Brachial Pulse Wave Research Articles

Effects of acute dietary nitrate supplementation on aortic blood pressures and pulse wave characteristics in post-menopausal women

PurposeConsumption of nitrate-rich beetroot juice can lower blood pressure in peripheral as well as central arteries and may exert additional hemodynamic benefits (e.g. reduced aortic wave reflections). The specific influence of nitrate supplementation on arterial pressures and aortic wave properties in postmenopausal women, a group that experiences accelerated increases in these variables with age, is unknown. Accordingly, the primary aim of this study was to determine the effect of consuming nitrate-rich beetroot juice on resting brachial and aortic blood pressures (BP) and pulse wave characteristics in a group of healthy postmenopausal women, in comparison to a true (nitrate-free beetroot juice) placebo. MethodsBrachial (oscillometric cuff) and radial (SphygmoCor) pressures and derived-aortic waveforms were measured during supine rest in thirteen healthy postmenopausal women (63 ± 1 yr) before and 100 min after consumption of 140 ml of either nitrate-rich (9.7 mmol, 0.6 gm NO3−) or nitrate-depleted beetroot juice on randomized visits approximately 10 days apart (cross-over design). Ten young premenopausal women (22 ± 1 yr) served as a reference (non-supplemented) cohort. ResultsBrachial and derived-aortic variables showed the expected age-associated differences in these women (all p < 0.05). In post-menopausal women, nitrate supplementation reduced (p < 0.05 vs. placebo visit) brachial systolic BP (BRnitrate −4.9 ± 2.1 mmHg vs BRplacebo +1.1 ± 1.8 mmHg), brachial mean BP (BRnitrate −4.1 ± 1.7 mmHg vs BRplacebo +0.9 ± 1.3 mmHg), aortic systolic BP (BRnitrate −6.3 ± 2.0 mmHg vs BRplacebo +0.5 ± 1.7 mmHg) and aortic mean BP (BRnitrate −4.1 ± 1.7 mmHg vs BRplacebo +0.9 ± 1.3 mmHg), and increased pulse pressure amplification (BRnitrate +4.6 ± 2.0% vs BRplacebo +0.7 ± 2.5%, p = 0.04), but did not alter aortic pulse wave velocity or any other derived-aortic variables (e.g., augmentation pressure or index). ConclusionsDietary nitrate supplementation favorably modifies aortic systolic and mean blood pressure under resting conditions in healthy postmenopausal women. Acute supplementation of nitrate does not, however, appear to restore indices of aortic stiffness in this group. Future work should evaluate chronic, long-term effects of this non-pharmacological supplement.

Ankle–Brachial Index, plasma homocysteine, and brachial-ankle pulse wave velocity are important indicators in the diagnosis of early stage lower-extremity arterial occlusive disease

Background: This study evaluated noninvasive methods for the diagnosis and classification of lower-extremity arterial occlusive disease (LEAOD), specifically, plasma homocysteine (pHcy), ankle–brachial index (ABI), and brachial-ankle pulse wave velocity (baPWV). Materials and Methods: The study involved 102 patients with intermittent claudication treated at Beijing Chao Yang Hospital from 2010 to 2011. The affected arteries were assessed by computed tomography angiography (CTA) and categorized depending on the degree of occlusion as normal, stenotic, or occluded. ABI, pHcy, and baPWV were measured and compared among the groups. Factors that can affect ABI readings were analyzed. Results: Compared with patients in the normal group, the stenotic and occluded patients had significantly higher pHcy and baPWV, and lower ABI levels. The pHcy levels of the stenotic and occluded groups were similar. While statistically significant different ABI and baPWV levels were shown between the stenotic and occluded groups. The t values were 9.43 and 3.76, and the P

Effects of Newer Antidiabetic Drugs on Endothelial Function and Arterial Stiffness: A Systematic Review and Meta-Analysis.

Background Newer antidiabetic drugs, i.e., dipeptidyl peptidase-4 (DPP-4) inhibitors, sodium-glucose cotransporter-2 (SGLT-2) inhibitors, and glucagon-like peptide-1 receptor agonists (GLP-1 RAs) may exert distinct cardiovascular effects. We sought to explore their impact on vascular function. Methods Published literature was systematically searched up to January 2018 for clinical studies assessing the effects of DPP-4 inhibitors, GLP-1 RAs, and SGLT-2 inhibitors on endothelial function and arterial stiffness, assessed by flow-mediated dilation (FMD) of the brachial artery and pulse wave velocity (PWV), respectively. For each eligible study, we used the mean difference (MD) with 95% confidence intervals (CIs) for FMD and PWV. The pooled MD for FMD and PWV were calculated by using a random-effect model. The presence of heterogeneity among studies was evaluated by the I2 statistic. Results A total of 26 eligible studies (n = 668 patients) were included in the present meta-analysis. Among newer antidiabetic drugs, only SGLT-2 inhibitors significantly improved FMD (pooled MD 1.14%, 95% CI: 0.18 to 1.73, p = 0.016), but not DPP-4 inhibitors (pooled MD = 0.86%, 95% CI: -0.15 to 1.86, p = 0.095) or GLP-1 RA (pooled MD = 2.37%, 95% CI: -0.51 to 5.25, p = 0.107). Both GLP-1 RA (pooled MD = −1.97, 95% CI: -2.65 to -1.30, p < 0.001) and, to a lesser extent, DPP-4 inhibitors (pooled MD = -0.18, 95% CI: -0.30 to -0.07, p = 0.002) significantly decreased PWV. Conclusions Newer antidiabetic drugs differentially affect endothelial function and arterial stiffness, as assessed by FMD and PWV, respectively. These findings could explain the distinct effects of these drugs on cardiovascular risk of patients with type 2 diabetes.

Arterial Stiffness in Balkan Endemic Nephropathy, an Environmental Form of Aristolochic Acid Nephropathy.

Balkan endemic nephropathy (BEN), an environmental form of aristolochic acid nephropathy is characterized with later onset and milder forms of hypertension (HT). Thus, we hypothesized that arterial stiffness progresses slower in BEN patients resulting in lower CV mortality. A total of 186 hemodialysed (HD) patients (90 BEN, 96 non-BEN; 67.3 + 13.0 years) were enrolled and followed-up for 25 months. Brachial blood pressure (BP) and pulse wave velocity (PWV) were determined before mid-week dialysis. BEN patients were older (72.1 ± 37.1 vs. 62.8 ± 15.1; p < 0.001), had shorter duration of HT prior commencement of HD than non-BEN patients (36 vs. 84 months; p < 0.001). There were no differences in BP, but BEN patients were treated with less antihypertensive drugs (p < 0.01). BEN patients had lower PWV values at baseline and at the end of follow-up period despite being chronologically older (p < 0.001). Baseline PWV > 10 m/s was associated with higher risk for CV mortality (aHR 1.8 [1.4, 2.4]). In multivariate analyses BEN was predictor of lower PWV. During the follow-up period significantly less CV deaths were observed in BEN vs. on-BEN patients (12 vs. 31; p = 0.001). CV mortality adjusted for other risk factors was significantly lower in BEN group (aHR 0.2 [0.1, 0.5]). Overall BEN patients had longer mean survival time on HD (22.3 vs. 18.2 months; p < 0.001). Observed slower vascular aging (i.e., lower PWV) in BEN patients compared to other ESRD patients is related to the later onset of HT and milder stages of HT during predialytic clinical course and better control of BP and phosphate during HD.

Relationship between long-chain omega-3 polyunsaturated fatty acid intake and ankle brachial index, pulse wave velocity and resting heart rate in a sample of overweight adults: A secondary analysis of baseline data in the HealthTrack study.

The present study aimed to explore the association between dietary long-chain omega-3 polyunsaturated fatty acid (LCn3PUFA) intake and cardiovascular risk indicators (ankle brachial index, resting heart rate and brachial-ankle pulse wave velocity) in a clinical sample of overweight and obese participants volunteering for a weight loss trial. This was a secondary analysis of baseline data from the HealthTrack study (n = 351). LCn3PUFA intake was calculated via a diet history and the association with ankle brachial index, resting heart rate and brachio-ankle pulse wave velocity was explored using linear regression after controlling for covariates. LCn3PUFA intake was inversely associated with ankle brachial index (R2 change = 0.021, F change (1, 339) = 8.864, P < 0.05) and resting heart rate (R2 change = 0.014, F change (1, 342) = 5.337, P < 0.05) but not with brachio-ankle pulse wave velocity (R2 change = 0.001, F change (1, 339) = 0.725, P > 0.05). In this clinical sample of overweight adults, LCn3PUFA consumption was significantly associated with a lower resting heart rate, adding to the current evidence on the potential benefits of LCn3PUFA consumption. It also supports the value of targeting a diet rich in this nutrient when planning future dietetic approaches. Relationships with ankle brachial index and pulse wave velocity require further investigation. Future research should assess the effect of changes in dietary LCn3PUFA intake on novel cardiovascular risk indicators.

Ankle-brachial difference pulse wave velocity (abD-PWV) measured with a new device is related to the presence of atherosclerotic carotid plaques

Aim: We have developed a new device (VOPITB) which measures the pulse wave velocity easily in arms and legs independently. The aim was to find the relationship of ankle brachial difference pulse wave velocity (abD-PWV) with the presence of atherosclerotic carotid plaques measured by ultrasonography.

Impaired Brachial Flow-Mediated Dilatation May Predict Symptomatic Intracranial Arterial Dissections

Background and PurposeSpontaneous intracranial arterial dissections are characterized by the sudden disruption of the internal elastic lamina in the intracranial arteries. The purpose of our retrospective study was to investigate whether patients with nontraumatic intracranial arterial dissections had normal endothelial function. MethodsThe study included symptomatic patients with nontraumatic intracranial arterial dissections who underwent an endothelial function test. Controls were selected from headache patients matched for sex and age. Endothelial function was assessed using flow-mediated dilatation. We investigated patients’ ankle brachial index and pulse wave velocity to determine the degree of atherosclerosis. Patient characteristics, brachial flow-mediated dilatation, ankle brachial index, and pulse wave velocity were compared between the 2 groups. ResultsDuring the study period, there were 22 patients with nontraumatic intracranial arterial dissections matched with 22 controls. Clinical characteristics were compared between the groups. Although there were no significant differences in ankle brachial index or pulse wave velocity between the 2 groups, patients with intracranial arterial dissections had lower flow-mediated dilatation values than controls (median flow-mediated dilatation, 3.95% in dissection patients versus 7.3% in controls, P = .0035). Brachial flow-mediated dilatation was impaired in symptomatic patients with nontraumatic intracranial arterial dissections despite the normal ankle brachial index and pulse wave velocity. ConclusionsImpaired brachial flow-mediated dilatation is a probable predictor of intracranial arterial dissections.

Is Kidney Stiffness Measured Using Elastography Influenced Mainly by Vascular Factors in Patients with Diabetic Kidney Disease?

Studies published so far using ultrasound-based elastography in the kidneys, lack to prove a clear relationship between kidney shear wave speed (KSWS) and renal disease progression. Taking into account that the kidney is a highly vascularized organ, the present study aims to find a relationship between KSWS and vascular factors (blood pressure [BP], arterial stiffness). Our study included 38 diabetic kidney disease patients (mean age 56.52 ± 16.12 years, 19 female, 19 male). KSWS, an indicator of renal stiffness, was measured using point Shear Wave Elastography (pSWE; Siemens Acuson S2000). In every patient, we recorded BP, and we measured aortic augmentation index (AAI) and brachial pulse wave velocity (PWV), using oscillometry. We found statistically significant indirect correlations of KSWS with indicators of arterial stiffness, such as PWV ( r = -.41, p = .036), and AAI ( r = -.37, p = .031). We found also an indirect correlation of KSWS with diastolic BP ( r = -.65, p = .02) and systolic BP ( r = -.54, p = .008). We found no correlation of KSWS with estimated glomerular filtration rate (eGFR), urinary albumin/creatinine ratio, stage of diabetic retinopathy, or glycated hemoglobin. Our study shows that high BP and the progression of arteriosclerosis (high PWV and AAI), leads to a decrease of renal stiffness. Thus, it seems that KSWS is influenced by renal blood flow, rather than other factors, such as albuminuria or chronic kidney disease stage.

Comparison of laboratory and ambulatory measures of central blood pressure and pulse wave reflection: hitting the target or missing the mark?

Prior studies demonstrating clinical significance of noninvasive estimates of central blood pressure (BP) and pulse wave reflection have relied primarily on discrete resting measures. The aim of this study was to compare central BP and pulse wave reflection measures sampled during a single resting laboratory visit against those obtained under ambulatory conditions. The secondary aim was to investigate the reproducibility of ambulatory central BP and pulse wave reflection measurements. Forty healthy participants (21 males; 24 ± 3 years) completed three measurements of brachial artery pulse wave analysis (Oscar 2 with SphygmoCor Inside) in the laboratory followed by 24 hours of ambulatory monitoring. Seventeen participants repeated the 24-hour ambulatory monitoring visit after at least 1 week. Ambulatory measures were divided into daytime (9 AM–9 PM), nighttime (1 AM–6 AM), and 24-hour periods. Compared with laboratory measurements, central systolic BP, augmentation pressure, and augmentation index (with and without heart rate normalization) were higher (all P < .01) during daytime and 24-hour periods but lower during the nighttime period (all P < .001). The drop in nighttime brachial systolic BP was larger than central systolic pressure (Δ −20 ± 6 vs. −15 ± 6 mm Hg; P < .0001). Repeat ambulatory measurements of central BP and pulse wave reflection displayed good-to-excellent intraclass correlation coefficients (r = 0.58–0.86; all P < .01), although measures of pulse wave reflection had higher coefficients of variation (14%–41%). The results highlight absolute differences in central BP and pulse wave reflection between discrete laboratory and ambulatory conditions. The use of ambulatory measures of central BP and pulse wave reflection warrant further investigation for clinical prognostic value.

Analysis of Status and Risk Factors for Macrovascular Complications in Type 2 Diabetes Mellitus

The status and risk factors for atherosclerosis (AS) were investigated and the sensitivity and accuracy of existing examine methods of AS were evaluated in patients with diabetes mellitus(T2DM). Ninety nine patients who diagnosed with the WHO 1999 criteria for T2DM were enrolled in this study, which were divided into atherosclerotic group(group A) and non-atherosclerosis group(group B). The clinical characteristics, including fasting plasma glucose(FPG), postprandial plasma glucose(PPG), total cholesterol(TC), triglyceride(TG), high-density lipoprotein cholesterol(HDL-C), low-density lipoprotein cholesterol(LDL-C), glycosylated hemoglobin A1c(HbAlc) and early examination methods of AS, including carotid intima-media thickness(CIMT), ankle brachial index(ABI) and pulse wave velocity (PWV) were recorded. The t-test, χ2 test or linear regression model were used for retrospective analyses then showed that the prevalence rate of carotid plaque was 29.3%( 29/99), there is no difference between the distribution of age and gender in the group with or without plaque (χ2 = 0.044, P>0.05; t = 0.850, P>0.05). It also demonstrated that systolic blood pressure(SBP), diastolic blood pressure (DBP), LDL-C, CIMT, history of smoke were significantly higher in plaques group than that of without plaques ( P＜0.05). Logistic analysis showed that LDL-C and CIMT were independent risk factors for incidence of cervical atheromatous plaques in type 2 diabetic patients (P＜0.05). The risk of AS has increased by 1.7 times by every unit of LDL-C, as well as increased by 13.8 times by every unit of CIMT. CIMT and PWV, but not ABI, are valuable for AS diagnosing. According to sensitivity and specificity, the best diagnostic value for CIMT is 0.9mm and for PWV is 1560.As a result, LDL-C and CIMT are independent risk factors for AS. Early intervention and controlling of risks factors will have clinical value for prevention and treatment of macrovascular diseases in T2DM. The corresponding cut-off points 1560 of PWV is better than 1400 for diagnosis of AS in this hospital.

Method Comparison and Validation of the Determination of Ejection Duration from Oscillometric Measurements

The ejection duration (ED) is an important indicator of ventricular function as well as ventriculo-arterial coupling, especially for heart failure with reduced ejection fraction. Thus, the non-invasive oscillometric determination of ED from arterial pressure waves could enhance methods of pulse wave analysis. The aim of this work was to compare different approaches to calculate the ED from oscillometric measurements and to test and to validate the determination of ED with results from measurements using radial tonometry. Oscillometric and tonometric pulse wave measurements were obtained in direct succession from each patient with the Mobil-O-Graph and with the Sphygmocor device in a comparative study. Also, the results from the internal algorithm of SphygmoCor were obtained. Several methods for the determination of ED were implemented and applied to the given measurements. The results of Mobil-O-Graph were compared with the ejection durations from the internal algorithm of SphygmoCor. Several algorithms had a mean error lower than the step size of the recordings. The algorithm using numerical central differences to find the maximum curvature of the curve was chosen for the determination of ED due to its lowest standard deviation compared with others, its low mean error and its stability. The mean difference between Mobil-O-Graph and SphygmoCor was 7 ms (35 SD). An algorithm for determination of ED was selected and tested successfully on radial and brachial recordings. As the differences between locations as well as between algorithms are sufficiently small, the determination of ejection duration from brachial oscillometric pulse waves seems feasible.

Cardiovascular Assessment in Human Research.

A number of noninvasive tests exist for assessing cardiovascular structure and function. This chapter describes protocols for flow-mediated dilation (FMD) of the brachial artery and pulse wave velocity (PWV) and pulse wave analysis (PWA) for measurement of arterial stiffness. The chapter alsodescribes the different methodological approaches involved in applying these techniques for optimizing their validity, comparability, and potential uses as clinical and physiological research tools.

Correlation and Regression Analysis on the Parameters of Central Aortic and Brachial Pulse Waves

Correlation and Regression Analysis on the Parameters of Central Aortic and Brachial Pulse Waves

The correlation of brachial ankle pulse wave velocity with arterosclerosis at different estimated levels of glomerular filtration rate

To explore the relationship between brachial ankle artery pulse wave velocity of the (baPWV) in different estimation GFR (eGFR) groups and atherosclerosis.In 2010, 2012 and 2014, eGFR and baPWV were detected in 1 427 healthy persons.As eGFR level decreased, baPWV increased accordingly with higher proportion of baPWV ≥1 400 cm/s.The percentage of eGFR lower than 60 ml·min-1·1.73 m-2 was similar in subgroups with different baPWV.However, the proportion of eGFR reduction≥30% decreased according to the elevation of baPWV.Multivariate logistic regression analysis indicated the lower the eGFR, the higher the risk of atherosclerosis.Low eGFR is an independent risk factor for atherosclerosis.

Noninvasive oscillometric cardiac output determination in the intensive care unit \u2013 comparison with invasive transpulmonary thermodilution

Assessment of the cardiac output (CO) is usually performed with invasive techniques requiring specialized equipment in the intensive care unit (ICU). With TEL-O-GRAPH (TG), CO can be derived from the oscillometrically obtained brachial pulse wave during the measurement of brachial blood pressure. CO and stroke volume (SV) determinations with TG were compared with transpulmonary thermodilution measurements with the PICCO system (PICCO) in 38 haemodynamically unstable ICU patients with a total of 84 comparison measurements performed. SV (33.3 ± 9.0 ml/m2 vs. 44.3 ± 14.4 ml/m2, p < 0.001) and CO (2.7 ± 0.5 l/min/m2 vs. 3.8 ± 1.2 l/min/m2, p < 0.001) were underestimated significantly with TG and oscillometric brachial systolic blood pressure (BP) was significantly lower and diastolic BP significantly higher than invasive femoral artery pressure. A linear correlation was found between CO dimension and CO underestimation with TG. Correct tracking of CO changes with a fluid challenge was possible in 69.5% of measurements. Oscillometric noninvasive CO is possible in the ICU, but accuracy and precision of this new method are lacking. Implementation of a correction factor accounting for the linear increase in CO underestimation observed with increasing CO could improve CO assessment with TG in haemodynamically unstable patients.

Brachial ankle gradient pulse wave velocity (bag-PWV) measured with a new device correlates with carotid femoral pulse wave velocity

Brachial ankle gradient pulse wave velocity (bag-PWV) measured with a new device correlates with carotid femoral pulse wave velocity

Regression analysis and transfer function in estimating the parameters of central pulse waves from brachial pulse wave.

This study mainly analyzed the parameters such as ascending branch slope (A_slope), dicrotic notch height (Hn), diastolic area (Ad) and systolic area (As) diastolic blood pressure (DBP), systolic blood pressure (SBP), pulse pressure (PP), subendocardial viability ratio (SEVR), waveform parameter (k), stroke volume (SV), cardiac output (CO) and peripheral resistance (RS) of central pulse wave invasively and non-invasively measured. These parameters extracted from the central pulse wave invasively measured were compared with the parameters measured from the brachial pulse waves by a regression model and a transfer function model. The accuracy of the parameters which were estimated by the regression model and the transfer function model was compared too. Our findings showed that in addition to the k value, the above parameters of the central pulse wave and the brachial pulse wave invasively measured had positive correlation. Both the regression model parameters including A_slope, DBP, SEVR and the transfer function model parameters had good consistency with the parameters invasively measured, and they had the same effect of consistency. The regression equations of the three parameters were expressed by Y'=a+bx. The SBP, PP, SV, CO of central pulse wave could be calculated through the regression model, but their accuracies were worse than that of transfer function model.

Central Cardiovascular Hemodynamics and Vascular Stiffness during Handgrip Exercise with and without Blood Flow Restriction

Walking, coupled with bilateral blood flow restriction (BFR) in legs, augments the central cardiovascular adjustment to activity (e.g., greater blood pressure, and aortic wave reflection) as compared to walking without BFR. Whether the same occurs in response to unilateral, upper-body exercise performed with BFR is unknown. PURPOSE: To examine the central cardiovascular hemodynamics and vascular stiffness responses to low- and high-intensity, unilateral handgrip exercise performed with and without BFR. METHODS: Eight college-aged males (Age=24±5 yrs; BMI=30±7 kg/m2, handgrip max voluntary contraction-MVC=52±8 kg) underwent three 5-minute bouts (counter-balanced, 10 mins rest between) of rhythmic handgrip dynamometry (1-2 sec duty cycle, 20 squeezes/min) performed at a low (40% MVC) and high-intensity (60% MVC) with and without proximal occlusion (80-100mmHg, 50-80% arterial occlusion assessed via radial artery Doppler-ultrasound). Brachial pulse wave analysis and carotid applanation tonometry (heart rate-HR, mean arterial pressure-MAP, augmentation index-AIx, aortic pulse wave velocity-PWV, wave reflection magnitude-RM%) were performed at baseline and at the end of each 5-min bout of handgrip. To provide an index of peripheral vasoconstriction, perfusion of the vastus lateralis (oxy-hemoglobin, via Near-Infrared Spectroscopy) was also examined during these time points. RESULTS: HR increased more during high-intensity handgrip, both with and without BFR, as compared to low-intensity with BFR (60% with BFR=+9±7, vs. 60% without BFR=+9±7, vs. 40% with BFR=+4±5 bpm, P<0.001). Central MAP increased during all handgrip bouts, with the greatest change during high-intensity with BFR (+17±4 mmHg, P<0.001), but comparable responses observed between low-intensity with BFR and high-intensity without (low-intensity with BFR=+9±4, P<0.001; vs. high-intensity without BFR=+13±3 mmHg, P<0.001). No change was observed for AIx, RM%, aortic PWV, or microvascular perfusion across all handgrip bouts (P>0.05). CONCLUSIONS: These preliminary findings indicate that unilateral, handgrip exercise performed with and without BFR produces an intensity-dependent increase in HR and central MAP, with no change occurring in aortic wave reflection, vascular stiffness or leg vasoconstriction.

Heritability of Vascular Structure and Function: A Parent-Child Study.

BackgroundUnderstanding the heritable contribution of vascular measures, from parent to offspring, may aid in risk stratification and atherosclerosis prevention efforts. We hypothesized that measures of vascular structure and function would be heritable in this cohort of parents and their adolescent offspring.Methods and ResultsHigh‐resolution ultrasound scans of the brachial and carotid arteries were obtained in parents (n=558) and their offspring (n=369). Lumen diameter and flow‐mediated dilation were measured in the brachial artery. Intima‐media thickness, lumen diameter, incremental elastic modulus, diameter distensibility, and cross‐sectional distensibility were measured, and carotid cross‐sectional compliance was measured in the carotid artery. Carotid–radial pulse wave velocity was obtained using SphygmoCor®. Heritability analysis (h2, expressed as %) using Sequential Oligogenic Linkage Analysis Routines was performed on the entire cohort and adjusted for age, sex, race, body–mass index, smoking, and mean arterial pressure. Data are presented as mean±SE. Measures of brachial artery diameter (h2=25±9%, P=0.001), lumen diameter (h2=55±9%, P<0.001), intima‐media thickness (h2=29±13%, P=0.014), diameter distensibility (h2=28±7%, P<0.001), cross‐sectional distensibility (h2=27±7%, P<0.001), and pulse wave velocity (h2=26±9%, P<0.001) were significantly heritable. Flow‐mediated dilation and incremental elastic modulus were not significantly heritable. Similar associations were observed in analysis restricted to siblings and complete Trios (mother, father, and child).ConclusionsThese data show that the majority of noninvasive measures of vascular structure and function are heritable, suggesting that measurement of these subclinical risk factors in parents may be helpful in assessing childhood risk for future cardiovascular disease.

Abstract TP216: Subtle Cardiovascular Measures in Young-onset Cryptogenic Ischemic Stroke: A Prospective Case-control Study

Background: Worldwide, ≈1.3 million annual ischemic strokes (IS) occur in young adults (&lt;50 years of age), of which up to 50% remain cryptogenic after a complete diagnostic work-up. In a pilot case-control study, we studied the value of arterial stiffness and related subendocardial viability in the search of underlying pathophysiology in these patients. Methods: We prospectively enrolled 51 patients aged 18-49 with recent imaging-positive cryptogenic IS and 51 age- and sex-matched stroke-free controls (NCT01934725). Measurements were done with an applanation tonometry (SphygmoCor). Augmentation Index (AIx) served as a measure of stiffness in small arteries. Aortic and brachial pulse wave velocities (aPWV; bPWV) reflected stiffness in large and intermediate-sized arteries, respectively. Subendocardial viability ratio (SEVR) was derived from radial artery waveform measures, reflecting myocardial oxygen supply and demand. Related-samples statistics were applied for univariate case-control analyses and linear regression to explore the relationship between parameters with significant association in case-control analysis. Results: AIx, aPWV, bPWV, heart rate, and systolic or diastolic blood pressures did not differ statistically between patients and controls. Mean SEVR was significantly lower in patients compared with controls (148±35 vs. 161±29, P=0.003). In patients, higher heart rate was inversely associated with SEVR (P&lt;0.001). Age, sex, migraine with and without aura, smoking, and systolic and diastolic blood pressure showed no independent association with SEVR. Conclusions: To our knowledge, this is the first report to show an association between SEVR and stroke. Yet unrecognized subtle cardiovascular pathology may play a role in early-onset cryptogenic IS.