*Listed in surname order.
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Alberto Avolio
Macquarie Medical School. Faculty of Medicine, Health and Human Sciences
Macquarie University
Australia
Session Title: Session 2: Use of Arterial Stiffness in Clinical Practice
Session Date & Time: July 14 (Fri) 13:00-14:40
Lecture Title: Large artery stiffness in the clinic: the future
Pulse wave velocity (PWV) is used to obtain a quantitative measure of stiffness of large arteries and is associated with cardiovascular risk. The most common measurement of PWV is carotid-femoral PWV (cfPWV) and brachial-ankle PWV (baPWV). Both cfPWV and baPWV provide a single value of PWV involving the aortic trunk and upper and lower limbs respectively. Recent studies have shown that obtaining two separate measures of aortic PWV and either leg or arm PWV can be used to compute a stiffness gradient as the ratio or difference of the two PWV values. The stiffness gradient has been shown to have improved prediction of cardiovascular risk in different age groups. However, age-related vascular changes involve not only changes in arterial stiffness but also changes in vessel diameter, and large arteries, especially the aorta, tend to dilate with age. This presentation examines the physiological basis for the use of stiffness gradient as a novel vascular metric by assessing changes in arterial stiffness not only using PWV but also vessel diameter. Since ultrasound technology is now becoming more widespread and probes and devices becoming smaller (eg. mobile phones), their combination with segmental PWV measurements have the potential to improve the clinical utility and risk prediction of PWV as a measure of arterial stiffness in the clinical setting.
Session Title: Session 9: Michael O'Rourke Lecture
Session Date & Time: July 15 (Sat) 12:00-12:40
Lecture Title: Evolution of device application in arterial hemodynamics
The conventional measurement or blood pressure using the brachial cuff sphygmomanometer provides quantitative information on the pressure pulse by being able to non-invasively quantify the maximum (systolic) and minimum (diastolic) value of blood pressure. Before the advent of the sphygmomanometer (late nineteenth century), information was obtained by sphygmography, which provided a registration of the shape of the arterial pulse in a peripheral artery. This presentation examines the seminal work done by Michael O’Rourke in describing the arterial pulse in terms of oscillatory phenomena involving basic concepts of wave propagation and pulsatile relations of blood [pressure and flow. O’Rourke’s work in pulsatile arterial hemodynamics has had global influence in potentiating widespread research in basic and applied hemodynamics. It has resulted in development of techniques where brachial cuff sphygmomanometry was combined with modern sphygmography to enhance the conventional measurement of blood pressure by producing the first ever practical devices for non-invasive estimation of arterial blood pressure at the heart.
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Session Title: Session 8: New Frontier of Cardiovascular Disease Prevention and Rehabilitation
Session Date & Time: July 15 (Sat) 10:40-12:00
Lecture Title: The evolution of cardiac rehabilitation: Past, present and future directions
Cardiac rehabilitation (CR) is a comprehensive program designed to help patients recover from cardiovascular events and includes a combination of exercise, education, and counseling to help patients improve their physical and mental health, reduce the risk of future cardiac events, and improve their overall quality of life. Initially, CR programs were limited to hospital-based programs that focused on exercise training and risk factor modification. Over time, the focus of cardiac rehabilitation has expanded to include education, counseling, and lifestyle interventions. Today, CR programs are available in a variety of settings, including hospitals, clinics, and community centers. These programs are typically interdisciplinary, with a team of healthcare professionals, working together to develop individualized treatment plans for patients. CR programs typically last 12-16 weeks and involve a combination of supervised exercise, education, and counseling sessions. The potential benefits of more “intensive” CR programs will be discussed in this symposium. The future of cardiac rehabilitation must focus on the development of new technologies and approaches to improve patient outcomes, including the use of wearable technology to monitor patient activity levels, and the development of telemedicine and virtual reality-based programs that can be accessed from home. The development of telerehabilitation models will also be discussed in this symposium.
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Session Title: Session 2: Use of Arterial Stiffness in Clinical Practice
Session Date & Time: July 14 (Fri) 13:00-14:40
Lecture Title: Clinical significance of arterial stiffness in hypertension: Where we are?
Arterial stiffness generally refers to the loss of arterial compliance due to changes in structural and functional arterial wall properties and it is strongly and bidirectionally related with hypertension. However, the complete understanding of the underlying mechanisms through which arterial stiffness and hypertension are related is still under research, as well as their cause-effect and temporal relationship. Whereas untreated hypertension induces a subsequent late acceleration of large artery stiffness, increasing evidence suggest that arterial stiffness could precede and even contribute to the pathogenesis of hypertension itself by alterating systolic hemodynamic load. The latest ESC/ESH guidelines for the management and treatment of hypertension state that a detailed assessment of asymptomatic organ damage, including arterial stiffness, may be considered when it influences patient management. Arterial stiffness has incremental value in the estimation of cardiovascular risk when added to traditional risk factors. Detecting arterial stiffness may upgrade an individual cardiovascular risk and indicate a need for instituting BP-lowering treatment in younger individuals with mildly elevated BP (who may otherwise not be treated). Repeated measures over time may help identify non-regressors, a very high risk subset.
Session Title: Session 7: Special Lecture
Session Date & Time: July 15 (Sat) 08:30-10:20
Lecture Title: EVA and SUPERNOVA: Extreme phenotypes of vascular ageing
"Pulse wave velocity is an established marker of early vascular aging, but may also help identifying individuals with supernormal vascular ageing. We recently hypothesized that individuals with the largest difference between chronological and vascular age show the lowest rate of cardiovascular events, and may thus be defined as supernormal vascular aging. We developed an algorithm for vascular age calculation in a subset of the Reference Values for Arterial Stiffness Collaboration Database and based on this calculation we defined early, normal and supernormal vascular ageing. We investigated the risk for fatal and non-fatal cardiovascular events associated with vascular aging categories in an independent cohort, and we demonstrated that compared to normal vascular aging, supernormal vascular aging had lower risk, whereas early vascular aging had higher risk of cardiovascular events, in particular coronary events. This study represented the first validation of the clinical significance of the SUPERNOVA concept based on prospective data. Its further characterization may help discovering novel protective molecular pathways and providing preventive strategies for successful vascular aging."
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Anping Cai
Cardiology
Guangdong Provincial People’s Hospital, Guangdong Cardiovascular Institute
China
Session Title: Session 4: Application of Artificial Intelligence and Novel Device
Session Date & Time: July 14 (Fri) 15:30-17:00
Lecture Title: Prognostic implications of machine learning-derived echocardiographic phenotypes in community hypertensive patients
We developed an algorithm for vascular age calculation in a subset of the Reference Values for Arterial Stiffness Collaboration Database and based on this calculation we defined early, normal and supernormal vascular ageing. We investigated the risk for fatal and non-fatal cardiovascular events associated with vascular aging categories in an independent cohort, and we demonstrated that compared to normal vascular aging, supernormal vascular aging had lower risk, whereas early vascular aging had higher risk of cardiovascular events, in particular coronary events. This study represented the first validation of the clinical significance of the SUPERNOVA concept based on prospective data. Its further characterization may help discovering novel protective molecular pathways and providing preventive strategies for successful vascular aging.
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Chen-Huan Chen
Medicine
National Yang Ming Chiao Tung University College of Medicine
Taiwan
Session Title: Session 11: Hot Topic in Vascular Research in Asia-Pacific (II)
Session Date & Time: July 15 (Sat) 14:40-16:10
Lecture Title: Proximal aorta and cognitive dysfunction
The proximal aorta acts as a coupling device between cardiovascular and brain function. Aging and accelerated stiffening of the proximal aorta cause increased microvascular brain pulsatility, which accelerates the development of cerebral small vessel disease. The resulting cerebral small vessel disease may contribute to early cognitive decline and vascular dementia. Central arterial hemodynamics, such as central pulse pressure, were associated with structural brain damage and poorer cognitive performance among older adults. Our epidemiological data further demonstrate that stiffening of the proximal aorta, as indexed by excess pressure integral or aortic characteristics impedance, is more important than systemic arterial stiffening, as indexed by carotid-femoral pulse wave velocity, in the association with cognitive function.
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Hao-min Cheng
Faculty of Medicine
National Yang Ming Chiao Tung University
Taiwan
Session Title: Session 11: Hot Topic in Vascular Research in Asia-Pacific (II)
Session Date & Time: July 15 (Sat) 14:40-16:10
Lecture Title: Cardiovascular risk in isolated diastolic hypertension and isolated low diastolic blood pressure
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Session Title: Session 7: Special Lecture
Session Date & Time: July 15 (Sat) 08:30-10:20
Lecture Title: Role of arterial stiffness in disease and therapeutic opportunities: An update
Large-artery (aortic) stiffening, which occurs with aging and various pathologic states, impairs this cushioning function, and has important consequences on cardiovascular health, including isolated systolic hypertension, excessive penetration of pulsatile energy into the microvasculature of target organs that operate at low vascular resistance, and abnormal ventricular-arterial interactions that promote left ventricular remodeling, dysfunction, and failure. We will present an update regarding methods to measure large-artery stiffness, genetic determinants of large artery stiffness, and pathophysiologic consequences of arterial stiffening.
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Shao-Yuan Chuang
Institutes of Population Health Sciences
National Health Research Institutes
Taiwan
Session Title: Session 5: Hot Topic in Vascular Research in Asia-Pacific (I)
Session Date & Time: July 14 (Fri) 17:00-18:30
Lecture Title: Association of neutrophil-to-lymphocyte ratio with cerebral small vessel disease
Inflammation is a well-recognized risk factor for vascular aging, cognitive dysfunction and Cerebral small vessel disease (CSVD). However, the association between NLR (peripheral inflammation marker) and CSVD remain to be determined. We aimed to investigate the association between neutrophil /Lymphocyte ratio (NLR) and CSVD and the modify effect of physical activity among older adults.
A total of 720 adults (≥ 50 years) from the community-based I-Lan Longitudinal Aging Study were included. The proportions of neutrophil and Lymphocyte were obtained from the examination of complete blood count with fresh fasting blood samples. Physical activity was evaluated by the international physical activity questionnaire (IPAQ, METs/Week). We further detected the presence of CSVD including lacune, microbleed, and white matter hyperintensity (WMH) on brain magnetic resonance imaging, which were used to construct a combined CSVD score. General linear regression and logistic regression analysis were exploited to evaluate the association between, neutrophil /Lymphocyte ratio (NLR), and CSVD, and further analyzed the modified effect of physical activity.
The averages of white matter hyperintensity were 1.91, 2.24 and 3.74 cm3, for the groups of 1st , 2nd and 3rd tertial of NLR (p-value for trend <.0001). The proportions of presence of microbleed and lacune were 8.37% and 6.61%, respectively for 1st, 14.18% and 10.34%, respectively for 2nd , and 19.83% and 16.38% for 3rd of tertial of NLR (all p-value for trend < 0.05). CSVD score in 1st, 2nd and 3rd of tertial of NLR were 0.81, 1.05 and 1.50, respectively (p-value for trend<.0001). In the ordinal logistic regression analysis adjusting for age, sex, systolic blood pressure, low-density lipoprotein cholesterol, fasting glucose, smoking and drinking, compared with those with 1st tertial of NLR, those with 2nd and 3rd had an odds ratio of 1.22 (0.85-1.74), and 1.84 (1.27-2.66) for CSVD score, respectively. The stratified analysis shows that those with 3rd tertial of NLR still had higher odds for CSVD [2.46(1.44~4.19)], compared to those with 1st tertial of NLR among older adults with lower physical activity (<9330 METs/week; n=358) only, but not among those with higher physical activity.
High NLR were independently and positively associated with CSVD, and physical activity may mitigate the association. Increased physical exercise may help to minimize the inflammatory impact of CSVD development. Keywords: neutrophil /Lymphocyte ratio; physical activity; Cerebral small vessel disease; Lacune; Microbleed; White matter hyperintensity. -
Qian-Hui Guo
The Shanghai Institute of Hypertension
Ruijin Hospital, Shanghai Jiao Tong University School of Medicine
China
Session Title: Session 5: Hot Topic in Vascular Research in Asia-Pacific (I)
Session Date & Time: July 14 (Fri) 17:00-18:30
Lecture Title: Intelligent management and etiological classification of hypertension
The prevalence of hypertension increasing along with the population aging, although the management level of hypertension has been improved obviously, the control rate is still very low. Telemonitoring and artificial intelligence offers new strategies for hypertension management. Based on remote transmission and big data technology, a web-based standardized blood pressure (BP) analysis and reporting system covers automatic office BP, ambulatory and home BP measurements, provides accurate BP readings, offers standardized interpretation, fully reflects the characteristics of individual' BP, and eventually contributes to the prediction and early warning of cardiovascular diseases. With the support of big data and artificial intelligence machine learning technology, it can not only improve the detection efficiency of secondary hypertension but also make it possible to describe the main pathophysiological causes of most traditional primary hypertension, and effective treatment for the etiological factors will helps to improve the hypertension control status.
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Session Title: Session 4: Application of Artificial Intelligence and Novel Device
Session Date & Time: July 14 (Fri) 15:30-17:00
Lecture Title: BP variability and cufless PTT-based BP monitoring
There have been several evidence that increased blood pressure (BP) variability was associated with target organ damage and cardiovascular events. To detect BP variability during a certain period, continuous BP reading is ideal. Pulse transit time (PTT), which refers to the travel time of the systolic pressure wave between two arterial sites, typically the aortic valve and a peripheral site, has been developed as a novel cuffless form of continuous BP monitoring. Previously, our study demonstrated that the advantage of continuous BP monitoring using PTT might be the ability to identify maximum and minimal BPs. This session will discuss the clinical significance of BP variability and the usefulness of PTT-estimate BP as a method of assessing BP variability.
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Kazuomi Kario
Cardiovascular Medicine
Jichi Medical University School of Medicine
Japan
Session Title: Session 3: Lifetime Achievement Award & Special Lecture
Session Date & Time: July 14 (Fri) 14:40-15:10
Lecture Title: HOPE-Asia
The Hypertension Cardiovascular Outcome Prevention and Evidence in Asia (HOPE Asia) Network was formed in 2016 with the main goal of improving the management of hypertension and organ protection in Asia towards achieving zero cardiovascular events. To achieve this goal, Asian experts collaborate and exchange expertise to stay updated on the latest evidence, achieve consensus, conduct clinical studies on the current status, disseminate the HOPE Asia outcome to each country, and facilitate research on hypertension in Asia.
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Session Title: Session 10: Special Lectures
Session Date & Time: July 15 (Sat) 13:40-14:40
Lecture Title: What AI can't tell you about Reaven's Syndrome X and CVD
The late Gerald Reaven introduced the term “Syndrome X” in his famous Banting lecture in 1988. He used the algebraic term “X” to refer to insulin resistance, which at the time was unrecognized as the key driver of cardiovascular disease. Reaven advocated for Syndrome X to be renamed the Insulin Resistance Syndrome. Although electronic search of the term “Syndrome X” now considers it synonymous with metabolic syndrome, Reaven considered the two as fundamentally different. We will review how Reaven's Insulin Resistance Syndrome differs from metabolic syndrome and its relevance to cardiovascular disease today.
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Yen-Hung Austin Lin
Internal Medicine
National Taiwan University Hospital
Taiwan
Session Title: Session 5: Hot Topic in Vascular Research in Asia-Pacific (I)
Session Date & Time: July 14 (Fri) 17:00-18:30
Lecture Title: Vascular complications in primary aldosteronism
"Primary aldosteronism (PA) affects 5-13% of patients with hypertension, and is characterized by an inappropriate production of aldosterone. Increasing evidence indicates that PA is much more prevalent than previously believed, making this disease the most frequent cause of secondary hypertension. PA can be mainly divided into two subtypes: aldosterone-producing adenoma (APA) and idiopathic adrenal hyperplasia (IAH). In recent studies, the incidence of PA is getting higher and higher. In AHA 2017 guideline for hypertension prevention, the incidence of PA is 8 % in general hypertension and 20% in resistant hypertension. Excessive aldosterone influences multiple systems in human body and cause numerous diseases including cardiovascular, renal, immune, metabolic and psychological diseases. These make PA is a very important issue in hypertensive society. In clinical aspect, PA patients had more cardiovascular complications, including coronary artery disease, myocardial infarction, stroke, transient ischemic attack, atrial fibrillation and heart failure than in patients with essential hypertension (EH). Moreover, in structure of cardiovascular system, PA patients have more prominent left ventricular mass, cardiac fibrosis, impaired endothelial dysfunction and increased arterial stiffness than EH patients. The altered structure can be reversible partially after treatment. Due to the important role of PA, our research team (TAIPAI) was assembled in 2005 to organize multi-discipline researches. There are more than 2000 cases in our data registry. About 75-100 PA patients are new-diagnosed or referred to our team each year. We had published more than 100 papers and more than half of them were in cardiovascular field. The cardiovascular research in TAIPAI study group includes large clinical cohort study, basic researches, and population science. We focus on cardiac and vascular structure / functional change of PA patients and the reversibility after treatment. This speech will cover new insights of vascular complications of PA, including our recent works related to somatic mutation and cortisol co-secretion on cardiovascular system in PA patients. "
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Gary Mitchell
Research and Development
Cardiovascular Engineering, Inc., Norwood, MA
USA
Session Title: Session 10: Special Lectures
Session Date & Time: July 15 (Sat) 13:40-14:40
Lecture Title: Vascular origins of cardiometabolic disease
Aortic stiffening and premature vascular aging were once thought to be consequences of “accelerated aging” of the aorta as a result of factors such as longstanding hypertension, obesity, diabetes and lipid abnormalities. However, an analysis from the Framingham Heart Study (FHS) demonstrated that aortic stiffness precedes and contributes to the pathogenesis of hypertension. Recent work from FHS investigators and others has shown that abnormal aortic stiffness also precedes and contributes to the pathogenesis of obesity, insulin resistance, diabetes and lipid abnormalities, potentially starting from an early age, suggesting that aortic stiffness represents a primordial risk factor that contributes to the pathogenesis of cardiometabolic disease and subsequent adverse clinical outcomes.
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Session Title: Session 7: Special Lecture
Session Date & Time: July 15 (Sat) 08:30-10:20
Lecture Title: Sympathetic Nervous Regulation of Arterial Stiffness with Aging and Hypertension
Postganglionic sympathetic nerves innervate target organs such as the heart, peripheral arteries and the kidney and regulate acute alterations in blood pressure.
Chronically elevated sympathetic nerve activity (SNA) is associated with cardiovascular target organ damage such as peripheral and carotid artery wall remodeling and left ventricular hypertrophy.
In addition, acute experimental increases in SNA result in reductions in compliance of both central and peripheral arteries but are confounded by elevations in mean arterial pressure making interpretation difficult. In this regard, whether elevations in SNA modulate increases in stiffness of the central elastic arteries independent of mean arterial pressure remains controversial.
We provide evidence that higher SNA is associated with elevated carotid-femoral pulse wave velocity (PWV) and lower carotid artery compliance independent of mean arterial pressure in healthy young and middle-aged/older adults.
Experimentally raising SNA while holding mean arterial pressure constant using lower body negative pressure results in significant elevations in carotid-femoral PWV among both young and middle-aged/older adults, although the decrease in carotid artery compliance appears blunted in middle-aged/older adults. Consistent with this, experimental maneuvers such as lower-limb venous occlusion known to raise SNA also increase carotid-femoral PWV in adults with hypertension.
Taken together, short term and possibly long-term elevations in SNA contribute in part to increases in central artery stiffness in humans. Future studies are needed to test whether chronically elevated SNA with aging and hypertension is a potential therapeutic target for the treatment of accelerated central artery stiffness. -
James Sharman
College of Health and Medicine, University of Tasmania
Australia
Session Title: Session 4: Application of Artificial Intelligence and Novel Device
Session Date & Time: July 14 (Fri) 15:30-17:00
Lecture Title: Validation of current and novel blood pressure measurement devices
Session Title: Session 7: Special Lecture
Session Date & Time: July 14 (Fri) 08:30-10:20
Lecture Title: Australian initiative to address hypertension control
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Session Title: Session 8: New Frontier of Cardiovascular Disease Prevention and Rehabilitation
Session Date & Time: July 15 (Sat) 10:40-12:00
Lecture Title: Intensive cardiac rehabilitation: A comprehensive approach
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Rod Taylor
MRC/CSO Social and Public Health Sciences Unit & Robertson Centre for Biostatistics,
School of Health and Well Being, College of Medical, Veterinary and Life SciencesUniversity of Glasgow, Glasgow, Scotland
UK
Session Title: Session 8: New Frontier of Cardiovascular Disease Prevention and Rehabilitation
Session Date & Time: July 15 (Sat) 10:40-12:00
Lecture Title: Remote Cardiac Rehabilitation: Opportunities and Challenges
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Session Title: Session 5: Hot Topic in Vascular Research in Asia-Pacific (I)
Session Date & Time: July 14 (Fri) 17:00-18:30
Lecture Title: Vascular aging and cardiovascular risk factors
Arterial stiffness is a robust marker of vascular aging and is reported to worsen cardiovascular (CV) health via several mechanisms. A variety of factors, such as the conventional risk factors for cardiovascular disease, and environmental, genetic, and epigenetic factors have been demonstrated to affect the arterial stiffness. In view of the multiplicity of factors affecting the arterial stiffness, arterial stiffening does not progress at a uniform rate in the general population. Recently, the concept of two extreme phenotypes of vascular aging (hereinafter, vascular phenotypes), as assessed by measurement of the pulse wave velocity, has been proposed, namely, the healthy vascular aging, normal vascular aging and early vascular aging phenotypes. According to a recent study, the two vascular phenotypes portend a good and poor CV prognosis, respectively. In my presentation, I would like to discuss the vascular aging and cardiovascular risk factors.
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Kelvin Tsoi
JC School of Public Health and Primary Care
The Chinese University of Hong Kong
Hong Kong
Session Title: Session 11: Hot Topic in Vascular Research in Asia-Pacific (II)
Session Date & Time: July 15 (Sat) 14:40-16:10
Lecture Title: Genetic architecture of blood pressure variability
This study aims to investigate the causal inference by applying a mendelian randomization (MR) study using single-nuc1eotide polymorphisms (SNPs).
The genetic instruments were chosen from BPV GWAS based on UK Biobank data. Four dementia GWA studies were applied: (1) The International Genomic of Alzheimer’s Project (IGAP) GWAS for dementia; (2) and (3) UK Biobank GWAS for proxy phenotypes of Alzheimer’s dementia: the maternal and paternal family history (MFH and PFH-UKBB); (4) A combined GWAS meta-analysis from the abovementioned GWAS results. Four MR methods were employed to measure the causal effect: IVW-MR with random effect and fixed effect, MR-Egger, and weighted median MR.
Six independent SNPs were chosen as instrument variants for SBPV and five for DBPV. Significant causal effects of SBPV on dementia were found in the PFH-UKBB dataset, and the odds ratio of dementia per 10-unit increase in SBPV was 1.028, 1.015, and 1.015 for MR-Egger, weighted median, and IVW-MR, respectively (Table 1). One significant result was found for DBPV in MFH-UKBB. No significant results were found on other datasets.
This study demonstrates that systolic blood pressure variability is a causal risk factor for Alzheimer’s disease while the evidence from diastolic blood pressure variability is insufficient. -
Jiguang Wang
The Shanghai Institute of Hypertension
Ruijin Hospital, Shanghai Jiaotong University School of Medicine
China
Session Title: Session 2: Use of Arterial Stiffness in Clinical Practice
Session Date & Time: July 14 (Fri) 13:00-14:40
Lecture Title: Update of the clinical use of large artery stiffness
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Wei Zhang
Cardiovascular Medicine
State Key Laboratory of Medical Genomics, Shanghai Key Laboratory of Hypertension,
Shanghai Institute of Hypertension, Ruijin Hospital,
Shanghai Jiao Tong University School of MedicineChina
Session Title: Session 4: Application of Artificial Intelligence and Novel Device
Session Date & Time: July 14 (Fri) 15:30-17:00
Lecture Title: Use of AI technology in detection of arrhythmia and blood pressure measurement in atrial fibrillation
Atrial fibrillation is a common cardiac arrhythmia in the elderly. Consecutive participants aged ≥65 years attending outpatient clinics were enrolled for atrial fibrillation screening using handheld single-lead electrocardiogram (ECG, Kardia® Heart Monitor) with an artificial intelligent analysis system from April 2017 to December 2022. Each ECG rhythm strip was reviewed form the research team. Atrial fibrillation or uninterpretable single-lead ECGs were referred for 12-lead ECG. Blood pressure was measured 3 times consecutively with a 30-60 seconds interval using an automated oscillometric blood pressure monitor (HEM-9200T; Omron Healthcare, Kyoto, Japan). Participants without atrial fibrillation at baseline received ECG screening at various frequencies and were followed up for incident atrial fibrillation.