Central Diastolic Pressure Research Articles

Novel theory and potential applications of central diastolic pressure decay time constant

Central aortic diastolic pressure decay time constant (τ\\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{mathrsfs} \\usepackage{upgreek} \\setlength{\\oddsidemargin}{-69pt} \\begin{document}$${\\uptau }$$\\end{document}) is according to the two-element Windkessel model equal to the product of total peripheral resistance (R\\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{mathrsfs} \\usepackage{upgreek} \\setlength{\\oddsidemargin}{-69pt} \\begin{document}$$R$$\\end{document}) times total arterial compliance (C\\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{mathrsfs} \\usepackage{upgreek} \\setlength{\\oddsidemargin}{-69pt} \\begin{document}$$C$$\\end{document}). As such, it is related to arterial stiffness, which has considerable pathophysiological relevance in the assessment of vascular health. This study aimed to investigate the relationship of the constant τ\\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{mathrsfs} \\usepackage{upgreek} \\setlength{\\oddsidemargin}{-69pt} \\begin{document}$${\\uptau }$$\\end{document} with the product TMBPcPP\\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{mathrsfs} \\usepackage{upgreek} \\setlength{\\oddsidemargin}{-69pt} \\begin{document}$$T\\frac{MBP}{{cPP}}$$\\end{document}, given by heart period (T\\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{mathrsfs} \\usepackage{upgreek} \\setlength{\\oddsidemargin}{-69pt} \\begin{document}$$T$$\\end{document}) times the ratio of mean blood pressure (MBP) to central pulse pressure (cPP\\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{mathrsfs} \\usepackage{upgreek} \\setlength{\\oddsidemargin}{-69pt} \\begin{document}$$cPP$$\\end{document}). The relationship was derived by performing linear fitting on an in silico population of n1 = 3818 virtual subjects, and was subsequently evaluated on in vivo data (n2 = 2263) from the large Asklepios study. The resulted expression was found to be τ=k′TMBPcPP,\\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{mathrsfs} \\usepackage{upgreek} \\setlength{\\oddsidemargin}{-69pt} \\begin{document}$${\\uptau } = k^{\\prime}T\\frac{MBP}{{cPP}},$$\\end{document} with k′=0.7\\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{mathrsfs} \\usepackage{upgreek} \\setlength{\\oddsidemargin}{-69pt} \\begin{document}$$k^{\\prime} = 0.7$$\\end{document} (R2 = 0.9). The evaluation of the equation on the in vivo human data reported high agreement between the estimated and reference τ\\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{mathrsfs} \\usepackage{upgreek} \\setlength{\\oddsidemargin}{-69pt} \\begin{document}$${\\uptau }$$\\end{document} values, with a correlation coefficient equal to 0.94 and a normalized RMSE equal to 5.5%. Moreover, the analysis provided evidence that the coefficient k′\\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{mathrsfs} \\usepackage{upgreek} \\setlength{\\oddsidemargin}{-69pt} \\begin{document}$$k^{\\prime}$$\\end{document} is age- and gender-independent. The proposed formula provides novel theoretical insights in the relationship between τ\\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{mathrsfs} \\usepackage{upgreek} \\setlength{\\oddsidemargin}{-69pt} \\begin{document}$${\\uptau }$$\\end{document} and central blood pressure features. In addition, it may allow for the evaluation of τ\\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{mathrsfs} \\usepackage{upgreek} \\setlength{\\oddsidemargin}{-69pt} \\begin{document}$${\\uptau }$$\\end{document} without the need for acquiring the entire central blood pressure wave, especially when an approximation of the cPP\\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{mathrsfs} \\usepackage{upgreek} \\setlength{\\oddsidemargin}{-69pt} \\begin{document}$$cPP$$\\end{document} is feasible. This study adds to the current literature by contributing to the accessibility of an additional biomarker, such as the central diastolic pressure decay time constant, for the improved assessment of vascular ageing.

Arterial Blood Pressure Features of Hypertensive Patients with Typical and Atypical 460 nm Skin Fluorescence Response to Transient Ischaemia.

Flow-mediated skin fluorescence (FMSF) at 460 nm is a non-invasive method for assessing dynamic changes in the reduced form of nicotinamide adenine dinucleotide (NADH) and microcirculation in forearm skin under varying conditions of tissue perfusion. Typically, fluorescence increases during ischaemia, but atypical cases show a temporary signal decrease instead of a constant increase. This study aimed to explore the clinical implications of atypical FMSF patterns in patients with newly diagnosed untreated hypertension. NADH fluorescence and pulse wave analysis were performed on 65 patients. Differences in peripheral and arterial pulse pressure profiles were examined based on FMSF curve courses. Patients with atypical curve courses had significantly (p < 0.05 or lower for all) higher heart rate, peripheral and central diastolic pressure, tension time index, central rate pressure product, shorter diastole duration, and reservoir pressure-time integral. Hypertensive patients with atypical FMSF signals had less advantageous blood pressure profiles. Although the underlying factors causing these symptoms are unknown, the atypical FMSF pattern may reflect increased sympathetic stimulation and vascular resistance. The visual assessment of the FMSF curve may have important clinical implications that deserve further investigation.

VASCULAR WALL RIGIDITY IN PATIENTS WITH DEGENERATIVE AORTIC STENOSIS BEFORE AND AFTER AORTIC VALVE SURGICAL PROSTHESIS

Introduction. The most common cause of aortic valve surgery is aortic stenosis. So far, the focus has been on evaluating the valve itself, while increasing aortic stiffness increases the load on the left ventricle, contributing to greater impairment of cardiovascular function. Arterial stiffness is a well-established predictor of cardiovascular complications. Objective: To evaluate the dynamics of aortic stiffness in patients with degenerative aortic stenosis against the background of surgical correction of the defect. Material and methods. The study included 33 patients referred for surgical treatment of the defect. Among them, men predominated somewhat (57.6%). All patients were diagnosed with severe aortic stenosis - the area was 0.74 (0.60; 0.90) cm2, the peak and mean pressure gradients on the aortic valve were 85.5 (72.0; 98) mm Hg. Art. and 50.2 (41.0; 56.0) mm Hg. Art. respectively. 22 patients (66.7%) underwent aortic valve replacement with a mechanical prosthesis, the rest of the patients underwent operations combined with coronary artery bypass grafting or prosthetics of the ascending aorta. All patients underwent a study of aortic stiffness indicators, namely: pulse wave velocity in the carotid-radial (CR PWS) and carotid-femoral segments (CF PWS), central systolic pressure in the aorta (CSBP), central diastolic pressure in the aorta (CDAP), aortic central pulse pressure (CPAP), aortic pressure augmentation (AP), augmentation index normalized to heart rate 75 (AIx75). The parameters were measured before the operation and 7-14 days after it. The registration of the pulse wave was carried out by a non-invasive method of applanation tonometry using the SphygmoCor device (AtCor Medical Inc., Australia). Mean values are presented as median and interquartile range. Mean differences in dependent groups were assessed using the Wilcoxon test. Results. CR PWV in the postoperative period decreased and amounted to 7.2 (6.4; 7.5) m/s versus 7.9 (6.6; 9.4) m/s before surgery (p=0.03). There was no significant decrease in PWV CF after aortic valve replacement, however, there was a tendency to decrease (8.1 (6.7; 9.4) m/s before surgery versus 7.4 (6.4; 7.6) m/s). s after surgery, p=0.07). After surgery, CBP decreased and amounted to 103.8 (97; 113) mm Hg. Art. against the original 117.8 (102; 132) mm Hg. Art., (p&lt;0.001). CDAP also decreased and amounted to 69.4 (66; 74) mm Hg. Art. after surgery, while the initial CDBP was 74.8 (70; 81) mm Hg. Art. after surgery (p=0.01). The CPA indicators decreased and amounted to 36 (27; 44) mm Hg after the operation. Art. against the initial value of 43 (31; 53) mm Hg. Art. (p=0.03). There was also a decrease in AIx75 from 31.7 (19.5; 43)% to 17.5 (7; 25)% (p &lt; 0.001) and AR from 16.4 (7; 24.5) mm Hg. Art. up to 10.2 (6; 12) mm Hg Art. (p=0.002). Conclusion. Thus, in patients with degenerative aortic stenosis after its surgical correction, the following indicators of vascular stiffness decrease: carotid-radial pulse wave velocity, central systolic and diastolic pressure in the aorta, index and augmentation pressure. There was no statistically significant dynamics of the carotid-femoral velocity of pulse wave propagation.

#6157 PREDICTORS OF 24 PULSE WAVE VELIOCITY IN HYPERTENSIVE CHRONIC KIDNEY DISEASE PATIENTS: A CASE CONTROL STUDY

Abstract Background and Aims Pulse wave velocity (PWV) is a significant predictor of chronic kidney disease (CKD) progression and death in people with impaired kidney function. It is known that patients with type 2 diabetes mellitus have higher values of PWV. Our study assessed the difference in arterial stiffness parameters (value of peripheral and central blood pressure parameters and PWV) according diabetic status and to evaluate predictors of PWV in hypertensive CKD patients. Method This case control, cross-sectional study included 252 hypertensive CKD patients 143 (56.7%) men and 109 (43.3%) women, aged 67 years (IQR = 15). For each participant data about sex, age, height, presence of CKD, AH and other comorbidities were collected. Laboratory parameters (urea, creatinine, estimated glomerular filtration rate (eGFR), glycated hemoglobin (HbA1c)) were obtained from peripheral blood and 24-hour urine samples were collected to analyze albuminuria. Each participant underwent 24-hour ambulatory blood pressure measurement using the IEM Mobil-O-Graph based on the oscillometry. Tanita MC780 Multi Frequency segmental body composition analyzer was used to measure body weight and level of visceral fat. Body mass index (BMI) was calculated. Results Out of 252 participants with AH and CKD, 107 (42.5%) also had DM. Participants with DM were older (p&amp;lt;0001), had higher pulse pressure (p&amp;lt;0.001) and PWV (p&amp;lt;0.001) while the levels of peripheral and central diastolic pressure (p&amp;lt;0.001) were lower. Regarding body composition parameters, DM participants had higher BMI (p = 0.001) and visceral fat level (p&amp;lt;0.001). Positive predictors of PWV adjusted for age, sex, presence of DM and eGFR were HbA1c (β = 0.216, p = 0.007), albuminuria (β = 0.000, p = 0.002), central and peripheral systolic and diastolic blood pressure (β = 0.035, p&amp;lt;0.001; β = 0.035, p&amp;lt;0.001; β = 0.033, p&amp;lt;0.001; β = 0.035, p&amp;lt;0.001), pulse pressure (β = 0.047, p&amp;lt;0.001) and mean arterial pressure (β = 0.042, p&amp;lt;0.001). Body composition parameters were not found to be significant predictors of PWV. Conclusion We found significant differences in 24-hour blood pressure parameters and body composition in relation to the presence of DM. One possible explanation for the lower peripheral and central diastolic blood pressure in diabetic participants is the older age of these participants. Accordingly, PWV as a parameter of arterial stiffness, which is higher in DM participants, could also be due to the age difference. As for the predictors of PWV, the expected predictors were parameters of blood pressure. HbA1c and albuminuria were also associated with PWV as parameter of arterial stiffness in CKD participants with AH.

#6184 PULSE WAVE VELOCITY AND AMBULATORY BLOOD PRESSURE IN PATIENTS WITH RENAL HYPERFILTRATION

Abstract Background and Aims Recent studies have been implicated that abnormally increased glomerular filtration rate, defined as renal hyperfiltration, may be a risk factor for the development of renal damage and cardiovascular disease. Herein, we aimed to investigate the possible relationship between renal hyperfiltration(RHf) and pulse wave velocity, ambulatory blood pressure measurements and clinical parameters. Method All individuals included the study were between 18 and 65 years old. The eGFR (CKD-EPI) values of above 140 ml/min/1.73 m² were defined as RHf. Nineteen individuals in the renal hyperfiltration group and 20 in the control group were included. Blood and urine samples of the cases were examined. The individuals with diabetes, obesity, pregnancy, hypertension, cardiovascular disease, peripheral artery disease, cerebrovascular disease, chronic rheumatological disease, and thyroid dysfunction were excluded from the study. The parameters related arterial stiffness and ambulatory blood pressure measurements were obtained in all cases. The results were analyzed statistically. Results The two groups were similar in terms of gender, age, BMI and smoking. In RHf group, total cholesterol, 24-hour urine proteinuria and albuminuria, SBP, DBP, MAP and PP values ​​were found higher than control group. Interestingly, the differences of “night time” measurements of all these hemodynamic parameters were more pronounced in RHf group. The trend of “non-dipper” pattern was to be higher in the hyperfiltration group. In arterial stiffness parameters the augmentation pressure (AP), central systolic pressure (CSP), reflection magnitude (RM), central diastolic pressure (CBP), and pulse pressure amplification (PPA) were found significantly different. Pearson's corelation analysis revealed that AP, CSP, CBP was the positively; RM was negatively correlated with eGFR in hyperfiltration group (Table 1 and 2). Multivariate linear regression analysis revealed that AP, 24-hour proteinuria and mean arterial pressure were the independent parameters related to hyperfiltration. Logistic regression showed that only AP was an independent predictor of hyperfiltration (p = 0.001, OR = 0.84; 0.757-0.935, CI 95%). Conclusion We found that augmentation pressure is the most important independent parameter correlated with RHf among arterial stiffness measurements. The vascular risk may be increased in this population.

Disparities in the Prevalence and Risk Factors for Carotid and Lower Extremities Atherosclerosis in a General Population—Bialystok PLUS Study

This study was conducted in a representative sample of area residents aged 20-80 years old. The aim of the study was to assess the prevalence of classic risk factors of atherosclerosis in the studied population and to search for new risk factors in these patient subpopulations. A total of 795 people (mean age 48.64 ± 15.24 years, 45.5% male) were included in the study group. Two independent data analyses were performed. In the first analysis, the study group was divided into two subgroups depending on the presence or absence of atherosclerotic plaques in carotid arteries (APCA). APCA were observed in 49.7% of the study group: in the population aged between 41 and 60 years in 49.3%, and those between 61 and 70 years in 86.3%. Patients with APCA were more often diagnosed with arterial hypertension, diabetes, and hypercholesterolemia. In the second analysis, the study group was divided into two subgroups depending on the presence of lower extremities atherosclerotic disease (LEAD). Patients with an ABI (ankle-brachial index) ≤ 0.9 constituted 8.5% of the study group, and they were significantly older, and more often diagnosed with diabetes and APCA. To identify the factors most strongly associated with APCA and an ABI ≤ 0.9, logistic regression was used, with stepwise elimination of variables. The strongest factors associated with APCA were current smoking and diastolic central pressure. We did not note such an association and did not find additional parameters to facilitate the diagnosis of LEAD in asymptomatic patients. The most important observation in our study was the high prevalence of APCA in the study population, especially in the group of young people under the age of 60.

Impact of Obesity Phenotype on Central Aortic Hemodynamics and Arterial Stiffness in a Chinese Health Assessment Population.

This study aimed to explore the association between BMI and/or central obesity parameters and measures of arterial hemodynamics to assess the effect of obesity on function of large arteries. Data was obtained from 634 subjects undergoing health assessment at Ruijin Hospital, Shanghai. Subjects were divided into 3 groups according to their Body Mass Index (BMI (kg/ ) 24 normal, 24-28 overweight, 28 obese). In addition, central obesity was described by waist-hip ratio (WHR) and waist-height ratio (WHtR). Radial arterial waveforms and carotid-femoral pulse wave velocity (cf-PWV) were measured with the subjects recumbent. Central arterial pressures were measured by pulse wave analysis of the radial waveform calibrated to peripheral cuff systolic (PSP) and diastolic pressure (PDP) to obtain central systolic pressure (CSP), central diastolic pressure (CDP), central pulse pressure (CPP), central augmentation pressure (CAP), and central augmentation index (cAIx). Pulse pressure was determined from the ratio of peripheral (PPP) and central (CPP) pulse pressure (PPP/CPP). CAP and cAIx were lowest in the obese group (p 0.01). Pressure amplification was significantly higher as BMI increased (p 0.05). After adjusting for confounding factors, WC, WHtR and WHR were independent risk factors for cf-PWV ( = 0.120, p = 0.001, = 0.103, p = 0.004, = 0.092, p = 0.013), When BMI, WC, WHtR, WHR were put into the stepwise linear regression model, only WC was an independent risk factor for cf-PWV ( = 0.135, p 0.001). Central obesity (WC and WHR) measures may have greater predictive value for vascular stiffness than BMI. This possibility warrants further studies focused on arterial wave travel and its relationship with body fat distribution.

PHARMACOLOGICAL TREATMENT OF ARTERIAL HYPERTENSION GUIDED BY PERIPHERAL OR CENTRAL BLOOD PRESSURE: COMPARISON OF THE TWO STRATEGIES IN THE INCIDENCE OF INTERMEDIATE OUTCOMES

Objective: To compare the parameters of central and peripheral blood pressure measurements, arterial stiffness, target organ damage (TOD), biochemical and renal profiles among participants who had the therapeutic strategy guided by central (CG) and peripheral (PG) blood pressure values. Design and method: Randomized study in two groups: CG and PG. Five visits were carried out, the first (V1) being selection and randomization followed by intermediate visits, every 3 months, to assess blood pressure and adjust antihypertensive drugs. The procedures performed in the initial and final visit (V5) were: measurement of central arterial pressure and pulse wave velocity (PWV) (mobil-o-graph) and peripheral (OMRON HEM1100), carotid ultrasound, echodopplercardiogram and laboratory tests. Paired and unpaired t and chi-square tests were used. Adopted significance level of 5% and a confidence interval of 95%. Results: A total of 59 participants were evaluated (30 from the CG and 29 from the PG). Age, BMI, central and peripheral blood pressure measurements, PWV, left ventricular mass index (LVMI), carotid intimal mean thickness, biochemical profile and glomerular filtration rate did not differ between the two groups (p &gt; 0.05) in randomization. The augmentation index (AIx) was higher in the CG than in the PG at randomization (27.3% ± 12.2% vs 20.3% ± 13.3% p 0.041). After 1 year of follow-up, in the analysis between the groups, the central diastolic pressure was lower in the CG (78.9mmHg ± 9.7mmHg vs 84.3 ± 10.4mmHg, p 0.024) and the difference in AIx between the groups ceased to exist. When intra-group comparisons were made before and after the intervention, a reduction in the PWV (p &lt; 0.001) and LVMI (p = 0.018) was observed in the CG. In PG there was an increase in PWV (p &lt; 0.001) and LVMI (p = 0.003). Conclusions: The intervention guided by central pressure, after 1 year of follow-up, was able to reduce the central diastolic pressure and correct the AIx parameter and, in the intra-group analysis, it promoted a reduction in PWV and LVMI. There was no difference between the two groups regarding the improvement of outcomes related to central and peripheral blood pressure, cardiac and vascular TOD, biochemical and renal profile.

ARTERIAL STIFFNESS ASSESSMENT IN DIABETIC PATIENTS IN A CARDIOLOGY CLINIC

Objective: Arterial stiffness is a complex phenomenon characterized by decreased compliance of the great arteries. In diabetes, the arterial wall undergoes a series of biomechanical changes, which can result in arterial stiffness. The mechanisms of these structural and functional arterial alterations in diabetes include insulin resistance, collagen accumulation due to inadequate enzymatic glycation, endothelial and autonomic nervous system dysfunction. Increased arterial stiffness is a marker of cardiovascular risk in diabetic patients. We aimed to evaluate the arterial stiffness of diabetic pateients in a private cardiology clinic Design and method: We evaluated 46 patients in cardiology service, who underwent central pressure assessment with the Mobil O’Graph device. All additional information about the patients conditions were taken from their medical records. Results: A total of 46 patients underwent the examination, being 26 of them women (56%), with a mean age of 58.93 years (+-35). Of these patients, 22 (47.8%) were diabetic, reported by their medical records. The mean central systolic pressure of diabetic patients was 142.9mmHg (+-35.1) and the central diastolic pressure was 86.9mmHg (+-19.9). The mean pulse wave velocity was 9.68 (+-5.31), with 11 (50%) above the normal value, according to the Brazilian Guideline of Hypertension 2020. Conclusions: As seen in the analyzed patients, diabetic patients are at high risk for an increase in arterial stiffness. This is possibly because the mechanisms that cause changes in endothelial collagen loss, such as advanced glycation end products and the inhibitor of formation of these products, aminoguanidine, are exacerbated in diabetic patients. The importance of assessing arterial stiffness, through pulse wave velocity, in diabetic patients is evident.

Gaming for better health? Comparison of cardiorespiratory and hemodynamic responses of exergaming with moderate endurance exercise

Abstract Funding Acknowledgements Type of funding sources: None. Introduction Exergames are interactive video games that require the player to move their body to progress through the game. Even though numerous studies have determined a higher exercise intensity in exergames compared to sedentary videogames, the literature remains equivocal as to whether exergames elicit intensity levels that result in relevant physiological responses. The aim of the present study was to assess whether an exergaming session (ES) in an innovative exergame represents a physiological relevant exercise stimulus capable of producing favorable hemodynamic responses similar to moderate endurance exercise (MEE). Therefore, cardiovascular responses during and after an ES and an ET were assessed and compared. Methods Twenty-seven healthy young adults aged 25±4 years (48% female; BMI 23.0±2.1 kg/m2) participated in the study. The Maximum heart rate (HRmax) and the maximum oxygen consumption (VO2max) were determined during a cardiopulmonary exercise test on a treadmill. Furthermore, participants completed both a typical MEE (35 minutes, 65% of HRmax) on a treadmill and an ES (28 minutes). Heart rate (HR) and oxygen consumption were recorded during both training sessions. Both before and during the 45 minutes after the training sessions, the peripheral and central blood pressure (BP) were assessed. Results HR and oxygen consumption were significantly higher during ES than during MEE (p&amp;lt;0.001). Throughout the ES, the participants achieved a mean HR of 86±4 % of HRmax. Mean oxygen consumption reached 66±5 % of VO2max. 45 Minutes after the ES, there was a significant decrease in peripheral systolic (-6.2±2.9 mmHg; p&amp;lt;0.001) and diastolic (-4.8±5.7 mmHg; p&amp;lt;0.001), as well as in central systolic (-4.9±5.4 mmHg; p&amp;lt;0.001) and diastolic (-4.8±5.2 mmHg; p&amp;lt;0.001) BP compared to baseline. After MEE, only the peripheral diastolic (-2.3±3.4 mmHg; p=0.003), and central diastolic (-2.2±3.8 mmHg; p=0.006) pressure were significantly lower than the resting values before the exercise. The interaction effects showed significant differences in peripheral and central systolic BP as well as in peripheral diastolic BP (p=0.05). Conclusion The ES represents a vigorous exercise stimulus that triggers relevant peripheral and central BP reactions that are more pronounced than after an MEE. Exergaming may therefore be a promising tool for the prevention of cardiovascular diseases.

A Game-Based Approach to Lower Blood Pressure? Comparing Acute Hemodynamic Responses to Endurance Exercise and Exergaming: A Randomized Crossover Trial.

The present randomized crossover study aimed to determine whether an exergaming session in an innovative, functional fitness game could be an effective exercise approach that elicits favorable blood pressure (BP) responses, such as a typical moderate endurance exercise (ET). Therefore, acute hemodynamic responses after a training session in the ExerCube and an ET on a treadmill were assessed and compared. Twenty-eight healthy recreational active participants (13 women; aged 24.8 ± 3.9 years) completed an exergaming session (EX) and an ET in a randomized and counterbalanced order. Before and throughout the 45 min after the training, the peripheral and central BP were measured. After the ET, there was a moderate decrease in both peripheral systolic (−1.8 mmHg; p = 0.14) and diastolic (−0.8 mmHg; p = 0.003), as well as central diastolic (−1.5 mmHg; p = 0.006) pressure compared to the resting value before the exercise. After the EX, there was a significant decrease in peripheral systolic (−6.3 mmHg; p < 0.001) and diastolic (−4.8 mmHg; p < 0.001), as well as central systolic (−5.8 mmHg; p < 0.001) and diastolic (−5.3 mmHg; p < 0.001) pressure compared to baseline. The interaction effects showed significant differences in peripheral and central systolic BP as well as in peripheral diastolic BP (p = 0.05). The EX seems to be an effective training approach that triggers relevant peripheral and central BP-responses, which are more pronounced than after a typical ET. Therefore, the ExerCube can be a time-efficient training tool to improve cardiovascular health.

Abstract 13861: Cardiac Predictors of Outcomes in Patients With Pulmonary Arterial Hypertension

Introduction: Pulmonary arterial hypertension (PAH) has significant anatomical, functional, and hemodynamic effects on the right heart. Yet, the prognostic value of these changes remains unclear. Methods: From the Cleveland Clinic Pulmonary Hypertension Registry, we included patients diagnosed with PAH between 2007-2013 who had right heart cath (RHC), transthoracic echocardiography (TTE), and cardiac computed tomography (CCT) within six months of each other. Right-sided ventricular and valvular anatomy and function were thoroughly assessed with CCT and TTE, while hemodynamics were determined by RHC. The primary outcome was a composite of all-cause mortality and hospitalization for PAH. The mean follow-up was 45 (+/- 42.4) months. Results: A total of 88 patients were included (mean age 55, 79% female). Among CCT, TTE, and RHC variables, RV diastolic pressure was the sole predictor of the primary outcome on multivariable analysis (HR 2.43, p=0.001) (Figure 1). When considering each outcome separately, central venous pressure and RV diastolic pressure were both predictive of death (HR 2.27, p=0.045 and 2.18, p=0.03 respectively), whereas RV diastolic pressure and pulmonary arterial mean pressure were predictors of hospitalization (HR 2.18, p=0.038 and 2.19, p=0.035 respectively) (Table 1). Tricuspid annular anatomy by CCT, and tricuspid regurgitation and RV size and function by TTE were not significantly associated with clinical outcomes. Conclusions: Right heart hemodynamics predict clinical outcomes in patients with PAH, while anatomic and functional characteristics do not.

ASSESSMENT OF ARTERIAL RIGIDITY IN DIABETIC PATIENTS ATTENDED IN A CARDIOLOGY SERVICE

INTRODUCTIONArterial stiffness is a complex phenomenon characterized by decreased compliance of the great arteries. In diabetes, the arterial wall undergoes a series of biomechanical changes, which can result in arterial stiffness. The mechanisms of these structural and functional arterial alterations in diabetes include insulin resistance, collagen accumulation due to inadequate enzymatic glycation, endothelial and autonomic nervous system dysfunction. Increased arterial stiffness is a marker of cardiovascular risk in diabetic patients. MethodsWe evaluated 46 patients in cardiology service, who underwent central pressure assessment with the Mobil O'Graph device. ResultsA total of 46 patients underwent the examination, 26 women (56%), with a mean age of 58.93 years (+-35). Of these patients, 22 (47.8%) were diabetic. The mean central systolic pressure of diabetic patients was 142.9mmHg (+-35.1) and the central diastolic pressure was 86.9mmHg (+-19.9). The mean pulse wave velocity was 9.68 (+-5.31), with 11 (50%) above the normal value, according to the Brazilian Guideline of Hypertension 2020. DiscussionAs seen in the analyzed patients, diabetic patients are at high risk for an increase in arterial stiffness. This is possibly because the mechanisms that cause changes in endothelial collagen loss, such as advanced glycation end products and the inhibitor of formation of these products, aminoguanidine, are exacerbated in diabetic patients. ConclusionThe importance of assessing arterial stiffness, through pulse wave velocity, in diabetic patients is evident.

Validation of Central Pressure Estimation in Patients with an Aortic Aneurysm Before and After Endovascular Repair.

The aim of this study was to investigate if non-invasive central pressure estimations are accurate in patients with an abdominal aortic aneurysm, before and after endovascular repair. Secondary evaluation was if measurement-accuracy was dependent on anatomical characteristics. Procedural invasive and non-invasive pressure-measurements were performed simultaneously both before and after endovascular repair in 20 patients with an infrarenal abdominal aortic aneurysm. Invasive catheter measurements were performed in the abdominal aorta. A tonometric device was used to perform non-invasive pressure-wave-analysis at the radial artery. A generalized transfer-function was used to generate an ascending aortic waveform for both measurements, allowing for direct comparison. Pre-treatment the mean differences between methods were -5.5 mmHg (p=.904), -11.8 (p<.001), and -7.2 mmHg (p=.124) for central systolic, diastolic, and mean pressure, respectively. The accuracy was dependent of aneurysm sac volume and intraluminal thrombus volume. Post-treatment limits of agreement were smaller for all pressure parameters compared to pre-treatment. The mean differences were 6.5 mmHg (p=.007), -6.4 (p<.020), and 1.6 mmHg (p=.370) for central systolic, diastolic, and mean pressure, respectively. In untreated AAA's the accuracy of non-invasive central pressure estimation was acceptable (mean difference between 5 and 10 mmHg) when compared to invasive pressures, but dependent of AAA characteristics. After EVAR the accuracy of central pressure estimation improved (reduction of 75% of the mean difference between pre and post measurements) TRIAL REGISTRATION NUMBER: NCT03469388; 3-5-2018.

Randomized blinded trial of automated REBOA during CPR in a porcine model of cardiac arrest

BackgroundResuscitative endovascular balloon occlusion of the aorta (REBOA) reportedly elevates arterial blood pressure (ABP) during non-traumatic cardiac arrest. ObjectivesThis randomized, blinded trial of cardiac arrest in pigs evaluated the effect of automated REBOA two minutes after balloon inflation on ABP (primary endpoint) as well as arterial blood gas values and markers of cerebral haemodynamics and metabolism. MethodsTwenty anesthetized pigs were randomized to REBOA inflation or sham-inflation (n = 10 in each group) followed by insertion of invasive monitoring and a novel, automated REBOA catheter (NEURESCUE® Catheter & NEURESCUE® Assistant). Cardiac arrest was induced by ventricular pacing. Cardiopulmonary resuscitation was initiated three min after cardiac arrest, and the automated REBOA was inflated or sham-inflated (blinded to the investigators) five min after cardiac arrest. ResultsIn the inflation compared to the sham group, mean ABP above the REBOA balloon after inflation was higher (inflation: 54 (95%CI: 43–65) mmHg; sham: 44 (33–55) mmHg; P = 0.06), and diastolic ABP was higher (inflation: 38 (29–47) mmHg; sham: 26 (20–33) mmHg; P = 0.02), and the arterial to jugular oxygen content difference was lower (P = 0.04). After return of spontaneous circulation, mean ABP (inflation: 111 (95%CI: 94–128) mmHg; sham: 94 (95%CI: 65–123) mmHg; P = 0.04), diastolic ABP (inflation: 95 (95%CI: 78−113) mmHg; sham: 78 (95%CI: 50−105) mmHg; P = 0.02), CPP (P = 0.01), and brain tissue oxygen tension (inflation: 315 (95%CI: 139−491)% of baseline; sham: 204 (95%CI: 75−333)%; P = 0.04) were higher in the inflation compared to the sham group. ConclusionInflation of REBOA in a porcine model of non-traumatic cardiac arrest improves central diastolic arterial pressure as a surrogate marker of coronary artery pressure, and cerebral perfusion. Institutional protocol number2017-15-0201-01371.

Abstract 249: Association of Diastolic Blood Pressure and Myocardial Perfusion Pressure with Survival During Pediatric Cardiopulmonary Resuscitation

Introduction: Myocardial perfusion pressure (MPP), defined as the aortic diastolic pressure minus the central venous diastolic pressure, is an important determinant of return of spontaneous circulation (ROSC) in cardiac arrest. However, measuring MPP requires both arterial and venous catheters and is often not possible. When only invasive arterial monitoring is available, diastolic blood pressure (DBP) is suggested as a surrogate for MPP during resuscitation and is also associated with survival after cardiac arrest. Hypothesis: We hypothesized that DBP measured during chest compression delivery would mirror MPP during resuscitation and both would be associated with survival. Methods: We performed a retrospective, secondary analysis of 102 swine resuscitations. Pediatric swine underwent asphyxial cardiac arrest and were resuscitated with predefined periods of basic and advanced life support (BLS and ALS). MPP and DBP were recorded every 30 s during chest compression delivery. Results: For both survivors and non-survivors, DBP mirrored MPP throughout resuscitation ( Figure 1A, B ). During BLS, both MPP and DBP were significantly greater in survivors (MPP: 8.5 0.6 vs. 1.1 0.5 mmHg; p &lt; 0.0001; DBP 17.3 0.6 vs. 8.7 0.5 mmHg; p &lt; 0.0001). During ALS, MPP and DBP were greater in survivors than non-survivors (MPP: 20.5 1.0 vs. 0.7 0.3 mmHg; p &lt; 0.0001; DBP 32.3 0.9 vs. 8.8 0.2 mmHg; p &lt; 0.0001). During ALS, the magnitude of change in both MPP and DBP after the first epinephrine administration in survivors was greater than in non-survivors (MPP: 24.4 3.3 vs. 4.8 0.9 mmHg; p &lt; 0.0001; DBP: 24.5 3.1 vs. 5.4 0.8 mmHg; p &lt; 0.0001). Conclusion: These observations confirm that both DBP and MPP are associated with survival in cardiac arrest and validate the use of DBP as a surrogate for MPP. Figure 1: Myocardial perfusion pressure (MPP) and diastolic blood pressure (DBP) during BLS and ALS in survivors (A) and non-survivors (B). Arrows indicate administration of epinephrine during ALS.

Central aortic pressure and long-term outcome in hypertensive patients undergoing percutaneous coronary intervention

Elevated central pulse pressure (CPP) had a negative influence on long-term outcome in patients with hypertension (HT). However, little is known about the impact of central pulse pressure on long-term outcomes in hypertensive patients undergoing PCI. A total number of 1184 hypertensive patients who received PCI procedure were prospectively collected. They were divided into two groups according to the median of central pulse pressure. Baseline characteristics, risk factors, hemodynamic data including central systolic pressure (CSP), central diastolic pressure (CDP) and CPP were measured. Invasive strategies were also analyzed to compare the long term outcome between patients with reference CPP and patients with high CPP. We further analyzed the predictors for myocardial infarction (MI), mortality, repeated PCI procedure in hypertensive patients undergoing PCI. We found patients in the reference CPP group had a lower CSP and higher CDP compared with high CPP group (Both P < 0.001) and male preponderance (P < 0.001). Patients with diabetes and chronic kidney disease (CKD) tend to have a high CPP (both P < 0.001). Drugs including Angiotensin Converting Enzyme inhibitors (ACEI) and statin were used more frequently in patients with reference CPP group (P = 0.035 and P = 0.001, respectively). Freedom from all-cause mortality and cardiovascular(CV) mortality was lower in the patients with high CPP group (P = 0.001, P = 0.01, respectively).Logistic regression revealed that CPP is a major predictor for all-cause mortality and repeated PCI procedure [hazard ratio (HR): 2.46 and 1.41, respectively]. In hypertensive patients receiving PCI, elevated CPP had a negative impact on long-term mortality; CPP also strongly predicts all-cause mortality and repeated PCI procedures in hypertensive patients undergoing PCI.

¿Son la velocidad de la onda del pulso y la rigidez arterial marcadores para evaluar la ateroesclerosis preclínica en pacientes con hipertensión resistente?

Introducción: La velocidad de la onda de pulso y la rigidez arterial se considera estándar de oro para evaluar daño a órganos diana que haya surgido subclinicamente. La disfunción endotelial es directamente proporcional al desarrollo de la aterosclerosis preclínica. Estos marcadores sustitutos mencionados anteriormente son relativamente más altos en pacientes con hipertensión no controlada o resistente. El objetivo fue evaluar si la rigidez arterial y la velocidad de la onda del pulso también son marcadores sustitutos del desarrollo de la aterosclerosis preclínica en pacientes con hipertensión resistente.&#x0D; Métodos y materiales: Se incluyeron en el estudio un total de 160 pacientes con hipertensión resistente de Croacia e India. La presión arterial central y otros valores clínicos se evaluaron utilizando un dispositivo no invasivo.&#x0D; Resultados: Las estadísticas del grupo se hicieron con perspectiva de género, los valores de la presión arterial sistólica (PA-S), la presión arterial diastólica (PA-D), la presión arterial media (PAM), la presión central sistólica (PC-S) ,la presión central diastólica ( PC-D), la presión de pulso central (cPP) y la velocidad de la onda de pulso (VOP) han sido descritas. Los valores de PA-S en hombres / mujeres fueron 147.26 ±22.12/ 144.10 ± 21.29; los valores de PA-D en hombres/mujeres fueron 94.98 ± 13.36 / 88.57 ± 12.25 respectivamente.&#x0D; Conclusiones: con los resultados obtenidos se puede concluir que la rigidez arterial es un marcador independiente que es directamente proporcional a la disfunción endotelial y al desarrollo de aterosclerosis preclínica.

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.

Acute cognitive, mood and cardiovascular effects of green and black tea

AbstractTea is often described as having “refreshing” properties. Indeed, components of both green and black tea have been shown to acutely improve aspects of cognition and mood and to affect cardiovascular function. There is, however, surprising little research directly comparing these effects between different types of tea. This study therefore examined acute cognitive, mood, and cardiovascular effects of green tea and black tea.A double blind, randomised, placebo-controlled,balanced, three-way cross-over study was conducted. Fourteen healthy young adults (M = 23.8, SD = 3 years) consumed placebo (water), green tea and black tea in balanced order at least 24 h apart.The drinks were prepared according to standardised procedures and consumed under double-blind conditions (in opaque containers with lemon cordial added for taste-masking). Mood and cognition were measured at baseline then 90 min post-treatment, cardiovascular function was assessed post-dose only. Mood was evaluated using a series of visual analogue scales, cognitive performance was assessed using a suite of standardised tests from the Computerised Mental Performance Assessment System (COMPASS), gauging performance on aspects of attention, memory and executive function.Peripheral and central systolic and diastolic pressure,augmentation pressure, augmentation index,and blood flow velocity were measured via Sphygmocor pulse wave analysis and Doppler ultrasound, respectively. There were a number of significant effects associated with the active treatments. Compared with placebo, black tea and green tea was associated with significantly improved digit vigilance accuracy (p &lt; .01), while green tea was associated with higher alertness (p &lt; .05).Regarding cardiovascular outcomes, black tea and green tea significantly increased central diastolic pressure, and peripheral diastolic pressure in comparison to placebo (P &lt; .01). Black tea also significantly increased central systolic pressure compared to green tea and placebo (p &lt; .05). Analysis of treatment guessing suggested that the masking procedure was highly effective. In conclusion, the present study shows that green tea improves alertness. Since black tea contains higher levels of caffeine, this effect is likely underpinned by non-caffeine mechanisms or caffeine/non-caffeine compound interactions.Improved vigilance is consistent with caffeine effects which may be modulated by cardiovascular effects. Interestingly the cardiovascular effects are opposite to those reported for chronic tea interventions. These results suggest that acute cognitive and cardiovascular components of tea merit further investigation both in the presence and absence of caffeine.