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NEW DEVELOPMENTS IN MEDICAL RESEARCH
ADVANCES IN ARTERIAL
STIFFNESS RESEARCH
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liability is assumed for incidental or consequential damages in connection with or arising out of information
contained herein. This digital document is sold with the clear understanding that the publisher is not engaged in
rendering legal, medical or any other professional services.
NEW DEVELOPMENTS
IN MEDICAL RESEARCH
Additional books in this series can be found on Nova’s website
under the Series tab.
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under the e-books tab.
NEW DEVELOPMENTS IN MEDICAL RESEARCH
ADVANCES IN ARTERIAL
STIFFNESS RESEARCH
BECKY CHAVEZ
EDITOR
New York
https://t.me/med1917
Copyright © 2016 by Nova Science Publishers, Inc.
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NOTICE TO THE READER
The Publisher has taken reasonable care in the preparation of this book, but makes no expressed or
implied warranty of any kind and assumes no responsibility for any errors or omissions. No liability is
assumed for incidental or consequential damages in connection with or arising out of information
contained in this book. The Publisher shall not be liable for any special, consequential, or exemplary
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Independent verification should be sought for any data, advice or recommendations contained in this
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This publication is designed to provide accurate and authoritative information with regard to the subject
matter covered herein. It is sold with the clear understanding that the Publisher is not engaged in
rendering legal or any other professional services. If legal or any other expert assistance is required, the
services of a competent person should be sought. FROM A DECLARATION OF PARTICIPANTS
JOINTLY ADOPTED BY A COMMITTEE OF THE AMERICAN BAR ASSOCIATION AND A
COMMITTEE OF PUBLISHERS.
Additional color graphics may be available in the e-book version of this book.
Library of Congress Cataloging-in-Publication Data
Library of Congress Control Number: 2016946633
ISBN: 978-1-63485-859-5 (eBook)
Published by Nova
Science Publishers, Inc. † New York
https://t.me/med1917
CONTENTS
Preface vii
Chapter 1 Pulmonary Arterial Stiffness: Toward a Predictor
of PAH and a Key Parameter to Make PH Reversible 1
Juan C. Grignola, Antonio Roman
and Enric Domingo
Chapter 2 Local and Regional Arterial Stiffness Measurement
in Clinical Practice 41
Iana Simova, Maurizio Galderisi,
Tzvetana Katova, Dimitar Simov
and Nikolay Dimitrov
Chapter 3 Arterial Stiffness in Chronic Obstructive Pulmonary
Disease: Is There a Common Pathway for Vascular
and Pulmonary Involvement? 53
Adriana Albu
Chapter 4 Wnt Osteoblast Pathway and Ostoprotegerin: Links
between Bone Turnover, Vascular Calcifications
and Arterial Stiffness 75
Eirini Stavrinou, Charalambos Koumaras
and Aikaterini Papagianni
https://t.me/med1917
Contents
vi
Chapter 5 Ambulatory Arterial Stiffness Index
during Pregnancy in Type 1 Diabetes Mellitus 97
Finn F. Lauszus,
Hanine Fadel Mustafa Al-Far,
Ingvild Tjessem, Ole W. Rasmussen
and Jens Fuglsang
Chapter 6 Pulse Wave Velocity and Cardiovascular Morbidity
and Mortality in Patients on Renal Replacement
Therapy 119
Vaia D. Raikou
Chapter 7 Higher Arterial Stiffness Related to Blood Pressure
Overresponse to Arm and Leg Resistance Exercises
in Elderly Individuals 137
Takeshi Otsuki and Takahiro Kotato
Index 157
https://t.me/med1917
PREFACE
This book provides new research advances on arterial stiffness. Chapter
One addresses the pulmonary vascular resistance (PVR) and total pulmonary
vascular capacitance (Cp) product of the pulmonary circulation as a global
estimate of right ventricular (RV) afterload, the assessment of the local arterial
stiffness indices and its relationship with PVR and Cp, and finally, reviews the
cause-effect relationships between large/conduit stiffening and distal/resistive
vascular disease. Chapter Two discusses local and regional arterial stiffness
measurement in clinical practice. Chapter Three reviews the processes
involved in the pathogenesis of arterial stiffness in COPD, and the possible
role of COPD therapy in vascular alterations. Chapter Four reviews links
between bone turnover, vascular calcifications and arterial stiffness. Chapter
Five examines ambulatory arterial stiffness index during pregnancy in Type 1
diabetes mellitus. Chapter Six provides a review on the pulse wave velocity
and cardiovascular morbidity and mortality in patients on renal replacement
therapy. Chapter Seven focuses on the higher arterial stiffness related to blood
pressure overresponse to arm and leg resistance exercises in elderly
individuals.
Chapter 1 – Right ventricular (RV) adaptation to increased pulmonary
arterial (PA) load is a critical determinant of outcomes in pulmonary
hypertension (PH). Pulmonary vascular resistance (PVR) and total pulmonary
vascular capacitance (Cp) assess global resistive and elastic properties of the
pulmonary arterial vasculature, respectively. They show an inverse
relationship that is usually described by a hyperbolic fit in both health and
disease states including arterial PH (PAH). Conflicting data is supporting PVR
to be prognostic value in PH. However, Cp is a strong independent predictor
of mortality in patients with PAH. Cp depends on the prevailing mean
https://t.me/med1917
Becky Chavez
viii
pulmonary arterial pressure (mPAP) and on a genuine change in the arterial
wall stiffness as a result of vascular remodeling. At present, The authors lack a
complete understanding of the process of large/proximal and small/distal PA
stiffening during the course of PH disease. Current dogma suggests that distal
changes in the pulmonary vasculature usually precede those associated with
stiffening in the central vessels. However, recent data have provided evidence
that conduit systemic arterial stiffness is an independent predictor of blood
pressure progression and incident hypertension. Similarly, data in pulmonary
circulation suggests that vascular stiffening itself may be the initial vascular
event that begets subsequently remodeling. Accordingly, human data seem to
indicate that pulmonary intimal lesions are associated with the severely
increased mPAP in the late stage of the disease. Recent evidence shows that
large PA stiffening impairs its buffering function and increases distal
vasculature flow pulsatility leading to distal PA remodeling and stiffening.
Although PAH remains an incurable disease, animal models of PH and
emerging human data put on doubt the concept of the pulmonary vascular
remodeling irreversibility and emphasize efforts that experts must make for
early detection of pulmonary vascular disease. The authors will address the
PVR-Cp product of the pulmonary circulation as a global estimate of RV
afterload, the assessment of the local arterial stiffness indices and its
relationship with PVR and Cp, and finally, they put forward the cause-effect
relationships between large/conduit stiffening and distal/resistive vascular
disease, analyzing if it is possible the reversible remodeling in PAH.
Chapter 2 – Arterial stiffness (AS) is an independent predictor of
cardiovascular morbidity and mortality and may be considered as a marker
of cardiovascular risk and a potential therapeutic target in selected
populations, in particular in patients with arterial hypertension. In clinical
setting an association of AS indices has been demonstrated with established
cardiovascular risk factors, such as age, male sex, hypertension, diabetes,
obesity and smoking. Increased AS (or decreased arterial elasticity) is a
marker of subclinical organ damage, which is a factor of great importance in
patients with arterial hypertension – it helps to establish cardiovascular risk
and could re-classify a substantial proportion of intermediate risk subjects into
high or low risk categories. Therefore, the measurement of AS is important
(and recommended) in hypertensive patients at moderate cardiovascular risk.
AS could be measured locally (usually with echo-tracking methods),
regionally (using tonoports, mechano-transducers and standard Doppler
probes) and through the analysis of central aortic pulse wave. The largest
amount of evidence that AS indices could serve as an independent predictors
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