Textbook of Arterial Stiffness and Pulsatile Hemodynamics in Health and Disease

1st Edition - March 28, 2022
Editor: Julio A. Chirinos
Language: English
Hardback ISBN:
9 7 8 - 0 - 3 2 3 - 9 1 3 9 1 - 1
eBook ISBN:
9 7 8 - 0 - 3 2 3 - 9 1 6 4 8 - 6

Textbook of Arterial Stiffness and Pulsatile Hemodynamics in Health and Disease, Two Volume Set covers the principles, physiology, biologic pathways, clinical implicati… Read more

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Textbook of Arterial Stiffness and Pulsatile Hemodynamics in Health and Disease, Two Volume Set covers the principles, physiology, biologic pathways, clinical implications and therapeutics surrounding arterial stiffness and pulsatile hemodynamics, along with a thorough overview of the field. The book presents complex engineering concepts in a way that those in science and medicine can more easily understand. It includes detailed illustrations. Additionally, it presents advanced bioengineering concepts in boxes for readers who wants more in-depth biophysical knowledge. This is a must-have reference for students, researchers and clinicians interested in learning more about this field.

Cover image
Title page
Table of Contents
Copyright
Contributors
Foreword
Preface
Acknowledgments
Volume 1
Section I. Biophysical and technical principles
Chapter 1. Basic principles that determine relationships between pulsatile hemodynamic phenomena and function of elastic vessels
Introduction
Pulsatile phenomena
Elastic vessels
The arterial vasculature as a distributed system of branching distensible tubes
Wave propagation phenomena—pulse wave velocity and arterial stiffness
Vascular impedance
Summary
Chapter 2. Measurements of arterial pressure and flow in vivo
Introduction
Cuff mercury sphygmomanometry
Cuff “oscillometric” blood pressure
Radial artery applanation tonometry
Cuff central aortic blood pressure
Cuffless blood pressure wearables
Invasive, intra-arterial blood pressure
Summary of blood pressure measurement methods
Measurements of arterial flow
Supplementary material
Chapter 3. Essential principles of pulsatile pressure-flow relations in the arterial tree
Introduction
Arterial input impedance: a frequency-domain characterization
Interpreting input impedance: the windkessel perspective
Interpreting input impedance: the wave-system perspective
The reservoir-wave concept—overarching paradigm or misleading enigma?
Concluding remarks
Chapter 4. MRI for the assessment of aortic stiffness and pulsatile hemodynamics
Introduction
Aortic stiffness assessed by MRI
Advanced methodology to assess pulsatile aortic properties using MRI
Conclusions
Chapter 5. Computed tomography of the aorta
Introduction
Basics of CT and physics
Anatomy of aorta
Aortic assessment using CT for characterizing aortic geometry, diameter, centerline length, and shape
Changes in aortic geometry with aging
Aortic calcification
Quantification of aortic calcification
Progression of aortic calcification
The importance of aortic calcification detection
Chapter 6. Radionuclide-based imaging of the aortic wall
Introduction
Positron emission tomography imaging
18F-fluorodeoxyglucose positron emission tomography
18F-sodium fluoride positron emission tomography
Methods of analysis and limitations of positron emission tomography imaging
Future directions
Conclusion
Chapter 7. Arterial wall stiffness: basic principles and methods of measurement in vivo
Introduction
Arteries—what's inside?
Mechanics of arterial tissues: bioengineering principles and perspective
Mechanics of arterial tissues: clinical/in vivo perspective
From local pressure-diameter to pulse wave velocity
Measuring (aortic) pulse wave velocity in vivo
Total arterial compliance
Concluding remarks
Chapter 8. Ambulatory measurement of pulsatile hemodynamics
Ambulatory 24-h measurement of brachial blood pressure and heart rate
Pulsatile and steady state hemodynamics
Techniques and devices for 24-h ambulatory measurement of pulsatile (and steady state) hemodynamics
24-h variability (“dipping”) of pulsatile and steady state hemodynamics
24-h ambulatory measurement of pulsatile (and steady state) hemodynamics—clinical studies
24-h ambulatory measurement of pulsatile (and steady state) hemodynamics—drug trials
Summary and outlook
Chapter 9. Animal models and methods to study arterial stiffness
Introduction
In vivo methods to study arterial stiffness
Ex vivo methods to study arterial stiffness
Mouse models to study arterial stiffness
Comparison of methods
Section II. Basic and applied physiology
Chapter 10. Hemodynamic role of the aorta
Introduction
Hemodynamic consequences of large artery stiffness
Aortic stiffening and its role in target organ damage
Mechanisms of arterial stiffening and therapeutic approaches
Conclusions
Chapter 11. Wave reflection in the arterial tree
Introduction
Pressure and flow in the absence of wave reflection
The basis of wave reflection: impedance mismatching
Models of arterial wave reflection
Re-reflections and the horizon effect
Ventricular wave re-reflection
Wave reflection, windkessel function, and diastolic pressure decay
Methods for assessing the magnitude and timing of arterial wave reflection
Summary
Chapter 12. Linking arterial stiffness to microvascular remodeling
Motivation
A microvascular remodeling view of large arterial stiffening
Cell dynamics involved in microvascular growth and remodeling
Consideration of microvascular patterning alterations associated with hypertension and aging
Circulating factors and hemodynamics as putative links between arterial stiffness and the microcirculation
Conclusions and future opportunities
Chapter 13. Myocardial function: from myofilaments to cardiac pump
The heart is an adaptive pump
Cardiac structure is tightly coupled to function
The cardiac cycle
Electromechanical coupling
Mechanisms of myocardial contraction
Mechanisms of myocardial relaxation and ventricular filling
Cardiac metabolism
Cardiac performance is governed by heart rate and loading conditions
Functional assessment of the cardiovascular system
Assessing intrinsic cardiac performance: contractility, relaxation, and compliance
The pressure-volume loop
Deriving performance indexes from acute load manipulation
Time-varying afterload, wave reflection, and their toll in the heart
Conclusions
Chapter 14. Systolic–diastolic coupling
Historical background
Gross cardiac anatomy, ventricular myocyte orientation, and mechanism of contraction
Summary
Supplementary data
Chapter 15. Ventricular–arterial coupling: the pressure–volume plane
Introduction
Conclusions
Chapter 16. Myocardial wall stress and the systolic loading sequence
Introduction
Quantification of myocardial wall stress
Arterial wave reflection
Conclusions
Chapter 17. Assessment of ventricular arterial interactions via arterial pressure-flow relations in humans
Overview of arterial pressure-flow relations
Noninvasive assessment of aortic pressure-flow relations
Age relations of pressure-flow variables across the lifespan
Aortic pressure-flow measures and the heart
Pressure-flow measures and cardiovascular disease events
Summary
Chapter 18. Hemodynamic determinants of myocardial oxygen demand and supply
Myocardial O2 demand
Myocardial O2 supply
Aortic stiffness
The myocardial oxygen supply: demand index
Buckberg index estimated by arterial tonometry
Section III. Biologic pathways leading to arterial stiffness and dysfunctional pulsatile hemodynamics
Chapter 19. Role of elastin and elastin-derived peptides in arterial stiffness: from synthesis to potential therapeutic interventions
Elastic fibers and elastin
Elastin role in arterial function
Elastin modifications during aging and pathophysiological consequences
Elastin-derived peptides signaling, elastin receptor complex, and pathophysiological consequences
Elastin biology-derived therapeutic options
Conclusion
Chapter 20. Inflammation and arterial stiffness
Introduction
Arterial stiffness and low-grade inflammation
Arterial stiffness in patients with primary vasculitides
Arterial stiffness in chronic inflammatory diseases
Antiinflammatory treatment for arterial stiffness
Mechanisms of inflammation-induced arterial stiffening
Increased synthesis of matrix metalloproteinases
Conclusion
Chapter 21. Mechanisms of calcification in the aortic wall and aortic valve
Cardiovascular events associated with calcification in the aortic wall and aortic valve
Calcification is a result of multiple synergistic pathogenic processes
Experimental approaches in cardiovascular calcification
Therapeutic target discovery in cardiovascular calcification
Final considerations
Chapter 22. Vascular smooth muscle cell dysfunction: role in arterial stiffening and cardiovascular disease
Contractile tone of vascular smooth muscle cells
Endocytosis and phagocytosis abilities of vascular smooth muscle cells
Integrin-mediated and nuclear mechanotransduction in vascular smooth muscle cells
Vascular smooth muscle cell plasticity
Participation of inflammation and immunity in vascular smooth muscle cell functions
Conclusion
Chapter 23. Endothelial cell dysfunction and senescence: biologic mechanisms and hemodynamic consequences
Introduction
In vivo evidence of cellular senescence in age-related diseases
Molecular mechanism of cellular senescence
Endothelial cell senescence in age-related disorders
Antisenescence therapy
Conclusion
Chapter 24. Autonomic and neuroendocrine modulation of arterial stiffness and hemodynamics
Autonomic control of the cardiovascular system
Assessing autonomic modulation of large-artery stiffness: methodological considerations
Parasympathetic modulation of large-artery stiffness
Sympathetic modulation of large-artery stiffness
Neuroendocrine modulation of arterial stiffness
Summary
Chapter 25. Cellular mechanisms of aging and their impact on the aortic/arterial wall
Introduction
Effects of aging on the arterial tree
Cellular and molecular mechanisms of vascular aging
Chronic kidney disease as a model of early vascular aging and role of calcification
Summary
Volume 2
Section IV. Clinical significance of arterial stiffness and pulsatile hemodynamics
Chapter 26. Normal aging: arterial stiffness and remodeling over the life course
Preamble
Insights from cross-sectional epidemiological and cohort data
Insights from longitudinal cohort data: the early life trajectory
Insights from longitudinal cohort data: the adult life trajectory
Conclusions
Chapter 27. Early vascular aging and supernormal vascular aging: genetics, epigenetics, and the environment
The background and characteristics of early vascular aging
Atherosclerosis versus arteriosclerosis
Structural components of arterial wall aging
Cross-talk between the micro- and macrocirculation
Vascular aging and target organ damage
Genetics and epigenetics
Low socioeconomic status and vascular aging
Intervention studies on vascular aging and early vascular aging
The concept and usefulness of supernormal vascular aging
Conclusion
Chapter 28. Ethnic differences in arterial stiffness and central aortic hemodynamics
Is studying ethnic differences in vascular or any physiological feature or disease useful?
Arterial stiffness through the life-course across different ethnic/geographic groups
Ethnicity and the menopausal transition
The elderly
Summary and conclusions
Chapter 29. Arterial stiffness and pulsatile hemodynamics in systemic hypertension
Introduction
Consequence of arterial stiffness on pressure pulsatility
Arterial stiffness and wave reflection in systemic hypertension
Influence of lumen area on compliance, wave reflection, and pressure pulsatility
Peripheral and central blood pressure in aging hypertensives
Interaction between hypertension and arterial stiffness
High central blood pressure, hypertension-mediated organ damage, and cardiovascular complication
Predictive value of arterial stiffness and wave reflection in hypertensives
The particular case of very elderly hypertensives
Conclusion
Chapter 30. Arterial stiffness and pulsatile hemodynamics in diabetes and obesity
Introduction
Pathophysiologic role of diabetes mellitus in the development of increased arterial stiffness
Epidemiologic association of diabetes mellitus with the development of increased arterial stiffness
Epidemiologic association of obesity and the metabolic syndrome with the development of increased arterial stiffness
Increased arterial stiffness as a potential contributor to the development of diabetes mellitus
Conclusions and future directions
Chapter 31. Cardiovascular risk prevention in clinical medicine: current guidelines in the United States and in Europe
Epidemiology of hypertension
Cardiovascular risk assessment in the management of hypertension
Therapeutic goals in the management of hypertension
Additional therapeutic considerations for hypertension management in current guidelines
How do large artery stiffness and pulsatile hemodynamics factor into guideline recommendations for the treatment of other cardiovascular risk factors?
Summary
Chapter 32. Cardiovascular risk prevention in clinical medicine: current guidelines in Asia
Cardiovascular risk prevention in clinical practice: current guidelines in Asia
Chapter 33. Arterial stiffness for cardiovascular risk stratification in clinical practice
Introduction
Arterial stiffness
Central pressure and wave reflection indices
Conclusions/future perspectives
Chapter 34. Role of the heart and arterial tree in physiologic adjustments during exercise
Cardiac output
Exercise hemodynamics
Pulmonary hemodynamics during exercise
Central hemodynamics during exercise
Blood flow redistribution
Exercise hyperemia
Cardiovascular limitations to exercise
Summary
Chapter 35. Invasive hemodynamic assessments during exercise: normal patterns and clinical value
Introduction
Physiology of invasive hemodynamic assessment
Measurement of flow
Vascular load
Assessment during exercise
Clinical utility in the evaluation of suspected heart failure
More advanced assessment
Conclusion
Chapter 36. Arterial stiffness and pulsatile hemodynamics in heart failure
Introduction
Heart failure: definition and classification
The arterial tree in HF
Therapeutic implications
Conclusions
Chapter 37. Ventricular–arterial coupling and arterial load in aortic valve disease
Introduction
Anatomical interaction between the LV, aortic valve, and aortic root
Functional interaction between the left ventricle, aortic valve, and aorta
Interaction between LV outflow tract and aortic valve
Interaction between aorta and aortic valve in aortic valve disease
Interaction between aorta, aortic valve, and LV in AS
Impact of arterial load following aortic valve replacement
Conclusion
Chapter 38. Arterial stiffness and atherosclerosis: mechanistic and pathophysiologic interactions
Introduction
Vascular failure: interaction between atherosclerosis and arterial stiffness
Interaction between vascular disease and hemodynamic stress
Conclusion
Chapter 39. Arterial stiffness and pulsatile hemodynamics in coronary artery disease and other forms of atherosclerotic vascular diseases
Introduction
Coronary artery disease
Peripheral artery disease
Aortic calcification
Stroke and cerebrovascular disease
Perspectives
Chapter 40. Arterial stiffness and pulsatile hemodynamics in renal disease
Importance of kidney disease
Unique features of the kidney circulation
Role of known factors for chronic kidney disease progression
Clinical epidemiology of large artery stiffness in chronic kidney disease
Clinical pulsatility indices and kidney function
Mechanisms of increased arterial stiffness in chronic kidney disease
Vascular calcification
Therapies
Chapter 41. Arterial stiffness, pulsatile hemodynamics, and the vascular contributions to dementia
Introduction
Conclusions
Chapter 42. Arterial stiffness and pulsatile hemodynamics in pregnancy and pregnancy-related vascular complications
Healthy pregnancy
Pregnancy complications
Exercise in pregnancy
Concluding remarks
Chapter 43. Arterial stiffness and pulsatile hemodynamics in pediatric populations
Introduction
Vascular effects of various disease states
Methods and normal values in children
Future directions
Chapter 44. Aortopathies and arteriopathies
Introduction
Approaches to defining the genetic contributions to arterial and aortic disease
Pathogenic mechanisms
Arteriopathies with limited aortic involvement
Disorders that primarily involve the aorta with arterial involvement
Disorders that primarily affect the aorta
Precision medicine
Chapter 45. Arterial stiffness and pulsatile hemodynamics in thoracic aortopathies
Epidemiology and sex differences of thoracic aortic disease
Clinical management of thoracic aortic aneurysm
Histopathological links between thoracic aortic aneurysms and arterial aging
Aortic wall structure, aortic stiffness, and arterial biomechanics in thoracic aortic aneurysm
Measures of aortic stiffness and pulsatile hemodynamic as markers of disease activity and thoracic aortic aneurysm–related risk
Conclusions and future directions
Chapter 46. Arterial stiffness and pulsatile hemodynamics in congenital heart disease
Background
Hypertension after coarctation repair
Cardiovascular morbidity
Abnormalities of pulsatile hemodynamics
What causes the arterial abnormalities arise in coarctation?
Vascular abnormalities in other forms of congenital heart disease
Conclusions
Chapter 47. Infection and arterial stiffness
Introduction
Arterial stiffness and sepsis
Arterial stiffness and human immunodeficiency virus infection
Chapter 48. Arterial stiffness, hemodynamics, and microvascular complications in conditions characterized by low arterial pulsatility
Introduction
Low pulsatile hemodynamics in continuous-flow left ventricular assist device therapy
Effects of low pressure and flow pulsatility on the macrocirculation
Consequences of low pressure and flow pulsatility on the microcirculation
Left ventricular assist device therapy and exercise capacity
Conclusions
Section V. Therapeutic approaches to improve arterial stiffness and pulsatile hemodynamics
Chapter 49. Effects of common antihypertensive treatments on pulsatile arterial hemodynamics
Introduction
Antihypertensive drug classes and their mechanisms of action
Data acquisition, extraction, and analysis
Antihypertensive drugs versus placebo or no-treatment
Renin-angiotensin-aldosterone inhibitors and calcium-channel blockers versus diuretics, β-blockers, and α-blockers
Vasodilating versus nonvasodilating β-blockers
Angiotensin receptor neprilysin inhibitor versus angiotensin receptor blocker
Organic and inorganic nitrates, soluble guanylyl cyclase stimulators and cyclic guanosine monophosphate (cGMP)-binding phosphodiesterase (PDE5) inhibitors
Device-based antihypertensive therapy
Conclusions and perspectives
Chapter 50. Pharmacologic approaches to reduce arterial stiffness
Introduction
Potential therapeutic targets for arterial destiffening: preclinical studies
Clinical studies on aortic and large artery destiffening
Summary
Conclusion
Chapter 51. Organic and dietary nitrates, inorganic nitrite, nitric oxide donors, and soluble guanylate cyclase stimulation
Part 1: introduction
Part 2: organic nitrates
Part 3: inorganic nitrite
Part 4: inorganic (dietary) nitrate
Part 5: nitric oxide donors
Part 6: soluble guanylate cyclase
Conclusions and future directions
Chapter 52. Effect of exercise training and weight loss on arterial stiffness and pulsatile hemodynamics
Introduction
Effect of high cardiorespiratory fitness and habitual aerobic PA on central artery stiffness and pulsatile hemodynamics with aging
Effect of aerobic exercise interventions on central artery stiffness and pulsatile hemodynamics in young and MA/O adults with and without hypertension
Effect of resistance exercise training on large central artery stiffness and central pulsatile hemodynamics
Effect of obesity, weight loss, and weight gain on central arterial stiffness
Chapter 53. Dietary salt and arterial stiffness
Introduction
Dietary salt and blood pressure
Dietary salt and cardiovascular outcomes
Blood pressure independent effects of dieatary salt
Dietary salt and arterial stiffness
Lifestyle and dietary salt
Conclusion
Chapter 54. Role of arterial stiffness and central hemodynamics in personalized medicine in hypertension
Introduction
Isolated systolic hypertension in the elderly
Isolated systolic hypertension in the young
Isolated diastolic hypertension
Isolated central hypertension and isolated brachial hypertension
White coat hypertension
Masked hypertension
Isolated nocturnal hypertension
Exaggerated blood pressure variability
Summary and conclusion
Section VI. Arterial stiffness and pulsatile hemodynamics in the pulmonary circulation
Chapter 55. Pulsatile hemodynamics and ventricular–arterial interactions in the pulmonary circulation: physiologic concepts
Introduction
Measurements in the pulmonary circulation
The pulmonary vasculature
The right ventricle
Ventriculoarterial coupling
Differences between the systemic and pulmonary circulation
Normal values in the pulmonary circulation
Summary
Chapter 56. Pulmonary arterial load and ventricular–arterial coupling in pulmonary hypertension
Introduction
Pulmonary arterial load in pulmonary hypertension
The right ventricular function in pulmonary hypertension
The cardiovascular interaction in pulmonary hypertension
Summary
Chapter 57. Biologic mechanisms and consequences of pulmonary artery stiffening in pulmonary hypertension
Pulmonary vascular stiffening and mechanobiological feedback in PH pathogenesis
Regulation of smooth muscle contractility and tone
Proliferation
Inflammation and endothelial dysfunction
Endothelial to mesenchymal transition
Angiogenesis
Metabolic reprogramming and mitochondrial dysregulation
Targeting PA stiffness and mechanotransduction in PH
Conclusion
Chapter 58. Therapeutic approaches to improve pulmonary arterial load and right ventricular–pulmonary arterial coupling
Introduction
Right ventricular dysfunction and failure
The components of right ventricular afterload
Approach to the management of right ventricular failure
Therapies targeting right ventricular afterload
Advanced therapeutic options for treatment of right venrticular failure
Emerging therapeutic options
Conclusion
Index

Julio A. Chirinos

Dr. Julio A. Chirinos, MD, PhD, is an Associate Professor of Medicine and Director of the Arterial Hemodynamics and Cardiac Imaging Quantification Core Laboratory at the University of Pennsylvania Perelman School of Medicine. Dr. Chirinos directs an NIH-funded research program focused on the role of arterial stiffness and ventricular arterial interactions in heart disease, mechanisms of human heart failure and the use of proteomics to discern mechanisms of human heart failure. He currently leads clinical studies and trials designed to therapeutically target the arterial tree in order to reduce maladaptive cardiac remodeling, diastolic dysfunction, and to treat patients with Heart Failure and Preserved Ejection Fraction, an epidemic condition for which no effective proven pharmacologic therapies are currently available. He also leads various cohort studies with deep cardiovascular phenotyping aimed at characterizing phenotypic profiles in humans. Dr. Chirinos also directs a core analysis laboratory for assessments of cardiac and arterial structure and function with non-invasive imaging, which has served as the core lab for various multicenter studies. His laboratory utilizes a combination of imaging modalities (including arterial tonometry, echocardiography and cardiac MRI) coupled with modeling approaches to characterize arterial physiology and ventricular-arterial interactions in humans. Dr. Chirinos has published >200 papers, chapters, reviews, and editorials and has been an invited speaker in >120 scientific sessions. He has participated in various clinical expert committees for the American Heart Association, American Society of Echocardiography, European Society of Cardiology, American Society of Hypertension, European Association of Cardiovascular Imaging and the Lancet Commission for Hypertension. Dr. Chirinos is currently the Vice-President of the North American Artery society, which promotes the study of arterial function as a determinant of cardiovascular disease. He is an Associate Editor of Circulation Heart Failure and a former Editor of the Cochrane Group (Cochrane Collaboration), Senior Consulting Editor of the Journal of the American College of Cardiology – Cardiovascular Imaging, Associate Editor for the Journal of Clinical Hypertension and member of the editorial board of Pulse and the Journal of Geriatric Cardiology. He is also a Visiting Professor at the University of Ghent in Belgium, where he maintains an active collaboration with the Asklepios Investigators aimed at characterizing arterial aging at the population level.

Affiliations and expertise

Associate Professor of Medicine, University of Pennsylvania Perelman School of Medicine, USA; Director, Arterial Hemodynamics and Cardiac Imaging Quantification Core Laboratory; Visiting Professor, University of Ghent, Ghent, Belgium

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