Aortic Diastolic Pressure Research Articles

Arterial hypertension and depressive disorders: combination treatment with antihypertensive and psychotropic therapy

Objective. To evaluate the effectiveness of combination treatment with antihypertensive drugs and antidepressant in patients with uncontrolled hypertension (UHTN) and depressive disorders (DD). Design and methods. The study involved 160 patients with UHTN and DD and prescribed a combination therapy including an angiotensin-converting enzyme (ACE) inhibitor (perindopril 10 mg/day) and a thiazide-like diuretic (indapamide SR, 1,5 mg/day). Patients were randomized into 2 groups: 1st group recieved antihypertensive treatment with an antidepressant (selective serotonin reuptake inhibitors, escitalopram 10 mg/day); 2nd group received calcium channel blocker (CCBs, amlodipine 5–10 mg/day). At baseline and after 24 weeks all patients underwent clinical examination, ambulatory blood pressure monitoring (ABPM) (“Petr Telegin”, BPLab Vasotens, Russia) with 25‑minute intervals between the measurements during the day and 50‑minute intervals at night. We assessed the average 24‑hour, daytime and nighttime systolic blood pressure (SBP), diastolic blood pressure (DBP), variability of blood pressure (BP), hypertension time index, the size and speed of morning rise in BP, daily index, pulse pressure. In addition, we evaluated arterial stiffness: the propagation time of the reflected wave (RWTT, ms), the estimated PWV in the aorta (PWVao, m/s) adjusted to systolic BP 100 mm Hg and heart rate 60 beats/min (RWTT ms, PWVao m/s), augmentation index. We also assessed central aortic pressure: systolic aortic pressure, aortic diastolic pressure, mean pressure in the aorta, aortic augmentation index. All the patients filled in the Hospital Anxiety and Depression Scale (HADS), Tsung depression scale, Spielberger’s scale of the anxiety, Wayne questionnaire and the SF‑36 questionnaire for the assessment of quality of life. Results. Combined antihypertensive therapy with escitalopram provided the target BP achievement in half of patients after 4 weeks, while in the control group an increase in the amlodipine dose to 10 mg per day was required to achieve target BP in 75.6 % of patients. After 24 weeks, group 1 showed better ABPM parameters compared to the control group. In addition, daily BP profile was normalized in a larger number of patients than in control group. Antidepressants led to a comparable to the calcium antagonist therapy regression of the indicators of arterial stiffness and the central aortic pressure. After 24 weeks, a positive change in DD was registered in the group treated with escitalopram, while in the group 2 depression indicators remained at a high level. The use of antidepressant resulted in a significant decrease in anxiety disorders and autonomic disturbances, whereas in patients treated with “traditional” antihypertensive therapy, an increase of anxiety level and baseline autonomic dysfunction remained unchanged. Also, the group of antidepressant showed greater improvement of the quality of life assessed by the SF‑36 questionnaire. Conclusions. The use of escitalopram in combination therapy provided a rapid achievement of target BP and more significant improvement in the main ABPM indicators, normalization of daily BP profile, a significant improvement in the emotional status and autonomic function, reduction of the depression and anxiety symptoms, improvement in quality of life compared to the treatment without antidepressant.

Effects of Curcumin on Parameters of Myocardial Oxidative Stress and of Mitochondrial Glutathione Turnover in Reoxygenation after 60 Minutes of Hypoxia in Isolated Perfused Working Guinea Pig Hearts.

In cardiovascular surgery ischemia-reperfusion injury is a challenging problem, which needs medical intervention. We investigated the effects of curcumin on cardiac, myocardial, and mitochondrial parameters in perfused isolated working Guinea pig hearts. After preliminary experiments to establish the model, normoxia was set at 30 minutes, hypoxia was set at 60, and subsequent reoxygenation was set at 30 minutes. Curcumin was applied in the perfusion buffer at 0.25 and 0.5 μM concentrations. Cardiac parameters measured were afterload, coronary and aortic flows, and systolic and diastolic pressure. In the myocardium histopathology and AST in the perfusate indicated cell damage after hypoxia and malondialdehyde (MDA) levels increased to 232.5% of controls during reoxygenation. Curcumin protected partially against reoxygenation injury without statistically significant differences between the two dosages. Mitochondrial MDA was also increased in reoxygenation (165% of controls), whereas glutathione was diminished (35.2%) as well as glutathione reductase (29.3%), which was significantly increased again to 62.0% by 0.05 μM curcumin. Glutathione peroxidase (GPx) was strongly increased in hypoxia and even more in reoxygenation (255% of controls). Curcumin partly counteracted this increase and attenuated GPx activity independently in hypoxia and in reoxygenation, 0.25 μM concentration to 150% and 0.5 μM concentration to 200% of normoxic activity.

Central pressure appraisal: Clinical validation of a subject-specific mathematical model

Introduction Current evidence suggests that aortic blood pressure has a superior prognostic value with respect to brachial pressure for cardiovascular events, but direct measurement is not feasible in daily clinical practice. Aim The aim of the present study is the clinical validation of a multiscale mathematical model for non-invasive appraisal of central blood pressure from subject-specific characteristics. Methods A total of 51 young male were selected for the present study. Aortic systolic and diastolic pressure were estimated with a mathematical model and were compared to the most-used non-invasive validated technique (SphygmoCor device, AtCor Medical, Australia). SphygmoCor was calibrated through diastolic and systolic brachial pressure obtained with a sphygmomanometer, while model inputs consist of brachial pressure, height, weight, age, left-ventricular end-systolic and end-diastolic volumes, and data from a pulse wave velocity study. Results Model-estimated systolic and diastolic central blood pressures resulted to be significantly related to SphygmoCor-assessed central systolic (r = 0.65 p <0.0001) and diastolic (r = 0.84 p<0.0001) blood pressures. The model showed a significant overestimation of systolic pressure (+7.8 (-2.2;14) mmHg, p = 0.0003) and a significant underestimation of diastolic values (-3.2(-7.5;1.6), p = 0.004), which imply a significant overestimation of central pulse pressure. Interestingly, model prediction errors mirror the mean errors reported in large meta-analysis characterizing the use of the SphygmoCor when non-invasive calibration is performed. Conclusion In conclusion, multi-scale mathematical model predictions result to be significantly related to SphygmoCor ones. Model-predicted systolic and diastolic aortic pressure resulted in difference of less than 10 mmHg in the 51% and 84% of the subjects, respectively, when compared with SphygmoCor-obtained pressures

Abstract 18329: Aortic Pulse Wave Velocity Improves Following Moderate-intensity Continuous Training but not High-intensity Interval Training in Older Men and Postmenopausal Women

Introduction: Aortic pulse wave velocity (AoPWV), a measure of arterial stiffness, increases with age and is an independent predictor of cardiovascular disease. Higher levels of habitual physical activity are associated with reduced AoPWV, but the effect of well-controlled aerobic training interventions in healthy older adults remains unclear. We hypothesized that moderate-intensity continuous training (MICT) and high-intensity interval training (HIIT) will both improve AoPWV in healthy older adults. Methods: Thirty five sedentary older men and postmenopausal women, free of overt cardiovascular disease (age, 65±1 yrs, body mass index, 27.7±0.8 kg/m 2 ; systolic and diastolic blood pressures, 116±2 and 69±1 mmHg, respectively; mean±SE) participated in this intervention. Subjects were randomized to MICT (n=13), HIIT (n=12) or non-exercise control group (CONT; n=10). Isocaloric MICT and HIIT were performed on Airdyne bicycles 4 days/week for 8 weeks under supervision. MICT consisted of 47 min of cycling at 70% of maximal heart rate, while HIIT consisted of 40 min of cycling at alternating intensities of 90% and 70% of maximal heart rate. AoPWV, aortic systolic and diastolic blood pressures were evaluated using applanation tonometry (SphygmoCor) before and after the intervention. Results: AoPWV improved by 0.52 m/s in MICT (9.26±0.39 vs. 8.75±0.35 m/s, pre- vs. post-intervention; P&lt;0.05), but did not change in HIIT (9.29±0.29 vs. 9.16±0.38 m/s, P&gt;0.05) or CONT (8.82±0.75 vs. 9.26±0.70 m/s, P&gt;0.05). Aortic systolic blood pressure (MICT: 106±2 vs. 107±3 mmHg; HIIT: 115±3 vs. 113±4 mmHg; CONT: 109±5 vs. 110±4 mmHg) and diastolic blood pressure (MICT: 69±2 vs. 69±2 mmHg; HIIT: 70±2 vs. 70±2 mmHg; CONT: 68±2 vs. 69±2 mmHg) did not change with the intervention (P&gt;0.05). Body mass index remained unchanged in all groups (P&gt;0.05). Conclusions: MICT Airdyne exercise leads to arterial destiffening, however, HIIT does not lead to improved arterial stiffness in healthy older men and postmenopausal women.

Abstract 13081: Large Volume Intra-Aortic Balloon Counterpulsation: Efficacy and Safety of the Mega 50cc in 150 Consecutive Patients

Background: Intraaortic balloon counterpulsation (IABC) with the larger volume (LV) 50 cc Mega balloon offers greater aortic diastolic augmentation and systolic unloading than its 40cc predecessor. We retrospectively analyzed our single center tertiary care experience with 150 consecutive patients (pts) with LV IABC to gauge its efficacy and safety. Methods: Retrospective chart review for demographic, procedural, safety and in-hospital outcome data was undertaken on 150 pts. In 64 pts, hemodynamic data by Swan was available pre- IABC, and 4, 24, and 48 hours during IABC. Results: LV IABC was deployed for cardiogenic shock and/or CHF (n=128), coronary ischemia (n=11), or high risk PCI/surgery (n=11): Mean age 58±15 with 18% over age 80, 21% female, 36% % African-American. The median LVEF was 22% (15.3%-33.2%) and 37% were non-ischemic myopathy. 19% of IABC insertions were emergent at bedside without fluoroscopy. Median duration of IABC was 92 hrs (48hrs-235 hrs) during which a leak or poor augmentation developed in 3%. 3(2%) pts had major vascular complications; 3(2%) pts had major bleeding. 51(34%) pts escalated from IABC to Impella, LVAD, or heart transplantation. Overall, in-hospital mortality was 27%. In the subgroup of 100 pts in whom IABC was the initial therapy for cardiogenic shock mortality was only 32%. Hemodynamic data (64 pts) pre-IABC vs 48 hrs: Aortic systolic pressure decreased (mean systolic unloading) -10.7 +/-25 mmHg; absolute Aortic diastolic pressure (augmented dias AoP) 108 ± 22mmHg; mean PA decreased -5.4±11; mean RA -3.2±6 (all p &lt;0.05). Cardiac output and index increased by of 0.7±1.6 l/min, and 0.4±0.8 l/min/m2 respectively (p&lt;0.005). Conclusion: LV IABC with the 50cc Mega balloon is a safe first line percutaneous support strategy in critically ill pts with easy bed-side deployment and relatively few device related complications. Despite conflicting results from clinical trials, we observed, a significant improvement in hemodynamic indices in a broad range of pts with relatively few vascular and bleeding complications with IABC. Among the 100 pts in whom IABC was the initial ventricular assist therapy for cardiogenic shock, survival to hospital discharge was 68%.

Abstract 13475: Acute Hemodynamic Effects of Large Capacity Intra-aortic Balloon Counterpulsation Pumps in Patients With Advanced Heart Failure

Over 40,000 intra-aortic balloon counterpulsation pumps (IABPs) are implanted in the United States annually. We explored the hemodynamic effect of large capacity (50cc) IABPs in patients with advanced heart failure. Methods: We conducted a prospective, observational study in 10 consecutive patients with Stage D, NYHA Class 3 or 4, non-ischemic heart failure referred for non-emergent IABP placement. Left ventricular (LV) hemodynamics were recorded for 10 minutes using a conductance catheter (CD Leycom; Figure) before and after activation of a 50cc IABP (Maquet Inc). Next, the 50cc IABP was halted for 10 minutes and a 10cc gas-extension tube inserted into the driveline to reduce the displacement volume to 40cc. LV hemodynamics were again recorded for 10 minutes before and after 40cc-IABP activation. Results: Mean age of the study population was 58±14 with an LV ejection fraction of 15±8%. The 50cc IABP reduced LV stroke work (LVSW: 1666±760 vs 1260±774 mmHg x mL, p&lt;0.01), end-systolic pressure (LVESP: 89±24 vs 75±23 mmHg, p&lt;0.05), and dP/dt max (868±225 vs 744±220 mmHg/sec, p&lt;0.01). The IABP with 40cc of volume displacement reduced LVSW (1717±814 vs 1424±703, p&lt;0.05), LVESP (94±19 vs 84±20, p&lt;0.05), and dP/dt max (890±171 vs 810±179, p&lt;0.01). Both 50cc and 40cc settings increased aortic diastolic pressures and reduced systolic pressures to similar degrees. Neither 50cc nor 40cc of volume displacement altered arterial elastance, LV volumes, or end-diastolic pressures (Figure). No hemodynamic differences between 50cc and 40cc of volume displacement were observed. Conclusions: This is the first study of large capacity IABPs using conductance catheters in patients with advanced heart failure. Both 50cc and 40cc volume displacement balloons reduced LV stroke work primarily by reducing LV end-systolic pressure with minimal effect on LV volumes. The clinical utility of IABPs in heart failure requires further study.

Comparison Between 30:1 and 30:2 Compression-to-ventilation Ratios for Cardiopulmonary Resuscitation: Are Two Ventilations Necessary?

Controversy is continuing over the need for ventilation and the optimal compression-ventilation (CV) ratio during cardiopulmonary resuscitation (CPR). The aim of this study was to comparatively elucidate the effect on hemodynamics and arterial oxygen saturation of a single ventilation relative to two consecutive ventilations during CPR in a dog model of cardiac arrest. Twenty mongrel dogs were divided into two groups. After 3 minutes of ventricular fibrillation (VF), the single-ventilation group received CPR with a 30:1 CV ratio, and the two-ventilation group received CPR with a 30:2 CV ratio, all with room air for 7 minutes. Thereafter, continuous chest compressions and intermittent ventilation at rate of 10 per minute were followed for both groups for 10 minutes. Hemodynamic parameters, arterial blood gas profiles, and variables from CPR were compared at baseline and at 5, 10, 15, and 20 minutes after induction of VF. Hemodynamic parameters including aortic systolic and diastolic pressures, right atrial systolic and diastolic pressures, coronary perfusion pressure, end-tidal carbon dioxide tension, and arterial blood gas profiles including arterial oxygen tension, arterial oxygen saturation, and arterial carbon dioxide tension were not different between two groups during CPR. In the 30:1 group, the period of compression interruption was shorter and chest compression fraction was higher than that in the 30:2 group (6 sec/min vs. 10.9 sec/min, p < 0.001; 90.0% vs. 81.8%, p < 0.001). CPR with a 30:1 CV ratio, compared to CPR with a 30:2 CV ratio, results in comparable arterial oxygenation saturation and hemodynamics.

Wave Separation, Wave Intensity, the Reservoir-Wave Concept, and the Instantaneous Wave-Free Ratio: Presumptions and Principles.

Wave separation analysis and wave intensity analysis (WIA) use (aortic) pressure and flow to separate them in their forward and backward (reflected) waves. While wave separation analysis uses measured pressure and flow, WIA uses their derivatives. Because differentiation emphasizes rapid changes, WIA suppresses slow (diastolic) fluctuations of the waves and renders diastole a seemingly wave-free period. However, integration of the WIA-obtained forward and backward waves is equal to the wave separation analysis-obtained waves. Both the methods thus give similar results including backward waves spanning systole and diastole. Nevertheless, this seemingly wave-free period in diastole formed the basis of both the reservoir-wave concept and the Instantaneous wave-Free Ratio of (iFR) pressure and flow. The reservoir-wave concept introduces a reservoir pressure, Pres, (Frank Windkessel) as a wave-less phenomenon. Because this Windkessel model falls short in systole an excess pressure, Pexc, is introduced, which is assumed to have wave properties. The reservoir-wave concept, however, is internally inconsistent. The presumed wave-less Pres equals twice the backward pressure wave and travels, arriving later in the distal aorta. Hence, in contrast, Pexc is minimally affected by wave reflections. Taken together, Pres seems to behave as a wave, rather than Pexc. The iFR is also not without flaws, as easily demonstrated when applied to the aorta. The ratio of diastolic aortic pressure and flow implies division by zero giving nonsensical results. In conclusion, presumptions based on WIA have led to misconceptions that violate physical principles, and reservoir-wave concept and iFR should be abandoned.

Pesticides Exposure and Cardiovascular Hemodynamic Parameters Among Male Workers Involved in Mosquito Control in East Coast of Malaysia.

Research findings have linked exposure to pesticides to an increased risk of cardiovascular (CVS) diseases. Therefore, this study aimed to assess the impact of chronic mix-pesticides exposure on CVS hemodynamic parameters. A total of 198 male Malay pesticide-exposed and 195 male Malay nonexposed workers were examined. Data were collected through exposure-matrix assessment, questionnaire, blood analyses, and CVS assessment. Explanatory variables comprised of lipid profiles, paraoxonase 1 (PON1), and oxidized low-density lipoprotein (ox-LDL). Outcome measures comprised of brachial and aortic diastolic blood pressure (DBP) and systolic BP (SBP), heart rate, and pulse wave velocity (PWV). Linear regressions identified the B coefficient showing how many units of CVS parameters are associated with each unit of covariates. Diazoxonase was significantly lower and ox-LDL was higher among pesticide-exposed workers than the comparison group. The final multivariate linear regression model revealed that age, body mass index (BMI), smoking, and pesticide exposure were independent predictors of brachial and aortic DBP and SBP. Pesticide exposure was also associated with heart rate, but not with PWV. Lipid profiles, PON1 enzymes, and ox-LDL showed no association with any of the CVS parameters. Chronic mix-pesticide exposure among workers involved in mosquito control has possible association with depression of diazoxonase and the increase in ox-LDL, brachial and aortic DBP and SBP, and heart rate. This study raises concerns that those using pesticides may be exposed to hitherto unrecognized CVS risks among others. If this is confirmed by further studies, greater efforts will be needed to protect these workers.

6A.07

Objective: For ease of measurement, and the utility of ambulatory central aortic blood pressure measurement, there has been a move toward brachial cuff-based devices for non-invasive computation of central aortic blood pressure quantities based on waveform features. However, waveforms detected by volumetric cuff displacement techniques are inherently more damped than signals obtained by applanation tonometry, potentially impacting on parameters reliant on higher frequency components of the pulse waveform. Design and method: In 45 subjects (age 46 ± 17 years, 30 male), in-clinic, seated measurements taken in triplicate using three brachial cuff-based devices (BPLab, [Petr Telgin]; Oscar2, [SunTech/AtCor Medical]; SphygmoCor XCEL, [AtCor Medical]) were compared using repeated measures ANOVA and Bland-Altman statistics against radial tonometric assessment of central aortic pressure (SphygmoCor CvMS, [AtCor Medical]). Results are expressed as means ± standard error. Results: There was good agreement between devices for aortic systolic pressure (aSP) and aortic diastolic pressure (aDP). There was great variability in aortic augmentation index (aAIx), ejection duration (ED) and subendocardial viability ratio (SEVR, Table). Cuff-based device regression slopes against the tonometer-based method varied markedly for aSP (BPLab, 0.76; Oscar2, 0.92; XCEL, 0.77), aAIx (BPLab, 0.32; Oscar2, 0.74; XCEL, 0.88), ED (BPLab, 1.07; Oscar2 does not report; XCEL, 0.83), and SEVR (BPLab, 0.16; Oscar2 does not report; XCEL, 0.81).Conclusions: Parameters relying on the low frequency components of the peripheral waveform have better agreement between cuff-based devices than parameters that rely on higher frequency waveform components. Further research is required for quantitative assessment of filtering methods utilised in cuff-based devices, as well as the cuff-based approach itself for use in measuring AIx, ED and SEVR.

Acquired aortic atresia: Catheter therapy using covered stents

To maintain aortic continuity, aortic arch interruption is usually treated surgically. We present our experience of aortic arch reconstruction using percutaneous implantation of covered stents and mid-term follow-up. To describe the feasibility, safety, and effectiveness using percutaneous placement of covered stents for functional aortic atresia and mid-term follow-up. Nine patients (7 males), mean age of 30.8 ±16.2 years (range 13-58 years) and mean body weight of 65.7± 14.9 kg (range 52-95 kg), were investigated for systemic hypertension and found to have functional aortic interruption. All were treated with percutaneous perforation, combined with balloon dilation and implantation of covered stents. After stent implantation, control angiograms were performed. All the patients had functional aortic interruption and continuity was established by perforating the atretic segment with trans-septal Brockenbrough needle or the stiff end of a guide wire. A covered Cheatham-Platinum CP stent was used to establish the luminal continuity of the aortic arch. Angiograms after stent deployment showed good forward flow through the stent and hemodynamic assessment revealed minimal gradients across the stent. The mean invasive descending aortic systolic blood pressure before stenting was 86.6 ± 14.3 mm Hg, which increased to 116.5 ± 16.3 mm Hg, after stenting (P = 0.004). The mean invasive descending aortic diastolic blood pressure before stenting was 63.6 ± 8.1 mm Hg, which increased to 79.7 ± 13.3 mm Hg after stenting (P = 0.002). Percutaneous treatment of functional aortic atresia with covered stents is feasible, safe, and effective alternative to surgery with excellent short- and mid-term results.

Abstract 246: Thoracic versus Abdominal Aortic Stiffness in Young and Old Non-Human Primates

We demonstrated that thoracic aortic stiffness is increased in aging monkeys, with the mechanism involving increased vascular smooth muscle cell (VSMC) stiffness. In view of the importance of increased abdominal aortic stiffness to greater incidence of abdominal aortic aneurysms, the goal of this investigation was to determine differences in thoracic vs. abdominal aortic stiffness in young and old monkeys (fascicularis and rhesus). Most prior studies on aortic stiffness have been conducted in vitro or in anesthetized animals with indirect measurements of stiffness. A novel feature of the current investigation was to measure aortic diameter and pressure instantaneously and continuously in chronically instrumented, conscious young (n=25, 5-12yrs) and old male (n=21, &gt;24yrs) monkeys, instrumented with aortic pressure gauges and ultrasonic aortic diameter crystals on the thoracic and abdominal aorta. The aortic stiffness index, β[[Unable to Display Character: &amp;#61484;]][[Unable to Display Character: &amp;#61472;]]calculated as a ratio of systolic and diastolic aortic pressures and diameters, was markedly greater, p&lt;0.05, in abdominal, compared with thoracic, aorta in both young (33±5.0 in abdominal vs. 14±2.2 in thoracic) and old monkeys (57±6.3 in abdominal vs. 34±0.4 in thoracic). Although both thoracic and abdominal aortic stiffness were greater in old monkeys, p&lt;0.05, surprisingly, abdominal aortic stiffness in young monkeys (33±5.0) was equal to thoracic aortic stiffness in old monkeys (34±0.4). Using atomic force microscopy, aortic VSMC stiffness was 2 fold greater, p&lt;0.05, in old monkeys vs. young monkeys, but there were no differences in abdominal vs. thoracic aortic VSMC stiffness in either young or old monkeys. In summary, as expected, aging increased aortic stiffness, with the mechanism, in part, due to increased VSMC stiffness. However, aortic stiffness was increased more in the abdominal than thoracic aorta both in young and old monkeys, with the magnitude of the increase in the abdominal aorta of the young monkeys, similar to that which occurs with aging in the thoracic aorta. These findings point out the major differences in stiffness along the aorta and have relevance to the greater frequency of abdominal aortic aneurysms.

FP862SERUM OSTEOPROTEGERIN LEVELS ASSOCIATED WITH AORTIC AUGMENTATION INDEX IN RENAL TRANSPLANT RECIPIENTS

Objectives: Arterial stiffness is recognized as an independent risk factor for cardiovascular morbidity and mortality. Recent studies found that osteoprotegerin (OPG) is associated with arterial stiffness and may reflect endothelial dysfunction. The aim of this study was to evaluate the relationship between fasting serum OPG levels and the aortic augmentation index (AIx) in renal transplant recipients. Materials and methods: Fasting blood samples were obtained from 66 renal transplant recipients. The aortic AIx was measured using a validated tonometry system (SphygmoCor). Serum OPG levels were measured using a commercial enzyme-linked immunosorbent assay kit. Results: Univariate linear analysis of the aortic AIx in renal transplant recipients revealed that body fat mass (r 1⁄4 0.377, p 1⁄4 0.002), aortic diastolic blood pressure (DBP; r 1⁄4 0.307, p 1⁄4 0.020), triglycerides (r 1⁄4 0.260, p 1⁄4 0.035), and logarithmically transformed OPG (log-OPG, r 1⁄4 0.402, p < 0.001) were positively correlated, whereas height (r 1⁄4 0.361, p 1⁄4 0.004) and body weight (r 1⁄4 0.212, p 1⁄4 0.041) were negatively correlated with the aortic AIx in renal transplant recipients. Multivariate forward stepwise linear regression analysis of the factors significantly associated with the aortic AIx showed that log-OPG (R2 1⁄4 0.213, p < 0.001), height (R2 1⁄4 0.081, p 1⁄4 0.009), and aortic DBP (R2 1⁄4 0.058, p 1⁄4 0.022) were independent predictors of the aortic AIx in renal transplant recipients. Conclusion: These results suggest that the serum fasting OPG level is associated with the aortic AIx in renal transplant recipients. Copyright © 2016, Buddhist Compassion Relief Tzu Chi Foundation. Published by Elsevier Taiwan LLC. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/bync-nd/4.0/).

Aortic Pulse Wave Characteristics In Postmenopausal Women With And Without A History Of Hypertensive Pregnancy

&lt;a name=“OLE_LINK2”&gt;&lt;/a&gt;&lt;a name=“OLE_LINK1”&gt;Hypertensive pregnancy (HP) disorders have been linked to a four‐fold increased risk for development of future cardiovascular diseases. We examined whether history of HP in postmenopausal women (N=20, 59±5 yr) influenced the risk factors for cardiovascular disease as assessed by aortic pulse wave characteristics, compared to age and parity matched controls (N=18, 60±4 yr). Non‐invasive aortic pressure waveforms were synthesized from high‐fidelity pressure waveforms obtained from SphygmoCor applanation tonometry using the radial artery. Aortic systolic and diastolic blood pressure (ASBP, ADBP), aortic augmentation index (AIx), augmented pressure (AP), aortic pulse pressure (APP), and left ventricular wasted energy (Ew) were calculated from the generated aortic pressure waveform. There were no differences in ASBP (125±4 vs. 129±4 mmHg), ADBP (79±2 vs. 81±2 mmHg), AP (17±2 vs. 17±2 mmHg), AIx (35±2 vs. 29±1%), AIx @75BPM (31±2 vs. 29±1%), Ew (3313±338 vs. 3364±432 dynes/cm2/s), between women with a history of HP vs. matched controls, respectively (P&gt;0.05 for all). Body mass index was significantly higher in women with a history of HP (30.6±1 vs. 26.7±1 kg/m2, P&lt;0.05), however it did not statistically influence any of the indices (P&gt;0.05 for all). Our results suggest that postmenopausal women with a history of HP do not demonstrate elevated aortic blood pressure or altered aortic pulse wave characteristics in comparison to matched controls. &lt;/a&gt;Supported by: National Institute of Aging 1P50AG044170‐01 and CTSA UL1 TR000135 and HL 118154

Acute Effects of External Pneumatic Compression on Peripheral and Central Hemodynamics

Use of external pneumatic compression (EPC) to improve recovery after exercise is increasing. However, the acute hemodynamic effects of EPC have not been determined. The purpose of this study was to investigate the acute effects of EPC on the aortic pressure waveform (AoPW) during EPC therapy. Twenty (n=20) young participants (23.5±3.9 years) were included in this study. Analysis of the AoPW was evaluated continuously using applanation tonometry before, during, and after a single 1‐hr therapeutic session of EPC. A sequential EPC device was employed with target inflation pressures of ~100 mmHg of compression. Peripheral systolic blood pressure was increased by 5.8±1.3 mmHg during EPC and remained elevated 10 minutes post treatment, p&lt;0.05. Aortic systolic blood pressure was increased by 5.9±1.1 mmHg during EPC and remained elevated 10 minutes post treatment, p&lt;0.01. Both peripheral and aortic diastolic blood pressure were significantly increased by 5.1±0.9 and 4.8±0.9 mmHg, respectively, during EPC and remained elevated 10 minutes post treatment, p&lt;0.05. Peripheral and aortic mean arterial pressure were increased by 4.2±1.0 and 4.3±1.1 mmHg, respectively, during EPC and remained elevated 10 minutes post treatment when compared to baseline values, p&lt;0.05. EPC at target inflation pressures of 100mmHg increases total peripheral resistance to lower limb blood flow which results in increases in peripheral and central blood pressures during therapy and persists at least 10 minutes post treatment.

(735) - Impact of Initial Acidic Reperfusion on the Functional Recovery of DCD Hearts During Ex Vivo Heart Perfusion

s S251 normothermic beating state and transitioned into working mode for assessment of myocardial function by measuring the cardiac index (mL/minute/gram heart tissue) achieved at a left atrial pressure of 8 mmHg and an aortic diastolic pressure of 40 mmHg. RESULTS: Hearts sustained an equivalent period of warm ischemia (5 C1⁄428 1, 25 C1⁄429 1, 35 C1⁄427 1 minutes, p1⁄40.50) prior to IR. During IR coronary blood flow (5 C1⁄4483 53, 25 C1⁄4722 60, 35 C1⁄4906 36 mL/min, p<0.01) and coronary sinus lactate concentration (5 C1⁄4 0.73 0.06, 25 C1⁄41.33 0.03, 35 C1⁄41.75 0.15 umol/L, p<0.01) differed among treatment groups. Greater preservation of endothelial cell integrity (electron microscopy endothelial injury score: 5 C1⁄43.2 0.5, 25 C1⁄41.8 0.2, 35 C1⁄41.7 0.3, p1⁄40.01) and less myocardial injury (troponin I: 5 C1⁄491 6, 25 C1⁄464 16, 35 C1⁄457 7 pg/ mL/gram, p1⁄40.04) were evident in hearts reperfused at warmer temperatures. IR under profoundly hypothermic conditions impaired the recovery of indexed cardiac output (5 C1⁄43.9 0.8, 25 C1⁄46.2 0.4, 35 C1⁄46.5 0.0.6 mL/min/ gram, p<0.01). CONCLUSION: Avoidance of profound hypothermia during IR with a normokalemic adenosine-lidocaine cardioplegia minimizes injury and improves the functional recovery of DCD hearts. 384 GENDER SPECIFIC INFLUENCES ON EFFECTOR T-CELL FUNCTION AND PROLIFERATION: 2-METHOXYESTRADIOL MODULATES CELLULAR REJECTION JG Luc, JY Zhao, ED Michelakis, DH Freed, J Nagendran

Impact of Aortic Stiffness Evaluated by Aortic Pulsatility on Fractional Flow Reserve.

Fractional flow reserve (FFR) is a highly reproducible, accurate and lesion-specific index to indicate inducible ischemia for a particular coronary artery lesion. Invasively measured aortic pulsatility (AP) is an indicator of aortic stiffness. In this study we aimed to evaluate the possible impact of AP in terms of aortic stiffness on FFR measurement. In this study, we reviewed the FFR evaluation of 90 patients who had intermediate lesions (40-70% stenosis measured with quantitative coronary analysis) at the left anterior descending artery (LAD). AP was calculated as the ratio of aortic pulse pressure (systolic-diastolic pressure) to mean pressure. Aortic systolic pressure, aortic diastolic pressure, aortic pulse pressure and also aortic pulsatility did not differ significantly between patients with FFR ≤ 0.80 and FFR > 0.80 (p = 0.44, p = 0.28, p = 0.93 and p = 0.41, respectively). In subgroups arranged according to the degree of luminal narrowing (40-50%, 51-60%, and 61-70%), we did not observe significant correlation between AP and FFR value in subgroups with 40-50% and 51-60% lesions (r = 0.03, p = 0.95 and r = 0.07, p = 0.69, respectively). However, a statistically significant negative correlation between FFR value and AP in the subgroup of patients with 61-70% lesions was detected (r = -0.54, p = 0.04). These findings suggested that aortic stiffness might have a possible impact on FFR measurement in coronary lesions of 61-70% stenosis evaluated quantitatively. Aortic pulsatility; Fractional flow reserve; Stiffness.

Routine cine-CMR segmentation via a novel automated algorithm (LV-METRIC) for assessment of aortic physiology: a clinical validation study

Methods Cine-CMR (SSFP) was performed on 1.5 Tesla (GE) scanners; pulse sequence parameters were equivalent to those for routine CMR (typical TR 3.4 msec, TE 1.14 msec, flip angle 60, temporal resolution 30 msec). Images were acquired in conventional cardiac (2, 3, 4 chamber) long axis or axial imaging planes. Aortic area was uniformly measured in a non-aneurysmal location within the mid-descending thoracic aorta: Cine-CMR was quantified via a novel “partial voxel” segmentation algorithm (LV-METRIC) that accounts for relative proportion of blood within each individual imaging voxel. Maximum (systolic) and minimum (diastolic) aortic areas and brachial pulse pressure were used to calculate distensibility, a measure of arterial compliance, of the mid-descending thoracic aorta.

May Distal Coronary Pressure Measurement taken from Anastomosed Radial Artery Grafts Predict Early-Term Graft Patency?

Background: Visual estimates on angiography are inaccurate in assessing the functional significance of a coronary stenosis. Severity of stenosis in the native coronary artery is critical to both the short and long-term patency of the radial artery. Materials and Methods: A one hundred patients were selected. Radial artery is used for all patients. After all distal anastomoses are done and the systolic blood pressure reached over 100 mmHg, we have made arterial pressure measurement from the proximal side of radial artery graft. Results: All patients were followed-up. Serial postoperative coronary angiographies were performed at the first six postoperative months. There was no death in the first postoperative six months follow-up. We have detected ten radial artery graft occlusions and string sign. Five right coronary artery, four circumflex artery and one diagonal artery radial artery grafts occluded. The percentage of systolic aortic and coronary pressure measurement (C/Ao-s %) on occluded graft patients was ranged from 81 to 97. Percentage of diastolic aortic and coronary pressure measurement (C/Ao-d%) was ranged from 83 to 90. Percentage of mean aortic and coronary pressure measurement (C/Ao-m%) was ranged from 84 to 95. Conclusion: We concluded that we can predict of radial artery prognosis based on the severity degree of coronary artery stenosis. We have found ten radial artery grafts occluded. Unfortunately ten radial artery measurements are not enough for establishing a reliable cut-off value. We need more studies for creating a cut-off value determination.

Albuminuria is Associated With Subendocardial Viability Ratio in Chronic Kidney Disease Patients

Background/Aims: Albuminuria is a well-established marker of subclinical organ damage. Pulse-wave analysis (PWA) employs the technique of applanation tonometry to obtain a peripheral pulse pressure waveform, from which central hemodynamic data are derived by application of the transfer function. Using PWA we can measure the subendocardial viability ratio (SEVR) and ejection duration (ED). SEVR or the Buckberg index is a non-invasive estimate of myocardial workload, oxygen supply and perfusion and a measure of the ability of the arterial system to meet the heart`s energy requirements. ED is the duration of ventricular ejection. The objective of this study was to evaluate the relationship between albuminuria and PWA parameters in chronic kidney disease (CKD) patients. Methods: We studied 86 CKD patients aged 59.8±13.5 years, 56 (65.1%) were male. PWA analysis and 24-hour ambulatory blood pressure (24hABP) monitoring were performed. The following parameters were calculated: (1) aortic augmentation index with and without correction for a heart rate of 75 (Aix and AIx@ HR75), (2) SEVR, calculated as the ratio of the diastolic pressure time index and the systolic pressure time index, (3) ED, (4) estimated central aortic systolic and diastolic pressure and (5) central aortic pulse pressure calculated as the difference between estimated aortic systolic and diastolic BP. Blood samples and urine albumin-to-creatinine ratio (UACR) were analyzed; UACR values were natural log transformed (lnUACR). Results: Using CKD-EPI creatinine-cystatin C formula the eGFR in patients was 7-130 ml/min/1.73m² (mean 32.6; SD±24.6). We found statistically significant correlation between lnUACR and cystatin C (r=0.308; P=0.004), eGFR (r=-0.219; P=0.04), hemoglobin (r=-0.255; P=0.02), phosphorus (r=0.222; P=0.04), iPTH (r=0.268; P=0.01), SEVR (r=-0.254; P=0.02) and ED (r=0.315; P=0.003). No statistically significant correlations between lnUACR and cardiac biomarkers TnI, NT-proBNP, central aortic BP and 24h ABP values were found. Using multiple regression analysis statistically significant association was found between SEVR as dependent variable and lnUACR (β=-0.223, P=0.039), sex (β=-0.216, P=0.035), and diabetes (β=0.332, P=0.001). Multiple regression analysis with ED as dependent variable has shown statistically significant association with lnUACR (β=0.242, P=0.031) and diabetes (β=-0.275, P=0.01). Patients were stratified into tertiles according to the lnUACR. Statistically significant differences in serum creatinine (P=0.001), cystatin C (P=0.012), hemoglobin (P=0.03), calcium (P=0.036), iPTH (P=0.008), SEVR (P=0.007) and ED (P=0.004) were found between tertiles. In post hoc analysis we found statistically significant differences between first and third tertile in SEVR (P=0.002; 95% CI:10.5-45) and in ED (P=0.001; 95% CI:-6.89-(-1.87)). Conclusions: Nondialysis CKD patients with higher levels of albuminuria have lower SEVR and higher ED and our results have shown the importance of central hemodynamic parameters like are SEVR and ED as a better or earlier noninvasive hemodynamic indexes in these patients.