Central Aortic Blood Pressure Research Articles

Accuracy of methods to estimate central aortic SBP via upper arm cuff: a systematic review and meta-analysis.

Central aortic BP may predict cardiovascular outcomes better than upper arm brachial BP. In recent years, technology has enabled central BP estimation by recording a peripheral BP waveform from a standard upper arm cuff. The accuracy of these devices is not well documented, and this study aimed to address this issue. This study was a systematic review, conducted according to PRISMA guidelines, of observational studies published between 2008 and 2023 that reported accuracy testing of cuff-based central BP devices, compared with reference invasive aortic BP. The primary analysis was stratified according to each commercially available device. Pooled estimates were calculated using random-effects models based on mean differences and standard errors. Six thousand four hundred and fifteen studies were screened, and 27 studies met inclusion criteria (plus one unpublished study). This generated data for seven devices that are commercially available, which were tested among 2125 adult participants. There was very high heterogeneity when all devices were pooled (I2 = 97.5%), and, when stratified by device, the accuracy of estimated central BP was highly device-dependent (range of accuracy across different devices -12.4 mmHg (-16.3 to -8.5) to 3.2 mmHg (0.2-6.1). Two of the seven commercially available devices had not undergone external validation testing. The accuracy of commercially available cuff-based central BP devices is highly device-specific and not all are accurate for the estimation of central SBP. These findings have major implications for the appropriate interpretation of studies that use cuff-based estimated central BP.

Assessment of inflammatory biomarkers and risk factors for cardiovascular diseases in overweight and obesity

Aim. To study biomarkers of inflammation in overweight and obese individuals.Material and methods. A total of 180 people with overweight or obesity were included. Anthropometric and biochemical parameters were determined in all patients. The concentrations of C-reactive protein (CRP), fibrinogen, interleukin (IL)-6, IL-10, and tumor necrosis factor alpha (TNF-α) were studied.Results. The following significant correlations have been established: IL-6 — with the levels of central aortic pressure, systolic and diastolic blood pressure (BP), heart rate (HR), levels of glucose, uric acid, low-density lipoprotein cholesterol (LDL-C); TNF-α — with concentrations of uric acid, triglycerides, cystatin C, creatinine and glomerular filtration rate; CRP — with body mass index, diastolic BP, heart rate, levels of uric acid, LDL-C, cystatin C. A significant correlation of IL-6, IL-10 and TNF-α with the proteinuria level was established.Conclusion. In individuals with overweight or obesity, a direct correlation was found between serum concentrations of IL-6 and levels of BP, heart rate, lipids, carbohydrates, uric acid and proteinuria. In overweight or obesity, the serum TNF-α level has a direct correlation with hyperuricemia, hyperfibrinogenemia, hypertriglyceridemia, proteinuria and reduced renal filtration function, and the level of CRP is associated with an increase in diastolic BP, heart rate, uric acid, fibrinogen, LDL-C and cystatin C.

Optimization and validation of a suprasystolic brachial cuff-based method for noninvasively estimating central aortic blood pressure.

Clinical studies have extensively demonstrated that central aortic blood pressure (CABP) has greater clinical significance in comparison with peripheral blood pressure. Despite the existence of various techniques for noninvasively measuring CABP, the clinical applications of most techniques are hampered by the unsatisfactory accuracy or large variability in measurement errors. In this study, we proposed a new method for noninvasively estimating CABP with improved accuracy and reduced uncertain errors. The main idea was to optimize the estimation of the pulse wave transit time from the aorta to the occluded lumen of the brachial artery under a suprasystolic cuff by identifying and utilizing the characteristic information of the cuff oscillation wave, thereby improving the accuracy and stability of the CABP estimation algorithms under various physiological conditions. The method was firstly developed and verified based on large-scale virtual subject data (n = 800) generated by a computational model of the cardiovascular system coupled to a brachial cuff, and then validated with small-scale in vivo data (n = 34). The estimation errors for the aortic systolic pressure were -0.05 ± 0.63 mmHg in the test group of the virtual subjects and -1.09 ± 3.70 mmHg in the test group of the patients, both demonstrating a good performance. In particular, the estimation errors were found to be insensitive to variations in hemodynamic conditions and cardiovascular properties, manifesting the high robustness of the method. The method may have promising clinical applicability, although further validation studies with larger-scale clinical data remain necessary.

Efficacy of beta-blockers on blood pressure control and morbidity and mortality endpoints in hypertensives of African ancestry: an individual patient data meta-analysis.

Compared with first-line antihypertensives, beta-blockers (BB) have been reported to lower the central aortic blood pressure suboptimally and are associated with increased stroke risk. This observation has not been investigated in hypertensives of African ancestry. We hypothesised that an individual patient data meta-analysis (IPD-MA) on the efficacy of second- or third-generation beta-blockers (STGBBs) in hypertensives of African descent may provide new insights. A single-stage IPD-MA analysed the efficacy of STGBB in lowering the mean arterial blood pressure and reducing the composite outcomes: cardiovascular death, stroke, and myocardial infarction. A total of 11,860 participants from four randomised control trials were included in the analysis. Second- or third-generation beta-blockers reduced the mean arterial pressure by 1.75 mmHg [95% confidence interval (CI):1.16-2.33; P < 0.001] in all participants included in the analysis, and by 1.93 mmHg (95% CI: 0.86-3.00; P < 0.001) in hypertensive Africans. In patients with established cardiovascular disease, where the benefits of BB therapy are well established, STGBBs were associated with an adjusted odds ratio of 1.33 (95% CI: 1.06-1.65; P = 0.015) of the composite outcome, most likely due to confounding. Similarly, the risk of total myocardial infarction was 1.76 times higher (95% CI: 1.15-2.68; P = 0.008) in hypertensives of African ancestry on STGBBs. The STGBBs reduced the mean arterial pressure comparably to other antihypertensives, and they were not associated with an increased risk of stroke.

Invasively Measured Aortic Systolic Blood Pressure and Office Systolic Blood Pressure in Cardiovascular Risk Assessment in CKD

IntroductionCentral aortic blood pressure (BP) could be a better risk predictor than brachial BP. This study examined whether invasively measured aortic systolic BP improved outcome prediction beyond risk prediction by conventional cuff-based office systolic BP in patients with and without chronic kidney disease (CKD). MethodsIn a prospective, longitudinal cohort study aortic and office systolic BPs were registered in patients undergoing elective coronary angiography. CKD was defined as estimated glomerular filtration rate <60 ml/min/1.73 m2. Multivariable Cox models were used for the association with incident myocardial infarction (MI), stroke, and death. ResultsAortic and office systolic BPs were available in 39,866 patients (mean age: 64 years; 58% males; 64% with hypertension) out of which 6,605 (17%) had CKD. During a median follow-up of 7.2 years (interquartile range: 4.6-10.1 years), 1,367 strokes (CKD: 353), 1,858 MIs (CKD: 446) and 7,551 deaths (CKD: 2,515) occurred. CKD increased the risk of stroke, MI and death significantly. Office and aortic systolic BP were both associated with stroke in non-CKD patients (adjusted hazard ratios with 95% confidence interval per 10 mmHg: 1.08 (1.05–1.12) and 1.06 (1.03–1.09), respectively) and with MI in CKD patients (adjusted hazard ratios: 1.08 (1.03–1.13) and 1.08 (1.04–1.12), respectively). There was no significant difference between prediction of outcome with office or aortic systolic BP when adjusted models were compared with C-statistics. ConclusionRegardless of CKD status, invasively measured central aortic systolic BP does not improve the ability to predict outcome compared with brachial office BP measurement.

Pulse wave analysis measurements: important, underestimated and undervalued parameters in cardiovascular health problems.

Central aortic stiffness is established as a reliable measure of cardiovascular disease. While pulse wave velocity (PWV) analysis measures arterial distensibility, risk profile of cardiovascular diseases can be expanded with following pulse wave analysis measurements: central aortic systolic blood pressure (CABPS), central aortic pulse pressure (CAPP), central aortic reflection magnitude (CARM), central aortic augmented pressure (CAAP) and central aortic augmentation index (CAAIx). The aim of this study is to evaluate the clinical usefulness and importance of pulse wave analysis measurements in specific cardiovascular conditions and diseases, both in term of diagnosis and therapeutic monitoring. One thousand sixty-six subjects were included. According to age bracket, four cohorts were investigated-healthy subjects (NL), hypertensive patients (HP), ischemic heart disease (IHD) and valvular heart disease (VHD) patients. Arterial stiffness was analyzed through Sphygmocor XCEL Central Blood Pressure Measurement System and Sphygmocor XCEL PWV Measurement System. Furthermore we observed the pulse wave analysis measurements of 14 patients with diagnose of ADHD who were referred by a child psychiatrist, in order to investigate the initiation of methylphenidate treatment. Statistically significant differences were found between NL and HP cohorts, across almost all age brackets, regarding pulse wave analysis measurements. In the risk stratification of arterial stiffness hypertension and especially central aortic blood pressure systolic (CABPS) seems a determining factor. Pulse wave analysis measurements for IHD and VHD cohort comparisons with NL counterparts, revealed non- statistically significant variations. Elevated CAAP, CAAIx and CARM within the youngest age group (0-10 years) in attention-deficit-hyperactivity-disorder (ADHD) patients warrant attention. Following such investigations, CABPS appears as a robust predominant factor in problems of arterial stiffness. Pulse wave analysis and PWV are important parameters in the evaluation and monitoring of arterial hypertension and cardiovascular diseases. There is a hypothesis that CAAP could be an important and even decisive parameter in the diagnosis of ADHD. Further investigation needed.

On the similarity between aortic and carotid pressure diastolic decay: a mathematical modelling study

Aortic diastolic pressure decay (DPD) has been shown to have considerable pathophysiological relevance in the assessment of vascular health, as it is significantly affected by arterial stiffening. Nonetheless, the aortic pressure waveform is rarely available and hence the utility of the aortic DPD is limited. On the other hand, carotid blood pressure is often used as a surrogate of central (aortic) blood pressure in cardiovascular monitoring. Although the two waveforms are inherently different, it is unknown whether the aortic DPD shares a common pattern with the carotid DPD. In this study, we compared the DPD time constant of the aorta (aortic RC) and the DPD time constant of the carotid artery (carotid RC) using an in-silico-generated healthy population from a previously validated one-dimensional numerical model of the arterial tree. Our results demonstrated that there is near-absolute agreement between the aortic RC and the carotid RC. In particular, a correlation of ~ 1 was reported for a distribution of aortic/carotid RC values equal to 1.76 ± 0.94 s/1.74 ± 0.87 s. To the best of our knowledge, this is the first study to compare the DPD of the aortic and the carotid pressure waveform. The findings indicate a strong correlation between carotid DPD and aortic DPD, supported by the examination of curve shape and the diastolic decay time constant across a wide range of simulated cardiovascular conditions. Additional investigation is required to validate these results in human subjects and assess their applicability in vivo.

A study on transfer function to estimate the central aortic blood pressure waveform

Noninvasive measurement of the central aortic blood pressure has become an important technique that has generated a lot of interest around the medicine industry because it can estimate the central aortic blood pressure waveform without inserting a pressure-sensing catheter into the ascending aorta. The accuracy of noninvasive estimation of aortic hemodynamics and cardiac contractility is still debatable in noninvasive measurement of the central aortic blood methods. The objective of this project is to investigate the transfer functions available for converting radial blood pressure waveforms to central aortic blood pressure waveforms. In this project, three different transfer functions will be investigated which are The Generalized Transfer Function, N-Point Moving Average and Adaptive Transfer Function in order to recommend the effective method in terms of accuracy. The study methodology will be conducted through the software MATLAB R2021b. The investigation of these three methods will be conducted with data collected from virtual subjects from the HaeMod database. The Generalized transfer function, N-Point Moving Average and Adaptive Transfer Function will be coded, evaluated, and analyzed as part of the methodology. The determination of the most effective method among the three transfer functions will be attributed according to output comparison of Systolic peak differences, the RMSE and the MAPE between the estimated central aortic blood pressure and the measured central aortic blood pressure.

Central Aortic Blood Pressure Waveform Estimation with a Temporal Convolutional Network.

A novel temporal convolutional network (TCN) model is utilized to reconstruct the central aortic blood pressure (aBP) waveform from the radial blood pressure waveform. The method does not need manual feature extraction as traditional transfer function approaches. The data acquired by the SphygmoCor CVMS device in 1,032 participants as a measured database and a public database of 4,374 virtual healthy subjects were used to compare the accuracy and computational cost of the TCN model with the published convolutional neural network and bi-directional long short-term memory (CNN-BiLSTM) model. The TCN model was compared with CNN-BiLSTM in the root mean square error (RMSE). The TCN model generally outperformed the existing CNN-BiLSTM model in terms of accuracy and computational cost. For the measured and public databases, the RMSE of the waveform using the TCN model was 0.55 ± 0.40 mmHg and 0.84 ± 0.29 mmHg, respectively. The training time of the TCN model was 9.63 min and 25.51 min for the entire training set; the average test time was around 1.79 ms and 8.58 ms per test pulse signal from the measured and public databases, respectively. The TCN model is accurate and fast for processing long input signals, and provides a novel method for measuring the aBP waveform. This method may contribute to the early monitoring and prevention of cardiovascular disease.

INVASIVE VALIDATION OF THE ANTARES ALGORITHM FOR ESTIMATING CENTRAL BLOOD PRESSURE IN PATIENTS WITH CHRONIC KIDNEY DISEASE

Objective: Chronic kidney disease (CKD) is characterized by decreased renal autoregulatory capacity, increased proteinuria, and direct transmission of systemic blood pressure to the glomeruli. Thereby, an increase in central (aortic) blood pressure (cBP) accelerates the progression of CKD. Antares is a pulse wave analysis algorithm designed to allow a non-invasive estimation of cBP using automated oscillometric blood pressure devices. We aimed to compare the invasively measured cBP with the estimated cBP using the Antares algorithm in patients with CKD. Design and method: 26 patients with stages 3-5 CKD (eGFR &lt;60 ml/min/1.73m2, 88% stage 3 CKD, age 78±9 years, BMI 29±5 kg/m2, 65% male) were included and cBP was measured invasively during elective coronary angiography and simultaneously non-invasively using the custo screen 400 device (custo med GmbH, Ottobrunn, Germany) with the integrated Antares algorithm (Redwave Medical GmbH, Jena, Germany). Results: The mean difference for cBP was -0.7 ± 6.3 mmHg for central systolic BP (cSBP), -2.0 ± 5.1 mmHg for central mean arterial pressure (cMAP) and -4.2 ± 7.2 mmHg for central diastolic BP (cDBP). High correlations were found between estimated and invasively measured cBP (cSBP, r = 0.96; cMAP, r = 0.92; cDBP, r = 0.77; all p&lt;0.001). Conclusions: The present study demonstrates that the Antares algorithm can estimate cBP with high accuracy in patients with CKD. Measurement of cBP and subsequent therapeutic interventions could improve renal and cardiovascular prognosis in these patients.

Accuracy of Estimated Central Systolic Blood Pressure and Augmentation Index in Patients With Type 2 Diabetes Mellitus

It has been suggested that transfer functions to estimate central aortic systolic blood pressure (SBP) and central BP waveform parameters (i.e., augmentation index) may be less accurate in patients with type 2 diabetes mellitus (T2DM). However, these observations have not been confirmed in a large sample, which was the aim of this study. Consecutive patients with and without T2DM undergoing coronary angiography at the Royal Hobart Hospital had BP recorded at the ascending aorta and radial artery with a fluid-filled catheter. Radial BP waveforms were processed using the SphygmoCor Cardiovascular Management System (CVMS) transfer function (AtCor, Sydney) to estimate central BP. Two invasive waveform calibration methods were used: 1) aortic mean arterial pressure/diastolic BP (MAP/DBP); and 2) radial SBP and DBP (SBP/DBP). between-group analyses were performed unadjusted and adjusted for age, sex, hypertension, hypercholesterolaemia, body mass index, and coronary artery disease. Data from 64 patients with T2DM (61±11 years, 73% male) and 186 patients without T2DM (62±8 years, 70% male) were analysed. There was no difference in the accuracy of estimated central SBP between groups when compared with invasive aortic SBP from MAP/DBP calibration (T2DM –1.8±6 mmHg vs –1.1±5 mmHg; p=0.37; adjusted p=0.59) or radial SBP/DBP calibration (T2DM –1.2±9 mmHg vs –2.0±9 mmHg; p=0.57; adjusted p=0.66). Augmentation index was not significantly different between patients with and without T2DM 0.8±12% vs 3.7±14%; p=0.13, respectively). Estimated central SBP and augmentation index do not appear to be less accurate in patients with T2DM when waveforms are calibrated with invasive BP.

CHARACTERISTIC OF RESPONDERS TO RENAL DENERVATION - CROATIAN REAL-LIFE STUDY

Objective: Heterogeneity in response to renal denervation (RDN) is acknowledged phenomena and one of most important tasks in this field is to find reliable predictive biomarker for positive response. Our aim was to analyse characteristics of resistant hypertensive patients who were responders 6 months after RDN. Design and method: Out of 31 truly resistant patients whom secondary forms of hypertension were ruled out and were enrolled into the Croatian Spyral RDN registry, 18 (10 m, 8 w, average age 49.3) were eligible for analyses. Office BP, ABPM, central BP and PWV were measured with Omron M6, Molbilograph and Sphygmocor devices, respectively. Sympathetic/parasympathetic activity was measured with ANX-3.0 ANSAR device. Results: Responders were 6.7 years older, less obese with at basal slightly higher eGFR (88.6 vs. 79.8), uric acid (406.5 vs. 376.4), salt intake (12.6 g/day vs.9.8 g/day) and had significantly higher basal office BP (169.5/99.7 vs. 153.3/96.5) as well as ABPM values. Central aortic systolic BP and Aix were higher in responders (154.5 vs, 147.1; 31.5 vs 27.3) without difference in PWV (10.1 vs. 9.6). Responders had lower values of PP amplification (1.22 vs. 1.33). Significantly higher basal sympathetic activity (LFa/RFa) was determined in responders than in non-responders (6.68 vs. 1.25). Conclusions: Responders were older with higher basal office BP, ABPM but also higher central BP and Aix with lower pulse pressure amplification. They ingested more salt, had higher values of uric acid and importantly had more exaggerated sympathetic activity. Whether some of identified parameters could be considered as a biomarker for positive response in resistant hypertensive patients should be determined in larger cohort of patients.

IMPACT OF DIABETES MELLITUS ON ARTERIAL STIFFNESS, AND PULSATILE HEMODYNAMICS IN HEART FAILURE WITH PRESERVED EJECTION FRACTION

Objective: The aim of the current study was to characterize different parameters of arterial stiffness and pulsatile hemodynamics in patients with arterial hypertension and metabolic syndrome according the presence of diabetes mellitus and diastolic dysfunction. Design and method: 121 consecutive patients with left ventricular ejection fraction &gt; 40% were included in the study. LV diastolic function was assessed using pulsed wave Doppler on transthoracic echocardiography. Brachial-ankle pulse wave velocity (baPWV) and the cardio-ankle vascular index (CAVI) was measured using a VaSera VS-1500® device (Fukuda Denshi). Ambulatory BP monitoring over 24 hours was performed using the Mobilograph device (IEM, Stolberg, Germany) which measures brachial and central (aortic) BP, as well as time-resolved waveforms, allowing for ambulatory pulse wave analysis (including wave separation into forward and backward waves and reflection magnitude) Results: Among 121 patients included, diabetes mellitus was present in 55 (54.5%) and diastolic dysfunction in 54 (45.4%). The presence of impaired myocardial relaxation on echocardiography was associated with markedly increase of arterial stiffness parameters – CAVI (8.7 vs 8.1, p = 0.03), PWV (8.8 vs 7.9, p = 0.001), central hemodynamics - central SBP (129.4 vs 114 mmHg, p&lt;0.001), cardiac output and total peripheral resistance (1.34 vs 1.25, p = 0.001) and pulsatile hemodynamics - with reduced reflection magnitude (60.7 vs 63, p = 0.04). Diabetic subjects with HFpEF exhibited a markedly greater left ventricular wall thickness and left atrium size on echocardiography. Pronounced aortic stiffening was also observed in the diabetic group (pulse wave velocity, 8.7 vs 7.9, p, 0.001; cardio-ankle vascular index, 9.1 vs 7.8, p&lt;0.001), with an adverse pulsatile hemodynamic profile characterized by increased forward and backward wave amplitude and reduced reflection magnitude (61 vs 64.8, p = 0.05). Conclusions: The presence of diastolic dysfunction is associated with changes of arterial stiffness and pulsatile hemodynamics. Diabetes mellitus is a key determinant of left ventricular remodeling, arterial stiffness, adverse pulsatile hemodynamics, and ventricular-arterial interactions in HFpEF.

EFFICACY OF BETA-BLOCKERS ON BLOOD PRESSURE CONTROL, MORBIDITY AND MORTALITY ENDPOINTS IN HYPERTENSIVES OF AFRICAN ANCESTRY: AN INDIVIDUAL PATIENT DATA META-ANALYSIS

Objective: Beta-blockers have been reported to sub-optimally lower central aortic blood pressure and cause an increased stroke incidence. There is a paucity of data regarding beta-blocker efficacy in patients of African origin. We proposed that an individual patient data meta-analysis (IPD-MA) focusing on the efficacy of traditional and second or third-generation beta-blockers (STGBBs) in the whole and African hypertensive population may provide new insights. Design and method: A single-stage IPD-MA analysed the efficacy of STGBBs in the setting of other anti-hypertensives for lowering mean arterial pressure (MAP) and reducing the occurrence of composite outcome (total cardiovascular mortality, stroke and myocardial infarction). Results: A total of 11860 participants were included in the analysis, of which 3864 (32.5%) were on STGBB. STGBBs reduced the MAP by 1.75 mmHg (95% confidence interval (CI): 1.16 - 2.33; p&lt;0.001) in the whole population and by 1.93 mmHg (95% CI: 0.86 - 3.00; p&lt;0.001) in 3880 African hypertensives, outperforming angiotensin-converting enzyme inhibitors (ACE-I) in the whole population studied and ACE-I and calcium channel blockers in the African population. Confounding through beta-blocker use in established cardiovascular disease resulted in STGBBs being associated with an adjusted odds ratio of 1.33 (95 % CI: 1.06 - 1.65; p = 0.015) of the composite outcome while controlling for age, gender, race and smoking history. STGBBs were not associated with an increase in the odds of stroke in African hypertensives nor the whole population. Conclusions: STGBBs reduced the MAP comparably to other anti-hypertensives. No increase in the odds of stroke was found.

Non-invasive central aortic pressure measurement: what limits its application in clinical practice?

The following article highlights the need for methodological transparency and consensus for an accurate and non-invasive assessment of central aortic blood pressure (aoBP), which would contribute to increasing its validity and value in both clinical and physiological research settings. The recording method and site, the mathematical model used to quantify aoBP, and mainly the method applied to calibrate pulse waveforms are essential when estimating aoBP and should be considered when analyzing and/or comparing data from different works, populations and/or obtained with different approaches. Up to now, many questions remain concerning the incremental predictive ability of aoBP over peripheral blood pressure and the possible role of aoBP-guided therapy in everyday practice. In this article, we focus on "putting it on the table" and discussing the main aspects analyzed in the literature as potential determinants of the lack of consensus on the non-invasive measurement of aoBP.

Racial Differences in Blood Pressure and Autonomic Recovery Following Acute Supramaximal Exercise in Women.

Despite the growing popularity of high-intensity anaerobic exercise, little is known about the acute effects of this form of exercise on cardiovascular hemodynamics or autonomic modulation, which might provide insight into the individual assessment of responses to training load. The purpose of this study was to compare blood pressure and autonomic recovery following repeated bouts of acute supramaximal exercise in Black and White women. A convenience sample of twelve White and eight Black young, healthy women were recruited for this study and completed two consecutive bouts of supramaximal exercise on the cycle ergometer with 30 min of recovery in between. Brachial and central aortic blood pressures were assessed by tonometry (SphygmoCor Xcel) at rest and 15-min and 30-min following each exercise bout. Central aortic blood pressure was estimated using brachial pressure waveforms and customized software. Autonomic modulation was measured in a subset of ten participants by heart-rate variability and baroreflex sensitivity. Brachial mean arterial pressure and diastolic blood pressure were significantly higher in Blacks compared to Whites across time (race effect, p = 0.043 and p = 0.049, respectively). Very-low-frequency and low-frequency bands of heart rate variability, which are associated with sympathovagal balance and vasomotor tone, were 22.5% and 24.9% lower, respectively, in Blacks compared to Whites (race effect, p = 0.045 and p = 0.006, respectively). In conclusion, the preliminary findings of racial differences in blood pressure and autonomic recovery following supramaximal exercise warrant further investigations of tailored exercise prescriptions for Blacks and Whites.

Central aortic blood pressure and pulse wave characteristics in patients with decscending thoracic and abdominal aortic aneurysm: features, dynamics, and prognostic significance

Aortic aneurysm (AA) is one of the most formidable cardiovascular diseases, characterized by subtle clinical manifestations and a high risk of complications. Predisposing factors in the development of AA are age, arterial hypertension (HTN), atherosclerosis, and inflammatory aortic diseases. Those are associated with changes in vascular stiffness. HTN causes increased tension in the aortic wall when the pulse wave of blood pressure (BP) rises in patients with AA. Indicators of central BP and vascular stiffness are of particular interest. They present as independent risk factors for cardiovascular events but are poorly studied among patients with AA. The purpose of the review is to summarize the ideas about the relationship of AA with the indicators of vascular stiffness and central hemodynamics in patients with non-operated AA, as well as after endovascular AA repair. Here we discuss the predictive accuracy and applicability of individual markers concerning AA progression and surgical treatment outcomes, as well as unresolved issues and prospects for further research.

Association of hypertriglyceridemia with risk factors for cardiovascular and renal complications in individuals with high cardiovascular risk

Aim. To study clinical and functional manifestations of hypertriglyceridemia and its association with risk factors for cardiovascular and renal complications in individuals with high cardiovascular risk.Material and methods. The study included 272 patients (129 men and 143 women; mean age, 53,9±13,7 years) with a high cardiovascular risk, which was stratified using Systematic Coronary Risk Evaluation (SCORE) model by the presence of cardiovascular disease, and/or diabetes, and/or age ≥65 years, and/or blood pressure (BP) &gt;180/110 mm Hg, and/or total cholesterol (TC) level &gt;8,0 mmol/l. All study participants underwent clinical and paraclinical examination. Serum content of triglycerides (TGs) ≥1,7 mmol/L was considered hypertriglyceridemia (HTG). Depending on TG level, the entire sample was divided into 2 following subgroups: subgroup 1 (n=178) — serum triglycerides ≤1,6 mmol/l; subgroup 2 (n=94) — serum triglycerides ≥1,7 mmol/l, i.e. HTG.Results. We revealed significantly more persons with obesity (46,8%) and type 2 diabetes (28,7%) in HTG subgroup. There were 56,3% and 36,1% patients of HTG subgroup with hypertension (HTN) and coronary artery disease (CAD), respectively. A mid-high TG level (from 1,7 to 2,3 mmol/l) in the subgroup of patients with HTG was detected in 38,3% of cases. The serum content of TG from 2,3 to 5,6 mmol/l was detected in 54,2% of patients. TG level ≥5,6 mmol/l was detected in 7,5% of cases. In the subgroup of patients with HTG, high levels of systolic, diastolic and central (aortic) BP, body mass index, phosphorus, creatinine, cystatin C, estimated glomerular filtration rate (eGFR), and carotid intima-media thickness (IMT) were detected significantly more common. In the general sample, a significant direct relationship between TG concentration and cystatin C (r=0,168) and an inverse (negative) relationship with eGFR (r=-0,220) was obtained.Conclusion. Elevated serum TG levels are often observed in individuals with obesity, type 2 diabetes, hypertension and CAD. Patients with HTG had a pronounced cardiovascular and renal risk, including a significant increase in BP and carotid IMT, high levels of total cholesterol, low-density lipoprotein cholesterol, phosphorus, creatinine, cystatin C, and a decrease in eGFR. HTG was associated with an increase in serum cystatin C and a deterioration in renal nitrogen excretion.

PS-C04-11: EFFECT OF ANKLE BRACHIAL INDEX EXAMINATION ON CENTRAL AORTIC BLOOD PRESSURE IN PATIENTS WITH PERIPHERAL ARTERY DISEASE

Background: Ankle brachial index (ABI) measurements are useful for detecting peripheral artery disease (PAD) as a screening test. In general, ABI examinations are contraindicated in patients with aortic aneurysm and history of aortic aneurysm. However, little is known whether ABI examinations elevate central aortic blood pressure (CBP). Method: From June 2018 to August 2020, we prospectively analyzed 66 patients who were performed cardiac catheterization through femoral approach and divided into peripheral artery disease complicated (PAD, N = 27) and uncomplicated (non-PAD, N = 39) groups. After insertion of pigtail catheter into both ascending (Asc), abdominal (Abd) positions, resting CBPs at Asc and Abd were measured. Subsequently, we measured each CBP during ABI, respectively. We compared resting CBP (R-CBP) and CBP during ABI (ABI-CBP) between PAD and non-PAD groups. Results: In non-PAD group, ABI-CBP at Abd was significantly higher than BL-CBP (P &lt; 0.05). On the other hand, there were no significant ABI-CBP elevation at Asc and Abd in PAD. There was no case with CBP elevation more than 20mmHg during ABI measurements in both groups. Furthermore, no clinical events were observed after ABI measurements in both groups. Conclusion: ABI was considered a safe testing in patients with suspected PAD.

Invasive validation of the Antares algorithm for determining central blood pressure based on upper arm oscillometric pulse waves in patients with type 2 diabetes

IntroductionAntares is a pulse wave analysis (PWA) algorithm designed to allow a non-invasive estimation of central (aortic) blood pressure (cBP) using automated oscillometric blood pressure (BP) devices. Diabetes may affect...