Arterial Pressure Volume Index Research Articles

A Noninvasive Arterial Stiffness Index to Estimate the Severity of Coronary Atherosclerosis in Patients Undergoing Coronary Angiography

The early diagnosis and appropriate treatment of subclinical atherosclerosis before the onset of life-threatening cardiovascular (CV) diseases are major unmet medical needs in current clinical practice. Noninvasive arterial stiffness indices, the arterial velocity–pulse index (AVI) and the arterial pressure–volume index (API) have been associated with CV risks, conventional arterial stiffness indices, and the severity of coronary atherosclerosis. However, few studies have examined the relationship between these indices and the occurrence of CV events. We measured the AVI and API in 113 consecutive patients admitted to Yokohama City University Hospital for cardiac catheterization between June 2015 and March 2016. Patients were followed until September 2022, and the occurrence of CV events was assessed. The mean age was 71.2 ± 10.7 years, and 83 patients (73.5%) were male. In total, 80 patients (70.8%) had hypertension, 87 (77.0%) had dyslipidemia, and 91 (80.5%) had a history of ischemic heart disease (IHD). The mean follow-up duration was 1752 ± 819 days. Patients who received elective percutaneous coronary intervention (PCI) based on the results of coronary angiography (CAG) at the time of enrollment had significantly higher API than those who did not (38.5 ± 12.6, n = 17 vs. 31.3 ± 7.4, n = 96, p = 0.001). The API was independently associated with the risk of elective PCI in multiple logistic regression analysis. In conclusion, the API could be a useful indicator for estimating the need for coronary interventional treatment in patients with a high CV risk.

Uncoupling of the center-to-periphery arterial stiffness gradient and pulse pressure amplification in viral pneumonia infection

ObjectivesArterial stiffness is a common manifestation of viral pneumonia infections, including COVID-19. Nevertheless, the relationship between the center-to-periphery arterial stiffness gradient and pulse pressure amplification (PPA) in infectious diseases remains unclear. This study aimed to investigate this relationship utilizing arterial pressure volume index (API) and arterial velocity pulse index (AVI) ratio.MethodsAPI/AVI and PPA were measured in 219 participants with COVID-19 and 374 normal participants. Multiple linear regression was used to assess the association of API/AVI and PPA, and restricted cubic spline was used to investigate the non-linear relationship between API/AVI and PPA. Receiver operating characteristic curve (ROC) analysis was used to evaluate the effects of API/AVI in identifying COVID-19 infection and severe stage.ResultsThere was a significant J-shaped relationship between API/AVI and PPA in COVID-19 group, while a M-shaped relationship was observed in normal group. API/AVI decreased rapidly as PPA decreased until API/AVI decreased slowly at PPA of 1.07, and then API/AVI decreased slowly again at PPA of 0.78. ROC results showed that API/AVI demonstrated excellent accuracy in identifying COVID-19 infection (AUC = 0.781) and a high specificity (84.88%) in identifying severe stage.ConclusionsThere was a J-shaped association between the API/AVI and PPA in viral infected patients, while a M-shaped relationship in the normal participants. API/AVI is better for identifying infected and uninfected patients, with a high specificity in identifying those in severe stages of the disease. The attenuation or reversal of API/AVI may be associated with the loss of PPA coupling.

The Effect of Aerobic Exercises on Arterial Stiffness in Older People: A Systematic Review and Meta-Analysis.

Aerobic exercise is a cost-effective intervention to improve arterial stiffness, but its effects on older people are unclear; this review aims to determine those effects. Five databases were searched for randomized controlled trials of aerobic exercises. Backward and forward citations and clinical trial registries were also reviewed. Data were extracted and synthesized. A random-effects model was used in a meta-analysis. The risk of bias and the certainty of the evidence were also assessed. The protocol of this review was registered (PROSPERO registration number: CRD42022349494). Eighteen studies (n = 775) were identified. Aerobic exercises included cycling, walking, swimming, standing core exercise, bench step exercise, aquarobic exercise, jogging, running, upper-limb cycling, and aquatic walking. Postintervention, improvements were seen in the pulse wave velocity (SMD9 = -0.89, 95% confidence interval (CI)-1.57 to -0.22), arterial velocity-pulse index (MD2 = -6.84, 95% CI -9.05 to -4.63), and arterial pressure-volume index (MD2 = -4.97, 95% CI -6.9 to -3.04), but not in the augmentation index, arterial compliance, or beta stiffness index. Exercise lasting >8 weeks but not 4-8 weeks significantly improved pulse wave velocity. Aerobic exercise had a beneficial effect on healthy older people but not on older people with disease. The overall risk of bias was high in 9 of the included studies, with some concerns in the remaining studies. The certainty of the evidence was very low. Aerobic exercises, particularly those lasting >8 weeks, appear to be effective at improving pulse wave velocity in older people postintervention. Future trials with robust designs are needed.

Increased arterial pressure volume index and cardiovascular risk score in China

Background and objectiveThe new non-invasive arterial stiffness indices, arterial pressure volume index (API) is explored as a novel marker of residual stress in the wall of the peripheral muscular arteries at zero-stress state in clinical settings. The present study aimed to study the association of API with cardiovascular disease (CVD) risk in China (China-PAR).MethodsAccording to China-PAR score, participants were divided into three groups: low risk (< 5%), medium risk (5–9.9%), and high risk (≥ 10.0%). API ≥ 31 was defined as high API, and the incidences of high API were compared. Logistic regression models were used to analyze the risk factors of high API and high risk China-PAR categories. The association between China-PAR and API was analyzed by restrictive cubic spline.ResultsThe study included 4311 participants. After adjustments for confounding factors, high API was independent factor associated with high risk China-PAR categories, and the probability of high API was 1.366 times higher than that in normal API subjects. While, the independent factors associated with high API were BMI, blood pressure and heart rate. Furthermore, API had a significant U-shaped association with China-PAR. CVD risk was lowest with API of 19 units, the fastest increase at 26 units and the flattest starting point at 59 units.ConclusionAPI, an indicator of arterial stiffness and residual stress, had a U-shaped association with China-PAR score and might play an important role in predicting CVD risk in Chinese natural populations.

Relationship of Arterial Stiffness and Central Hemodynamics With Cardiovascular Risk In Hypertension.

Hypertension is becoming a serious public health problem and noninvasive estimation of central hemodynamics and artery stiffness have been identified as important predictors of cardiovascular disease. The study included 4,311 participants, both sex and aged between 20 and 79 years. Arterial velocity pulse index, arterial pressure-volume index (AVI, API, and the index of artery stiffness), central systolic blood pressure, central artery pulse pressure (CSBP, CAPP, and estimated via oscillometric blood pressure monitor), and 10-year risk score of cardiovascular disease in China (China-PAR) and Framingham cardiovascular risk score (FCVRS) were assessed at baseline. Regression model was performed to identify factors associated with high cardiovascular disease risk stratification. The relationships between CSBP, CAPP and China-PAR, and FCVRS were analyzed by restrictive cubic spline functions. The uncontrolled hypertension group showed the highest values of AVI, API, CSBP, and CAPP. In the regression analysis, CAPP and hypertension subtypes were identified as significant predictors of high cardiovascular risk stratification, and CAPP was strongly correlated with API in this cohort. Finally, CSBP and CAPP showed significant J-shaped relationships with China-PAR and FCVRS. Subjects with uncontrolled hypertension present with elevated values of CAPP, CSBP, API, AVI, China-PAR, and FCVRS scores. CAPP was independently associated with high cardiovascular risk stratification, and there was a significant J-shaped relationship with China-PAR and FCVRS that may identify people with higher cardiovascular risk.

PS-C11-4: UPPER ARM SBP DECLINE ASSOCIATED WITH REPEATED CUFF-OSCILLOMETRIC INFLATION SIGNIFICANTLY CORRELATED WITH ARTERIAL STIFFNESS INDEX

Background: It is unknown how the repeated cuff-oscillometric inflations with blood pressure measurements are related to arterial stiffness and central arterial pressure, and how changes to the novel indexes of arterial stiffness, AVI (arterial velocity pulse index) and API (arterial pressure volume index) will be brought about by the repeated cuff-oscillometric inflations. Aim: We evaluated the clinical significance of the new non-invasive vascular indexes AVI and API in outpatients with various clinical backgrounds to explore potential utilities of these two indexes by using repeated cuff-oscillometric inflation in actual clinical settings. Methods: In 250 consecutive outpatients, we performed a cross-sectional, retrospective, single center, observational study to investigate arterial stiffness using blood pressure and the AVI and API with three times repeated measurements that used multifunctional blood pressure monitoring device, AVE-1500 (Shisei Datum, Tokyo, Japan). Results: Of the 250 enrolled subjects, 236 were analyzed. 62.7% of the patients were male, with an overall mean age of 68.1 ± 12.1. The mean SBP (systolic blood pressure) and DBP (diastolic blood pressure) of first time measurement were 133.07 ± 21.20 mmHg and 73.94 ± 13.56 mmHg, respectively. The mean AVI and API of first time measurement were 23.83 ± 8.30 and 31.12 ± 7.86, respectively. In each measurement with repeated measurements of BP (SBP/DBP), AVI and API, although DBP and AVI did not have the significant changes throughout the measurements, both SBP and API decreased significantly according to the measurement orders. Conclusions: In this study, upper arm SBP decline associated with repeated cuff-oscillometric inflation significantly correlated with arterial stiffness index. Furthermore, it would suggest that arterial stiffness could be predicted by the changes in repeated SBP measurements.

Upper-Arm SBP Decline Associated with Repeated Cuff-Oscillometric Inflation Significantly Correlated with the Arterial Stiffness Index.

We evaluated the clinical significance of the new non-invasive vascular indices to explore their potential utility using repeated cuff-oscillometric inflation. In 250 consecutive outpatients, we performed a cross-sectional, retrospective, single-center, observational study to investigate sequential differences in arterial stiffness using blood pressure, arterial velocity pulse index (AVI), and arterial pressure volume index (API) with repeated measurements. Males accounted for 62.7% of the patients, and the mean age was 68.1 ± 12.1 years. The mean systolic blood pressure (SBP) and diastolic blood pressure (DBP) of the first reading in repeated measurements were 133.07 ± 21.20 mmHg and 73.94 ± 13.56 mmHg, respectively. The mean AVI and API were 23.83 ± 8.30 and 31.12 ± 7.86, respectively. In each measurement of these parameters, although DBP and AVI did not show significant changes throughout repeated measurements, SBP and API decreased significantly according to the measurement orders. Furthermore, changes in SBP and API were significantly correlated in several of the models. In this study, it was concluded that upper-arm SBP decline associated with repeated cuff-oscillometric inflation was significantly correlated with the arterial stiffness index. The findings of this study will allow clinicians to easily recognize the progression of atherosclerosis through regular, routine practice. In conclusion, this study suggests that changes in repeated SBP measurements may be predictive of arterial stiffness and atherosclerosis.

Association of Arterial Stiffness Indices with Framingham Cardiovascular Disease Risk Score

Purpose: The new non-invasive arterial stiffness indices, arterial velocity pulse index (AVI) and arterial pressure volume index (API) are known to be associated with cardiovascular disease risk. The present study aimed to examine the “dose-response” associations between AVI, API and Framingham cardiovascular disease risk score (FCVRS). Methods: This survey included individuals with arterial stiffness indices collected at age 18 years and older. We used Pearson’s correlation coefficients and multivariate linear analyses to evaluate associations of AVI and API to other variables. The associations between FCVRS and AVI, API were analyzed by restrictive cubic spline. Results: 4311 people were included in the full study population, including 2091 males and 2220 females. In restricted cubic spline regression models, AVI or API had significant U-shaped associations with FCVRS, with the lowest risk score of cardiovascular disease was 8 units or 18 units, respectively. After AVI increased to 12 units, FCVRS increased rapidly until AVI was 27 units, and the FCVRS increased relatively flat afterward. For API, results were similar. When API increased to 23 units, the FCVRS increased rapidly, and after API was 52 units, FCVRS increased relatively flat. Conclusions: AVI or API had U-shaped associations with FCVRS. The associations may provide a new perspective for early treatment or lifestyle modifications to prevent cardiovascular diseases.

Relationships Between Arterial Pressure-Volume Index and Cardiovascular Disease Biomarkers in Patients With Hypertension.

BackgroundThe arterial pressure-volume index (API), which is obtained by conventional blood pressure measurement, is a new marker for arterial stiffness. The aim of this study was to clarify the relationships between the API and various clinical parameters, including cardiovascular disease (CVD) biomarkers, in patients with hypertension for the prevention of CVD.MethodsThis cross-sectional study enrolled 288 patients with hypertension receiving pharmacological treatment, without a history of CVD (males/females: 115/173; age: 63 ± 11 years (mean ± standard deviation)). The API was automatically calculated using a commercial device.ResultsThe API was significantly correlated with important CVD biomarkers, such as the concentration of urinary albumin (r = 0.42, P < 0.001), high-sensitivity troponin T (r = 0.39, P < 0.001), and skin autofluorescence (marker of advanced glycation end products in tissues) (r = 0.41, P < 0.001). Multiple regression analyses demonstrated that when the API was used as a subordinate factor, these biomarkers were independent variables. According to the receiver operating characteristic curve analysis, an API of > 26 is the optimal cut-off point for determining albuminuria as ≥ 30 mg/g Cr, high high-sensitivity cardiac troponin T concentration as ≥ 0.014 ng/mL, or high skin autofluorescence as ≥ 3.0 arbitrary unit (area under the curve = 0.703, 0.702, and 0.704; and P < 0.001, respectively).ConclusionThis investigation demonstrates that API had an independent relationship with relevant CVD biomarkers, such as urinary albumin, high-sensitivity troponin T, and skin autofluorescence. Additionally, the outcomes of receiver operating characteristic curve analysis are presented as values that an API > 26 defines for these biomarkers linked with the formation of CVD.

Relationships between muscle sympathetic nerve activity and novel indices of arterial stiffness using single oscillometric cuff in patients with hypertension.

The arterial velocity pulse index (AVI) and arterial pressure‐volume index (API) have been proposed as new arterial stiffness indices that can be measured using an oscillometric cuff. Sympathetic nerve activity (SNA) contributes to arterial stiffness via increasing vascular smooth muscle tone. However, the associations between SNA and the AVI or API are not understood. The purpose of this study was to evaluate the relationships between muscle sympathetic nerve activity (MSNA) and the AVI or API in healthy individuals and patients with hypertension (HT). Forty healthy individuals (40.1 ± 15.2 years, 8 females) (healthy group) and 40 patients with HT (60.2 ± 13.6, 18 females) (HT group) were included in this study. The AVI, API, MSNA, beat‐by‐beat blood pressure, and heart rate were recorded simultaneously. The AVI and API were higher in the HT group than in the healthy group (AVI, 26.1 ± 7.6 vs. 16.5 ± 4.0, p < 0.001; API, 31.2 ± 8.6 vs. 25.5 ± 7.2, p = 0.002). MSNA in the HT group was also higher than in the healthy group (p < 0.001). MSNA was correlated with the AVI, but not with the API, in both the healthy group (R = 0.52, p = 0.001) and HT group (R = 0.57, p < 0.001). MSNA was independently correlated with the AVI in multivariate analysis (ß = 0.34, p = 0.001). In conclusion, AVI, obtained by a simple and less user‐dependent method, was related to the MSNA in healthy individuals and patients with HT.

Effects of high-intensity interval training on improving arterial stiffness in Chinese female university students with normal weight obese: a pilot randomized controlled trial

BackgroundHigh intensity interval training (HIIT) has been reported to exert better effects on cardiovascular fitness in obesity, but little known about the arterial stiffness (AS) in female university students with normal weight obesity (NWO). Thus, this study aimed to investigate the effects of HIIT on the body composition, heart rate (HR), blood pressure (BP), blood lipids metabolism as well as the novel parameters of propensity for AS (arterial velocity pulse index [AVI], arterial pressure volume index [API]) for female university students with NWO.MethodsForty female university students with NWO were randomly assigned to control group (n = 20) and HIIT group (3 bouts of 9‑min intervals at 90% of the maximal heart rate [HRmax], interspersed by 1 min rest, 5 days a week, n = 20). Tests were performed before and after 4 weeks of training. Repeated measures ANOVA and simple effect test analysis were used to analyze dependent variable changes.ResultsAfter 4 weeks HIIT statistically significantly improved the body composition by decreasing the body mass index, body fat percent, total body fat mass (BFM), BFM of left arm, measured circumference of left arm, and obesity degree, and increasing the total body skeletal muscle mass, protein content, total body water, fat free mass, body cell mas, and InBody score. HIIT also statistically significantly decreased the HR and BP. As for the lipid profile, HIIT obviously ameliorated the blood lipids metabolism by decreasing the levels of total cholesterol (TC), triglyceride, low-density lipoprotein, and TC/HDL, and increasing the levels of high-density lipoprotein (HDL). In addition, the AVI and API were markedly decreased via HIIT intervention.ConclusionsHIIT produced significant and meaningful benefits for body composition, HR, BP, and blood lipids metabolism, and could decrease AS in female university students with NWO. This suggests that HIIT may effectively reduce the risk of arteriosclerosis and protect the cardiovascular function for female university students with NWO.Trial registration ChiCTR2100050711. Registered 3 September 2021. Retrospectively registered.

Arterial Stiffness Index and Exercise Tolerance in Patients Undergoing Cardiac Rehabilitation.

Arterial stiffness contributes to the development of cardiovascular disease (CVD). However, the relationship between the arterial stiffness and exercise tolerance in CVD patients with preserved ejection fraction (pEF) and those with reduced EF (rEF) is unclear. We enrolled 358 patients who participated in cardiac rehabilitation and underwent cardiopulmonary exercise testing at Juntendo University Hospital. After excluding 195 patients who had undergone open heart surgery and 20 patients with mid-range EF, the patients were divided into pEF (n = 99) and rEF (n = 44) groups. Arterial stiffness was assessed using arterial velocity pulse index (AVI) and arterial pressure volume index (API) at rest. The patients in the pEF group were significantly older and had a higher prevalence of coronary artery disease than the rEF group. The pEF group had significantly lower AVI levels and higher API levels than the rEF group. In the pEF group, the peak oxygen uptake (peak VO2) and the anaerobic threshold was significantly higher than those in the rEF group. The peak VO2 was significantly and negatively correlated with AVI and API in the pEF group (All, P < 0.05), but not in the rEF group. Multivariate linear regression analyses demonstrated that AVI was independently associated with peak VO2 (β = -0.34, P < 0.05) in the pEF group. In conclusion, AVI may be a useful factor for assessing exercise tolerance, particularly in CVD patients with pEF.

Novel index of arterial reflected waves, Arterial Velocity pulse Index, relates to muscle sympathetic nerve activity independent of Arterial Pressure volume Index in patients with hypertension

Abstract Background Arterial reflected wave is determined by not only atherosclerosis but also sympathetic nerve activity. Recently, Arterial Velocity pulse Index (AVI), which is an index of arterial reflected waves, and Arterial Pressure volume Index (API), which is an index of volume of a conductive blood vessel, have been proposed as new index of arterial stiffness. However, it is unclear whether API and AVI would be associated with muscle sympathetic nerve activity (MSNA) in hypertensive subjects. Purpose The purpose of this study was to evaluate the correlation between AVI, API and MSNA in hypertensive subjects. Method 41 hypertensive patients and 40 non-hypertensive subjects were included in this study. We performed a cross-sectional, observational study. Hypertension (HT) was defined as systolic blood pressure (SBP) ≥140 mmHg, diastolic blood pressure (DBP) ≥90 mmHg or medical treatment for HT. AVI and API was measured by NAS-1000 (Nihon Koden, Japan). MSNA, central sympathetic outflow to peripheral muscle, was recorded directly from peroneal nerve. MSNA was expressed by burst frequency (bursts/minute) and burst incidence (bursts/100heartbeats). Blood pressure, heart rate and MSNA were recorded simultaneously. Results Age, systolic and diastolic pressure were significantly higher in hypertensive patients compared to control (40±15 vs 61±13 years, p&amp;lt;0.001; 142±16 vs 113±9 mmHg, p&amp;lt;0.001; 81±14 vs 67±9 mmHg, p&amp;lt;0.001). MSNA and AVI were significantly augmented in hypertensive patients compared to control (34±11 vs. 23±6 bursts/min, p&amp;lt;0.05; 26±7 vs. 16±4, p&amp;lt;0.05). AVI was correlated with MSNA in each group (hypertension: r=0.59, P&amp;lt;0.001, non-hypertension: r=0.51, p&amp;lt;0.001). However, no correlation was shown between API and MSNA in each group (hypertension: r=0.22, p=0.15, non-hypertension: r=0.07, p=0.63). Multiple regression analysis also showed MSNA was significantly related with AVI but was not with API. Conclusion Our finding showed that AVI relates to MSNA independent of API in patients with hypertension. It suggested that Novel index of arterial reflected waves, AVI, is helpful to estimate augmented SNA in hypertensive subjects regardless of volume of a conductive blood vessel. Funding Acknowledgement Type of funding source: None

New indices of arterial stiffness correlate with disease severity and mid-term prognosis in acute decompensated heart failure.

Arterial stiffness has been implicated in pathophysiology of heart failure (HF) since it is involved in the ventricular-vascular coupling. Recently, new indices obtained by a cuff oscillometric technique, the arterial velocity pulse index (AVI) for the stiffness of central arteries and the arterial pressure volume index (API) for the stiffness of peripheral arteries have been developed and validated. However, the AVI and API measurement has not been attempted in HF population. This study aimed to investigate the relationship between the AVI, API and clinical parameters and outcomes in HF patients. A prospective cohort of patients with acute decompensated HF were enrolled within 6months, who were admitted to a tertiary referral hospital in China. Measurement of the AVI and API (AVE-1500, Shisei Datum, Tokyo, Japan) was performed on the day of admission and discharge. Patients were followed up to 6months for the composite endpoint of all-cause death and rehospitalization for HF. A total of 127 patients were recruited for analysis (60 ± 15years, 70% male). 80% of the patients were in New York Heart Association (NYHA) Class III or IV at admission with mean left ventricular ejection fraction (LVEF) of 34 ± 9%. During hospitalization, all patients received guideline-directed medical therapy if not contraindicated. The AVI (27.3 ± 5.0 vs. 28.6 ± 6.7, P = 0.002) and API (24.9 ± 4.9 vs. 26.0 ± 6.5, P = 0.05) were lower at discharge than at admission. By dividing the patients into mild to severe group based on systolic blood pressure (SBP) and LVEF or into tertiles according to the amino-terminal pro-brain natriuretic peptide (NT-proBNP), transmitral E velocity over mitral annular e' velocity (E/e' ratio), it was observed that the AVI increased with a higher level of NT-proBNP (P for trend < 0.001), a larger E/e' (P for trend < 0.001) and a lower LVEF (P for trend = 0.0183), while the API increased as the E/e' and systolic blood pressure became higher (both P for trend < 0.05). The improvement in AVI at discharge was correlated with LVEF (R = -0.3024, P < 0.05) and NT-proBNP improvement (R = 0.3118, P < 0.05), while the change in API was positively correlated with SBP change (R = 0.3897, P < 0.001). In 6months after discharge, there were 52 predefined events including 15 deaths and 44 rehospitalization for HF. Apart from the level of NT-proBNP, the AVI at discharge of ≥ 26 showed a trend of being associated with the composite outcome (HR 2.747, 95% CI 1.411-5.349, P < 0.001 for univariate analysis; HR 1.864, 95% CI 0.892-3.893, P = 0.09761 for multivariate analysis). New noninvasive arterial stiffness indices as the AVI and API reflected severity of illness and midterm prognosis in admitted HF patients. Further studies are warranted for understanding its mechanisms and developing clinical applications.

Increased arterial velocity pulse index is an independent factor related to skeletal muscle mass reduction and tissue damage in patients with cardiovascular disease.

Reduced skeletal muscle mass is the most important component of sarcopenia. Aging and chronic diseases, including chronic heart failure, are the causes of reduced skeletal muscle mass. However, little is known about the mechanism of skeletal muscle mass reduction in patients with cardiovascular disease (CVD). The purpose of this study was to assess the associations among skeletal muscle mass reduction, endothelial function, and other markers of advanced vascular damage in CVD patients. This was a retrospective cross-sectional analysis that included 310 inpatients with CVD in our hospital. Flow-mediated vasodilation (FMD) was performed to assess early vascular damage, i.e., endothelial dysfunction. The arterial velocity pulse index (AVI) and arterial pressure volume index (API) were assessed to reveal signs of advanced vascular damage, such as arterial stiffening and increased peripheral resistance. The bioelectrical phase angle (PA), as a marker of tissue damage, and the skeletal muscle index (SMI) were measured. Correlation analyses were performed among these parameters. Sarcopenia was diagnosed in 25.5% of patients according to the Asian Working Group for Sarcopenia criteria. Greater progression of arterial stiffness, shown by a higher AVI, and more severe tissue damage, shown by a narrower PA, were found in individuals with sarcopenia. Stepwise multivariate regression analysis showed that sex, age, PA, hypertension, and AVI were factors independently correlated with SMI. In conclusion, advanced vascular damage, such as increased arterial stiffness and peripheral resistance, might play an important role in the reduction in skeletal muscle mass, possibly through damage to skeletal muscle tissue in CVD patients.

Effects of different intensities and durations of aerobic exercise training on arterial stiffness.

[Purpose] In the present study, we investigated the effects of regular aerobic training with different intensities and durations on new indices of arterial stiffness measured via an upper-arm oscillometric device. [Participants and Methods] We gathered data from 41 middle-aged and older people (age 65.0 ± 11.7 years). Participants were randomly divided into five groups: (1) 15 minutes of low intensity aerobic training (n=10); (2) 30 minutes of low intensity training (n=7); (3) 15 minutes of moderate-intensity training (n=9); (4) 30 minutes of moderate-intensity training (n=8); and (5) a non-training group (n=7). Training was conducted for 8 weeks, three times per week. Arterial pulse wave index, arterial pressure-volume index, brachial-ankle and heart-brachial pulse wave velocity, cardio-ankle vascular index, brachial and ankle blood pressure, heart rate, and peak oxygen uptake were measured before and after the intervention. [Results] All indicators of arterial stiffness and brachial and ankle blood pressure in the exercise groups were significantly lower after versus before the intervention. Peak oxygen uptake did not differ before versus after the intervention. [Conclusion] The present findings indicate that regular aerobic exercise may be important in reducing arterial stiffness regardless of the intensity or duration of aerobic exercise.

Roles of arterial pressure volume index and arterial velocity pulse index trajectories in risk prediction in hypertensive patients with heart failure with preserved ejection fraction

ABSTRACTBackground: Arterial pressure volume index (API) and arterial velocity pulse index (AVI) contribute to the development of vascular damage and cardiovascular disease. However, the relationship between common API/AVI trajectories and cardiovascular outcomes in hypertensive patients with heart failure with preserved ejection fraction (HFpEF) is unknown.Methods: A total of 488 consecutive hypertensive patients with HFpEF who repeatedly underwent API/AVI measurements were prospectively examined. We then applied API/AVI measurements into actual clinical practice. Latent mixture modeling was performed to identify API/AVI trajectories. Hazards ratios (HRs) were measured using Cox proportional hazard models.Results: We identified four distinct API/AVI trajectory patterns: low (7.6%), moderate (43.8%), high (28.9%), and very high (19.7%). Compared with the low group, higher API trajectories were associated with increased risk of total cardiovascular events (high group, adjusted HR: 2.91, 95% confidence interval [CI]: 1.97–4.26; very high group, adjusted HR: 2.46, 95%CI: 1.18–3.79). Consistently, higher AVI trajectories were also associated with a higher risk of total cardiovascular events (high group, adjusted HR: 2.58, 95%CI: 1.23–5.47; very high group, adjusted HR: 3.12, 95%CI: 1.83–6.08), compared with the low trajectory group.Conclusion: High API/AVI trajectories are strong predictors of cardiovascular risk in hypertensive patients with HFpEF. Among these patients, measuring API/AVI may improve risk stratification and provide additional information to tailor treatment strategies.

P4506New indices of arterial stiffness correlates with disease severity and mid-term prognosis in acute decompensated heart failure

Abstract Background Arterial stiffness has been implicated in pathophysiology of heart failure (HF) since it is involved in the ventricular-vascular coupling. Recently, new indices obtained by a cuff oscillometric technique, the arterial velocity-pulse index (AVI) for the stiffness of central arteries and the arterial pressure-volume index (API) for the stiffness of peripheral arteries have been developed and validated. However, the AVI and API measurement has not been attempted in HF population. Purpose This study aimed to investigate the relationship between the AVI, API and clinical outcomes in HF patients. Methods A prospective cohort of patients with acute decompensated HF were enrolled within 6 months, who were admitted to a tertiary referral hospital in China. Measurement of the AVI and API (AVE-1500, Shisei Datum, Tokyo, Japan) was performed on the day of admission and discharge. Patients were followed up to 6 months for the composite endpoint of all-cause death and HF rehospitalization. Results A Total of 127 patients were recruited for analysis (60±15 years, 70% male). 80% of the patients were in New York Heart Association (NYHA) Class III or above at admission, who presented a mean left ventricular ejection fraction (LVEF) of 34±9%. During hospitalization, all patients received guideline directed medical therapy if not contraindicated. The AVI (27.3±5.2 vs. 28.6±6.7, p=0.002) and API (24.9±4.9 vs. 26.0±6.5, p=0.05) were lower at discharge than at admission. By dividing the patients into tertiles according to the amino-terminal pro-brain natriuretic peptide (NT-proBNP), LVEF, transmitral E velocity over mitral annular e' velocity (E/e' ratio) and systolic blood pressure (SBP) at admission, it was observed that the AVI increased with a higher level of NT-proBNP (p for trend &lt;0.001), a larger E/e' (p&lt;0.001) and a lower LVEF (p=0.001), while the API increased as the SBP became higher (p=0.005).The improvement in AVI at discharge was correlated with that in LVEF (R=-0.3024, p&lt;0.05) and NT-proBNP (R=0.3118, p&lt;0.05), while the change in API was positively correlated with that in SBP (R=0.3897, p&lt;0.001). In 6 months after discharge, there were 52 predefined events including 15 deaths and 44 HF rehospitalization. Apart from the level of NT-proBNP, the AVI at discharge of ≥26 showed a trend of being associated with the composite outcome (2.747, 1.411–5.349, p&lt;0.001 for univariate analysis; 1.8648, 0.8928–3.8949, p=0.0973 for multivariate analysis). Conclusions New noninvasive arterial stiffness indices as the AVI and API reflected severity of illness and mid-term prognosis in admitted HF patients. Further studies are warranted for understanding its mechanisms and developing clinical applications.

Seasonal variation of novel arterial stiffness indexes in Japanese hypertensive patients

ABSTRACTBackground and Objective: Seasonal variation of blood pressure (BP) is well known, and a relationship between increases in BP and the incidence of cardiovascular accidents (CVAs) in the winter has been reported. Parameters of arterial stiffness may exhibit seasonal variation; however, available data are currently limited. Novel arterial stiffness indexes, namely the arterial velocity pulse index (AVI) and arterial pressure–volume index (API), can be determined through usual maneuver for BP measurement during the regular examination in the outpatient clinic.The present study assessed the seasonal variation of AVI and API in 59 hypertensive patients undergoing stable treatment and regularly visiting our outpatient clinic over a period of 30 months.Methods: BP, pulse rate (PR), AVI, and API were measured using the AVE-1500 (Pasesa) in the sitting position. Six time frames of assessment were established. All measurements (average: 17.9 measurements per person) were sorted using these six time frames, and their averages were used for analysis.Results: Significant seasonal variations in PR (P < 0.001) and AVI (P < 0.001), along with weak variation in systolic BP (SBP) (P = 0.047) and marginal variation in API (P = 0.055), were confirmed by repeated analysis of variance. SBP, API, and PR were decreased, whereas AVI was increased in the summer. Coefficient variations were SBP 5.1%, PR 4.9%, AVI 12.6%, and API 10.6%.Conclusion: AVI was associated with reflected wave like as augmentation index. Thus, a high AVI may suggest increased central wave reflection. Although the significance of seasonal variation of AVI remains unknown, AVI may influence seasonal variations in the incidence of CVA.

163. Efficacy of a novel non-invasive indicator of arteriosclerosis for the prediction of hypertensive disorder of pregnancy

Introduction Prediction of the onset of hypertensive disorder of pregnancy (HDP) has been burden for the obstetrician. Arterial velocity pulse Index (AVI) which reflects systemic hemodynamic status and arterial pressure volume Index (API) which reflects brachial artery stiffness are effective for accessing risks of adult cardiovascular disease because they are simply evaluated by an arm-cuff monitor and indicate a future risk for arteriosclerosis. However, the efficacy of AVI and API for pregnant woman remains unknown. The aim of the present study is to preliminarily examine distributions of AVI and API during pregnancy and assess the involvement of AVI and API in HDP. Methods AVI and API of pregnant women who visit to the outpatient unit of Kumamoto University Hospital between 2015 and 2017 were examined using PASESA®AVE-1500 (Shisei Datum, Tokyo, Japan). All pregnant outcomes were prospectively reviewed after the measurement of AVI and API and were thereafter classified into HDP group and non-HDP group with or without a diagnosis of HDP. Spearman tests and Student t tests were used for statistical analysis. Results Outcomes of a total of 144 pregnant women were identified. The mean age of the women was 32.9 ± 5.0 years old (20–42 years old). AVI and API were assessed at 32 ± 8 weeks of gestation (ranges; 10–42 weeks). There was negative correlation between API and weeks of gestation, whereas AVI was not corelated with the gestational weeks. Twelve women (8.3%) developed HDP. The mean AVI in HDP group was not different with that in non–HDP group (15.2 ± 3.2 vs 14.4 ± 2.8, P = 0.49). The mean API in HDP group was significantly higher than that in non-HDP group (29.0 ± 8.0 vs 23.5 ± 5.7, P Conclusion This is a first report to examine the range of AVI and API in pregnant women. Evaluation of API during pregnancy may worth to predict of the onset of HDP.