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Novel Noninvasive Assessment of Pulmonary Arterial Stiffness Using Velocity Transfer Function.

ABSTRACT: Background Pulmonary artery ( PA ) stiffness is associated with increased pulmonary vascular resistance ( PVR ). PA stiffness is accurately described by invasive PA impedance because it considers pulsatile blood flow through elastic PA s. We hypothesized that PA stiffness and impedance could be evaluated noninvasively by PA velocity transfer function ( VTF ), calculated as a ratio of the frequency spectra of output/input mean velocity profiles in PA s. Methods and Results In 20 participants (55±19 years, 14 women) undergoing clinically indicated right-sided heart catheterization, comprehensive phase-contrast and cine-cardiac magnetic resonance imaging was performed to calculate PA VTF , along with right ventricular mass and function. PA impedance was measured as a ratio of frequency spectra of invasive PA pressure and echocardiographically derived PA flow waveforms. Mean PA pressure was 29.5±13.6 mm Hg, and PVR was 3.5±2.8 Wood units. A mixed-effects model showed VTF was significantly associated with PA impedance independent of elevation in pulmonary capillary wedge pressure ( P=0.005). The mean of higher frequency moduli of VTF correlated with PVR (ρ=0.63; P=0.003) and discriminated subjects with low (n=10) versus elevated PVR (≥2.5 Wood units, n=10), with an area under the curve of 0.95, similar to discrimination by impedance (area under the curve=0.93). VTF had a strong inverse association with right ventricular ejection fraction (ρ=-0.73; P<0.001) and a significant positive correlation with right ventricular mass index (ρ=0.51; P=0.02). Conclusions VTF , a novel right ventricular- PA axis coupling parameter, is a surrogate for PA impedance with the potential to assess PA stiffness and elevation in PVR noninvasively and reliably using cardiac magnetic resonance imaging.

SUBMITTER: Gupta A

PROVIDER: S-EPMC6222968 | biostudies-literature |

REPOSITORIES: biostudies-literature

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Project description:Background and objectivesThe independent link between arterial stiffness and CKD remains unknown. We investigated the association of indicators of arterial stiffness with decline in kidney function.Design, setting, participants, & measurementsWe studied 3666 participants (mean age =65 years old; 58% women) from the Rotterdam Study. Pulse pressure (PP), carotid stiffness, and pulse wave velocity (PWV) were measured. We created genetic risk scores for PP and PWV. Annual declines in kidney function and incident CKD were assessed using eGFR. To put our findings in context of the literature, we performed a meta-analysis of the available population-based studies.ResultsAfter a median (interquartile range) follow-up time of 11 (10.7-11.3) years, 601 participants with incident CKD were recognized. In the model adjusted for age, sex, mean arterial pressure, heart rate, and baseline GFR, each SD higher PP was associated with 0.15-ml/min per 1.73 m(2) steeper annual eGFR decline (95% confidence interval [95% CI], 0.10 to 0.20) and 11% higher risk of incident CKD (95% CI, 1.05 to 1.18). Each SD greater carotid stiffness was associated with 0.08-ml/min per 1.73 m(2) steeper annual eGFR decline (95% CI, 0.04 to 0.13) and 13% higher risk of incident CKD (95% CI, 1.05 to 1.22). Each SD higher PWV was associated with 7% higher risk of incident CKD (95% CI, 1.00 to 1.14). Incorporating our findings in a meta-analysis, each SD higher PP and PWV were associated with 16% (95% CI, 1.12 to 1.21) and 8% (95% CI, 1.03 to 1.14) higher risks of incident CKD. Each SD higher PP genetic risk score was associated with 0.06-ml/min per 1.73 m(2) steeper annual eGFR decline (95% CI, 0.01 to 0.10) and 8% higher risk of incident CKD (95% CI, 1.03 to 1.14). There was no association between PWV genetic risk score and kidney function decline.ConclusionsHigher indices of arterial stiffness are associated with steeper decline in kidney function. This suggests that vascular stiffness could be considered as a target for delaying decline in kidney function.

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Novel Noninvasive Assessment of Pulmonary Arterial Stiffness Using Velocity Transfer Function.

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