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Aristotele. IGaleno. V ASCULAR R EMODELING. Active process of structural alteration that involves cell growth cell death cell migration production and degradation of EM. V ASCULAR R EMODELING. Dynamic interaction between locally generated growth factors vasoactive substances

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Aristotele

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IGaleno


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VASCULARREMODELING

  • Active process of structural alteration that involves

    • cell growth

    • cell death

    • cell migration

    • production and degradation of EM


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VASCULARREMODELING

  • Dynamic interaction between locally generated

    • growth factors

    • vasoactive substances

    • hemodynamic stimuli


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VASCULARREMODELING

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


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VASCULARREMODELING

SENSORS

TRANSDUCERS

STRUCTURAL CHANGES

MEDIATORS


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SIGNALS

SENSORS

MEDIATORS


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VSMC–inflammatory cell interactions in atherosclerosis

MMPs secreted by macrophages degrade the extracellular matrix

Macrophages

induce

VSMC

apoptosis

TNF-

Fibrous

cap

IL-1

Macrophage

IFN-g

T-lymphocyte

PDGF

Inflammatory cytokines inhibit matrix protein production by VSMCs

Macrophages secrete growth factors that promote VSMC recruitment and proliferation


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THE SPECTRUM OF VASCULAR REMODELING

pressure

flow

injury


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avventizia

c

b

media

a

intima


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Fluctuations in Amplitude of Flow, Pressure,

and Diameter in a Large Artery

Flow

Pressure

Diameter

300%

60%

10%


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Changes in the Contour and Amplitude

of the Pressure and Flow Waves in Arteries

100

Pressure mmHg

80

60

Asc.

aorta

Aorta

arch

Abd

aorta

Fem.

artery

Sap.

artery

140

100

60

Flow cm/s

20

0

-20


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Representative Radial arterial Waveform in Different Age Groups

Age 25 years

Age 47 years

Age 80 years

McVeigh GE et al. Hypertension 1999; 33:1392-1398


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Spessore mio-intimale

Area mio-intimale

1,1

22

0,9

18

mm2

mm

0,7

14

10

0,5

NG

RC

IE

IC

NG

RC

IE

IC

Placche

Eventi CV

%

%

30

50

20

30

10

10

0

NG

RC

IE

IC

NG

RC

IE

IC

Alterazioni Carotidee ed Eventi Cardiovascolari

MJ Koren et al Ann Intern Med 1991

MJ Roman et al JACC 1996


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Progressive Increase in CV Mortality

According to Tertiles of the Distribution of PP

Fatal CV Events (x 100 pts-years)

<50 51-65 >65

<45 46-53 >53

aPP, mmHg

cPP, mmHg

Verdecchia P et al. Hypertension 1998; 32:983-988


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Progressive Increase in CV Morbidity

According to Tertiles of the Distribution of PP

Total CV Events (x 100 pts-years)

<50 51-65 >65

<45 46-53 >53

aPP, mmHg

cPP, mmHg

Verdecchia P et al. Hypertension 1998; 32:983-988


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Relationship Between Tertiles of PP and Total CV Events

Total CV Events (x 100 pts-years)

<53 46-53 >45

Average 24-h PP, mmHg

<50 51-65 >65

clinic PP, mmHg

Verdecchia P et al. Hypertension 1998; 32:983-988


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Comparison of LVM and RWT

and Tertile of Arterial Stiffness Index

p=NS

p<0.001

RWT

LVM (g)

First

Second

Thrid

First

Second

Thrid

Tertiles of Stiffness Index

Tertiles of Stiffness Index

Roman MJ et al. Hypertension 2000; 36:489-494


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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


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Probabilities of Overall Survival and Event-free Survival According to Level of PWV Divided Into Tertiles

Probability of Overall Survival

Probability of Event-free Survival

Blacher J et al. Circulation 1999; 99:2434-2439


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100

80

60

365

730

1095

1460

Survival by Quartiles of Pulse Pressure Adjusted

for Age and EF in Patients with LV Dysfunction

Quartile 2

Quartile 1

Quartile 3

Survival (%)

Quartile 4

Follow-up time (days)

Domanski et al. JACC 1999; 33:951-8


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Relative Risk for Total CV Mortality

According to PP and Gender and Presence of Hypertension

NT Women

NT Men

HT Women

HT Men

0.4

1.4

0.8

1.2

0.6

1.6

1.0

1.8

2.0

RR

Chen et al. JACC 1998; 32:1221-7


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Predict Event Rates for Stroke and Coronary Events

Rate

15

Coronary events

10

Stroke

5

0

50

60

70

80

90

100

110

120

DBP (mmHg)

Millar JA et al. Hypertension 2000; 36:907-911


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Empiric Models of RR Index for Stroke and Coronary Events

when Predicted by Mean BP and PP

Risk

Risk

1.80

Stroke risk

MI risk

1.80

1.50

1.50

1.20

1.20

0.90

0.90

0.60

0.60

70

50

90

110

130

70

50

90

110

130

DBP (mmHg)

Millar JA et al. Hypertension 2000; 36:907-911


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Pulse Wave Velocity

Systole


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COMPLIANCE

Absolute change in volume following changes in pressure

Distensibility

Relative volume or diameter change for a given pressure

Pulse Wave Velocity

Speed of travel of the pulse along an arterial segment distance


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ARTERIES – from heart

capillaries

VEINS – to heart


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Peak Percent Increase in FBF After Acetylcholine (ACh) Infusion Versus LVMI in Hypertensives

800

r = -0.554

p < 0.00001

600

Peak Response to ACh

(% of increase)

400

200

0

50

100

150

200

250

LVMI (g/m2)

F Perticone et al., Circulation 1999


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Ipertensione Arteriosa e Danno d’Organo


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