deficient HBSS buffer containing sodium nitroprusside. Biomechanical properties were determined using a constituent-based quasi-linear modelling framework [5], adjusted to include length-dependent VSMC contraction. Collagen/elastin content and cell nuclei were imaged using two-photon laser scanning microscopy.

Results: With ageing, aortas displayed increased wall thickness, reduced contractility, and similar passive pulse wave velocities (PWVs), but lost their capacity to alter PWV with contraction at low and high pressures (Figure A–C). With ageing, microscopy data showed that ECM microstructure was unchanged, but cell nuclei were less concentrated, less circumferentially aligned, and less elongated (Figure D–F).

Conclusions: Ageing decreased the aorta’s vasoconstrictive capacity to modulate PWV, potentially as a result of VSMC phenotypic switching.

Figure legend

References

1. De Moudt S, Hendrickx JO, Neutel C, De Munck D, Leloup A, De Meyer GRY, Martinet W, Fransen P. Progressive aortic stiffness in aging C57Bl/6 mice displays altered contractile behaviour and extracellular matrix changes. Commun Biol. 2022 Jun 17;5 (1):605. https://doiorg.publicaciones.saludcastillayleon.es/10.1038/s42003-022-03563-x. PMID: 35710942; PMCID: PMC9203497.

2. Nicholson CJ, Xing Y, Lee S, Liang S, Mohan S, O'Rourke C, Kang J, Morgan KG. Ageing causes an aortic contractile dysfunction phenotype by targeting the expression of members of the extracellular signal-regulated kinase pathway. J Cell Mol Med. 2022 Mar;26 (5):1456–1465. https://doiorg.publicaciones.saludcastillayleon.es/10.1111/jcmm.17118. Epub 2022 Feb 18. PMID: 35181997; PMCID: PMC8899171.

3. Cavinato C, Murtada SI, Rojas A, Humphrey JD. Evolving structure-function relations during aortic maturation and aging revealed by multiphoton microscopy. Mech Ageing Dev. 2021 Jun;196:111471. https://doiorg.publicaciones.saludcastillayleon.es/10.1016/j.mad.2021.111471. Epub 2021 Mar 16. PMID: 33741396; PMCID: PMC8154707.4.van der Bruggen, Reesink, Spronck, Bitsch, Hameleers, Megens, Schalkwijk, Delhaas, Spronck. Sci Rep. 2021;11:2671.

5. Giudici, van der Laan, van der Bruggen, Parikh, Berends, Foulquier, Delhaas, Reesink, Spronck. Biomech Model Mechanobiol. 2023; [in press].

19 4.03 Angiotensin AT2 receptor stimulation modulates endothelial BMP-2 levels by the AT2R-PP2A-AMPK pathway

19.1 Sanz-Gómez M ¹, Manzano-Lista F¹, Roscales S¹, Csàky A¹, Bragado-García E¹, Fernández-Alfonso M¹

19.1.1 ¹Instituto Pluridisciplinar, Universidad Complutense De Madrid, Madrid, Spain

Background: Increased arterial stiffness is related to vascular calcification (VC), especially in chronic kidney disease (CKD) [1]. VC is regulated by bone morphogenetic proteins (BMPs), i.e. the pro-osteogenic BMP-2, which is increased in both patients and animal models with CKD [2]. The aim of this study was to investigate the role of the angiotensin AT2R on BMP-2 expression and its possible link with the PP2A-AMPK pathway.

Methods: 22- and 45-week-old male Munich Wistar Frömter (MWF) rats were used as a model of advanced CKD. p-Thr174AMPK levels, BMP-2 and AT2R expression were determined in kidneys by Western blot and PCR, respectively.

Results: 45-week-old MWF showed a decreased AT2R expression associated to higher p-Thr172AMPK and BMP-2 levels compared to 22-week-old rats. There was a positive correlation between pAMPK and BMP-2, whereas pAMPK correlation with AT2R expression was negative. To assess the role of AT2R on AMPK phosphorylation, human endothelial EAHy926 cells were treated with the non-peptidic AT2R agonist, Compound 21 (C21, 5 min, 100 µM) showing a significant reduction in pAMPK level that was prevented in the presence of the PP2A inhibitor, okadaic acid (OA, 20 min, 100 µM). AMPK activation by 2-Deoxyglucose (2-DG, 15 min, 1 mM) significantly increased phosphorylation levels, which were reduced by C21. Similarly, C21 induced a reduction of BMP-2 expression, which was reversed by OA and 2-DG.

Conclusions: We show for the first time that endothelial AMPK Thr-172 phosphorylation state is actively regulated by an AT2R-dependent PP2A activation. Downregulation of AT2R in CKD might thus trigger BMP-2 expression and VC.

References

1. Yang, P., Troncone, L., Augur, Z. M., Kim, S. S. J., McNeil, M. E., & Yu, P. B. (2020). The role of bone morphogenetic protein signaling in vascular calcification. Bone, 141, 115542. https://doiorg.publicaciones.saludcastillayleon.es/10.1016/j.bone.2020.115542

2. Manzano-Lista, F. J., Sanz-Gómez, M., González-Moreno, D., Vega-Martín, E., Gil-Ortega, M., Schulz, A., Rubio, M. Á., Ruiz-Hurtado, G., Ruilope, L. M., Aránguez, I., Kreutz, R., & Fernández-Alfonso, M. S. (2022). Imbalance in Bone Morphogenic Proteins 2 and 7 Is Associated with Renal and Cardiovascular Damage in Chronic Kidney Disease. International journal of molecular sciences, 24 (1), 40. https://doiorg.publicaciones.saludcastillayleon.es/10.3390/ijms24010040

20 4.04 Promoting chronic kidney disease-induced vascular media calcification through intravenous iron administration

20.1 Van den Branden A ¹, Opdebeeck B¹, Van den Berghe T¹, Verhulst A¹

20.1.1 ¹University of Antwerp—Laboratory of Pathophysiology, Wilrijk, Belgium

Background: Vascular media calcification (VC) is a severe complication in chronic kidney disease (CKD) patients. Intravenous (i.v.) iron is administered to alleviate iron deficiency anemia in CKD patients. Iron is suggested to be sequestered in vascular cells during (CKD-induced) inflammatory conditions, potentially leading to oxidative stress, a driving force behind VC. We studied the effect of i.v. iron administration on VC development in CKD rats.

Methods: To induce CKD, rats received 10-day adenine treatment followed by i.v. injections with vehicle or iron (3 or 10 mg/kg/dose) thrice/week for 4 weeks. VC was evaluated by measuring aortic calcium content and %calcified area on Von Kossa-stained sections. Aortic iron accumulation was assessed by total iron staining and iron content measurement. Rats with normal renal function, treated with vehicle/iron, were also included.

Results: Adenine treatment induced equal renal function decline in rats treated with vehicle or iron. VC was increased in CKD rats exposed to both iron concentrations, indicated by elevated aortic calcium content (mean ± SEM in mg Ca/g wet tissue; 3 mg/kg: 12.51 ± 6.17, p = 0.5197; 10 mg/kg: 25.28 ± 7.65, p = 0.0097 vs vehicle: 2.32 ± 1.07) and increased %calcified area (mean ± SEM; 3 mg/kg: 19.49 ± 6.99%, p = 0.0892; 10 mg/kg: 29.90 ± 6.83%, p = 0.0025 vs vehicle: 4.43 ± 2.96%) compared to vehicle-treated rats. Iron accumulated in calcified aortas of CKD iron-treated rats, visualized by positive iron staining. A positive correlation (p = 0.0001, r = 0.7351) was observed between aortic calcium and iron content in the CKD iron-treated groups. Normal renal function rats did not show aortic calcification or iron accumulation.

Conclusions: I.v. iron administration to CKD rats induced aortic iron sequestration and promoted VC.

Figure 1 Legend

21 4.05 How arterial stiffness and volume determine the range of pulse pressure: a physiological perspective.

21.1 Chamoun R ¹, Delhaas T¹, Kroon A¹, Reesink K¹

21.1.1 ¹Maastricht University Medical Center, Maastricht, The Netherlands

Background: The current thresholds for systolic and diastolic blood pressure that define the diagnosis and management of hypertension do not take into account pulse pressure (PP, i.e., systolic blood pressure minus diastolic blood pressure). Pulse pressure is positively affected by stiffness of the arterial system and negatively affected by its volume. Due to progressive elastin degradation with age, the arterial system’s stiffness as well as its volume increase. We investigated how PP changes in response to stiffness and volume changes, to quantify the interrelationship.

Methods and Results: CircAdapt is a computer model of the whole circulation capturing cardiac and vascular structure and function, as well as central pressure and peripheral flow regulations (http://www.circadapt.org/). In CircAdapt we changed the values of stiffness (k) and volume (V) of the arterial system by applying either a 50% amplification or a 50% reduction of their reference values, and recorded PP. Simulations showed that a 50% increase in k or a 50% decrease in V gives a comparable increase in PP (Fig. 1: blue columns). Combined opposite 50% changes in k and V explain a tenfold change in PP (Fig. 1: orange columns).

Conclusion: Physiologically, stiffness as well as volume of the arterial system are equal determinants of pulse pressure. How both properties are distributed in a reference or hypertensive population is unchartered, warranting next steps of investigation.

22 5.01 A tug-of-war between different mechanical testing techniques for arteries

22.1 Giudici A ^1,2, Delhaas T¹, Reesink K¹, Spronck B^1,3

22.1.1 ¹Department of Biomedical Engineering, CARIM School for Cardiovascular Diseases, Maastricht University, Maastricht, The Netherlands, ²GROW School for Oncology and Reproduction, Maastricht University, Maastricht, The Netherlands, ³Macquarie Medical School, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sidney, Australia

Background: Vascular ageing increases cardiovascular risk. Unlike in the clinic, ex vivo preclinical research allows the direct characterisation of arterial wall mechanics via experimental testing setups. However, different experimental setups simplify the physiological loading configuration to different extents and may thus lead to discordant conclusions. We aimed to simulate how different alterations to structural/material properties of the aortic wall affect its distensibility as measured by three experimental setups: 1) tubular biaxial testers (independently inflating and extending arteries), 2) pressure myographs, and 3) uniaxial testers.

Methods: Simulations were performed using a previously described tri-layered computational model of n = 10 porcine thoracic aortas [1]. Biaxial testing was simulated as intraluminal pressurisation while keeping the artery extended at its in vivo length. Pressure myography involved intraluminal pressurisation without axial extension. Uniaxial testing consisted of releasing the wall’s residual stresses and enforcing the load-free condition in all directions but circumferential [2]. Three simulated arterial alterations were compared to the unaltered wall (control): (1) 80% elastin fragmentation, (2) 50% intima-media thickening, and (3) adventitial collagen crosslinking.

Results: Figure 1A shows how the three alterations affected the aortic response to in vivo pressurisation. All three setups similarly detected the elastin fragmentation-induced decrease in distensibility (Fig. 1B). However, uniaxial testing significantly underestimated/failed to detect the effects of intima-media thickening and collagen crosslinking on distensibility (Fig. 1C–D).

Conclusions: Inherent differences exist between experimental biomechanical testing techniques, the results of which should not be directly cross-compared. Unphysiological loading conditions may lead to misinterpretation of disease-induced alterations in arterial mechanics.

Figure 1 Legend

References

[1] Giudici A, Khir AW, Szafron JM, Spronck B. From Uniaxial Testing of Isolated Layers to a Tri-Layered Arterial Wall: A Novel Constitutive Modelling Framework. Ann Biomed Eng. 2021 Sep;49 (9):2454–2467. https://doiorg.publicaciones.saludcastillayleon.es/10.1007/s10439-021-02775-2. Epub 2021 Jun 3. PMID: 34081251; PMCID: PMC8455406.

[2] Giudici A, Spronck B. The role of layer-specific residual stresses in arterial mechanics: Analysis via a novel modelling framework. Artery Res 2022, 28:41–54.

23 5.02 Feasibility of Laser-Doppler-Vibrometry to measure cardiac signals for Heart–Carotid Pulse-Wave Velocity estimation

23.1 Beeckman S ¹, Badhwar S⁶, Li Y^3,4, Aasmul S⁵, Bruno R⁶, Boutouyrie P⁶, Madhu N², Segers P¹

23.1.1 ¹Ghent University - BioMMedA/IBiTech, Ghent, Belgium, ²IDlab, Ghent University - imec, Ghent, Belgium, ³Photonics Research Group, Ghent University-imec, Gent, Belgium, ⁴Center for Nano- and Biophotonics, Ghent, Belgium, ⁵Medtronic Bakken Research Center, Maastricht, The Netherlands, ⁶INSERM U970, Université Paris Cité, Paris, France

Background: Carotid–femoral pulse-wave velocity (cfPWV) has been recognized as a biomarker for arterial stiffness and is measurable by laser-Doppler vibrometry (LDV), measuring pulse-induced skin displacements in the neck and groin [1, 2]. cfPWV, however, excludes the ascending aorta, the largest contributor to total arterial compliance. We, therefore, explored the feasibility of measuring heart–carotid pulse-wave velocity (hcPWV) using LDV.

Methods: A clinical feasibility study was conducted, wherein 22 patients (ages 24–78) were measured with an LDV prototype developed within the context of a Horizon 2020 project, capable of simultaneously acquiring LDV signals along 6 beams on 2 handpieces. We particularly investigated signals acquired at two chest measurement sites: the base of the heart (right second intercostal space) and the apex (left fifth intercostal space). For every patient and measurement site, 3 LDV recordings were performed without, and one with ECG. LDV signals measured at base and apex were investigated for features indicating opening of the aortic valve.

Results: Data from both measuring sites showed discernable heart cycles, with features that could be linked to the closure of the mitral and aortic valves (first and second heart sounds). Signal quality, however, was poorer than signals measured at the carotid artery.

Conclusions: We conclude that LDV allows measuring skin displacements and accelerations at the chest to identify the first and second heart sounds. Combining these with carotid signals, the CARDIS (H2020 grant ID: 644798) device has the potential to measure hcPWV, and stiffness of the most proximal arteries if pathlength can be assessed.

Figure 1 Legend

References

[1] Segers P, Rietzschel ER, Chirinos JA. How to Measure Arterial Stiffness in Humans. Arterioscler Thromb Vasc Biol. 2020 May;40 (5):1034–1043. https://doiorg.publicaciones.saludcastillayleon.es/10.1161/ATVBAHA.119.313132. Epub 2019 Dec 26. PMID: 31875700; PMCID: PMC7180118.

[2] Seoni S, Beeckman S, Li Y, Aasmul S, Morbiducci U, Baets R, Boutouyrie P, Molinari F, Madhu N, Segers P. Template Matching and Matrix Profile for Signal Quality Assessment of Carotid and Femoral Laser Doppler Vibrometer Signals. Front Physiol. 2022 Jan 11;12:775052. https://doiorg.publicaciones.saludcastillayleon.es/10.3389/fphys.2021.775052. PMID: 35087417; PMCID: PMC8787261.

24 5.03 Exploring arterial health in extreme environments: Lessons from a 12-day Mars analog mission

24.1 Derobertmasure A ^1,2,3, Kafi L², Obeid H¹, Truong Ngnoc H², Burk J⁴, Decadi A⁶, Renaud C^5,7, Villa-Massone J⁷, Davidson K⁴, Kennedy E⁷, Bruno R^1,2,3, Chhun S³, Boutouyrie P^1,2,3

24.1.1 ¹INSERM U970 Team 7 – PARCC - Paris Cardiovascular Research Centre, Paris, France, ²Pharmacology Unit-Hôpital Européen Georges Pompidou - APHP, Paris, France, ³Université Paris Cité, Paris, France, ⁴Mars Society, Lakewood, USA, ⁵UMONS - Université de Mons, Mons, Belgique, ⁶ESA- European Space Agency, Paris, France, ⁷ISU - International Space University, Strasbourg, France

Background: Long-term spaceflights (> 6 months) induce early vascular aging in astronauts, compromising space missions, particularly as new individuals with unique profiles are expected to fly. The lack of vascular data in astronauts necessitates to test non-invasive and portable techniques to assess arterial health in conditions analog to spaceflight. We hypothesize that the extreme environment modifies vascular remodeling, posing a significant threat for astronauts. We evaluated arterial stiffness and body composition during a 12-day Mars analog mission at Mars Desert Research Station, Utah.

Methods: Arterial stiffness was measured using finger-to-toe pulse wave velocity (ftPWV) by photo-plethysmography (pOpmètre^®) and connected scale (Withings^®). Blood pressure was measured by a connected blood pressure monitor (Withings^®). Measurements were taken daily, including after extravehicular activities, for six crew members.

Results: Following the 12-day mission, subjects experienced a progressive weight loss (− 2.0 kg, p < 0.05), primarily in fat and water mass, which strongly correlated with ftPWV reduction (p = 0.0017). Blood pressure did not change during the mission. Extravehicular activities induced tachycardia (p < 0.03), but did not change ftPWV or SBP. Measurements of ftPWV were limited by Raynaud phenomenon in some subjects.

Conclusions: Estimating PWV with the pOpmètre^® device is feasible in extreme environment and isolated conditions, with minimally trained crew. Even on a small group, weight loss due to restricted food supply and increased physical activity was associated with BP-independent improvement in arterial stiffness. Further studies are required to see whether the short-term positive evolution of weight and ftPWV persists or reverses during longer term missions.

25 5.04 Aortic pulse wave velocity, strain and distensibility by magnetic resonance imaging are linearly related to aortic wall stiffness

25.1 Guala A ¹, Cilla M³, Dux-Santoy L¹, Martínez M³, Ruiz-Munoz A¹, Teixido-Tura G^1,2, Galian-Gay L², Garrido-Oliver J¹, Morales-Galan A¹, Ferreira González I^1,2, Peña E³, Rodriguez-Palomares J^1,2

25.1.1 ¹VHIR, Barcelona, Spain, ²Hospital Vall d'Hebron, Barcelona, Spain, ³University of Zaragoza, Zaragoza, Spain

Background: Aortic “stiffness” is an established predictor of adverse cardiovascular events and mortality in the general population (1, 2) and a descriptor of arterial ageing (3). Cardiovascular magnetic resonance (CMR) allows for the quantification of parameters theoretically linked to aortic stiffness, such as pulse wave velocity (PWV), distensibility (AD) and strain (4). Nonetheless, whether these parameters describe aortic wall stiffness has not been tested.

Methods: Ascending aorta (AAo) specimens were extracted from 20 patients undergoing ascending aorta replacement for aneurysms. Two specimens (15 × 5 mm, one originally aligned with the circumferential and the other longitudinal aortic direction) were extracted and tested under extension force control with elongation being measured by laser video extensometer (5). Few days before the intervention, patients underwent a comprehensive CMR protocol, where blood pressure was measured. The tangent of the stress–strain curve at patient-specific diastolic pressure was extracted from ex-vivo tests. AAo PWV and the Eh product (E being Young modulus and h wall thickness) were measured from 4D flow CMR (6), while AD and AAo longitudinal strains were quantified from cine images (7).

Results: Clear linear correlations were identified between circumferential elastic modulus and PWV (R = 0.652), AAo AD (R = − 0.502) and Eh (R = 0.602). Similarly, a marked linear correlation was identified between AAo longitudinal strain and longitudinal elastic modulus (R = − 0.513).

Conclusions: Regional pulse wave velocity, distensibility and strain measured by magnetic resonance imaging are linearly related to aortic wall stiffness and can thus provide insights into aortic wall stiffness.

Figure 1 Legend

References

1. Ohyama Y, Ambale-Venkatesh B, Noda C, Kim JY, Tanami Y, Teixido-Tura G, Chugh AR, Redheuil A, Liu CY, Wu CO, Hundley WG, Bluemke DA, Guallar E, Lima JAC. Aortic Arch Pulse Wave Velocity Assessed by Magnetic Resonance Imaging as a Predictor of Incident Cardiovascular Events: The MESA (Multi-Ethnic Study of Atherosclerosis). Hypertension. 2017 Sep;70 (3):524–530. https://doiorg.publicaciones.saludcastillayleon.es/10.1161/HYPERTENSIONAHA.116.08749. Epub 2017 Jul 3. PMID: 28674039; PMCID: PMC5612667.

2. Redheuil A, Wu CO, Kachenoura N, Ohyama Y, Yan RT, Bertoni AG, Hundley GW, Duprez DA, Jacobs DR Jr, Daniels LB, Darwin C, Sibley C, Bluemke DA, Lima JAC. Proximal aortic distensibility is an independent predictor of all-cause mortality and incident CV events: the MESA study. J Am Coll Cardiol. 2014 Dec 23;64 (24):2619–2629. https://doiorg.publicaciones.saludcastillayleon.es/10.1016/j.jacc.2014.09.060. PMID: 25524341; PMCID: PMC4273646.

3. Climie RE, Alastruey J, Mayer CC, Schwarz A, Laucyte-Cibulskiene A, Voicehovska J, Bianchini E, Bruno RM, Charlton PH, Grillo A, Guala A, Hallab M, Hametner B, Jankowski P, Königstein K, Lebedeva A, Mozos I, Pucci G, Puzantian H, Terentes-Printzios D, Yetik-Anacak G, Park C, Nilsson PM, Weber T. Vascular ageing: moving from bench towards bedside. Eur J Prev Cardiol. 2023 Aug 21;30 (11):1101–1117. https://doiorg.publicaciones.saludcastillayleon.es/10.1093/eurjpc/zwad028. Erratum in: Eur J Prev Cardiol. 2023 Aug 21;30 (11):1165. https://doiorg.publicaciones.saludcastillayleon.es/10.1093/eurjpc/zwad134. PMID: 36738307; PMCID: PMC7614971.

4. Bianchini E, Lønnebakken MT, Wohlfahrt P, Piskin S, Terentes-Printzios D, Alastruey J, Guala A. Magnetic Resonance Imaging and Computed Tomography for the Noninvasive Assessment of Arterial Aging: A Review by the VascAgeNet COST Action. J Am Heart Assoc. 2023 May 16;12 (10):e027414. https://doiorg.publicaciones.saludcastillayleon.es/10.1161/JAHA.122.027414. Epub 2023 May 15. PMID: 37183857; PMCID: PMC10227315.

5. Peña JA, Martínez MA, Peña E. Layer-specific residual deformations and uniaxial and biaxial mechanical properties of thoracic porcine aorta. J Mech Behav Biomed Mater. 2015 Oct;50:55–69. https://doiorg.publicaciones.saludcastillayleon.es/10.1016/j.jmbbm.2015.05.024. Epub 2015 Jun 4. PMID: 26103440.

6. Guala A, Rodriguez-Palomares J, Dux-Santoy L, Teixido-Tura G, Maldonado G, Galian L, Huguet M, Valente F, Gutiérrez L, González-Alujas T, Johnson KM, Wieben O, Sao Avilés A, Garcia-Dorado D, Evangelista A. Influence of Aortic Dilation on the Regional Aortic Stiffness of Bicuspid Aortic Valve Assessed by 4-Dimensional Flow Cardiac Magnetic Resonance: Comparison With Marfan Syndrome and Degenerative Aortic Aneurysm. JACC Cardiovasc Imaging. 2019 Jun;12 (6):1020–1029. https://doiorg.publicaciones.saludcastillayleon.es/10.1016/j.jcmg.2018.03.017. Epub 2018 May 16. PMID: 29778849.

7. Guala A, Teixidó-Tura G, Rodríguez-Palomares J, Ruiz-Muñoz A, Dux-Santoy L, Villalva N, Granato C, Galian L, Gutiérrez L, González-Alujas T, Sanchez V, Forteza A, García-Dorado D, Evangelista A. Proximal aorta longitudinal strain predicts aortic root dilation rate and aortic events in Marfan syndrome. Eur Heart J. 2019 Jul 1;40 (25):2047–2055. https://doiorg.publicaciones.saludcastillayleon.es/10.1093/eurheartj/ehz191. PMID: 30977783.

26 5.05 The effects of bariatric surgery on blood pressure management in Type 2 Diabetes: Insights from a ten-year follow up study

26.1 Mannan F¹, Wiltshire R¹, Ghaffari P², Alsbeni M², Waheed U², Syed A^2,3, Gibson M^2,3, Heald A ^2,3

26.1.1 ¹Division of Cardiovascular Sciences, Faculty of Biology, Medicine and Health, Manchester University, Manchester, United Kingdom, ²Department of Endocrinology and Diabetes, Salford Royal Hospital, Salford, United Kingdom, ³The School of Medicine and Manchester Academic Health Sciences Centre, Manchester University, Manchester, United Kingdom

Background: It is well established that bariatric surgery results in improved metabolic profile and in particular lower blood glucose levels in people with type 2 diabetes mellitus (T2D) (1). However, limited data exist on the longer term trajectory of blood pressure (BP)/BP treatment requirements following bariatric surgery (2).

Methods: We undertook a 10-year prospective cohort study on people who underwent bariatric surgery (gastric bypass/sleeve gastrectomy) between 2009 and 2012 at a single tertiary surgical centre in North-West England, UK. Parameters including BP readings/HbA1c/BMI and antihypertensive medication use were drawn from electronic patient records at regular intervals.

Results: 119 individuals were included in the study. Optimal metabolic health state was achieved at 12 months post-surgery for BMI (− 14.9 kg/m² (95% CI: 13.4–16.2, p < 0.001)), systolic BP (sBP) (− 15.0 mmHg 95% CI: 8.2–21.8 mmHg, p < 0.001)), diastolic BP (dBP) (− 8.1 mmHg, 95% CI: 4.3–11.9, p < 0.001)) and HbA1c (− 24.4 mmol/mol, 95% CI: 18.3–30.6, p < 0.001). A sustained reduction in both sBP/dBP was maintained for up to 5 years, mirroring reduction in concurrent use of antihypertensive medications (164 prescriptions v 66 at 5 years). However, at latest follow-up, there was an observed increase in antihypertensive prescription (95 v 66) (Fig. 1) with was no statistically significant change in mean BP. Furthermore, the number of individuals with clinically diagnosed hypertension (BP 140/90 or more was lowest at 5 years (n = 53 v 86 pre-op) before rising at the latest follow-up (n = 62) as did BMI (+ 3.1 kg/m²) and HbA1c (+ 7.5 mmol/mol).

Conclusion: Our study demonstrates that bariatric surgery has a positive impact on blood pressure management as reflected by both absolute measurements and reduced antihypertensive medication use, but over time, antihypertensive prescriptions do steadily increase again.

Figure Legend

References

1. Sheng B, Truong K, Spitler H, Zhang L, Tong X, Chen L. The Long-Term Effects of Bariatric Surgery on Type 2 Diabetes Remission, Microvascular and Macrovascular Complications, and Mortality: a Systematic Review and Meta-Analysis. Obes Surg 2017; 27: 2724–2732

2. Harsha DW, Bray GA. Weight loss and blood pressure control (Pro). Hypertension. 2008 Jun;51 (6):1420–5; discussion 1425. https://doiorg.publicaciones.saludcastillayleon.es/10.1161/HYPERTENSIONAHA.107.094011. PMID: 18474829.

27 P01 Exploring arterial microstructure across species using advanced image processing and analysis of contrast-enhanced microCT data

27.1 Pétré M ^1,2,3, Gennart I¹, Leyssens L^1,2, Pyka G¹, Fehervary H^3,6, Famaey N^3,6, Kerckhofs G^1,2,4,5

27.1.1 ¹Institute of Mechanics, Materials and Civil Engineering (iMMC), Louvain-la-neuve, Belgium, ²Institut de recherche expérimentale et clinique (IREC), Louvain-la-neuve, Belgium, ³Dpt. Mechanical Engineering, Leuven, Belgium, ⁴Dpt. Materials Engineering, Leuven, Belgium, ⁵Prometheus, Division of Skeletal Tissue Engineering, Leuven, Belgium, ⁶FIBEr, Leuven, Belgium

Cardiovascular diseases remain the leading cause of death, necessitating improved treatments. The complex microstructure of vascular tissues, which remodels and adapts due to aging and diseases, contributes to the challenge of developing suitable treatments. Understanding these microstructural changes is essential for better-understanding disease progression and designing effective treatments. Classical 2D histology enabled to demonstrate that vascular tissues often present high microstructural disorganization or damage both in terms of content and architecture of the fibrous constituents (i.e. elastic lamellae and collagen fibers) [1], but offer only 2D information making it difficult to quantify the extent of disorganization or damage present in the entire tissue of interest. Therefore, contrast-enhanced computed tomography (CECT) can provide 3D information on the microstructure of vascular tissue. However, image post-processing techniques such as denoising, sharpening filters, and (manual) thresholding are still highly reliant on individual users and hence, subjective. As a result, comparing image analysis results becomes challenging. Therefore, we investigated an image analysis protocol to study the elastic lamellae present in sheep, porcine, and rat aorta to quantify their volume fraction and tortuosity. For this purpose, we evaluated different filters (i.e. median, mean, Gaussian, and unsharp filters) and their parameters (i.e. kernel size and standard deviation) based on different mathematical metrics and proposed an optimized two-step post-processing protocol. Similarly, we evaluated automatic thresholding methods (i.e. K-means, Otsu, and Frangi) based on the sum of square differences. Moreover, we demonstrated that using Cryo-CECT enables us to visualize more fibrous constituents present in the extracellular matrix than just the elastic lamellae.

Figure 1 Legend

References

[1] Tsamis A, Krawiec JT, Vorp DA. Elastin and collagen fibre microstructure of the human aorta in ageing and disease: a review. J R Soc Interface. 2013 Mar 27;10 (83):20121004. https://doiorg.publicaciones.saludcastillayleon.es/10.1098/rsif.2012.1004. PMID: 23536538; PMCID: PMC3645409.

28 P02 A proof-of-concept of an imageless ultrasound system to assess arterial diameter and wall thickness.

28.1 Amado Rey A ^1,2, Budde D^1,2, Gonçalves Seabra A^1,2,3, Castro V⁴, Stieglitz T^1,2,3,5

28.1.1 ¹Laboratory for Biomedical Microtechnology. Department of Microsystems Engineering (IMTEK), University of Freiburg, Freiburg, Germany, ²IMBIT//NeuroProbes, University of Freiburg, Freiburg, Germany, ³BrainLinks-BrainTools Center, University of Freiburg, Freiburg, Germany, ⁴Universidade Federal de Viçosa (UFV), Viçosa, Brazil, ⁵Bernstein Center Freiburg, University of Freiburg, Freiburg im Breisgau, Germany

Background: Ultrasound is the most accurate tool to measure arterial wall thickness, with a resolution of up to 1 µm. Non-invasive and continuous measurements of arterial parameters can be derived into local arterial stiffness, an important predictor of vascular age [1]. In this work, a proof-of-concept of a new A-Mode ultrasound probe, pulser and receiver system to prevent cardiovascular diseases is presented.

Methods: A customized unfocused 5 MHz bulk lead zirconium titanate (PZT) transducer with a penetration depth of 21.1 mm is used for phantom arterial measurements. The transducer is connected to a custom-made bipolar pulser-receiver printed circuit board (PCB), with a total dimension of only 8.5 cm². The pulser is programmed by a FPGA. The system measurements of vessel diameter and wall thickness with silicone tubes (5–10 mm of diameter) and an agar phantom were validated with a B-Mode image ultrasound (DRAMISKI OPUS-D, Poland) [2].

Results: The in-vitro validation achieved a Pearson correlation coefficient (r) of 0.97 for the first (anterior) arterial wall in the phantom. The PCB power consumption of the complete system was 320 mW. The system allows to send arbitrary pulses via the FPGA, where voltage, type and length of pulse and frequency can be adapted to each specific patient and medical application.

Conclusions: The proof-of-concept of a PCB-based ultrasound system was presented. The system monitors arterial wall and diameter distension with high accuracy (r = 0.95), low-power consumption (320 mW) and can be used to derive local arterial stiffness [3].

Figure 1 Legend

References

[1] Kucharska-Newton AM, Stoner L, Meyer ML. Determinants of Vascular Age: An Epidemiological Perspective. Clin Chem. 2019 Jan;65 (1):108–118. https://doiorg.publicaciones.saludcastillayleon.es/10.1373/clinchem.2018.287623

[2] G.-Y. Li, Y. Jiang, Y. Zheng, W. Xu, Z. Zhang, and Y. Cao, “Arterial Stiffness Probed by Dynamic Ultrasound Elastography Characterizes Waveform of Blood Pressure,” IEEE transactions on medical imaging, vol. 41, no. 6, pp. 1510–1519, 2022, https://doiorg.publicaciones.saludcastillayleon.es/10.1109/TMI.2022.3141613.

[3] G. Fiori, F. Fuiano, A. Scorza, S. Conforto, and S. A. Sciuto, “Non-Invasive Methods for PWV Measurement in Blood Vessel Stiffness Assessment,” IEEE reviews in biomedical engineering, vol. 15, pp. 169–183, 2022, https://doiorg.publicaciones.saludcastillayleon.es/10.1109/RBME.2021.3092208.

29 P03 Developing a novel method for measuring ‘heart-to-carotid’ pulse wave velocity

29.1 Badhwar S ¹, Beekman S³, Gencer U^1,2, Khettab H², Ngoc Truong H², Soulat G^1,2, Boutouyrie P^1,2, Mousseaux E^1,2, Segers P³, Maria Bruno R^1,2

29.1.1 ¹Université de Paris, PARCC, INSERM, Paris, France, ²Assistance Publique Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Paris, France, ³Ghent University - BioMMedA/IBiTech, Ghent Oost-vlaanderen, Ghent, Belgium

Background: Ascending aorta is the arterial segment most impacted by vascular ageing, but only few techniques allow its evaluation (1). This study aims to develop a novel approach to evaluate heart-to-carotid pulse wave velocity (PWVHC), combining tonometry and MRI and comparing it with existing techniques.

Methods: PWV (ascending to descending aorta—PWVAD) by 4Dflow MRI and carotid–femoral PWV (PWVCF) by tonometry were obtained sequentially in patients undergoing clinically indicated cardiac MRI. ECG-R-peak to carotid transit time was measured (TTRpeak-Car) by tonometry. Mitral valve (MV) and aortic valve (AV) motions were tracked to identify MV closure and AV opening, using MRI. Isovolumetric-contraction time (TTIVCT), and heart–carotid TT (TTHC) were calculated (Figure a). Distance from aortic valve to isthmus from MRI images, and TTHC, were used to calculate PWVHC. PWVHC was not calculated if heart rate difference between MRI and tonometry was > 10 bpm.

Results: MRI from 30 patients (median age 43 years old, IQR 31–67) were analysed. PWVAD could be calculated for 25 and PWVHC for 23. There was significant correlation between PWVAD and PWVHC (r = 0.63, p = 0.004) (Figure b). Correlation between PWVAD and PWVHC with PWVCF was not significant (r = 0.27 p = 0.19 and r = 0.17 p = 0.45, respectively).

Conclusion: We developed a novel method to measure PWVHC based on combination of tonometry and MRI, comparable to aortic PWV. This is the first step for using markers of cardiac valve motion, such as laser Doppler vibrometry, currently under development (INSIDE project, grant no. 871547), for measuring PWVHC in routine.

Figure 1 Legend

References

1. Climie RE, Alastruey J, Mayer CC, Schwarz A, Laucyte-Cibulskiene A, Voicehovska J, Bianchini E, Bruno RM, Charlton PH, Grillo A, Guala A, Hallab M, Hametner B, Jankowski P, Königstein K, Lebedeva A, Mozos I, Pucci G, Puzantian H, Terentes-Printzios D, Yetik-Anacak G, Park C, Nilsson PM, Weber T. Vascular ageing: moving from bench towards bedside. Eur J Prev Cardiol. 2023 Aug 21;30 (11):1101–1117. https://doiorg.publicaciones.saludcastillayleon.es/10.1093/eurjpc/zwad028. Erratum in: Eur J Prev Cardiol. 2023 Aug 21;30 (11):1165. https://doiorg.publicaciones.saludcastillayleon.es/10.1093/eurjpc/zwad134. PMID: 36738307; PMCID: PMC7614971.

30 P04 Triboelectric nanogenerator force sensor development for pulse wave analysis

30.1 Yan R ¹, Pradyumnan Srinivasan A¹, Clough R¹, Carr-White G¹, Rhode K¹, Alastruey J¹

30.1.1 ¹King's College London, London, United Kingdom

Background: In an aging society, with the increasing number of people living alone, wearable sensors have potential for cardiovascular disease monitoring in daily life. Current sensors require frequent charging and are expensive, which limits their use in developing countries. This project aims to develop a self-powered pressure sensor based on a triboelectric nanogenerator (TENG), which is self-powered, inexpensive, soft and easy to wear for multi-parameter sensing and monitoring of cardiovascular disease.

Methods: Two TENG sensor structures were designed to meet the needs of different usage scenarios (Fig. 1A): a flat sandwich structure for vertical pressure sensing and a cylindrical barrel structure for multidirectional pressure sensing. A motor-driven structure was designed for highly reproducible and accurate testing of different weights impacting the TENG sensors (Fig. 1B). TENG voltage output was compared with impact force measurements acquired by an ATI Multi-Axis Force/Torque Sensor (ATI, North Carolina, USA).

Results: Peak voltage correlated well with peak force (Fig. 1C) and increased significantly with increasing impact weights (Fig. 1D).

Conclusion: Our proposed TENG designs hold promises for non-invasive wearable pulse wave measurement to monitor cardiovascular disease in daily life. We aim to continue validation and miniaturise using nanofabrication.

Figure 1 Legend

31 P05 A free software tool for assessing vascular mechanics in children using the oscillometric method

31.1 Moros C¹, Pupi L², Wagmaister B ¹, Pastaro D¹, Sardella Á¹

31.1.1 ¹Gutierrez Children´s Hospital, Ciudad de Buenos Aires, Argentina, ²Artery LATAM, Buenos Aires, Argentina

Introduction: Early detection of bad habits can help physicians to provide timely interventions to prevent or reverse them. In children, arterial stiffness determined by pulse wave velocity (PWV) is an important and early marker of arterial disease.

Objectives: DEVAIN-PWV (Children Accelerated Vascular Detection–PWV) is a free software tool that aims to: (1)—standardize and prospectively record vascular mechanics studies (VMS) in childhood and (2)—promote multi-institutional registries that enable research in this new area of prevention.

Material and methods: DEVAIN-PWV program uses Access Database. Childhood EVA (Early Vascular Aging) was considered when central aortic pressure (CAP) or/and PWV > 95th percentile.

Results: VMS were recorded from 665 patients (59.9% (398) were male; mean age was 14.31 ± 3.6 years old). 42.9% (286) had normal weight, 20.6% (137) overweight, and 36.5% (243) obese. The measurements were: PWV 4.7 m/s ± 0.43, CAP 73.5 mmHg ± 15.6, 15.5% (103) CAP ≥ 95th percentile, 14.9% (99) PWV ≥ 95th percentile, 18.5% (123) abnormal augmentation index @75 (AIX), and 41.7% (278) abnormal total peripheral vascular resistance (TPVR). EVA was observed in 30.5% (203) of the participants and was associated with male sex (p < 0.0001, OR: 1.26, 95% CI: 1.1–1.59), abnormal AIX (p < 0.0001, OR: 2.5, 95% CI: 2.1–3), and increased TPVR (p < 0.0001, OR: 5.7, 95% CI: 4–8.3). Normal weight was identified as a protective factor (p = 0.022, OR: 0.6, 95% CI: 0.45–0.89).

Conclusions: One-third of the patients studied showed EVA. DEVAIN-VOP program proved to be a useful software tool that facilitates the assessment of pediatric vascular mechanics.

Figure Legend

32 P06 Measuring Carotid–Femoral Pulse-Wave Velocity with Real-Time Laser-Doppler Vibrometry

32.1 Beeckman S ¹, Badhwar S⁶, Bruno R⁶, Li Y^3,4, Aasmul S⁵, Madhu N², Segers P.¹

32.1.1 ¹Ghent University - BioMMedA/IBiTech, Ghent, Belgium, ²IDlab, Ghent University - imec, Ghent, Belgium, ³Photonics Research Group, Ghent University-imec, Ghent, Belgium, ⁴Center for Nano- and Biophotonics, Ghent, Belgium, ⁵Medtronic Bakken Research Center, Maastricht, The Netherlands, ⁶INSERM U970, Université Paris Cité, Paris, France.

Background: Arterial stiffness can be assessed via carotid–femoral pulse-wave velocity (cfPWV), a biomarker that can be reliably measured via, amongst others, laser-Doppler vibrometry (LDV) [1]. The aim of this study is to benchmark LDV measurements, acquired in an ongoing study, against reference techniques as the Sphygmocor system, thereby validating this technology.

Methods: 22 patients (ages 24–78) had their cfPWV measured during a clinical feasibility study using the CARDIS (H2020 grant ID: 644798) LDV device. A new software was installed providing real-time filters and signal quality feedback [2]. Each patient had 3 measurements taken. All measurements were inspected and graded visually with scores ranging from 1 (very bad) to 5 (perfect). Heartbeats were visually identified in the LDV signals to get as reliable pulse-transit times (PTTs) as possible. Resulting PTTs were compared to Sphygmocor values also measured for every patient.

Results: Good quality signals (scores 4–5) were obtained in 14/22 subjects. The mean difference in transit times between LDV and Sphygmocor was − 1.14 (± 6.83) ms, with a correlation coefficient of 0.91 (P < 0.05) (see Figure).

Conclusions: The data confirm that LDV potentially allows measuring cfPWV with an accuracy comparable to Sphygmocor, provided an adequate signal quality can be achieved. We are further improving real-time signal quality feedback and, importantly, working on a prototype that will no longer require the use of retroreflective patches in the neck and groin (INSIDE project, H2020 grant ID: 871547).

Figure 1 Legend

References

[1] Y. Li, L. Marais, H. Khettabet, al. Silicon photonics-based laser Doppler vibrometer array for carotid-femoral pulse wave velocity (PWV) measurement. Biomedical Optics Express. 11 (7), p.3913–3926. Published: June 22, 2020. https://doiorg.publicaciones.saludcastillayleon.es/10.1364/BOE.394921

[2] Seoni S, Beeckman S, Li Y, et al. Template Matching and Matrix Profile for Signal Quality Assessment of Carotid and Femoral Laser Doppler Vibrometer Signals. Front Physiol. 2022; 12:775052. Published 2022 Jan 11. https://doiorg.publicaciones.saludcastillayleon.es/10.3389/fphys.2021.775052

33 P07 Two-photon microscopy for imaging of RBCs aging and antiaging compound testing

33.1 Tsakanova G ¹, Ayvazyan V, Tatikyan S, Yeremyan A, Avagyan E, Harutyunyan K, Mnatsakanyan L, Sargsyan M, Ghazaryan M, Karapetyan M, Hovakimyan A, Arakelova E

33.1.1 ¹Institute of Molecular Biology NAS RA; ²CANDLE Synchrotron Research Institute, Yerevan, Armenia

Background: Using laser scanning two-photon microscopy technique, we demonstrate a novel approach for the investigation of oxidative stress in human living red blood cells (RBCs) that could efficiently be applied in clinical research and testing of antioxidant compounds.

Methods: In total, 60 healthy volunteers and 40 male Wistar rats were involved in this study. The albumen gland extract was used as a potential antiaging compound. Oxidant–antioxidant status was evaluated in the blood samples via spectrophotometric analysis, two-photon imaging and cell viability assays.

Results: Oxidative stress is clearly visible on the two-photon microscopy images of RBCs under oxidative stress compared to no fluorescence in controls (P < 0.0001). It significantly increases in RBCs by the increase of age (P < 0.05) and is in positive correlation with age (P < 0.001) and negative correlation (P < 0.05) with the activity of catalase in RBCs and ferroxidase activity of ceruloplasmin in plasma. The in vivo animal experiments showed a significant increase in the levels of catalase and superoxide dismutase in treated older adult rats. The ex vivo human studies demonstrated that the extract has no effect on cell viability, significantly increases the number of RBCs, and decreases age-related oxidative stress and the percentage of hemolysis of RBCs by aging.

Conclusions: We demonstrate that two-photon laser scanning imaging is a valuable tool for studying oxidative stress in living RBCs not only under oxidative stress-related different pathological conditions, including aging and radiation exposure on the organism but also in the studies of the effects of different natural or chemically synthesized compounds.

34 P10 Preliminary results of a VascAgeNet survey: knowledge and perceptions of the regulatory framework applied to medical devices for vascular ageing evaluation

34.1 Martina M ¹, Park C², Bruno R³, Climie R⁴, Dogan S⁵, Guvenc Tuna B⁶, Manouchehri M⁷, Panayiotou A⁸, Terentes-Printzios D⁹, Testa M¹⁰, Triantafyllou A¹¹, Mayer C¹², Bianchini E¹

34.1.1 ¹Institute Of Clinical Physiology - Italian National Research Council (cnr-ifc), Pisa, Italy, ²University College London (UCL), London, United Kingdom, ³Université Paris Cité, Inserm, PARCC, F-75015, Paris, France, ⁴Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia, ⁵Yeditepe University, School of Medicine, Department of Medical Biology,, Turkiye, ⁶Yeditepe University, School of Medicine, Department of Biophysics,, Turkiye, ⁷University of Complutense; School of Pharmacy; Department of Pharmacology, Pharmacognosy and Botany, Madrid, Spain, ⁸School of Health Sciences, Cyprus University of Technology, Limassol, Cyprus, ⁹First Department of Cardiology, National and Kapodistrian University of Athens, Medical School, Hippokration Hospital, Athens, Greece, ¹⁰Thema srl, Imola, Italy, ¹¹Aristotle University of Thessaloniki, Thessaloniki, Greece, ¹²AIT Austrian Institute of Technology GmbH, Center for Health & Bioresources, Medical Signal Analysis, Vienna, Austria

Background: Regulation has a key role for the development of medical technologies throughout their lifecycle since it is aimed to guarantee effectiveness and safety for users (1). Requirements of the Regulation (EU) 2017/745 on medical devices (MDR) impact on novel and previously approved systems (2) (3). Identification of needs related to key stakeholders (clinicians, researchers, companies) can be helpful for an effective implementation of MDR in design, development and adoption of medical devices, improving the translation in clinical practice of vascular ageing assessment for the society benefit.

Methods: A survey was developed by a dedicated VascAgeNet team and distributed within the community by EUSurvey platform to explore knowledge and perceptions of the medical device regulatory framework for vascular ageing assessment.

Results: Results were derived from 100 participants (27% clinicians, 62% researchers, and 11% industry employees) and evidenced mostly a fair knowledge of the MDR (despite self-judged as poor by 51%). Safety (83%), validation (56%), and risk management (50%) were considered relevant and strongly associated with the regulatory process. Structured support and regulatory procedures connected with medical devices in the daily work are lacking (only in 33% of the cases, a regulatory department is available).

Conclusions: Regulation was recognized as relevant by the stakeholders in VascAgeNet community, raising awareness about needs for training in medical device regulatory sciences, as recently reported. (4) Initiatives to support the regulatory sector are not yet easily available and would be appreciated from the scientific community. The survey was developed by the COST Action CA18216, VascAgeNet supported by COST (http://www.cost.eu).

References

1. Bianchini E, Mayer CC. Medical Device Regulation: Should We Care About It? Artery Res. 2022;28 (2):55–60. https://doiorg.publicaciones.saludcastillayleon.es/10.1007/s44200-022-00014-0. Epub 2022 Mar 31. PMID: 35378951; PMCID: PMC8968778.

2. Fraser AG, Byrne RA, Kautzner J, Butchart EG, Szymański P, Leggeri I, de Boer RA, Caiani EG, Van de Werf F, Vardas PE, Badimon L. Implementing the new European Regulations on medical devices-clinical responsibilities for evidence-based practice: a report from the Regulatory Affairs Committee of the European Society of Cardiology. Eur Heart J. 2020 Jul 14;41 (27):2589–2596. https://doiorg.publicaciones.saludcastillayleon.es/10.1093/eurheartj/ehaa382. PMID: 32484542.

3. Mayer CC, Francesconi M, Grandi C, Mozos I, Tagliaferri S, Terentes-Printzios D, Testa M, Pucci G, Bianchini E. Regulatory Requirements For Medical Devices And Vascular Ageing: An Overview. Heart Lung Circ. 2021 Nov;30 (11):1658–1666. https://doiorg.publicaciones.saludcastillayleon.es/10.1016/j.hlc.2021.06.517. Epub 2021 Aug 3. PMID: 34362673.

4. Perceived training needs of regulators, Notified Bodies and clinicians for successful implementation of the EU MDR: survey results. J Med Device Regul. 2023; (May). Available from: https://globalregulatorypress.com/product/perceived-training-needs-of-regulators-notified-bodies-and-clinicians-for-successful-implementation-of-the-eu-mdr-survey-results/

35 P11 Shorter sleep duration is associated with increased aortic stiffness in older women and younger men from the general population

35.1 Johansson M ¹, Nilsson P¹

35.1.1 ¹Lund University, Malmo, Sweden

Background: Short sleep duration predicts increased risk of incident cardiovascular disease and mortality [1, 2]. The relationship between sleeping habits and aortic stiffness as a risk marker remains largely unexplored in the European general population [3, 4].

Methods: We included 3429 subjects from a north-European population-based cohort (mean age 42 ± 1 years, 53.3% women). Data on self-reported sleeping habits were collected. Aortic stiffness was assessed in all subjects by carotid–femoral pulse wave velocity (c–f PWV, Sphygmocor^®), and 24-h aortic PWV (arteriograph) (n = 1322). Linear regression was stratified by sex and age, and adjusted for systolic blood pressure, heart rate and BMI.

Results: Study characteristics are shown in Table. Figures 1 and 2 illustrate the distribution of PWV in relation to sleep duration. Both daytime and nighttime 24 h aortic PWV was significantly higher in women > 50 years who slept ≤ 6 versus ≥ 7 h (daytime β 0.38 m/s, p = 0.003 and nighttime β 0.37 m/s, p = 0.011). On the contrary, c–f PWV was significantly higher in men ≤ 50 years who slept ≤ 6 versus ≥ 7 h (c–f PWV β 0.28, p < 0.001). Increased c–f PWV was also significantly linked to poor versus good sleep quality in women > 50 years (c–f PWV β 0.27, p = 0.04). No differences were observed in the remaining groups.

Conclusions: Shorter sleep duration ≤ 6 h is associated with increased aortic stiffness in older women and younger men from the general population. Higher aortic stiffness is also linked to poor sleep quality in women > 50 years. Further studies are warranted to elucidate the long-term role of shorter sleep duration on developing aortic stiffness.

Figure Legend

References

1. Cappuccio FP, Cooper D, D'Elia L, Strazzullo P, Miller MA. Sleep duration predicts cardiovascular outcomes: a systematic review and meta-analysis of prospective studies. Eur Heart J. 2011 Jun;32 (12):1484–92. https://doiorg.publicaciones.saludcastillayleon.es/10.1093/eurheartj/ehr007. Epub 2011 Feb 7. PMID: 21300732.

2. Cui H, Xu R, Wan Y, Ling Y, Jiang Y, Wu Y, Guan Y, Zhao Q, Zhao G, Zaid M. Relationship of sleep duration with incident cardiovascular outcomes: a prospective study of 33,883 adults in a general population. BMC Public Health. 2023 Jan 18;23 (1):124. https://doiorg.publicaciones.saludcastillayleon.es/10.1186/s12889-023-15042-x. PMID: 36653782; PMCID: PMC9847128.

3. Hu H, Li H, Huang X, Bao H, Song Y, Wang B, Liu C, Xu R, Liu L, Wang X, Huo Y, Xu X, Cheng X, Qin X, Li P. Association of self-reported sleep duration and quality with BaPWV levels in hypertensive patients. Hypertens Res. 2020 Dec;43 (12):1392–1402. https://doiorg.publicaciones.saludcastillayleon.es/10.1038/s41440-020-0509-y. Epub 2020 Jul 16. PMID: 32678321; PMCID: PMC7671938.

4. Liu X, Song Q, Wu S, Wang X. Long sleep duration and risk of increased arterial stiffness in a Chinese population. Medicine (Baltimore). 2020 Sep 4;99 (36):e22073. https://doiorg.publicaciones.saludcastillayleon.es/10.1097/MD.0000000000022073. PMID: 32899076; PMCID: PMC7478423.

36 P12 Decoding the effect of social gradient and area indicators on arterial health: Preliminary data from the DEpICT Study

36.1 Photiou G ¹, Middleton N², Panagiotakos D³, Panayiotou A¹

36.1.1 ¹Cyprus International Institute for Environmental and Public Health, School of Health Sciences, Cyprus University of Technology, Limassol, Cyprus, Paphos, Cyprus, ²Department of Nursing, Cyprus University of Technology, Limassol, Cyprus, Limassol, Cyprus, ³Department of Nutrition and Dietetics, Harokopio University, Athens, Greece., Athens, Greece

Background: Arterial stiffness, as measured by pulse wave velocity (cfPWV), is a robust indicator of arterial health as well as CVD events and all-cause mortality in the general population. Socioeconomic status (SES) as well as local environmental and other social health indicators could affect cardiovascular risk.

Methods: Participants were older than 40 years old, of Greek-Cypriot origin and living in the same neighbourhood in Limassol for at least the past 5 years. Individual-level data include self-reported information on quality of life (SF-12) (2), physical activity (IPAQ) (3), adherence to the Mediterranean diet and general health and well-being (GHQ-12). Arterial health is measured as pulse wave velocity (cfPVW) and central pulse pressure (Complior Analyse, ALAM Medical).

Results: Preliminary results are reported for the first 202 participants (54% male; mean age: 55.49 ± 8.76). Mean cfPWV was 8.52 m/s ± 1.66 and mean cPP was 34.03 ± 12.73. Systolic and diastolic blood pressure and heart rate were 117.07 ± 16.39, 74.82 ± 10.54 and 69.78 ± 10.14, respectively. When asked to self-rate their health, 50.5% rated it in the excellent/very good category and 49.5% in the average/good. Mean MedDietScore was 30.81 ± 5.13 which is considered average adherence to the Mediterranean diet. Age was significantly associated with both cfPWV and cPP, as well as MedDietScore (p < 0.001 for all), while sex was only associated with cfPWV (p < 0.001).

References

1. Vlachopoulos C, Aznaouridis K, Stefanadis C. Prediction of cardiovascular events and all-cause mortality with arterial stiffness: a systematic review and meta-analysis. J Am Coll Cardiol. 2010 Mar 30;55 (13):1318–27. https://doiorg.publicaciones.saludcastillayleon.es/10.1016/j.jacc.2009.10.061. PMID: 20338492.

2. Failde I, Medina P, Ramirez C, Arana R. Construct and criterion validity of the SF-12 health questionnaire in patients with acute myocardial infarction and unstable angina. J Eval Clin Pract. 2010 Jun;16 (3):569–73. https://doiorg.publicaciones.saludcastillayleon.es/10.1111/j.1365-2753.2009.01161.x. Epub 2010 Apr 21. PMID: 20438603.

3. Papathanasiou G, Georgoudis G, Papandreou M, Spyropoulos P, Georgakopoulos D, Kalfakakou V, Evangelou A. Reliability measures of the short International Physical Activity Questionnaire (IPAQ) in Greek young adults. Hellenic J Cardiol. 2009 Jul-Aug;50 (4):283–94. PMID: 19622498.

37 P13 Supervised home-based high intensity interval training on an all-extremity non-weight-bearing ergometer improves wave reflection in healthy older adults

37.1 Christou D ¹, Lapierre-Nguyen S¹, Kim J¹, Soonhuae C¹, Riesco E², Sakarya Y¹, Handberg E¹, Leach D¹, Nichols W¹

37.1.1 ¹University of Florida, Gainesville, United States, ²University of Sherbrooke, Sherbrooke, Canada

Background: Aging is associated with stiffening of large elastic arteries resulting in early wave reflection, which increases aortic systolic blood pressure (BP) and left ventricular afterload. These age-related alterations predispose older adults to cardiovascular disease (CVD). Endurance training is recommended for reducing CVD risk. We have recently developed a supervised home-based exercise intervention using high intensity interval training (HIIT) on an all-extremity non-weight-bearing ergometer (ANE; HIIT-ANE). The purpose of this study was to evaluate the effect of 8 weeks of home-based HIIT-ANE on aortic hemodynamics in older adults.

Methods: Twenty healthy sedentary older adults participated in this study (age: 66 ± 1, means ± SE). HIIT-ANE was remotely delivered at home under supervision via video conferencing (Zoom) and live heart rate monitoring (Zephyr OmniSense). Aortic wave characteristics were assessed using wave separation analysis (SphygmoCor XCEL): (1) at baseline; (2) after 8 weeks of normal lifestyle (control); and (3) after 8 weeks of home-based HIIT-ANE.

Results: Wave reflection—assessed as augmentation index—improved in response to HIIT-ANE but remained unchanged in response to the control (effect of time: P < 0.001; pre- vs. post-HIIT-ANE: 31.6 ± 2.1 vs. 25.9 ± 1.7%, P < 0.001 and pre- vs. post-control: 31.3 ± 2.0 vs. 31.6 ± 2.1%, P = 1.0). Aortic systolic and diastolic BP and pulse pressure did not significantly change (effect of time: P ≥ 0.1).

Conclusions: Supervised HIIT-ANE, remotely delivered at home, improved wave reflection but did not influence central and peripheral blood pressures. Our exercise intervention merits further investigation in a full-size randomized controlled trial.

This work was supported by the National Institutes of Health grant AG063143.

38 P14 Acute Effects of Exercise Modes on Arterial Stiffness and Cardiac Autonomic Function in Healthy Young and Middle-Aged Adults

38.1 Lopes A ^1,2, Coelho R^1,2, Simão B^1,2, Oliveira I^1,3, Marôco J⁴, Laranjo S^5,6, Santa-Clara H^1,2, Melo X⁷

38.1.1 ¹1.Ginásio Clube Português, Research & Development Department, GCP Lab, Lisboa, Portugal, 2.Centro Interdisciplinar de Estudo da Performance Humana, Faculdade de Motricidade Humana – Universidade de Lisboa, Oeiras, Portugal, Lisbon, Oeiras, Portugal, ²1.Ginásio Clube Português, Research & Development Department, GCP Lab, Lisboa, Portugal 2.Centro Interdisciplinar de Estudo da Performance Humana, Faculdade de Motricidade Humana – Universidade de Lisboa, Oeiras, Portugal, Lisbon, Oeiras, Portugal, ³1.Ginásio Clube Português, Research & Development Department, GCP Lab, Lisboa, Portugal 2.Centro Interdisciplinar de Estudo da Performance Humana, Faculdade de Motricidade Humana – Universidade de Lisboa, Oeiras, Portugal, Lisbon, Oeiras, Portugal, ⁴1.Ginásio Clube Português, Research & Development Department, GCP Lab, Lisboa, Portugal, 3.Faculdade de Ciências da Saúde e do Desporto, Universidade Europeia, Lisboa, Portugal, Lisbon, Portugal, ⁵4.Exercise and Health Sciences Department, University of Massachusetts Boston, Boston, Massachusetts, United States, Boston, Massachusetts, United States, ⁶5.Department of Physiology, NOVA Medical School|Faculdade de Ciências Médicas da Universidade Nova de Lisboa, Lisboa, Portugal, 2.Comprehensive Health Research Center, Universidade NOVA de Lisboa, Lisboa, Portugal, Lisbon, Portugal, ⁷1.Ginásio Clube Português, Research & Development Department, GCP Lab, Lisboa, Portugal 2.Centro Interdisciplinar de Estudo da Performance Humana, Faculdade de Motricidade Humana – Universidade de Lisboa, Oeiras, Portugal, Lisbon, Oeiras, Portugal, ⁸7.Centro de Investigação Interdisciplinar Egas Moniz (CiiEM), Egas Moniz School of Health and Science, Caparica, 2829-511 Almada, Portugal., Almada, Portugal

The acute effects of exercise on arterial stiffness (AS) (1), heart rate variability (HRV) (2), and baroreflex sensitivity (BRS) (3) have been studied in laboratory models of aerobic, resistance and combined exercise (4, 5, 6). However, the transferability of these findings to ecological exercise settings, such as group fitness classes, remains unclear (7, 8). The aim of this study was to compare the post-exercise parasympathetic reactivation of the heart (continuous heart rate and blood pressure monitoring) and changes in local (ultrasound) and regional (applanation tonometry) arterial stiffness (AS) between the different fitness classes in ecological exercise settings. Twenty-four participants, including young and middle-aged adults, attended four 45-min intervention sessions consisting of group fitness classes (bike, pump power, and global training) or no exercise (Control). Assessments of AS, HRV, and BRS were conducted before and after exercise (10-, 20-, and 30-min intervals). Central pulse wave velocity (PWV) increased immediately following the group fitness classes in both age groups (9, 10, 11), while peripheral PWV did not change (12). Local PWV-β was higher in middle-aged adults (13) compared to the control condition, but no changes were observed after specific fitness classes (10, 11, 14). HRV was significantly reduced 10 min after the group fitness classes (15, 16), and BRS decreased immediately following all classes (17, 18). These findings indicate that post-exercise responses varied depending on age 12, anatomical segments (19), and time measurements (20), but not the modality of exercise (21). The results suggest that the acute effects of exercise on AS, blood pressure, and the autonomic nervous system observed in laboratory models may not directly translate to more ecological exercise settings.

References

1. Heffernan KS, Collier SR, Kelly EE, Jae SY, Fernhall B. Arterial stiffness and baroreflex sensitivity following bouts of aerobic and resistance exercise. Int J Sports Med. 2007 Mar;28 (3):197–203. https://doiorg.publicaciones.saludcastillayleon.es/10.1055/s-2006-924290. Epub 2006 Oct 6. PMID: 17024636.

2. Pollock ML, Gaesser G, Butcher J, Després JP et al. (1998). ACSM Position Stand: The Recommended Quantity and Quality of Exercise for Developing and Maintaining Cardiorespiratory and Muscular Fitness, and Flexibility in Healthy Adults. Medicine & Science in Sports & Exercise. 30. 975–991. https://doiorg.publicaciones.saludcastillayleon.es/10.1097/00005768-199806000-00032.

3. Kaikkonen P, Rusko H, Martinmäki K. Post-exercise heart rate variability of endurance athletes after different high-intensity exercise interventions. Scand J Med Sci Sports. 2008 Aug;18 (4):511–9. https://doiorg.publicaciones.saludcastillayleon.es/10.1111/j.1600-0838.2007.00728.x. Epub 2007 Dec 7. PMID: 18067516.

4. Mendonca GV, Heffernan KS, Rossow L, Guerra M, Pereira FD, Fernhall B. Sex differences in linear and nonlinear heart rate variability during early recovery from supramaximal exercise. Appl Physiol Nutr Metab. 2010 Aug;35 (4):439–46. https://doiorg.publicaciones.saludcastillayleon.es/10.1139/H10-028. PMID: 20725109.

5. Billman GE. Heart rate variability—a historical perspective. Front Physiol. 2011 Nov 29;2:86. https://doiorg.publicaciones.saludcastillayleon.es/10.3389/fphys.2011.00086. PMID: 22144961; PMCID: PMC3225923.

6. Dong JG. The role of heart rate variability in sports physiology. Exp Ther Med. 2016 May;11 (5):1531–1536. https://doiorg.publicaciones.saludcastillayleon.es/10.3892/etm.2016.3104. Epub 2016 Feb 23. PMID: 27168768; PMCID: PMC4840584.

7. Riebe, D. et al. ACSM’s Guidelines for exercise testing and prescription. Tenth edition, 2018. Wolters Kluver. ISBN 13:978-1-4963–3907-2.

8. Leicht AS, Sinclair WH, Spinks WL. Effect of exercise mode on heart rate variability during steady state exercise. Eur J Appl Physiol. 2008 Jan;102 (2):195–204. https://doiorg.publicaciones.saludcastillayleon.es/10.1007/s00421-007-0574-9. Epub 2007 Oct 6. PMID: 17922138.

9. Gkaliagkousi E, Gavriilaki E, Nikolaidou B, Triantafyllou G, Douma S. Exercise-induced pulse wave velocity changes in untreated patients with essential hypertension: the effect of an angiotensin receptor antagonist. J Clin Hypertens (Greenwich). 2014 Jul;16 (7):482–7. https://doiorg.publicaciones.saludcastillayleon.es/10.1111/jch.12340. Epub 2014 May 22. PMID: 24853292; PMCID: PMC8031989.

10. Heffernan KS, Jae SY, Edwards DG, Kelly EE, Fernhall B. Arterial stiffness following repeated Valsalva maneuvers and resistance exercise in young men. Appl Physiol Nutr Metab. 2007 Apr;32 (2):257–64. https://doiorg.publicaciones.saludcastillayleon.es/10.1139/h06-107. PMID: 17486167.

11. Collier SR, Kanaley JA, Carhart R Jr, Frechette V, Tobin MM, Hall AK, Luckenbaugh AN, Fernhall B. Effect of 4 weeks of aerobic or resistance exercise training on arterial stiffness, blood flow and blood pressure in pre- and stage-1 hypertensives. J Hum Hypertens. 2008 Oct;22 (10):678–86. https://doiorg.publicaciones.saludcastillayleon.es/10.1038/jhh.2008.36. PMID: 18432253.

12. Trachsel Y, Herzig D, Marcin T, Zenger N, Dysli M, Trachsel LD, Wilhelm M, Eser P. Response of peripheral arterial pulse wave velocity to acute exercise in patients after recent myocardial infarction and healthy controls. PLoS One. 2019 Jul 9;14 (7):e0219146. https://doiorg.publicaciones.saludcastillayleon.es/10.1371/journal.pone.0219146. PMID: 31287825; PMCID: PMC6615613.

13. Babcock MC, Lefferts WK, Hughes WE, Fitzgerald KL, Leyer BK, Redmond JG, Heffernan KS. Acute effect of high-intensity cycling exercise on carotid artery hemodynamic pulsatility. Eur J Appl Physiol. 2015 May;115 (5):1037–45. https://doiorg.publicaciones.saludcastillayleon.es/10.1007/s00421-014-3084-6. Epub 2014 Dec 28. PMID: 25543325.

14. Rosenberg AJ, Schroeder EC, Grigoriadis G, Wee SO, Bunsawat K, Heffernan KS, Fernhall B, Baynard T. Aging reduces cerebral blood flow regulation following an acute hypertensive stimulus. J Appl Physiol (1985). 2020 May 1;128 (5):1186–1195. https://doiorg.publicaciones.saludcastillayleon.es/10.1152/japplphysiol.00137.2019. Epub 2020 Apr 2. PMID: 32240012.

15. Gladwell VF, Sandercock GR, Birch SL. Cardiac vagal activity following three intensities of exercise in humans. Clin Physiol Funct Imaging. 2010 Jan;30 (1):17–22. https://doiorg.publicaciones.saludcastillayleon.es/10.1111/j.1475-097X.2009.00899.x. Epub 2009 Sep 10. PMID: 19744086.

16. Terziotti P, Schena F, Gulli G, Cevese A. Post-exercise recovery of autonomic cardiovascular control: a study by spectrum and cross-spectrum analysis in humans. Eur J Appl Physiol. 2001 Mar;84 (3):187–94. https://doiorg.publicaciones.saludcastillayleon.es/10.1007/s004210170003. PMID: 11320634.

17. Grossman P, Taylor EW. Toward understanding respiratory sinus arrhythmia: relations to cardiac vagal tone, evolution and biobehavioral functions. Biol Psychol. 2007 Feb;74 (2):263–85. https://doiorg.publicaciones.saludcastillayleon.es/10.1016/j.biopsycho.2005.11.014. Epub 2006 Nov 1. PMID: 17081672.

18. Laborde S, Mosley E, Thayer JF. Heart Rate Variability and Cardiac Vagal Tone in Psychophysiological Research—Recommendations for Experiment Planning, Data Analysis, and Data Reporting. Front Psychol. 2017 Feb 20;8:213. https://doiorg.publicaciones.saludcastillayleon.es/10.3389/fpsyg.2017.00213. PMID: 28265249; PMCID: PMC5316555.

19. Kingsley JD, Figueroa A. Acute and training effects of resistance exercise on heart rate variability. Clin Physiol Funct Imaging. 2016 May;36 (3):179–87. https://doiorg.publicaciones.saludcastillayleon.es/10.1111/cpf.12223. Epub 2014 Dec 18. PMID: 25524332.

20. Kingwell BA, Berry KL, Cameron JD, Jennings GL, Dart AM. Arterial compliance increases after moderate-intensity cycling. Am J Physiol. 1997 Nov;273 (5):H2186–91. https://doiorg.publicaciones.saludcastillayleon.es/10.1152/ajpheart.1997.273.5.H2186. PMID: 9374752.

21. Michael S, Jay O, Halaki M, Graham K, Davis GM. Submaximal exercise intensity modulates acute post-exercise heart rate variability. Eur J Appl Physiol. 2016 Apr;116 (4):697–706. https://doiorg.publicaciones.saludcastillayleon.es/10.1007/s00421-016-3327-9. Epub 2016 Jan 18. PMID: 26781711.

39 P15 Evaluation of the Age-Dependence of Conventional and Novel Photoplethysmography Parameters for the Identification of New Cardiovascular Aging Indicators

39.1 Antali F ¹, Kulin D¹, Kulin S², Miklós Z³

39.1.1 ¹Semmelweis University, Institute Of Translational Medicine, Budapest, Hungary, ²E-Med4All Europe Ltd., Budapest, Hungary, ³National Korányi Institute for Pulmonology, Budapest, Hungary

Cardiovascular (CV) mortality increases with age partly due to physiological ageing of the CV system. Early vascular ageing raises CV risks. Personalizing risk assessment by defining CV age could reduce CV events (1). Photoplethysmography (PPG), analyzing the peripheral arterial pulse wave may be an effective method for estimating CV age. Ageing index and some other PPG parameters were proven to have age correlation; however, the age dependence of many other pulse wave parameters remains unclear (2). We aimed to identify age correlations of PPG indices and pulse rate variability (PRV) parameters including few novel parameters which were calculated to further investigate the various aspects of CV ageing.

Our study included 118 healthy (M/F: 53/65, mean age: 31.76 ± 11.82SD) volunteers for PPG parameter calculation and 106 (M/F:44/62, mean age: 32.64 ± 12.16SD) for PRV parameter calculation (age: 19–74 years). 2-min pulse wave recording was obtained using a pulse oximeter. A proprietary software (E-Med4All Europe Ltd., Budapest, Hungary) evaluated PPG and PRV parameter (3, 4) values, which were compared with age (Pearson’s and Spearman’s correlation).

PPG parameters describing cardiac ejection time positively correlated with age, while those indicating arterial elasticity showed negative correlation. Composite PPG parameters proposed as indicators of CV health and fitness had negative correlation (p < 0.001, IrI > 0.4) Most PRV parameters exhibited negative correlation, indicating reduced adaptive capacity due to ageing (p < 0.05, IrI > 0.3).

PPG-based pulse waveform analysis provides a wide range of age-related parameters, making it a promising method for estimating cardiovascular age. Future studies will include subjects with vascular ageing conditions beyond physiological values (hypertension, heart failure, and coronary artery disease).

References

1. Bruno, R. M. et al. Early and Supernormal Vascular Aging: Clinical Characteristics and Association With Incident Cardiovascular Events. Hypertension 76, 1616–1624 (2020).

2. Charlton, P. H. et al. Assessing hemodynamics from the photoplethysmogram to gain insights into vascular age: a review from VascAgeNet. American Journal of Physiology—Heart and Circulatory Physiology 322, H493–H522 (2022).

3. Kulin, D. et al. Preclinical, multi-aspect assessment of the reliability of a photoplethysmography-based telemonitoring system to track cardiovascular status. Applied Sciences (Switzerland) 10, 1–17 (2020).

4. Antali, F. et al. Multimodal assessment of the pulse rate variability analysis module of a photoplethysmography-based telemedicine system. Sensors 21, (2021).

40 P16 Differences between SCORE and Framingham Risk Score-based vascular age calculation methods based on data from the Three Generations Health Program in Hungary

40.1 Nemcsik J ¹, Gyöngyösi H¹, Szőllősi G^2,3, Csenteri O², Jancsó Z², Móczár C¹, Torzsa P¹, Andréka P², Vajer P²

40.1.1 ¹Semmelweis University, Department of Family Medicine, Budapest, Hungary, ²Gottsegen National Cardiovascular Center, Budapest, Hungary, ³Department of Health Informatics, Faculty of Health Sciences, University of Debrecen, Debrecen, Hungary

Full article previously published

41 P19 Maximal exercise testing unmasks exaggerated systolic blood pressure response independent from reduced fibrinolytic response in black but not white postmenopausal females

41.1 Marôco J ¹, Szymanski L², Baynard T¹, Fernhall B¹

41.1.1 ¹Integrative Human Physiology Laboratory, Manning College of Nursing & Health Sciences, University of Massachusetts Boston, Boston, MA, USA, Boston, United States, ²Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Mayo Clinic College of Medicine, Rochester, Minnesota, USA, Rochester, United States

Background: Exercise testing unmasks more exaggerated systolic blood pressure responses (SBP) in black compared to white male adults. Such exaggerated responses, if translatable to females, may detect racial disparities particularly relevant during menopause. Racial differences have been reported for fibrinolytic potential and given the endothelium involvement in BP regulation, and as a source of fibrinolytic markers, it follows that fibrinolytic and BP response to exercise could be linked. Thus, we examined BP and fibrinolytic responses to exercise testing in black and white postmenopausal females.

Methods: Postmenopausal females (blacks = 40; whites = 41; 47–70 years) performed maximal treadmill exercise. BP and blood draws were conducted before and immediately after exercise. Plasma samples, using minimal stasis, were analyzed for tissue plasminogen activator (tPA) and plasminogen activator inhibitor 1 (PAI-1) activity and antigen, respectively.

Results: Resting SBP and fibrinolytic potential were similar between black and white females (figure). Black females exhibited greater increases in SBP during exercise (change = 75, 95% CI: 64–86 mmHg, p < 0.001) than white females (change = 60, 95% CI: 48–71 mmHg, p < 0.001). Black compared to white females had smaller changes in tPA and PAI-1 activities after exercise (figure). SBP exercise-induced changes were dissociated from those of tPA (r = − 0.10, p = 0.42) or PAI-1 (r = 0.13, p = 0.30), even by race (p > 0.05). Results were unaffected controlling for fitness and BMI.

Conclusions: Exercise testing revealed exaggerated SBP responses independent from smaller fibrinolytic responses in black postmenopausal females. Our findings show that maximal exercise can unmask potential risk factors for cardiovascular disease in black females not evident at rest.

Figure Legend

42 P20 Association between affective temperaments and short-term blood pressure variability

42.1 Gyöngyösi H ¹, Kőrösi B¹, Batta D¹, Gonda X², Rihmer Z², Nemcsik-Bencze Z³, László A⁴, Nemcsik J¹

42.1.1 ¹Semmelweis University, Department of Family Medicine, Budapest, Hungary, ²Semmelweis University, Department of Psychiatry and Psychotherapy, Budapest, Hungary, ³Semmelweis University, Department of Neuroradiology, Medical Imaging Centre, Budapest, Hungary, ⁴GP practice Jula/Schindler, Nuremberg, Germany

Background: Affective temperaments (depressive, anxious, cyclothymic, irritable and hyperthymic) have important role in psychopathology. Previously cyclothymic temperament was associated with different hypertensive conditions, while irritable temperament correlated with nighttime peripheral and central systolic blood pressure in men. The aim of this study was to evaluate the association between affective temperaments and short-term peripheral blood pressure variability in untreated patients who were studied because of elevated office blood pressure.

Methods: The oscillometric Mobil-O-Graph was used to measure the 24-h peripheral and central blood pressure. Weighted systolic (wSBPv) and diastolic blood pressure variabilities (wDBPv) were calculated. Affective temperaments were evaluated with Temperament Evaluation of Memphis, Pisa, Paris and San Diego Autoquestionnaire.

Results: Seventy-three patients were involved to this study (45 men, 28 women). No significant correlations were found between affective temperaments and wSBPv and wDBPv neither in the whole population, nor in men or women separately. However, cyclothymic temperament tended to correlate with wSBPv both in the total population (r = 0.176, p = 0.136) or in women (r = 0.268, p = 0.169). Similarly, there has been a tendency to correlation between cyclothymic temperament with wDBPv in the total population (r = 0.149, p = 0.209) or in women separately (r = 0.224, p = 0.252), respectively.

Conclusion: There has been a tendency of association between cyclothymic temperament and wSBPv and wDBPv in the total population, especially in women. As the number of the involved women was low, more extended study is needed to clarify possible associations between affective temperaments and BP variability.

43 P21 Causal associations between pulse pressure and target organ damage: a Mendelian randomization study

43.1 Dib M ¹, Zagkos L², Meena D², Azzo J¹, Salman O¹, Gan S¹, Kun S¹, Pourmussa B¹, Tzoulaki I², Gill D², Burgess S^3,4, Chirinos J¹

43.1.1 ¹University of Pennsylvania Perelman School of Medicine, Philadelphia, United States, ²Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, United Kingdom, ³MRC Integrative Epidemiology Unit, University of Bristol, Bristol, United Kingdom, ⁴Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom

Background: Large-artery stiffness (LAS) leads to an increased pulse pressure (PP) and is thought to induce target organ damage (TOD) (1). However, causal associations of PP have not been unequivocally assessed in humans. Mendelian randomization (MR) can assess causal associations between exposures and outcomes of interest (2). We investigated bi-directional causal associations between elevated PP and TOD phenotypes using MR.

Methods: Genetic association estimates from independent cohorts (N = 33,000–1.1 million participants) were used for MR analyses. PP was examined for bidirectional causal associations with left ventricular mass (LVM), myocardial interstitial fibrosis, heart failure (HF), chronic kidney disease (CKD), cognitive performance, brain white matter hyperintensities (WMH), type 2 diabetes (T2D) and preeclampsia (PE).

Results: A 10-mmHg increase in genetically predicted PP was associated with higher odds of HF [Odds ratio (OR) = 1.113, 95% confidence interval = 1.085–1.137], CKD [1.075, 1.048–1.103), and T2D [1.137, 1.102–1.173]. Similarly, a 10-mmHg increase in genetically predicted PP was associated with greater PE risk [1.435, 1.256–1.638] and greater LVM [β = 3.527 g/m², 3.026–4.028]. The association of genetically predicted PP on risk of HF, CKD and T2D was independent of genetically predicted mean arterial pressure. Bidirectional MR also supported a causal effect of T2D (β = 0.527 mmHg, 0.396–0.658) and PE (β = 2.365 mmHg, 0.783–3.947) on PP.

Conclusions: We provide evidence supporting causal associations between PP and T2D, CKD, HF and increased risk of LV hypertrophy in humans, consistent with the deleterious effects of LAS on LV afterload and on microvascular integrity in low-resistance target organs. Early interventions aimed at lowering LAS may reduce the risk of adverse outcomes.

Figure 1 Legend

References

1. Chirinos JA, Segers P, Hughes T, Townsend R. Large-artery stiffness in health and disease: JACC state-of-the-art review. Journal of the American College of Cardiology. 2019;74 (9):1237–63.

2. Davey Smith G, Hemani G. Mendelian randomization: genetic anchors for causal inference in epidemiological studies. Human Molecular Genetics. 2014;23 (R1): R89-R98.

44 P22 Kidney function in subclinical atherosclerosis: the Malmö Diet Cancer study

44.1 Lundbergs R¹, Bimer Annel N¹, Nilsson P², Laucyte-Cibulskiene A ^2,3

44.1.1 ¹Faculty of Medicine, Lund University, Lund, Sweden, ²Department of Clinical Sciences, Lund University, Malmö, Sweden, ³Department of Nephrology, Lund University, Malmö, Sweden

Background: Kidney function is important for ensuring healthy vascular aging. However, a decline in glomerular filtration (eGFR) hastens vascular changes such as atherosclerosis that could be measured as carotid intima-media thickness (IMT). We aimed to access how eGFR is related to subclinical atherosclerosis measured as IMT in the common carotid artery (IMTmeanCCA) and maximal IMT in the carotid bifurcation (IMTmaxBulb) in a population-based Swedish cohort.

Methods: 3082 individuals without diabetes or history of previous cardiovascular events that participated in the Malmö Diet Cancer cohort were analyzed. Mean age at baseline was 57.1 years, 60% women, 33.6% prevalent hypertension and mean BMI 25 kg/m². Kidney function was estimated by cystatin C (eGFRcys) and creatinine-based (eGFRcr) glomerular filtration equations (CAPA and LMrev formulas, respectively). For determining altered filtration, the eGFRcys/eGFRcr ratio was utilized. Ultrasound technique (ACUSON Seqouia, Acuson, Mountain View, CA) was used to measure IMTmeanCCA and IMTmaxBulb at baseline (n = 3082) and after mean follow-up of 16 years (n = 2000).

Results: In linear regression analyses adjusted for traditional cardiovascular risk factors, higher baseline eGFRcys was associated with lower baseline IMTmaxBulb (β = − 0.003; P = 0.009) but not IMTmeanCCA or follow-up measurements. Baseline eGFRcr could, however, only predict higher IMTmaxBulb after follow-up (β = 0.006, P = 0.002). eGFRcys/eGFRcr below sex-specific 25th percentile (< 0.69 in women and < 0.81 in men) was related to higher IMTmaxBulb at baseline and follow-up. However, this relationship disappeared after adjustment for lipid-lowering and antihypertensive medication.

Conclusions: A combination of different eGFR measurements improves the identification of subclinical atherosclerosis.

45 P23 Microvascular endothelial function is not associated with albuminuria in metabolic syndrome

45.1 Juceviciene A³, Ryliskyte L³, Badariene J³, Laucyte-Cibulskiene A ^1,2,3

45.1.1 ¹Department of Nephrology, Lund University, Malmö, Sweden, ²Department of Clinical Sciences, Lund University, Malmö, Sweden, ³Faculty of Medicine, Institute of Clinical Medicine, Vilnius University, Vilnius, Lithuania

Background: Metabolic syndrome (MetS) has been related to macro- and microvascular dysfunction (1), including a higher risk for chronic kidney disease. Microalbuminuria is not only a marker of kidney damage but also might reflect on endothelial function. Therefore, we have tried to analyze if microvascular endothelial function, evaluated by laser Doppler flowmetry, is related to albuminuria in Lithuanian high cardiovascular risk cohort.

Methods: 1401 middle-aged individuals (808 women, 623 men, estimated kidney function based on creatinine 30 ml/min/1.73 m² and higher, 20% with diabetes) who fulfilled NCEP-ATP III criteria for MetS and performed estimation of kidney function including measurement of urinary-albumin-to-creatinine ratio (UACR) have been selected. Laser Doppler flowmetry (PeriFlux System 5000, Perimed, Sweden) was utilized for microvascular endothelial function. Endothelial function was determined from the percentage change of flow from peak to the rest flow (PF-RF).

Results: PF-RF was not significantly correlated to UACR (r-Spearman − 0.05; p = 0.08). UACR was not normally distributed, median 0.62 mg/mmol; therefore, Gamma (identity) analysis was used to analyze the relationship to endothelial function. However, no association could be identified after adjustment for sex, age, diabetes, blood pressure, waist circumference, and kidney function.

Conclusions: In individuals with MetS, albuminuria failed to show a relationship to endothelial function raising a question of whether UACR underestimated albuminuria level due to higher creatinine excretion in the urine in overweight subjects or the use of antihypertensive/lipid-lowering medication that diminish these effects.

References

1. Czernichow, S., Greenfield, J., Galan, P. et al. Macrovascular and microvascular dysfunction in the metabolic syndrome. Hypertens Res 33, 293–297 (2010). https://doiorg.publicaciones.saludcastillayleon.es/10.1038/hr.2009.228

46 P24 Impact of postural change on arterial stiffness measurements in hemodialysis patients and its potential as a vascular stress test

46.1 Khataei S ^1,2, De Rico É^1,2, Tairi A^1,2, Fortier C^1,2, Agharazii M^1,2

46.1.1 ¹Chu De Québec Research Center, Hôtel-dieu De Québec Hospital, Québec, Canada, ²Division of Nephrology, Faculty of Medicine, Laval University, Québec, Canada

Background: Aortic stiffness, a risk factor for cardiovascular disease, is measured by carotid–femoral pulse wave velocity (PWV) in the supine position. It can be estimated by algorithms that integrate age and pulse wave profile parameters (ePWV). However, finger-to-toe PWV (ftPWV) has been proposed as a user-friendly substitute and can be obtained in the sitting position, giving us the opportunity to examine arterial wall properties in a dynamic manner. The aim is to study the impact of body position (supine vs sitting) on the ePWV and on the ftPWV in patients with end-stage kidney disease.

Methods: In a cross-sectional study involving adult hemodialysis patients, we performed vascular assessments in the supine and sitting positions. The ePWV was determined using the Mobil-o-graph and the ftPWV was measured using the pOpmètre. Three measures were obtained with each device in each position. Generalized estimated equations were then used to calculate the average of ePWV and ftPWV with respect to each position.

Results: In 81 patients (31 females), the average age was 66 ± 16 years and 53% were diabetic. The ePWV was 10.7 m/s (IC95%: 9.5–12.0 m/s) in the supine position and 10.7 m/s (IC95%: 9.4–12.0 m/s) in the sitting position. However, the ftPWV was 12.9 m/s (IC95%: 10.5–15.3 m/s) in the supine position and significantly increased to 18.9 m/s (IC95%: 15.9–21.9 m/s) in the sitting position.

Conclusion: There is a significant increase in the ftPWV which presents an intriguing opportunity to investigate whether a postural change can be used as a vascular stress test.

47 P25 Characterization of Hypercoagulability in Pulmonary Hypertensive Patients

47.1 Abd Al Rahim S ¹, Valentin S², Lagrange J¹, Louis H¹, Ahmed M¹, Regnault V¹, Lacolley P¹, Perrin J¹, Chaouat A²

47.1.1 ¹University Of Lorraine, Nancy, France, ²Department of Pneumology, CHRU Nancy, Nancy, France

Background: Hemostatic abnormalities and dysregulation of the coagulation cascade has long been recognized in the context of pulmonary arterial hypertension (PAH). Anatomopathological data suggest an in situ intra pulmonary thrombosis; however, mechanisms are little known.

Objective: To compare coagulation profile in whole blood and plasma samples, obtained from jugular veins and pulmonary arteries of patients having PAH.

Methods and Results: Blood samples were collected directly from the patients’ jugular vein and pulmonary artery during the initial right-heart catheterization performed at CHRU Nancy. In vitro clot formation was observed by total Thrombus-formation Analyser System (T-TAS) by perfusing whole blood through a Chip coated with collagen and tissue factor at high shear rate. We observed a different pattern of clot formation in patients treated with anticoagulants (prolonged occlusion time, lower thrombus formation). There was no difference in occlusion time, and thrombus formation between samples obtained from pulmonary artery and jugular vein. T-TAS parameters were similar in PAH patients and healthy volunteers. We also measured the thrombin generation in plasma using thrombography. Endogenous thrombin potential and the maximum amount of thrombin formed were higher in plasma of pulmonary artery compared to jugular vein (1497 ± 71.8 nM.min vs 1222 ± 172 nM.min). The results were coherent when comparing plasma-rich and plasma-poor platelets.

Conclusion: These preliminary results suggest a difference in clotting potential in patients having PAH. Our results also suggest a more favorable environment for thrombosis in the pulmonary arteries than in the jugular veins.

48 P26 Association between Intima-Media Thickness (IMT) measured by echotracking with cholesterol in naïve hypertensive patients

48.1 Rodilla E^1,2, Baba M ^3,4, Mozos I^3,5, Acámer S¹, Montalar Z¹, Fernández M¹, Mendizábal A¹, Jiménez I¹, Canales S¹, Belda A¹

48.1.1 ¹Hospital de Sagunto, Valencia, Spain, ²Universidad Cardenal Herrera-CEU Universities, Valencia, Spain, ³Center for Translational Research and Systems Medicine, "Victor Babes" Univerisity of Medicine and Pharmacy, Timisoara, Romania, ⁴Doctoral School Medicine-Pharmacy, "Victor Babes" University of Medicine and Pharmacy, Timisoara, Romania, ⁵Department of Functional Sciences-Pathophysiology, "Victor Babes" University of Medicine and Pharmacy, Timisoara, Romania

Background: According to 2023 ESH Guidelines for the Management of Arterial Hypertension, Carotid IMT (intima–media thickness), which is quantified by carotid ultrasound is considered a marker for the early stage of atherosclerosis. Our objective was to assess the predictive value of blood lipids to identifying patients who have increased values of carotid IMT.

Methods: Prospective, descriptive, cross-sectional study including all consecutive patients referred to a HTN Unit with suspected naïve HTN without prior pharmacological treatment. IMT was defined as the thickness of intimal and medial layers of the carotid artery assessed with Ultrasound Echotracking Esaote. Standard clinical tests were performed.

Results: Since 2010, 512 consecutive patients entered the study, with 284 women (55.5%), 228 men (44.5%), a mean age of 49.6 years (± 11.9), mean office BP of 131/77 (± 15/10) mmHg, and ambulatory BP of 125/80 (± 10/8) mmHg. The values of the blood lipids were: Col 190 (± 35) mg/dl, LDL-c 109 (± 32) mg/dl, HDL-c 59 (± 16)mg/dl, TG 110 (± 56) mg/dl, non-HDL-c 131 (± 35) mg/dl, ApoAI 161 (± 30) mg/dl, ApoB 97 (± 23) mg/dl, and ApoB/ApoAI 0.6 (± 0.2). In multivariate analysis, IMT adjusted for age, sex, blood pressure and tobacco is directly correlated with ApoB/ApoA-I and is inversely correlated with LDL, only when calculated together with ApoB/ApoA-I, in newly diagnosed hypertensive patients with office systolic blood pressure and 24 h ABPM systolic blood pressure.

Conclusions: ApoB/apoAI is an effective predictor of subclinical atherosclerosis even in the presence of low LDL in newly diagnosed naïve hypertensive patients without prior pharmacological treatment.

References

Mancia Chairperson G, Kreutz Co-Chair R, et al. Authors/Task Force Members:. 2023 ESH Guidelines for the management of arterial hypertension The Task Force for the management of arterial hypertension of the European Society of Hypertension Endorsed by the European Renal Association (ERA) and the International Society of Hypertension (ISH). J Hypertens. 2023 Jun 21. https://doiorg.publicaciones.saludcastillayleon.es/10.1097/HJH.0000000000003480. Epub ahead of print. PMID: 37345492.

49 P27 Vascular smooth muscle cells undergo a phagocytic phenotype upon platelet engulfment

49.1 Van De Velde G ¹, Louis H¹, Lacolley P¹, Regnault V¹, Bascetin R¹

49.1.1 ¹DCAC UMR_S 1116, Vandoeuvre-les-nancy, France

Background: Vascular smooth muscle cells (VSMC) are contractile cells acquiring different phenotypes and associated functions during atherosclerosis development. Atherosclerosis is characterized by blood constituent infiltration in the vascular wall including platelets. Aged erythrocyte phagocytosis by VSMC has been linked to increased oxidative metabolism within the plaque (1). Platelets membrane also participates in lipid accumulation in the plaque when phagocytosed by macrophages (2, 3). The role of VSMC in platelet clearance and the consequence on lipid accumulation within the vascular wall remain to be elucidated.

Methods: Adherent VSMC were co-cultured with activated and/or aged platelets characterized by phosphatidylserine exposure.

Results: Using confocal microscopy, we showed the engulfment of activated and/or aged platelets within VSMC. This process involves VSMC’s cytoskeleton (actin filament and vimentin) reorganization around the engulfed platelets. We observed that platelets size within VSMC decreased with the platelet/VSMC co-culture time. We also checked the contractile phenotype of VSMC. Smooth muscle myosin heavy chain (SM-MHC) expression decreased upon platelet phagocytosis while macrophage-like marker CD68 increased.

Conclusions: Our data show that VSMC engulf platelets through an actin-dependent phagocytosis process leading to changes of VSMC toward a less contractile phenotype. PLT engulfment could be an inducible pathogenic event that is responsible for VSMC phenotypic switching in atherosclerosis and their pro-coagulant status.

References

1. Delbosc S, Bayles RG, Laschet J, Ollivier V, Ho-Tin-Noé B, Touat Z, et al. Erythrocyte Efferocytosis by the Arterial Wall Promotes Oxidation in Early-Stage Atheroma in Humans. Front Cardiovasc Med. 2017 Aug 2;4:43.

2. Chandler AB, Hand RA. Phagocytized platelets: a source of lipids in human thrombi and atherosclerotic plaques. Science (80-) [Internet]. 1961 [cited 2022 Oct 28];134 (3483):946–7. Available from: https://pubmed.ncbi.nlm.nih.gov/13692295/

3. Hoffmeister KM, Felbinger TW, Falet H, Denis C V., Bergmeier W, Mayadas TN, et al. The Clearance Mechanism of Chilled Blood Platelets. Cell [Internet]. 2003 Jan 10 [cited 2022 Mar 11];112 (1):87–97. Available from: http://www.cell.com/article/S0092867402012539/fulltext

50 P28 Integrin αv contributes to the regulation of vascular smooth muscle cell stiffness

50.1 Bascetin R¹, Belozertseva E, Henrion D, Regnault V, Lacolley P, Lacaze E, Challande P, Li Z

50.1.1 ¹DCAC UMR_S 1116, Vandoeuvre-les-nancy, France

Background: Integrin αv functions as a receptor for adhesion proteins in vascular smooth muscle cells (VSMC) and plays a crucial role in arterial ageing. Our aim was to define the arterial phenotype in adult mice conditionally inactivated for αv integrin subunit in VSMC (αVSMKO) and its role in angiotensin II (Ang II)-induced arterial and VSMC stiffness.

Methods: αVSMKO and control mice were treated with Ang II for 4 weeks. In vivo arterial distensibility and in vitro vascular reactivity were determined in the carotid artery. Young elastic modulus was determined by atomic force microscopy of VSMC.

Results: Arterial pressure at baseline and pressure effect of Ang II were similar between control and αVSMKO mice. The carotid distensibility/pressure, elastic modulus/wall stress curves and vascular reactivity were similar in both control and αVSMKO mice, indicating no change in arterial stiffness. Treatment with Ang II resulted in increased carotid stiffness in both groups of mice as well as in vascular reactivity and myogenic tone. Electronic microscopy analysis of carotids revealed no significant difference between both groups of mice at baseline. Ang II-treated αVSMKO mice have fewer vesicles containing collagen fiber-like materials in VSMCs compared to control, consistent with decreased vascular fibrosis reported previously. Elastic modulus of cultured αVSMKO VSMCs was higher than that of control at baseline and after Ang II treatment.

Conclusion: Our study demonstrates that αv inactivation increases VSMC stiffness in vitro and that effect of cell stiffness on entire wall stiffness could be mitigated by additional changes such as αv-mediated fibrosis.

51 P29 Vascular damage in early chronic kidney disease is not related to periaortic adipose tissue dysfunction

51.1 Guzman Aguayo A ¹, Sanz Gómez M¹, Manzano Lista F¹, Palma Guzmán P¹, Plaza A², Fernández-Alfonso M¹

51.1.1 ¹Instituto Pluridisciplinar de UCM, Madrid, Spain, ²Facultad de Farmacia CEU San Pablo, Madrid, Spain

Background: Perivascular adipose tissue (PVAT) exerts a paracrine action on vascular function and structure (1, 2). Munich Wistar Frömter rats (MWF), a model of chronic kidney disease (CKD), exhibit early kidney damage at 10 weeks of age, which progresses to endothelial dysfunction and hypertension at 16 weeks of age (3). We hypothesize that PVAT may contribute to the onset of vascular damage in CKD.

Methods: 10- and 16-week-old MWF were used. The expression of inflammatory, profibrotic and osteogenic factors in periaortic PVAT was determined by RT-PCR. Wistar (W) rats were used as control (n = 5/group).

Results: 16-week-old MWF showed renal damage, endothelial dysfunction and higher systolic blood pressure than W. No differences in arterial stiffness, pulse wave velocity or vascular structure were observed yet. PVAT showed lower expression of some profibrotic (Tgfß, Col1a1) and inflammatory (Tnf⍺) factors with age in MWF with no differences in osteogenic factors (Bmp-2, Bglap). However, BMP-7 and lipocalin were higher in MWF compared to W at 16 weeks of age showing a positive correlation among each other. This effect might be due to the increased browning of PVAT, since UCP-1 expression is significantly higher in MWF compared to W at both ages.

Conclusions: In MWF, PVAT does not show increased expression of inflammatory, fibrotic or calcifying factors compared to healthy rats, and seems, thus, not to be involved in the onset of vascular damage in MWF at early ages. It remains to be established whether PVAT alterations are related to the progression of arterial stiffness at later ages.

References

1. Gil-Ortega M, Somoza B, Huang Y, Gollasch M, Fernández-Alfonso M.S. Regional differences in perivascular adipose tissue impacting vascular homeostasis. Trends in Endocrinology and Metabolism. 2015, 26 (7): 367–375.

2. Watts SW, Gollasch M. Editorial: Perivascular Adipose Tissue (PVAT) in Health and Disease. Front Physiol. 2018 Jul 30;9:1004. https://doiorg.publicaciones.saludcastillayleon.es/10.3389/fphys.2018.01004. PMID: 30104983; PMCID: PMC6078060.

3. Gil-Ortega M, Vega-Martín E, Martín-Ramos M, González-Blázquez R, Pulido-Olmo H, Ruiz-Hurtado G, Schulz A, Ruilope L.M, Kolkhof P, Somoza B, Kreutz R, Fernández-Alfonso M.S. Finerenone Reduces Intrinsic Arterial Stiffness in Munich Wistar Frömter Rats, a Genetic Model of Chronic Kidney Disease. Am J Nephrol 2020,51:294–303.

52 P30 Inter-individual variability in carotid artery intima-media thickness with short-term Western-diet consumption in healthy adults: relation to intestinal enzymes and the gut microbiome

52.1 Longtine A ¹, Greenberg N¹, Burnsed-Torres M¹, González A⁴, Ziemba B¹, Lubieniecki K¹, Rossman M¹, Adam E¹, Lally H¹, Chonchol M², Davy K³, Knight R⁴, Seals D¹, Brunt V^1,2

52.1.1 ¹University Of Colorado Boulder, Boulder, United States, ²University of Colorado Anschutz Medical Campus, Aurora, United States, ³Virginia Polytechnic Institute and State University, Blacksburg, United States, ⁴University of California San Diego, San Diego, United States

Background: Western-diet (WD) consumption increases population-level CVD risk, but not all WD-consumers develop CVD. Understanding mechanisms underlying variability between individuals “protected-from” (WD-P) vs. “sensitive-to” (WD-S) WD could lead to novel CVD-related therapies. We explored variability in WD-induced changes in carotid intima-media thickness (cIMT), a predictor of future CVD risk, and whether heterogeneous responses related to circulating lipopolysaccharide (LPS), a pro-inflammatory/CVD-associated bacterial-membrane component, and alkaline phosphatase (ALP), an intestinal enzyme that detoxifies LPS, regulates intestinal permeability/lipid absorption, and attenuates atherosclerosis when overexpressed in WD-fed mice.

Methods: 26 healthy adults (20–78 yr) underwent 7 days of WD-feeding (40%kcal fat, 25%kcal sugar, 11–14 g/day fiber). Pre/post WD, cIMT, gut microbiome composition (16S rRNA), intestinal permeability (lactulose:mannitol test), and serum/plasma LPS-binding protein (LPSbp), ALP (~ 20% is intestinally derived), and total/LDL-cholesterol were determined. Statistics: 2-way ANOVA.

Results: WD increased cIMT in some (WD-S [ΔcIMT > 0 mm]: + 0.051 ± 0.013 mm; n = 16; p < 0.01) but not other individuals (WD-P [ΔcIMT ≤ 0 mm]: − 0.025 ± 0.013 mm; n = 10; p = 0.16). Baseline abundance of key LPS-containing gut bacteria and LPSbp were lower in WD-P vs. WD-S (p < 0.05), and ΔcIMT related to higher baseline LPSbp (r2 = 0.14; p = 0.09). Baseline ALP, intestinal permeability, and cholesterol were similar between the groups (p ≥ 0.26). However, in WD-S, WD increased intestinal permeability and cholesterol (p < 0.05) and decreased ALP (p = 0.08) without changes in other liver enzymes, suggesting ΔALP was intestinal. Post-WD ALP inversely related to ΔcIMT (r2 = 0.21; p = 0.03). WD-P was protected against these changes (p ≥ 0.29).

Conclusions: WD-P individuals have lower LPS-containing bacteria/LPSbp and appear resistant to WD-induced changes in ALP, intestinal permeability, and cholesterol. These pathways may be viable therapeutic targets for conferring CV-protection to WD-S individuals.

53 P31 Substrate stiffness reduces expression and activation of endothelial nitric oxide synthase (eNOS) and related eNOS signalling molecules in human endothelial cells

53.1 Veppala B¹, Gangoda S¹, Gupta V¹, Butlin M¹, Avolio A ¹

53.1.1 ¹Macquarie Medical School, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, Australia

Background: Vascular stiffness leads to remodeling of extracellular matrix (ECM) and reduced activation of endothelial nitric oxide synthase (eNOS) and production of nitric oxide (NO). This study investigated expression and phosphorylation of eNOS (peNOS), phosphorylation of extracellular signal-regulated kinases (pERK), intercellular adhesion molecule 1 (ICAM-) and amyloid precursor protein (APP) in human umbilical vein endothelial cells (HUVECs) and human cerebral microvascular endothelial cells (HCMECs) in response to differing substrate stiffness.

Methods: Experiment 1: HUVECs were grown on micropillar substrates of 4 or 10 µm mimicking increased substrate stiffness with decreasing height. Experiment 2: HCMECs were grown on dextran hydrogels of tuneable gel stiffness with ligand density of 2, 4, and 7 mMol/L. Experiment 3: HCMECs were grown on cytosoft plates of elastic modulus 0.2–64 kPa. For all experiments, cells were grown for 48 h and assessed for effect of substrate stiffness on eNOS, ICAM-1, APP, peNOS, and pERK on Western blots.

Results: Increased micropillar stiffness decreased eNOS expression in HUVECs (10 µm: 609 ± 115%, 4 µm: 100%, p = 0.005). Increasing stiffness of hydrogels (baseline, 2 mM/L: 100%) decreased peNOS (7 mM/L: 8 ± 26%, p = 0.01), pERK (4 mM/L: 62 ± 9.5%, p = 0.006; 7 mM/L: 35 ± 10%, p = 0.0001) and APP (4 mM/L: 51 ± 18%, p = 0.05). With increasing cytosoft plate stiffness (baseline 0.2 kPa: 100%), HCMECs showed decreased ICAM-1 (0.5 kPa vs 16 kPa, 144 ± 34% to 20 ± 34%, p = 0.01; 0.5 kPa vs 64 kPa, 36 ± 109; p = 0.05).

Conclusions: Results demonstrate eNOS expression is modulated by substrate stiffness, suggesting NO contributes to positive feedback for increased ECM stiffness.

54 P32 100 years since the Nobel Prize award to AV Hill (if not Bramwell) and Otto Meyerhof

54.1 Baulmann J, Cruickshank J

The 1922 Bramwell–Hill equation (PWV = √ ((A)/ρ)/dP/dA) from Manchester, UK is the basis of our Society’s work. 2023 is the centenary of the Nobel prize being formally awarded to AV Hill, a mathematical physiologist, and Otto Meyerhof, a biochemist in Heidelberg, Germany for separate work on skeletal muscle mechanics and energy production. There was no mention of the arterial studies nor in a recent excellent biography [1]. Are there hints from both Laureates’ work of how vascular smooth muscle (VSM) interacts with endothelium? This talk will illustrate key points in both careers.

Hill and Langley (1909) found that nicotine-induced frog muscle contraction, reversible on washing but blocked by curare, followed sigmoid curves—the first example of drug— ‘receptor’ interaction, a basis for the 1913 Michaelis–Menten equation and quantitative pharmacology. Hill worked with Barcroft on oxygen’s dissociation curves from haemoglobin and its ‘Bohr’ effect—‘positive cooperative reactions’. On first visiting Germany in 1910, Hill observed Burker’s experiments in Tubingen on heat generated during muscle contraction. In Manchester then UCL London, Hill studied muscle during exercise.

Meyerhof grew up in Berlin, despite glomerulonephritis graduating in Heidelberg, 1909. In Naples with Warburg, he studied sea-urchin egg respiration that increased sixfold on fertilisation. After WW1, his experiments in Kiel on lactate metabolism in stimulated muscle recovering in oxygen confirmed its re-conversion to glycogen. Energy consumed in lactate oxidation exactly matched the deficit in re-synthesised glycogen. Lohmann in Meyerhof’s lab, then in Heidelberg, isolated various phosphate compounds from muscle, and then adenyl-pyro-phosphate—ATP. It was just before Meyerhof was chased out of Nazi Germany, only just escaping across the French–Spanish border as it shut.

Energetics in VSM arising from these Laureates’ work seems understudied. Modern potential questions include measuring contractile force down the aorta with resulting variations in waveform transmission, together with effects of regional collagen deposition, and many more.

References

Brown, Andrew, Bound by Muscle: Biological Science, Humanism, and the Lives of A. V. Hill and Otto Meyerhof (New York, 2022; online edn, Oxford Academic, 17 Nov. 2022), https://doiorg.publicaciones.saludcastillayleon.es/10.1093/oso/9780197582633.001.0001

55 P35 Causal associations between aortic arterial stiffness, aortic size, and type 2 diabetes: a Mendelian randomization study

55.1 Dib M ¹, Gill D², Burgess S³, Chirinos J¹

55.1.1 ¹University of Pennsylvania Perelman School of Medicine, Philadelphia, United States, ²Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, United Kingdom, ³Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom

Background: Healthy aging and various disease states may lead to large artery stiffness (LAS) and a subsequent rise in pulse pressure (PP), in addition to a decrease in arterial compliance and distensibility (1). Aortic size also impacts characteristic impedance and PP independently of wall stiffness. Associations between LAS and the subsequent development and progression of type 2 diabetes (T2D) have been reported (2, 3). However, causal associations have not been unequivocally investigated in humans. We investigated bi-directional causal associations between indicators of arterial stiffness and maximum ascending aortic size (AAomax) and T2DM using Mendelian randomization (MR), a robust approach for assessing causal associations between exposures and outcomes of interest.

Methods: We used genetic association estimates from 20,282 individuals of the UK Biobank with available cardiac MRI data to assess the bidirectional causal between T2DM and 4 indicators: PP, total arterial compliance, aortic distensibility and AAomax.

Results: A 10-mmHg increase in genetically predicted PP was associated with higher odds of T2DM [OR: 1.13, 95% CI: 1.10, 1.17]. Genetically predicted T2DM was associated with a 0.53 mmHg [0.39, 0.65] increase in PP, a 0.03 10⁻³ mmHg⁻¹ m⁻² [− 0.05, − 0.01] decrease in aortic distensibility and a 0.04 cm² m⁻² [0.04, 0.06] decrease in AAomax.

Conclusions: We provide evidence supporting a bidirectional causal association between PP and T2D, and supportive evidence of an effect of T2D on PP, aortic distensibility and AAomax, but not total arterial compliance. These findings emphasize the causal interactions between metabolism and hemodynamics, that likely contribute to the development of T2DM and its complications.

Figure 1 Legend

References

1.Chirinos JA, Segers P, Hughes T, Townsend R. Large-Artery Stiffness in Health and Disease: JACC State-of-the-Art Review. J Am Coll Cardiol. 2019;74 (9):1237–63.

2.Cohen JB, Mitchell GF, Gill D, Burgess S, Rahman M, Hanff TC, et al. Arterial Stiffness and Diabetes Risk in Framingham Heart Study and UK Biobank. Circ Res. 2022;131 (6):545–54.

3.Tian X, Zuo Y, Chen S, Zhang Y, Zhang X, Xu Q, et al. Hypertension, Arterial Stiffness, and Diabetes: a Prospective Cohort Study. Hypertension. 2022;79 (7):1487–96.

56 P36 Correlation between Metabolic-Associated Fatty Liver Disease and cardiovascular pathology: Insights from arterial stiffness, cardiac dysfunction and atherosclerosis

56.1 Cozma A ^1,2, Terec A³, Taru M¹, Orasan O^1,2, Procopciuc L¹

¹“Iuliu Hatieganu” University of Medicine and Pharmacy, Cluj-Napoca, Romania, ²Clinical CF Hospital, Cluj-Napoca, Romania, ³"Niculae Stancioiu" Heart Institute, Cluj-Napoca, Romania

Background: NAFLD and its progressive form, NASH, are presumed to be associated with cardiovascular pathology, but the extent of their involvement in cardiology requires more insight [1]. As similar risk factors exist between these conditions, a correlation may be considered, leading to additional screening for cardiovascular pathology in patients with MAFLD [2].

Methods: A total of 34 patients diagnosed with NAFLD/NASH based on liver biopsy (NASH Clinical Research Network score—steatosis S0–S3, fibrosis F0-F4) were included. Cardiological investigations examined the correlation between MAFLD type and arterial stiffness, pulse wave velocity, and early cardiac dysfunction. Arterial stiffness was determined using parameters such as pulse wave velocity (PWVao) and augmentation index. Early cardiac dysfunction was assessed with speckle tracking GLS, and subclinical atherosclerosis was measured using carotid intima-media thickness. Ventriculo-arterial coupling was subsequently determined (PWVao/GLS).

Results: The study included 34 patients with a mean age of 60.06 ± 11.02 years, 33.3% men, and 66.7% women. Among them, 20.6% were diagnosed with NAFLD and 79.4% with NASH. A statistically significant difference in ventriculo-arterial coupling (p = 0.025) was found between the NAFLD and NASH groups. The mean values were 0.77 ± 0.33 (95% CI [0.42; 1.12]) in the NAFLD group and 0.54 ± 0.17 (95% CI [0.47; 0.62]) in the NASH group. However, the other parameters examined did not show statistical significance.

Conclusions: Atherosclerosis and MAFLD synergistically contribute to inflammation and insulin resistance. Screening for subclinical atherosclerosis in patients with fatty liver could contribute to developing future CVD screening strategies.

References

1. Yeo JL, Gulsin GS, Dattani A, Brady EM, Bilak JM, Ayton SL, et al. Association of hepatic steatosis with subclinical cardiac dysfunction in asymptomatic people with type 2 diabetes.

2. Song Y, Dang Y, Wang P, Tian G, Ruan L. CHD is Associated with Higher Grades of NAFLD Predicted by Liver Stiffness. J Clin Gastroenterol. 2020 Mar 1;54 (3):271–7.

57 P37 Cardio-ankle vascular index impact for predicting cardiovascular deaths among metabolic syndrome subjects

57.1 Jucevičienė A ^1,2, Puronaitė R^1,2, Ryliškytė L^1,2

57.1.1 ¹Faculty of Medicine, Vilnius University, Vilnius, Lithuania, ²Vilnius University Hospital Santaros Clinics, Vilnius, Lithuania

Background: Metabolic syndrome (MetS) is a highly populated cluster of cardiometabolic risk factors among adults bearing increased costs for public health systems worldwide by increasing the risk of various chronic diseases followed by cardiovascular events including death. This study was aimed to analyze the relationship between cardio-ankle vascular index (CAVI) and cardiovascular deaths.

Methods: A prospective study enrolled 8180 participants from Lithuanian high-risk cohort (LitHiR) of subjects with metabolic syndrome (NCEP/ATPIII criteria) and without overt cardiovascular disease. All participants were followed up for cardiovascular deaths after their initial assessment, including CAVI measurements. Cox regression analysis and survival tree analysis were used for statistical analysis.

Results: 43% and 57% of the subjects were males and females with the median ages of 47 and 57 years at baseline correspondingly. During the follow-up period (median 6.3 years), a total of 120 female and 100 male participants died from cardiovascular death. CAVI increase by one unit was found to increase cardiovascular death risk by 18.4% (HR 1.184, 95% CI 1.066–1.314, p = 0.002) among male, but not female (p = 0.219) participants using Cox regression analysis. Survival tree analysis revealed CAVI as primary (> 9.2, p = 0.005) and C-reactive protein (CRP) as secondary variables (> 10.9 mg/l, p = 0.01) for lower survival rate among male participants; however, CAVI was not on the list of main variables for female participants where the top three consisted of CRP (> 17.2 mg/l, p < 0.001), fastened glucose (> 7.46 mmol/l, p = 0.002) and triglycerides (> 4.32 mmol/l, p = 0.008).

Conclusions: Our follow-up study reveals strong relationship between CAVI and cardiovascular deaths among male but not female participants.

58 P38 Pulse wave velocity and electrolyte levels of diabetic patients: correlation study

58.1 Mendes M¹

58.1.1 ¹Lucélia C. Magalhães, Amália I. C. Santana, Mariana Mendes, Cecilia Araújo, Daniele Bustolim, Rita Alves, Magno Mercês, Salvador, Brazil, ²Rodrigo Lima, Monique Cerqueira, Salvador, BRAZIL

Introduction: Pulse wave velocity (PWV) is a relevant marker of unfavorable cardiovascular outcomes. Just as high sodium levels can exert endothelial dysfunction and arterial stiffness, on the other hand, potassium acts as a vascular protector.

Objective: To evaluate the correlation between 24-h urinary sodium and potassium values and arterial stiffness among diabetic patients.

Methodology: This is a quantitative study, carried out in a community center in Salvador-Bahia. Tests were scheduled for patients diagnosed with diabetes. The data collection procedures involved the application of a questionnaire, 24-h urine collection for sodium and potassium dosages and measurement of pulse wave velocity (OPV) with SphygmoCor^® flattening tonometer at the UniFTC school clinic. Data analysis involved descriptive measures and Spearman's linear correlation coefficient between laboratory tests and adjusted PWV. The STATA v.12 software was used for treatment and generation of results. The level of statistical significance was set at 5%. The study protocol was approved by the Research Ethics Committee involving human beings.

Results: 120 individuals were evaluated. The studied population consisted mainly of women (75.8%), black (95.8%), with incomplete elementary education (35.0%) and income of up to 1 minimum wage (63.3%). The average fasting glucose was 154 mg/dL (± 81.4). Spearman's correlation coefficient between PWV and urinary sodium was − 0.05 (p = 0.68) and between PWV and urinary potassium of − 0.10 (p = 0.45), both negative and without statistical significance.

Conclusion: It is noticed that sodium did not obtain statistical significance when attributed to PWV. In addition, potassium can be used as a negative predictive indication of arterial stiffness.

References

1. Refardt J, Winzeler B, Christ-Crain M. Diabetes Insipidus: An Update. Endocrinol Metab Clin North Am. 2020 Sep;49 (3):517–531. https://doiorg.publicaciones.saludcastillayleon.es/10.1016/j.ecl.2020.05.012. Epub 2020 Jul 15. PMID: 32741486.

2. Tomiyama H, Matsumoto C, Shiina K, Yamashina A. Brachial-Ankle PWV: Current Status and Future Directions as a Useful Marker in the Management of Cardiovascular Disease and/or Cardiovascular Risk Factors. J Atheroscler Thromb. 2016;23 (2):128–46. https://doiorg.publicaciones.saludcastillayleon.es/10.5551/jat.32979. Epub 2015 Nov 11. PMID: 26558401.

59 P39 Correlation between arterial stiffness and creatinine clearance: study among patients with diabetes mellitus

59.1 Mendes M ¹

59.1.1 ¹Lucélia C. Magalhães, Amália I. C. Santana, Mariana Mendes, Daniele Brustolim, Monique Cerqueira, Magno Merces, Rodrigo Lima, Rita Alves, Cecília Araújo, Salvador, Brazil

Introduction: Arterial stiffness predicts an increased risk of cardiovascular events. In addition, it is increased in patients with chronic kidney disease. One of the parameters evaluated is nitrogenous slags such as creatinine, which shows a decline in the glomerular filtration rate.

Objective: To evaluate the correlation between arterial stiffness and creatinine clearance in diabetic patients.

Methodology: This is a quantitative study, carried out in a community center in Salvador-Bahia. The sample involved 120 diabetic individuals. Creatinine clearance was investigated in a 24-h urine sample. The pulse wave velocity (PWV) was used to establish arterial stiffness and involved measuring the pulse wave velocity between the carotid and right femoral, coupled to the electrocardiogram using the SphygmoCor^® device. The frequency and descriptive measures the Spearman linear correlation coefficient between laboratory tests and the adjusted PWV. The STATA v.12 software was used for treatment and generation of results. The level of statistical significance was set at 5%. The study protocol was approved by the Research Ethics Committee involving human beings.

Results: The study population consisted mainly of women (75.8%), black (95.8%), with incomplete elementary education (35.0%) and income of up to 01 minimum wage (63.3%). The average fasting glucose was 154 mg/dL (± 81.4). Spearman's correlation coefficient between PWV and creatinine clearance was − 0.07 (p = 0.58), that is, it was not statistically significant.

Conclusion: It is inferred that it had no statistical significance when associated with PWV.

References

1. Ammirati AL. Chronic Kidney Disease. Rev Assoc Med Bras (1992). 2020 Jan 13;66Suppl 1 (Suppl 1): s03–s09. https://doiorg.publicaciones.saludcastillayleon.es/10.1590/1806-9282.66.S1.3. PMID: 31939529.

2. Vallée A, Safar ME, Blacher J. Hypertension artérielle permanente essentielle: définitions et revue hémodynamique, clinique et thérapeutique [Essential hypertension: Definitions, hemodynamic, clinical and therapeutic review]. Presse Med. 2019 Jan;48 (1 Pt 1):19–28. French. https://doiorg.publicaciones.saludcastillayleon.es/10.1016/j.lpm.2018.11.017. Epub 2019 Jan 18. PMID: 30665781.

60 P40 Correlation of serum and urinary electrolyte levels of diabetic patients

60.1 Mendes M ¹

60.1.1 ¹Lucélia C. Magalhães, Amália I. C. Santana, Cecília Araújo, Daniele Brustolim, Monique Cerqueira, Magno Merces, Rodrigo Lima, Rita Alves, Mariana Mendes, Salvador, Brazil

Introduction: Diabetes is an intermediate metabolism disorder, characterized by acute or chronic complications of hyperglycemia. Diabetes is a chronic metabolic disorder resulting from the state of hypoinsulinism. The effects of hormones against insulin will predominate, exaggerating biochemical reactions.

Objective: To evaluate the correlation between serum sodium and creatinine values, sodium and creatinine clearance, potassium and creatinine clearance among diabetic patients.

Methodology: This is a quantitative study, carried out in a community center in Salvador-Bahia. Tests were scheduled for patients diagnosed with diabetes. Data collection procedures involved the application of a questionnaire, 24-h urine collection for dosages of sodium, potassium, creatinine clearance, and blood collection for serum creatinine dosage. Data analysis involved descriptive measures and Spearman's linear correlation coefficient between laboratory tests. The STATA v.12 software was used for treatment and generation of results. The level of statistical significance was set at 5%. The studied protocol was approved by the Research Ethics Committee involving human beings.

Results: 120 individuals were evaluated. The studied population consisted mainly of women (75.8%), black (95.8%), with incomplete elementary education (35.0%) and income of up to 1 minimum wage (63.3%). The average fasting glucose was 154 mg/dL (± 81.4). The sodium correlation coefficient between serum creatinine was − 0.31 (p = 0.01), between sodium and creatinine clearance of 0.46 (p < 0.001) and between potassium and creatinine clearance 0.28 (p = 0.02).

Conclusion: It is noticed that the electrolytes indicators of renal function obtained statistical significance when associated and can be used as predictors of renal dysfunction.

References

1. Kaul K, Tarr JM, Ahmad SI, Kohner EM, Chibber R. Introduction to diabetes mellitus. Adv Exp Med Biol. 2012;771:1–11. https://doiorg.publicaciones.saludcastillayleon.es/10.1007/978-1-4614-5441-0_1. PMID: 23393665.

2. Levey AS, Coresh J. Chronic kidney disease. Lancet. 2012 Jan 14;379 (9811):165–80. https://doiorg.publicaciones.saludcastillayleon.es/10.1016/S0140-6736(11)60178-5. Epub 2011 Aug 15. PMID: 21840587.

61 P41 The effect of endurance exercise on arterial blood pressure in trained type 1 diabetic patients compared to healthy controls

61.1 Potocnik I ¹, Potocnik N¹

61.1.1 ¹University of Ljubljana, Medical faculty, Institute of Physiology, Ljubljana, Slovenia

Introduction: Exercise is one of the most effective nonpharmacological regulators of cardiovascular health and is, therefore, recommended in treatment guidelines for type 1 diabetes (T1D). The aim of this study was to compare the effect of endurance exercise (EE) on arterial blood pressure response in trained T1D participants and age-, VO2max-, and sex-matched healthy controls immediately after and 24 h after completion of EE.

Methods: Mean arterial blood pressure (MAP) was measured in 9 T1D (age 31.3 ± 13.3, BMI 24.3 ± 2.5) and 9 healthy runners (age 30.5 ± 13.9, BMI 22.7 ± 1.6) before (baseline) and at two consecutive time points after EE in the form of 2 h of cycling below the anaerobic threshold. A two-way repeated measurements ANOVA with Bonferroni post hoc test was used to examine changes between the groups. Time was a within-participant factor, while control and T1D were two between-group factors.

Results: A significant time effect showed that MAP decreased 24 h after completion of EE compared to baseline (94.51 ± 11.06 and 102.13 ± 11.03 mmHg, p = 0.015, ε = 0.429) and no differences between baseline and immediately after completion of EE (p = 0.107) or between immediately after and 24 h after completion of EE (p = 0.99). No main effect of group was found (p = 0.236, ε = 0.086) and there was no significant interaction between group and time on MAP (p = 0.467, ε = 0.042).

Conclusion: Our results show that the pattern of change in MAP to EE is well maintained in trained T1D participants. Postexercise recovery lasted at least 24 h after cessation of EE.

62 P42 A novel marine oil from zooplankton Calanus finmarchicus improves diastolic haemodynamics in obese pre-diabetic women

62.1 Stöhr E ^1,2, Junge S³, Spahiu F¹, Jonas W³, van de Flierdt E³, Schuchardt J³, Hahn A³

62.1.1 ¹Institute of Sport Science, Leibniz University Hannover, Hannover, Germany, ²Columbia University Irving Medical Center, New York City, USA, ³Institute of Food Science and Human Nutrition, Leibniz University Hannover, Hannover, Germany

Background: Diabetes alters cardiac glucose metabolism and reduces cardiovascular function. There is evidence that long-chain omega-3 fatty acids (lc-n3-FA) and carotenoids may have beneficial effects on cardiac function. Therefore, an exploratory study was conducted to determine whether 12 weeks of supplementation with Calanus oil (CalOi), a novel marine oil containing astaxanthin and lc-n3-FA in the form of wax esters, can improve cardiovascular function in pre-diabetics.

Methods: Systolic and diastolic cardiac function (echocardiography), central and peripheral haemodynamics (BP and PWV, oscillometry), metabolic (HOMA-IR, HbA1c, glucose, triglycerides) as well as inflammatory markers (CRP) were assessed in 20 pre-diabetic obese women (age: 59 ± 10; BMI: 34 ± 4) before and after 12 weeks of 4 g of CalOi/day.

Results: Following the 12-week intervention, fasting glucose (p = 0.01), triglycerides (p = 0.001) and central diastolic blood pressure (p = 0.05) were significantly reduced, while the diastolic E/A ratio was increased and crossed the important threshold of 1 (0.97–1.03, p = 0.02). In contrast, there were no differences in cardiac volumes, HbA1c, HOMA-IR, CRP, PWV, central systolic BP, or AIx (p > 0.05). The change in E/A from pre- to post-intervention was related to the change in HOMA-IR (r = 0.40, p = 0.08) but not to the change in triglycerides (r = 0.27, p = 0.25), glucose (r = 0.19, p = 0.43) or HbA1c (r = 0.08, p = 0.73).

Conclusions: In pre-diabetic obese women, 12 weeks of CalOi supplementation altered glucose and triglyceride concentrations as well as central diastolic haemodynamics. Future studies should prospectively determine whether the improved diastolic function with CalOi use is causally linked to altered glucose metabolism or to increases in circulating triglyceride concentrations.

Figure 1 Legend

References

1. Burhop, M.; Schuchardt, J.P.; Nebl, J.; Müller, M.; Lichtinghagen, R.; Hahn, A. Marine Oil from C. finmarchicus Enhances Glucose Homeostasis and Liver Insulin Resistance in Obese Prediabetic Individuals. Nutrients 2022, 14, 396. https://doiorg.publicaciones.saludcastillayleon.es/10.3390/nu14020396

2. Sliem H, Nasr G. Left ventricular structure and function in prediabetic adults: Relationship with insulin resistance. J Cardiovasc Dis Res. 2011 Jan;2 (1):23–8. https://doiorg.publicaciones.saludcastillayleon.es/10.4103/0975-3583.78583

63 P43 A longitudinal clinical trajectory analysis examining the accumulation of co-morbidity in people with type 2 diabetes (T2D) compared with non-T2D individuals

63.1 Heald A ^1,2, Qin R³, Williams R^4,5, Warner-Levy J¹, Narayanan R⁶, Khan Z¹, Fernandez I⁷, Gibson M^1,2, McCay K³, Peng Y³, Anderson S⁸, Ollier W³

63.1.1 ¹Salford Royal Hospital, Salford, United Kingdom, ²The School of Medicine and Manchester Academic Health Sciences Centre, Manchester, United Kingdom, ³Faculty of Science and Engineering, Manchester Metropolitan University, Manchester, United Kingdom, ⁴Division of Informatics, Imaging and Data Science, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, United Kingdom, ⁵NIHR Greater Manchester Patient Safety Translational Research Centre, The University of Manchester, Manchester, United Kingdom, ⁶St Helens and Knowsley Teaching Hospitals NHS Trust, St Helens, United Kingdom, ⁷Stroke Pharmacogenomics and Genetics, Institut d’Investigació Biomèdica Sant Pau (IIB SANT PAU), Barcelona, Spain, ⁸University of the West Indies, Cave Hill Campus, Bridgetown, Barbados

Background: Type 2 diabetes mellitus (T2D) is commonly associated with an increasing complexity of multi-morbidity/related treatment (1,2). Understanding the longitudinal clinical history of individuals may provide additional insights.

Methods: In this study, we utilised longitudinal data from the DARE (Diabetes Alliance for Research in England) study (3). Data from 1932 individuals (T2D n = 1196 vs matched non-T2D controls n = 736) were extracted and subjected to trajectory analysis over a period of up to 50 years.

We also mapped diagnosed coronary artery disease (CAD) by social disadvantage quintile, with lower respiratory tract infection (RTI) as comparator group.

Results: Mean age of T2D diagnosis was 52.6 years (95% CI 52.0–53.4). In the years leading up to T2D diagnosis, individuals who eventually received a T2D diagnosis exhibited increase in several clinical phenotypes. Immediately prior to T2D diagnosis, a significantly greater prevalence of hypertension (35%)/respiratory tract infection (34%)/heart conditions (17%)/eye–nose–throat infections (19%)/asthma (12%) was observed (Figure). The corresponding trajectory of each of these conditions was much less dramatic in matched (controls). Post-T2D diagnosis, the proportions of T2D individuals exhibiting hypertension/CKD/retinopathy/infections climbed rapidly before plateauing. At the last follow-up by quintile of disadvantage, proportion (%) people with diagnosed CAD was for quintile 1 (least disadvantaged) 6.4%; quintile 2: 4.0%; quintile 3: 6.1%; quintile 4: 9.8%, quintile 5: 11.0% (F 3.4, p = 0.01) with similar pattern for RTI.

Conclusions: These findings provide novel insights into the onset/natural progression of T2D, suggesting an early phase of inflammation-related (vascular)disease activity before clinical diagnosis of T2D. Furthermore, measures that reduce social inequality have potential to reduce the social gradient in CAD reported here.

Figure 1 Legend

References

1. Olokoba AB, Obateru OA, Olokoba LB. Type 2 diabetes mellitus: a review of current trends. Oman Med J. 2012;27:269–273.

2. Liu R, Li L, Shao C, Cai H, Wang Z. The Impact of Diabetes on Vascular Disease: Progress from the Perspective of Epidemics and Treatments. J Diabetes Res. 2022 Apr 8;2022:1531289.

3. https://www.diabetesgenes.org/current-research/dare/: Accessed 25 June 2023.

64 P46 Investigating macrovascular wall thickness of the forearm in systemic sclerosis

64.1 Slijkhuis B¹, Van Roon A ¹, van Gessel A¹, Stel T¹, van de Zande S¹, Brouwer E¹, Mulder D¹

64.1.1 ¹University Medical Center Groningen, Groningen, Netherlands

Background: The full extent of damage caused by systemic sclerosis (SSc) is still relatively unknown. Research concerning the influence of SSc on the macrovasculature of the forearm is limited, while further studies on this topic may give us better insight in the progression of SSc.

Methods: In this study, we evaluated the vessel wall of the brachial, ulnar, and radial arteries in SSc patients. Forty-two patients and twelve healthy controls were studied with a median age of 62 and 58, respectively. The intima-media thickness (IMT) and lumen diameter were measured using ultra-high-frequency ultrasound (48 MHz). A severity score index was created to include unmeasurable vessel walls in the analysis from patients who had severely affected arteries.

Results: Examples of ultrasound IMT measurements and different degrees of clarity are shown in Fig. 1. IMT was measurable at 235 out of 252 sites (93%) in SSc patients. No significant differences were observed for the IMT. Severity scores for stenosis or occlusion were higher in the ulnar arteries compared to the other vessels (21.4% and 16.7% versus 2.4% for the right brachial artery and 0% for the radial arteries and left brachial artery). Patients with SSc had a smaller lumen diameter for the radial and ulnar arteries (all p > 0.05).

Conclusion: This study shows that a quantitative and qualitative assessment is needed to characterize the vessel wall more thoroughly. Moreover, despite its exploratory nature, this study supports that the macrovasculature (radial and ulnar arteries) is involved in the progression of SSc.

Figure Legend

65 P47 Blood pressure abnormalities in otherwise healthy patients receiving stiff endographs after blunt traumatic aortic rupture

65.1 Guala A ¹, Gil-Sala D², Ruiz-Muñoz A¹, Garcia-Reyes M², Azancot M², Dux-Santoy L¹, Teixido-Tura G^1,2, Garrido-Oliver J¹, Tello C², Galian-Gay L², Carrasco-Poves A¹, Ferreira-Gonzalez I^1,2, Bellmunt-Montoya S^1,2, Rodriguez-Palomares J^1,2

65.1.1 ¹VHIR, Barcelona, Spain, ²Hospital Universitari Vall d’Hebron, Barcelona, Spain

Background: Endovascular aortic repair (TEVAR) is the treatment of choice for injuries of the thoracic aortic in patients with blunt trauma, which are often young and healthy. The development of hypertension (HT) in these patients is frequent and a concern (1). Whether physiological changes (2) due to certain characteristics of the TEVAR or its implantation play a role in the development of HT in these patients has not being study.

Methods: Twenty-six patients who had a traumatic injury of the thoracic descending aorta requiring TEVAR implantation were included. They underwent 24-h ambulatory blood pressure monitoring, magnetic resonance imaging to quantify AAo pulse wave velocity (PWV), AAo and AbdAo distensibility and AAo longitudinal strain (3–5) and tonometry to measure carotid–femoral PWV (cfPWV).

Results: Ten years after intervention, 17 (65%) patients had hypertension. Age, sex, BSA, native aortic diameters and stiffness were not related to HT. Distal TEVAR oversizing (p = 0.051) was larger while TEVAR was more proximal (p = 0.025) in patients developing HT. Proximal (p = 1.000) and distal (p = 0.597) TEVAR diameter and its length (p = 0.525) were similar in patients developing or not HT. cfPWV tended to be higher in patients developing HT (p = 0.066): it was abnormally high in 6 out of 17 patients with HT and in none of the 9 patients without HT (p = 0.054).

Conclusions: In the long term, the majority of patients with traumatic aortic injury treated with TEVAR presented hypertension. TEVAR stiffness, proximal landing zone location and distal oversizing are potentially modifiable surgical characteristics related to hypertension.

References

1. Tzilalis VD, Kamvysis D, Panagou P, Kaskarelis I, Lazarides MK, Perdikides T, Prassopoulos P, Boudoulas H. Increased pulse wave velocity and arterial hypertension in young patients with thoracic aortic endografts. Ann Vasc Surg. 2012 May;26 (4):462–7. https://doiorg.publicaciones.saludcastillayleon.es/10.1016/j.avsg.2011.06.021. Epub 2012 Jan 27. PMID: 22284778.

2. Gil-Sala D, Guala A, Garcia Reyes ME, Azancot MA, Dux-Santoy L, Allegue Allegue N, Teixido Turà G, Goncalves Martins G, Ruiz Muñoz A, Constenla García I, Evangelista A, Tello Díaz C, Ferreira González I, Rodríguez-Palomares JF, Bellmunt S. Geometric, Biomechanic and Haemodynamic Aortic Abnormalities Assessed by 4D Flow Cardiovascular Magnetic Resonance in Patients Treated by TEVAR Following Blunt Traumatic Thoracic Aortic Injury. Eur J Vasc Endovasc Surg. 2021 Nov;62 (5):797–807. https://doiorg.publicaciones.saludcastillayleon.es/10.1016/j.ejvs.2021.07.016. Epub 2021 Sep 10. PMID: 34511317.

3. Guala A, Rodriguez-Palomares J, Dux-Santoy L, Teixido-Tura G, Maldonado G, Galian L, Huguet M, Valente F, Gutiérrez L, González-Alujas T, Johnson KM, Wieben O, Sao Avilés A, Garcia-Dorado D, Evangelista A. Influence of Aortic Dilation on the Regional Aortic Stiffness of Bicuspid Aortic Valve Assessed by 4-Dimensional Flow Cardiac Magnetic Resonance: Comparison With Marfan Syndrome and Degenerative Aortic Aneurysm. JACC Cardiovasc Imaging. 2019 Jun;12 (6):1020–1029. https://doiorg.publicaciones.saludcastillayleon.es/10.1016/j.jcmg.2018.03.017. Epub 2018 May 16. PMID: 29778849.

4. Guala A, Teixidó-Tura G, Rodríguez-Palomares J, Ruiz-Muñoz A, Dux-Santoy L, Villalva N, Granato C, Galian L, Gutiérrez L, González-Alujas T, Sanchez V, Forteza A, García-Dorado D, Evangelista A. Proximal aorta longitudinal strain predicts aortic root dilation rate and aortic events in Marfan syndrome. Eur Heart J. 2019 Jul 1;40 (25):2047–2055. https://doiorg.publicaciones.saludcastillayleon.es/10.1093/eurheartj/ehz191. PMID: 30977783.

5. Ruiz Muñoz A et al. Aortic stiffness descriptors by cardiac magnetic resonance are correlated with mechanical testing of ex-vivo aortic aneurysms specimens, Cardiovascular Research, Volume 118, Issue Supplement_2, October 2022, cvac157.101, https://doiorg.publicaciones.saludcastillayleon.es/10.1093/cvr/cvac157.101

66 P48 Arterial pulse waves and the impact of aortic valve stenosis: a database and assessment of haemodynamics and pulse waves for the monitoring and quantification of the disease

66.1 Wilson D ¹

66.1.1 ¹King's College London, London, United Kingdom

Aortic valve stenosis presents itself as the most prevalent form of heart valve disease, entailing high levels of mortality and morbidity where asymptomatic cases often pass through early detection and, therefore, avoid management and operative interventions. Arterial pulse waves have been used as a rich source of information on patient health in both clinical and now consumer devices, yet specific disease information and their impact on wave morphology is not rigorously understood. One-dimensional arterial blood flow modelling, with use of a complex 4 chamber heart model was, therefore, tested on 11 degrees of aortic valve orifice area ranging between 3.0 cm² and 0.5 cm² (classifying within a mild to severe range of stenosis) and across an age range of 50–75 in intervals of 5 years, resulting in a database consisting of 14,580 subjects. Subject-specific cardiac vascular determinants carry across each age group allowing for the monitoring of disease progression per subject, this could be used for distinguishing and quantifying pulse waves of moderate to surgically intervenable levels. Initial investigation of this publicly available database indicates distinguishable features in pressure and flow waveforms even in cases below clinically significant levels and in line with the mechanisms behind a reduced valve area, this could allow for earlier red flagging of patient progression through the disease with non-invasive at home measurement devices.

67 P49 Both the mechanical and the neural components of baroreflex sensitivity are decreased in patients with early stage of schizophrenia

67.1 Cseh D ^1,2, Sárközi A³, Horváth L⁴, Réthelyi J⁵, Kollai M², Mersich B⁵

67.1.1 ¹Division of Experimental Medicine and Immunotherapeutics, University Of Cambridge, Cambridge, United Kingdom, ²Department of Physiology, Semmelweis University, Budapest, Hungary, ³Saint Margaret Hospital, Budapest, Hungary, ⁴Zala County Saint Raphael Hospital, Zalaegerszeg, Hungary, ⁵Department of Psychiatry and Psychotherapy, Semmelweis University, Budapest, Hungary

Background: Decreased baroreflex sensitivity (BRS), which is an early indicator of impaired cardiovascular autonomic regulation, is present in patients with schizophrenia.¹ However, the underlying mechanisms behind deteriorated baroreflex function are not well understood. Therefore, the goal of our study was the determination of BRS and its mechanical and neural components (mBRS and nBRS, respectively) in patients with early stage of schizophrenia.

Methods: 40 patients (29 [24–34] years) and 40 age- and sex-matched control subjects were examined. The measurements of the schizophrenic patients were performed during their first hospitalisation and the diagnosis of schizophrenia was made according to DSM-V. BRS was determined by the spontaneous sequence technique. Distensibility coefficient of the common carotid artery was determined using high-precision carotid echotracking and applanation tonometry, and represented mBRS. The ratio of BRS and mBRS provided nBRS. Between-group comparisons were made by binary logistic regression.

Results: The first models were adjusted for age and sex. BRS was reduced in the patient group compared with the control group (8.4 [6.7–13.9]† vs. 20.1 [14.5–27.2] ms/mmHg). Both mBRS and nBRS were decreased in patients compared with controls (4.76 ± 1.06† vs. 5.80 ± 1.39 1/(10³ × mmHg); 2.11 ± 1.06† vs. 3.65 ± 1.31 ms × 10³, respectively). Further adjustment for mean blood pressure or smoking habits did not change our results (median [interquartile range]; mean ± SD; † p < 0.01).

Conclusions: Our results indicate that stiffening of the baroreceptor vessel walls and damage of the neural elements of the baroreflex arc are both responsible for the impaired baroreflex function in patients with early stage of schizophrenia.

References

1. Bär KJ, Boettger MK, Berger S, Baier V, Sauer H, Yeragani VK, Voss A. Decreased baroreflex sensitivity in acute schizophrenia. J Appl Physiol (1985). 2007 Mar;102 (3):1051–6. https://doiorg.publicaciones.saludcastillayleon.es/10.1152/japplphysiol.00811.2006. Epub 2006 Nov 16. PMID: 17110512.

68 P50 The impact of SARS-CoV-2 on heart rate variability and baroreflex sensitivity

68.1 Van Gessel A ¹, Van Roon A¹, Mulder D¹, Harms M¹

68.1.1 ¹University Medical Centre Groningen, Groningen, Netherlands

Background: In patients with post-COVID-19 syndrome, some of the symptoms can be explained by a change in autonomic function [1]. In this study, we want to establish if a SARS-CoV-2 infection has changed the autonomic function in fully recovered subjects.

Methods: We studied subjects with (N = 15, 8 female) and without (N = 15, 8 male) a passed SARS-CoV-2 infection. We recorded beat-to-beat systolic blood pressure (SBP, mmHg) and inter-beat interval (IBI, ms) using a Finapres NOVA (FMS, Enschede, the Netherlands). We calculated low-frequency band power (LF, ms²), high-frequency band power, (HF, ms²) and baroreflex sensitivity (BRS, ms/mmHg)) using CARSPAN software [2]. We compared supine baseline (mean of two 5 min segments) with standing (last 5 min of 10 min) and 70° tilted position (last 5 min of 10 min). SPSS 28 was used to perform the statistical tests.

Results: Age and BMI were not different between the groups (p = 0.20 and p = 0.24). Change in IBI was larger for standing compared to tilt (− 184 vs − 153 ms, p < 0.001) but was not different between the groups. Changes in variability measures are shown in the figure. LF power was not changed by the manoeuvres for both the groups. HF was significantly reduced (all p < 0.001), but reductions were not different between the groups. BRS was reduced by the manoeuvres in the same way.

Conclusions: We found no evidence for an impaired autonomic nervous system in subjects after a passed infection.

References

1.Shouman K, Vanichkachorn G, Cheshire WP, Suarez MD, Shelly S, Lamotte GJ, Sandroni P, Benarroch EE, Berini SE, Cutsforth-Gregory JK, Coon EA, Mauermann ML, Low PA, Singer W. Autonomic dysfunction following COVID-19 infection: an early experience. Clin Auton Res. 2021 Jun;31 (3):385–394. https://doiorg.publicaciones.saludcastillayleon.es/10.1007/s10286-021-00803-8. Epub 2021 Apr 16. PMID: 33860871; PMCID: PMC8050227.

2.Dietrich A, Riese H, van Roon AM, van Engelen K, Ormel J, Neeleman J, Rosmalen JG. Spontaneous baroreflex sensitivity in (pre)adolescents. J Hypertens. 2006 Feb;24 (2):345–52. https://doiorg.publicaciones.saludcastillayleon.es/10.1097/01.hjh.0000200517.27356.47. PMID: 16508583.

69 P51 Long-term Effect of Mild COVID-19 Infection on Arterial Stiffness and Augmentation Index

69.1 Srivastava P ¹, Chandran D¹, Soneja M¹, Jaryal A¹, Deepak K¹

69.1.1 ¹All India Institute Of Medical Sciences, New Delhi, NEW DELHI, India

Background: SARS-CoV-2 interferes and can increase arterial stiffness and affect vascular ageing in the short and long term even in young adults (1, 2). We investigated the long-term impact of mild COVID-19 infection on arterial stiffness and aortic blood pressure.

Methods: Thirty COVID-19 survivors (mean age—36.5 ± 9.3) participated in the study at 3–6 months of clinical recovery from RT-PCR-positive mild COVID-19. Arterial stiffness was assessed by calculating Augmentation index (AIx%) and carotid–femoral pulse wave velocity (cf-PWV) by applanation tonometry using SphygmocorR. The assessments were performed at 3–6 months (baseline) and followed up after 6 months of baseline, i.e. 9–12 months (visit-2) after COVID-19 infection.

Results: There is no significant difference observed in brachial as well as aortic systolic and diastolic blood pressures between baseline and visit-2. Aortic Mean BP significantly reduced (91.7 ± 9.8 Vs 52.1 ± 29.2, p < 0.0001), while aortic pulse pressure increased (31.1 ± 4.02 Vs 68.7 ± 30.4, p < 0.0001) after 9–12 months of COVID-19 infection. AIx and cf-PWV also remain statistically unchanged from baseline to 9–12 months after COVID-19 infection.

Conclusions: There is no significant difference observed in Aortic stiffness and augmentation index after 9–12 months of mild COVID-19 infection. Mild COVID-19 infection appears not to be affecting arterial stiffness. The severity of the infection and long hospital stays may affect arterial stiffness and vascular ageing in COVID survivors.

References

1.Szeghy RE, Stute NL, Province VM, Augenreich MA, Stickford JL, Stickford ASL, et al. Six-month longitudinal tracking of arterial stiffness and blood pressure in young adults following SARS-CoV-2 infection. J Appl Physiol. 2022 May 1;132 (5):1297–309.

2.Behrooz L, Ho JE, Hamburg NM. Vascular Aging After COVID-19: A Story of Lasting Injury or Prolonged Healing? Circ Res. 2022 Apr 29;130 (9):1286–8.

70 P52 Impaired arterial vasoconstriction during experimental sympathetic activation in men with abdominal aortic aneurysm

70.1 Shlimon K ², Bjarnegård N³, Skoog J³, Lindenberger M¹

70.1.1 ¹Department of Cardiology in Linköping, and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden, Linköping, Sweden, ²Department of Anaesthesiology and Intensive Care in Linköping, and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden, Linköping, Sweden, ³Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden, Linköping, Sweden

Background: Abdominal aortic aneurysm (AAA) is associated with morphological and functional changes in non-aneurysmal arteries and veins [1, 2]. Previous observations have shown markedly higher blood flow in subcutaneous adipose tissue in subjects with AAA [3]. The aim of this study was to investigate peripheral arterial tone and blood pressure in response to experimental sympathetic activation in men with AAA.

Methods: This study comprised 31 men with AAA (70.1 ± 2.8 years) and 29 controls (70.6 ± 3.4 years). Lower body negative pressure (LBNP) at – 15 and – 30 mmHg was used to elicit sympathetic activation. Venous occlusion plethysmography was used to measure forearm blood flow (FBF, ml/100 ml/min) at rest and during LBNP. Heart rate and blood pressure were monitored noninvasively beat-by-beat. Forearm vascular resistance (FVR, mmHg/ml/100 ml/min) was calculated by dividing mean arterial pressure (MAP, mmHg) with FBF. Plasma norepinephrine (P-NE, nmol/l) was measured at rest and during LBNP.

Results: During rest FBF (4.6 ± 1.6 vs 4.4 ± 1.9, p = 0.70), FVR (24.6 ± 10.6 vs 26.9 ± 11.0, p = 0.45), P-NE (2.7 ± 0.9 vs 2.3 ± 0.6, p = 0.12), and MAP (99 ± 11 vs 100 ± 12, p = 0.86) were similar in AAA vs controls. FVR was significantly lower in AAA than in controls during − 30 mmHg (p < 0.001) but not − 15 mmHg LBNP. Blood pressure, heart rate, and plasma norepinephrine (130 ± 21 vs 133 ± 19% of rest values, p = 0.55) were similar in both the groups during LBNP.

Conclusions: Impaired ability to increase forearm arterial tone during experimental sympathetic activation was observed in men with AAA, further supporting the view that AAA is associated with functional alterations in arterial regulation beyond the aorta.

Figure Legend

References

[1] Shlimon K, Lindenberger M, Welander M, Dangardt F, and Bjarnegard N. Radial artery lumen diameter and intima thickness in patients with abdominal aortic aneurysm. JVS Vasc Sci 3: 274–284, 2022.

[2] Skoog J, Shlimon K, Bjarnegard N, and Lindenberger M. Assessment of Upper Extremity Venous Compliance in Patients With Abdominal Aortic Aneurysms. Eur J Vasc Endovasc Surg 60: 739–746, 2020.

[3] Midttun M, Sejrsen P, and Paaske WP. Is non-specific aneurysmal disease of the infrarenal aorta also a peripheral microvascular disease? Eur J Vasc Endovasc Surg 19: 625–629, 2000.

71 P53 Characterising the endothelial response post Transient Ischaemic Attack (TIA). An observational sub study of PREDICT-EV

71.1 Williams J ¹, Raven R¹, Whelan C¹, Stone K¹, Geen J², White J³, McDonnell B¹, James P¹

71.1.1 ¹Centre of Cardiovascular Health and Ageing, Cardiff Metropolitan University, Cardiff, United Kingdom, ²Department of Clinical Biochemistry, Prince Charles Hospital, Cwm Taf Morgannwg University Health Board, Merthyr, United Kingdom, ³Stroke Services, Clinical Gerontology, Prince Charles Hospital, Cwm Taf Morgannwg University Health Board, Merthyr, United Kingdom

Background: Transient ischaemic attack (TIA) patients are 25% more likely to suffer a stroke within 12 months (1) and present with increased pulse pressure, following their cerebrovascular event. Endothelial function, as measured by nitric oxide metabolites (NOx) has a key role in regulating arterial haemodynamics and pulse pressure. Endothelial-derived extracellular vesicles (eEV), express proteins indicative of the parent cell and are considered a marker of endothelial activation. However, the relationships between pulse pressure, NOx and eEV, are currently unknown following TIA.

Methods: 103 TIA patients and 20 age-matched, non-TIA controls, were recruited from TIA clinic (CTMUHB). Cohort characteristics, seated systolic, diastolic, pulse pressure and mean arterial pressure have been determined. eEV concentration and phenotype were characterised using flow cytometry. NOx was determined from patient plasma using ozone-based chemiluminescence.

Results: Although mean arterial pressure was not different between the groups (101.05 ± 14.32mmHg vs. 102.81 ± 9.93 mmHg, Fig. 1A), pulse pressure was significantly higher in TIA patients (69.50 ± 19.87 mmHg vs .57.75 ± 17.26 mmHg, p = 0.05, Fig. 1B). Despite no difference in the production of eEV (26.18 ± 4.21% vs. 28 ± 1.76%), the proportion of EV expressing activation marker E-Selectin (CD62E) was significantly higher in the TIA group (22.64 ± 3.92% vs. 35.07 ± 2.45%, p = 0.036). Total NOx was significantly higher in TIA patients (3448 ± 293.1nM vs. 16764 ± 1020 nM, p < 0.001). Those patients with higher endothelial activation (%CD62E + EV) had the highest levels of total NOx (p = 0.031).

Conclusion: These early data provide an insight into the differences in pulse pressure, endothelial activation, and NO production in patients post-TIA. Further work is required to determine the interaction of these variables in the compensatory response to TIA and future risk of stroke.

Figure 1 Legend

References

1. Lioutas V, Ivan CS, Himali JJ, et al. Incidence of Transient Ischemic Attack and Association With Long-term Risk of Stroke. JAMA. 2021;325 (4):373–381. https://doiorg.publicaciones.saludcastillayleon.es/10.1001/jama.2020.25071

72 P54 Peripheral blood pressure, pulse wave velocity and cognition – a longitudinal study (CEREBRO Project)

72.1 Silva C ^1,2, Gonçalves F^1,2, Oliveira M², Castanho T^3,4,5,6, Vila I^1,2, Costa A², Brito A^1,2, Ferreira P^1,7, Carvalho A^1,2, Guimarãe Cunha P^1,2,3,4, Cotter J^1,2,3,4

72.1.1 ¹Centre for the Research and Treatment of Arterial Hypertension and Cardiovascular Risk, Internal Medicine Department, Hospital Senhora da Oliveira, Guimarães, Portugal, ²Academic Centre, Hospital da Senhora da Oliveira, Guimarães, Portugal, ³Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal, ⁴ICVS/3B’s - PT Government Associate Laboratory, Braga/Guimarães, Portugal, ⁵ Clinical Academic Center – Braga, Braga, Portugal, ⁶P5 Medical Center, Braga, Portugal, ⁷VasCor Project, University Center of Science and Technology, Salvador, Brazil

Background: Cognitive dysfunction is an emerging contributor to the burden of disease. The link between cognitive decline and hemodynamic factors has been debated [1–4]. In these preliminary results of CEREBRO Project, we look into the slope of variation in cognition associated with PWV in a one-year follow-up of hypertensive patients.

Methods: In an observational prospective study of hypertensives, clinical, hemodynamic and neurocognitive evaluations were collected, at baseline and one-year later. A preliminary principal components analysis was conducted, followed by cluster analysis. Four dimensions of cognitive performance and mood were used: Memory, Executive, Mini-Mental State Examination (MMSE), and Global Depression Scale (GDS). Three clusters of patients were formed and analyzed. We assessed the one-year evolution of cognitive tests (Δtest) and their association with baseline PWV in each cluster.

Results: 61 subjects were included (54% female, mean age 70 years). Baseline mean BP was 144/80 mmHg and PWV was 9.6 m/s. Cluster 1 patients had higher scores in Memory and GDS. Cluster 2 had the best MMSE, the lowest GDS score, and the worst Executive performance. Cluster 3 had the best Executive performance and the worst scores in MMSE and Memory. PWV was significantly lower in Cluster 3. ΔMMSE was positive in Cluster 3 and significantly different than the variation observed in the other clusters. ΔSRCLTR and ΔSRDR memory tests also showed significantly different variations between Clusters 2 and 3.

Conclusions: In clusters with lower PWV, the one-year evolution of global cognitive and memory tests was better than in patients with higher PWV.

References

1. Mitchell GF, van Buchem MA, Sigurdsson S, et al. Arterial stiffness, pressure and flow pulsatility and brain structure and function: the Age, Gene/Environment Susceptibility-Reykjavik study. Brain: a journal of neurology. 2011;134 (Pt 11):3398–407.

2. Cooper LL, Woodard T, Sigurdsson S, et al. Cerebrovascular Damage Mediates Relations Between Aortic Stiffness and Memory. Hypertension. 2016;67 (1):176–82.

3. Brisset M, Boutouyrie P, Pico F, et al. Large-vessel correlates of cerebral small-vessel disease. Neurology. 2013;80 (7):662–9.

4. Webb AJ, Simoni M, Mazzucco S, Kuker W, Schulz U, Rothwell PM. Increased cerebral arterial pulsatility in patients with leukoaraiosis: arterial stiffness enhances transmission of aortic pulsatility. Stroke. 2012;43 (10):2631–6.

73 P57 Influence of dynamic axial stretching on the biomechanical characteristics of the ascending aorta

73.1 Parikh S ¹, Giudici A^1,2, Huberts W^1,3, Delhaas T¹, Bidar E⁴, Spronck B^1,5, Reesink K¹

73.1.1 ¹Department of Biomedical Engineering, CARIM School for Cardiovascular Diseases, Maastricht University, Maastricht, Netherlands, ²GROW School for Oncology and Reproduction, Maastricht University, Maastricht, Netherlands, ³Cardiovascular Biomechanics, Biomedical Engineering, Eindhoven University of Technology, Eindhoven, Netherlands, ⁴Department of Cardiothoracic Surgery, Heart & Vascular Centre, Maastricht University Medical Centre, Maastricht, Netherlands, ⁵Macquarie Medical School, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, Australia

Background: The ascending thoracic aorta (ATA) not only distends but also dynamically elongates during the cardiac cycle [1]. This elongation may also affect its circumferential expansion. In vivo biomechanical parameter estimation studies [2, 3], often overlook this dynamic axial stretching, which can potentially lead to inaccurate parameter estimations. We investigated the impact of fixed and varying axial stretches on the estimation of ATA biomechanical characteristics.

Methods: Holzapfel–Gasser–Ogden model parameters for four human aneurysmatic ATAs were obtained from [2]. Cylindrical ATA models were stretched axially to 1.2 times their unloaded length and inflated to patient-specific [2] diastolic pressures (80 ± 15 mmHg; mean ± standard deviation). Then, while pressurising to systolic pressure (141 ± 7 mmHg), two scenarios were simulated: (1) keeping axial stretch fixed at 1.2, and (2) superimposing an additional dynamic axial stretch of 1.04 (= 4% axial engineering strain) [1]. Circumferential and axial stress and material stiffness were calculated at systolic pressure; volume compliance and stored strain energy density were calculated over the simulated cardiac cycle.

Results: With superimposed additional axial stretch (scenario 2), axial stress and stiffness and stored strain energy density increased by 15.9 ± 0.2% (p = 0.008), 20.2 ± 1.5% (p = 0.073), and 18.1 ± 6.3% (p < 0.001), respectively (Figure B, D, E), while circumferential stress and stiffness did not change (Figure A, C). With superimposed stretch, volume compliance was increased in all but the stiffest arteries (Figure F).

Conclusion: Estimated biomechanical characteristics are significantly influenced by the physiologically occurring axial stretching of the ATA over the cardiac cycle. These axial deformations should be taken into account during in vivo biomechanical characterisation of the ATA.

Figure 1 Legend

References

1. Parikh S, Ganizada B, Debeij G, Natour E, Maessen J, Spronck B, et al. Intra-operative video-based measurement of biaxial strains of the ascending thoracic aorta. Biomedicines. 2021;9:670.

2. Smoljkić M, Fehervary H, Van den Bergh P, Jorge-Peñas A, Kluyskens L, Dymarkowski S, et al. Biomechanical characterization of ascending aortic aneurysms. Biomechanics and modeling in mechanobiology. 2017;16:705–720.

3. Trabelsi O, Duprey A, Favre J-P, Avril S. Predictive models with patient specific material properties for the biomechanical behavior of ascending thoracic aneurysms. Annals of biomedical engineering. 2016;44:84–98.

74 P58 Blood pressure estimation through pulse waves: an in silico study on age groups

74.1 Gonçalves Seabra A ^1,2,3, Amado-Rey A^1,2,3, Stieglitz T^1,2,3,4

74.1.1 ¹Laboratory for Biomedical Microtechnology, Department of Microsystems Engineering – IMTEK, University of Freiburg, Freiburg im Breisgau, Germany, ²IMBIT//NeuroProbes, University of Freiburg, Freiburg im Breisgau, Germany, ³BrainLinks-BrainTools Center, University of Freiburg, Freiburg im Breisgau, Germany, ⁴Bernstein Center Freiburg, University of Freiburg, Freiburg im Breisgau, Germany

Background: There is a need for cuffless blood pressure (BP) monitoring systems. Ultrasound-based approaches could outperform PPG by providing superior resolution, and the ability to extract multiple hemodynamic pulse waves and parameters across various sites (1). Previous studies have estimated BP through ultrasound-extracted pulse waves, employing different mathematical models. However, a critical research question arises: does the best-performing model vary with age and measuring site?

Methods: Four models were evaluated for estimating BP using arterial distension: a linear (M1), an exponential (M2), a logarithmic model with PWV (M3/M4), and a correlation model with blood flow (M5) (2). Pulse waves from an open-source in silico database (3) were used as the models’ input parameters. Healthy subjects (n = 4374), aged at ten-year intervals, were divided into young (25–35 years old), middle (45–55 years old), and late (65–75 years old) adulthood. The performance of the models was assessed across the age groups at the carotid, brachial, and radial arteries.

Results: Pearson’s pulse pressure correlation and pulse wave mean difference were comparable across most models, except for M5, which was significantly lower. In middle and late adulthood, M2 had the lowest systolic blood pressure (SBP) mean difference at all arterial sites. In young adulthood, M3/4 demonstrated the lowest SBP mean difference at the carotid artery, while at the brachial and radial arteries, it was M1.

Conclusions: Although novel evidence supports the use of the commonly employed exponential model (M2) in the older age groups, the best-performing model differs between arterial sites in young adulthood.

Figure 1 Legend

References

1. Zhao L, Liang C, Huang Y, Zhou G, Xiao Y, Ji N et al. Emerging sensing and modeling technologies for wearable and cuffless blood pressure monitoring. npj Digit. Med. 2023; 6 (1):93. Available from: URL: https://www.nature.com/articles/s41746-023-00835-6.

2. Gonçalves Seabra AC, Da Silva AF, Stieglitz T, Amado-Rey AB. In silico blood pressure models comparison. IEEE Sensors J. 2022; 22 (23):23,486–93.

3. Charlton PH, Mariscal Harana J, Vennin S, Li Y, Chowienczyk P, Alastruey J. Modeling arterial pulse waves in healthy aging: a database for in silico evaluation of hemodynamics and pulse wave indexes. Am J Physiol Heart Circ Physiol 2019; 317 (5):H1062–H1085.

75 P59 Bayesian inversion of a one-dimensional vascular model reveals heterogeneous cardiovascular changes in sepsis

75.1 Catling F ¹, Parker K¹, Hughes A², Harris S², Gordon A¹

75.1.1 ¹Imperial College London, London, United Kingdom, ²University College London, London, United Kingdom

Background: Patients undergo heterogeneous cardiovascular changes in sepsis, with varying degrees of hypovolaemia, myocardial depression, vasoplegia and large-artery stiffening. These pathologies alter wave transmission and reflection in the arterial tree, as well as cardiac output. We thus aim to infer them from the radial arterial pressure waveform, enabling personalised resuscitation.

Methods: We specified a cardiovascular model, including a 67-arterial-segment one-dimensional vascular submodel and submodels of measurement noise. Hierarchical prior distributions were defined over the model parameters. 17 ‘baseline’ patient states were sampled with prior standard deviations (SDs) reduced to 25% of normal. 402 transitions from baselines to heterogeneous sepsis states were simulated as independent uniform random (0–2 SDs) decreases in stroke volume, left ventricular ejection time (LVET) and peripheral resistance, and increases in large-artery stiffness and arterial radii. We simulated radial arterial pressure waveforms at baselines and in sepsis, then ran Bayesian inference ([1] introduces similar methods) on them to assess where changes from baseline were identifiable.

Results: Median (IQR) mean arterial pressures were 83 mmHg (79–86) at baseline and 58 mmHg (52–66) in sepsis. Pressure waveforms identified changes in stroke volume and LVET, and larger resistance changes in specific vascular beds (see figure). Changes in large-artery stiffness (Pearson correlation 0.55) and arterial radii (Pearson correlation 0.12) were not identifiable.

Conclusions: Our model partially identifies heterogeneous cardiovascular changes in sepsis from a noisy radial pressure waveform, and thus has the potential to personalise treatment. Identification was achieved despite the model’s complexity by applying realistic constraints when modelling and specifying priors.

Figure 1 Legend

References

[1] Paun LM, Husmeier D. Markov chain Monte Carlo with Gaussian processes for fast parameter estimation and uncertainty quantification in a 1D fluid-dynamics model of the pulmonary circulation. Int J Numer Method Biomed Eng 2021;37:e3421.

76 P60 Haemodynamic effects of endovascular repair of abdominal aortic aneurysms: an in vitro study.

76.1 Rangarajan E ¹, Rhode K¹, Abisi S^1,2, Alastruey J¹

76.1.1 ¹King's College London, London, United Kingdom, ²Guy’s and St Thomas’ NHS Foundation Trust, London, United Kingdom

Background: Endovascular aortic repair is an established treatment for aortic aneurysmal disease, offering lower morbidity and mortality compared to open surgery [1]. Fenestrated endovascular aortic aneurysm repair requires precise planning and positioning to prevent misalignment [2]. Branched endovascular aortic aneurysm repair with external branches fits a wider range of anatomies but requires a wider working aortic lumen and longer aortic cover, increasing the risk of spinal cord ischaemia [3]. There are no in vivo, in vitro, or in silico studies to understand the haemodynamic effects of different repair designs. This project attempts to build and test a bench model to investigate these effects.

Methods: Desktop 3D printers manufactured dissolvable PVA moulds for fabricating aortic phantoms from computed tomography images (Fig. 1). The phantoms underwent uniaxial tensile testing to discern mechanical properties. Furthermore, a high-accuracy pulsatile flow pump was constructed, featuring a linear actuator-based piston to simulate realistic pulse waves. This pump was integrated into a closed-loop system passing through aortic and mitral valve phantoms. To verify the accuracy of pulse waves, pressure and flow rate sensors were employed, first in a 2-m-long silicone tube and then in aortic phantoms, with and without aneurysms.

Results: Phantom materials compared favourably with in vivo data of human aorta allowing for high-level flow mimicking capability, with elastic modulus of 483 ± 3 kPa and dimensional accuracy of ± 0.2 mm. The pump flow produced realistic pressure and flow waveforms.

Conclusion: The proposed experimental pipeline provides patient-specific haemodynamic information that can be used to aid clinicians in stent selection.

Figure 1 Legend

References

1.Prinssen M, Verhoeven ELG, Buth J, Cuypers PWM, van Sambeek MRHM, Balm R, et al. A Randomized Trial Comparing Conventional and Endovascular Repair of Abdominal Aortic Aneurysms. New England Journal of Medicine. 2004 Oct 14;351 (16):1607–18.

2.Scurr JRH, McWilliams RG. Fenestrated Aortic Stent Grafts. Seminars in Interventional Radiology [Internet]. 2007 Jun 1 [cited 2020 Oct 22];24 (2):211–20.

3.Spanos K, Kölbel T, Kubitz JC, Wipper S, Konstantinou N, Heidemann F, et al. Risk of spinal cord ischemia after fenestrated or branched endovascular repair of complex aortic aneurysms. Journal of Vascular Surgery. 2019 Feb;69 (2):357–66.

77 P61 Comparison of automated peripheral photoplethysmographic and echocardiographic measurements to assess the usability of pulse wave analysis in the evaluation of central hemodynamics

77.1 Kulin D ^1,2, Antali F^1,2, Horváth M³, Kulin S², Miklós Z⁴, Szűcs A³

77.1.1 ¹Institute of Translational Medicine - Semmelweis University, Budapest, Hungary, ²E-Med4All Europe Ltd., Budapest, Hungary, ³Heart and Vascular Center - Semmelweis University, Budapest, Hungary, ⁴National Korányi Institute for Pulmonology, Budapest, Hungary

Background: Echocardiography is the primary imaging technique used in cardiology. Photoplethysmography (PPG) is a non-invasive, accessible method for recording the peripheral pulse wave. (1) However, the relationship between echocardiography and PPG indices is still uncertain and, therefore, remains an area of ongoing research. (2) Our aim was to assess the correlation between echocardiography and PPG parameters in healthy subjects.

Methods: 37 healthy volunteers (M/F: 16/21, age: 20–57 years, mean: 36.97 ± 11.44SD) underwent echocardiographic examination with simultaneous 2-min-long recording of the pulse wave using PPG placed on the right index finger. A proprietary evaluation software (E-Med4All Europe Ltd., Budapest, Hungary) (3) calculated 33 PPG parameters, which were compared with 43 echocardiography parameters using Pearson’s correlation.

Results: Several PPG parameters exhibited a medium (0.3 < IrI < 0.5) or strong (IrI > 0.5) correlation with certain cardiac ultrasound parameters (p < 0.05). We confirmed that PPG parameters estimating the duration of cardiac ejection correlate strongly with echocardiographic ejection time. As a novel finding, we observed that cardiac ultrasound parameters used for assessment of diastolic function showed significant correlation with 8 PPG parameters, including 3 composite parameters. Moreover, left ventricular dimensions and systolic function parameters were found to correlate with 5 PPG parameters, including 2 composite parameters.

Conclusions: Our findings suggest that PPG-based pulse wave analysis offers insights not only into circulatory hemodynamics but may also provide considerable first-line information about cardiac function in everyday clinical practice and home monitoring. We plan to conduct further studies to determine the clinical relevance of PPG analysis in various cardiac diseases.

Figure 1 Legend

References

1. Allen J. Photoplethysmography and its application in clinical physiological measurement. Physiol Meas [Internet]. 2007 Mar 1;28 (3):R1–39.

2.Chan GSH, Middleton PM, Celler BG, Wang L, Lovell NH. Automatic detection of left ventricular ejection time from a finger photoplethysmographic pulse oximetry waveform: Comparison with Doppler aortic measurement. Physiol Meas. 2007;28 (4):439–52.

3. Kulin D, Antali F, Kulin S, Wafa D, Lucz KI, Veres DS, et al. Preclinical, multi-aspect assessment of the reliability of a photoplethysmography-based telemonitoring system to track cardiovascular status. Appl Sci. 2020;10 (22):1–17.

78 P62 Investigating the Impact of Aortic Valve Stenosis on Pulse Wave Morphology Using Simulated Waveforms

78.1 Wilson D ¹, Alastruey J¹, Clough R¹

78.1.1 ¹King's College London, London, United Kingdom

Background: Aortic valve stenosis (AVS) is a serious and complex condition, affecting 2–5% of adults over 65. Detecting asymptomatic cases is challenging, leading to delayed intervention and management (1). Understanding the impact of AVS on pulse wave (PW) morphology could improve early detection. This study investigates this relationship using simulated PWs.

Methods: We developed a validated one-dimensional, systemic arterial blood flow model combined with a 4-chamber heart model (2). Using an established methodology (3), a database of 14,580 subjects aged 50–75 years (5-year intervals) was created. Aortic valve orifice areas from 3.0 cm² to 0.5 cm² (0.25 cm² increments) were used, representing increasing AVS. This approach enables the investigation of left ventricular ejection fraction in combination with AVS, which is a guideline-recommendation for AVS disease and treatment management.

Results: Highly distinguishable features in PW morphology were observed, even in cases below clinically significant levels of AVS (Fig. 1). These features included a rounded aortic flow pattern, reduced peak values, decreased reverse flow, and a delayed pulse onset to peak flow. Changes in central PW morphology were amplified throughout the arterial network. Notably, an area reduction of at least 2.9 cm² caused an increased time from pulse onset to peak in the photoplethysmogram PW and its diastolic/inflection point. These effects were further influenced by age-related cardiovascular determinants such as heart rate, stroke volume, arterial diameter, pulse wave velocity, and mean arterial pressure.

Conclusion: The peripheral photoplethysmogram PW contains sufficient information for early detection of AVS progression using non-invasive at-home measurement devices.

Figure Legend

References

(1) Lee G, Chikwe J, Milojevic M, Wijeysundera HC, Biondi-Zoccai G, Flather M, Gaudino MF, Fremes SE, Tam DY. ESC/EACTS vs. ACC/AHA guidelines for the management of severe aortic stenosis. European Heart Journal. 2023 Mar 7;44 (10):796–812.

(2) Mynard JP, Smolich JJ. One-dimensional haemodynamic modeling and wave dynamics in the entire adult circulation. Annals of biomedical engineering. 2015 Jun;43:1443–60.

(3) Charlton PH, Mariscal Harana J, Vennin S,Li Y, Chowienczyk P, Alastruey J. Modeling arterial pulse waves in healthy aging: a database for in silico evaluation of hemodynamics and pulse wave indexes. American Journal of Physiology-Heart and Circulatory Physiology. 2019 Nov 1;317 (5):H1062–85.

79 P64 Optimization of the Fit Parameters for the Constitutive Model of Remodeling Arteries of Mice from Older to Elder

79.1 Tuna B ¹, Ozkan C¹, Buyukkaya O¹, Karadag C¹, Dogan A¹, Keles N¹, Yalcin O², Dogan S¹, Okyar A¹

79.1.1 ¹Yeditepe University, Kayısdagi, Turkey, ²Koc University, Sariyer, Turkey

Arterial mechanical behavior and structural changes that occur with aging lead to functional deterioration, posing a risk factor from middle age onwards [1]. However, it is unknown how these changes behave during the transition from middle to old age. Constitutive models could be used to numerically determine the changes due to remodeling in the arteries [2]. In here, realized within the COST action VascAgeNet, pressure–diameter response of arteries of 49- to 76-week-old-mice in in-vitro was used to optimize the fit parameters and determine the factors in vascular aging.

For this purpose, the mean arterial blood pressure of 49- and 76-week-old (n = 15–9) male mice was measured by tail-cuff. Following euthanasia, second-order mesenteric arteries were isolated. In vitro pressure–diameter (5–125 mmHg) relations were measured by pressure myography. Multi-variable optimization for parameter identification was performed, and the fiber-reinforced model was fitted (Figure-1). All computations were performed using the general purpose Octave program.

Systolic, mean arterial pressure, and diastolic arterial blood pressure averaged 115;90;82 mmHg, respectively, in 49-week-old-mice, while 106;83;73 averages were measured for 76-week-old-mice, which indicated a decrease with aging (p > 0.05). Artery diameter was also decreased with spontaneous aging. Two of the elasticity parameters in the fiber-reinforced model (mu and k2) indicated no differences between the groups, while the k1 parameter (initial elastic modulus of the fiber) was significantly higher for 76-week-old-mice (p < 0.05).

The passive response of elderly arteries to pressure change showed a slight variation in its elasticity compared to the middle-aged experimental group. Blood pressure and pressure myography could be better described by the use of a suitable constitutive model.

Figure Legend

References

1. Thijssen DHJ, Carter SE, Green DJ. Arterial structure and function in vascular ageing: are you as old as your arteries?: Arterial structure and function in vascular ageing. J Physiol [Internet]. 2016;594 (8):2275–84. Available from: https://doiorg.publicaciones.saludcastillayleon.es/10.1113/JP270597

2. Okyar F, Buyukkaya O, Karadag CV , Tuna B, Identifcation of constitutive arterial tissue parameters using inverse deformation analysis from passive inflation experiments. Artery Research 2023 Vol. 29 Issue 1 Pages 1–50. https://doiorg.publicaciones.saludcastillayleon.es/10.1007/s44200-022-00028-8. https://doiorg.publicaciones.saludcastillayleon.es/10.1007/s44200-022-00028-8