Non-invasive Assessment of Arterial Stiffness in Human

( Hwang Moon-hyon ) 인천대학교 스포츠과학연구소 2016 스포츠科學硏究誌 Vol.29 No.0

Larger arterial trees contribute to initial adjustments of blood pressure by their own buffering capacity. Due to their anatomical characteristics to buffer pressure wave, they are more vulnerable than smaller vasculatures. Thus, the assessment of central artery stiffness has more clinical importance than that of peripheral artery stiffness. Although several mechanistic candidates to determine arterial stiffness have been introduced, it seems that arterial stiffness is determined by three major mechanisms: anatomical alteration of vascular wall, autonomic nervous system, and vascular endothelial function. Arterial stiffness measures including pulse wave velocity, augmentation index, carotid artery compliance, and beta-stiffness index can be accurately assessed in central and peripheral vascular trees by using non-invasive methodologies such as tonometry-, blood pressure cuff-, and Doppler-based systems. Arterial stiffness has clinical implications in that arterial stiffness is an independent risk factor for future cardiovascular events and also reflects cardiovascular mortality and even all-cause mortality. Thus, it is very important to understand the principles of arterial stiffness measures, and to assess arterial stiffness with standardized, validated methodological procedures.

대사증후군에서 중심대동맥압의 변화

이지인,손태서,권혁상,이정민,장상아,차봉연,손현식 대한당뇨병학회 2008 Diabetes and Metabolism Journal Vol.32 No.6

The metabolic syndrome (MS) has been characterized as a cluster of risk factors that includes dyslipidemia, hypertension, glucose intolerance and central obesity. This syndrome increases the risk of cardiovascular disease. Augmentation index (AIx), a composite of wave reflection form medium-sized muscular arteries is related to the development of coronary artery disease. The aim of this study is to examine the change on central aortic waveforms in subjects between patients with metabolic syndrome and normal subjects. Using the non-invasive technique of pulse wave analysis by applantation tonometry, we investigated central aortic waveforms in 45 patients with MS and 45 matched controls. The MS was defined by NCEP-ATP III criteria. Age did not differ between the two groups. AIx was significantly elevated in patinets with MS compared with controls (21.91 ± 11.41% vs 18.14 ± 11.07%; P < 0.01). Subendocardial viability ratio (SEVR) (158.09 ± 28.69 vs 167.09 ± 30.06; P < 0.01) was significantly decreased in patients with MS compared with controls. Only the fasting glucose (r = 0.317, P = 0.03) among the components of MS and age (r = 0.424, P = 0.004) had a positive correlation with AIx. AIx increased as the number of MS components increased. These results show that the MS increased systemic arterial stiffness. Age and fasting blood glucose are independent risk factors of arterial stiffness in MS. The individual MS components, except for fasting blood glucose, do not affect arterial stiffness independently. But the clustering of MS components might interact to synergistically affect arterial stiffness. (KOREAN DIABETES J 32:522-528, 2008) The metabolic syndrome (MS) has been characterized as a cluster of risk factors that includes dyslipidemia, hypertension, glucose intolerance and central obesity. This syndrome increases the risk of cardiovascular disease. Augmentation index (AIx), a composite of wave reflection form medium-sized muscular arteries is related to the development of coronary artery disease. The aim of this study is to examine the change on central aortic waveforms in subjects between patients with metabolic syndrome and normal subjects. Using the non-invasive technique of pulse wave analysis by applantation tonometry, we investigated central aortic waveforms in 45 patients with MS and 45 matched controls. The MS was defined by NCEP-ATP III criteria. Age did not differ between the two groups. AIx was significantly elevated in patinets with MS compared with controls (21.91 ± 11.41% vs 18.14 ± 11.07%; P < 0.01). Subendocardial viability ratio (SEVR) (158.09 ± 28.69 vs 167.09 ± 30.06; P < 0.01) was significantly decreased in patients with MS compared with controls. Only the fasting glucose (r = 0.317, P = 0.03) among the components of MS and age (r = 0.424, P = 0.004) had a positive correlation with AIx. AIx increased as the number of MS components increased. These results show that the MS increased systemic arterial stiffness. Age and fasting blood glucose are independent risk factors of arterial stiffness in MS. The individual MS components, except for fasting blood glucose, do not affect arterial stiffness independently. But the clustering of MS components might interact to synergistically affect arterial stiffness. (KOREAN DIABETES J 32:522-528, 2008)

P033 : Association of arterial stiffness with disease severity in psoriasis patients: a cross-sectional study

( Soo Young Kim ),( Nam Kyung Roh ),( Ho Jung Jung ),( Yu Ri Kim ),( Jae Wook Jung ),( Yu Na Lee ),( Hyung Jin Hahn ),( Hyun Jung Park ),( Yang Won Lee ),( Yong Beom Choe ),( Kyu Joong Ahn ) 대한피부과학회 2013 대한피부과학회 학술발표대회집 Vol.65 No.2

Background: Psoriasis is associated with an increased risk of atherosclerosis although the underlying mechanism remains unclear. Endothelial dysfunction is the critical early step in the process of atherogenesis commonly assessed by measuring arterial stiffness. Objectives: We aimed to investigate an increase of arterial stiffness in patient with psoriasis and examine the relationship between arterial stiffness and other characteristics of the patients with psoriasis. Methods: Twenty-six patients with psoriasis and 25 age-and sex-matched healthy controls were enrolled. Baseline demographics and laboratory data were recorded. The severity of the disease was evaluated by the Psoriasis Area and Severity Index (PASI). Arterial stiffness index as cardioankle vascular index (CAVI) and aortic augmentation index were measured. The relation of arterial stiffness index with clinical features of psoriasis and various laboratory values was assessed. Results: The left CAVI significantly increased in the psoriatic patients than those in the healthy controls. There was a positive correlation between arterial stiffness parameters and age, systolic/diastolic blood pressure and urea. The incidence of CVD risk factors as hypertension, diabetes, dyslipidemia were significantly high in patients with psoriasis. Conclusion: We found that CAVI significantly increased in psoriasis patients. Arterial stiffness in patients with psoriasis is positively related with age, blood pressure and urea level.

Role of Inflammation in the Pathogenesis of Arterial Stiffness

박성하,Edward G. Lakatta 연세대학교의과대학 2012 Yonsei medical journal Vol.53 No.2

Increased arterial stiffness is an independent predictor of cardiovascular disease independent from blood pressure. Recent studies have shed new light on the importance of inflammation on the pathogenesis of arterial stiffness. Arterial stiffness is associated with the increased activity of angiotensin II, which results in increased NADPH oxidase activity, reduced NO bioavailability and increased production of reactive oxygen species. Angiotensin II signaling activates matrix metalloproteinases (MMPs) which degrade TGFβ precursors to produce active TGFβ, which then results in increased arterial fibrosis. Angiotensin II signaling also activates cytokines, including monocyte chemoattractant protein-1, TNF-α, interleukin-1, interleukin-17 and interleukin-6. There is also ample clinical evidence that demonstrates the association of inflammation with increased arterial stiffness. Recent studies have shown that reductions in inflammation can reduce arterial stiffness. In patients with rheumatoid arthritis,increased aortic pulse wave velocity in patients was significantly reduced by anti tumor necrosis factor-α therapy. Among the major classes of anti hypertensive drugs, drugs that block the activation of the RAS system may be more effective in reducing the progression of arterial stiffness. Thus, there is rationale for targeting specific inflammatory pathways involved in arterial stiffness in the development of future drugs. Understanding the role of inflammation in the pathogenesis of arterial stiffness is important to understanding the complex puzzle that is the pathophysiology of arterial stiffening and may be important for future development of novel treatments.

중년 여성의 체력과 동맥경직도의 관련성

정은지(Eunji Jung),박세정(Saejong Park),노호성(Hosung Nho) 한국생활환경학회 2013 한국생활환경학회지 Vol.20 No.2

The purpose of this study was to examine the relationship between arterial stiffness and physical fitness in middle-aged women and the independent influence of cardiorespiratory fitness (CRF) or muscle fitness (MF) on arterial stiffness. The participants performed a physical fitness test including grip strength, sit-ups, 20 m shuttle run, sit and reach, 10 m × 4 rep shuttle run and long jump. The indexes of MF (sum of the z scores for relative grip strength and sit ups) and TF (sum of the z-scores for all fitness factors) was calculated. Brachial-ankle pulse wave velocity (ba PWV) was measured to assess the arterial stiffness. The results were following: significant differences were found in total cholesterol (P < 0.05), HDLC (P < 0.05), LDLC (P < 0.01), triglyceride (P < 0.05), Framingham Risk Score (P < 0.001) and coronary heart disease risk (P < 0.001) among the levels of arterial stiffness but not in body mass index or percent body fat. There were significant negative correlations between health-related or skill-related physical fitness and CHD risk, and there were significant differences in CRF (P < 0.001), MF (P < 0.001) or TF (P < 0.001) among the levels of the CHD risk. The arterial stiffness has significant negative correlations with muscular strength (P < 0.05), muscular endurance (P < 0.001), cardiorespiratory (P < 0.001), agility (P < 0.05), or power (P < 0.05), and also with MF(P < 0.001) or TF(P < 0.001). The lowest levels of arterial stiffness presented higher CRF(P < 0.001), MF(P < 0.001) or TF(P < 0.001) and both CRF and MF were all independent factors for the arterial stiffness. These findings suggest that a comprehensive exercise program including not only cardiorespiratory endurance but also muscular strength, muscular endurance, agility and power may be needed for improving the arterial stiffness.

Impact of Cigarette Smoking and Exercise on Arterial Stiffness: A Narrative Literature Review

박원일,성순창,홍광석 한국운동생리학회 2023 운동과학 Vol.32 No.2

PURPOSE: Smoking often causes acute and chronic cardiovascular disorders. Cigarette smoking increases oxidative stress, reduces nitric oxide bioavailability, and changes the extracellular matrix, impairing arterial stiffness. However, regular physical activity and smoking cessation significantly and rapidly reverse the detrimental effects. This narrative review summarizes the relevant research that describes the impacts of cigarette smoking on the cardiovascular system and demonstrates the therapeutic or preventative roles of exercise and smoking cessation in smoking-associated arterial stiffness. METHODS: We used scientific search engines, including PubMed, Web of Science, Google Scholar, and Wiley Online Library, to identify previous studies exploring the effects of smoking, exercise, and smoking cessation on arterial stiffness. RESULTS: We discussed the most important therapeutic and/or preventive roles of exercise and smoking cessation in decreasing arterial stiffness. Most studies have demonstrated that acute and chronic smoking increase arterial stiffness. Smoking and physical activity were negatively associated. However, this relationship was often attenuated or reversed during adult exercise interventions. In addition, smoking cessation reversed the effects of smoking on arterial stiffness. CONCLUSIONS: Smoking increases the risk of acute and chronic cardiovascular disease. Cigarette smoking deteriorates arterial stiffness by altering the vascular walls. However, regular exercise and smoking cessation can improve or prevent impaired arterial stiffness

일시적 근력 운동 후 동맥경직도 증가와 자율신경계 변화의 관련성

안의수 ( E. S. Ahn ),윤은선 ( E. S. Yoon ) 한국운동생리학회(구-한국운동과학회) 2010 운동과학 Vol.19 No.3

일시적 또는 지속적인 근력운동은 동맥경직도를 증가시키는 것으로 알려져 있지만, 아직 그 정확한 기전에 대해서는 밝혀지지 않았다. 자율신경계 기능 저하는 동맥경직도 증가와 관련 있으며, 근력운동 직후에는 자율신경계 기능이 일시적으로 감소된다. 따라서, 본 연구의 목적은 일시적인 근력 운동 후 동맥경직도와 자율신경계의 변화를 살펴보고 두 지표간의 상관성에 대해 알아보고자 하였다. 연구 대상은 평균 연령 21세의 남성 14명으로 하였다. 연구 설계는 한 피험자가 근력운동과 통제 처치를 두 번 모두 받는 교차설계로 하였다. 근력운동은 최대근력의 60%강도에서 8종목의 전신운동을 15회 반복, 2세트 실시하였으며, 통제 처치는 운동과 동일 시간 동안 누운 자세에서 휴식을 취하였다. 심박수, 혈압 및 동맥경직도 지표로서 경동맥-대퇴동맥 맥파전파속도와 대동맥 증폭지수를 측정하였으며, 자율신경계 기능 검사로서 심박수 변이도를 측정하였다. 모든 변인은 처치 전과 처치 후 20분에 측정하였다. 실험 결과 다음과 같은 결과를 얻었다. 근력 운동 후 20분에 안정시 심박수, 대동맥 수축기 혈압, 경동맥-대퇴동맥 맥파전파속도 그리고 심박수 75박에서의 대동맥 증폭지수가 유의하게 증가하였으며, 부교감신경계 활성도의 지표인 RMSSD, NN50, pNN50은 유의하게 감소하는 결과를 나타내었다(p<.05). 근력운동 후, 동맥경직도와 자율신경계 변화와의 상관관계를 분석한 결과, 경동맥-대퇴동맥 맥파전파속도 변화값과 RMSSD 변화값이 유의한 음의 상관을 보였다(r=-0.39, p<.05). 결론적으로 본 연구 결과는 일시적 근력운동 후 증가된 동맥경직도는 자율신경계 변화, 즉 부교감신경계 활성도 감소와 관련이 있을 것으로 사료된다. Although acute and chronic resistance exercise is associated with increases in arterial stiffness, the underlying mechanisms are not completely understood. Autonomic nervous system function is associated with arterial stiffness. The purpose of this study was to test the hypothesis that acute resistance exercise would increase arterial stiffness and this increased arterial stiffness would be related to changes in autonomic nervous system function. Using a randomized cross over design, 14 healthy young subjects(age 21±2 yrs, BMI 23.4±1.9 kg/m2) completed a resistance exercise session and a sham control session(rest in the exercise room) on two separate days. Carotid-femoral pulse wave velocity(PWV) and aortic augmentation index(AIx) were used as indices of arterial stiffness. Heart rate variability was used to assess autonomic function. Vascular and autonomic measures were made at baseline and 20 minutes after resistance exercise(8 exercises, 60% of 1 repetition maximal). There were significant increases in resting heart rate(59.2±2.6 to 80.4±3.1bpm), aortic systolic blood pressure(96.6±2.4 to 102.4±2.1mmHg), carotid-femoral PWV(6.07±0.3 to 6.36±0.2m/s), and AIx@75bpm(-15.3±3.4 to -0.07±3.3%)(all p<.05) after resistance exercise compared with sham control. The root-mean square of successive differences(RMSSD), number of RR intervals differing by greater than 50 ms(NN50), and percentage of NN50(pNN50) as an indices of parasympathetic modulation were significantly decreased after resistance exercise(p<.05). Also, change in carotid-femoral PWV after resistance exercise was associated with changes in RMSSD (r=-0.39, p<.05) after resistance exercise. These data indicate that arterial stiffness is increased following acute resistance exercise and changes in arterial stiffness are associated with changes in heart rate variability. This would suggest that increases in arterial stiffness following resistance exercise are associated with changes in autonomic tone.

Increased pulse wave velocity and augmentation index after isometric handgrip exercise in patients with coronary artery disease

문신항,문재철,허다희,임영협,최준혁,김송이,김기석,주승재 대한고혈압학회 2015 Clinical Hypertension Vol.21 No.4

Background Arterial stiffness of patients with coronary artery disease (CAD), which is expected to be increased due to a generalized atherosclerotic process of human body, may be more evident after the acute increase of blood pressure (BP) or peripheral vascular resistance. Isometric handgrip exercise is a simple and easily applicable method to achieve this goal. We investigated the changes of hemodynamic parameters and arterial stiffness indexes after handgrip exercise in patients with CAD. Methods Forty-two subjects, who underwent coronary angiography (CAG), were enrolled. After CAG, baseline arterial waveforms were traced at the aortic root and external iliac artery using right coronary catheters. Arterial waveforms were recorded at 1, 2, and 3 min in the aortic root and at 3 min in the external iliac artery after isometric handgrip exercise at 30% ~ 40% of the maximal handgrip power. Augmentation pressure (AP) and augmentation index (AIx) were measured at aortic pressure waveforms. Pulse wave velocity (PWV) was calculated using the ECG-gated time difference of the upstroke of arterial waveforms and the distance between the aortic root and the external iliac artery. Results Thirty patients had CAD (CAD group), and others showed no significant coronary stenosis (non-CAD group). Baseline hemodynamic parameters including AIx and PWV were not different between both groups. After isometric handgrip exercise, central systolic blood pressure (BP), central diastolic BP, central pulse pressure, peripheral systolic BP, and peripheral pulse pressure were increased in all patients. AIx inclined significantly from 1 min after exercise only in patients with CAD (before 17.7% ± 9.7% vs. 3 min after exercise 22.3% ± 10.7%, p < 0.001). PWV also increased significantly after exercise only in patients with CAD (before 10.03 ± 1.99 m/s vs. 3 min after 11.09 ± 2.45 m/s, p < 0.001). Conclusions Arterial stiffness indexes at rest were not different between patients with and without CAD. After isometric handgrip exercise, increased arterial stiffness became evident only in patients with CAD.

Effects of Acute Resistance Exercise on Arterial Stiffness in Young Men

윤은선,정수진,천성근,오유성,김설향,제세영 대한심장학회 2010 Korean Circulation Journal Vol.40 No.1

Background and Objectives: Increased central arterial stiffness is an emerging risk factor for cardiovascular disease. Acute aerobic exercise reduces arterial stiffness, while acute resistance exercise may increase arterial stiffness, but this is not a universal finding. We tested whether an acute resistance exercise program was associated with an increase in arterial stiffness in healthy young men. Subjects and Methods: Thirteen healthy subjects were studied under parallel experimental conditions on 2 separate days. The order of experiments was randomized between resistance exercise (8 resistance exercises at 60% of 1 repeated maximal) and sham control (seated rest in the exercise room). Carotid-femoral pulse wave velocity (PWV) and aortic augmentation index as indices of aortic stiffness were measured using applanation tonometry. Measurements were made at baseline before treatments, 20 minutes, and 40 minutes after treatments (resistance exercise and sham control). Results: There was no difference in resting heart rate or in arterial stiffness between the two experimental conditions at baseline. At 20 minutes after resistance exercise, heart rate, carotid-femoral PWV and augmentation index@75(%) were significantly increased in the resistance exercise group compared with the sham control (p<0.05). Brachial blood pressure, central blood pressure and pulse pressure were not significantly increased after resistance exercise. Conclusion: An acute resistance exercise program can increase arterial stiffness in young healthy men. Further studies are needed to clarify the effects of long-term resistance training on arterial stiffness.

The role of habitual physical activity on arterial stiffness in elderly Individuals: a systematic review and meta-analysis

( Wonil Park ),( Hun-young Park ),( Kiwon Lim ),( Jonghoon Park ) 한국운동영양학회 2017 Physical Activity and Nutrition (Phys Act Nutr) Vol.21 No.4

[Purpose] Physical inactivity behavior at middle age or older is a major risk factor for cardiovascular disease. However, the effects of levels of habitual physical activity on arterial stiffness in elderly population remain unclear currently. Therefore, the purpose of this study was to demonstrate whether the effects of habitual physical activity could attenuate arterial stiffness in elderly individuals via a meta-analysis. [Methods] We searched the Medline and Embase databases from January 1997 through November 2017, using the medical subject headings “older population”, “physical activity” (e.g., walking, cycling, climbing, and any participation in sports), “arterial stiffness”, “pulse wave velocity”, and “cardiovascular health” published in English. Six articles (2,932 participants) were included in this meta-analysis. We investigated the effects of habitual physical activity on arterial stiffness, which was measured by the pulse wave velocity. [Results] Results confirmed heterogeneity (Q-value = 160.691, p = 0.000, I2 = 96.888) between individual studies. The effect size was calculated using random effect model. It has shown that physically active individuals have significantly lower arterial stiffness than their sedentary peers do (standardized mean difference: -1.017 ± 0.340, 95% confidence interval: -1.684 ~ -0.350, p = 0.003). [Conclusions] Findings of our systematic review and meta-analysis indicate that habitual physical activity can significantly ameliorate arterial stiffness in the elderly population.