La stiffness vascolareF. Antonini-Canterin (Sacile - Pordenone)

La stiffness vascolare

“Le penseur”August Rodin, 1902

- What?- How?- Why?

1. Arterial stiffness

Stiffness arteriosa: cos’è?

Windkessel model: the arterial system is compared to a fire-hose system.

Proximal part:

CUSHIONING FUNCTION

(more elastic arteries)

Periphery:

CONDUIT FUNCTION

(stiffer arteries)

Proximal and distal arteries

More elastic Stiffer

The higher the arterial stiffness, the higher the speed of travel of forward and retrograde waves.

Lower PWVLower PP

Higher PWVHigher PP

Propagative model: the arterial system is compared to a tree in winter

Forward wave Backward wave

Propagative model

From arteries to heart…

In young (with elastic arteries) the pulsewave reflection arrives in diastole and thecoronary perfusion is augmented.

In elderly (with stiff arteries) the speedof travel of pulse wave is higher and thereflection wave is premature in latesystole, increasing central PP and SBP;SBP increases the load on the LV, leadingto ventricular hypertrophy and increasedmyocardial oxigen demand.

2. Arterial stiffness

Arterial stiffness

PWV - MRI

Augmentation index

CAROTID ECHOTRACKING

CAROTID QAS

A simple echo method to estimate systemic arterial compliance

Hypertension 1999; 33;800

Systemic stiffness

JACC 2005; 46: 291SAC is calculated as the ratio of stroke volume index to arterial pulse pressure

3. Arterial stiffness

Arterial stiffness: clinical applications

Circulation 2006;113:664

1678 subjects (sex- and age-stratified random sample of the general Danish population

Circulation 2006;113:657

2835 apparently healthy subjects

Clin Med Research 2007;1:45

PWV RR

Role of Serum Uric Acid Levels on local carotid arterial stiffness and

intima-media thickness: a high resolution echo-tracking study.

Francesco Antonini-Canterin, Giulio Prati, Stefano Poli, Marco Pellegrinet, Olga Vriz, Salvatore

La Carrubba, Vitantonio Di Bello, Scipione Carerj, Concetta Zito, Daniela Pavan, Anca

Mateescu, Carmen Ginghina, Bogdan A. Popescu, Gian Luigi Nicolosi

Group 1: no RFGroup 2: 1 RFGroup 3: ≥ 2 RF

La prevenzione è sempre appropriata!