Advancing the Measurement of Arterial Stiffness in Healthy and End-Stage Renal Disease Populations
Rombough, Rosemarié E.
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Cardiovascular disease (CVD) is a leading cause of morbidity and mortality in both the general and at-risk populations [e.g., end-stage renal disease (ESRD) patients]. Arterial stiffness is a major contributor to the occurrence and progression of CVD. The ability to measure arterial stiffness accurately and easily could be important in the detection and prevention of CVD. Applanation tonometry (AT) is considered the reference method for determining pulse wave velocity (PWV), an index of arterial stiffness; however, AT has been reported to have several limitations and practical problems. Photopleysmography (PPG) may be a potential alternative to AT in the determination of PWV, but its validity and reliability need to be more definitively established. Second, there is conflicting evidence as to whether peripheral measurements of arterial stiffness can be used as a surrogate for central measures. Accordingly, the primary objectives of this dissertation were: a) to aid in establishing the validity and/or reliability of PWV assessed using the new PPG method compared to the reference (AT) method (Study 2 and Study 3), and b) to provide further insight regarding whether peripheral PWV by PPG is in fact a valid surrogate measure of central PWV by PPG (Study 2). There are also many factors that can affect the interpretation of arterial stiffness measurements that are poorly understood in terms of their mechanisms and magnitude of impact. As such, this dissertation also addresses: c) the influence of hemodialysis (HD) on arterial stiffness (Study 1) and d) the influence of maximal aerobic exercise on arterial stiffness (Study 3). The findings of the studies in this dissertation established the validity and/or reliability of the PPG method (Study 2 and Study 3), refuted the use of peripheral PWV measurements as surrogates for central ones (Study 2), clarified the influence of HD on arterial stiffness (Study 1), and confirmed the acute impact of aerobic exercise on arterial stiffness (Study 3). Ultimately, these findings may help healthcare practitioners to interpret arterial stiffness measurements more accurately and facilitate the assessment of arterial stiffness in becoming a standard part of CVD screening in healthy and at-risk populations alike.