Association of Bilateral Brachial-Ankle Pulse Wave Velocity Difference with Peripheral Vascular Disease and Left Ventricular Mass Index

Sheng-Hsiung Sheu,Wen-Chol Voon,Tsung-Hsien Lin,Wen-Ter Lai,Ho-Ming Su,Szu-Chia Chen,Alberico Catapano,Chun-Yuan Chu,Wen-Hsien Lee,Chee-Siong Lee,Po-Chao Hsu

doi:10.1371/journal.pone.0088331

Abstract

Unequal arterial stiffness had been associated with cardiovascular risks. We investigated whether an association existed between unequal arterial stiffness indicated by bilateral brachial-ankle pulse wave velocity (baPWV) difference and ankle-brachial index (ABI), baPWV, echocardiographic parameters and interarm and interankle systolic blood pressure (BP) differences. A total of 1111 patients referred for echocardiographic examination were included in this study. The BPs, ABI and baPWV were measured simultaneously by an ABI-form device. The ΔbaPWV was defined as absolute value of difference between bilateral baPWV. We performed three multivariate analyses for determining the factors associated with a ΔbaPWV ≧ 185 cm/s (90 percentile of ΔbaPWV) (model 1: significant variables in univariate analysis and ABI <0.9 and baPWV; model 2: significant variables in univariate analysis and left ventricular mass index [LVMI]; model 3: significant variables in univariate analysis and interankle systolic BP difference ≧ 15 mmHg). The ABI <0.9 and high baPWV (both P<0.001) in model 1, high LVMI (P = 0.021) in model 2 and an interankle systolic BP difference ≧ 15 mmHg (P = 0.026) in model 3 were associated with a ΔbaPWV ≧ 185 cm/s, but the interarm systolic BP difference ≧ 10 mmHg was not (P = NS). Our study demonstrated ABI <0.9, high baPWV, high LVMI and an interankle systolic BP difference ≧ 15 mmHg were associated with unequal arterial stiffness.

Highlights

Arterial stiffness is an independent predictor for adverse cardiovascular outcomes in various populations [1,2,3]
In the present study, using a simultaneous measurement technique, we found that anklebrachial index (ABI),0.9, high brachial-ankle pulse wave velocity (baPWV), high Left ventricular mass index (LVMI) and an interankle systolic blood pressure (BP) difference $15 mmHg were independently associated with a large bilateral baPWV difference, but an interarm systolic BP difference $10 mmHg was not
Arterial stiffness measured by pulse wave velocity (PWV) in different segments appeared to be differentially associated with micro- and macro-vascular complications [24]

Summary

Introduction

Arterial stiffness is an independent predictor for adverse cardiovascular outcomes in various populations [1,2,3]. The exact mechanisms responsible for the correlation between unequal arterial stiffness and adverse cardiovascular outcomes remain unclear. Previous studies have found there was a significant association of a blood pressure (BP) difference between arms and ankles with peripheral vascular disease, pre-existing coronary artery disease, left ventricular hypertrophy (LVH) and increased cardiovascular mortality and all-cause mortality [7,8,9,10,11,12,13]. The large interarm or interankle BP difference might result from unequal limb atherosclerosis and be associated with peripheral vascular disease, LVH and poor cardiovascular outcomes. The hypothesis that an association exists between an interarm and interankle BP difference and unequal arterial stiffness has never been examined

Methods

Results

Conclusion