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Aortic-brachial stiffness mismatch and mortality in dialysis population.
Hypertension. 2015 Feb; 65(2):378-84.H

Abstract

We hypothesized that increased aortic stiffness (central elastic artery) combined with a decrease in brachial stiffness (peripheral muscular artery) leads to the reversal of the physiological stiffness gradient (ie, mismatch), promoting end-organ damages through increased forward pressure wave transmission into the microcirculation. We, therefore, examined the effect of aortic-brachial stiffness mismatch on mortality in patients in need of dialysis. In a prospective observational study, aortic-brachial arterial stiffness mismatch (pulse wave velocity ratio) was assessed using carotid-femoral pulse wave velocity divided by carotid-radial pulse wave velocity in 310 adult patients on dialysis. After a median follow-up of 29 months, 146 (47%) deaths occurred. The hazard ratio (HR) for mortality related to PWV ratio in a Cox regression analysis was 1.43 (95% confidence interval [CI], 1.24-1.64; P<0.001 per 1 SD) and was still significant after adjustments for confounding factors, such as age, dialysis vintage, sex, cardiovascular disease, diabetes mellitus, smoking status, and weight (HR, 1.23; 95% CI: 1.02-1.49). The HRs for changes in 1 SD of augmentation index (HR, 1.35; 95% CI, 1.12-1.63), carotid-femoral pulse wave velocity (HR, 1.29; 95% CI, 1.11-1.50), and carotid-radial pulse wave velocity (HR, 0.80; 95% CI, 0.67-0.95) were statistically significant in univariate analysis, but were no longer statistically significant after adjustment for age. In conclusion, aortic-brachial arterial stiffness mismatch was strongly and independently associated with increased mortality in this dialysis population. Further studies are required to confirm these finding in lower-risk groups.

Authors+Show Affiliations

From the CHU de Québec Research Center, L'Hôtel-Dieu de Québec Hospital, Québec, Québec, Canada (C.F., F.M., S.D., K.M., S.A.D.S., M.L., M.A.); Division of Nephrology, Faculty of Medicine, Université Laval, Québec, Québec, Canada (C.F., F.M., S.D., K.M., S.A.D.S., M.L., M.A.); Université Paris Descartes, Paris, France (P.B.); Department of Pharmacology, Hôpital Européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris, Paris, France (P.B.); and Institut National de la Santé et de la Recherche Médicale, U970-PARCC, France (P.B.).From the CHU de Québec Research Center, L'Hôtel-Dieu de Québec Hospital, Québec, Québec, Canada (C.F., F.M., S.D., K.M., S.A.D.S., M.L., M.A.); Division of Nephrology, Faculty of Medicine, Université Laval, Québec, Québec, Canada (C.F., F.M., S.D., K.M., S.A.D.S., M.L., M.A.); Université Paris Descartes, Paris, France (P.B.); Department of Pharmacology, Hôpital Européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris, Paris, France (P.B.); and Institut National de la Santé et de la Recherche Médicale, U970-PARCC, France (P.B.).From the CHU de Québec Research Center, L'Hôtel-Dieu de Québec Hospital, Québec, Québec, Canada (C.F., F.M., S.D., K.M., S.A.D.S., M.L., M.A.); Division of Nephrology, Faculty of Medicine, Université Laval, Québec, Québec, Canada (C.F., F.M., S.D., K.M., S.A.D.S., M.L., M.A.); Université Paris Descartes, Paris, France (P.B.); Department of Pharmacology, Hôpital Européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris, Paris, France (P.B.); and Institut National de la Santé et de la Recherche Médicale, U970-PARCC, France (P.B.).From the CHU de Québec Research Center, L'Hôtel-Dieu de Québec Hospital, Québec, Québec, Canada (C.F., F.M., S.D., K.M., S.A.D.S., M.L., M.A.); Division of Nephrology, Faculty of Medicine, Université Laval, Québec, Québec, Canada (C.F., F.M., S.D., K.M., S.A.D.S., M.L., M.A.); Université Paris Descartes, Paris, France (P.B.); Department of Pharmacology, Hôpital Européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris, Paris, France (P.B.); and Institut National de la Santé et de la Recherche Médicale, U970-PARCC, France (P.B.).From the CHU de Québec Research Center, L'Hôtel-Dieu de Québec Hospital, Québec, Québec, Canada (C.F., F.M., S.D., K.M., S.A.D.S., M.L., M.A.); Division of Nephrology, Faculty of Medicine, Université Laval, Québec, Québec, Canada (C.F., F.M., S.D., K.M., S.A.D.S., M.L., M.A.); Université Paris Descartes, Paris, France (P.B.); Department of Pharmacology, Hôpital Européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris, Paris, France (P.B.); and Institut National de la Santé et de la Recherche Médicale, U970-PARCC, France (P.B.).From the CHU de Québec Research Center, L'Hôtel-Dieu de Québec Hospital, Québec, Québec, Canada (C.F., F.M., S.D., K.M., S.A.D.S., M.L., M.A.); Division of Nephrology, Faculty of Medicine, Université Laval, Québec, Québec, Canada (C.F., F.M., S.D., K.M., S.A.D.S., M.L., M.A.); Université Paris Descartes, Paris, France (P.B.); Department of Pharmacology, Hôpital Européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris, Paris, France (P.B.); and Institut National de la Santé et de la Recherche Médicale, U970-PARCC, France (P.B.).From the CHU de Québec Research Center, L'Hôtel-Dieu de Québec Hospital, Québec, Québec, Canada (C.F., F.M., S.D., K.M., S.A.D.S., M.L., M.A.); Division of Nephrology, Faculty of Medicine, Université Laval, Québec, Québec, Canada (C.F., F.M., S.D., K.M., S.A.D.S., M.L., M.A.); Université Paris Descartes, Paris, France (P.B.); Department of Pharmacology, Hôpital Européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris, Paris, France (P.B.); and Institut National de la Santé et de la Recherche Médicale, U970-PARCC, France (P.B.).From the CHU de Québec Research Center, L'Hôtel-Dieu de Québec Hospital, Québec, Québec, Canada (C.F., F.M., S.D., K.M., S.A.D.S., M.L., M.A.); Division of Nephrology, Faculty of Medicine, Université Laval, Québec, Québec, Canada (C.F., F.M., S.D., K.M., S.A.D.S., M.L., M.A.); Université Paris Descartes, Paris, France (P.B.); Department of Pharmacology, Hôpital Européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris, Paris, France (P.B.); and Institut National de la Santé et de la Recherche Médicale, U970-PARCC, France (P.B.). Mohsen.Agharazii@crhdq.ulaval.ca.

Pub Type(s)

Journal Article
Observational Study
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

25452473

Citation

Fortier, Catherine, et al. "Aortic-brachial Stiffness Mismatch and Mortality in Dialysis Population." Hypertension (Dallas, Tex. : 1979), vol. 65, no. 2, 2015, pp. 378-84.
Fortier C, Mac-Way F, Desmeules S, et al. Aortic-brachial stiffness mismatch and mortality in dialysis population. Hypertension. 2015;65(2):378-84.
Fortier, C., Mac-Way, F., Desmeules, S., Marquis, K., De Serres, S. A., Lebel, M., Boutouyrie, P., & Agharazii, M. (2015). Aortic-brachial stiffness mismatch and mortality in dialysis population. Hypertension (Dallas, Tex. : 1979), 65(2), 378-84. https://doi.org/10.1161/HYPERTENSIONAHA.114.04587
Fortier C, et al. Aortic-brachial Stiffness Mismatch and Mortality in Dialysis Population. Hypertension. 2015;65(2):378-84. PubMed PMID: 25452473.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Aortic-brachial stiffness mismatch and mortality in dialysis population. AU - Fortier,Catherine, AU - Mac-Way,Fabrice, AU - Desmeules,Simon, AU - Marquis,Karine, AU - De Serres,Sacha A, AU - Lebel,Marcel, AU - Boutouyrie,Pierre, AU - Agharazii,Mohsen, Y1 - 2014/12/01/ PY - 2014/12/3/entrez PY - 2014/12/3/pubmed PY - 2015/3/7/medline KW - aortic stiffness KW - arterial stiffness KW - chronic kidney disease KW - dialysis KW - pulse wave analysis KW - pulse wave velocity SP - 378 EP - 84 JF - Hypertension (Dallas, Tex. : 1979) JO - Hypertension VL - 65 IS - 2 N2 - We hypothesized that increased aortic stiffness (central elastic artery) combined with a decrease in brachial stiffness (peripheral muscular artery) leads to the reversal of the physiological stiffness gradient (ie, mismatch), promoting end-organ damages through increased forward pressure wave transmission into the microcirculation. We, therefore, examined the effect of aortic-brachial stiffness mismatch on mortality in patients in need of dialysis. In a prospective observational study, aortic-brachial arterial stiffness mismatch (pulse wave velocity ratio) was assessed using carotid-femoral pulse wave velocity divided by carotid-radial pulse wave velocity in 310 adult patients on dialysis. After a median follow-up of 29 months, 146 (47%) deaths occurred. The hazard ratio (HR) for mortality related to PWV ratio in a Cox regression analysis was 1.43 (95% confidence interval [CI], 1.24-1.64; P<0.001 per 1 SD) and was still significant after adjustments for confounding factors, such as age, dialysis vintage, sex, cardiovascular disease, diabetes mellitus, smoking status, and weight (HR, 1.23; 95% CI: 1.02-1.49). The HRs for changes in 1 SD of augmentation index (HR, 1.35; 95% CI, 1.12-1.63), carotid-femoral pulse wave velocity (HR, 1.29; 95% CI, 1.11-1.50), and carotid-radial pulse wave velocity (HR, 0.80; 95% CI, 0.67-0.95) were statistically significant in univariate analysis, but were no longer statistically significant after adjustment for age. In conclusion, aortic-brachial arterial stiffness mismatch was strongly and independently associated with increased mortality in this dialysis population. Further studies are required to confirm these finding in lower-risk groups. SN - 1524-4563 UR - https://www.unboundmedicine.com/medline/citation/25452473/Aortic_brachial_stiffness_mismatch_and_mortality_in_dialysis_population_ L2 - https://www.ahajournals.org/doi/10.1161/HYPERTENSIONAHA.114.04587?url_ver=Z39.88-2003&amp;rfr_id=ori:rid:crossref.org&amp;rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -