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Aristotele

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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  1. Aristotele

  2. IGaleno

  3. VASCULARREMODELING • Active process of structural alteration that involves • cell growth • cell death • cell migration • production and degradation of EM

  4. VASCULARREMODELING • Dynamic interaction between locally generated • growth factors • vasoactive substances • hemodynamic stimuli

  5. 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

  6. VASCULARREMODELING SENSORS TRANSDUCERS STRUCTURAL CHANGES MEDIATORS

  7. SIGNALS SENSORS MEDIATORS

  8. 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

  9. THE SPECTRUM OF VASCULAR REMODELING pressure flow injury

  10. avventizia c b media a intima

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

  12. 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

  13. 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

  14. 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

  15. 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

  16. 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

  17. 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

  18. 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

  19. 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

  20. 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

  21. 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

  22. 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

  23. 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

  24. 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

  25. Pulse Wave Velocity Systole

  26. 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

  27. ARTERIES – from heart capillaries VEINS – to heart

  28. 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

  29. Ipertensione Arteriosa e Danno d’Organo

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