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Hypertension and nephrology

DECEMBER 10, 2018

[Prognostic role of arterial stiffness in IgA nephropathy]

SÁGI Balázs, KÉSŐI István, VAS Tibor, CSIKY Botond, KOVÁCS Tibor, NAGY Judit

[Background: Arterial stiffness has a prognostic role in chronic cardiovascular diseases. Pulse wave velocity (PWV) determined by the carotid-femoral pulse detection is accepted as a gold standard method. Further diagnostic procedures are in use to assess the arterial stiffness including the finger photoplethysmography. The prognostic role of this method is limited in chronic renal diseases. The goal of our investigation was to determine the prognostic significance of the stiffness index (SIDVP) measured by the photoplethysmographic method in IgA nephropathy. Patients and methods: One hundred and three histologically proved IgA nephropathy patients with chronic kidney disease stage 1-4 were investigated (67 male, 36 female, 45 ± 11 years) and followed for an average 65 (6-107) months. The stiffness index was determined by the volume alteration of the digital artery during the cardiac cycle (Pulse Trace system, Micro Medical, Gilingham, Kent, UK). The primary combined end point was total mortality, major cardiovascular events (stroke, myocardial infarction or cardiovascular procedure, for example revascularisation) plus achieving end stage renal disease. The secondary end points were cardiovascular and renal end points alone. Results: The patients with increased stiffness index (> 10 m/s) had significantly more combined primary end point events (10/60 vs. 19/43, P = 0.015). In case of the secondary end points the renal end points were significantly more frequent in patients with higher stiffness index. Stiffness index has also proved to be an independent predictor on survival from other cardiovascular risk factors (age, hypertension, diabetes, obesity, lipid disturbances and decrease of renal function) using the Cox regression model in IgA nephropathy. Every 1 m/s increase in stiffness index resulted a 17% gain in the occurrence of the combined primary end point. Conclusions: Stiffness index determined by finger photoplethysmography is an eligible parameter to assess the prognosis in IgA nephropathy. Increased stiffness index in IgA nephropathy seems to be a good prognostic tool for identification of higher risk patients.]

Clinical Neuroscience

MARCH 30, 2012

[The comparative analysis of arterial wall thickness and arterial wall stiffness in smoking and non-smoking students]

LÉRÁNT Brigitta, CHRISTINA Straesser, OLÁH László, KARDOS László, CSIBA László

[Aim - Our aim was to detect the adverse effects of smoking on arterial wall thickness and arterial wall stiffness in young, healthy university students. Question - Does only a few years of smoking result in measurable vascular alterations in healthy young people? Methods - We measured the intima-media thickness (IMT) on both common carotids by means of carotid ultrasound, then we examined the stiffnessparameters of the blood vessels (pulse wave velocity, PWV; augmentation index, Aix) with the help of arteriograph. Subjects - We recruited 25 smoking and 25 non-smoking young volunteers aged 19-33 for our examinations. Exclusion citeria included any known diseases, abnormally high cholesterol levels, BMI value exceeding 30 kg/m2. Only regular smokers were allowed to participate in the smoking group (at least for six months, minimum five cigarettes a day). Results - In case of smokers morphological, hemodinamic and stiffnessparameters showed significantly higher values compared to non-smokers. Mean bilateral IMT was 0.52±0.034 mm in case of smokers, while in non-smokers we measured 0.46±0.036 mm (this difference is significant: p<0.01). PWV and heart rate also showed significantly higher values in smoking group (PWV: p<0.01; heart rate: p<0.05). Unadjusted to age, gender and smoking status there was a significant correlation between IMT and PWV (0.1 mm thicker IMT - 0.6354 m/s faster PWV). Gender differences were found in vascular changes caused by smoking. Conclusion - The adverse effects of smoking on arterial wall thickness and arterial wall stiffness can be seen even at a young age, only after a few years of smoking. Both higher IMT and higher PWV sensitively predict vascular damages.]

Hypertension and nephrology

FEBRUARY 20, 2010

[Pathophysiology, measurement methods and prognostic role of arterial stiffness]

TIMÁR Orsolya, SOLTÉSZ Pál

[In the past decade, a novel property of circulation, arterial stiffness (or decreased arterial distensibility) began to recieve special attention. Three years ago, Hypertonia and Nephrologia has already reviewed the gathered information on the clinical significance of arterial stiffness, described two commonly used stiffness parameters, pulse wave velocity (PWV) and augmentation index (AIx), and assessed the relationship of arterial stiffness and the traditional risk factors. Recently, more and more clinical epidemiological studies provided evidence that the parameters quantifying arterial stiffness are more than innocent side effects of cardiovascular changes, as they can be linked to target organ damage and increased mortality. In the present study, we review the pathomechanism and current methods of measurement of decreased arterial compliance, we summarize the results of recently closed epidemiologic studies and finally, we will briefly discuss possible measures of arterial stiffness treatment.]

Lege Artis Medicinae

JUNE 20, 2011

[The role and significance of vascular aging in the risk stratification of cardiovascular prevention]

VÉRTES András

[The structure and function of arteries change throughout one’s lifetime. The most important changes include lumenal dilation, diffuse intimal and medial thickening, increased stiffness, reduced compliance of central arteries and endothelial dysfunction. Arterial stiffness, an increased pulse wave velocity (PWV) and an increased carotid intima-media thickness (IMT) are independent predictors of cardiovascular events. The early vascular aging (EVA) could help clinicians to determine the increased cardiovascular risk. EVA can be be determined by noninvasive methods, as arterial stiffness and carotid IMT. EVA can be suitable for the early detection of cardiovascular diseases.]