Textbook of Arterial Stiffness and Pulsatile Hemodynamics in Health and Disease, 2 Volume Set

9780323916486v1_WEB
	Front Matter
	Textbook of Arterial Stiffness and Pulsatile Hemodynamics in Health and Disease
	Textbook of Arterial Stiffness and Pulsatile Hemodynamics in Health and Disease
	Copyright
	Contents of Volume 1
	Contributors
	Foreword
	Preface
	Acknowledgments
	I - Biophysical and technical principles
		1 - Basic principles that determine relationships between pulsatile hemodynamic phenomena and function of elastic v ...
			Introduction
			Pulsatile phenomena
				Pulsatility as an evolutionary requirement for self-sustaining circulatory systems
				Fundamental association of pulsatility and vascular structure and function
			Elastic vessels
				Hemodynamic pulsatility and structure of the arterial wall
				Pressure dependence of arterial stiffness: an essential ingredient for optimal arterial design
					Fundamental importance of pressure-dependent arterial stiffness (nonlinear elasticity) for arteries
					Influence of pressure-dependent arterial stiffness on hemodynamic pulsatility
			The arterial vasculature as a distributed system of branching distensible tubes
				Structural implications of arterial branching
				Structural and functional effects of arterial branching on pulsatility phenomena-implications for measurement of blood pressure
			Wave propagation phenomena-pulse wave velocity and arterial stiffness
				Wave speed and pulse wave velocity
					Wave speed
					Pulse wave velocity
				Pulse wave velocity and pressure-independent arterial stiffness index beta (β)
				Pulse wave propagation and oscillatory phenomena
					Forward and backward waves
			Vascular impedance
				Steady pressure and flow: resistance
					Arterial properties that determine relationship of steady pressure and flow
				Oscillatory pressure and flow: impedance
					Arterial properties that determine relationship of pulsatile pressure and flow
					Effects of blood viscosity and pulsatile flow: Womersley\'s alpha
				Input impedance
				System linearity
					Intermodulation: justification for assumptions of system linearity
					Nonlinearity in arterial models
				Relation between characteristic impedance and pulse wave velocity
				Pressure and flow relationship in the time domain
			Summary
			References
		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
				Pulsed wave-Doppler
				Phase-contrast magnetic resonance imaging
			Supplementary material
			References
		3 - Essential principles of pulsatile pressure-flow relations in the arterial tree
			Introduction
			Arterial input impedance: a frequency-domain characterization
				Impedance: generalizing resistance for sinusoidal signals
				Calculating impedance at the inlet of the arterial tree
			Interpreting input impedance: the windkessel perspective
				Estimating total arterial compliance by use of windkessel models
					The decay-time and area method
					The pulse pressure method
			Interpreting input impedance: the wave-system perspective
				Characteristic impedance revisited: inertia and compliance combined
				Input impedance: fingerprint of arterial wave reflections
				The arterial system: a network of tubes with distributed reflection sites
					The tube model-too simple as a paradigm
					The arterial tree-scattered reflections
					Estimating Zc from impedance
				Pressure-flow relations in the time domain
				Time domain formulation of wave separation equations
				Estimating characteristic impedance in the time domain
				Wave separation analysis in practice: an instruction manual
				Wave power analysis: energizing hemodynamics
				Wave power to assess the nature and timing of wave reflection
				Energetics in the arterial circulation
			The reservoir-wave concept-overarching paradigm or misleading enigma?
			Concluding remarks
			References
		4 - MRI for the assessment of aortic stiffness and pulsatile hemodynamics
			Introduction
			Aortic stiffness assessed by MRI
				Aortic strain and distensibility
				Aortic pulse wave velocity
					Aging and aortic stiffness measurements in MRI
					Cardiovascular risk factors, left ventricular function, and aortic stiffness
					Prognostic value of proximal aortic stiffness measures
			Advanced methodology to assess pulsatile aortic properties using MRI
				Flow analysis
					Combining pressure and flow
					4D flow
			Conclusions
			Disclosures
			References
		5 - Computed tomography of the aorta
			Introduction
			Basics of CT and physics
				Spatial resolution
				Temporal resolution
				ECG-gated versus non‒ECG-gated CTA
				Contrast resolution
				3D reconstruction
				Challenges
			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
			References
		6 - Radionuclide-based imaging of the aortic wall
			Introduction
			Positron emission tomography imaging
				Positron emission tomography radionuclides
				Positron emission tomography/computed tomography fusion imaging
			18F-fluorodeoxyglucose positron emission tomography
				Historical background and mechanisms
				Interpretation of 18F-fluorodeoxyglucose signal
				Practical considerations in 18F-fluorodeoxyglucose imaging
				18F-fluorodeoxyglucose positron emission tomography imaging of the arterial wall
					18F-fluorodeoxyglucose positron emission tomography imaging in prognostic assessment
					18F-fluorodeoxyglucose positron emission tomography in translational research and clinical trials
					18F-fluorodeoxyglucose uptake in aortic aneurysms and large vessel vasculitis
			18F-sodium fluoride positron emission tomography
				Historical background and mechanisms
				Interpretation of 18F-sodium fluoride- signal
				18F-sodium fluoride- positron emission tomography imaging of the aortic calcification activity
					Intimal calcification activity
					Medial arterial calcification activity
					18F-sodium fluoride- positron emission tomography in aortic aneurysms, large vessel vasculitis, and other aortic pathologies
			Methods of analysis and limitations of positron emission tomography imaging
			Future directions
			Conclusion
			Acknowledgments
			References
		7 - Arterial wall stiffness: basic principles and methods of measurement in vivo
			Introduction
			Arteries-what\'s inside?
				Large artery stiffness and stiffening-a tale of elastin and collagen
			Mechanics of arterial tissues: bioengineering principles and perspective
				Stress and strain-what\'s in a name?
				Stresses acting on the arterial wall
				Arteries consist of anisotropic, viscoelastic, nonlinear tissue
				A glimpse on strain energy functions
			Mechanics of arterial tissues: clinical/in vivo perspective
				Local functional indices from pressure-area data: compliance and distensibility
					(Area) compliance and distensibility
					Compliance coefficient and distensibility coefficient
				Stiffness moduli
				Shear wave elastography-an in-vivo bioengineering perspective?
			From local pressure-diameter to pulse wave velocity
			Measuring (aortic) pulse wave velocity in vivo
				Transit-time methods
				Loop-based methods to measure local pulse wave velocity
				Pulse wave imaging
			Total arterial compliance
				Total arterial compliance versus arterial stiffness and pulse wave velocity
				Total arterial compliance versus effective arterial elastance
			Concluding remarks
			References
		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
			References
		9 - Animal models and methods to study arterial stiffness
			Introduction
				Mechanical concepts
			In vivo methods to study arterial stiffness
				Blood pressure measurements
				Invasive blood pressure to measure arterial stiffness by transit time
				High-resolution ultrasound
				Applanation tonometry
			Ex vivo methods to study arterial stiffness
				Atomic force microscopy
				Wire myography
				Pressure myography
				Biaxial biomechanical testing
				Digital image correlation
			Mouse models to study arterial stiffness
				Aging
				Connective tissue disorders
				Diabetes and obesity
				Hypertension
			Comparison of methods
				Recommendations
			References
	II - Basic and applied physiology
		10 - Hemodynamic role of the aorta
			Introduction
			Hemodynamic consequences of large artery stiffness
				Effect on the early systolic aortic pulse pressure rise
				Effect on wave speed (Fig. 10.2)
				Effect of aortic stiffness on wave reflections in first-order bifurcations
			Aortic stiffening and its role in target organ damage
				Arterial stiffness and the heart
				Arterial stiffness and the kidney
				Arterial stiffness and the brain
				Arterial stiffness and the placental circulation
				Aortic stiffness, metabolic dysfunction, and diabetes mellitus
				Arterial stiffness and testicular dysfunction
			Mechanisms of arterial stiffening and therapeutic approaches
			Conclusions
			Acknowledgments
			References
		11 - Wave reflection in the arterial tree
			Introduction
			Pressure and flow in the absence of wave reflection
			The basis of wave reflection: impedance mismatching
				Impact of wave reflection on arterial pressure and flow
				Reflection and transmission coefficients
				Arterial junctions
				Tapering
				Resistance vessels
				Stenosis
				Aneurysms
				Stents
			Models of arterial wave reflection
				Single tube model
				Asymmetric T-tube model
				Tapered tube models
				Branching network models
				Synthesis
			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
				Pulse wave analysis
				Wave separation
				Frequency domain analysis
				Wave intensity
			Summary
			References
		12 - Linking arterial stiffness to microvascular remodeling
			Motivation
			A microvascular remodeling view of large arterial stiffening
			Cell dynamics involved in microvascular growth and remodeling
				Endothelial cells
				Pericytes
				Smooth muscle cells
				Macrophages
				Lymphatic endothelial cells
			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
			Acknowledgments
			References
		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
			References
		14 - Systolic-diastolic coupling
			Historical background
			Gross cardiac anatomy, ventricular myocyte orientation, and mechanism of contraction
				Anatomy of the heart
				Contractile function of myocytes
				Ventricular myocyte orientation and function
				The cardiac cycle
				Atrioventricular valve plane displacement: give and take
				Locked and loaded: recovering elastic energy during diastole
			Summary
			Supplementary data
			References
		15 - Ventricular-arterial coupling: the pressure-volume plane
			Introduction
				The pressure volume plane
				The LV chamber as a time-varying elastance
				Relationship between the pressure-volume area and LV energetics
				The concept of effective arterial elastance and assessment of ventricular-arterial coupling in the pressure-volume plane
				Assessing the consequences of primary LV dysfunction, changes in arterial load and their consequences in the pressure-volum ...
				Strengths and limitations of the pressure-volume plane
			Conclusions
			Acknowledgments
			References
		16 - Myocardial wall stress and the systolic loading sequence
			Introduction
				Myocardial afterload versus ventricular afterload
			Quantification of myocardial wall stress
				The time course of ejection-phase MW
			Arterial wave reflection
				LV loading sequence and its role in LV hypertrophy
				LV loading sequence and its role in LV fibrosis
				Effect of mid-to-late systolic load on LV diastolic dysfunction
				Myocardial loading sequence and atrial dysfunction
				Late systolic load and heart failure risk
				Cellular processes in the myocardium
			Conclusions
			Acknowledgments
			References
		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
			References
		18 - Hemodynamic determinants of myocardial oxygen demand and supply
			Myocardial O2 demand
				Left ventricular afterload
				Systolic wall stress
				Heart rate
				Contractility
				Depolarization
				Shortening against load (Fenn effect)
				Supporting the state of activity
				Maintenance of cell viability in basal conditions
			Myocardial O2 supply
				Diastolic pressure decay
				Coronary blood flow regulation
					Coronary self-regulation
					Endothelial vasoactive mediators
					Metabolic regulation
				Arterial oxygen content
			Aortic stiffness
				Increase in systolic blood pressure
				Decrease in diastolic blood pressure
				Increase in pulse wave velocity
			The myocardial oxygen supply: demand index
				Buckberg index corrected for cardiac mass
				Buckberg index corrected for arterial O2 content
				Reference values for the Buckberg index
			Buckberg index estimated by arterial tonometry
				Limits in Buckberg index estimation by arterial tonometry
				Buckberg index estimated by arterial tonometry and echocardiography
				New perspectives in Buckberg index estimated by arterial tonometry
			References
	III - Biologic pathways leading to arterial stiffness and dysfunctional pulsatile hemodynamics
		19 - Role of elastin and elastin-derived peptides in arterial stiffness: from synthesis to potential therapeutic in ...
			Elastic fibers and elastin
				Function and composition
				Elastogenesis
					Microfibrils deposition
					Synthesis and secretion of tropoelastin
					Microassembly
					Cross-linking and macromolecular assembly
			Elastin role in arterial function
				Elastin: a major functional vascular wall component of vertebrate\'s arteries
				Elastin role in normal hemodynamics
			Elastin modifications during aging and pathophysiological consequences
				Nonenzymatic posttranslational modifications of elastin
				Mechanical fatigue and enzymatic fracture of elastin
				Pathophysiological consequences of elastin modifications
			Elastin-derived peptides signaling, elastin receptor complex, and pathophysiological consequences
				Elastin-derived peptides
				Elastin receptor complex-dependent cell signaling
				Pathophysiological roles of elastin-derived peptides
			Elastin biology-derived therapeutic options
				Targeting elastin synthesis
				Targeting proteolysis and nonenzymatic posttranslational modifications
				Elastin-derived peptides and elastin receptor complex modulators
			Conclusion
			References
		20 - Inflammation and arterial stiffness
			Introduction
			Arterial stiffness and low-grade inflammation
				Cross-sectional studies
				Prospective studies
				Experimental models of inflammation
			Arterial stiffness in patients with primary vasculitides
			Arterial stiffness in chronic inflammatory diseases
				Rheumatoid arthritis
				Inflammatory bowel disease
				Systemic lupus erythematosus
				Systemic sclerosis
				Chronic obstructive pulmonary disease
				Human immunodeficiency virus infection
			Antiinflammatory treatment for arterial stiffness
				Antilipidemic drugs
			Mechanisms of inflammation-induced arterial stiffening
				Endothelial dysfunction
			Increased synthesis of matrix metalloproteinases
				Calcification
				Smooth muscle proliferation and changes in the composition of extracellular matrix
				Direct vascular inflammation
			Conclusion
			References
		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
				Atherosclerosis and intimal calcification of the aortic wall
				Nonatherosclerotic medial aortic wall calcification
				Calcific aortic valve disease
				The role of hemodynamic shear stress in vascular calcification
				Synergistic effects of risk factors in vascular endothelial dysfunction
			Experimental approaches in cardiovascular calcification
			Therapeutic target discovery in cardiovascular calcification
			Final considerations
			Funding
			References
		22 - Vascular smooth muscle cell dysfunction: role in arterial stiffening and cardiovascular disease
			Contractile tone of vascular smooth muscle cells
				Vascular tone
				Myogenic tone
				Vascular smooth muscle cell relaxation
			Endocytosis and phagocytosis abilities of vascular smooth muscle cells
				Endocytosis
				Phagocytosis
				Scavenger receptors and eat me signaling
			Integrin-mediated and nuclear mechanotransduction in vascular smooth muscle cells
				Membrane mechanotransduction
				Nuclear mechanotransduction
			Vascular smooth muscle cell plasticity
				Regulation of vascular smooth muscle cell differentiation by growth factors and transcriptional factors
				Epigenetic determinants of vascular smooth muscle cell plasticity
				Cell senescence
			Participation of inflammation and immunity in vascular smooth muscle cell functions
				Cytokines et chemokines
				Innate immunity and extracellular vesicles
				Failure in the resolution of inflammation
			Conclusion
			References
		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
				Inhibition of cellular senescence
				Inhibition of senescence-associated secretory phenotype
				Elimination of senescent cells (senolysis)
			Conclusion
			References
		24 - Autonomic and neuroendocrine modulation of arterial stiffness and hemodynamics
			Autonomic control of the cardiovascular system
				Parasympathetic nervous system
				Sympathetic nervous system
			Assessing autonomic modulation of large-artery stiffness: methodological considerations
			Parasympathetic modulation of large-artery stiffness
			Sympathetic modulation of large-artery stiffness
				Relationships between sympathetic activity and arterial stiffness: cross-sectional studies
				Can acute modulation of sympathetic activity alter large-artery stiffness?
					Evidence from muscular arteries
					Evidence from elastic arteries
				Does chronic sympathetic modulation contribute to large-artery stiffness?
					Evidence from muscular arteries
					Evidence from elastic arteries
			Neuroendocrine modulation of arterial stiffness
				Renin-angiotensin-aldosterone system
				Endothelin-1
				Insulin
				Testosterone
				Estrogen
					Do sex hormones modify the relationship between muscle sympathetic nerve activity and arterial stiffness?
			Summary
			References
		25 - Cellular mechanisms of aging and their impact on the aortic/arterial wall
			Introduction
			Effects of aging on the arterial tree
				Endothelial dysfunction
				Elastic arteries
				Muscular arteries
				Small arteries
				The role of the adventitia in vascular remodeling
			Cellular and molecular mechanisms of vascular aging
				Vascular inflammation
				Oxidative stress
				Adaptation to oxidative stresses: role of Nrf2 and sirtuins
				Senescence
			Chronic kidney disease as a model of early vascular aging and role of calcification
			Summary
			References
	Back Matter
9780323916486v2_WEB
	Front Matter
	Textbook of Arterial Stiffness and Pulsatile Hemodynamics in Health and Disease
	Textbook of Arterial Stiffness and Pulsatile Hemodynamics in Health and Disease
	Copyright
	Contents of Volume 2
	Contributors
	Foreword
	Preface
	Acknowledgments
	IV - Clinical significance of arterial stiffness and pulsatile hemodynamics
		26 - Normal aging: arterial stiffness and remodeling over the life course
			Preamble
			Insights from cross-sectional epidemiological and cohort data
				Blood pressure and pulse wave velocity
				Cross-sectional wave reflection data
			Insights from longitudinal cohort data: the early life trajectory
			Insights from longitudinal cohort data: the adult life trajectory
				Manifestations in middle-aged and aged individuals
				Effects of aging on wave reflections
			Conclusions
			References
		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
			Acknowledgments
			References
			Further reading
		28 - Ethnic differences in arterial stiffness and central aortic hemodynamics
			Is studying ethnic differences in vascular or any physiological feature or disease useful?
				Relationships to blood pressure
			Arterial stiffness through the life-course across different ethnic/geographic groups
				Fetal life, infancy, childhood, and adolescence (see Table 1)14
				Young adults (see Table 2)14
					Middle-aged and elderly populations
				Retinal vessels
				Pulse wave velocity measures in AORTIC segments by Magnetic Resonance Imaging (MRI)
				HIV
			Ethnicity and the menopausal transition
			The elderly
				Renal impairment/failure (end-stage renal disease)
			Summary and conclusions
			References
		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
				Cardiac damage
				Brain damage
				Renal damage
				Cardiovascular and renal outcome
			Predictive value of arterial stiffness and wave reflection in hypertensives
			The particular case of very elderly hypertensives
			Conclusion
			Acknowledgments
			References
		30 - Arterial stiffness and pulsatile hemodynamics in diabetes and obesity
			Introduction
			Pathophysiologic role of diabetes mellitus in the development of increased arterial stiffness
				The role of advanced glycation end-products in the development of arterial stiffness
				Nitric oxide, oxidative stress, and arterial stiffness
			Epidemiologic association of diabetes mellitus with the development of increased arterial stiffness
				Risk of increased arterial stiffness and adverse cardiovascular events in patients with diabetes mellitus type 2
				Risk of increased arterial stiffness and adverse cardiovascular events in patients with diabetes mellitus type 1
				Risk of increased arterial stiffness and adverse cardiovascular events in patients with prediabetes
				The role of arterial stiffness in the promotion of diabetic microvascular disease
				Arterial stiffness and diabetic retinopathy
				Arterial stiffness and diabetic nephropathy
				Arterial stiffness and diabetic neuropathy and autonomic dysfunction
				Arterial stiffness and cognitive dysfunction in patients with diabetes mellitus
			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
			Acknowledgments
			References
		31 - Cardiovascular risk prevention in clinical medicine: current guidelines in the United States and in Europe
			Epidemiology of hypertension
				Definition and classification of hypertension
			Cardiovascular risk assessment in the management of hypertension
				Blood pressure measurement
				Risk assessment tools
				Hypertension-mediated organ damage and risk modifiers
				Arterial stiffness and cardiovascular risk
			Therapeutic goals in the management of hypertension
				Blood pressure treatment thresholds and targets in US/EU guidelines
				Blood pressure goals in older adults
				Chronic kidney disease
				Diabetes
				Blood pressure J-curve: role of large artery stiffness and implications for treatment targets
			Additional therapeutic considerations for hypertension management in current guidelines
				Nonpharmacologic and pharmacologic interventions
				Other considerations in the approach to hypertension management
				How do isolated systolic hypertension, pulse pressure, and LAS factor into current guideline recommendations for the treatm ...
			How do large artery stiffness and pulsatile hemodynamics factor into guideline recommendations for the treatment of other c ...
				Risk enhancers
				Risk groups
			Summary
			References
		32 - Cardiovascular risk prevention in clinical medicine: current guidelines in Asia
			Cardiovascular risk prevention in clinical practice: current guidelines in Asia
				Characteristics of cardiovascular risks in Asia, in comparison to the United States, Europe, and other populations
				Current Asian guidelines on cardiovascular prevention
					Hypertension
					Dyslipidemia
					Diabetes mellitus
					Life style modification
				Role of vascular markers in Asian cardiovascular prevention guidelines
				Perspective for the prevention of cardiovascular risk in Asia
			References
		33 - Arterial stiffness for cardiovascular risk stratification in clinical practice
			Introduction
			Arterial stiffness
			Central pressure and wave reflection indices
			Conclusions/future perspectives
			References
		34 - Role of the heart and arterial tree in physiologic adjustments during exercise
			Cardiac output
				Heart rate response during exercise
				Stroke volume response during exercise
				Ventricular-vascular coupling
			Exercise hemodynamics
			Pulmonary hemodynamics during exercise
				Pulmonary arterial pressure and resistance during exercise
				Pulmonary blood volume expansion, diffusion capacity, and pulmonary artery distensibility during exercise
			Central hemodynamics during exercise
				Mean arterial pressure
				Central pressure and pulse wave dynamics
				Pulse pressure amplification
				Blood flow pulsatility
				Large artery stiffness and characteristic impedance
			Blood flow redistribution
				Total peripheral resistance and functional sympatholysis
			Exercise hyperemia
				Vasoactive substances
				Conducted vasodilation
				Flow-mediated vasodilation
				Mechanical actions of the muscle
			Cardiovascular limitations to exercise
			Summary
			References
		35 - Invasive hemodynamic assessments during exercise: normal patterns and clinical value
			Introduction
				Role for invasive hemodynamics in diagnostic ambiguity
			Physiology of invasive hemodynamic assessment
				Assessment of left-sided filling pressures
				Right atrial pressure
				Concept of pericardial restraint
			Measurement of flow
				The Fick principle
				CO assessment using VO2 measured versus assumed
				Thermodilution CO
			Vascular load
				Systemic vascular load
				Pulmonary vascular load
			Assessment during exercise
				Normal range of resting and exercise value
				Preforming an exercise hemodynamic study
					Setup
					Supine versus upright
				Measurement of pressures
					End-expiration versus respiratory averaged
					Cardiac output reserve
				Added value of simultaneous exercise echocardiography
			Clinical utility in the evaluation of suspected heart failure
				HFpEF
					Diagnostic uncertainty
					Evaluation of specific phenotypes
					Bayesian approach can guide decision to refer for invasive assessment
				HFrEF
					Value in determining cardiac component of limitation
					Degree of pulmonary hypertension, RV dysfunction
				PAH
					Utility in atypical PAH
				Valve disease
					Paradoxical LG AS
					Severe TR with pericardial restraint
			More advanced assessment
				Peripheral O2 utilization
				Ventilation and expired gas analysis
			Conclusion
			References
		36 - Arterial stiffness and pulsatile hemodynamics in heart failure
			Introduction
			Heart failure: definition and classification
			The arterial tree in HF
				The aorta in HF
					The aorta in HFpEF
					The aorta in HFrEF
					Large artery stiffness as a predictor of incident HF
					Large artery stiffness as a predictor of outcomes in established HF
				Arterial wave reflection in heart failure
					Wave reflection and LV hypertrophy
					Effect of mid-to-late systolic load on LV diastolic dysfunction
					Arterial wave reflection and the risk of incident HF
				Hemodynamic role of the microvasculature in HF
					The microvasculature as a determinant of LV load
					Effects of peripheral microvascular function on exercise capacity
					Role of the coronary microcirculation
				Macrovascular-microvascular cross-talk: role of large arterial pulsatile hemodynamics in microvascular dysfunction and HFpE ...
			Therapeutic implications
				Spironolactone
				Vasodilators
				NO donors
				Soluble guanylate cyclase stimulators/activators
				Neprilysin inhibitors
				The matrix gla protein pathway
			Conclusions
			Acknowledgments
			References
		37 - Ventricular-arterial coupling and arterial load in aortic valve disease
			Introduction
			Anatomical interaction between the LV, aortic valve, and aortic root
				Anatomical interrelation between the LV outflow tract, aortic valve, and aortic root
				Bicuspid aortic valve and aortopathy
			Functional interaction between the left ventricle, aortic valve, and aorta
				Ventriculo-valvulo-arterial coupling
				Impact of aortic stenosis on ventriculo-arterial coupling
				Impact of aortic regurgitation on ventriculo-arterial coupling
			Interaction between LV outflow tract and aortic valve
			Interaction between aorta and aortic valve in aortic valve disease
				Aortic stenosis
					Effacement of sinotubular junction
					Pressure recovery
					Interaction between hypertension and AS
				Aortic regurgitation
			Interaction between aorta, aortic valve, and LV in AS
			Impact of arterial load following aortic valve replacement
			Conclusion
			References
		38 - Arterial stiffness and atherosclerosis: mechanistic and pathophysiologic interactions
			Introduction
			Vascular failure: interaction between atherosclerosis and arterial stiffness
				Pulse wave velocity and atherosclerosis
					In coronary arteries
					In cerebral arteries
					In the carotid artery
				Cardio-ankle vascular index and atherosclerosis
				Other arterial stiffness parameters
			Interaction between vascular disease and hemodynamic stress
				SHATS: a proposed novel clinical entity
				Mechanisms and evidence
					BP variability
					Hemodynamic factors
					Vascular component
				Role in organ damage and cardiovascular events
				Proposed diagnostic score
				Potential treatment strategies
			Conclusion
			Acknowledgments
			References
		39 - Arterial stiffness and pulsatile hemodynamics in coronary artery disease and other forms of atherosclerotic va ...
			Introduction
			Coronary artery disease
				Clinical evidence
				Mechanism
			Peripheral artery disease
				Clinical evidence
				Mechanism
			Aortic calcification
				Clinical evidence
				Mechanism
			Stroke and cerebrovascular disease
				Clinical evidence
				Mechanism
			Perspectives
			References
		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
				Cross-sectional findings
					General populations with kidney measurements
					Chronic kidney disease-not on dialysis
					Chronic kidney disease-on dialysis (end-stage kidney disease/end-stage renal disease)
					Longitudinal studies (see Table 40.1)
			Clinical pulsatility indices and kidney function
				Pulsatility index
				Resistive index
			Mechanisms of increased arterial stiffness in chronic kidney disease
			Vascular calcification
				Renin system activation
				Changes in vessel wall proteins
				Advanced glycation endproducts
				Endothelial dysfunction
				Inflammation/oxidative stress
			Therapies
			References
		41 - Arterial stiffness, pulsatile hemodynamics, and the vascular contributions to dementia
			Introduction
				Review of studies linking arterial stiffness to Alzheimer\'s disease and related dementias
					Arterial stiffness and cognitive impairment
					Arterial stiffness and cognitive function
					Arterial stiffness and brain structural abnormalities on magnetic resonance imaging
					Association of arterial stiffness and Alzheimer\'s disease biomarkers
				Assessing evidence of the association between arterial stiffness and dementia
			Conclusions
			References
		42 - Arterial stiffness and pulsatile hemodynamics in pregnancy and pregnancy-related vascular complications
			Healthy pregnancy
				Blood volume and hematological changes
				Cardiac output
				Vascular remodeling and vascular resistance
				Blood pressure
				Arterial stiffness
			Pregnancy complications
				Blood volume
				Cardiac output
				Vascular remodeling and vascular resistance
				Blood pressure
				Arterial stiffness
				Fetal growth restriction
			Exercise in pregnancy
			Concluding remarks
			References
		43 - Arterial stiffness and pulsatile hemodynamics in pediatric populations
			Introduction
			Vascular effects of various disease states
				Obesity
					Pulse wave velocity
					Pulse wave analysis
					Distensibility
					Global measures
				Dyslipidemia
					Pulse wave velocity
					Pulse wave analysis
					Distensibility
					Global measures
				Hypertension
					Pulse wave velocity
					Pulse wave analysis
					Distensibility
					Global measures
				Diabetes
					Pulse wave velocity
					Pulse wave analysis
					Global measures
				Other conditions
			Methods and normal values in children
				Pulse wave velocity
					Applanation tonometry
					Oscillometric devices
					Cardiac magnetic resonance imaging
					Sex-specific differences in pulse wave velocity
					Race-specific differences in pulse wave velocity
					Conclusions about pulse wave velocity normal values
				Pulse wave analysis
				Distensibility
			Future directions
			References
		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
			References
		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
				Marfan syndrome
				Loeys-Dietz syndrome
				Familial thoracic aortic aneurysms and dissections
				Bicuspid aortic valve
				Turner\'s syndrome
				Ehlers-Danlos syndrome
				Degenerative aortopathy
			Measures of aortic stiffness and pulsatile hemodynamic as markers of disease activity and thoracic aortic aneurysm-related risk
			Conclusions and future directions
			References
		46 - Arterial stiffness and pulsatile hemodynamics in congenital heart disease
			Background
				Normal aortic morphology
				Aortic development
				Coarctation of the aorta and interrupted aortic arch
			Hypertension after coarctation repair
			Cardiovascular morbidity
			Abnormalities of pulsatile hemodynamics
				Arterial stiffness-regional effects
				Central pressure and total arterial compliance
				Aortic wave reflections
				Geometric considerations
					Aortic arch obstruction
					Types of repair
					Three-dimensional shape and hemodynamics
			What causes the arterial abnormalities arise in coarctation?
				Congenital stiffness or control of systemic vascular resistance?
				Evolution to vasculopathy-inflammation and biomechanics
			Vascular abnormalities in other forms of congenital heart disease
				Tetralogy of fallot
				Other forms of congenital heart disease
			Conclusions
			References
		47 - Infection and arterial stiffness
			Introduction
			Arterial stiffness and sepsis
				Effect of sepsis on the circulatory system
					Short term
					Intermediate and long term
				Sepsis and arterial stiffness
					Animal studies on sepsis and arterial stiffness
					Human studies on sepsis and arterial stiffness
					Potential mechanisms for an effect of sepsis on arterial stiffness
					Can alterations of the human microbiome by antibiotics used to treat acute infections affect the associations between sepsi ...
			Arterial stiffness and human immunodeficiency virus infection
				Myocardial infarction in people living with human immunodeficiency virus
				Heart failure in people living with human immunodeficiency virus
				Human immunodeficiency virus infection and arterial stiffness
				Conclusion
			References
		48 - Arterial stiffness, hemodynamics, and microvascular complications in conditions characterized by low arterial  ...
			Introduction
			Low pulsatile hemodynamics in continuous-flow left ventricular assist device therapy
			Effects of low pressure and flow pulsatility on the macrocirculation
				Sympathetic nerve activity, vascular remodeling, and aortic stiffness
				Endothelial dysfunction
				Blood pressure
			Consequences of low pressure and flow pulsatility on the microcirculation
				Right heart failure and respiratory complications
				Cerebrovascular complications
				Gastrointestinal bleeding
				Pharmacological decision-making in relation to PP and PI in LVAD patients
			Left ventricular assist device therapy and exercise capacity
			Conclusions
			References
	V - Therapeutic approaches to improve arterial stiffness and pulsatile hemodynamics
		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 phos ...
			Device-based antihypertensive therapy
			Conclusions and perspectives
			References
		50 - Pharmacologic approaches to reduce arterial stiffness
			Introduction
			Potential therapeutic targets for arterial destiffening: preclinical studies
				Inflammation and oxidative stress
				Vascular calcification
				Elastase inhibitors and extracellular matrix metalloproteases
				Micro-RNAs
				Mineralocorticoid receptor antagonism
				Amyloid-β and arterial stiffness
			Clinical studies on aortic and large artery destiffening
				Drugs inhibiting the renin-angiotensin-aldosterone system and mineralocorticoid antagonists
				Statins and other lipid lowering therapy
				Antioxidant vitamins and vitamin B12/folate supplementation
				Antidiabetic drugs and advanced glycosylation end-product breakers
				Antiinflammatory drugs
				Drugs targeting arterial calcification and bone mineral metabolism
			Summary
			Conclusion
			References
		51 - Organic and dietary nitrates, inorganic nitrite, nitric oxide donors, and soluble guanylate cyclase stimulation
			Part 1: introduction
				Nitric oxide signaling in the vasculature and vasodilatation
				The effect of nitric oxide on cardiac function
				Endothelial paracrine regulation of left ventricular function
				Effects of nitric oxide signaling at the myocardial level
				Interaction with phosphodiesterase
			Part 2: organic nitrates
				Pulsatile hemodynamic effects of organic nitrates
			Part 3: inorganic nitrite
				Early pharmacological studies of nitrite on arterial tension/waveform
				Reevaluation of nitrite in the ``nitric oxide era\'\'
				Recent assessment of vascular effects of nitrite
				The effect of inorganic nitrite on the cardiovascular system-ventricular hemodynamics
				Clinical applications of inorganic nitrite
			Part 4: inorganic (dietary) nitrate
				Discovery of the inorganic nitrate-nitrite-NO pathway and its cardiovascular relevance
				Dietary nitrate and blood pressure
				Dietary nitrate and arterial stiffness/pulse wave velocity
				Inorganic nitrate and angina
				Limitations of organic and dietary/inorganic nitrates
				Safety concerns regarding dietary nitrate and inorganic nitrite
			Part 5: nitric oxide donors
				Sodium nitroprusside
			Part 6: soluble guanylate cyclase
				The role of soluble guanylate cyclase in the cardiovascular system
				Dysfunctional soluble guanylate cyclase signaling
				Drugs that target soluble guanylate cyclase
				Soluble guanylate cyclase stimulators
				Soluble guanylate cyclase activators
				Nitroxyl
			Conclusions and future directions
			References
			Further reading
		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 wit ...
			Effect of aerobic exercise interventions on central artery stiffness and pulsatile hemodynamics in young and MA/O adults wi ...
			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
			References
		53 - Dietary salt and arterial stiffness
			Introduction
			Dietary salt and blood pressure
			Dietary salt and cardiovascular outcomes
			Blood pressure independent effects of dieatary salt
				Heart
				Inflammation
				Arteries
					Endothelial function
				Potential mechanisms of reduced endothelial function by high salt (Fig. 53.2)
					Oxidative stress
					Endothelial cell stiffening
				Brain and sympathetic outflow
			Dietary salt and arterial stiffness
				Potential mechanisms of increased arterial stiffness by high salt
				Dietary salt and pulsatile load
			Lifestyle and dietary salt
				Potassium
				Exercise/physical activity
			Conclusion
			References
		54 - Role of arterial stiffness and central hemodynamics in personalized medicine in hypertension
			Introduction
			Isolated systolic hypertension in the elderly
				Arterial stiffness and central pulsatile hemodynamics in ISH in the elderly
				Usefulness of noninvasive measurement of arterial stiffness and central pulsatile hemodynamics in the diagnosis of ISH in t ...
				Usefulness of noninvasive measurement of arterial stiffness and central pulsatile hemodynamics in the treatment of ISH in t ...
				Prognostic value of noninvasive measurements of arterial stiffness and central pulsatile hemodynamics in ISH in the elderly
			Isolated systolic hypertension in the young
				Arterial stiffness and central pulsatile hemodynamics in ISH in the young
				Usefulness of noninvasive measurements of arterial stiffness and central pulsatile hemodynamics in the diagnosis of ISH in  ...
				Usefulness of noninvasive measurements of arterial stiffness and central pulsatile hemodynamics in the treatment of ISH in  ...
				Prognostic value of noninvasive measurement of arterial stiffness and central pulsatile hemodynamics in ISH in the young
			Isolated diastolic hypertension
				Arterial stiffness and central pulsatile hemodynamics in IDH
				Usefulness of arterial stiffness and central pulsatile hemodynamics in the diagnosis of IDH
				Usefulness of arterial stiffness and central pulsatile hemodynamics in the treatment of IDH
				Prognostic value of arterial stiffness and central pulsatile hemodynamics in IDH
			Isolated central hypertension and isolated brachial hypertension
				Arterial stiffness and central pulsatile hemodynamics in ICH and IBH
				Usefulness of arterial stiffness and central pulsatile hemodynamics in the diagnosis of ICH and IBH
				Usefulness of arterial stiffness and central pulsatile hemodynamics in the treatment of ICH and IBH
				Prognostic value of arterial stiffness and central pulsatile hemodynamics in ICH and IBH
			White coat hypertension
				Arterial stiffness and central pulsatile hemodynamics in white coat hypertension
				Usefulness of noninvasive measurements of arterial stiffness and central pulsatile hemodynamics in the diagnosis of white c ...
				Usefulness of noninvasive measurement of arterial stiffness and central pulsatile hemodynamics in the treatment of white co ...
				Prognostic value of noninvasive measurements of arterial stiffness and central pulsatile hemodynamics in white coat hyperte ...
			Masked hypertension
				Arterial stiffness and central pulsatile hemodynamics in masked hypertension
				Usefulness of noninvasive measurements of arterial stiffness and central pulsatile hemodynamics in the diagnosis of masked  ...
				Usefulness of noninvasive measurements of arterial stiffness and central pulsatile hemodynamics in the treatment of masked  ...
				Prognostic value of noninvasive measurements of arterial stiffness and central pulsatile hemodynamics in masked hypertension
			Isolated nocturnal hypertension
				Arterial stiffness and central pulsatile hemodynamics in INH
				Usefulness of noninvasive measurements of arterial stiffness and central pulsatile hemodynamics in the diagnosis of INH
				Prognostic value of noninvasive measurements of arterial stiffness and central pulsatile hemodynamics in INH
			Exaggerated blood pressure variability
				Arterial stiffness and central pulsatile hemodynamics in exaggerated BPV
				Usefulness of noninvasive measurement of arterial stiffness and central pulsatile hemodynamics in the diagnosis of exaggera ...
				Prognostic value of noninvasive measurement of arterial stiffness and central pulsatile hemodynamics in exaggerated BP vari ...
			Summary and conclusion
			References
	VI - Arterial stiffness and pulsatile hemodynamics in the pulmonary circulation
		55 - Pulsatile hemodynamics and ventricular-arterial interactions in the pulmonary circulation: physiologic concepts
			Introduction
			Measurements in the pulmonary circulation
				Pressures in the pulmonary system
					Right atrial pressure as a function of time
					Right ventricular pressure as a function of time
					Pulmonary artery pressure as a function of time
					Pulmonary artery wedge pressure
					Pulmonary capillary pressure
				Flow measurements in the pulmonary system
					Cardiac output
					Pulmonary artery flow
				Volume measurements of the right heart
					Echocardiography
					Cardiac MRI
					Conductance catheter
					Right atrial volume as a function of time
					Right ventricular volume as a function of time
			The pulmonary vasculature
				Anatomy and function of the pulmonary vasculature
				Descriptions of the pulmonary vascular load
					Frequency domain
					Windkessel description
					Pulmonary vascular resistance
					Pulmonary arterial compliance
					Characteristic impedance
					Wave reflection
					Relation of pressure levels
					Arterial time constant
			The right ventricle
				Anatomy and function of the right ventricle
					Ventricular anatomy
					Ventricular function
				Descriptions of the right ventricular function
					Ventricular pressure-volume relation
					End-systolic elastance
					Arterial elastance
					End-diastolic elastance
					Ventricular interaction
			Ventriculoarterial coupling
				Maximal power or efficiency: energetic coupling
				Ventriculoarterial coupling determined from the pressure-volume relation
				Surrogate measures of ventriculoarterial coupling in the pressure-volume plane
			Differences between the systemic and pulmonary circulation
			Normal values in the pulmonary circulation
			Summary
			References
		56 - Pulmonary arterial load and ventricular-arterial coupling in pulmonary hypertension
			Introduction
				Definition of pulmonary hypertension
				The properties of pulmonary arterial load and right ventricular function
			Pulmonary arterial load in pulmonary hypertension
				Heart-independent arterial load
				Nonpulsatile arterial load: pulmonary vascular resistance
				Pulsatile arterial load
					Pulmonary arterial input impedance
					Pulmonary arterial compliance
					Time constant of the pulmonary circulation
					Characteristic impedance of the proximal arteries
					Effective arterial elastance
				Heart-dependent arterial load
					Pulmonary artery pressure (mean, systolic, and diastolic pressure)
					Wave reflection: wave separation analysis and wave intensity analysis
					Right ventricular wall stress/tension
			The right ventricular function in pulmonary hypertension
				Load-independent right ventricular function
					Right ventricular contractility: end-systolic elastance
					Right ventricular diastolic stiffness: end-diastolic elastance
				Load-dependent right ventricular function
					Cardiac output and stroke volume
					Right ventricular volume and ejection fraction
					Echocardiographic measures
			The cardiovascular interaction in pulmonary hypertension
				The right ventricle-pulmonary artery coupling: Ees/Ea
				Right ventricle volumetric adaptation and wall stress
				Left ventricle-right ventricle interaction
			Summary
			References
		57 - Biologic mechanisms and consequences of pulmonary artery stiffening in pulmonary hypertension
			Pulmonary vascular stiffening and mechanobiological feedback in PH pathogenesis
				Pulmonary hypertension
				Pulmonary vascular stiffening in clinical studies
				Pathophysiology of pulmonary vascular stiffening in disease progression
			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
			References
		58 - Therapeutic approaches to improve pulmonary arterial load and right ventricular-pulmonary arterial coupling
			Introduction
			Right ventricular dysfunction and failure
				Response to normal loading conditions
				Pathophysiology of acute right heart failure
				Pathophysiology of chronic right heart failure
			The components of right ventricular afterload
			Approach to the management of right ventricular failure
				Optimization of preload and volume status
				Maintaining myocardial perfusion
				Improving contractility
				Neurohormonal modulation
			Therapies targeting right ventricular afterload
				Relationship between resistance and compliance
				Ventricular-vascular coupling
				Therapeutic agents for treatment of pulmonary arterial hypertension
				Approach to the treatment of pulmonary arterial hypertension
				Creation of palliative right-to-left shunts
				Approach to treatment of group 2 pulmonary hypertension
			Advanced therapeutic options for treatment of right venrticular failure
			Emerging therapeutic options
			Conclusion
			References
	Index
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		P
		Q
		R
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	Back Matter