Textbook of Arterial Stiffness and Pulsatile Hemodynamics in Health and Disease, 2 Volume Set

9780323916486v1_WEB Front Matter Textbook of Arterial Stiffness and Pulsatile Hemodynamics in Health and Disease Textbook of Arterial Stiffness and Pulsatile Hemodynamics in Health and Disease Copyright Contents of Volume 1 Contributors Foreword Preface Acknowledgments I - Biophysical and technical principles 1 - Basic principles that determine relationships between pulsatile hemodynamic phenomena and function of elastic v ... Introduction Pulsatile phenomena Pulsatility as an evolutionary requirement for self-sustaining circulatory systems Fundamental association of pulsatility and vascular structure and function Elastic vessels Hemodynamic pulsatility and structure of the arterial wall Pressure dependence of arterial stiffness: an essential ingredient for optimal arterial design Fundamental importance of pressure-dependent arterial stiffness (nonlinear elasticity) for arteries Influence of pressure-dependent arterial stiffness on hemodynamic pulsatility The arterial vasculature as a distributed system of branching distensible tubes Structural implications of arterial branching Structural and functional effects of arterial branching on pulsatility phenomena-implications for measurement of blood pressure Wave propagation phenomena-pulse wave velocity and arterial stiffness Wave speed and pulse wave velocity Wave speed Pulse wave velocity Pulse wave velocity and pressure-independent arterial stiffness index beta (β) Pulse wave propagation and oscillatory phenomena Forward and backward waves Vascular impedance Steady pressure and flow: resistance Arterial properties that determine relationship of steady pressure and flow Oscillatory pressure and flow: impedance Arterial properties that determine relationship of pulsatile pressure and flow Effects of blood viscosity and pulsatile flow: Womersley's alpha Input impedance System linearity Intermodulation: justification for assumptions of system linearity Nonlinearity in arterial models Relation between characteristic impedance and pulse wave velocity Pressure and flow relationship in the time domain Summary References 2 - Measurements of arterial pressure and flow in vivo Introduction Cuff mercury sphygmomanometry Cuff ``oscillometric'' blood pressure Radial artery applanation tonometry Cuff central aortic blood pressure Cuffless blood pressure wearables Invasive, intra-arterial blood pressure Summary of blood pressure measurement methods Measurements of arterial flow Pulsed wave-Doppler Phase-contrast magnetic resonance imaging Supplementary material References 3 - Essential principles of pulsatile pressure-flow relations in the arterial tree Introduction Arterial input impedance: a frequency-domain characterization Impedance: generalizing resistance for sinusoidal signals Calculating impedance at the inlet of the arterial tree Interpreting input impedance: the windkessel perspective Estimating total arterial compliance by use of windkessel models The decay-time and area method The pulse pressure method Interpreting input impedance: the wave-system perspective Characteristic impedance revisited: inertia and compliance combined Input impedance: fingerprint of arterial wave reflections The arterial system: a network of tubes with distributed reflection sites The tube model-too simple as a paradigm The arterial tree-scattered reflections Estimating Zc from impedance Pressure-flow relations in the time domain Time domain formulation of wave separation equations Estimating characteristic impedance in the time domain Wave separation analysis in practice: an instruction manual Wave power analysis: energizing hemodynamics Wave power to assess the nature and timing of wave reflection Energetics in the arterial circulation The reservoir-wave concept-overarching paradigm or misleading enigma? Concluding remarks References 4 - MRI for the assessment of aortic stiffness and pulsatile hemodynamics Introduction Aortic stiffness assessed by MRI Aortic strain and distensibility Aortic pulse wave velocity Aging and aortic stiffness measurements in MRI Cardiovascular risk factors, left ventricular function, and aortic stiffness Prognostic value of proximal aortic stiffness measures Advanced methodology to assess pulsatile aortic properties using MRI Flow analysis Combining pressure and flow 4D flow Conclusions Disclosures References 5 - Computed tomography of the aorta Introduction Basics of CT and physics Spatial resolution Temporal resolution ECG-gated versus non‒ECG-gated CTA Contrast resolution 3D reconstruction Challenges Anatomy of aorta Aortic assessment using CT for characterizing aortic geometry, diameter, centerline length, and shape Changes in aortic geometry with aging Aortic calcification Quantification of aortic calcification Progression of aortic calcification The importance of aortic calcification detection References 6 - Radionuclide-based imaging of the aortic wall Introduction Positron emission tomography imaging Positron emission tomography radionuclides Positron emission tomography/computed tomography fusion imaging 18F-fluorodeoxyglucose positron emission tomography Historical background and mechanisms Interpretation of 18F-fluorodeoxyglucose signal Practical considerations in 18F-fluorodeoxyglucose imaging 18F-fluorodeoxyglucose positron emission tomography imaging of the arterial wall 18F-fluorodeoxyglucose positron emission tomography imaging in prognostic assessment 18F-fluorodeoxyglucose positron emission tomography in translational research and clinical trials 18F-fluorodeoxyglucose uptake in aortic aneurysms and large vessel vasculitis 18F-sodium fluoride positron emission tomography Historical background and mechanisms Interpretation of 18F-sodium fluoride- signal 18F-sodium fluoride- positron emission tomography imaging of the aortic calcification activity Intimal calcification activity Medial arterial calcification activity 18F-sodium fluoride- positron emission tomography in aortic aneurysms, large vessel vasculitis, and other aortic pathologies Methods of analysis and limitations of positron emission tomography imaging Future directions Conclusion Acknowledgments References 7 - Arterial wall stiffness: basic principles and methods of measurement in vivo Introduction Arteries-what's inside? Large artery stiffness and stiffening-a tale of elastin and collagen Mechanics of arterial tissues: bioengineering principles and perspective Stress and strain-what's in a name? Stresses acting on the arterial wall Arteries consist of anisotropic, viscoelastic, nonlinear tissue A glimpse on strain energy functions Mechanics of arterial tissues: clinical/in vivo perspective Local functional indices from pressure-area data: compliance and distensibility (Area) compliance and distensibility Compliance coefficient and distensibility coefficient Stiffness moduli Shear wave elastography-an in-vivo bioengineering perspective? From local pressure-diameter to pulse wave velocity Measuring (aortic) pulse wave velocity in vivo Transit-time methods Loop-based methods to measure local pulse wave velocity Pulse wave imaging Total arterial compliance Total arterial compliance versus arterial stiffness and pulse wave velocity Total arterial compliance versus effective arterial elastance Concluding remarks References 8 - Ambulatory measurement of pulsatile hemodynamics Ambulatory 24-h measurement of brachial blood pressure and heart rate Pulsatile and steady state hemodynamics Techniques and devices for 24-h ambulatory measurement of pulsatile (and steady state) hemodynamics 24-h variability (``dipping'') of pulsatile and steady state hemodynamics 24-h ambulatory measurement of pulsatile (and steady state) hemodynamics-clinical studies 24-h ambulatory measurement of pulsatile (and steady state) hemodynamics-drug trials Summary and outlook References 9 - Animal models and methods to study arterial stiffness Introduction Mechanical concepts In vivo methods to study arterial stiffness Blood pressure measurements Invasive blood pressure to measure arterial stiffness by transit time High-resolution ultrasound Applanation tonometry Ex vivo methods to study arterial stiffness Atomic force microscopy Wire myography Pressure myography Biaxial biomechanical testing Digital image correlation Mouse models to study arterial stiffness Aging Connective tissue disorders Diabetes and obesity Hypertension Comparison of methods Recommendations References II - Basic and applied physiology 10 - Hemodynamic role of the aorta Introduction Hemodynamic consequences of large artery stiffness Effect on the early systolic aortic pulse pressure rise Effect on wave speed (Fig. 10.2) Effect of aortic stiffness on wave reflections in first-order bifurcations Aortic stiffening and its role in target organ damage Arterial stiffness and the heart Arterial stiffness and the kidney Arterial stiffness and the brain Arterial stiffness and the placental circulation Aortic stiffness, metabolic dysfunction, and diabetes mellitus Arterial stiffness and testicular dysfunction Mechanisms of arterial stiffening and therapeutic approaches Conclusions Acknowledgments References 11 - Wave reflection in the arterial tree Introduction Pressure and flow in the absence of wave reflection The basis of wave reflection: impedance mismatching Impact of wave reflection on arterial pressure and flow Reflection and transmission coefficients Arterial junctions Tapering Resistance vessels Stenosis Aneurysms Stents Models of arterial wave reflection Single tube model Asymmetric T-tube model Tapered tube models Branching network models Synthesis Re-reflections and the horizon effect Ventricular wave re-reflection Wave reflection, windkessel function, and diastolic pressure decay Methods for assessing the magnitude and timing of arterial wave reflection Pulse wave analysis Wave separation Frequency domain analysis Wave intensity Summary References 12 - Linking arterial stiffness to microvascular remodeling Motivation A microvascular remodeling view of large arterial stiffening Cell dynamics involved in microvascular growth and remodeling Endothelial cells Pericytes Smooth muscle cells Macrophages Lymphatic endothelial cells Consideration of microvascular patterning alterations associated with hypertension and aging Circulating factors and hemodynamics as putative links between arterial stiffness and the microcirculation Conclusions and future opportunities Acknowledgments References 13 - Myocardial function: from myofilaments to cardiac pump The heart is an adaptive pump Cardiac structure is tightly coupled to function The cardiac cycle Electromechanical coupling Mechanisms of myocardial contraction Mechanisms of myocardial relaxation and ventricular filling Cardiac metabolism Cardiac performance is governed by heart rate and loading conditions Functional assessment of the cardiovascular system Assessing intrinsic cardiac performance: contractility, relaxation, and compliance The pressure-volume loop Deriving performance indexes from acute load manipulation Time-varying afterload, wave reflection, and their toll in the heart Conclusions References 14 - Systolic-diastolic coupling Historical background Gross cardiac anatomy, ventricular myocyte orientation, and mechanism of contraction Anatomy of the heart Contractile function of myocytes Ventricular myocyte orientation and function The cardiac cycle Atrioventricular valve plane displacement: give and take Locked and loaded: recovering elastic energy during diastole Summary Supplementary data References 15 - Ventricular-arterial coupling: the pressure-volume plane Introduction The pressure volume plane The LV chamber as a time-varying elastance Relationship between the pressure-volume area and LV energetics The concept of effective arterial elastance and assessment of ventricular-arterial coupling in the pressure-volume plane Assessing the consequences of primary LV dysfunction, changes in arterial load and their consequences in the pressure-volum ... Strengths and limitations of the pressure-volume plane Conclusions Acknowledgments References 16 - Myocardial wall stress and the systolic loading sequence Introduction Myocardial afterload versus ventricular afterload Quantification of myocardial wall stress The time course of ejection-phase MW Arterial wave reflection LV loading sequence and its role in LV hypertrophy LV loading sequence and its role in LV fibrosis Effect of mid-to-late systolic load on LV diastolic dysfunction Myocardial loading sequence and atrial dysfunction Late systolic load and heart failure risk Cellular processes in the myocardium Conclusions Acknowledgments References 17 - Assessment of ventricular arterial interactions via arterial pressure-flow relations in humans Overview of arterial pressure-flow relations Noninvasive assessment of aortic pressure-flow relations Age relations of pressure-flow variables across the lifespan Aortic pressure-flow measures and the heart Pressure-flow measures and cardiovascular disease events Summary References 18 - Hemodynamic determinants of myocardial oxygen demand and supply Myocardial O2 demand Left ventricular afterload Systolic wall stress Heart rate Contractility Depolarization Shortening against load (Fenn effect) Supporting the state of activity Maintenance of cell viability in basal conditions Myocardial O2 supply Diastolic pressure decay Coronary blood flow regulation Coronary self-regulation Endothelial vasoactive mediators Metabolic regulation Arterial oxygen content Aortic stiffness Increase in systolic blood pressure Decrease in diastolic blood pressure Increase in pulse wave velocity The myocardial oxygen supply: demand index Buckberg index corrected for cardiac mass Buckberg index corrected for arterial O2 content Reference values for the Buckberg index Buckberg index estimated by arterial tonometry Limits in Buckberg index estimation by arterial tonometry Buckberg index estimated by arterial tonometry and echocardiography New perspectives in Buckberg index estimated by arterial tonometry References III - Biologic pathways leading to arterial stiffness and dysfunctional pulsatile hemodynamics 19 - Role of elastin and elastin-derived peptides in arterial stiffness: from synthesis to potential therapeutic in ... Elastic fibers and elastin Function and composition Elastogenesis Microfibrils deposition Synthesis and secretion of tropoelastin Microassembly Cross-linking and macromolecular assembly Elastin role in arterial function Elastin: a major functional vascular wall component of vertebrate's arteries Elastin role in normal hemodynamics Elastin modifications during aging and pathophysiological consequences Nonenzymatic posttranslational modifications of elastin Mechanical fatigue and enzymatic fracture of elastin Pathophysiological consequences of elastin modifications Elastin-derived peptides signaling, elastin receptor complex, and pathophysiological consequences Elastin-derived peptides Elastin receptor complex-dependent cell signaling Pathophysiological roles of elastin-derived peptides Elastin biology-derived therapeutic options Targeting elastin synthesis Targeting proteolysis and nonenzymatic posttranslational modifications Elastin-derived peptides and elastin receptor complex modulators Conclusion References 20 - Inflammation and arterial stiffness Introduction Arterial stiffness and low-grade inflammation Cross-sectional studies Prospective studies Experimental models of inflammation Arterial stiffness in patients with primary vasculitides Arterial stiffness in chronic inflammatory diseases Rheumatoid arthritis Inflammatory bowel disease Systemic lupus erythematosus Systemic sclerosis Chronic obstructive pulmonary disease Human immunodeficiency virus infection Antiinflammatory treatment for arterial stiffness Antilipidemic drugs Mechanisms of inflammation-induced arterial stiffening Endothelial dysfunction Increased synthesis of matrix metalloproteinases Calcification Smooth muscle proliferation and changes in the composition of extracellular matrix Direct vascular inflammation Conclusion References 21 - Mechanisms of calcification in the aortic wall and aortic valve Cardiovascular events associated with calcification in the aortic wall and aortic valve Calcification is a result of multiple synergistic pathogenic processes Atherosclerosis and intimal calcification of the aortic wall Nonatherosclerotic medial aortic wall calcification Calcific aortic valve disease The role of hemodynamic shear stress in vascular calcification Synergistic effects of risk factors in vascular endothelial dysfunction Experimental approaches in cardiovascular calcification Therapeutic target discovery in cardiovascular calcification Final considerations Funding References 22 - Vascular smooth muscle cell dysfunction: role in arterial stiffening and cardiovascular disease Contractile tone of vascular smooth muscle cells Vascular tone Myogenic tone Vascular smooth muscle cell relaxation Endocytosis and phagocytosis abilities of vascular smooth muscle cells Endocytosis Phagocytosis Scavenger receptors and eat me signaling Integrin-mediated and nuclear mechanotransduction in vascular smooth muscle cells Membrane mechanotransduction Nuclear mechanotransduction Vascular smooth muscle cell plasticity Regulation of vascular smooth muscle cell differentiation by growth factors and transcriptional factors Epigenetic determinants of vascular smooth muscle cell plasticity Cell senescence Participation of inflammation and immunity in vascular smooth muscle cell functions Cytokines et chemokines Innate immunity and extracellular vesicles Failure in the resolution of inflammation Conclusion References 23 - Endothelial cell dysfunction and senescence: biologic mechanisms and hemodynamic consequences Introduction In vivo evidence of cellular senescence in age-related diseases Molecular mechanism of cellular senescence Endothelial cell senescence in age-related disorders Antisenescence therapy Inhibition of cellular senescence Inhibition of senescence-associated secretory phenotype Elimination of senescent cells (senolysis) Conclusion References 24 - Autonomic and neuroendocrine modulation of arterial stiffness and hemodynamics Autonomic control of the cardiovascular system Parasympathetic nervous system Sympathetic nervous system Assessing autonomic modulation of large-artery stiffness: methodological considerations Parasympathetic modulation of large-artery stiffness Sympathetic modulation of large-artery stiffness Relationships between sympathetic activity and arterial stiffness: cross-sectional studies Can acute modulation of sympathetic activity alter large-artery stiffness? Evidence from muscular arteries Evidence from elastic arteries Does chronic sympathetic modulation contribute to large-artery stiffness? Evidence from muscular arteries Evidence from elastic arteries Neuroendocrine modulation of arterial stiffness Renin-angiotensin-aldosterone system Endothelin-1 Insulin Testosterone Estrogen Do sex hormones modify the relationship between muscle sympathetic nerve activity and arterial stiffness? Summary References 25 - Cellular mechanisms of aging and their impact on the aortic/arterial wall Introduction Effects of aging on the arterial tree Endothelial dysfunction Elastic arteries Muscular arteries Small arteries The role of the adventitia in vascular remodeling Cellular and molecular mechanisms of vascular aging Vascular inflammation Oxidative stress Adaptation to oxidative stresses: role of Nrf2 and sirtuins Senescence Chronic kidney disease as a model of early vascular aging and role of calcification Summary References Back Matter 9780323916486v2_WEB Front Matter Textbook of Arterial Stiffness and Pulsatile Hemodynamics in Health and Disease Textbook of Arterial Stiffness and Pulsatile Hemodynamics in Health and Disease Copyright Contents of Volume 2 Contributors Foreword Preface Acknowledgments IV - Clinical significance of arterial stiffness and pulsatile hemodynamics 26 - Normal aging: arterial stiffness and remodeling over the life course Preamble Insights from cross-sectional epidemiological and cohort data Blood pressure and pulse wave velocity Cross-sectional wave reflection data Insights from longitudinal cohort data: the early life trajectory Insights from longitudinal cohort data: the adult life trajectory Manifestations in middle-aged and aged individuals Effects of aging on wave reflections Conclusions References 27 - Early vascular aging and supernormal vascular aging: genetics, epigenetics, and the environment The background and characteristics of early vascular aging Atherosclerosis versus arteriosclerosis Structural components of arterial wall aging Cross-talk between the micro- and macrocirculation Vascular aging and target organ damage Genetics and epigenetics Low socioeconomic status and vascular aging Intervention studies on vascular aging and early vascular aging The concept and usefulness of supernormal vascular aging Conclusion Acknowledgments References Further reading 28 - Ethnic differences in arterial stiffness and central aortic hemodynamics Is studying ethnic differences in vascular or any physiological feature or disease useful? Relationships to blood pressure Arterial stiffness through the life-course across different ethnic/geographic groups Fetal life, infancy, childhood, and adolescence (see Table 1)14 Young adults (see Table 2)14 Middle-aged and elderly populations Retinal vessels Pulse wave velocity measures in AORTIC segments by Magnetic Resonance Imaging (MRI) HIV Ethnicity and the menopausal transition The elderly Renal impairment/failure (end-stage renal disease) Summary and conclusions References 29 - Arterial stiffness and pulsatile hemodynamics in systemic hypertension Introduction Consequence of arterial stiffness on pressure pulsatility Arterial stiffness and wave reflection in systemic hypertension Influence of lumen area on compliance, wave reflection, and pressure pulsatility Peripheral and central blood pressure in aging hypertensives Interaction between hypertension and arterial stiffness High central blood pressure, hypertension-mediated organ damage, and cardiovascular complication Cardiac damage Brain damage Renal damage Cardiovascular and renal outcome Predictive value of arterial stiffness and wave reflection in hypertensives The particular case of very elderly hypertensives Conclusion Acknowledgments References 30 - Arterial stiffness and pulsatile hemodynamics in diabetes and obesity Introduction Pathophysiologic role of diabetes mellitus in the development of increased arterial stiffness The role of advanced glycation end-products in the development of arterial stiffness Nitric oxide, oxidative stress, and arterial stiffness Epidemiologic association of diabetes mellitus with the development of increased arterial stiffness Risk of increased arterial stiffness and adverse cardiovascular events in patients with diabetes mellitus type 2 Risk of increased arterial stiffness and adverse cardiovascular events in patients with diabetes mellitus type 1 Risk of increased arterial stiffness and adverse cardiovascular events in patients with prediabetes The role of arterial stiffness in the promotion of diabetic microvascular disease Arterial stiffness and diabetic retinopathy Arterial stiffness and diabetic nephropathy Arterial stiffness and diabetic neuropathy and autonomic dysfunction Arterial stiffness and cognitive dysfunction in patients with diabetes mellitus Epidemiologic association of obesity and the metabolic syndrome with the development of increased arterial stiffness Increased arterial stiffness as a potential contributor to the development of diabetes mellitus Conclusions and future directions Acknowledgments References 31 - Cardiovascular risk prevention in clinical medicine: current guidelines in the United States and in Europe Epidemiology of hypertension Definition and classification of hypertension Cardiovascular risk assessment in the management of hypertension Blood pressure measurement Risk assessment tools Hypertension-mediated organ damage and risk modifiers Arterial stiffness and cardiovascular risk Therapeutic goals in the management of hypertension Blood pressure treatment thresholds and targets in US/EU guidelines Blood pressure goals in older adults Chronic kidney disease Diabetes Blood pressure J-curve: role of large artery stiffness and implications for treatment targets Additional therapeutic considerations for hypertension management in current guidelines Nonpharmacologic and pharmacologic interventions Other considerations in the approach to hypertension management How do isolated systolic hypertension, pulse pressure, and LAS factor into current guideline recommendations for the treatm ... How do large artery stiffness and pulsatile hemodynamics factor into guideline recommendations for the treatment of other c ... Risk enhancers Risk groups Summary References 32 - Cardiovascular risk prevention in clinical medicine: current guidelines in Asia Cardiovascular risk prevention in clinical practice: current guidelines in Asia Characteristics of cardiovascular risks in Asia, in comparison to the United States, Europe, and other populations Current Asian guidelines on cardiovascular prevention Hypertension Dyslipidemia Diabetes mellitus Life style modification Role of vascular markers in Asian cardiovascular prevention guidelines Perspective for the prevention of cardiovascular risk in Asia References 33 - Arterial stiffness for cardiovascular risk stratification in clinical practice Introduction Arterial stiffness Central pressure and wave reflection indices Conclusions/future perspectives References 34 - Role of the heart and arterial tree in physiologic adjustments during exercise Cardiac output Heart rate response during exercise Stroke volume response during exercise Ventricular-vascular coupling Exercise hemodynamics Pulmonary hemodynamics during exercise Pulmonary arterial pressure and resistance during exercise Pulmonary blood volume expansion, diffusion capacity, and pulmonary artery distensibility during exercise Central hemodynamics during exercise Mean arterial pressure Central pressure and pulse wave dynamics Pulse pressure amplification Blood flow pulsatility Large artery stiffness and characteristic impedance Blood flow redistribution Total peripheral resistance and functional sympatholysis Exercise hyperemia Vasoactive substances Conducted vasodilation Flow-mediated vasodilation Mechanical actions of the muscle Cardiovascular limitations to exercise Summary References 35 - Invasive hemodynamic assessments during exercise: normal patterns and clinical value Introduction Role for invasive hemodynamics in diagnostic ambiguity Physiology of invasive hemodynamic assessment Assessment of left-sided filling pressures Right atrial pressure Concept of pericardial restraint Measurement of flow The Fick principle CO assessment using VO2 measured versus assumed Thermodilution CO Vascular load Systemic vascular load Pulmonary vascular load Assessment during exercise Normal range of resting and exercise value Preforming an exercise hemodynamic study Setup Supine versus upright Measurement of pressures End-expiration versus respiratory averaged Cardiac output reserve Added value of simultaneous exercise echocardiography Clinical utility in the evaluation of suspected heart failure HFpEF Diagnostic uncertainty Evaluation of specific phenotypes Bayesian approach can guide decision to refer for invasive assessment HFrEF Value in determining cardiac component of limitation Degree of pulmonary hypertension, RV dysfunction PAH Utility in atypical PAH Valve disease Paradoxical LG AS Severe TR with pericardial restraint More advanced assessment Peripheral O2 utilization Ventilation and expired gas analysis Conclusion References 36 - Arterial stiffness and pulsatile hemodynamics in heart failure Introduction Heart failure: definition and classification The arterial tree in HF The aorta in HF The aorta in HFpEF The aorta in HFrEF Large artery stiffness as a predictor of incident HF Large artery stiffness as a predictor of outcomes in established HF Arterial wave reflection in heart failure Wave reflection and LV hypertrophy Effect of mid-to-late systolic load on LV diastolic dysfunction Arterial wave reflection and the risk of incident HF Hemodynamic role of the microvasculature in HF The microvasculature as a determinant of LV load Effects of peripheral microvascular function on exercise capacity Role of the coronary microcirculation Macrovascular-microvascular cross-talk: role of large arterial pulsatile hemodynamics in microvascular dysfunction and HFpE ... Therapeutic implications Spironolactone Vasodilators NO donors Soluble guanylate cyclase stimulators/activators Neprilysin inhibitors The matrix gla protein pathway Conclusions Acknowledgments References 37 - Ventricular-arterial coupling and arterial load in aortic valve disease Introduction Anatomical interaction between the LV, aortic valve, and aortic root Anatomical interrelation between the LV outflow tract, aortic valve, and aortic root Bicuspid aortic valve and aortopathy Functional interaction between the left ventricle, aortic valve, and aorta Ventriculo-valvulo-arterial coupling Impact of aortic stenosis on ventriculo-arterial coupling Impact of aortic regurgitation on ventriculo-arterial coupling Interaction between LV outflow tract and aortic valve Interaction between aorta and aortic valve in aortic valve disease Aortic stenosis Effacement of sinotubular junction Pressure recovery Interaction between hypertension and AS Aortic regurgitation Interaction between aorta, aortic valve, and LV in AS Impact of arterial load following aortic valve replacement Conclusion References 38 - Arterial stiffness and atherosclerosis: mechanistic and pathophysiologic interactions Introduction Vascular failure: interaction betwe