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Università degli Studi di Catanzaro Magna Græcia.

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Presentation on theme: "Università degli Studi di Catanzaro Magna Græcia."— Presentation transcript:

1 Università degli Studi di Catanzaro Magna Græcia

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4 V ASCULAR R EMODELING Active process of structural alteration that involves cell growth cell death cell migration production and degradation of EM

5 Università degli Studi di Catanzaro Magna Græcia Dynamic interaction between locally generated growth factors vasoactive substances hemodynamic stimuli V ASCULAR R EMODELING

6 Università degli Studi di Catanzaro Magna Græcia Is usually an adaptive process that occurs in response to long-term changes in hemodynamic conditions, but it may subsequently contribute to the pathophysiology of vascular diseases and circulatory disorders V ASCULAR R EMODELING

7 Università degli Studi di Catanzaro Magna Græcia SENSORSTRANSDUCERS MEDIATORS STRUCTURAL CHANGES V ASCULAR R EMODELING

8 Università degli Studi di Catanzaro Magna Græcia MEDIATORS SENSORS SIGNALS

9 MMPs secreted by macrophages degrade the extracellular matrix IFN- IL-1 PDGF VSMC–inflammatory cell interactions in atherosclerosis TNF- Fibrous cap Macrophage Macrophages induce VSMC apoptosis Macrophages induce VSMC apoptosis T-lymphocyte Inflammatory cytokines inhibit matrix protein production by VSMCs Macrophages secrete growth factors that promote VSMC recruitment and proliferation

10 Università degli Studi di Catanzaro Magna Græcia THE SPECTRUM OF VASCULAR REMODELING pressureflowinjury

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12 a a b b c c intima media avventizia

13 Università degli Studi di Catanzaro Magna Græcia

14 Fluctuations in Amplitude of Flow, Pressure, and Diameter in a Large Artery FlowPressureDiameter 300%60%10%

15 Università degli Studi di Catanzaro Magna Græcia 100 80 60 140 100 60 20 -20 0 Pressure mmHg Flow cm/s Asc. aorta Aorta arch Abd aorta Fem. artery Sap. artery Changes in the Contour and Amplitude of the Pressure and Flow Waves in Arteries

16 Università degli Studi di Catanzaro Magna Græcia Representative Radial arterial Waveform in Different Age Groups Age 25 yearsAge 47 yearsAge 80 years McVeigh GE et al. Hypertension 1999; 33:1392-1398

17 Università degli Studi di Catanzaro Magna Græcia Alterazioni Carotidee ed Eventi Cardiovascolari MJ Koren et al Ann Intern Med 1991 MJ Roman et al JACC 1996 0,5 0,7 0,9 1,1 NGRCIEIC Spessore mio-intimale mm 10 14 18 22 NGRCIEIC Area mio-intimale mm 2 Placche 10 30 50 NGRCIEIC % Eventi CV 0 10 20 30 NGRCIEIC %

18 Università degli Studi di Catanzaro Magna Græcia Fatal CV Events (x 100 pts-years) cPP, mmHg Progressive Increase in CV Mortality According to Tertiles of the Distribution of PP aPP, mmHg 65 53 Verdecchia P et al. Hypertension 1998; 32:983-988

19 Università degli Studi di Catanzaro Magna Græcia Total CV Events (x 100 pts-years) cPP, mmHg Progressive Increase in CV Morbidity According to Tertiles of the Distribution of PP aPP, mmHg 65 53 Verdecchia P et al. Hypertension 1998; 32:983-988

20 Università degli Studi di Catanzaro Magna Græcia Total CV Events (x 100 pts-years) Average 24-h PP, mmHg Relationship Between Tertiles of PP and Total CV Events clinic PP, mmHg 45 65 Verdecchia P et al. Hypertension 1998; 32:983-988

21 Università degli Studi di Catanzaro Magna Græcia LVM (g) Tertiles of Stiffness Index Comparison of LVM and RWT and Tertile of Arterial Stiffness Index First Roman MJ et al. Hypertension 2000; 36:489-494 SecondThridFirstSecondThrid Tertiles of Stiffness Index RWT p=NSp<0.001

22 Università degli Studi di Catanzaro Magna Græcia Carotid Arterial Stiffness as a Predictor of Cardiovascular and All-Cause Mortality in End-Stage Renal Disease Jacques Blacher, Bruno Pannier, Alain P. Guerin, Sylvain J. Marchais, Michel E. Safar, Gérad M. London Hypertension, 1998;32:570-74

23 Università degli Studi di Catanzaro Magna Græcia Probability of Overall Survival Probability of Event-free Survival Probabilities of Overall Survival and Event-free Survival According to Level of PWV Divided Into Tertiles Blacher J et al. Circulation 1999; 99:2434-2439

24 Università degli Studi di Catanzaro Magna Græcia Survival by Quartiles of Pulse Pressure Adjusted for Age and EF in Patients with LV Dysfunction Domanski et al. JACC 1999; 33:951-8 60 80 100 36573010951460 Quartile 2 Quartile 1 Quartile 3 Quartile 4 Follow-up time (days) Survival (%)

25 Università degli Studi di Catanzaro Magna Græcia Chen et al. JACC 1998; 32:1221-7 Relative Risk for Total CV Mortality According to PP and Gender and Presence of Hypertension 0.4 0.6 0.8 1.0 1.2 1.4 1.6 1.8 2.0 NT Women NT Men HT Women HT Men RR

26 Università degli Studi di Catanzaro Magna Græcia Millar JA et al. Hypertension 2000; 36:907-911 0 15 5090100120 10 5 706080110 Stroke Rate Coronary events DBP (mmHg) Predict Event Rates for Stroke and Coronary Events

27 Università degli Studi di Catanzaro Magna Græcia Empiric Models of RR Index for Stroke and Coronary Events when Predicted by Mean BP and PP Millar JA et al. Hypertension 2000; 36:907-911 Stroke riskMI risk DBP (mmHg) 0.60 1.20 1.80 5090110130 1.50 0.90 70 0.60 1.20 1.80 5090110130 1.50 0.90 70 Risk

28 Università degli Studi di Catanzaro Magna Græcia Pulse Wave Velocity Systole

29 Università degli Studi di Catanzaro Magna Græcia Absolute change in volume following changes in pressure C OMPLIANCE Relative volume or diameter change for a given pressure D istensibility Speed of travel of the pulse along an arterial segment distance P ulse W ave V elocity

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32 ARTERIES – from heart VEINS – to heart capillariescapillaries

33 Università degli Studi di Catanzaro Magna Græcia LVMI (g/m 2 ) r = -0.554 p < 0.00001 Peak Response to ACh (% of increase) 0 200 400 600 800 50100150200250 Peak Percent Increase in FBF After Acetylcholine (ACh) Infusion Versus LVMI in Hypertensives F Perticone et al., Circulation 1999

34 Università degli Studi di Catanzaro Magna Græcia Ipertensione Arteriosa e Danno dOrgano


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