Science is constantly growing through time. The only way to test our knowledge is what we do with what we know. In this regard TensioMed team has always been looking for the new approaches to make the most out of Arterigraph, parallel with ongoing worldwide issues such as detecting subjects having higher risk to get infected by COVID-19.
Different academically and clinically valuable information will not only renew the knowledge but also shed a light on the various practical aspects of Arteriograph to get the best possible prognostic, diagnostic and therapeutic results.
Wide variety of genetic and environmental factors are responsible for the progression of atherosclerosis, a condition that afflicts the large and medium sized arteries. It is characterised by localised fibrous thickening of arterial wall, formation of plaques which are prone to rupture, and formation of thrombi.
Therefore, the late consequences of atherosclerosis will result in life-threatening disease such as coronary heart diseases, cerebrovascular disease, and peripheral vascular disease.
Upon narrowing of coronary artery and insufficient perfusion of heart, pain-producing substances accumulate in the myocardium and cause angina pectoris which disappears in rest. If coronary artery is unable to supply the heart due to atherosclerosis, myocardial infarction happens.
In cerebral circulation, atherosclerotic plaques are the main cause of thrombotic stroke. Extensive atherosclerosis in abdominal aorta can lead to aneurismal dilation and rupture. Constriction of one or both renal arteries due to atherosclerosis will cause renovascular hypertension, and last but not the least pain, ulceration and gangrene are the results of compromised circulation in limbs.
In most developed countries atherosclerosis is the underlying cause in almost half of all deaths. However, along with improvement of lifestyle, early detection of arterial stiffness and accessibility to screening methods are crucial. Arteriograph provides an ideal solution by revealing atherosclerosis and avoiding a large portion of clinical problems.
Several events occurring simultaneously lead to development of atherosclerosis. Among them endothelial damage is the most important initiator of atherosclerosis.
High blood pressure, diabetes, smoking and high concentrations of cholesterol and triglyceride in the blood, known as “lethal four”, are the main causes of arterial damage and its further complications.
Elevated levels of low-density lipoprotein (LDL), will enhance the intima deposition of extra LDL. Later the trapped LDL undergoes further modifications and will be taken up by macrophages which then transform to foam cells. These together incorporate to formation of fatty streak and fibrotic plaque, proliferation and dedifferentiation of intima media, activation of platelets and haemostasis and consequently endothelial cell injury.
Along from healthy lifestyle including low LDL diet, physical activity and reduced amount of alcohol and tobacco smoke, regular assessment of central cardiovascular parameters plays an important role to detect pathological changes in arterial system before it leads to serious clinical events.
Arteriograph is known to be the gold standard of this early detection. Non-invasive and accurate analysis of central hemodynamics data can reveal the true vascular age and could be a great predictor of future cardiovascular complications.
Endothelium is responsible for maintaining vascular tone trough Nitric Oxide (NO). Nitric Oxide as a crucial endothelium-derived molecule for vascular relaxation proved the endothelium to be more than just a passive interface between blood and the vessel wall.
Moreover, endothelial damage in response to injuries such as high mechanical stress, hypertension, or free radicals, will lead to insufficient amount of Nitric Oxide production and increased secretion of local mediators and tissue ACE-Ang II. Later, these changes will proceed by vascular pathologies such as Atherosclerosis.
Over the past few years many methodological approaches have been developed to measure the function of the endothelium. The most common non-invasive surrogate are Flow Mediated Dilation (FMD) and Arteriography.
FMD measures the ability of the arteries to respond to endothelial NO release during reactive hyperaemia after a brief occlusion of the artery with a pressure cuff. The respective diameter changes of the artery are measured by ultrasound technique.
Although the ability of measuring endothelial function by Flow Mediated Dilation (FMD) has boosted clinical research in this field, but its application is technically challenging and requires extensive training and standardisation. Arteriograph however, is easy to access and perform, automated and have shown correlation with invasive micro vascular function. This make it a perfect candidate to be used as a clinical tool in daily practice.
Since the discovery of the obligatory role which has played by the endothelial cells in the relaxation of isolated arteries in the rabbits in response to exogenous stimuli is getting more attention, the endothelial function has been the matter of interest in several studies.
The endothelium-dependency of vascular resistance rests on a transfer of vasodilator material from the endothelial cells to the underlying vascular smooth muscle. It shortly became obvious that examination of vasoconstriction & vasodilation in human blood vessels, has a great diagnostical value and is required to be a part of routine clinical examinations.
However, the gold standard method to evaluate the endothelial function Flow Mediated Dilation (FMD) remains at the researchers’ mind.
The Arteriograph is a non-invasive validated device, which uses oscillometric pressure curves registered by pressure changes in the artery which are determined by endothelial function. Through this method one can easily gain a comprehensive set of information regarding the Total Peripheral Resistance and endothelial status.
Cough, Fever and Shortness of Breath. These are common symptoms of COVID-19 infected patients. All of them initiated in respiratory system just because of abundance expression of ACE2 as a co-receptor for virus access to the lungs. But lungs are not the only tissue producing ACE2.
The most common comorbidity observed in patient affected by COVID-19 is HYPERTENSION. Moreover Acute Kidney Injury and Diabetes Mellitus are considered as major clinical events usually observed in COVID-19 patients suggest that endothelium as the largest tissue in the body with same potential as lungs in expressing ACE2 should be the target of studies.
It has been shown that ACE2 cause vasodilatory effect, counterbalancing vasoconstricory effect of ACE1. Thus people with high ACE2 level might be prone to suffer from COVID-19 with higher probability. We suppose that elderly people with unexpected low peripheral resistance may be suspected for development of COVID-19.
Arteriograph can provide valuable information in case of endothelial integrity by measuring Augmentation index as a marker of total peripheral resistance. Based on this ability several investigations can be conducted to reveal whether endothelium is the main target of COVID-19 or not.
Atherosclerosis is a slow, complex disease that starts even in childhood and progresses when people grow older. In some subjects the disease can accelerates rapidly, causing major cardiovascular events like stroke or unexpected death. It is generally known that it begins with functional changes of endothelium such as insufficient NO production and results in structural damage to the most inner layer of the artery.
Knowing that atherosclerosis is responsible for a large portion of the clinical problems, possibly the single most influential solution would be advance detection of existing but hidden traces of premature atherosclerosis.
Arteriograph as an innovative device provides essential data required for this awareness. Parameters which are key indicators of clinically silent arterial damages consist the basis action of Arteriograph. Reliable, validated results of these measurements provide accurate, independent, and cumulative prognostic markers of future CV events.