Ts had higher AIx, AIx75 and PWV. Both proximal and distal descending aortic distensibility were reduced in CMV positive patients (P = 0.01 for both).Cytomegalovirus status as a determinant of arterial stiffnessIn univariate analysis, PWV was strongly associated with CMV positive status (B = 1.44, 95 confidence interval (CI) 0.3?.18, P,0.001). Pulse wave velocity was also associated with brachial,CMV Seropositivity and Arterial StiffnessFigure 1. Arterial stiffness across age quartiles in CMV positive (black columns) and CMV negative patients (hashed columns). (A) Pulse wave velocity increases with age (P,0.001) and is higher in CMV positive patients (P = 0.02). (B) Ascending aortic distensibility decreases with age (P,0.001) but is not significantly lower in CMV seropositive patients (P = 0.1). (C and D) Proximal and distal descending aortic distensibility decrease with age (P,0.001) and are significantly lower in CMV positive patients (P,0.001). doi:10.1371/journal.pone.0055686.gcentral and 24-hour systolic BP, mean arterial and pulse pressures, age, eGFR, HDL cholesterol, parathyroid Title Loaded From File hormone, albumin: creatinine ratio and hsCRP. These parameters were entered into a stepwise regression analysis. As expected, all BP measures exhibited significant colinearity, therefore only one parameter was entered into the model at a time. Central pulse pressure was entered into the presented model as the most highly correlated BP parameter. In multivariate analysis (Table 3) PWV remained positively associated with central pulse pressure, age and CMV status (B = 0.67, 95 CI 0.04?.21, P = 0.03). Substituting central systolic, Title Loaded From File brachial or 24-hour systolic BP or pulse pressures made no appreciable difference to the analyses. Cytomegalovirus seropositivity was inversely associated with ascending (B = 20.82, 95 CI 21.35?0.29, P = 0.003), proximal descending (B = 20.99, 95 CI 21.43?0.55, P,0.001) and distal descending (B = 21.27, 95 CI 21.85?0.68, P,0.001) aortic distensibility in univariate analyses. In multivariate analysis ascending aortic distensibility was not significantly associated with CMV seropositivity. Both proximal (B = 20.55, 95 CI 20.9?20.15, P = 0.007) and distal descending aortic distensibility (B = 20.74, 95 CI 21.27?0.21, P = 0.007) remained associated with CMV positivity after multivariate adjustment. Central pulse pressure was used in these models because it had the strongest univariate correlation with aortic distensibility. Substituting central systolic, brachial or 24-hour systolic BP or pulse pressures made no appreciable difference to the analyses.DiscussionIn patients with CKD, seropositivity for CMV was positively associated with PWV, the gold-standard measure of arterial stiffness. Furthermore, CMV seropositivity was consistently associated with decreased distensibility of the proximal and distal descending aorta, but not the ascending aorta. The increased arterial stiffness associated with CMV seropositivity together with the differential effects on aortic segments could provide novel insights into the pathophysiology of increased arterial stiffness in CKD and potentially in various disease states. The powerful prognostic significance of increased arterial stiffness is well recognized [3,5], Failure to buffer adequately intermittent left ventricular ejection into the arterial system results in left ventricular hypertrophy and fibrosis, cerebrovascular disease and further renal damage [3,5]. Many potential mechanisms hav.Ts had higher AIx, AIx75 and PWV. Both proximal and distal descending aortic distensibility were reduced in CMV positive patients (P = 0.01 for both).Cytomegalovirus status as a determinant of arterial stiffnessIn univariate analysis, PWV was strongly associated with CMV positive status (B = 1.44, 95 confidence interval (CI) 0.3?.18, P,0.001). Pulse wave velocity was also associated with brachial,CMV Seropositivity and Arterial StiffnessFigure 1. Arterial stiffness across age quartiles in CMV positive (black columns) and CMV negative patients (hashed columns). (A) Pulse wave velocity increases with age (P,0.001) and is higher in CMV positive patients (P = 0.02). (B) Ascending aortic distensibility decreases with age (P,0.001) but is not significantly lower in CMV seropositive patients (P = 0.1). (C and D) Proximal and distal descending aortic distensibility decrease with age (P,0.001) and are significantly lower in CMV positive patients (P,0.001). doi:10.1371/journal.pone.0055686.gcentral and 24-hour systolic BP, mean arterial and pulse pressures, age, eGFR, HDL cholesterol, parathyroid hormone, albumin: creatinine ratio and hsCRP. These parameters were entered into a stepwise regression analysis. As expected, all BP measures exhibited significant colinearity, therefore only one parameter was entered into the model at a time. Central pulse pressure was entered into the presented model as the most highly correlated BP parameter. In multivariate analysis (Table 3) PWV remained positively associated with central pulse pressure, age and CMV status (B = 0.67, 95 CI 0.04?.21, P = 0.03). Substituting central systolic, brachial or 24-hour systolic BP or pulse pressures made no appreciable difference to the analyses. Cytomegalovirus seropositivity was inversely associated with ascending (B = 20.82, 95 CI 21.35?0.29, P = 0.003), proximal descending (B = 20.99, 95 CI 21.43?0.55, P,0.001) and distal descending (B = 21.27, 95 CI 21.85?0.68, P,0.001) aortic distensibility in univariate analyses. In multivariate analysis ascending aortic distensibility was not significantly associated with CMV seropositivity. Both proximal (B = 20.55, 95 CI 20.9?20.15, P = 0.007) and distal descending aortic distensibility (B = 20.74, 95 CI 21.27?0.21, P = 0.007) remained associated with CMV positivity after multivariate adjustment. Central pulse pressure was used in these models because it had the strongest univariate correlation with aortic distensibility. Substituting central systolic, brachial or 24-hour systolic BP or pulse pressures made no appreciable difference to the analyses.DiscussionIn patients with CKD, seropositivity for CMV was positively associated with PWV, the gold-standard measure of arterial stiffness. Furthermore, CMV seropositivity was consistently associated with decreased distensibility of the proximal and distal descending aorta, but not the ascending aorta. The increased arterial stiffness associated with CMV seropositivity together with the differential effects on aortic segments could provide novel insights into the pathophysiology of increased arterial stiffness in CKD and potentially in various disease states. The powerful prognostic significance of increased arterial stiffness is well recognized [3,5], Failure to buffer adequately intermittent left ventricular ejection into the arterial system results in left ventricular hypertrophy and fibrosis, cerebrovascular disease and further renal damage [3,5]. Many potential mechanisms hav.
