Brachial Pulse Wave Research Articles

Association of endothelial function and lower extremity perfusion in peripheral artery disease.

Background: The current study aims to investigate the association between endothelial function and lower extremity perfusion in patients with peripheral artery disease (PAD). Patients and methods: In total 229 patients with PAD (Rutherford stage 0-3) were enrolled in the current study. Endothelial function was assessed by measuring flow-mediated dilation (FMD) and endothelial cell proliferation capacity (ECPC). Lower extremity perfusion was assessed by measuring oscillometry-based ankle brachial index (oABI) and pulse wave index (PWI). In addition, carotid intima-media-thickness (cIMT) was also measured as a surrogate marker for atherosclerosis. Correlations between FMD, ECPC, oABI, PWI, and cIMT were analysed using Pearson correlation coefficient. The relationship between the above variables and the severity of PAD was investigated using ordinal logistic regression analysis. Results: Correlation analysis showed that FMD negatively associated with PWI (r = -0.183, p = 0.005), ECPC positively associated with oABI (r = 0.162, p = 0.014), and oABI negatively associated with PWI (r = -0.264, p < 0.001). Ordinal logistic regression analysis showed that ECPC (β = -0.009, p = 0.048), oABI (β = -5.290, p < 0.001), and age (β = -0.058, p = 0.002) negatively associated with the PAD Rutherford stages. In addition, PWI (β = 0.006, p < 0.001), cIMT (β = 18.363, p = 0.043) positively associated with the PAD Rutherford stages. Conclusions: Endothelial function significantly associates with lower extremity perfusion in patients with PAD, and both are related to the severity of PAD.

Short-term vascular responses to spring and fall daylight savings time shifts.

Daylight saving time (DST) is a Western biannual time transition, setting the clock back 1 h in the fall and forward 1 h in the spring. There is an epidemiological link between DST and acute myocardial infarction risk in the first week following the spring shift; however, the mechanisms underlying the effect of DST on cardiovascular function remain unclear. The purpose of this study was to explore the short-term cardiovascular changes induced by fall and spring shifts in DST in a convenience sample of healthy adults. We hypothesized that spring, but not fall, DST shifts would acutely increase central pulse wave velocity, the gold standard measurement of central arterial stiffness. Twenty-one individuals (fall: n = 10; spring: n = 11) participated in four visits, occurring 1 wk before and at +1, +3, and +5 days after spring and fall time transitions. Central, brachial, and radial pulse wave velocity as well as carotid augmentation index were assessed with applanation tonometry. Sleep quality and memory function were assessed via questionnaire and the Mnemonic Similarities Task, respectively. Neither fall or spring transition resulted in changes to cardiovascular variables (carotid-femoral pulse wave velocity, carotid-brachial pulse wave velocity, carotid-radial pulse wave velocity, heart rate, mean arterial pressure, or augmentation index), sleep quality, or cognitive function (all P > 0.05). Our findings do not provide evidence that DST shifts influence cardiovascular outcomes in healthy adults. This study emphasizes the need for further research to determine the mechanisms of increased cardiovascular disease risk with DST that help explain epidemiological trends.NEW & NOTEWORTHY The debate of whether to abolish daylight savings time (DST) is, in part, motivated by the population-level increase in all-cause mortality and incidence of cardiovascular events following DST; however, there is an absence of data to support a physiological basis for risk. We found no changes in pulse wave velocity or augmentation index during the subacute window of DST. Large multisite trials are necessary to address the small, but meaningful, effects brought on by a societal event.

Effect of age and gender on ventricular-arterial coupling estimated using a non-invasive technique

BackgroundLeft ventricular-arterial coupling is assessed as the ratio of left ventricular end-systolic elastance (Ees) to arterial elastance (Ea). Previous studies have introduced non-invasive estimations of Ees/Ea. It requires only four variables, namely pre-ejection period, ejection time, end-systolic pressure and diastolic pressure. The aims of the present study were to clarify the reference values of Ees/Ea estimated using the noninvasive technique, and to investigate the effects of age and gender on Ees/Ea in healthy subjects.MethodsThis retrospective study utilized data from healthy, 30-79-year-old subjects. We recorded electrocardiogram, phonocardiogram, and brachial arterial pulse waves simultaneously using the vascular screening system, and used the observed variables to calculate Ees/Ea. We separated subjects into five groups according to their age and compared Ees/Ea among the different age groups.ResultsThe study included 2114 males and 2292 females. Ees/Ea ranged from 1.87 to 2.04 in males, and 1.98 to 2.32 in females. We observed no age-related differences in Ees/Ea in males (p = 0.10), and significant differences in females (p < 0.001). Ees/Ea in males was not different compared to those in females in 60-69-year-old group (p = 0.92). Whereas Ees/Ea was higher in females compared to those in males in the other age groups. The differences between medians of Ees/Ea in males and those in females were 0.45 (p < 0.001), 0.24 (p < 0.001), 0.13 (p = 0.01), and 0.13 (p = 0.03) in 30–39, 40–49, 50–59, and 70-79-year-old age groups, respectively.ConclusionsWe clarified the reference values of Ees/Ea in healthy subjects. The effect of age on Ees/Ea is different in males and females, although Ees/Ea is maintained within a relatively narrow range in all subjects.

Impaired Cardiovagal Activity as a Link Between Hyperglycemia and Arterial Stiffness in Adults With Type 2 Diabetes Mellitus Among an Eastern Indian Population: A Cross-sectional Study

ObjectivesCardiac autonomic neuropathy (CAN) is one of the most common yet overlooked complications of type 2 diabetes mellitus (T2DM). Individuals with T2DM with CAN have a 5-fold higher rate of cardiovascular morbidity and mortality. The presence of CAN in T2DM could potentially lead to arterial stiffness. However, only sparse data are available suggesting any association between autonomic dysfunction and arterial stiffness in T2DM. MethodsWe recruited 80 people with T2DM and 74 healthy controls for our study. Heart rate variability (HRV) testing was performed to assess autonomic function. Assessment of arterial stiffness was done by measuring the brachial pulse wave velocity (baPWV) and augmentation index (AI). ResultsThe time-domain parameters were significantly decreased (p<0.001) and frequency-domain parameters, such as total power and high-frequency band expressed as a normalized unit, were found to be significantly reduced in people with T2DM (p<0.001). Both baPWV and AI were significantly higher in people with T2DM compared with healthy controls (p<0.001). We observed a moderate correlation between standard deviation of normal to normal interval (SDNN) and baPWV (r=−0.437, p=0.002) and AI (r=−0.403, p=0.002). A multiple linear regression model showed an association between SDNN and arterial stiffness parameters, such as baPWV and AI, which were statistically significant (p<0.05) in a fully adjusted model that included the conventional risk factors for atherosclerosis. ConclusionsImpaired cardiovagal activity is an independent risk factor for the development of arterial stiffness. Incorporation of HRV testing into the diabetes management protocol would have potential benefits for identifying individuals at high risk of developing cardiovascular events. Hence, preventive measures can be taken as early as possible to improve patient outcomes.

Association between obstructive sleep apnea and vascular injury in hypertensive patients

Objective: To investigate the relationship between obstructive sleep apnea (OSA), apnea hypopnea index (AHI) and vascular injury in hypertensive patients. Methods: This cross-sectional study enrolled patients admitted to the Hypertension Department of TEDA International Cardiovascular Hospital from April 2020 to April 2023, who finished portable sleep monitoring. Sleep monitoring indicators, flow-mediated vasodilation (FMD), carotid artery ultrasound, carotid intima-media thickness, cervical and femoral pulse wave conduction velocity (cfPWV), brachial and ankle pulse wave conduction velocity (baPWV) were analyzed. OSA was classified into mild (5 times/h≤AHI<15 times/h), moderate (15≤AHI<30 times/h), and severe (AHI≥30 times/h) based on AHI levels. FMD<6.0% was defined as vascular endothelial injury, and cfPWV>10 m/s and/or baPWV>18 m/s was defined as arterial stiffness. Multivariate logistic regression analysis was used to explore the correlation between AHI, OSA severity and vascular injury, and subgroup analysis was performed in young (age≤45 years) and middle-to-old patients (age>45 years). Sensitivity analysis was performed by excluding patients with diabetes, cerebrovascular disease and coronary heart disease. The correlation between AHI and vascular injury index was analyzed by restricted cubic spline. Results: A total of 555 adult hypertensive patients were included, the mean age was (39.7±9.2) years, 422 were males (76.0%), and the prevalence of OSA was 66.7% (370/555). Multivariate logistic regression analysis showed that moderate OSA (OR=2.83, P=0.019) and severe OSA (OR=3.40, P=0.016) were positively correlated with vascular endothelial injury after adjusting for age, sex, body mass index and mean arterial pressure. Subgroup analysis showed that log AHI (OR=1.99, P=0.035), moderate OSA (OR=4.83, P=0.010) and severe OSA (OR=4.64, P=0.015) were associated with vascular endothelial injury in young hypertensive patients. The results of sensitivity analysis were similar to the above results. The results of restricted cubic spline analysis showed that AHI was correlated with FMD (P=0.022), and the slope of the curve was the largest when AHI was between 0 and 10 times/h. There was no correlation between log AHI and OSA severity and carotid intima-media thickening and arterial stiffness (all P<0.05). Conclusions: OSA is associated with vascular endothelial injury in hypertensive patients, especially in young patients.

Diagnostic and Predictive Value of Brachial–Ankle Pulse Wave Velocity and Pulse Pressure Index for Coronary Heart Disease in Elderly Patients With Hypertension

Abstract OBJECTIVE To explore the diagnostic and predictive value of pulse pressure index (PPI) and brachial–ankle pulse wave velocity (baPWV) for coronary heart disease (CHD) in elderly patients with hypertension. METHODS A total of 307 elderly patients who had chest pain or chest distress and coronary angiography were enrolled. According to the Gensini score, patients with CHD (n = 260) were divided into low-risk group (&amp;lt;20 points, n = 96), moderate-risk group (20–40 points, n = 80), and high-risk group (&amp;gt;40 points, n = 84). baPWV was measured using an ankle–brachial index and pulse wave measuring device. Multivariate logistic regression analysis was used to analyze the risk factors of CHD. Receiver operating characteristic (ROC) curve was used to evaluate the diagnostic value of baPWV and PPI for CHD. RESULTS PPI and baPWV of elderly hypertensive patients with CHD at low, moderate, and high risk were higher than those without CHD [PPI: 0.43 ± 0.04, 0.45 ± 0.04, 0.45 ± 0.05 vs. 0.41 ± 0.05, F = 31.768, P &amp;lt; 0.001; baWV: 1,671 (1,587–1,755), 1,717 (1,597–1,843), 1,780 (1,661–1,960) vs. 1,570 (1,477–1,699) cm/s, X2 = 60.918, P &amp;lt; 0.001]. With the increase in CHD severity, the PPI and baPWV were significantly increased (P &amp;lt; 0.05). Spearman/Pearson correlation analysis showed that the Gensini score was positively correlated with baPWV and PPI, respectively (both P &amp;lt; 0.001). Multivariate logistic regression analysis showed that baPWV, PPI, and systolic blood pressure were the influencing factors of CHD in hypertensive patients. The areas under the ROC curve (95% CI) of baPWV, PPI, and their combination for diagnosing CHD were 0.792 (0.723–0.861), 0.708 (0.625–0.792), and 0.837 (0.779–0.895), respectively, and was significantly different between baPWV or PPI alone and the combination of the 2 (Z = −2.178, P = 0.029; Z = −3.330, P = 0.001). CONCLUSIONS Elevations of baPWV and PPI are positively correlated with the severity of CHD. Both baPWV and PPI have a diagnostic and predictive value for CHD in elderly hypertensive patients, and the combination of baPWV and PPI is more accurate.

Asymptomatic left ventricular systolic dysfunction in hypertensive patients with disturbed ventriculo arterial coupling

Abstract Funding Acknowledgements Type of funding sources: None. Background Left ventricular (LV) ejection fraction (LVEF) is most commonly used validated echocardiographic parameter of systolic function estimation, but left ventricular (LV) global longitudinal strain (GLS) is an early indicator of subclinical cardiac dysfunction, even when LVEF is normal. Purpose To investigate ventriculo – arterial coupling (VAC) and LV function in asymptomatic hypertensive patients without target organ damage to compare different echocardiographic parameters for systolic function. Methods A total 110 patients (56 ± 14 years) with hypertension, were separated in two groups: 32(men, ( 59 %)) patients with normal AE/Ees ratio (Arterial elastance (AE) and ventricular elastance (Ees)) and 78 (men, ( 64%)) hypertensive patients with decrease AE/Ees ratio, marker for ventriculo – arterial coupling. All patients underwent standard two – dimentional echocardiography with Speckle tracking analysis for LV - GLS. End – systolic pressure was determined from the brachial pulse wave. Arterial elastance (AE) and ventricular elastance (Ees) were calculated as and – systolic pressure/stroke volume and end – systolic pressure/end – systolic volume. Results Patients with disturbed VAC had concentric hypertrophy whereas patients with normal VAC had concentric remodeling. There were no significant differences in EF, but GLS in all patients was reduced. There were no statistically significant differences in LV diastolic function parameters. Statistically significant differences in echocardiographic parameters were found in patients with normal VAC in comparison with disturbed VAC (TABL. 1), There are negative correlation between LV - GLS and AE/Ees (r = -0.327, p = 0.001) and positive with Ees (r=0.250, p = 0.015). Conclusion LV - GLS is a more sensitive parameter of LV systolic function than LVEF, when LV concentric hypertrophy is present in hypertensive patients. Further investigation are needed to confirm the superiority of GLS over LVEF in LV systolic function estimation and its implementation in clinical practice.

KOROTKOFF SOUNDS DO NOT PROVIDE AN ACCURATE ESTIMATE OF SYSTOLIC AND DIASTOLIC PRESSURE IN SPHYGMOMANOMETRY AND CANNOT BE USED AS A CALIBRATION STANDARD FOR NIBP DEVICES

Objective: Noninvasive blood pressure (NIBP) devices are calibrated against validated auscultation sphygmomanometers using Korotkoff sounds. This study aimed to investigate the timing of Korotkoff sounds in relation to pulse appearance in the brachial artery and values of intra-arterial blood pressure. Design and method: Experiments were carried out on 15 participants, (14 males, 64.3 ±10.4 years; one female, 86 yo), undergoing coronary angiography. A conventional (oscillometric) BP cuff, with a microphone for Korotkoff sounds, was placed on the upper arm. Intra-arterial brachial artery pressure (IABP) was measured below the cuff with a fluid-filled catheter inserted via the radial artery and an external transducer. Finger photoplethysmography was used to measure brachial pulse wave velocity (PWV). Korotkoff sounds were processed electronically and custom algorithms identified the cuff pressure (CP) at which the first and last Korotkoff sounds were heard. PWV and max slope of the IABP pressure pulse were recorded to estimate arterial stiffness. Results: The brachial artery closed at a CP of 132.0±17.1 mmHg. Systolic (SBP), and diastolic (DBP) pressure were 147.6±14.3 and 72.7±10.1mmHg; mean pressure (MP, 100.1±10.4 mmHg) was similar to MP derived from the peak of the oscillogram (98.5±13.6 mmHg). Difference between IABP and CP recorded at first and last occurrence of Korotkoff sounds were, SBP: 18.9±8.3 (range 2-29) mmHg, DBP: 4.0±4.3 (range -1.6 -12.4) mmHg. Multiple linear regression showed that differences increase with arterial stiffness and can be compensated for using a prediction equation for calculation of true SBP (tSBP) using heart rate (HR) and Korotkoff derived systolic (SBPk) and diastolic (DBPk), at least over the limited age range for this study cohort. Conclusions: SBP and DBP derived from the onset and termination of Korotkoff sounds can underestimate IABP by up to 29 mmHg. Since Korotkoff sounds are the recommended method mandated by the universal standard for the validation of blood pressure measuring devices, these errors are propagated through to all NIBP measurement devices irrespective of whether they use auscultatory or oscillometric methods thus explaining the well known differences recorded between NIBP measurements and intra-arterial BP measurements.

High Fidelity Pressure Wires Provide Accurate Validation of Non-Invasive Central Blood Pressure and Pulse Wave Velocity Measurements.

Central blood pressure (cBP) is known to be a better predictor of the damage caused by hypertension in comparison with peripheral blood pressure. During cardiac catheterization, we measured cBP in the ascending aorta with a fluid-filled guiding catheter (FF) in 75 patients and with a high-fidelity micromanometer tipped wire (FFR) in 20 patients. The wire was withdrawn into the brachial artery and aorto-brachial pulse wave velocity (abPWV) was calculated from the length of the pullback and the time delay between the ascending aorta and the brachial artery pulse waves by gating to the R-wave of the ECG for both measurements. In 23 patients, a cuff was inflated around the calf and an aorta-tibial pulse wave velocity (atPWV) was calculated from the distance between the cuff around the leg and the axillary notch and the time delay between the ascending aorta and the tibial pulse waves. Brachial BP was measured non-invasively and cBP was estimated using a new suprasystolic oscillometric technology. The mean differences between invasively measured cBP by FFR and non-invasive estimation were -0.4 ± 5.7 mmHg and by FF 5.4 ± 9.4 mmHg in 52 patients. Diastolic and mean cBP were both overestimated by oscillometry, with mean differences of -8.9 ± 5.5 mmHg and -6.4 ± 5.1 mmHg compared with the FFR and -10.6 ± 6.3 mmHg and -5.9 ± 6.2 mmHg with the FF. Non-invasive systolic cBP compared accurately with the high-fidelity FFR measurements, demonstrating a low bias (≤5 mmHg) and high precision (SD ≤ 8 mmHg). These criteria were not met when using the FF measurements. Invasively derived average Ao-brachial abPWV was 7.0 ± 1.4 m/s and that of Ao-tibial atPWV was 9.1 ± 1.8 m/s. Non-invasively estimated PWV based on the reflected wave transit time did not correlate with abPWV or with atPWV. In conclusion, we demonstrate the advantages of a novel method of validation for non-invasive cBP monitoring devices using acknowledged gold standard FFR wire transducers and the possibility to easily measure PWV during coronary angiography with the impact of cardiovascular risk factors.

The Association between Ankle–Brachial Index/Pulse Wave Velocity and Cerebral Large and Small Vessel Diseases in Stroke Patients

(1) Background: The study investigated whether the ankle-brachial index (ABI) and pulse wave velocity (baPWV) could reflect the severity of small vessel disease (SVD) and large artery atherosclerosis (LAA). (2) Methods: A total of 956 consecutive patients diagnosed with ischemic stroke were prospectively enrolled from July 2016 to December 2017. SVD severity and LAA stenosis grades were evaluated via magnetic resonance imaging and carotid duplex ultrasonography. Correlation coefficients were calculated between the ABI/baPWV and measurement values. Multinomial logistic regression analysis was performed to determine predictive potential. (3) Results: Among the 820 patients included in the final analysis, the stenosis grade of extracranial and intracranial vessels was inversely correlated with the ABI (p < 0.001, respectively) and positively correlated with the baPWV (p < 0.001 and p = 0.004, respectively). Abnormal ABI, not baPWV, independently predicted the presence of moderate (adjusted odds ratio, aOR: 2.18, 95% CI: 1.31-3.63) to severe (aOR: 5.59, 95% CI: 2.21-14.13) extracranial vessel stenosis and intracranial vessel stenosis (aOR: 1.89, 95% CI: 1.15-3.11). Neither the ABI nor baPWV was independently associated with SVD severity. (4) Conclusions: ABI is better than baPWV in screening for and identifying the existence of cerebral large vessel disease, but neither test is a good predictor of cerebral SVD severity.

Cardiovascular profiles associated with white matter hyperintensities in healthy young women.

Women who experience hypertension in pregnancy have increased risk of both chronic hypertension and dementia. High blood pressure is associated with increased evidence of white matter hyperintensities (WMH) in brain imaging. WMH are disruptions of the white matter of the brain that occur with demyelination and axonal degeneration, are associated with vascular disease, occur more frequently in people with hypertension, and are associated with cognitive impairment. We evaluated the relationship between WMH and subclinical cardiovascular function in healthy young nulliparous women and women with a history of early-onset preeclampsia. Sixty-two reproductive-aged women were assessed during the follicular phase of the menstrual cycle after a 3-day sodium/potassium-controlled diet. Half of participants had a history of early-onset preeclampsia, and half were nulliparous. Blood was drawn to assess inflammatory markers. Cardiovascular assessments included tonometric blood pressure monitoring, volume loading to assess vascular compliance, echocardiography to assess cardiac ejection time, brachial pulse wave velocity of the brachial artery, assessing cardiovascular stiffness, and brachial artery flow mediated vasodilation to assess endothelial mediated dilatory response. T2 fluid-attenuated inversion recovery (FLAIR) MRI imaging was obtained. Two raters, blinded to cardiovascular assessments and pregnancy history, reviewed MRI scans for evidence of WMH using the Fazekas rating scale. WMHs were detected in 17 women; 45 had normal white matter structure. Participants with Fazekas score>0 had exaggerated response to volume loading compared to women with a Fazekas score of 0 and longer cardiac ejection times. Fazekas scores >0 had lower brachial flow-mediated vasodilation and increased white blood count compared to those with no evidence of WMH. Women with WMH had reduced cardiovascular compliance, and a trend towards decreased endothelial responsiveness compared to those without WMH. These data demonstrated that the relationship between cardiovascular and brain health was detectable in young, healthy, reproductive-aged women, and may play a role in later development of clinical disease. These findings may help identify women who are at risk for cognitive decline and pathological aging.

Effect of low-sodium salt applied to Chinese modified DASH diet on arterial stiffness in older patients with hypertension and type 2 diabetes.

the Dietary Approaches to Stop Hypertension (DASH) diet has multifunctional health benefits. We evaluated the effects of low-sodium salt applied to Chinese modified DASH diet on arterial stiffness in older patients with hypertension and type 2 diabetes. sixty-one older adults with hypertension and type 2 diabetes were randomly allocated to low sodium salt group (n = 31) or normal sodium salt group (n = 30). They were given the Chinese modified DASH diet plus low-sodium salt (52 % sodium chloride) or same diet plus regular salt (99 % sodium chloride) for eight weeks, respectively. Brachial and ankle pulse wave conduction velocity, ankle brachial index and atherosclerosis-related indices were measured at baseline and week 8. In addition, 24-hour urine and blood samples were measured at baseline, the 4th week and the end of the intervention. as compared with the baseline, the low sodium salt group significantly decreased in ankle brachial index (-0.09 ± 0.11, p < 0.001) and brachial and ankle pulse wave conduction velocity (-133.07 ± 265.99 cm/s, p = 0.010) at week 8 while the normal sodium salt group only decreased significantly in ankle brachial index (-0.06 ± 0.12, p = 0.010) at week 8. the low-sodium salt applied to Chinese modified DASH diet may improve arterial stiffness in patients with hypertension and type 2 diabetes. Further research with an extended follow-up is needed.

PS-C26-4: ASSOCIATIONS BETWEEN ARTERIAL STIFFNESS INDICES AND CHRONIC KIDNEY DISEASE CATEGORIES IN ESSENTIAL HYPERTENSIVE PATIENTS

Background: This study investigated the association between arterial stiffness indices and asymptomatic chronic kidney disease (CKD) risk categories in hypertensive patients by using oscillometric device. Methods: Arterial stiffness indices, including 24-hour brachial and aortic systolic blood pressure (SBP) and pulse wave velocity (PWV), were measured by an oscillometric Mobil-O-Graph device, brachial-ankle PWV (baPWV) by a volume-plethysmographic method, and renal resistive index (RI) by ultrasonography, in 184 essential hypertensive patients (66.0 ± 17.1 years, 47.3% male). CKD was categorized into 3 stages based on the Kidney Disease Improving Global Outcomes (KDIGO) criteria, using a combination of estimated glomerular filtration and albuminuria. Results: The 24-hour aortic PWV (aPWV), baPWV, and RI increased with worsening severity of CKD risk category (all P &lt; 0.01 for trend). Multivariate logistic regression analysis found that a 1 SD increase of nighttime aortic SBP (odds ratio [OR] 1.52), PWV (OR 4.80), or RI (OR 1.75) was an independent predictor of high or very-high CKD stage (all P &lt; 0.05). After adjustment for potential confounders, day-to-night change in brachial SBP as well as in aPWV differed among groups (P &lt; 0.05, respectively). In a multivariate regression model, day-to-night changes in aortic SBP and PWV, and RI were independently associated with day-to-night brachial SBP change. Conclusions: In hypertension, circadian hemodynamics in high CKD stage are characterized by higher nighttime values of aortic SBP and PWV and disturbed intrarenal hemodynamics. Further, the blunted nocturnal BP reduction in these patients might be mediated via disturbed intrarenal hemodynamics and circadian hemodynamic variation in aortic SBP and arterial stiffness.

PS-C03-12: FINGER-TO-TOE PULSE WAVE VELOCITY IN RESPONSE TO SITTING POSITION

Objective: Aortic stiffness is a non-traditional risk factor for cardiovascular disease and mortality and is associated with increased central pulse pressure. It is generally measured by carotid-femoral pulse wave velocity (PWV) in a supine position. We hypothesized that, in a sitting position, the additional hydrostatic pressure exerted on the vascular wall could represent a vascular stress test. Two alternative methods can now estimate aortic stiffness and can be used conveniently in different positions: 1) brachial pulse wave analysis approach used by Mobil-O-Graph and 2) transit time approach using finger-to-toe PWV by photoplethysmography with the pOpmetre. The aim of the present study is to determine the impact of postural changes on PWV and central blood pressure estimation using these two distinct methods. Design and method: Central blood pressure and PWV were assessed in 20 healthy subjects using Mobil-O-Graph (PWV-M) and pOpmetre (PWV-pop) in three positions: supine in bed, supine in reclining chair and sitting. Central systolic blood pressure (SBP) was determined by calibration of brachial systolic and diastolic blood pressures by both methods (SBP-M and SBP-pop). Generalized estimating equations were used for analysis. Results: The PWV-M remained relatively constant and generally independent of the position (5.5 ± 1.0, 5.3 ± 1.0 and 5.5 ± 1.0 m/s). While PWV-M and PWV-pop were similar in the supine position (5.5 ± 1.0 vs 5.4 ± 1.3 m/s, P = NS), PWV-pop increased very significantly to 5.9 ± 1.5 m/s in supine in reclining chair position (P = 0.04), and to 9.2 ± 1.7 m/s in sitting position (P &lt; 0.001). Central blood pressure estimation remained similar for SBP-M (110.2 ± 10.3 vs 106.9 ± 10.5 vs 108.8 ± 11.1 mmHg, P = NS) and for SBP-pop (107.7 ± 10.4 vs 110.3 ± 9.6 vs 109.5 ± 9.9 mmHg, P = NS). Conclusions: These results suggest that estimated PWV by brachial pulse wave analysis remains robust independent of position. However, the estimated finger-to-toe PWV by pulse transit time increases remarkably with the imposition of hydrostatic pressure on the vascular wall. We conclude that the finger-to-toe PWV may provide the opportunity to evaluated vascular wall property in a dynamic fashion using postural changes as a stress test.

Relationship Between Subclinical Cardiovascular Diseases and Cardiac Morpho-Functional Parameters in Preclinical Stage A/B Heart Failure Adults with Type 2 Diabetes.

Type 2 diabetes mellitus (T2DM) is a common risk factor for cardiovascular disease which increases the risk of heart failure. This study aimed to determine whether clinical characteristics and subclinical cardiovascular disease (CVD) features are correlated with echocardiographic morpho-functional parameters of T2DM patients. Two hundred and fifty-five T2DM patients without a history of coronary heart disease were enrolled in this cross-sectional study. The demographic characteristics, glucose and lipid levels were assessed for each patient. Carotid ultrasonography and peripheral artery examination were performed to measure carotid intima-media thickness (cIMT), carotid plaque, ankle-brachial index (ABI), brachial artery pulse wave velocity (baPWV), and carotid-femoral pulse wave velocity (cfPWV). Furthermore, echocardiography was conducted to evaluate cardiac morphology and systolic and diastolic function. The relationship between clinical characteristics, subclinical cardiovascular diseases, and cardiac morpho-functional parameters was explored with the Pearson and stepwise multivariable linear regression analyses. A total of 255 subjects aged 18-80 years were enrolled in the study. Multiple regression analysis revealed that left ventricular mass index (LVMI) was correlated with age (β=0.463, p = 0.000) and systolic blood pressure (SBP) (β=0.179, p = 0.003). Relative wall thickness (RWT) was related to cfPWV (β=0.006, p = 0.007) and homeostasis model assessment of insulin resistance (HOMA-IR) (β=0.000, p = 0.036). In contrast, left ventricular ejection fraction (LVEF) was inversely related to cIMT (β=-0.925, p = 0.019). The ratio of the peak flow velocity of early diastole to atrial contraction (peak E/A) was correlated with age (β=-0.014, p = 0.000), diastolic blood pressure (DBP) (β=-0.006, p = 0.001) and cfPWV (β=-0.025, p = 0.044). In preclinical stage A/B heart failure adults with T2DM, age, BP, HOMA-IR, cfPWV and cIMT are correlated with cardiac morpho-functional parameters.

Feasibility of Brachial Occlusion Technique for Beat-to-Beat Pulse Wave Analysis.

Czech physiologist Penaz tried to overcome limitations of invasive pulse-contour methods (PCM) in clinical applications by a non-invasive method (finger mounted BP cuff) for continuous arterial waveform detection and beat-to-beat analysis. This discovery resulted in significant interest in human physiology and non-invasive examination of hemodynamic parameters, however has limitations because of the distal BP recording using a volume-clamp method. Thus, we propose a validation of beat-to-beat signal analysis acquired by novel a brachial occlusion-cuff (suprasystolic) principle and signal obtained from Finapres during a forced expiratory effort against an obstructed airway (Valsalva maneuver). Twelve healthy adult subjects [2 females, age = (27.2 ± 5.1) years] were in the upright siting position, breathe through the mouthpiece (simultaneously acquisition by brachial blood pressure monitor and Finapres) and at a defined time were asked to generate positive mouth pressure for 20 s (Valsalva). For the purpose of signal analysis, we proposed parameter a “Occlusion Cuff Index” (OCCI). The assumption about similarities between measured signals (suprasystolic brachial pulse waves amplitudes and Finapres’s MAP) were proved by averaged Pearson’s correlation coefficient ( = 0.60, p < 0.001). The averaged Pearson’s correlation coefficient for the comparative analysis of OCCI between methods was = 0.88, p < 0.001. The average percent change of OCCI during maneuver: 8% increase, 19% decrease and percent change of max/min ratio is 35%. The investigation of brachial pulse waves measured by novel brachial blood pressure monitor shows positive correlation with Finapres and the parameter OCCI shows promise as an index, which could describe changes during beat-to-beat cardiac cycles.

Neck-to-height ratio, arterial stiffness and cardiometabolic risk factors in hyperlipidemic patients: A preliminary report

Background and Aims : Hyperlipidemia is an important cardiometabolic risk factor. Brachial pulse wave velocity (bPWV) predicts arterial stiffness (AS) and can detect subclinical atherosclerosis with accuracy, however, it's a high-cost tool. Neck-to-height ratio (NHR), inexpensive and easily obtainable anthropometric measurements, may be associated with AS. Aims: To evaluate the relationship between NHR, bPWV, and cardiometabolic parameters in treated hyperlipidemic patients.

ASSOCIATION BETWEEN ARTERIAL STIFFNESS AND LEFT VENTRICULAR FUNCTION IN HYPERTENSIVE PATIENTS

Objective: Increased arterial stiffness is an early predictor of cardiovascular changes. However the association between arterial stiffness with LV myocardial changes is poorly understood The aim of this study was to examine the relationship between arterial stiffness and LV function in well - controlled hypertensive patients. Methods: A total 100 consecutive patients with hypertension adapted by age, gender and BMI, were separated in two groups: 27 patients with normal ventriculo - arterial coupling (VAC) and 63 hypertensive patients with disturbed VAC, measured by arterial elastance/ventricular elastance ratio(AE/Ees). All patients underwent standard two - dimentional (2D) echocardiography with Speckle tracking analysis for left ventricle (LV) global longitudinal strain (GLS). End - systolic pressure was determined from the brachial pulse wave. Arterial elastance (AE) and ventricular elastance (Ees) were calculated as and - systolic pressure/stroke volume and end - systolic pressure/end - systolic volume. Parameters for arterial stiffness - 24 - hour central systolic pressure (cSys24 h), central pulse pressure (cPP24 h), augmentation index 24 h (Aix24 h) and 24 - hour pulse wave velocity (PWV24 h) were measured non - invasively with oscillometric method by Mobil-O-graph PWA. Results: Statistically significant differences in parameters of vascular stiffness were found in patients with normal AE/Ees ratio in comparison disturbed AE/Ees: cSys24 h (108.76 ± 7.65 vs. 115.12 ± 11.58 mm Hg, p = 0.03), cPP24 h (39.61 ± 12.25 vs. 47.12 ± 11.52 mm Hg, p = 0.03). There is a statistically significant difference in echocardiography parameters between patients with normal VAC in comparison to other group: LV - GLS (-17.98 ± 0.65 vs. -15.9 ± 1.8 %, p = 0.0001), AE (2.09 ± 0.63 vs. 1.75 ± 0.34, p = 0.003), Ees (2.89 ± 0.71vs. 4.29 ± 0.72, p = 0.0001), AE/Ees ratio (0.74 ± 0.27 vs. 0.47 ± 0.46, p = 0.003). There were no statistically significant differences in LV ejection fraction, PWV24 h, Aix24 h and heart rate between two groups. There are moderately positive correlation between cSys24 h and LVMI (r = 0.325, p = 0.001) and negative with AE/Ees (r = -0.326, p = 0.01). cPP24 h correlate positively with AE (r = 0.249, p = 0.015) and negative with E/Em (r = -0.220, p = 0.032). Conclusion: Elevated arterial stiffness was intimately determines early LV alterations, before LV dysfunction, becomes clinically evident

IMPACT OF POSTURAL POSITION ON DETERMINATION OF AORTIC STIFFNESS AND CENTRAL BLOOD PRESSURE

Objective: Aortic stiffness is associated with increased central pulse pressure and cardiovascular disease and mortality. It is generally performed by determination of carotid-femoral pulse wave velocity (PWV) in a supine position. Two alternative approaches have been developed to estimate aortic stiffness, namely brachial pulse waveform analysis (Mobil-O-Graph) and finger-to-toe PWV by photoplethysmography (pOpmeter). These devices make it possible to assess and estimate aortic stiffness conveniently in different positions. However, it remains unclear if the values obtained are independent of the position at the time of measurement. Therefore, the aim of the present study is to determine the extent of postural changes on pulse wave velocity and central blood pressure estimation using pOpmetre and Mobil-O-Graph devices in a group of healthy controls. Design and method: Central blood pressure and PWV were assessed in 20 healthy subjects using both Mobil-O-Graph (PWV-M) and pOpmetre (PWV-pop) in three positions: supine position in bed, supine position in medical sampling chair and a sitting position. Central systolic blood pressure (SBP) was determined by calibration of brachial systolic and diastolic blood pressures (C1 calibration) by both methods (SBP-M and SBP-pop). Results: In the supine position in bed, PWV-M and PWV-pop were similar (5.5 ± 1.0 vs 5.4 ± 1.3 m/s, P = NS). In the supine position in a sampling chair, PWV-M decreased slightly (5.3 ± 1.0 m/s, P = 0.04 vs supine in bed), while PWV-pop increased significantly (5.9 ± 1.5 m/s, P = 0.04 vs supine in bed). However, in the sitting position, while PWV-M was not statistically different from the supine position (5.5 ± 1.0 m/s, P = NS), PWV-pop increased very significantly (9.2 ± 1.7 m/s, P &lt; 0.001). Central blood pressure estimation remained similar for SBP-M (110.2 ± 10.3 vs 106.9 ± 10.5 vs 108.8 ± 11.1 mmHg, P = NS) and for SBP-pop (107.7 ± 10.4 vs 110.3 ± 9.6 vs 109.5 ± 9.9 mmHg, P = NS). Conclusions: These preliminary results tell us that postural position has little impact on the determination of aortic stiffness by the approach using brachial pulse wave analysis. However, finger-to-toe PWV increases remarkably with changes in position, possibly offering to explore the relationship between hydrostatic pressure and arterial stiffness as a dynamic test.

Association of 24-hour ambulatory central aortic pressure and left atrium-ventriculo-arterial interactions

Abstract Funding Acknowledgements Type of funding sources: None. INTRODUCTION Arterial stiffness is an independent risk factor in arterial hypertension, but little is known about the association between left –heart side remodeling and arterial stiffness in middle – aged hypertensive patients. AIM The aim of our study was to assess the independence between the parameters of arterial stiffness and their relation with left atrium – ventriculo – arterial coupling in hypertensive patients, without any target-organ damage (TOD). METHODS A total 110 patients (56 ± 14 years) with hypertension, were separated in two groups: 32 patients with normal EA/Ees ratio (Arterial elastance (AE) and ventricular elastance (Ees)) and 78 hypertensive patients with decrease EA/Ees ratio, marker for ventriculo – arterial coupling. All patients underwent standard two - dimentional echocardiography with Speckle tracking analysis for LA – reservoir (LARs), conduit (LAScd) and contractile (LASct) and LV global longitudinal strain ( LV - GLS). End – systolic pressure was determined from the brachial pulse wave. Arterial elastance (AE) and ventricular elastance (Ees) were calculated as and – systolic pressure/stroke volume and end – systolic pressure/end – systolic volume. Parameters for arterial stiffness – 24 - hour central systolic pressure (cSys24h), central pulse pressure (cPP24h) and 24 - hour pulse wave velocity (PWV24h) were measured non – invasively with oscillometric method by Mobil-O-graph PWA. RESULTS Statistically significant differences in parameters of vascular stiffness were found in patients with normal ventriculo – arterial coupling in comparison with disturbed EA/Ees: cSys24h (106.78 ± 9.33 vs. 114.59 ± 16.1 mm Hg, p = 0.02), cPP24h (39.89 ± 11.78 vs. 48.56 ± 10.21 mm Hg, p= 0.04). There were statistically significant differences in echocardiography parameters between patients with disturbed VAC in comparison to other group: LAScd (16.66 ± 1.67 vs. 19.57 ± 1.34 %, p&amp;lt; 0.001), LASr (31.76 ± 5.14 vs. 30.56 ± 3.28 %, p= 0.007) and LAVI (30.15 ± 9.20 vs. 36.78 ± 8.80 ml/m², p= 0.007). There was positive correlation between LAScd with EA/Ees (r = -0.285, p&amp;lt; 0.008) and negative E/Em (r = -0.278, p&amp;lt; 0.01). LAVI correlated moderate positively with E/Em ratio (r = 0.416, p&amp;lt; 0.0001) and negatively with LAScd (r = - 0.418, p &amp;lt; 0.0001). cSys24h correlated negatively with LV – GLS (r = - 0.218, p &amp;lt; 0.03) and with EA/Ees (r = - 0.253, p = 0.013). CONCLUSION In well-controlled hypertension, 24 - hour ambulatory central aortic pressure played a part in LV remodeling. High LV filling pressures determined LA remodeling and dysfunction in middle–aged patients. These results could be used for a new direction of central aortic pressure-guided therapy.