Search Results (185)

Background and Objectives: Type 2 diabetes mellitus (T2DM) is associated with subclinical cardiovascular changes, such as increased arterial stiffness and myocardial dysfunction. Vitamin D deficiency has been recognized as a potential contributing factor to vascular disease; however, its impact on early cardiac changes associated with T2DM remains poorly understood. Our aim was to evaluate the association between serum levels of 25-hydroxyvitamin D3 [25(OH)D3], arterial stiffness, and left ventricular global longitudinal strain (LV GLS) in patients with T2DM who do not have a clinically evident cardiovascular disease. Material and methods: This cross-sectional study evaluated the carotid intima–media thickness (IMT), aortic pulse wave velocity (PWVao), LV GLS, and serum 25(OH)D3 levels in patients diagnosed with T2DM (n = 65) compared to healthy control subjects (n = 55). Independent predictors of arterial stiffness were identified by a multivariate logistic regression analysis. Results: Patients with T2DM showed a significant increase in IMT and PWVao, a reduction in LV GLS, and low levels of 25(OH)D3 compared to subjects in the control group (all p < 0.05). Both vitamin D deficiency and T2DM were found to be independently associated with an increased arterial stiffness, with odds ratios of 2.4 and 4.8, respectively. A significant inverse relationship was identified between 25(OH)D3 levels and markers of arterial stiffness, as well as LV GLS, suggesting a possible association between the vitamin D status and the early onset of cardiovascular dysfunction. Conclusions: Patients with T2DM show early signs of heart and blood vessel problems, even with an ejection fraction that remains within normal limits. There is a significant correlation between vitamin D deficiency and increased arterial stiffness, along with impaired LV GLS, indicating its possible involvement in cardiovascular complications associated with diabetes. These findings support the utility of integrating vascular, myocardial, and vitamin D assessments in early cardiovascular risk stratification for T2DM patients. Full article

p-Cresyl sulfate (PCS), a gut-derived uremic toxin with proinflammatory and cytotoxic effects, has been implicated in cardiovascular injuries among patients with chronic kidney disease (CKD). Aortic stiffness (AS), assessed by carotid–femoral pulse wave velocity (cfPWV), is a recognized predictor of cardiovascular risk. This study investigated the association between serum PCS levels and AS in patients with nondialysis-dependent CKD. In total, 165 patients with nondialysis-dependent CKD were enrolled. Clinical data and fasting blood samples were collected. Arterial stiffness (AS) was assessed bilaterally by measuring carotid–femoral pulse wave velocity (cfPWV) on both the left and right sides. A value above 10 m/s was considered indicative of increased stiffness. Serum PCS levels were quantified using high-performance liquid chromatography–mass spectrometry. Fifty patients (30.3%) had AS. The AS group was significantly older and had higher diabetes prevalence, systolic blood pressure, fasting glucose, urinary protein-creatinine ratio, and PCS levels than the control group. In the multivariate analysis, both PCS (odds ratio [OR]: 1.097; 95% confidence interval [CI]: 1.024–1.175; p = 0.008) and age (OR: 1.057; 95% CI: 1.025–1.090; p < 0.001) were independently associated with AS. In conclusion, elevated serum PCS and older age were independently associated with AS. Thus, PCS is a potential early marker of vascular damage in CKD. Full article

Background/Objectives: Aortic stiffness is a strong independent factor in cardiovascular outcomes. The method of choice for evaluating aortic stiffness is the measurement of aortic pulse wave velocity (PWV). Endovascular aortic repair (EVAR) increases aortic rigidity and thus aortic stiffness. The aim of this study is to investigate the correlation between endograft length and post-operative increases in PWV in patients with abdominal aortic aneurysms (AAAs) subjected to EVAR. Methods: A prospective observational study enrolling 107 patients from February to December 2025 was conducted. Patient demographics and comorbidities were recorded. The length of the endografts was calculated by studying computed tomography angiograms (CTAs) and digital subtraction angiographies (DSAs) of the patients. PWV was measured pre-operatively and post-operatively during the first 24 h after EVAR, and the difference in PWV (dPWV) was calculated. Results: The mean age of the patients was 72 ± 7.5 years, and 93.5% of them were males. The mean transverse AAA diameter was 5.7 ± 1.1 mm, and the mean endograft length was 169.7 ± 26.9 mm. An extension to the external iliac artery was deployed in 10 patients (9.3%). A strong positive correlation was observed between dPWV and endograft length, indicating that each additional 1 mm in graft length corresponded to a 0.541% increase in dPWV. Patients with an extension to external iliac arteries exhibited a significantly higher mean dPWV (9.95 ± 2.08% vs. 27.12% ± 12.15%, t = −4.463, p = 0.002). No statistically significant differences in dPWV between the different endograft types were found (p = 0.74). Conclusions: Endograft length is strongly related to PWV elevation during the immediate post-operative time after EVAR, especially when the endograft is extended to the external iliac arteries. Full article

Introduction: Vascular aging is associated with a loss of aortic compliance (C_A), which results in increased left ventricular pressure–volume area (PVA), stroke work (SW) and myocardial oxygen consumption (MVO₂). Myocardial efficiency (MyoEff) is derived from the PVA and MVO₂ construct, which includes potential energy (PE). However, the SW/MVO₂ ratio does not include PE and provides a more accurate physiologic measure. Methods: We used a modified computational model (CM) to assess PVA and SW and calculate MVO₂ using a pressure-work index (e MVO₂), to derive MyoEff–PVA and MyoEff–SW metrics. Phase I evaluated five levels of human C_A from normal (N) to stiff (S) at 80 bpm, and Phase II evaluated two levels of C_A (N and S) at three heart rates (60, 100, and 140 bpm). Results: During Phase I, MyoEff–PVA increased from 20.7 to 31.2%, and MyoEff–SW increased from 14.8 to 18.9%. In Phase II, during the N setting coupled with increases in the heart rate, the MyoEff–PVA decreased from 29.4 to 14.8 to 9.5%; the MyoEff–SW also decreased from 22.5 to 10.3 to 5.9%. As expected, during the S setting, MyoEff–PVA decreased from 45.5 to 22.9 to 14.8; a similar effect occurred with the MyoEff–SW, demonstrating a decrease from 29.9 to 13.9 to 7.9%, respectively. Conclusions: The CM provided insights into a simple and clinically relevant calculation for assessing MyoEff. The agreement on the CM metrics aligns with studies conducted previously in the clinical setting. Full article

Metabolic dysfunction-associated steatotic liver disease (MASLD) corresponds to the condition of increased hepatic fat levels, which is the leading cause of hepatic failure and carcinoma. It is also an independent risk factor for cardiovascular disease (CVD) and mortality. MASLD can be due to obesity with insulin resistance and/or genetic predisposition, i.e., polymorphism in the patatin-like phospholipase domain-containing 3 (PNPLA3) gene. PNPLA3 polymorphism has been associated with increased hepatic fat levels, fibrosis, cirrhosis, and hepatocellular carcinoma, while its association with CVD remains to be fully understood. The aim of the current study was to examine whether the vascular phenotype of patients with MASLD differed between carriers and noncarriers of the PNPLA3 polymorphism. Adult patients with MASLD underwent clinical assessment, PNPLA3 genotyping, arterial tonometry for aortic stiffness measurement, and ultrasound examination of carotid arteries. In total, 117 patients with MASLD and no fibrosis (median hepatic stiffness was 4.71 kPa) were recruited. Carriers of the PNPLA3 polymorphism were younger and exhibited higher levels of ALT and APRI, as compared to wild-type subjects. On the other hand, carriers of the PNPLA3 polymorphism had not only a better metabolic profile (i.e., lower glucose and glycated hemoglobin) but also lower blood pressure, carotid intima-media thickness (IMT), and cardiovascular risk. In addition, PNPLA3 polymorphism was negatively correlated with aortic stiffness, which is a marker of arteriolosclerosis and vascular ageing. Our data are consistent with previous observations that in case of genetically-driven MASLD, there is an inverse association with common predictors of CVD. Our data support the view that the main contributors to CVD risk in patients with MASLD remain conventional cardiometabolic risk factors (i.e., age, glucose) that are more likely to be found in metabolic syndrome-related MASLD rather than genetically-driven MASLD, at least in the first stages of the disease. Full article

In patients on chronic peritoneal dialysis (PD), aortic stiffness (AS) is a common cardiovascular condition that can predict cardiovascular events and mortality. Decorin is a small leucine-rich proteoglycan that plays a vital role in extracellular matrix organization and vascular remodeling. The relationship between decorin and AS in patients with PD remains unclear. We enrolled 140 patients on PD and collected their demographic, anthropometric, and biochemical data. Serum decorin levels were measured using enzyme-linked immunosorbent assay. Based on carotid–femoral pulse wave velocity (cfPWV), a diagnosis of AS was established in 42 patients (30%), who were found to be of advanced age and showed higher prevalence rates of systolic blood pressure, diabetes, hypertension, triglyceride, fasting glucose, and lower decorin levels, compared with those who had no AS. After proper adjustment for confounding factors in the multivariable logistic regression model, AS development was associated with decorin, age, and triglyceride levels. Multivariable linear regression analysis showed that decorin, when subjected to logarithmic transformation, can be viewed as a significant independent predictor of cfPWV (β = −0.289; p < 0.001). Low decorin level was significantly and independently associated with AS in patients undergoing chronic PD. Full article

Patients undergoing aortic valve repair or replacement with associated alterations in stiffness characteristics often develop abnormalities in the aortic sinus vortex, which may impact aortic valve function. The correlation between altered aortic sinus vortex and aortic valve function remains poorly understood due to the complex fluid dynamics in the aortic valve and the challenges in simulating these conditions. The opening and closure mechanism of the aortic valve is studied using fluid–structure interaction (FSI) simulations, incorporating an idealized aortic valve model. The FSI approach models both the interaction between the fluid flow and the valve’s leaflets and the dynamic response of the leaflets during pulsatile flow conditions. Differences in the hemodynamic and vortex dynamic behaviors of aortic valve leaflets with varying stiffness are analyzed. The results reveal that, during the systolic phase, the formation of the sinus vortex is closely coupled with the jet emanating from the aortic valve and the fluttering motion of the leaflets. As leaflet stiffness increases, the peak vorticity of the sinus vortex increases, and the phase space of the vortex core develops a pronounced spiral trajectory. During the diffusion phase, the vortex strength decays exponentially, and the diffusion time is longer for stiffer leaflets, indicating a longer residence time of the sinus vortex that reduces the pressure difference on the leaflet during valve closure. Changes in leaflet stiffness play a critical role in the formation and development of sinus vortices. Furthermore, the dynamic characteristics of vortices directly affect the pressure balance on both sides of the valve leaflets. This pressure difference not only determines the opening and closing processes of the valve but also significantly influences the stability and efficiency of these actions. Full article

Background/Objectives: Cardiovascular disease is the main cause of morbidity and mortality in Chronic Kidney Disease (CKD), so it is of great importance to find simple and non-invasive tools to detect vascular damage in pre-dialysis CKD patients. This study aimed to assess the applicability of non-invasive techniques to evaluate vascular damage in stages CKD-2 to CKD-5 and its progression after an 18-month follow-up using (A) carotid–femoral pulse wave velocity (PWV) to assess aortic stiffness and (B) Superb Microvascular Imaging (SMI) ultrasound to assess adventitial neovascularization compared with other traditional techniques to evaluate vascular damage, such as carotid intima–media thickness and Kauppila index. Methods: The study involved 43 CKD patients in stages CKD-2 to CKD-5 and a group of 38 sex- and age-matched controls, studied at baseline and at an 18-month follow-up. Age, sex, body mass index, arterial pressure, pharmacological treatments, and blood and urinary parameters were collected. Aortic stiffness was determined by carotid–femoral PWV and abdominal aortic calcification was assessed in lateral lumbar X-rays and quantified by the Kauppila index. Carotid intima–media thickness (cIMT), the number of carotid plaques, and adventitial neovascularization were evaluated by SMI. Results: Vascular impairment was mostly detected in CKD-4 and CKD-5 stages, with increased aortic stiffness measured by PWV and increased carotid plaques and adventitial neovascularization measured by SMI ultrasound. Furthermore, CKD-5 patients showed greater abdominal aortic calcification. Interestingly, CKD patients displayed a negative correlation between serum soluble Klotho (sKlotho) and cIMT. Finally, CKD patients showed no progression of vascular impairment after the 18-month follow-up, with the exception of carotid plaques. Conclusions: Performing non-invasive PWV and SMI ultrasound might be useful to evaluate vascular damage in CKD before entering dialysis, possibly helping to prevent cardiovascular events, although future studies should clarify the use of these techniques in clinical practice. Full article

Background/Objectives: Vascular aging is associated with increased arterial stiffness and changes in the wall structure, leading to a loss of elasticity. Silicon is abundant in arteries and plays a key role in the synthesis and stabilization of elastin fibers. In animal models of accelerated cardiovascular aging, a specific nutritional supplement based on silicon-enriched spirulina (SpSi) has been shown to have beneficial effects on vascular function. The present study, designed as a randomized, double-blind, placebo-controlled trial, aimed to evaluate the effectiveness of this SpSi supplement on aging-related changes in vascular function among healthy older adults. Methods: Here, 120 healthy volunteers aged 60–75 years were enrolled and randomly assigned to either the SpSi group (n = 60) or placebo group (n = 60). Over 6 months, the participants received either 3.5 g of specific 1% silicon-enriched spirulina (SpSi group) or placebo tablets daily. The primary outcome was the assessment of arterial wall pressure waveforms, which included blood pressure (BP) readings and the determination of the aortic pulse wave velocity (aPWV). Secondary outcomes included the vasomotor endothelial function through post-ischemic vasorelaxation, measured using the reactive hyperemia index (RHI), and carotid intima–media thickness. Results: When considering the entire sample, none of the studied parameters differed between the placebo and SpSi groups. However, when focusing on individuals with high–normal blood pressure (i.e., systolic BP between 130 and 150 mmHg) and aPWV levels above cutoff values (>10 m/s), the BP decreased by 8% (p < 0.001) and aPWV decreased by 13.5% (p < 0.0001) in subjects receiving SpSi. In individuals with BP and aPWV levels below the cutoff values, no effect was observed. Conclusions: In healthy elderly individuals, SpSi supplementation improved high–normal blood pressure and aortic pulse wave velocity, suggesting an enhanced vascular function. Full article

Background/Objectives: Familial Mediterranean fever (FMF) is a chronic autoinflammatory disease. Throughout the disease, subclinical inflammation persists into the remission period. It is known that chronic inflammation causes endothelial dysfunction and, as a consequence, arterial stiffness occurs. In this study, carotid and aortic intima–media thicknesses (IMT) and arterial stiffness were measured in FMF patients to evaluate the risk of possible vascular damage due to chronic inflammation. Methods: The study included pediatric patients with FMF who had been in remission for a minimum of 3 months. Carotid and aortic IMT and arterial stiffness measurements were conducted using sonoelastography. The acute-phase reactants were also evaluated in all participants. Results: Carotid artery stiffness measurements by strain elastography were significantly higher in the patient group than in the control group. However, the aortic and carotid IMT were similar between the two groups. The acute-phase reactants were significantly higher in the patient group than in the control group. Conclusions: This study demonstrated that arterial stiffness increased in pediatric FMF patients. According to the results of the present study, the effects of chronic inflammation on arterial tissues may lead to atherosclerotic changes in the later stages of the disease and may pose a risk for coronary diseases. Arterial ultrasonographic and elastographic measurements to be performed periodically in children with FMF are noninvasive methods that can be used to evaluate the course of endothelial damage. We aimed to show that arterial stiffness may be a marker of early cardiovascular disease. Full article

Background/Objectives: Firefighters have an elevated risk of developing cardiovascular disease (CVD). Thus, it is vital to determine areas of health associated with the development of CVD that need improvement in the firefighter population, such as circulating lipids and arterial stiffness. The purpose of this study was to assess the potential relationship of lipid and lipoprotein metrics with measures of arterial stiffness in full-time firefighters in the southeastern United States. Methods: Twenty male full-time firefighters underwent a fasted blood draw to assess circulating lipids. Resting arterial stiffness was then assessed via pulse wave velocity (PWV) using an aortic measure. To determine the linear relationships between arterial stiffness and lipid measures of interest, a series of bivariate correlations were conducted as appropriate. The outcome variable was PWV measured continuously in m/s. The predictor variables were total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), small dense LDL-C (sdLDL-C), and triglycerides (TG) measured in mg/dL. All analyses were carried out using SPSS version 29 (α = 0.05). Results: TG levels were positively and moderately correlated with PWV (r_s = 0.497, p = 0.026). No other significant relationships were detected between PWV and the remaining variables TC (r_s = 0.104, p = 0.664), HDL-C (r_s = −0.328, p = 0.158), LDL-C (r_s = 0.184, p = 0.436), or sdLDL-C (r_s = 0.330, p = 0.155). Conclusion: Higher TG levels are associated with higher PWV and thus, arterial stiffness. Management of circulating TG may be an important consideration in maximizing arterial health and minimizing CVD risk. Full article

Background/Objectives: Poor metabolic control is associated with increased levels of advanced glycation end products (AGEs), which in turn may lead to increased arterial stiffness. The aim of this study was to estimate the association between glycated haemoglobin A1c (HbA1c) and aortic pulse wave velocity (a-PWV) in healthy subjects and to analyse the mediating effect of AGEs measured by skin autofluorescence (SAF) on this association. Methods: HbA1c, a-PWV and SAF were analysed in 390 healthy Spanish subjects from the EVasCu study (42.02 ± 13.14 years, 63.08% females). A directed acyclic graph (DAG) was generated to define the covariates to be included, and the model was confirmed via multiple linear regression analysis. Descriptive and exploratory analyses were performed to investigate the associations between variables. Finally, adjusted and unadjusted mediation analyses were performed to verify the influence of SAF on the main association between HbA1c and a-PWV. Results: Multiple linear regression analyses for a-PWV supported the validity of the structure in the DAG. Descriptive and exploratory analyses revealed that when the models were adjusted to include all covariates, the statistical significance of the main association disappeared. Mediation analysis revealed that SAF mediated 35.77% of the effect of HbA1c on a-PWV in the unadjusted model and 42.18% after adjusting for covariates. Conclusions: Our study suggests that increases in HbA1c levels are associated with increases in a-PWV and that this relationship is mediated by the SAF score in healthy adults. Full article

Objective: The aim of this study was to compare the outcomes of stiff wire-based 2D3D, 3D3D image fusion (IF), and non-image fusion techniques for simple zone 2 and zone 3 TEVAR cases in terms of radiation exposure, contrast dose, and fusion and projection accuracy. Methods: A single-center retrospective observational study was conducted based on data gathered from patients who underwent TEVAR between 2016 and 2023 at our tertiary aortic referral center. Those who underwent Z2 and Z3 TEVAR during the indicated period were included. The dose area product and number of DSAs were considered as primary outcomes, while projection accuracy and image fusion accuracy were considered as secondary outcomes. Results: A total of 79 patient were included. They were allocated to non-image fusion (NIF, n = 40), 2D3D IF (n = 14), and 3D3D IF (n = 25) groups. DAP was significantly lower both in the NIF [1542.75 µGym² (751.72–3351.25 µGym²), p = 0.011] and 2D3D IF [1320.1 µGym² (858.57–2572.07 µGym²), p = 0.013 groups compared to the 3D3D [2758.61 µGym² (2074.73–4772.9 µGym²)] cohort. In the Z3 subgroup, DAP was significantly lower in the 2D3D IF group compared to the 3D3D IF group [(1270.84 µGym² (860.56–2144.69 µGym²) vs. 2735.76 µGym² (1583.86–5077.23 µGym²), p = 0.044]. 2D3D image fusion was associated with a significantly lower number of pre-deployment angiographies compared to NIF [1 (1–1) vs. 2 (1–3), p = 0.031], which we used as a surrogate for contrast dose. Conclusions: The entire study population analysis showed a significantly lower DAP with 2D3D IF compared to 3D3D IF, while there was no significant difference compared to NIF. It seems that stiff wire-based 2D3D IF does not cost in terms of DAP compared to NIF, while it is more favorable compared to 3D3D IF. Additionally, simple Z3 TEVAR cases might be improved by implementing the stiff wire-based 2D3D technique as a result of decreased DAP compared to 3D3D IF and decreased contrast dose compared to NIF. Full article

Objective: The study aimed to assess the potential impacts of mean arterial pressure (MAP) and its determinants (cardiac output and systemic vascular resistance) on diabetic nephropathy (DNP)-associated impaired aortic function. Methods: This multi-ethnic study included 115 chronic kidney disease (CKD) patients (67 non-dialysis and 48 dialysis). Six aortic function measures were evaluated by SpygmoCor. The stroke volume was determined by echocardiography. Results: Hypertensive nephropathy (HNP) (53.9%), DNP (32.2%), glomerulonephritis (19.1%), and HIV-associated nephropathy (7.8%) composed the major CKD etiologies. Concurrent HNP and DNP were present in 31.1% of the patients. Participants with compared with those without concurrent HNP and DNP experienced more frequent established cardiovascular disease (43.2% versus 14.9%, p = 0.01), a faster pulse wave velocity (p = 0.001), and smaller total arterial compliance as an indicator of proximal aortic stiffness (p = 0.03). DNP was associated with each aortic function measure (p < 0.001–0.02) independent of potential confounders and MAP, as well as its determinants. HNP was not related to aortic function (p > 0.05 for all relationships). MAP and its determinants did not mediate the potential impact of DNP on aortic function (−4.1–6.4% contribution). Covariates that were associated with impaired aortic function measures included MAP and its determinants (p < 0.001–0.01). Conclusions: Mean or distending arterial pressure and its determinants were associated with impaired aortic function in the overall CKD population. However, these hemodynamic factors did not mediate DNP-associated impaired aortic function. Our results suggest that blood pressure lowering can be anticipated to improve impaired aortic function in the overall CKD population but not when it is solely induced by DNP. Full article

People with HIV (PWH) have an elevated risk of cardiovascular disease compared to those without HIV. This study aimed to investigate the relative serum expression of microRNAs (miRNAs) associated with arterial stiffness, a significant marker of cardiovascular disease. A total of 36 male PWH and 36 people without HIV, matched for age, body mass index, pack years, and dyslipidemia, were included in the study. Participants with a history of hypertension, diabetes mellitus, cardiovascular disease, cancer, or intravenous drug use were excluded. Markers of arterial stiffness, including carotid–femoral pulse wave velocity (cfPWV) and augmentation index adjusted to 75 beats per minute (AIx@75), were measured via applanation tonometry. We analyzed the relative expression of 11 circulating miRNAs using real-time PCR: let-7b-5p, miR-19b-3p, miR-21-5p, miR-29a-3p, miR-126-3p, miR-130a-3p, miR-145-5p, miR-181b-5p, miR-221-3p, miR-222-3p, and miR-223-3p. cfPWV was significantly higher in PWH compared to people without HIV (9.3 vs. 8.6 m/s, p = 0.019), while AIx@75, peripheral, and aortic blood pressures did not differ among groups. The relative expression of circulating miRNAs was significantly higher in PWH compared to controls for let-7b-5p (fold change: 5.24, p = 0.027), miR-21-5p (fold change: 3.41, p < 0.001), miR-126-3p (fold change: 1.23, p = 0.019), and miR-222-3p (fold change: 3.31, p = 0.002). Conversely, the relative expression of circulating miR-19b-3p was significantly lower in PWH (fold change: 0.61, p = 0.049). Among HIV-related factors, the nadir CD4+T-cell count of <200 cells/mm³ was independently associated with the relative expression of circulating let-7b-5p (β = 0.344, p = 0.049), while current non-nucleoside reverse transcriptase inhibitor (NNRTI) treatment was independently associated with the relative expression of circulating miR-126-3p (β = 0.389, p = 0.010). No associations were found between the duration of HIV infection or the duration of ART and the serum miRNA expression. This study highlights a distinct circulating miRNA profile in PWH with higher cfPWV compared to those without HIV, which may contribute to increased arterial stiffness. Full article