To fight the COVID-19 pandemic, messenger RNA (mRNA) vaccines were the first to be adopted by vaccination programs worldwide. We sought to investigate the short-term effect of mRNA vaccine ...administration on endothelial function and arterial stiffness. Thirty-two participants (mean age 37 ± 8 years, 20 men) who received the BNT162b2 mRNA COVID-19 vaccine were studied in three sessions in a sequence-randomized, sham-controlled, assessor-blinded, crossover design. The primary outcome was endothelial function (assessed by brachial artery flow-mediated dilatation (FMD)), and the secondary outcomes were aortic stiffness (evaluated with carotid-femoral pulse wave velocity (PWV)) and inflammation (measured by high-sensitivity C-reactive protein (hsCRP) in blood samples). The outcomes were assessed prior to and at 8 h and 24 h after the 1st dose of vaccine and at 8 h, 24 h, and 48 h after the 2nd dose. There was an increase in hsCRP that was apparent at 24 h after both the 1st dose (-0.60 95% confidence intervals CI: -1.60 to -0.20, p = 0.013) and the 2nd dose (maximum median difference at 48 h -6.60 95% CI: -9.80 to -3.40, p < 0.001) compared to placebo. The vaccine did not change PWV. FMD remained unchanged during the 1st dose but decreased significantly by 1.5% (95% CI: 0.1% to 2.9%, p = 0.037) at 24 h after the 2nd dose. FMD values returned to baseline at 48 h. Our study shows that the mRNA vaccine causes a prominent increase in inflammatory markers, especially after the 2nd dose, and a transient deterioration of endothelial function at 24 h that returns to baseline at 48 h. These results confirm the short-term cardiovascular safety of the vaccine.
Measurement of blood pressure is one of the most important and powerful clinical tools in clinical practice. Physicians use the classical method that was introduced more than 100 years ago with the ...emergence of the brachial cuff sphygmomanometer. The use of this method, despite its initial setbacks, spread like fire throughout the medical community with the boost by the early adoption by insurance companies to assess risk as well as the ease of use, the availability with the wide variety of devices, the good reproducibility and its predictive role. However, a long-forgotten dispute between measurements of peripheral (brachial) and central (aortic, carotid) blood pressure has resurfaced after the introduction of techniques and devices that can easily and accurately estimate non-invasively the central pressure waveform. Clinicians, until recently, focussed only on the pressure waveform trough (diastole) and peak (systole), ignoring the possible information provided by the rest of the arterial pressure waveform. Several restrictions exist with peripheral blood pressures measured with either an oscillometric or a sphygmomanometer device that blur the existing image of the ideal biomarker to describe the haemodynamic characteristics of the cardiovascular system. On the other hand, central pressures seem to be more pathophysiologically relevant to end-organ damage of the brain, heart and kidneys and on future events. Furthermore, measurement of the central waveform can provide clinically useful information, like the quantification of wave reflections with augmentation index, beyond blood pressure measured in the brachial artery. This article will explain the pathophysiological mechanisms linking central pressures to cardiovascular outcomes, review the evidence for the use of central blood pressure over peripheral pressures, elaborate on the prognostic role of central blood pressures and finally review the latest developments on the pharmacological modulation of central blood pressures.
Arterial involvement has been implicated in the coronavirus disease of 2019 (COVID-19). Fluorine 18-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) imaging is a ...valuable tool for the assessment of aortic inflammation and is a predictor of outcome. We sought to prospectively assess the presence of aortic inflammation and its time-dependent trend in patients with COVID-19.
Between November 2020 and May 2021, in this pilot, case-control study, we recruited 20 patients with severe or critical COVID-19 (mean age of 59 ± 12 years), while 10 age and sex-matched individuals served as the control group. Aortic inflammation was assessed by measuring 18F-FDG uptake in PET/CT performed 20-120 days post-admission. Global aortic target to background ratio (GLA-TBR) was calculated as the sum of TBRs of ascending and descending aorta, aortic arch, and abdominal aorta divided by 4. Index aortic segment TBR (IAS-TBR) was designated as the aortic segment with the highest TBR.
There was no significant difference in aortic 18F-FDG PET/CT uptake between patients and controls (GLA-TBR: 1.46 1.40-1.57 vs. 1.43 1.32-1.70, respectively, P = 0.422 and IAS-TBR: 1.60 1.50-1.67 vs. 1.50 1.42-1.61, respectively, P = 0.155). There was a moderate correlation between aortic TBR values (both GLA and IAS) and time distance from admission to 18F-FDG PET-CT scan (Spearman’s rho = − 0.528, P = 0.017 and Spearman’s rho = − 0.480, p = 0.032, respectively). Patients who were scanned less than or equal to 60 days from admission (n = 11) had significantly higher GLA-TBR values compared to patients that were examined more than 60 days post-admission (GLA-TBR: 1.53 1.42-1.60 vs. 1.40 1.33-1.45, respectively, P = 0.016 and IAS-TBR: 1.64 1.51-1.74 vs. 1.52 1.46-1.60, respectively, P = 0.038). There was a significant difference in IAS- TBR between patients scanned ≤ 60 days and controls (1.64 1.51-1.74 vs. 1.50 1.41-1.61, P = 0.036).
This is the first study suggesting that aortic inflammation, as assessed by 18F-FDG PET/CT imaging, is increased in the early post COVID phase in patients with severe or critical COVID-19 and largely resolves over time. Our findings may have important implications for the understanding of the course of the disease and for improving our preventive and therapeutic strategies.
The post-percutaneous coronary intervention (post-PCI) fractional flow reserve (FFR) can detect suboptimal PCI or residual ischemia and potentially lead to fewer adverse clinical outcomes. We sought ...to investigate the predictive value of the angiography-derived FFR for adverse cardiovascular events in patients after PCI. We conducted a comprehensive search of electronic databases, MEDLINE, EMBASE, and the Cochrane Library, for studies published until March 2023 that investigated the prognostic role of angiography-derived fractional flow reserve values after PCI. We investigated the best predictive ability of the post-PCI angiography-derived FFR and relative risk (RR) estimates with 95% confidence intervals (CIs) between post-PCI angiography-derived FFR values and adverse events. Thirteen cohort studies involving 6961 patients (9719 vascular lesions; mean follow-up: 2.2 years) were included in this meta-analysis. The pooled HR of the studies using specific cut-off points for post-PCI angiography-derived FFR was 4.13 (95% CI, 2.92–5.82) for total cardiovascular events, while the pooled HRs for target vessel revascularization, cardiac death, target vessel myocardial infarction, and target lesion revascularization were 6.87 (95% CI, 4.93–9.56), 6.17 (95% CI, 3.52–10.80), 3.98 (95% CI, 2.37–6.66) and 6.27 (95% CI, 3.08–12.79), respectively. In a sensitivity analysis of three studies with 1789 patients assessing the predictive role of the post-PCI angiography-derived FFR as a continuous variable, we found a 58% risk reduction for future adverse events per 0.1 increase in the post-PCI angiography-derived FFR value. In conclusion, post-PCI angiography-derived FFR is an effective tool for predicting adverse cardiovascular events and could be potentially used in decision making, both during PCI and in the long-term follow-up.
Despite the increasing use of transcatheter aortic valve procedures, many patients still require surgical aortic valve replacement (SAVR). Assessing arterial properties in patients undergoing SAVR ...for aortic valve stenosis can be challenging, and the existing evidence is inconclusive. Our study aimed to investigate the impact of SAVR on vascular stiffness and the quality of life, as well as the different effects of valve type on arterial properties.
We included 60 patients (mean age 70.25 ± 8.76 years, 65% men) with severe symptomatic aortic stenosis who underwent SAVR. Arterial stiffness (cfPWV, baPWV) and vascular parameters (AIx@75, central pressures, SEVR) were measured at baseline, pre-discharge, and 1-year post-operation. The QOL was assessed using the generic questionnaire-short-form health survey 36 (SF-36) pre-operatively and at 1 year.
Post-SAVR, cfPWV increased immediately (7.67 ± 1.70 m/s vs. 8.27 ± 1.92 m/s,
= 0.009) and persisted at 1 year (8.27 ± 1.92 m/s vs. 9.29 ± 2.59 m/s,
≤ 0.001). Similarly, baPWV (n = 55) increased acutely (1633 ± 429 cm/s vs. 2014 ± 606 cm/s,
< 0.001) and remained elevated at 1 year (1633 ± 429 cm/s vs. 1867 ± 408 cm/s,
< 0.001). Acute decrease in Alx@75 (31.16 ± 10% vs. 22.48 ± 13%,
< 0.001) reversed at 1 year (31.16 ± 10% vs. 30.98 ± 9%,
= 0.71). SEVR improved (136.1 ± 30.4% vs. 149.2 ± 32.7%,
= 0.01) and persisted at 1 year (136.1 ± 30.4% vs. 147.5 ± 30.4%,
= 0.01). SV had a greater cfPWV increase at 1 year (
= 0.049). The QOL improved irrespective of arterial stiffness changes.
After SAVR, arterial stiffness demonstrates a persistent increase at 1-year, with valve type having a slight influence on the outcomes. These findings remain consistent despite the perceived QOL.
Purpose/Background/Objectives
Hypertension is associated with increased cardiovascular risk, inflammation and arterial stiffness. We sought to investigate the role of inflammation and arterial ...stiffness in the prognosis of cardiovascular hospitalization in hypertensives patients over an extensive follow-up.
Methods
One hundred and seventy-three patients (mean age 52.5 ± 13.2 years, 57% males) untreated hypertensives at baseline without cardiovascular disease, were included in the study. Arterial stiffness was assessed with carotid-femoral pulse wave velocity (PWV). High-sensitivity C-reactive protein (hsCRP) was measured in venous blood samples.
Results
During 13.6 ± 0.4 years of follow-up, forty-four patients (25.4%) patients were admitted in hospital due to cardiovascular causes. In multivariable logistic regression analysis, only higher hsCRP (Odds Ratio OR = 3.34, 95% Confidence intervals CI: 1.22–9.51,
p
= 0.020) and increased PWV (OR = 1.48, 95% Confidence intervals CI: 1.03–2.12,
p
= 0.036) were associated with higher risk of cardiovascular hospitalizations, which was independent of age, gender, systolic blood pressure, left ventricular mass index and presence of diabetes. In further analysis, receiver operating characteristic (ROC) curves were generated to evaluate the ability of hsCRP and PWV to discriminate subjects with cardiovascular hospitalization. The area under the curve (AUC) and 95% CIs of the ROC curves were AUC = 0.69 (95% CI: 0.59–0.78,
p
< 0.001) for hsCRP and AUC = 0.74 (95% CI: 0.65–0.83,
p
< 0.001) for PWV (
Figure 1
).
Conclusion
Our study shows the independent complimentary prognostic role of inflammation and arterial stiffness in the prognosis of hypertensives even in studies with extensive follow-up.
Figure 1
Diagonal segments are produced by ties.
Purpose/Background/Objectives
Vitamin K antagonists (VKA) aggravate vascular calcifications burden, especially in haemodialysis patients potentially compounding their cardiovascular risk. We sought ...to investigate the relationship between VKA intake and aortic arch calcification (AAC) in patients with acute coronary syndrome (ACS).
Methods
Two hundred patients admitted with ACS were included in the study (mean age 66 ± 15 years). The extent of aortic arch calcification (AAC) on a postero-anterior plain chest X-ray was divided into four grades (0 to 3). Grades 0 to 1 and grades 2 to 3 were categorized as lower and higher AAC grade respectively. Anticoagulants were categorized to VKA and to non-VKA anticoagulants including new oral anticoagulants and low-molecular weight heparin.
Results
Twenty-eight (14%) patients at admission were on anticoagulants. Seventeen patients (8.5%) were treated with VKA and 12 patients (6%) with non-VKA anticoagulants. Higher ACC grade was observed in patients treated with VKA after adjustment for age, gender and chronic kidney disease. (Odds ratio OR = 3.64, 95% Confidence intervals CI: 1.08 to 12.20,
p
= 0.037). Interestingly, there was a non-statistically significant trend for reduced risk of higher AAC grade in patients treated with non-VKA anticoagulants (OR = 0.24, 95% CI: 0.04 to 1.47,
p
= 0.12). Age and history of chronic kidney disease were the most potent predictors of higher AAC grade (OR = 1.07, 95% CI: 1.03 to 1.10,
p
< 0.001 and OR = 6.07, 95% CI: 2.35 to 15.67,
p
< 0.001, respectively).
Conclusion
Our study shows intake of VKA is associated with higher risk of AAC in ACS patients, while non-VKA anticoagulants might be associated lower AAC grade.
Purpose/Background/Objectives
Aortic stiffness and hemodynamics are independent predictors of adverse cardiovascular events. Transcatheter aortic valve implantation (TAVI) is growingly used in high ...surgical risk patients with aortic valve stenosis. We sought to investigate the effect of TAVI on aortic stiffness.
Methods
Fifty-five high-risk patients (mean age 79.5 ± 8.8 years, 46% males) with severe symptomatic aortic stenosis undergoing TAVI were included. Arterial stiffness was estimated through carotid-femoral pulse wave velocity (cfPWV). Measurements were conducted prior to the implantation, at discharge and 1 year post-TAVI.
Results
Prior to the implantation, cfPWV was 7.5 ± 1.4 m/s for the overall population. There was a statistically significant increase in measurements of aortic stiffness at discharge (7.5 ± 1.4 vs 8.3 ± 1.9 m/s for cfPWV with
p
= 0.043) without a statistically significant change in SBP (
p
= NS) (
Figure 1
). There was also a significant increase in cfPWV (8.7 ± 1.8 m/s) after 1 year compared to the pre-procedural assessment (
p
= 0.001). We also observed a non-significant increase in peripheral SBP at 1 year compared to SBP measurements at baseline and at discharge (153 ± 24 m/s vs 147 ± 21and 148 ± 22 m/s, respectively;
p
= 0.319) and these changes were independent of age and gender (
Figure 1
).
Conclusion
Our study shows that both shortly as well as in the long-term after TAVI subjects experience an increase in aortic stiffness that is independent of changes in SBP. These findings further elucidate the hemodynamic consequences and provide evidence of a possible long-standing repercussion of TAVI.
Figure 1
Purpose/Background/Objectives
Cardiac autonomic dysfunction is associated with increased cardiovascular mortality and arrhythmias. The aim of the study was to investigate the effect of heart rate ...variability (HRV) in the prognosis of future arrhythmic events.
Methods
We studied 292 untreated at baseline hypertensives (mean age 53 ± 13, 153 males). Cardiac autonomic function was evaluated by analysis of short-term HRV using 24-h ambulatory blood pressure monitoring and the standard deviation of measurements. Left ventricular mass index (LVMI) was estimated echocardiographically. Aortic stiffness was assessed with carotid-femoral pulse wave velocity (cfPWV) and aortic augmentation index corrected for heart rate (AIx@75). Patients were followed up for 13 years. The primary endpoint was a composite of atrial/ventricular tachycardias, symptomatic multiple premature ventricular contractions, second and third-degree heart blocks and pacemaker/defibrillator placement.
Results
Patients with the primary endpoint (
n
= 37.13%) had lower 24-h daytime HRV (9.6 beats per minute vs 11.1 beats per minute,
p
= 0.005), higher systolic blood pressure (168 mmHg vs 163 mmHg,
p
= 0.003), higher cfPWV (8.4 m/s vs 7.7 m/s,
p
= 0.005), higher LVMI (133 g/m
2
vs 122 g/m
p
= 0.002) and higher AIx@75 (29.0% vs 26.3%,
p
= 0.043) compared to patients with no events. In Cox regression analysis, only higher HRV was associated with lower risk of arrhythmic events (Hazard ratio per 1 mmHg = 0.87, 95% Confidence intervals 0.76 to 0.995,
p
= 0.043) when adjusted for age, gender, cfPWV, LVMI and AIx@75.
Conclusion
Lower heart rate variability is associated with increased risk of future arrhythmic events suggesting an early sympathovagal imbalance that could lead to future events.
Purpose/Background/Objective
Arterial stiffness and aortic hemodynamics are independent predictors of adverse cardiovascular events. Indications for Transcatheter Aortic Valve Implantation (TAVI) are ...increasing in number and Aortic Valve Calcifications (AVC) are an important prognostic factor of TAVI. We sought to investigate the associations between AVC and aortic vascular function/hemodynamics.
Methods
Fifty-two high-risk patients (mean age 80.4 ± 8.5 years, 27 male) with severe symptomatic aortic stenosis undergoing TAVI were included. Arterial stiffness was estimated through carotid-femoral pulse wave velocity (cfPWV) and brachial-ankle pulse wave velocity (baPWV). Aortic hemodynamics were also measured. Measurements were conducted prior to the implantation and at discharge. In all patients, a native and contrast-enhanced multislice cardiac computed tomography were performed pre-interventionally. AVC were then graded semi-quantitatively.
Results
Group 1 (subjects with none/mild AVC, n = 29) did not significantly differ on age, gender and body-mass index compared to group 2 (subjects with moderate/severe AVC, n = 23). From the traditional cardiovascular risk factors, only hypertension (p = 0.008), coronary artery disease (p = 0.016), atrial fibrillation (p = 0.075) and insulin-dependent diabetes mellitus (p = 0.068) were more statistically or showed a significant trend to be more prevalent in group 2. Group 2 had significantly higher both cfPWV and baPWV (8.3 ± 1.7 vs 7.2 ±1.2 m/s and 1750 ± 484 cm/s vs. 2101 ± 590 cm/s with p = 0.008 and p = 0.022 respectively) compared to Group 1. (Figure) There was no difference in wave reflections indices between the two groups.
Conclusions
Our study shows that in patients with aortic stenosis there is a correlation between an increase in aortic stiffness and damage of aortic valvular leaflets as well as calcifications.
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