Brachial Pulse Research Articles

P0763A COMPARATIVE STUDY OF ARTERIAL STIFFNESS AND WAVE REFLECTIONS IN DIABETIC AND NON-DIABETIC PATIENTS WITH CKD

Abstract Background and Aims Arterial stiffness is associated with increased risk for target-organ damage, cardiovascular events and overall mortality in the general population, patients with diabetes mellitus and patients with chronic kidney disease (CKD) of all stages. This is the first study to evaluate in comparison arterial stiffness and arterial wave reflections in diabetic and non-diabetic patients with CKD. Method This study included 48 diabetic and 48 non-diabetic adult patients (>18 years) with CKD (eGFR: <90 και ≥15mL/min/1.73m2), matched in a 1:1 ratio for age, sex and eGFR within each CKD stage (2, 3a, 3b and 4). All patients underwent carotid-femoral pulse wave velocity (PWV), central blood pressure (BP), and wave reflections measurement with applanation tonometry (Sphygmocor, Atcor Medical, Australia). Results Office systolic and diastolic blood pressure was similar between diabetic and non-diabetic subjects with CKD in total and across CKD stages. Office brachial pulse pressure (PP) was significantly lower in non-diabetics (49.00±8.0 vs 52.67±8.7 mmHg, p= 0.034). Office PWV was marginally higher in diabetics compared with non-diabetics (10.89±2.0 vs 10.06±2.2 m/sec, p=0.056). In CKD stages 2 and 4, no significant difference in PWV between the two groups was noted, but PWV was higher for diabetics in CKD stages 3a (11.28±1.4 vs 9.83±1.5 m/sec, p=0.023) and 3b (11.13±1.9 vs 9.46±1.2 m/sec, p=0.016). Heart-rate-adjusted augmentation index [AIx(HR75)] was higher in diabetic compared with non-diabetic subjects only in CKD stage 4 (32.08±4.2 vs 25.92±6.6%, p=0.013). Conclusion Diabetic CKD patients present higher arterial stiffness than non-diabetic counterparts. The additional contribution of diabetes towards increased arterial stiffness is more prominent in patients with moderately impaired renal function (CKD stage 3a and 3b), whereas at stage 4, PWV was increased independent of diabetes presence.

P1026THE EFFECT OF DAPAGLIFLOZIN ON 24-HOUR BLOOD PRESSURE IN PATIENTS WITH TYPE-2 DIABETES MELLITUS: A DOUBLE-BLIND RANDOMIZED CLINICAL TRIAL

Abstract Background and Aims Arterial hypertension is present in >90% of patients with type-2 diabetes mellitus (DM). Previous evidence suggests that sodium-glucose transporter 2 (SGLT-2) inhibitors can effectively manage hyperglycemia, but also reduce office blood pressure (BP) levels. The aim of this study is to evaluate the effects of dapagliflozin on ambulatory brachial BP in patients with type-2 DM. Method This is a double-blind, randomized, placebo-controlled clinical trial including 85 adult patients with type-2 DM on monotherapy or combination therapy with two of: metformin, sulphonylurea, DDP-4 inhibitor, or insulin. Patients were randomized in a 1:1 ratio to oral dapagliflozin 10 mg per day or placebo for 12 weeks. Study participants underwent 24-h ambulatory BP monitoring with the Mobil-O-Graph NG monitor at baseline and study-end. Results Baseline demographic, clinical and laboratory parameters were similar in the two groups (age 61.74±6.73 vs 60.64±9.35; p=0.534). During follow-up, 24-hour brachial SBP decreased in the active (128.97±12.57 vs 123.17±12.35; p<0.001) but was similar in the control group (128.95±12.41 vs 128.86±13.45; p=0.942). Corresponding changes in 24-hour SBP levels was greater in the dapagliflozin group compared with the placebo group (-5.80±9.48 vs -0.10±8.70 mmHg; p=0.005). Similarly, 24-hour DBP decreased in the active (77.33±7.30 vs 75.11±6.37; p=0.008) and was unchanged in the placebo group (78.86±8.66 vs 78.96±7.64; p=0.911). Decrease in brachial pulse pressure (PP) was greater in the active group (-3.57±6.67 vs -0.21±6.31 mmHg; p=0.019), while 24-hour heart rate was stable in both groups. Dapagliflozin and placebo treatments were associated with similar rates of generally mild adverse effects. Conclusion Treatment with dapagliflozin can produce statistically significant and clinically meaningful reductions in 24-hour BP levels in type-2 diabetics. These agents can improve BP control in this population.

Primary Prevention: No Associations of Strength and Cardiorespiratory Fitness Status With Arterial Stiffness in Young School Children.

Pulse wave velocity (PWV) and central systolic blood pressure (CSBP) are well-established biomarkers of arterial stiffness. Further, fitness is known to be an important protective factor in adults in respect of vascular stiffening. However, the association of both muscular and cardiorespiratory fitness (CRF) with arterial properties in younger individuals has been inconsistent. The aim of the present study was to investigate the relationship between anthropometric data, CRF, strength status, and arterial stiffness parameters in German primary school children. A total of 76 children, age 6–11 years (63.2% males) were examined. Peripheral systolic blood pressure (PSBP) [mmHg] and peripheral diastolic blood pressure (PDBP) [mmHg] and PWV [m/s] were measured non-invasively after 10 min of rest with the oscillometric cuff-based Mobil-O-Graph (IEM, Healthcare, Stolberg, Germany). CSBP [mmHg] was calculated using the ARCSolver Algorithm (Austrian Institute of Technology, Vienna, Austria) based on the recorded brachial pulse waves. CRF was measured using the validated Progressive Aerobic Cardiovascular Endurance run (PACER), also called shuttle-run test, for estimating maximal aerobic capacity (VO2max). Hand-grip strength as an indicator of overall muscle strength was determined with the Jamar Analog Hand Dynamometer. The results were recorded in kilograms [kg]. For more detailed analyses, the study group was divided into subcohorts, namely a risk group including children with abnormal blood pressure or high body weight, and a healthy subgroup. Healthy children showed a positive association between PWV and body mass index (BMI) (p = 0.016) and CSBP and BMI (p = 0.033), respectively. Hand-grip strength was positively associated with CSBP (left: p = 0.013, right: p = 0.015) and PWV (left: p = 0.008, right: p = 0.002), as well as the number of shuttle run rounds were positively correlated to PWV (p = 0.038) in the whole cohort. No significant association of converted VO2max with arterial PWV was found. The multivariate regression analysis explained 38.8% (R2 = 0.388) of the variance and the model was a significant predictor of PWV [F(6, 29) = 3.060, p = 0.019], however, none of the integrated covariates (BMI, number of shuttle run rounds, VO2max, dominant hand-grip strength) contributed significantly to the model. The lack of associations between fitness, strength and arterial stiffness might be explained by the few harmful lifestyle factors influencing vascular changes in the first decade of life.

Characteristics of Brachial Pulse Pressure and Pulse Wave Velocity in Elderly Individuals with Atrial Fibrillation: an EVOPIU Retrospective Sub-Study

Aging and hypertension are common factors in increased central arterial stiffness and the prevalence of atrial fibrillation (AF). Individualized weighing of the risk-benefit of anticoagulation is recommended in patients with AF who have low established risk scores or, conversely, are at increased risk for bleeding. Parameters of arterial stiffness and wave reflection could improve risk stratification.

Association of pulse pressure with all-cause and cause-specific mortality

Brachial pulse pressure (PP) was used as a measure of arterial stiffness, and we investigated whether PP was associated with all-cause and cause-specific mortality in a rural Chinese population. A total of 13,223 participants were enrolled in the Rural Chinese Cohort Study during 2007-2008 and followed up in 2013-2014. Data were collected by questionnaire interview, anthropometric, and laboratory measurements. A multivariate Cox proportional-hazard model was used to estimate the hazard ratios (HRs) and 95% confidence intervals (CIs) of PP (increased by 1 standard deviation) for all-cause and cause-specific mortality. Subgroup analyses were conducted by sex and age. During a mean follow-up of 5.96 years, the all-cause mortality was 78.61/10000 person-years. The association of PP with all-cause and other causes of mortality was significant, and the adjusted HRs (95% CIs) were 1.16 (1.06-1.28), and 1.18 (1.00-1.40), respectively. On subgroup analyses, PP was positively associated with all-cause and cardiovascular disease (CVD) in participants <65 years or males and positively associated with other causes of mortality in males. The risk of all-cause and other causes of mortality increased with increasing PP in a rural Chinese population. Higher PP may increase the risk of all-cause and CVD mortality for males and people <65 years as well as the risk of other causes of mortality for males in rural Chinese people.

Variable association of 24-h peripheral and central hemodynamics and stiffness with hypertension-mediated organ damage: the VASOTENS Registry.

In this analysis of the telehealth-based Vascular health ASsessment Of The hypertENSive patients Registry, we checked how 24-h central and peripheral hemodynamics compare with hypertension-mediated organ damage (HMOD). In 646 hypertensive patients (mean age 52 ± 16 years, 54% males, 65% treated) we obtained ambulatory brachial and central SBP and pulse pressure (PP), SBP, and PP variability, pulse wave velocity and augmentation index with a validated cuff-based technology. HMOD was defined by an increased left ventricular mass index (cardiac damage, evaluated in 482 patients), an increased intima-media thickness (vascular damage, n = 368), or a decreased estimated glomerular filtration rate or increased urine albumin excretion (renal damage, n = 388). Ambulatory SBP and PPs were significantly associated with cardiac damage: the largest odds ratio was observed for 24-h central SBP [1.032 (1.012, 1.051), P = 0.001] and PP [1.042 (1.015, 1.069), P = 0.002], the weakest for brachial estimates. The association was less strong for vascular damage with a trend to the superiority of 24-h central [1.036 (0.997, 1.076), P = 0.070] over brachial PP [1.031 (1.000, 1.062), P = 0.052]. No statistically significant association was observed for renal damage. SBP and PP variabilities, pulse wave velocity and augmentation index were not associated with any form of HMOD. In the multivariate analysis, age was associated with any type of HMOD, whereas central SBP and PP were predictive of an increased risk of cardiac damage. In hypertensive patients a variable association exists between peripheral and central hemodynamics and various types of HMOD, with the most predictive power being observed for central SBP and PP for cardiac damage.

The Relation between Immune Cell Mitochondrial Respiration and Brachial Artery Pulse Pressure in Humans

Elevated pulse pressure (PP) occurs with advancing age due to stiffening of the elastic arteries and is an important risk factor for cardiovascular disease (CVD), even among normotensive adults. Mitochondrial function declines with aging and may contribute to the increase in PP through a mechanism involving oxidative stress and chronic inflammation; two important hallmarks of arterial aging. Emerging evidence indicates that mitochondrial respiration in peripheral blood mononuclear cells (PBMCs) is negatively associated with risk factors for CVD in heart failure; however, the role of impaired mitochondrial function on cardiovascular function in healthy adults is not known. We hypothesized that mitochondrial function would be negatively associated with brachial PP. Twenty‐two healthy adults free of overt CVD (12 M/10 F; age: 56 ± 21 years; age range: 22–78 years; blood pressure, BP: 123 ± 15/72 ± 10 mmHg; PP: 51 ± 11 mmHg) were included in this analysis. PP was determined from brachial artery BP assessed in triplicate in the non‐dominant arm using an automated BP monitor. PBMCs were isolated by density dependent centrifugation and used to assess mitochondrial function by respirometry using an Agilent Seahorse XFp Analyzer. Primary outcome measures included the oxygen consumption rate (OCR) at baseline (basal respiration; BASERESP) and following three serial injections of oligomycin, FCCP and rotenone/antimycin A into the respirometer to determine maximal respiration (MAXRESP). Spare respiratory capacity (SRC), an indicator of how well the cell can respond to an increased energetic demand, ATP‐linked oxygen consumption (ATPO2), and coupling efficiency, which is how well ATPO2 is matched to BASERESP, were also measured. The associations between mitochondrial function and PP were analyzed using multi‐linear regressions correcting for age. PP was not associated with BASERESP (p=0.89, R2=0.10, β=0.01), coupling efficiency (p=0.20, R2=0.18, β= −8.5), or ATPO2 (p=0.33, R2=0.15, β= −0.10). However, PP was inversely associated with MAXRESP (p=0.05, R2=0.28, β= − 0.03) and SRC (PP; p=0.02, R2=0.33, β=−0.04). These data suggest that the impaired mitochondrial respiration may be an important contributor to CVD risk through increases in pulse pressure. Future studies should explore whether these associations are mediated by increases in oxidative stress and inflammatory cytokines.Support or Funding InformationFunding Sources: P20GM113125, K01AG054731

Brachial pulse pressure is associated with the presence and extent of coronary artery disease in stable angina patients: a cross-sectional study

BackgroundPrevious epidemiological evidence has identified many risk factors for coronary artery disease (CAD). Pulse pressure (PP) was reported to be associated with CAD. However, more attention was paid to aortic PP than to brachial PP. This cross-sectional study aimed to investigate the direct relationship between brachial PP and the presence and extent of CAD in stable angina patients.MethodsWe recruited a total of 1118 consecutive patients with stable chest pain suspected of CAD. After screening with exclusion criteria, 654 patients were finally included in our study. Every patient underwent both blood pressure measurement and selective coronary angiography. Univariate and multivariate analysis were performed to analyze the association between PP and the presence and extent of CAD.ResultsThis study revealed that brachial PP was an independent correlate of multivessel CAD. In multivariate generalized linear regression model, increasing brachial PP (per 1 mmHg) were associated with the increased number of diseased vessels (β = 0.01, SE = 0.00, P < 0.0001). Binary logistic regression analysis further confirmed this association. The risk of multivessel CAD increased significantly in patients with brachial PP ≥ 60 mmHg (OR = 1.69, 95% CI = 1.14–2.48, P = 0.0084) and as per 1 mmHg increased in brachial PP (OR = 1.02, 95% CI = 1.01–1.03, P = 0.0002), independent of age, gender, body mass index (BMI), smoking, diabetes, hypercholesterolemia and creatinine (Cr). This association was still of statistical significance in subgroup analysis of hypertension and diabetes.ConclusionIncreasing brachial PP was significantly and independently associated with increased risk of multivessel coronary disease in stable angina patients. The association of brachial PP with CAD was more pronounced in hypertension group than in non-hypertension one.

Increased Aortic Characteristic Impedance Explains Relations Between Urinary Na+/K+ and Pulse or Systolic Blood Pressure.

Alterations in sodium (Na+) relative to potassium (K+) intake increase systolic blood pressure, effects in-part attributed to enhanced pulsatile loads (pulse pressure) beyond steady-state pressures (mean arterial pressure). Whether this effect is through reversible changes (increases in blood volume and hence aortic flow [Q] or wave reflection [Pb]), or potentially irreversible structural changes in the proximal aorta, is unknown. In 581 black South Africans, we determined 24-hour urinary Na+ and K+ excretion and aortic function from central aortic pressure (radial pulse wave analysis [SphygmoCor software]), velocity, and diameter measurements. Proximal aortic function was assessed from characteristic impedance (Zc). Beyond mean arterial pressure and additional confounders, urinary Na+/K+ was independently associated with Zc (P<0.005) but not peak aortic Q (P=0.30) or alternative aspects of Q or ejection volume. Although age was strongly associated with proximal aortic diameter, no independent relations between urinary Na+/K+ and aortic diameter were noted (P=0.17). Relations between urinary Na+/K+ and Zc translated into independent relations with early systolic compression wave pressures (QxZc [PQxZc]) and aortic forward wave pressures but not Pb. Moreover, neither reflected wave magnitude (P=0.92) nor aortic pulse wave velocity were independently associated with urinary Na+/K+. In product of coefficient mediation analysis, the independent relations between urinary Na+/K+ and peak aortic or brachial pulse pressure or systolic blood pressure were accounted for by Zc and PQxZc. In conclusion, abnormalities in Na+/K+ intake determine pulse pressure or systolic blood pressure beyond mean arterial pressure mainly through potentially irreversible impacts on proximal aortic impedance rather than readily modifiable increases in aortic flow (blood volume) or wave reflection.

Arterial Stiffness and Blood Pressure in Patients Newly Diagnosed with Graves’ Disease Compared with Euthyroid Controls

Introduction and Objective: The excess cardiovascular morbidity and mortality in hyperthyroidism and Graves’ disease (GD) is inadequately understood. We aimed to elucidate whether well-established cardiovascular risk factors such as arterial stiffness in terms of pulse wave velocity (PWV) and blood pressure differ in GD and controls. Methods: This was a cross-sectional study comparing 55 hyperthyroid patients with newly diagnosed GD and 55 euthyroid, population-based controls matched for age, sex and menopausal status. PWV and blood pressure were measured in office (SphygmoCor Xcel) and 24-h ambulatory settings (Arteriograph). Differences between groups were assessed using adjusted linear regression analysis. Results: Compared to controls, GD patients showed higher PWV in the 24-h but not in the office setting with an adjusted 24-h PWV difference of 1.0 (95% CI: 0.6–1.5) m/s. PWV was higher in GD at both day and night, and nightly PWV dipping was lower (–5.5, 95% CI: –10.4 to –0.6%). Furthermore, central and brachial pulse pressure was significantly higher in both the office and 24-h setting, whereas nightly central pulse pressure dipping was significantly lower in GD (–5.4, 95% CI: –10.5 to –0.2%). Mean arterial pressure did not differ between the groups. Conclusions: Despite comparable blood pressure, GD is associated with a higher 24-h PWV that was not detected in the office setting. Pulse pressure was higher in GD, whereas mean arterial pressure did not differ between the groups. Longitudinal studies should pursue whether higher PWV might be a piece to the puzzle of understanding the increased risk of cardiovascular disease in hyperthyroidism and GD.

The effect of ivabradine as part of standard therapy on vascular endothelial function and cardiac electrical instability in patients with post-infarction cardiosclerosis and heart failure

Aim. To reveal the equivalence of nebivolol replacement with ivabradine in the prevention of endothelial dysfunction and cardiac electrical instability in patients with heart failure with reduced ejection fraction (HFrEF).Material and methods. In current observational study, 126 patients with HFrEF in the postinfarction period were randomized into two groups for six-month treatment: group 1 (n=62) — standard therapy (acetylsalicylic acid 0,1 g/day, clopidogrel 75 mg/day, veroshpiron 50 mg/day, nebivolol 5 mg/day, perindopril 5 mg/day and rosuvastatin 20 mg/day; group 2 (n=66) — the same therapy with nebivolol replacement with ivabradine 10 mg/day. Initially and after 6 months, 24-hour Holter monitoring was performed, heart rate variability was determined. We also investigated endothelial dysfunction using the photoplethysmographic technique with post-occlusive reactive hyperemia (PORH) test.Results. The heart rate, the number of episodes and the duration of symptomatic and silent myocardial ischemia, total myocardial ischemia were significantly decreased in both groups (p&lt;0,001). The decrease of supraventricular extrasystole frequency in both groups had not statistical significance (p&gt;0,05). In both groups, after therapy, parameters of heart rate variability were improved with the parasympathetic predominance (p&lt;0,01). In both groups, the PORH test revealed the increase of brachial artery diameter (group 1 — 5,90Ѓ}3,15% and group 2 — 5,88Ѓ}1,82%) and pulse wave amplitude (group 1 — 1,81Ѓ}0,78 and group 2 — 1,73Ѓ}0,90 times), which indicates a trend towards an improvement in endothelial function. Intergroup comparisons did not reveal significant differences.Conclusion. Ivabradine is equivalent to nebivolol in preventing ventricular extrasystole and reducing heart rate, number of episodes of symptomatic and silent ischemia and the duration of total myocardial ischemia in patients with HFrEF. Ivabradine equivalently to nebivolol improves endothelial function and heart rate variability with reducing the sympathetic activity.

Abstract TP485: Aortic Stiffness Detrimental Effect in Brain Blood Flow Autoregulation

Background: Cerebral hemodynamic dysfunction is associated with brain small artery disease and poorer cognition. With aging, systemic arteries stiffen, magnifying the spread of pulsatility to distal organs. The brain is especially susceptible to pulsatility due to low impedance to flow. Increased pulsatility causes abnormal brain arteriolar remodeling in animal models. Therefore, we hypothesize that measures of aortic stiffness relate to poorer cerebral autoregulation, an in-vivo measure of arteriolar function. Methods: We recruited participants in the Washington Heights-Inwood Community Aging Project for this study. For autoregulation, both middle cerebral arteries were insonated at a depth of 50-58 mm. End-tidal CO2 (EtCO2) was measured continuously with a facemask. After ten minutes of baseline recording, a mixture of air enriched with 5% CO2 was administered through the facemask for 2 minutes. Cerebrovascular reactivity was calculated as % change in mean CBFV (mCBFV) per 1 mm increase in mean EtCO2 during CO2 inhalation. We averaged the right and left CO2 reactivity percentage. For aortic stiffness, we acquired carotid-femoral pulse wave velocity (cfPWV) with non-invasive oscillometry using the Vicorder system (Skidmore Medical Limited, Bristol, UK). We used generalized linear model to obtain beta estimates of the association between CO2 reactivity and cfPWV. Results: We included 158 participants (mean age 77±6.4 years, 67% women, 40% non-Hispanic black, 38% non-Hispanic white, and 20% Hispanic). Hypertension was present in 54% of the participants. cfPWV was associated with poorer CO2 reactivity (B=-0.038, P=0.047), independent of age, sex, ethnicity, and hypertension. Brachial pulse pressure (B=0.007, P=0.38) and mean arterial pressure (B=-0.017, P=0.21) were not associated with CO2 reactivity, and adding brachial pulse pressure and mean arterial pressure to the adjusted model did not change the association between cfPWV and poorer CO2 reactivity. Conclusions: Aortic stiffness is associated with poorer CO2 reactivity independent of traditional measures of hypertension, a marker of cerebral autoregulation and arteriolar health. Poorer CO2 reactivity may mediate the reported effects of aortic stiffness on brain outcomes.

Aortic stiffness is not only associated with structural but also functional parameters of retinal microcirculation

ObjectiveThe aim of the study was to test the hypothesis that alterations in large arteries are associated with microvascular remodelling and decreased retinal capillary blood flow. MethodsThe study group comprised of 88 patients with essential hypertension and 32 healthy controls. Retinal microcirculation was evaluated by scanning laser Doppler flowmetry. Macrovascular changes were assessed on the basis of arterial stiffness measurement (carotid-femoral pulse wave velocity), its hemodynamic consequences (central pulse pressure, augmentation pressure, augmentation index) and intima media thickness of common carotid artery. ResultsPulse wave velocity was inversely correlated to mean retinal capillary blood flow in hypertensive patients (R = −0.32, p < 0.01). This relationship remained significant in multivariate regression analysis after adjustment for age, sex, central systolic blood pressure (BP) and body mass index (β = −31.27, p < 0.001). Lumen diameter (LD) of retinal arterioles was significantly smaller in hypertensive then normotensive subjects (79.4 vs. 83.8, p = 0.03). Central and brachial systolic, diastolic and mean BPs were significantly correlated with LD and outer diameter of retinal arterioles. The relationship between LD and central BPs remained significant in multivariate analysis (β = −0.15, p = 0.03 for cSBP; β = −0.22, p = 0.04 for cDBP; β = −0.21, p = 0.03 for cMBP). Moreover, in a subgroup with cardiac damage central and brachial pulse pressure were positively associated with retinal wall thickness, wall cross sectional area, and wall to lumen ratio. ConclusionIn conclusion, the study provides a strong evidence that microcirculation is coupled with macrocirculation not only in terms of structural but also functional parameters.

Examination of Urinary Chlorpyrifos Biomarker Concentrations and Heart Rate in a Sample of US Children and Adolescents

Objective: The purpose of the investigation is to determine if a relationship exists between heart rate and urinary biomarkers of chronic, subacute chlorpyrifos pesticide exposure in youth. Methods: Using 2001-2002 NHANES data, a sample of 1233 children ages 6 - 18 was grouped based on detection status of 3,5,6-trichloropyridinol (TCPy) in urine. Radial pulse and brachial pulse were recorded as measures of heart rate by physicians. T-tests and linear regression analyses were performed to test for associations between TCPy concentrations and heart rate. Results: None of the associations between TCPy levels and heart rate outcomes were found to be significant. Nonsignificant effects in the TCPy-detected groups included a slightly reduced heart rate in girls, as well as a slightly elevated heart rate in boys when compared to the undetected controls. Neither was there any significant observable difference in heart rate due to detection status in the sample overall. Conclusions: At this time, an effect on heart rate attributable to chronic, low-level chlorpyrifos exposure in youth cannot be determined. Children and adolescents detected did not demonstrate a substantial change in pulse measures when compared to controls. It is recommended that subsequent studies examine chlorpyrifos biomarkers as they may relate to other indicators of cardiovascular health.

The Role of Arterial Stiffness and Central Hemodynamics in Heart Failure.

Whereas traditional understanding of left ventricular afterload was focused on a steady-state circulation model with continuous pressures and flow, a more realistic concept is emerging, taking the pulsatile nature of the heart and the arterial system into account. The most simple measure of pulsatility is brachial pulse pressure, representing the pulsatility fluctuating around the mean blood pressure level. Brachial pulse pressure is widely available, fundamentally associated with the development and treatment of heart failure (HF), but its analysis is often confounded in patients with established HF. The next step of analysis consists of arterial stiffness, central (rather than brachial) pressures, and of wave reflections. The latter are closely related to left ventricular late systolic afterload, ventricular remodeling, diastolic dysfunction, exercise capacity, and, in the long term, the risk of new-onset HF. Wave reflection may also evolve as a suitable therapeutic target for HF with preserved and reduced ejection fraction. A full understanding of ventricular-arterial coupling, however, requires dedicated analysis of time-resolved pressure and flow signals. This review provides a summary of current understanding of pulsatile hemodynamics in HF.

P1601 Relationship between aortic distensibility and aortic regurgitation assessed by CMR in bicuspid valve patients

Abstract Funding Acknowledgements Spanish Ministry of Economy and Competitiveness RTC-2016-5152-1, ISCIII PI17/00381, La Marató de TV3 (20151330), Eur FP7/People 267128 and CIBERCV BACKGROUND The severity of aortic regurgitation can be evaluated with cardiac magnetic resonance (CMR) through calculation of regurgitant fraction (RF) in phase contrast sequences acquired at the aortic root (as close as possible to the aortic valve). However, the impact of aortic distensibility in this evaluation remains unkown. PURPOSE The aim of the study was to evaluate the relation between aortic distensibility and RF valve in bicuspid aortic valve patients. METHODS We enrolled bicuspid aortic valve patients without significant aortic stenosis (maximum velocity &amp;lt;2.5 m/s) and connective tissue disease. All patients underwent a CMR study with phase contrast sequences for evaluation of regurgitant fraction at the level of the aortic valve. Aortic regurgitation was considered as mild, moderate or severe depending on RF value (mild &amp;lt;15%; moderate 15-30%; severe &amp;gt;30%). Furthermore we used cine-sequences of aortic root, ascending and proximal descending aorta to estimate aortic diameters and distensibilities, using Art Fun software. Distensibility was calculated as (change in aortic area between systole and diastole/diastolic area)/brachial pulse pressure. RESULTS A total of 98 bicuspid aortic valve patients were included (30% female, 49.7 ± 14.5 years). 75 (76,5%) AR was mild, 17 (17,4%) moderate and 6 (6,1%) severe. RF valvewas significantly correlated with aortic root diameter (r= 0.430 y p &amp;lt; 0.001 )and aortic distensibility at the level of the ascending (r = 0.273 p =0.016) and descending aorta (r = 0.502 and p&amp;lt; 0.001). Aortic distensibility was positively correlated with RFvalve even after adjustment for aortic diameter ( p = 0.002 and p &amp;lt;0.001 respectively) . (Table) (IMG) CONCLUSIONS In our study, aortic regurgitation in bicuspid valve patients, evaluated by CMR using RF valve, is related to aortic distensibility. Thus, aortic distensibility should be included in the evaluation of aortic regurgitation by CMR as additional parameter. However, longitudinal studies are needed to evaluate the impact of including aortic distensibility in the evaluation of AR severity by CMR. AR SEVERITY MILD MODERATE SEVERE Descending aorta distensibility(mean ± std. deviation) 2693,68 ± 997,5 3285,8 ±1952,7 5042,99 ±2873,44 Correlation between AR severity (by RFvalve) and descending aorta distensibility Abstract P1601 Figure.

Relationship between Brachial pulse pressure index and subclinical atherosclerosis among susceptible individuals

Background: Atherosclerosis develops gradually with a subclinical change in arterial elasticity. Pulse pressure index (PPI) (i.e. pulse pressure/systolic blood pressure) could be a predictive parameter of decreased arterial compliance. Objective: This study aimed to evaluate whether brachial PPI (BPPI) is an independent predictor for increased Carotid intima-media thickness (CIMT), and additionally, whether BPPI is superior to brachial pulse pressure (BPP) in the prediction of subclinical atherosclerosis. Methods: In this cross-sectional study, 115 patients, aged 40-60 years, who attended Minia University Hospital Medical units, were recruited. Subjects who had a history of coronary heart disease or stroke or were prescribed to drugs that could affect blood pressure on the day of the study were excluded. CIMT at a cut-off value of > 0.9 mm was used as a reference measure. Results: The mean values of BPPI and BPP were 0.37±0.06 and 49.17±12.59, respectively. Subjects with BPPI ≥ 0.36 (median value) had higher CIMT (0.81±0.15 versus 0.72±0.14) compared to those with BPPI 0.9 mm were 0.702 (p <0.001) and 0.598 (p =0.001), respectively. Conclusion: BPPI is a valuable predictive tool for subclinical atherosclerosis with higher predictive accuracy compared to BPP.

Prevalence of Peripheral Vascular Disease in Diabetic Foot Infections and its Effect on Management Outcome

Background: Foot infection is a common problem affecting diabetics. Ischemia is a major factor contributing to progress and morbidity of the disease. The prevalence of peripheral vascular disease is higher in diabetics with faster progression.&#x0D; Aim: This study aimed to observe the prevalence of peripheral vascular disease in patients with diabetic foot infections presenting to this tertiary care centre.&#x0D; Methods: This prospective observational study evaluated 250 patients with diabetic foot infection admitted to Ibrahim Medical College and BIRDEM General Hospital, Dhaka, from 1st January 2015 to 31st December 2015.Total 72 patients were selected for Duplex study of lower limb vessels, Ankle Brachial Pressure Index (ABPI) and Pulse oxymetrywhich established the diagnosis of peripheral vascular disease and all patients were treated according to the standard protocol.&#x0D; Results: Of the 72 patients peripheral vascular disease was found in 25 patients (34.7%) and majority of them (88%) had distal below the knee vessel stenosis. There was significant correlation with older age (75%) and history of tobacco use (64%). The clinical presentations and outcomes such as hospital stay, healing time, pain were worse in individuals with peripheral vascular compromise on Duplex study of lower limb vessels, ABPI and pulse oxymetry.&#x0D; Conclusion: In this study we observed that significant number of diabetics presenting with foot infections have underlying peripheral vascular disease .The patients might not all be symptomatic or show obvious signs of PVD but need to be investigated for the same. Early detection of peripheral vascular disease in patients presenting with diabetic foot infection, using Duplex study,ABPI and Pulse oxymetrywith routine clinical and laboratory assessment can be of great value in long term care of these individuals.&#x0D; J Bangladesh Coll Phys Surg 2020; 38(1): 12-17

Association Between Central Blood Pressure and Subclinical Cerebrovascular Disease in Older Adults.

Elevated blood pressure (BP) level is one of the most consistently identified risk factors for silent brain disease. BP values obtained at the proximal segment of the aorta (central BP) are more directly involved than brachial BP in the pathogenesis of cardiovascular disease. However, the association between central BP and silent cerebrovascular disease has not been clearly established. Participants in the CABL (Cardiovascular Abnormalities and Brain Lesions) study (n=993; mean age, 71.7±9.3 years; 37.9% men) underwent 2-dimensional echocardiography, arterial wave reflection analysis for determination of central BPs, and brain magnetic resonance imaging. Central BPs were calculated from the radial pulse waveform. Subclinical silent cerebrovascular disease was defined as silent brain infarction and white matter hyperintensity volume. Both brachial (P=0.014) and central pulse pressure (P=0.026) were independently associated with silent brain infarctions after adjustment for clinical variables, but not adjusting for each other. None of the brachial BP values was associated with upper quartile of white matter hyperintensity volume in multivariable analysis. Both central systolic BP (P<0.001) and central pulse pressure (P<0.001) were significantly associated with upper quartile of white matter hyperintensity volume in multivariable analysis, even after adjustment for brachial BP. In a predominantly older population-based cohort, both brachial and central pulse pressure were independently associated with silent brain infarction. However, higher central systolic BP and central pulse pressure, but not brachial BP, were significantly associated with white matter hyperintensity volume.

Plasminogen activator inhibitor-1 activity and the 4G/5G polymorphism are prospectively associated with blood pressure and hypertension status.

Plasminogen activator inhibitor-1 (PAI-1) has consistently shown positive associations with blood pressure (BP). Whether elevations in PAI-1 levels precede or result from raised BP is still under debate and data on prospective studies are limited. Hence, we investigated the prospective associations of PAI-1 and the 4G/5G polymorphism with brachial and central BP and pulse pressure (PP) over a 10-year period. Black South Africans aged 30 years and older were included. Baseline data collection commenced in 2005 (n = 2010) with follow-up data collection in 2010 (n = 1288) and 2015 (n = 926). Plasma PAI-1 activity (PAI-1act), 4G/5G polymorphism genotyping, waist circumference and BP measurements were performed and analysed using sequential regression and mixed models. In multivariable adjusted analyses, PAI-1act and the 4G/4G (vs. the 5G/5G) genotype increased the odds of developing hypertension in the total group [1.04 (1.01; 1.08) and 1.82 (1.07; 3.12) respectively]. Furthermore, PAI-1act was prospectively associated with brachial SBP (r = 0.0815) and PP (r = 0.0832) in the total group, and with central PP in women (r = 0.1125; all P < 0.05). Addition of waist circumference to the models either decreased or nullified the contribution of PAI-1act to BP and hypertension development. PAI-1act and the 4G/4G (vs. the 5G/5G) genotype increased the odds of developing hypertension. Furthermore, PAI-1act associated prospectively with both brachial and central BP. These associations were mediated in part by central adiposity. The study supports the hypothesis that PAI-1 also contributes to hypertension development rather than solely being a consequence thereof.