Assessment of arterial stiffness in chronic obstructive pulmonary disease by a novel method

The role of arterial stiffness as assessed by the cardio-ankle vascular index in patients with chronic obstructive pulmonary disease

BACKGROUND

Arteriosclerosis and cardiovascular disease (CVD) can greatly affect the progression of chronic obstructive pulmonary disease (COPD). However, standardized methods for evaluating arteriosclerosis in COPD have not been established. The cardio-ankle vascular index (CAVI) is a reliable marker of arterial stiffness and a potential marker for assessing arteriosclerosis. This study aimed to examine the associations between the CAVI and clinical parameters and to evaluate its predictive value for clinical outcomes in COPD.

METHODS

This retrospective, observational study included patients with COPD who underwent CAVI assessment. The relationships between CAVI and clinical parameters were analysed. The patients were stratified into two groups according to the median CAVI. We examined whether an elevated CAVI was associated with clinical outcomes and evaluated its predictive value for poor clinical outcomes, including disability (modified Rankin Scale score ≥4) or death.

RESULTS

A total of 102 patients were analysed (median age: 74 years; 94.1 % men). The median CAVI was 9.4. The CAVI was positively correlated with the percentage of a low attenuation area on computed tomography and negatively correlated with FEV1 and body mass index, independent of age and the smoking index. An elevated CAVI (>9.4) was associated with severe exacerbations and poor clinical outcomes. A multivariate analysis identified the CAVI as an independent predictor of poor clinical outcomes, regardless of age, severity of dyspnoea, and airflow obstruction.

CONCLUSION

Arterial stiffness assessed by the CAVI is a useful marker of COPD severity and may serve as a prognostic indicator and therapeutic target for improving COPD management.

Assessment of cardio-ankle vascular index in patients with abdominal aortic aneurysm: An observational study

OBJECTIVES

Arterial stiffness is associated with major adverse cardiovascular events. The aim of this study is to investigate arterial stiffness by cardio-ankle vascular index (CAVI) in patients with abdominal aortic aneurysm (AAA).

METHODS

This observational and cross-sectional study involved 59 subjects with AAA and 32 healthy subjects. All subjects underwent ultrasonography examination. CAVI was measured by VaSera-1000 CAVI instrument.

RESULTS

Mean abdominal aortic diameter of AAA patients and controls were 43.88 ± 9.28 mm and 20.43 ± 3.14 mm, consecutively. Baseline clinical characteristics of the patients and controls were similar for age, presence of hypertension, diabetes, dyslipidemia, coronary artery disease and smoking. Left ventricle ejection fraction and Left ventricle mass index (LVMI) were similar between groups. CAVI was significantly higher in patients with AAA than controls (9.74 ± 1.50 vs. 7.60 ± 1.07, p < 0.001). CAVI was positively correlated with AAA diameter (r = 0.461, p < 0.001) and negatively correlated with left ventricle ejection fraction (r= -0.254, p = 0.015). CAVI >8.3 had a sensitivity 89.8% and a specificity of 78.1% for predicting the presence of AAA in ROC analysis (area under curve = 0.897, 95%CI = 0.816-0.951, p < 0.001).

CONCLUSION

CAVI is increased in patients with AAA. Increased arterial stiffness may be a mechanical link between AAA, coronary artery disease and peripheral artery disease or a common mechanism effects the arterial stiffness, coronary artery disease, peripheral artery disease and AAA. Therefore, CAVI may be used as a valuable marker for risk stratification for the development of AAA in susceptible patients.

Relationship between pulmonary function and peripheral vascular function in older Chinese: Guangzhou biobank cohort study-CVD

BACKGROUND

Findings describing the relationship between pulmonary function and peripheral vascular function have been inconclusive. We explored this relationship in Guangzhou Biobank Cohort Study-Cardiovascular Subcohort (GBCS-CVD).

METHODS

Brachial-ankle pulse wave velocity (baPWV) and ankle brachial index (ABI) were measured by a waveform analyser, and pulmonary function by turbine flowmeter spirometry. Predicted forced expiratory volume in 1 s (FEV1) and forced vital capacity (FVC) were derived using equations for Chinese. Regression analyses were used to investigate the association.

RESULTS

Of 1528 older Chinese, 980 (64.1%) had arterial stiffness (baPWV ≥1400 cm/s), but only 29 (1.9%) had peripheral arterial disease (PAD) (ABI < 0.9). The mean (±standard deviation, SD) baPWV was 1547 (±298) cm/s and mean (±SD) ABI 1.09 (±0.09). Before and after adjusting for potential confounders, baPWV was negatively associated with FEV1 and FVC % predicted (% predicted = observed/predicted × 100%) (adjusted β: - 0.95 and - 1.16 respectively, p < 0.05), and ABI was marginally non-significantly positively associated with FEV1% predicted (adjusted β 0.02, p = 0.32) and FVC% predicted (adjusted β 0.02, p = 0.18). Compared to participants in the highest tertile of pulmonary function, those in the lowest had higher risk of arterial stiffness (adjusted odds ratio (AOR) 1.51, 95% CI 1.09-2.10 for FEV1 and AOR 1.69, 95% CI 1.22-2.33 for FVC), but the higher risk of PAD was marginally non-significant (AOR 1.64, p = 0.42 for FEV1 and AOR 1.65, p = 0.24 for FVC).

CONCLUSION

In older relatively healthy normal weight Chinese, pulmonary function was inversely dose-dependently associated with arterial stiffness, while the association with PAD was much weaker.

Subclinical cardiovascular disease in patients with chronic obstructive pulmonary disease: a systematic review

BACKGROUND

Cardiovascular disease (CVD) accounts for a significant portion of deaths in patients with COPD; however, evidence for early detection strategies for CVD in this population remain limited. Our paper aims to summarize existing data regarding subclinical CVD in patients with COPD with a view to identifying screening strategies in these patients.

METHODS

A systematic review of published literature was conducted for studies examining the relationship of COPD and markers of subclinical disease such as coronary artery calcification (CAC), carotid intima media thickness (cIMT), endothelial dysfunction, arterial stiffness as measured by pulse wave velocity (PWV) and augmentation indices (AIx). Both MEDLINE and EMBASE databases were searched till October 2015.

RESULTS

A total of 22 studies were included in the review. Compared with control subjects, patients with COPD had significantly higher cIMT (SMD 0.53, 95% CI 0.16-0.90), PWV (SMD 0.91, 95% CI 0.67-1.16) and AIx (SMD 0.86, 95% CI 0.52-1.19). Additionally, an overall higher prevalence of subclinical CVD as assessed by CAC, ABI and FMD was noted in our review.

CONCLUSION

Although our findings need further evaluation in prospective studies, our review presents significant evidence in support of increased subclinical CVD burden in COPD patients independent of smoking status. Further large-scale case-control studies are required to highlight the significance of subclinical CVD screening in COPD patients.

Assessment of arterial stiffness in patients with chronic lower extremity venous disease: An observational study

OBJECTIVES

Arterial stiffness is associated with major adverse cardiovascular events. Chronic venous insufficiency (CVI) is severe form of chronic venous disease (CVD). The aim of this study is to investigate arterial stiffness by cardio-ankle vascular index (CAVI) in patients with CVI.

METHODS

This observational and cross-sectional study involved 87 subjects with CVI and 86 healthy subjects. All subjects underwent ultrasonography examination. CAVI was measured by VaSera-1000 CAVI instrument.

RESULTS

High density lipoprotein cholesterol (HDL) was significantly lower in patients with CVI than controls (46.83 ± 9.25 mg/dl vs 51.33 ± 11.13 mg/dl, p = 0.004). Body mass index (BMI) was significantly higher in CVI patients than controls (28.53 ± 4.10 kg/m(2) vs 26.37 ± 5.16 kg/m(2), p = 0.003). Ankle brachial index (ABI) was significantly lower in patients with CVI compared to controls (1.08 ± 0.08 vs 1.14 ± 0.11, p < 0.001). CAVI was significantly higher in patients with CVI than controls (7.94 ± 1.37 vs 6.73 ± 1.16, p < 0.001). Mean arterial pressure (MAP) was significantly higher in patients with CVI than control group (105.41 ± 10.77 mmHg vs 99.70 ± 11.17 mmHg, p = 0.001). CAVI (p < 0.001, Odds ratio (OR) = 2.033, 95% Confidence interval (CI) = 1.493-2.768), ABI (p = 0.003, OR = 0.003, 95% CI = 0.001-0.137), female sex (p < 0.001, OR = 3.949, 95% CI = 1.613-9.663), and HDL (p < 0.001, OR = 0.923, 95% CI = 0.883-0.964) were the independent predictors of CVI. A CAVI value > 7.9 had a sensitivity 64.4% and a specificity of 94.7% for predicting the presence of CVI in ROC analysis (area under curve = 0.791, 95% CI = 0.723-0.849, p < 0.001).

CONCLUSION

CAVI is independently increased in CVI patients. Therefore CVI may be accepted a form of vascular sclerosis and vascular system should be evaluated in continuum not isolated.

Assessment of arterial stiffness in patients with venous thromboembolism: Separate or continuous circuits?

Objectives The aim of this study is to evaluate the association of venous thromboembolism with arterial stiffness by cardio-ankle vascular index method. Method We included 52 patients with a documented lower extremity venous thromboembolism within the last six months and 52 healthy subjects to this cross sectional observational study. Results Cardio-ankle vascular index (8.58 ± 1.60 versus 7.05 ± 1.44, p < 0.001, respectively) and systolic blood pressure (128.02 ± 7.13 mmHg versus 123.94 ± 8.12 mmHg, p = 0.008, respectively) were significantly higher among patients with venous thromboembolism than controls. Cardio-ankle vascular index was an independent predictor of venous thromboembolism in multivariate logistic regression analysis (p < 0.001, odds ratio = 1.864, 95% confidence interval = 1.370-2.536). Cardio-ankle vascular index value > 7.8 had a sensitivity of 82.7% and a specificity of 80.8% for predicting venous thromboembolism (area under curve = 0.789, 95% confidence interval = 0.698-0.863, p < 0.001) in receiver operating characteristic curve analysis. Conclusion We found that arterial stiffness was increased in patients with venous thromboembolism which highlights the fact that arterial and venous circulation is in continuum and an insult may affect both of these circuits.

Chronic obstructive pulmonary disease and ischemic heart disease comorbidity: overview of mechanisms and clinical management

In the last few years, many studies focused their attention on the relationship between chronic obstructive pulmonary disease (COPD) and ischemic heart disease (IHD), showing that these diseases are mutually influenced. Many different biological processes such as hypoxia, systemic inflammation, endothelial dysfunction, heightened platelet reactivity, arterial stiffness and right ventricle modification interact in the development of the COPD-IHD comorbidity, which therefore deserves special attention in early diagnosis and treatment. Patients with COPD-IHD comorbidity have a worst outcome, when compared to patients with only COPD or only IHD. These patients showed a significant increase on risk of adverse events and of hospital readmissions for recurrent myocardial infarction, heart failure, coronary revascularization, and acute exacerbation of COPD. Taken together, these complications determine a significant increase in mortality. In most cases death occurs for cardiovascular cause, soon after an acute exacerbation of COPD or a cardiovascular adverse event. Recent data regarding incidence, mechanisms and prognosis of this comorbidity, along with the development of new drugs and interventional approaches may improve the management and long-term outcome of COPD-IHD patients. The aim of this review is to describe the current knowledge on COPD-IHD comorbidity. Particularly, we focused our attention on underlying pathological mechanisms and on all treatment and strategies that may improve and optimize the clinical management of COPD-IHD patients.