Università degli Studi di Catanzaro Magna Græcia.

Università degli Studi di Catanzaro Magna Græcia




VASCULAR REMODELING

Active process of structural alteration that involves

cell growth

cell death

cell migration

production and degradation of EM


Dynamic interaction between locally generated

growth factors

vasoactive substances

hemodynamic stimuli

VASCULAR REMODELING


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

VASCULAR REMODELING


SENSORS

TRANSDUCERS

MEDIATORSSTRUCTURAL

CHANGES

VASCULAR REMODELING


MEDIATORSMEDIATORS

SENSORSSENSORS

SIGNALSSIGNALS


MMPs secreted by macrophages degrade the

extracellular matrix

MMPs secreted by macrophages degrade the

extracellular matrix

IFN-

IL-1

PDGF

VSMC–inflammatory cell interactions in atherosclerosis

TNF-Fibrous

capMacrophage

Macrophages induceVSMC

apoptosis

Macrophages induceVSMC

apoptosis

T-lymphocyte Inflammatory cytokines

inhibit matrix protein

production by VSMCs

Inflammatory cytokines

inhibit matrix protein

production by VSMCs

Macrophages secrete growth factors that promote VSMC recruitment and proliferation

Macrophages secrete growth factors that promote VSMC recruitment and proliferation


THE SPECTRUM OF VASCULAR REMODELINGTHE SPECTRUM OF VASCULAR REMODELINGTHE SPECTRUM OF VASCULAR REMODELINGTHE SPECTRUM OF VASCULAR REMODELING

pressurepressure flowflow injuryinjury



aabb

cc

intima

media

avventizia



Fluctuations in Amplitude of Flow, Pressure, and Diameter in a Large Artery

Flow Pressure Diameter

300% 60% 10%


100

80

60

140

100

60

20

-20

0

Pre

ssu

re m

mH

gFl

ow

cm

/s

Asc. aorta

Aortaarch

Abd aorta

Fem. artery

Sap. artery

Changes in the Contour and Amplitude of the Pressure and Flow Waves in Arteries


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


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

NG RC IE IC

Spessore mio-intimale

mm

10

14

18

22

NG RC IE IC

Area mio-intimale

mm

2

Placche

10

30

50

NG RC IE IC

%

Eventi CV

0

10

20

30

NG RC IE IC

%


Fata

l C

V E

vents

(x 1

00 p

ts-y

ears

)

cPP, mmHg

Progressive Increase in CV Mortality According to Tertiles of the Distribution of PP

0

0,2

0,4

0,6

0,8

1

1,2

1,4

aPP, mmHg

<50 51-65 >65 <45 46-53 >53

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


Tota

l C

V E

vents

(x 1

00 p

ts-y

ears

)

cPP, mmHg

Progressive Increase in CV Morbidity According to Tertiles of the Distribution of PP

0

0,5

1

1,52

2,5

3

3,5

44,5

5

aPP, mmHg

<50 51-65 >65 <45 46-53 >53



Tota

l C

V E

vents

(x 1

00 p

ts-y

ears

)

Average 24-h PP, mmHg

Relationship Between Tertiles of PP and Total CV Events

0

1

2

3

4

5

6

clinic PP, mmHg

<53 46-53 >45 <50 51-65 >65



LVM

(g)

Tertiles of Stiffness Index

Comparison of LVM and RWT and Tertile of Arterial Stiffness Index

0

50

100

150

200

250

First

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

0,25

0,35

0,45

Second Thrid First Second Thrid

Tertiles of Stiffness IndexR

WT

p=NS

p<0.001


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


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


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

365 730 1095 1460

Quartile 2Quartile 1Quartile 3Quartile 4

Follow-up time (days)

Surv

ival (%

)


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


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

0

15

50 90 100 120

10

5

7060 80 110

Stroke

Rate

Coronary events

DBP (mmHg)

Predict Event Rates for Stroke and Coronary Events


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 risk MI risk

DBP (mmHg)

0.60

1.20

1.80

50 90 110 130

1.50

0.90

700.60

1.20

1.80

50 90 110 130

1.50

0.90

70

Risk Risk


Pulse Wave Velocity

Systole


Absolute change in volume following changes in

pressure

COMPLIANCE

Relative volume or diameter change for a given

pressure

Distensibility

Speed of travel of the pulse along an arterial segment

distance

Pulse Wave Velocity




ARTERIES – from heartARTERIES – from heartARTERIES – from heartARTERIES – from heart

VEINS – to heartVEINS – to heartVEINS – to heartVEINS – to heart

capillariescapillariescapillariescapillaries


LVMI (g/m2)

r = -0.554p < 0.00001

Peak R

esp

on

se t

o

AC

h

(% o

f in

crease

)

0

200

400

600

800

50 100 150 200 250

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

F Perticone et al., Circulation 1999


Ipertensione Arteriosa e Danno d’Organo

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