Publications by authors named "John D Gotal"

Article Synopsis
  • Aortic stiffness, a measure of vascular health related to cardiovascular risk, is typically difficult to assess but can be approximated through analysis of arterial pressure waveforms rather than traditional pulse wave velocity measurements.
  • The study trained a convolutional neural network using waveform data from over 10,000 Icelandic participants and validated the model with the Framingham Heart Study, correlating waveform features with negative inverse carotid-femoral pulse wave velocity to create an AI-based vascular age estimate.
  • The AI-VascularAge model showed significant associations with future cardiovascular events, establishing its potential as a reliable and predictive tool in assessing cardiovascular risk beyond simple clinical measures.
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Article Synopsis
  • Background Waveform parameters from Windkessel models may help assess cardiovascular disease risk, as shown in a study using data from the Framingham Heart Study with 2,539 participants.
  • The analysis linked the nonlinear model-derived systolic time constant (τ) and reservoir pressure amplitude to cardiovascular events, indicating their potential use in risk stratification.
  • However, linear model parameters did not show significant associations with cardiovascular events, highlighting the need for further validation of these findings.
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Background: Left ventricular (LV) contraction displaces the aortic annulus and produces a force that stretches the ascending aorta. We hypothesized that aortic stiffening increases this previously ignored component of LV load and may contribute to hypertrophy. Conversely, aortic stretch-related work represents stored energy that may facilitate early diastolic filling.

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Background: Accurate assessment of mechanical properties of the proximal aorta is a requisite first step for elucidating the pathophysiology of isolated systolic hypertension. During systole, substantial proximal aortic axial displacement produces longitudinal strain, which we hypothesize causes variable underestimation of ascending aortic circumferential strain compared to values in the longitudinally constrained descending aorta.

Methods And Results: To assess effects of longitudinal strain, we performed magnetic resonance imaging in 375 participants (72 to 94 years old, 204 women) in the Age, Gene/Environment Susceptibility‐Reykjavik Study and measured aortic circumferential and longitudinal strain.

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Aortic stiffening, assessed by carotid-femoral pulse wave velocity, is associated with CKD. Transmission of excessive flow pulsatility into the low-impedance renal microvasculature may mediate this association. However, direct analyses of macrovascular-microvascular relations in the kidney are limited.

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High pulse pressure, a major cardiovascular risk factor, has been attributed to medial elastic fiber degeneration and aortic dilation, which transfers hemodynamic load to stiffer collagen. However, recent studies suggest higher pulse pressure is instead associated with smaller aortic diameter. Thus, we sought to elucidate relations of pulse pressure with aortic stiffness and aortic and cardiac dimensions.

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Background: Dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) is a potentially powerful tool for analysis of kidney structure and function. The ability to measure functional and hypofunctional tissues could provide important information in groups at risk for chronic kidney disease (CKD), such as the elderly.

Study Design: Observational study with a cross-sectional design.

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Aortic stiffness increases with age and vascular risk factor exposure and is associated with increased risk for structural and functional abnormalities in the brain. High ambient flow and low impedance are thought to sensitize the cerebral microcirculation to harmful effects of excessive pressure and flow pulsatility. However, haemodynamic mechanisms contributing to structural brain lesions and cognitive impairment in the presence of high aortic stiffness remain unclear.

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