PIVUS

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PIVUS

• Prospective Investigation of the Vasculature in
  Uppsala Seniors
• Principle investigatorLars Lind
• Uppsala University

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PIVUS

• Investigation of 1000 subjects aged 70 from the
  general population
• Primary aim
• To investigate endothelial function as a
  prospective CV risk factor in elderly subjects

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1016 subjects investigated in June 2004

• 3.5 years of inclusion of subjects
• 2 nurses half-time ( Kerstin, Nilla/Anna)
• 1 Laboratory technician full-time (Janne)
• 1 physician 30 (Lars)
• Participation rate of 51
• 51 females

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Investigations

• 3 tests of endothelial function
• 3 tests of arterial compliance
• Echocardiography
• Blood pressure
• Carotid a. ultrasound
• Body composition (DXA)
• Cardiac autonomic function (HRV, BRS)

• ECG
• Medical/drug history
• Dietary records -7days
• Smoking habits
• Exercise habits
• Blood sampling
• Lung function
• MRI angiographyheart
• DNA sampling

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History of CV diseases

• Myocardial infarction 7.1
• CABG/PTCA 5.0
• Stroke 3.3
• Hypertension medication 30
• Diabetes 7.4
• Lipid medciation 13
• CHF 4.9
• CV medication 47

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Endothelial function measurements
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Invasive forearm technique
Bild arm/nål
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Invasive forearm technique

• Measurements of resting forearm blood flow with
  venous occlusion plethysmography
• Infusion of Acetylcholine 25 and 50 ug/min to
  evaluate endothelial function

• Infusion of sodium nitroprusside 5 and 10 ug/min
  to evaluate endothelium-independent vasodilation

Bild pump
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Brachial ultrasound technique
Bild mätning
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Brachial ultrasound technique

• Measurements of the brachial artery diameter and
  flow at rest
• Re-evaluation after 5 min of flow occlusion in
  the forearm during the hyperemic state
• Flow-mediated vasodilation (FMD) is the degree of
  increase in diameter during hyperemia

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FMD
At rest
During hyperemia
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Pulse wave analysis

• Measurements of radial artery pulse wave with
  aplanation tonometry beftore and 15 min following
  injection of terbutaline 0.25mg sc
• Main read-outs are the relative changes in the
  amplitudes of the reflected systolic and first
  diastolic waves (b/a and d/a at a following
  figure).

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Pulse wave analysis
Bild Nilla
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Pulse wave analysis
Bild skärm
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Arterial compliancemeasurements
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Compliance in the carotid aretery measured by
ultrasound

• Diameter in the commmon carotid artery is
  measured in diastole and systole and this
  diameter change is related to the pulse pressure.
• One calculation performed is the elastic modulus

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Compliance measurements in carotid artery
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Compliance evaluated by pulse wave analysis

• The augmentation index obtained by pulse wave
  analysis could be used as an index of arterial
  compliance
• Another index or compliance is to measure the
  time between the systolic peak and the first
  reflected diastolic wave and divide by the length
  of aorta (half height). Gives an estimate of
  pulse wave volocity.

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Total arterial compliance

• Stroke volume is measured by echocardiography
• stroke volume/pulse pressure ratio is obtained by
  dividing by the pulse pressure

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12 lead ECG recording
bild
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ECG

• Minnesota-coding for prevalences of abnormalities
• 5-min digital recordings for calculations of QT
  dispersion and QT variability

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Echocardiography
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Echocardiography
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Variables measured at echo

• Left atrial diameter
• Left ventricular dimentions (IVS, LVEDD,
  PW,LVESD)
• Calculated and globally estimated ejection
  fraction
• Stroke volume and cardial index
• E/A-ratio
• Isovolumetric relaxation period
• Ejection time
• Myocardial performance index
• Atrio-ventricular plane displacement

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M-mode to determine LVmassStroke Volume and EF
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Doppler-derived indices-E/A-ratio
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Myocardial performance index
MPI(a-ET) / ET(ICTIVRT) / ET
a
Velocity
ET
Mitral flow
Mitral flow
Velocity
IVRT
ICT
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Ultrasound of the carotid arteries

• Occurence of plaque
• Visual and quantitative evaluation of the gray
  scale in plaque
• IMT in the far wall in the bulb and CCA

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Carotid artery ultrasound
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Carotid artery IMT
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5 min recording of BP and HR
Bild hörlur
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Cardiavascular autonomic function

• 5-min recordings of ECG and invasive blood
  pressure
• Analysis of baroreceptor sensitivity by sequence
  and spectral analysis methods
• Spectral analysis of RR-interval and blood
  pressure

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Variability in HR and BP
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Sequences BRS
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Spectral analysis
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Dietary assessment

• Self reported dietary intake over 7 days

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7 days dietary records
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Anthropometry

• Height
• Weight
• Waist/hip ratio
• BMI
• Waist height

Bild måttband
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Manually measured blood pressure
Bild Kerstin
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MR investigation-headed by Håkan Ahlström

• Whole-body MR angiography
• Cardiac MR for left ventricular dimentions, mass,
  stroke volume AV plane displacement
• Myocardial infarction diagnosis by Gd late
  enhancement

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MRI angiography
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Myocardial late enhancement- a sesitive way to
detect infarction
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Body composition by DXA-headed by Karl Mikaelsson

• Bone mineral density
• Fat mass
• Lean body mass

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DXA measurement(Karl Michaelsson, SH)
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BMD,lean massand fat
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Lung function measurements

• Vital capacity
• Peak expiratory flow
• FEV1

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Lung function - COPD
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Blood, plasma and serum have been frozen for
analysis of

• Lipids
• Inflammation
• Coagulation
• Oxidative stress/antioxidants
• Immunology
• DNA
• Metabolism
• Rheology