Central Augmentation Index Research Articles

963. Non-Invasive Detection of Cardiovascular Risk in People Living with HIV in Miami

BackgroundHIV is a risk factor for Cardiovascular Disease (CVD), and CVD is the leading cause of mortality among Hispanics (H). Hispanics in the US are disproportionately affected by HIV with higher rates of HIV related morbidity and mortality, as well as adverse CVD outcomes. This study sought to identify early markers of CVD risk among Hispanics living with HIV.MethodsInterim analysis of 38 H and non-Hispanics (NH) people living with HIV (PLWH), stable on antiretroviral regimen, 30-50 years of age, without previously detected CVD. Demographics, CD4 T cells, HIV RNA viral load, traditional early markers of CVD risk were collected. CVD risk markers were obtained with non-invasive tools: epicardial adipose tissue (EAT) thickness was assessed by echocardiogram; arterial stiffness was assessed by applanation tonometry sequentially at the carotid, femoral and radial arteries (including central augmentation index - AI, peripheral AI, radial pulse wave velocity - PWV, and femoral PWV). The Framingham Coronary Event Risk Score (FCER) was calculated for each subject. Descriptive and linear regression analysis for predictors of FCER measures were age adjusted.ResultsAmong the 38 participants enrolled the mean age was 42 years, 80% male, H 76%, NH 24%, Black 16%, with mean BMI of 26.7. 45% met clinical criteria for metabolic syndrome: high waist girth 24%, high blood pressure 18%, high Fasting Glucose 16%, high total cholesterol 21%, high triglycerides 26%, low HDL 45%, high LDL 18%, high TC/HDL ratio 68%. The mean EAT was 3.8 mm, mean central AI 20.2 %, mean peripheral AI 73%, mean femoral PWV 28.8 m/s, mean radial PWV 8.7 m/s. Older age was associated with greater central AI (r = 0.37, p =.01) and peripheral AI (r = 0.38, p =.01) but not with increased EAT. Regression analysis predicting FCER relationships showed radial PWV as an independent predictor of increased FCER (r = 0.36, p < .05).ConclusionRisk factors leading to CVD are common among this group of PLWH and radial PWV is a moderate predictor of increased FCER. Although measures of arterial stiffness are available, they are not routinely used to assess CVD risk. Further studies should evaluate the use of noninvasive methods for diverse PLWH, to prevent the development of CVD.Disclosures All Authors: No reported disclosures

Recovery Responses of Central Hemodynamics in Basketball Athletes and Controls After the Bruce Test.

PurposeIt is commonly believed that central hemodynamics is closely associated with the presence of cardiovascular events. However, controversial data exist on the acute response of competitive sports on central hemodynamics. Moreover, the central hemodynamic response to exercise is too transient to be investigated. Therefore, this study aimed to investigate the central hemodynamic response in young basketball athletes and controls after 1 h recovery after exercise.MethodsFifteen young basketball athletes and fifteen aged-matched controls were recruited to perform the Bruce test. Central hemodynamics were measured and calculated, including heart rate (HR), aortic systolic, diastolic, and pulse pressure (ASP, ADP, and APP), ejection duration (ED), sub-endocardial viability ratio (SEVR), central augmentation index (AIx), and AIx@HR75. Intra-group and inter-group differences were analyzed by two-way repeated measures ANOVA.ResultsASP significantly decreased at 10 min after exercise in athletes, while it markedly declined at 15 min after exercise in controls (p < 0.01). Additionally, only in the athlete group, ADP significantly decreased at 50 min and at 1 h after exercise. AIx was also significantly reduced at 1–2, 20, 30, and 40 min after exercise (all p < 0.05). Moreover, there were significant differences in the changes of these parameters between the two groups at these measurement points (p < 0.05). SEVR significantly recovered to the baseline level after 30 min, while ED and HR returned to baseline levels at 40 min after exercise in both groups.ConclusionSustained decrease of aortic BPs was sooner after the cessation of exercise in athletes than in controls, and changes of aortic stiffness were more evident in athletes than those in controls during the 1 h recovery period. Additionally, SEVR returned to the baseline sooner than ED and HR in athletes.

Central blood pressure and aortic pulse wave reflection in water-exercised postmenopausal hypertensive women: A cross-sectional study.

Exercise training has been associated with the attenuation of cardiovascular impairment after menopause. This study aimed to compare central and peripheral blood pressure and aortic pulse wave reflection in sedentary and trained (aerobic exercise in the water) hypertensive postmenopausal women. Hypertensive postmenopausal women were divided into sedentary (SED, n=53) and trained groups (TR, n=31). Self-reporting from the trained group presented a mean of 1.7±0.3years of exercise practice in the water. Central blood pressure and amplification indexes (AIx) were obtained by the applanation tonometry of radial and aortic arteries. No changes were observed in systolic blood pressure (SBP) in the TR group than the SED group; however, office diastolic blood pressure (DBP) was reduced compared to the SED group. Central blood pressure and augmentation index (AIx@75%) values were similar in the SED and TR groups. These data suggest that self-reported long-term exercise training in the water could not improve central hemodynamic variables in postmenopausal hypertensive women compared to sedentary ones. However, it should be emphasized that DBP levels were reduced in trained subjects, which might reduce cardiovascular outcomes.

Inhibition of interleukin-6 by tocilizumab improves endothelial glycocalyx and myocardial work index in patients with rheumatoid arthritis

Abstract Background/Introduction Tocilizumab, an interleukin-6 receptor blocker is used for the treatment of rheumatoid arthritis (RA). Purpose We investigated the effects of tocilizumab on endothelial glycocalyx and myocardial function in patients with RA. Methods Eighty patients with RA (age: 64±9 years) were randomized to tocilizumab (n=40) or prednisolone (n=40)for 3 months. We measured at baseline and 3 months post-treatment: a) perfused boundary region (PBR) of the sublingual arterial microvessels (increased PBR indicates reduced glycocalyx thickness), b) pulse wave velocity (PWV-Complior), central systolic blood pressure (cSBP) and augmentation index (AI), c) global LV longitudinal strain (GLS), longitudinal systolic (LongSr) and diastolic (LongSrE) strain rate, d) global myocardial work index (GWI), global constructive (GCW) and global wasted work (GWW) using speckle tracking imaging. Results At baseline, all patients had similar disease activity score and markers of vascular and myocardial function. Compared with baseline, patients under tocilizumab had reduced PBR (2.14±0.2 vs. 1.97±0.2μm), PWV (11±3 vs. 10.3±2m/s), cSBP (134±18 vs. 129±16mmHg) and LongSrE (0.91±0.3 vs. 1±0.3 1/s) at 3 months (p&amp;lt;0.05). There were no statistically significant differences in the above measured markers in patients under prednisolone (p&amp;gt;0.05) (Table). Compared with prednisolone, tocilizumab treatment achieved a greater increase of GLS (8.5% vs. 2.4%), GWI (12.2% vs. 2.7%), GCW (10.3% vs. 5.9%) and a greater reduction of GWW (−30% vs. −13%) (p&amp;lt;0.05 for all comparisons), despite a similar reduction in C-reactive protein post-treatment. The percent decrease of PBR was associated with the percent decrease of cSBP (r=0.46), PWV (r=0.37) and reversely related with the percent improvement of GLS (r=−0.43) and GWI (r=−0.39) (p&amp;lt;0.05). Conclusions IL-6 inhibition by tocilizumab improves endothelial and vascular function leading to a greater increase of effective myocardial work compared to prednisolone in patients with RA. Funding Acknowledgement Type of funding source: None

Haemodynamic characteristics and blood pressure evolution of hypertension subtypes in young to middle age adults

Abstract Aim The prognostic significance of different hypertension subtypes in young hypertensives, in particular of isolated systolic hypertensives (ISHs) is still debated. The aim of the present study was to investigate clinical and haemodynamic characteristics and blood pressure (BP) evolution of different hypertension subtypes in young stage I hypertensives. Methods We investigated 1206 young subjects from the HARVEST study: 81 normotensives (NTs), 146 ISHs, 281 isolated diastolic hypertensives (IDHs) and 698 systolic-diastolic hypertensives (SDHs) according to office BP values at baseline. Data on baseline haemodynamic and metabolic characteristics, BP and heart rate changes during follow-up (mean 7 years) were collected. ANCOVA analysis was used for all comparisons adjusting for age and sex. Results Males were more frequent among ISHs (90.4%) compared to other categories (70.4, 67.3, 71.5% among NTs, IDHs, SHDs). Moreover, ISHs were younger compared to the others (25.6±6.6 years, p&amp;lt;0.001) and thinner compared to SDHs (24.6±.2.6 vs 25.8±3.6 kg/m2, p=0.028). Heart rate was higher among ISHs (75.7±9.4 bpm) and SDHs (75.8±9.7) compared to other categories (p&amp;lt;0.001). Metabolic characteristics were not significantly different among groups. ISHs were more active in sports (55.5%) and drank less alcohol compared to others (p&amp;lt;0.001, p=0.05 respectively). Systolic white coat effect was higher among ISH (17.6±12.4 mmHg) compared to others (p&amp;lt;0.001), as was cardiac output ISH (6.3±1.2 ml/min) compared to NTs and IDHs (p&amp;lt;0.001); Peripheral resistances were similar in ISHs and NTs and were lower than in IDHs and SDHs (p&amp;lt;0.001). Small and large artery compliance was higher, central systolic BP and augmentation index were lower among NTs and ISHs compared to IDHs and SDHs, even if these differences were not statistically significant. During follow-up systolic BP decreased (−7.6±14.4 mmHg) among ISHs, while it increased among NTs and IDHs (p&amp;lt;0.001). Heart rate decreased in all categories but to a higher extent among ISHs (−3.8±10.9 bpm) and SDHs (−3.4±10.8 bpm) (p=0.002 vs others). Changes in diastolic BP were similar among ISHs and NTs and higher than those observed among IDHs and SDHs (p&amp;lt;0.001). The percent of patients who started pharmacological treatment during follow-up was 70.6% among SDHs, 54.1% among IDHs, 41.1% among ISHs, and 39.5% among NTs (p&amp;lt;0.001). Conclusions ISHs had increased cardiac output and white coat effect and lower peripheral resistances compared to other hypertension subtypes while distensibility parameters did not differ significantly among groups. The percent of patients who developed hypertension needing treatment was lower among ISHs than other hypertensives. This was due to a favourable time course of BP during follow-up. Longer follow-ups are needed to confirm the lower risk profile of ISH of the young Funding Acknowledgement Type of funding source: None

Sodium-glucose cotransporter-2 inhibitors and their combination with glucagon like peptide-1 receptor agonists improve endothelial glycocalyx and arterial stiffness in type-2 diabetes

Abstract Background/Introduction Type-2 diabetes mellitus (T2DM) is associated with endothelial and arterial dysfunction. Purpose We investigated the effects of insulin, glucagon like peptide-1 receptor agonists (GLP-1RA), sodium-glucose cotransporter-2 inhibitors (SGLT-2i)and their combination on endothelial and arterial function of T2DM patients. Methods A hundred-sixty T2DM patients (age: 58±10 years) were randomized to insulin (n=40), liraglutide (n=40), empagliflozin (n=40) or their combination (GLP-1RA+SGLT-2i) (n=40)as add-on to metformin. We measured at baseline, 4 and 12 months post-treatment: a) perfused boundary region (PBR) of the sublingual arterial microvessels (ranged from 5 to 25μm) using Sideview Darkfield imaging. Increased PBR indicates reduced glucocalyx thickness, b) pulse wave velocity (PWV-Complior), central systolic blood pressure (cSBP) and augmentation index (AI) of the aortic pulse wave. Results Twelve months post-treatment, all patients improved PBR, PWV and AI (p&amp;lt;0.05). GLP-1RA, SGLT-2i and their combination showed a greater reduction of PBR, PWV and cSBP than insulin, despite a similar HbA1c reduction (p&amp;lt;0.05). SGLT-2i or combined therapy with GLP-1RA and SGLT-2i showed a greater decrease of PWV (−10.1% and −13% vs. −3.6% and −8.6%) and cSBP (−3% and −5.5% vs. −0.8% and −1.5%)than insulin or GLP-1RA (p&amp;lt;0.05 for all comparisons). GLP-1RA or GLP-1RA+SGLT-2i provided a greater decrease of AI (−42.7% and −48.6% vs. +6.2% vs. −3.8%) compared with insulin or SGLT-2i (Table). The dual therapy showed the greatest effect on measured markers in patients with LVEF &amp;lt;55% (p&amp;lt;0.05). Conclusions Twelve-month treatment with SGLT-2i and its combination with GLP-1RA, showed a greater improvement on arterial elastic properties than GLP1RA or insulin treatment in T2DM. The combined therapy as second line was superior to either insulin, or GLP-1RA and SGLT-2i separately. Funding Acknowledgement Type of funding source: None

Effects of electronic cigarette on platelet and vascular function after one month of use

Abstract Background and aims Smoking is a major factor that contributes to the development of cardiovascular disease. Smoking cessation delays progress of coronary artery disease. Electronic cigarette is proposed as a bridge to smoking cessation. We examined its effects on platelet function after 1 month of use compared to tobacco smoking. Patients and methods 40 current smokers (mean age 48 years±5) without cardiovascular disease were randomized to smoke either a conventional cigarette (conv-cig) or an electronic cigarette (e-cig) (electronic cigarette fluid with nicotine concentration of 12 mg/dL) for one month. All subjects smoked an electronic cigarette with nicotine concentration 12 mg/dL for one month. Measurements were performed at baseline and after one month of smoking the conventional or electronic cigarette. We measured a) perfused boundary region (PBR) of the sublingual arterial micro vessels (range 5–25 micrometers), a marker inversely related with glycocalyx thickness, b) pulse wave velocity (PWV), central systolic blood pressure (cSBP) and augmentation index (AIx), c) platelet function by two different methods, namely the novel Platelet Function Analyzer PFA-100 and the traditional Light Transmission Aggregometry (LTA) d) the exhaled CO level (parts per million-ppm) as a smoking status marker; and e) the plasma malondialdehyde (MDA) levels, as an oxidative stress burden index. Results After 1 month of electronic smoking, we did not observe any significant change in platelet function and arterial stiffness (p&amp;gt;0.05 for all markers) with the exception of a reduction of MDA (1.22±0.1 vs 1.09±0.1 μmol/L, p=0.03) and exhaled CO; 14.9±0.7 vs 5.9±0.7 ppm, p&amp;lt;0.001. Conversely, after continuation of conventional cigarette smoking for a month, platelet function was further impaired as assessed by PFA [125,5±31,1 vs 152,35±51,4 U, p=0.047) and by LTA (epinephrine as stimulator) [59,8%±16,1 vs 35,6%±19.1, p&amp;lt;0.001] and markers of arterial stiffness were deteriorated, as assessed by PWV (9,5±2,8 vs 10,3±2,9, p=0,028) and by Aixc (8,36±35,9 vs 30,4±21,6, p=0,004). Conclusions Electronic Cigarette smoking has a neutral effect on platelet function and arterial stiffness markers compared to conventional tobacco smoking which further deteriorates platelet and vascular function during one moth of use. Funding Acknowledgement Type of funding source: None

Acute effects of transcatheter aortic valve replacement on the ventricular-aortic interaction.

Transcatheter aortic valve replacement (TAVR) is increasingly used to treat severe aortic stenosis (AS) patients. However, little is known regarding the direct effect of TAVR on the ventricular-aortic interaction. In the present study, we aimed to investigate changes in central hemodynamics after successful TAVR. We retrospectively examined 33 cases of severe AS patients (84 ± 6 yr) who underwent TAVR. Invasive measurements of left ventricular and aortic pressures as well as echocardiographic aortic flow were acquired before and after TAVR (maximum within 5 days). We examined alterations in key features of central pressure and flow waveforms, including the aortic augmentation index (AIx), and performed wave separation analysis. Arterial parameters were determined via parameter-fitting on a two-element Windkessel model. Resolution of AS resulted in direct increase in the aortic systolic pressure and maximal aortic flow (131 ± 22 vs. 157 ± 25 mmHg and 237 ± 49 vs. 302 ± 69 mL/s, P < 0.001 for all), whereas the ejection duration decreased (P < 0.001). We noted a significant decrease in the AIx (from 42 ± 12 to 19 ± 11%, P < 0.001). Of note, the arterial properties remained unchanged. There was a comparable increase in both forward (61 ± 20 vs. 77 ± 20 mmHg, P < 0.001) and backward (35 ± 14 vs. 42 ± 10 mmHg, P = 0.013) pressure wave amplitudes, while their ratio, i.e., the reflection coefficient, was preserved. Our results highlight the impact of TAVR on the ventricular-aortic interaction by affecting the amplitude, shape, and related attributes of the aortic pressure and flow pulse and challenge the interpretation of AIx as a solely vascular measure in AS patients.NEW & NOTEWORTHY Transcatheter aortic valve replacement (TAVR) is linked with an immediate increase in aortic systolic blood pressure and maximal flow, as well as steeper aortic pressure and flow wave upstrokes. After TAVR, the forward wave pumped by the heart is enhanced. Although the arterial properties remain unchanged, the central augmentation index (AIx) is markedly decreased after TAVR. This challenges the interpretation of AIx as a solely vascular measure in patients with aortic valve stenosis.

School-Based Exercise Intervention Improves Blood Pressure and Parameters of Arterial Stiffness in Children: A Randomized Controlled Trial.

To evaluate the effectiveness of a school-based exercise intervention on endurance performance (EP), blood pressure (BP), and arterial stiffness in children. A total of 105 students (mean age = 8.2 [0.6]y; 51% girls; body mass index = 17.8 [3.0]kg/m2) were randomized to the intervention group (IG, n = 51) and control group (CG, n = 54). During a 37-week experimental period, the IG received an exercise intervention (2 × 45min/wk) in addition to their regular school physical education class (3 × 45min/wk). EP, peripheral and central BP, pulse pressure, augmentation pressure, augmentation index, and aortic pulse wave velocity were assessed. Following the intervention, significant changes (P < .05) in EP, peripheral and central systolic BP, pulse pressure, augmentation pressure, augmentation index, and aortic pulse wave velocity were found in the IG. Children in the CG displayed significant changes in peripheral and central diastolic BP. An analysis of the baseline-to-post changes revealed significant between-group differences in EP (P < .001), pulse pressure (P = .028), augmentation pressure (P = .007), and aortic pulse wave velocity (P = .037) that favored the IG and in peripheral and central diastolic BP that favored the CG. The school-based exercise intervention had beneficial effects not only on EP but also on different hemodynamic parameters.

The Use of Enhanced External Counterpulsation in the Treatment of Patients with Coronary Artery Disease

Enhanced external counterpulsation (EECP) is one of the most effective and safe non-invasive methods of treatment for patients with coronary artery disease (CAD), including complicated chronic heart failure (CHF). This method of therapeutic neoangiogenesis, used in conjunction with traditional drug therapy and myocardial revascularization, can significantly improve the quality of management of these patients.Aim. To study the effect of the EECP course on exercise tolerance, quality of life, structural and functional parameters of blood vessels in patients with verified stable CAD complicated by CHF.Material and methods. Patients (n=70) with verified stable CAD (angina pectoris class II-III) complicated by CHF class II-III (NYHA) were included in non-randomized uncontrolled study. Data from 67 patients (48 to 74 years old; 47 men and 20 women) were included in the final analysis. All patients had a course of EECP (35 one-hour procedures with a compression pressure of 220-280 mm Hg). All patients initially and 1.5 months after the EECP course had a 6-minute walk test (6MWT), an assessment of the clinical status, quality of life of patients (MLHFQ; Minnesota Living with Heart Failure Questionnaire). Computer nailfold video capillaroscopy, photoplethysmography with pulse wave recording and contour analysis, applanation tonometry to assess central aortic systolic pressure and radial augmentation index (RAI) were performed to assess the structural and functional state of large and microcirculatory vessels.Results. A statistically significant improvement in exercise tolerance (increase in distance in 6MWT from 212 [189; 273] to 308 [251; 336] m), improvement in the clinical status of patients (decrease in points on the rating scale of clinical state from 6.5±1.8 to 4.4±1,2), improvement in the quality of life according to the MLHFQ questionnaire (from 51.9±6.2 to 38.6±7.1), increase in the left ventricle ejection fraction (from 41.6 [36.6;47.1] to 44.8 [39.5;50.7]%) were found. A statistically significant improvement in endothelial function indices of both large vessels (phase shift: from 5.6 [2.4;7.2] to 6.8 [3.3;8] m/s) and microcirculatory vessels (occlusion index: from 1.5 [1.2;1.7] to 1.66 [1.3;1.9]), as well as a decrease in functional disorders of nailfold capillaries (percent of perfused capillaries, capillary network density in the reactive hyperemia test) also were found. But no statistically significant changes in the structural remodeling indices of both large and microcirculatory vessels were found.Conclusion. A positive effect of the EECP course both on the functional status with an increase in exercise tolerance and improvement in the quality of life, and on the functional state of large vessels and microvasculature was found in patients with stable CAD complicated by CHF.

Multimodal assessment of vascular and ventricular function in children and adults with repaired aortic coarctation

BackgroundCoarctation of the Aorta (CoA) is associated with increased aortic stiffness and diastolic left ventricular dysfunction. The mechanisms involved and impact of age remain unclear. It was the aim of this study to characterize arterial and cardiac function, their correlation, and the effect of age in children and adults with repaired CoA. MethodsMultimodal cardiovascular assessment from the ascending aorta to microcirculation and endothelial function was performed prospectively. Statistical analyses included multivariable linear regression and correlation of vascular parameters with age and diastolic function. ResultsFifty-seven patients with well-repaired CoA and 77 healthy controls were included (age 8–59). There was no significant difference in age, gender, body surface area and BMI between the groups. Ascending aortic distensibility was decreased while common carotid intima media thickness, central augmentation index corrected to a heart rate of 75/min [Aix75], peripheral Aix75 and aging index were increased in the CoA group. Interestingly, in a subgroup analysis of CoA patients with tricuspid vs. bicuspid aortic valves (BAV), only the latter had increased Aix75. Carotid-femoral pulse wave velocity [cfPWV], reactive hyperemia index and microcirculation were not significantly different between CoA and control patients. Diastolic function was impaired in the CoA group relative to controls. Both diastolic function and age correlated moderate-strongly with arterial parameters. ConclusionsPatients with well repaired CoA have increased proximal arterial stiffness which correlates with diastolic function and age. Increased Aix75 may be attributed to a high prevalence of associated BAV. Neither cfPWV nor peripheral endothelial or microcirculatory function are impaired.

Aortic pulse wave velocity, central pulse pressure, augmentation index and chronic kidney disease progression in individuals with type 2 diabetes: a 3- year prospective study

BackgroundPulse wave velocity (PWV), central pulse pressure and augmentation index are arterial stiffness- related hemodynamic parameters but their associations with renal outcome are still controversial. We hereby aim to study, 1) which hemodynamic parameter is independently associated with progressive chronic kidney disease (CKD), 2) the association of 3-year change in PWV with CKD progression and, 3) the additive predictive value of PWV for progressive CKD.MethodsCarotid- femoral PWV, central pulse pressure and augmentation index were measured in 1444 participants with type 2 diabetes at baseline and 3 years apart. Progressive CKD was defined as confirmed eGFR decline 40% or greater.ResultsIn the follow-up, 102 participants experienced progressive CKD. All 3 hemodynamic parameters were significantly associated with progressive CKD In univariable analysis. However, only PWV remained statistically significant after adjustment for known clinical risk factors and the other 2 hemodynamic parameters (OR 1.14 [95% CI 1.01–1.29] per m/s increment). One m/s regression (decrement) in PWV in the 3-year follow-up was associated with 26% lower adjusted- risk of progressive CKD (OR 0.74, 95% CI 0.56–0.97). Adding PWV onto traditional risk factor- based model significantly improved classification (net reclassification improvement 0.25, 95% CI 0.05–0.45, P = 0.01) and positive prediction rate (24.5 to 32.3%).ConclusionsOf 3 arterial stiffness- related hemodynamic parameters, only PWV is independently associated with progressive CKD. PWV may be a potential intervention target to mitigate risk of CKD progression and also a biomarker to improve risk-stratification of adverse renal outcome in individuals with type 2 diabetes.

Age-associated changes in physiological and biochemical arterial stiffness markers in apparently healthy individuals

Objectives: Arterial stiffness occurs with increasing age and it is an independent cardiovascular risk factor. Brachial ankle pulse wave velocity (baPWV) and serum osteoprotegerin (OPG) are relatively new physiological and biochemical parameters to ascertain arterial stiffness. We determined age-associated changes in physiological and biochemical parameters of arterial stiffness. Materials and Methods: It was a cross-sectional, observational study conducted on apparently healthy 118 male and 114 female subjects of age group 30–&gt;60 years without any cardiovascular or peripheral vascular disease or on any antihypertensive and lipid-lowering therapy. Brachial systolic blood pressure (bSBP), brachial diastolic blood pressure, central systolic blood pressure (cSBP), central diastolic blood pressure (cDBP), heart rate, augmentation index (AIx[%]) and baPWV were recorded after 10 min of rest. Mean arterial pressure (MAP), pulse pressure (PP) and PP ratio (PPR) were derived from the recorded data. Serum samples were analysed to estimate OPG level and lipid profile. Kruskal–Wallis test was performed to compare the differences of the parameters. Spearman correlation analysis was performed to determine any association between baPWV and other parameters. Multiple linear regression analysis was performed to determine the factors associated with baPWV. P &lt; 0.05 was considered as statistically significant. Results: Males had significantly higher value of height, weight and PPR than females. Females had significantly higher values of BMI, AIx (%), cSBP, cPP and brachial PP than males. Aged males had significantly higher AIx (%), cPP and brachial PP in comparison to younger males. Aged females showed significantly higher AIx (%), cPP, brachial PP, serum cholesterol, triglyceride (TG), low-density lipoprotein cholesterol (LDLc) and very LDLc (VLDLc) in comparison to younger females. Serum OPG level was found to be a major factor influencing the values of baPWV in both males and females. Other cardiovascular parameters such as cSBP, cDBP, cMAP, brachial SBP and MAP influenced baPWV values in both genders, but biochemical parameters such as serum cholesterol, LDLc influenced baPWV values in the male participants in the present study. Regression analysis revealed that serum TG and OPG levels were strongly associated with baPWV in both genders. Conclusion: With increasing age, cardiovascular parameters such as central blood pressure, peripheral blood pressure and AIx (%) were increased in both genders, and PPR was decreased in males. The values of baPWV also exhibited an increasing trend with age. Serum cholesterol, TG, LDLc and VLDLc levels in females were increased with age. Serum OPG level and serum TG levels emerged as major influencing factors of baPWV values in both genders irrespective of age.

An instrument for measuring blood pressure and assessing cardiovascular health from the fingertip

Despite blood pressure being one the leading modifiable risk factors for cardiovascular disease and death, it is severely under-monitored. For this challenge we propose a finger artery non-invasive tono-oscillometric monitor (FANTOM) which is an automated low-cost instrument for measuring blood pressure and hemodynamic parameters from the fingertip. The sensing technology is highly scalable and could be integrated to a pulse oximeter probe for increased patient comfort. A tonometric cuff-less mechatronic system is used to apply pressure on the fingertip for (i) measuring oscillometric blood pressure, (ii) recording arterial waveform and for (iii) constructing central blood pressure (CBP) waveform. Clinical study on volunteers (n = 33) was performed against a commercially available arm cuff device yielding systolic and diastolic readings ((mean±SD) mmHg) of (−0.9 ± 7.3) mmHg and (−3.3 ± 6.6) mmHg respectively. The results comply with the Association for the Advancement of Medical Instrumentation (AAMI) standard for non-invasive blood pressure monitors. The arterial pulse recording morphology was compared against a volume clamp device (CNSystems CNAP 500) (n = 3) resulting in similar performance. Comparison of CBP against a pulse wave analysis (PWA) device (Atcor Medical Sphygmocor XCEL) (n = 5) revealed central aortic systolic pulse (CASP) and central augmentation index (cAIx) estimates with precision and accuracy of (2.0 ± 3.7) mmHg and (1.4 ± 6.2)% respectively. In conclusion, the results indicate that the proposed technology could be useful in the development of new portable or wearable blood pressure monitors. The sensing technology is highly scalable and could be integrated to a pulse oximeter probe for increased patient comfort.

CARDIORESPIRATORY FITNESS AND VASCULAR HEMODYNAMICS IN MIDDLE-AGED AND OLDER ADULTS

Clinical Exercise Physiology, Ball State University, Muncie, IN, USA Cardiovascular disease-related (CVD) mortality with older age is in part attributable to altered vascular hemodynamics including increased central and peripheral blood pressure (BP) and augmentation index (AIx). Cardiorespiratory fitness (CRF) is inversely associated with CVD mortality independent of traditional risk factors. It is unknown, however, if CRF is inversely related to vascular hemodynamics. PURPOSE: To investigate the relationship between CRF and vascular hemodynamics in an apparently healthy middle-aged and older adult population. METHODS: Apparently healthy males and females (N=101; 54 M, 47 F; Age: 63.5 ± 8.5) from the Ball State Adult Fitness Longitudinal Lifestyle Study (BALL ST) were studied. All participants underwent assessment of vascular hemodynamics, which included non-invasive central and peripheral BP, central and peripheral pulse pressure (systolic minus diastolic BP), AIx (%), AIx normalized to HR 75 (AIx% HR75) and directly-measured CRF (VO2max ; ml/kg/min). Age- and sex-adjusted CRF percentiles where calculated based on the Fitness Registry and Importance of Exercise National Database (FRIEND). Data were analyzed via Pearson correlations. RESULTS: CRF was inversely related with central systolic BP (cSBP, r = -0.330), central pulse pressure (cPP, r = -0.255), AIx %( r = -0.366), AIx% HR75 (r = -0.474), brachial systolic BP (bSBP, r = -0.227), and brachial pulse pressure (bPP, r = -0.172) (all, p<0.05). cSBP (r = -0.412), cPP (r = -0.249), AIx % (r = -0.202), AIx % HR75 (r = -0.292), and bSBP (r = -0.320) were correlated with FRIEND percentiles (all, p<0.05) whereas bPP (r = -0.131) was not (p> 0.05). CONCLUSION: Our findings demonstrate that more ideal measures of vascular hemodynamics are correlated with higher CRF in middle-age and older adults. These data support the notion that vascular hemodynamics may be a potential modulator in the inverse relationship between CRF and CVD in apparently healthy adults.

Effects Of Boxing Training On Peripheral And Central Blood Pressure And Arterial Stiffness In Prehypertension

PURPOSE: Early stages of high blood pressure, such as elevated blood pressure or stage 1 hypertension, have shown to increase cardiovascular mortality. Exercise is recommended for the prevention and treatment of high blood pressure; however, most clinical evidence is based on lower-body modalities of exercise. Therefore, the purpose of this study is to evaluate the effects of boxing training, a predominant upper-body exercise modality, on peripheral and central blood pressure and arterial stiffness in prehypertensive individuals. METHODS: A total of 14 young prehypertensive individuals were randomly allocated to a boxing training group or to a control group for 6 weeks. The boxing group underwent 42 minutes of boxing training three times per week while the control group performed flexibility and balance exercises. At the beginning and at the end of the intervention, brachial blood pressure was evaluated with an automatic cuff, central blood pressure by pulse wave analysis, and arterial stiffness by pulse wave velocity. A 2x2 repeated measures ANOVA design was employed to compare differences within and in between groups. Significance was established at p ≤ 0.05. RESULTS: After the intervention, only the boxing group showed a significant reduction on systolic blood pressure (p=0.027), diastolic blood pressure (p<0.001), central systolic blood pressure (p=0.011), augmentation index (p=0.021), and augmentation index at 75 beats per minute (p=0.008). No difference could be observed on pulse wave velocity in the boxing group (p=0.323), although a significant increment was seen in the control group (p=0.02). CONCLUSIONS: Boxing training is an effective treatment alternative to reduce peripheral and central blood pressure in prehypertensive individuals. To reduce arterial stiffness in prehypertensive individuals, longer boxing training protocols might be required.

Vascular Function Following An Acute Mental Stressor Among Fit Versus Non-fit Young Adults

PURPOSE: Acute mental stress impairs vascular function. The purpose of this study was to investigate if stress-induced vascular impairment is moderated by physical fitness. METHODS: Nineteen young, healthy adults (21.6±2.7 y, 23.9 ± 3.1 kg/m2,10 F) were classified as fit (n=11) or non-fit according to ACSM physical activity guidelines (75 min vigorous, or 150 min moderate-intensity aerobic exercise). Across two randomized visits, subjects underwent an experimental (stress) and control (non-stress) testing session. A five-min mental arithmetic task was given to induce stress in the experimental session following baseline measurements. Measurements were taken throughout the 60 mins after the stress/control period. Measures included central blood pressure (cSBP), augmentation index (AIx), and brachial-radial pulse wave velocity (PWV). Mixed linear models were used to perform statistical analyses, covarying for baseline measures. RESULTS: There was a significant fitness x condition interaction for AIx (p=0.038), such that the greatest AIx of fit individuals following stress exposure was 3.3 percentage points less than non-fit individuals (95% CI -1.29, -0.09, d = -1.34). There was no interaction of fitness and condition on PWV (p=0.785; 95% CI -0.18, 0.16), but there was an inconclusive effect of fitness (p=0.143), such that fit individuals had a PWV 0.37 m/s less than non-fit individuals (CI: -0.27, 0.04; d=-0.43). For cSBP, there was no fitness x condition interaction (p=0.653; 95% CI: -1.14, 1.83), but there was a main effect of condition (p=0.045) where, regardless of fitness, stress elicited a 3.05 mmHg greater increase in cSBP after the stressor compared to the non-stress condition (95% CI 0.01, 3.06; d=0.69). CONCLUSION: Fitness was associated with a healthier wave reflection profile following a stressor, as well as better overall vascular function. These adaptive effects of fitness on hemodynamic and vascular measures ensued despite stress-induced increases in cSBP occurring regardless of fitness status.

Reference values of office central blood pressure, pulse wave velocity, and augmentation index recorded by means of the Mobil-O-Graph PWA monitor.

Assessment of central blood pressure (BP), pulse wave velocity (PWV), and augmentation index (AIx) measurements may improve cardiovascular risk stratification. This study aimed to establish reference office values for central BP, PWV, and AIx by means of a Mobil-O-Graph PWA monitor and to evaluate the impact of cardiovascular risk factors (CVRFs) on these measurements. We cross-sectionally evaluated clinical characteristics, central BP, PWV, AIx, and peripheral BP measurements among 867 apparently healthy individuals (age = 46.0 ± 15.5 years, 39% males) who were free of obesity, hypertension, active smoking, dyslipidemia, and diabetes (CVRF-No) and 5632 individuals (age = 57.0 ± 14.7 years, 44% males) with at least one of these major CVRFs (CVRF-Yes). Reference values for central BP, PWV, and AIx were provided for the CVRF-No and CVRF-Yes groups, stratified by age and sex. PWV and AIx exhibited curvilinear increases with age, and there was an interaction between age and sex for central systolic BP and PWV in both the CVRF-No and CVRF-Yes groups. The results of a multivariable analysis including the whole sample (n = 6499) showed that obesity had a direct association with central BP, while diabetes was directly related to PWV. In addition, alcohol intake was directly associated with central BP, while performance of physical activity was inversely related to AIx. In conclusion, values of office-measured central BP, PWV, and AIx obtained in an apparently healthy population and in a population with CVRFs are now available according to age and sex and may be useful to build thresholds for use in clinical practice.

839-P: Peripheral and Central Blood Pressure Regulation in Recently Diagnosed Prediabetes

Hypertension is found in up to 90% people with type 2 diabetes. The relationship between blood pressure (BP) (dys)regulation and prediabetes is much less clear. Fifty individuals (mean age [±SD] 42.7±13.1 years, BMI 29.2±7.3 kg/m2) with prediabetes (31 IFG; 19 IGT) and normal BP and 20 age- and BMI-matched healthy persons (40.8±9.6 years, BMI 27.9±6.6 kg/m2) were enrolled into the study. In all participants fasting plasma insulin, adiponectin and interleukin-8 (IL-8) were assessed; and 24-hour ambulatory BP monitoring (ABPM Monitor Schiller BR-102 Plus) and central BP assessment with the applanation tonometry method (SphygmoCor XCEL) were perfomed. ABPM results were similar in both groups: 24-hour systolic, diastolic, mean arterial pressure (MAP) and pulse pressure were 124.1±10.8 and 123.5±7.6; 74.3±7.9 and 74.3±7.0; 89.8±7.2 and 90.4±6.6; 50.5±7.9 i 48.6±5.3 mmHg, respectively (p&amp;gt;0.05). In daytime the respective values were 127.0±11.2 and 126.6±7.4; 75.7±6.5 and 77.2±7.0; 92.4±7.5 and 93.2±6.5; 50.9±8.0 and 48.9±5.5 mmHg, and at nighttime 109.1±21.8 and 109.8±10.5; 61.5±12.7 and 62.7±8.8; 77.1±15.4 and 78.1±9.0; 47.1±11.3 and 46.7±5.4 mmHg (p&amp;gt;0.05). Central systolic, diastolic, end systolic BP, central mean pressure, central pulse height, augmentation index and central stroke volume index were also similar in both groups: 109.3±13.7 and 112.1±14.4, 77.1±9.5 and 80.4±10.7, 99.0±11.7 and 102.1±13.0, 91.3±10.6 and 95.2±11.4, 32.1±9.7 and 31.9±9.4 mmHg, 16.7±13.2 and 15.5±14.3%, 149.5±25.3 and 144.2±29.2 (p&amp;gt;0.05). No significant diffferences in plasma insulin, adiponectin or IL-8 were found between the groups (30.4±25.3 and 26.5±28.8 µIU/ml; 4.86±2.56 and 6.28±3.48 µg/ml; and 25.6±2.58 and 27.9±9.76 pg/ml, respectively, p&amp;gt;0.05). In conclusion, recently diagnosed prediabetes is not associated with any blood pressure abnormalities. Vigorous prevention of diabetes in people with prediabetes should be encouraged as it may lead to maintaining cardiovascular health. Disclosure A. Bogaczewicz-Slowikowska: None. P. Abramczyk: None. K. Cienszkowska: None. E. Janeczko-Sosnowska: None. Z. Gaciong: None. L. Czupryniak: None.

Effect of Mediterranean Diets with Varying Amounts of Lean Beef on Measures of Vascular Health

Abstract Objectives To evaluate the effects of Mediterranean (MED) diets with different quantities of lean beef (0.5, 2.5 and 5.5 oz/day) compared to an Average American diet (AAD) on brachial and central blood pressure, pulse wave velocity (PWV) and augmentation index (AI). Methods We conducted a multicenter, 4-period controlled feeding, randomized crossover study at Penn State University and USDA-Beltsville to evaluate the effects of MED diets (CHO 42%, PRO 17%, FAT 41%, SFA 8%, MUFA 26%, PUFA 8%) with different quantities of lean beef (0.5, 2.5 and 5.5 oz/day) compared to an average American diet (AAD; CHO 52%, PRO 15%, FAT 33%, SFA 12%, MUFA 13%, PUFA 8%) on vascular health. Participants (n = 66) included generally healthy males and females (BMI = 20–38 kg/m2) 30 to 67 years. Participants were randomized to each of the 4 diets for 4 weeks with an approximate 2-week break between treatments. Central blood pressure, PWV and AI were measured using the SphygmoCor ECEL-System. Endpoints were assessed at baseline and the end of each 4-week diet period. Results There was a significant treatment effect for PWV (P &amp;lt; 0.01); PWV was lower following consumption of the MED diets containing 0.5 oz. lean beef/day (6.86 m/sec ± 0.14; P &amp;lt; 0.05) and 2.5 oz. of lean beef/day (6.84 m/sec ± 0.15; P &amp;lt; 0.01) compared to the AAD (7.10 m/sec ± 0.14). Compared to the AAD, both the 0.5 oz./day (−3.30 mmHg ± 0.76) and 2.5 oz./day (−2.94 mmHg ± 0.76) MED diets elicited greater reductions in central systolic blood. A similar pattern was observed for central diastolic pressure. Compared to AAD, all three MED diets significantly decreased brachial systolic and diastolic pressures (P &amp;lt; 0.01 for all). Compared to baseline only the MED 0.5 elicited a significant reduction in AI (P &amp;lt; 0.01). Conclusions This study demonstrated improvements in measures of arterial stiffness and central blood pressure following Mediterranean diets containing low to moderate amounts of lean beef. Funding Sources National Cattleman's Beef Association, The Penn State Clinical and Translational Research Institute, Pennsylvania State University Clinical and Translational Science Award, and NIH/National Center for Advancing Translational Sciences grant no. UL1TR000127.