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Table of Contents
LETTER TO THE EDITOR
Year : 2022  |  Volume : 10  |  Issue : 2  |  Page : 138-139

Heart and vessels failure: A new pathologic description to consider in vascular disease


1 Department of Medicine, School of Medicine, Universidad El Bosque, Bogotá, Colombia
2 Department of Medicine, School of Medicine, Universidad Autonoma de Bucaramanga, Bucaramanga, Colombia
3 Department of Medicine, School of Medicine, Universidad De Santander, Bucaramanga, Colombia
4 Medical and Surgical Research Center, University of Cartagena; Colombian Chapter, Latin American Cardiology Network, Cartagena, Colombia

Date of Submission14-Aug-2021
Date of Acceptance13-Sep-2021
Date of Web Publication02-Mar-2022

Correspondence Address:
Dr. Ivan David Lozada-Martinez
Medical and Surgical Research Center, University of Cartagena, 130004, Cartagena
Colombia
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ajim.ajim_91_21

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How to cite this article:
Vela-Montenegro AF, Ardila-Acuña LY, Ropero AC, Lozada-Martinez ID. Heart and vessels failure: A new pathologic description to consider in vascular disease. APIK J Int Med 2022;10:138-9

How to cite this URL:
Vela-Montenegro AF, Ardila-Acuña LY, Ropero AC, Lozada-Martinez ID. Heart and vessels failure: A new pathologic description to consider in vascular disease. APIK J Int Med [serial online] 2022 [cited 2022 Aug 11];10:138-9. Available from: https://www.ajim.in/text.asp?2022/10/2/138/338907



Sir,

We read with great interest the article published by Desai et al.,[1] entitled “Arterial stiffness – A measurable vascular marker in clinical practice,” where the authors review the potential of arterial stiffness as a marker of cardiovascular risk, exploring the pathophysiological process of endothelial dysfunction and atherosclerosis, and its role in vascular failure.[1] We thank the authors for providing such evidence. However, we would like to discuss the impact of a new pathologic description to be considered during the review of vascular disease, heart and vessels failure (HVF).

HVF is an emerging concept described by Galati et al.,[2] where the authors evaluated 228 patients with heart failure versus a control group, with the objective of determining the hemodynamic changes of the arteries depending on the left ventricular ejection fraction. This study found that all parameters of arterial kinetics (work, power, velocity, and acceleration) were significantly elevated in the control group (P < 0.001).[2] In contrast, those who exhibited signs of heart failure had a substantial reduction in these parameters (P < 0.001). Interestingly, this same pattern was similarly present in both the common carotid artery and the posterior tibial artery (arteries studied).[2] Finally, and what allowed the establishment of the new concept of HVF, was the finding that patients with heart failure and preserved ejection fraction had greater vascular compromise than those with heart failure and reduced ejection fraction. That is, vascular disease does not always depend on heart failure and expresses different phenotypes, which can be identified through certain interventional procedures, therefore, the severity of vascular compromise depends on both heart failure and vascular remodeling itself, which can manifest itself through different and unspecific clinical pictures.[2] Based on the above, the authors concluded that there is a double mechanical compensatory activity performed by the great arteries (active propulsion and concurrent hemodynamic suction), which partially compensates the cardiac failure, but allows the progression of vascular failure.

However, the pathophysiological process is more complex. Buendía-Palacios et al.[3] stated that systemic hemodynamic atherothrombotic syndrome (another emerging concept of cardiovascular disease) is a conditioning factor of HVF.[3] The systemic hemodynamic atherothrombotic syndrome has its pathophysiological basis in the hypothesis of resonance of blood pressure variability, which has a direct impact on vascular health.[3],[4],[5] This hypothesis holds that there is a vicious cycle between neurometabolic blood pressure disorder, vascular injury of large vessels, small vessels, and microcirculation due to increased vascular pressures, and finally target organ injury (mainly brain, heart, kidney, and endothelium), which triggers major cardiovascular events, increased morbidity, mortality, and disability.[3],[4],[5]

Precisely because of the above, Kario[6] proposes the use of a diagnostic and severity score for 24-h blood pressure monitoring, with the aim of substantially protecting the endothelium.[6] However, evidence suggests that more and more pathophysiological mechanisms are influencing cardiovascular health (specifically of the vessels), so new diagnostic and severity criteria need to be developed, including arterial kinetic parameters, arterial structure, arterial pressure, and inflammatory processes (such as the presence of inflammatory plaque and pro-inflammatory markers), to estimate actual vascular compromise, and determine whether there is a change in global cardiovascular risk stratification.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Desai N, Venkatesh CR, Koregol P. Arterial stiffness – A measurable vascular marker in clinical practice. APIK J Int Med 2021;9:146-52.  Back to cited text no. 1
  [Full text]  
2.
Galati G, Germanova O, Iozzo RV, Buraschi S, Shchukin YV, Germanov A, et al. Hemodynamic arterial changes in heart failure: A proposed new paradigm of “Heart and Vessels Failure (HVF)”. Minerva Cardiol Angiol 2021 Jun 8.  Back to cited text no. 2
    
3.
Buendía-Palacios DC, Hernández-Nieto B, Delgado-Marrugo RD, Barahona-Botache SA, Bolaño-Romero MP. Systemic hemodynamic atherothrombotic syndrome: A conditioner of heart and vessels failure. Minerva Cardiol Angiol 2021 Aug 2.  Back to cited text no. 3
    
4.
Kario K. Systemic hemodynamic atherothrombotic syndrome and resonance hypothesis of blood pressure variability: Triggering cardiovascular events. Korean Circ J 2016;46:456-67.  Back to cited text no. 4
    
5.
Kario K, Chirinos JA, Townsend RR, Weber MA, Scuteri A, Avolio A, et al. Systemic hemodynamic atherothrombotic syndrome (SHATS) – Coupling vascular disease and blood pressure variability: Proposed concept from pulse of Asia. Prog Cardiovasc Dis 2020;63:22-32.  Back to cited text no. 5
    
6.
Kario K. Systemic hemodynamic atherothrombotic syndrome (SHATS): Diagnosis and severity assessment score. J Clin Hypertens (Greenwich) 2019;21:1011-5.  Back to cited text no. 6
    




 

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