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Prognostic application of arterial stiffness: task forces
1Centre Hospitalier Manhes, Fleury-Mérogis, France.
Insights
Increased pulse pressure, a cardiovascular risk factor, is linked to arterial stiffness. Measuring aortic pulse wave velocity (PWV) can predict mortality and guide risk reduction strategies in patients with end-stage renal disease.
Area of Science:
- Cardiovascular Medicine
- Nephrology
- Vascular Physiology
Background:
- Increased pulse pressure is an independent cardiovascular risk factor.
- Pulse pressure is influenced by cardiac output and arterial stiffness.
- Arterial stiffness, assessed by pulse wave velocity (PWV), is a key determinant of cardiovascular risk.
Purpose of the Study:
- To evaluate aortic PWV as a predictor of cardiovascular and all-cause mortality in patients with end-stage renal disease (ESRD).
- To explore the utility of aortic PWV in risk assessment and reduction strategies.
- To determine if changes in aortic PWV under pharmacologic regimens provide prognostic information.
Main Methods:
- Assessment of aortic pulse wave velocity (PWV) as a marker of aortic stiffness.
- Evaluation of carotid distensibility for local arterial stiffness.
- Analysis of therapeutic trial data correlating PWV changes with cardiovascular outcomes in ESRD patients.
Main Results:
- Aortic PWV is a strong independent predictor of mortality in ESRD patients, essential hypertension, and the elderly.
- Local arterial stiffness (carotid distensibility) also predicts cardiovascular risk in ESRD and transplant recipients.
- Lack of aortic PWV reduction despite blood pressure lowering predicted cardiovascular death in ESRD patients.
Conclusions:
- Aortic PWV measurement is valuable for risk assessment and stratification in ESRD patients.
- Monitoring arterial stiffness via aortic PWV can guide risk reduction strategies and assess treatment efficacy.
- Aortic PWV provides prognostic information beyond blood pressure reduction, aiding in early preventive therapy.
Abstract:
Epidemiologic and clinical studies have shown that increased pulse pressure is an independent cardiovascular risk factor in general population. Pulse pressure is determined by combined effects of cardiac factors (stroke volume) and the arterial stiffness. Arterial stiffness can be more directly evaluated by several measurements including the measure of pulse wave velocity (PWV). Aortic PWV, a marker of aortic stiffness, has been shown to be a strong independent predictor of cardiovascular and all cause mortality in patients with end-stage renal disease (ESRD) on hemodialysis as well as in patients with essential hypertension and older subjects over 80 years. Local arterial stiffness assessment, namely carotid distensibility was also shown to predict cardiovascular risk, both in ESRD patients and in renal transplant recipients. Furthermore, it has been shown in a therapeutic trial that the lack of aortic PWV attenuation despite significant drug-induced reduction in mean blood pressure was a significant predictor of cardiovascular death in subjects with ESRD. These results support the hypothesis that measurement of aortic PWV could then help, not only in risk assessment strategies, but also in risk reduction strategies by monitoring arterial stiffness under different pharmacologic regimens. The drug-related reduction of aortic PWV could then give prognostic information, additionally to blood pressure reduction. Aortic stiffness measurements could serve as an important tool in identifying ESRD patients at higher risk of cardiovascular disease. The ability to identify these patients would lead to better risk stratification and earlier and more cost-effective preventive therapy.