Diastolic Pressure Time Index Research Articles

The Protective Role of Resilience on Cardiovascular Health in Young Adults Exposed to Adverse Childhood Experiences

Background: Adverse childhood experiences (ACEs) are strong emotional or physical stressors that occur during sensitive developmental periods and are associated with reduced cardiovascular health (CVH). Resilience, or the psychological capacity of individuals to cope with adversity, has been recently shown to have a positive influence on CVH. Despite the dose-dependent detrimental impact of ACEs on CVH, it is unknown whether resilience exerts a protective cardiovascular effect against early stress. Thus, the purpose of this study was to investigate the impact that resilience may have on CVH in young adults who experienced ACEs. Methods: Eighteen young and apparently healthy adults (22±3 yo) with a history of severe ACE exposure (≥4) participated in this study and provided self-reported data about resilience. CVH was assessed non-invasively through transcutaneous arterial tonometry to evaluate arterial stiffness (pulse-wave velocity, PWV), myocardial oxygen demand (Systolic Pressure Time Index, SPTI), myocardial oxygen supply (Diastolic Pressure Time Index, DPTI) and myocardial perfusion (Subendocardial Viability Ratio, SEVR). Circulating biomarkers related to CVH were also evaluated (high-sensitive C-reactive protein, hsCRP). Results: Eleven participants reported high resilience (HR: resilience score≥95), while seven reported low resilience (LR: resilience score<95). Young adults with high resilience presented with a significantly lower myocardial oxygen demand (SPTI; HR: 1866±111 vs. LR: 2227±117mmHg·s/min, p=0.047) and higher myocardial perfusion (SEVR; HR: 168±13 vs.LR: 127 ±9% , p=0.034) than those with low resilience and a positive association between SEVR and resilience was identified ( r=0.492; p=0.045). No differences in myocardial oxygen supply ( p=0.225) or arterial stiffness ( p=0.614) were observed between groups. However, circulating hsCRP was also significantly lower in the HR group than the LR (0.89±0.3 vs. 2.96±1 mg/dL, p=0.041) and negatively associated with resilience ( r=-0.511; p=0.051). Conclusions: Our data suggests that, among young and apparently healthy adults exposed to childhood adversity, those who are psychologically more resilient exhibit higher myocardial perfusion and overall better CVH than those less resilient despite a history of severe ACEs. These findings suggest that resilience may protect, at least partially, against the early impact of ACEs on CVH. Future studies are thus warranted to further explore the relationship between resilience and CVH. Supported in part by the Child Health Research Institute at VCU. This is the full abstract presented at the American Physiology Summit 2024 meeting and is only available in HTML format. There are no additional versions or additional content available for this abstract. Physiology was not involved in the peer review process.

Transdermal Nicotine Patch Increases the Number and Function of Endothelial Progenitor Cells in Young Healthy Nonsmokers without Adverse Hemodynamic Effects.

Transdermal nicotine patches (TNPs), administering nicotine into the bloodstream through skin, have been widely used as nicotine replacement therapy, and exposure to nicotine can be detected by measurement of plasma cotinine concentration. In animal studies, nicotine treatment could increase the number of endothelial progenitor cells (EPCs), but the effect of TNPs on circulating EPCs and their activity in humans remained unclear. This study aimed to explore the influence of TNPs on circulating EPCs with surface markers of CD34, CD133, and/or KDR, and colony-forming function plus migration activity of early EPCs derived from cultured peripheral blood mononuclear cells before and after TNP treatments in young healthy nonsmokers. In parallel, pulse wave analysis (PWA) was applied to evaluate the vascular effect of TNP treatments. Twenty-one participants (25.8 ± 3.6 years old, 10 males) used TNP (nicotine: 4.2 mg/day) for 7 consecutive days. During the treatment, the CD34+ EPCs progressively increased in number. In addition, the number of EPCs positive for CD34/KDR, CD133, and CD34/CD133 were also increased on day 7 of the treatment. Furthermore, the early EPC colony-forming function and migration activity were increased with the plasma cotinine level positively correlating with change in colony-forming unit number. PWA analyses on day 7, compared with pretreatment, did not show significant change except diastolic pressure time index, which was prolonged and implied potential vascular benefit. In conclusion, 7-day TNP treatments could be a practical strategy to enhance angiogenesis of circulating EPCs to alleviate tissue ischemia without any hemodynamic concern.

Вплив поліморфізма гена рецепторів ангіотензина ii типу 1 на ефективність антигіпертензивної терапії у хворих із гіпертонічною хворобою, які перенесли інфаркт міокарда за результатами довготривалого спостереження

The purpose of the study was to evaluate the effectiveness of antihypertensive therapy based on the data of daily blood pressure monitoring in patients with hypertension and a history of myocardial infarction, taking into account the A1166C polymorphism of the angiotensin II type 1 receptor gene, based on the results of long-term follow-up. Materials and methods. The study included 36 men with arterial hypertension of the 1st to 3rd degree who had suffered a myocardial infarction. The average age was 57.0 (52.0; 64.0) years, the experience of arterial hypertension – 6.3 (4.0; 15.0) years, the period after a myocardial infarction – 48.0 (12.0; 144.0) months. When determining the A1166C polymorphism of the angiotensin II type 1 receptor gene, patients were divided into 3 groups: group 1 consisted of 18 (50%) patients with the AA genotype, group 2 included 12 (33.3%) patients with the AС genotype, and group 3 – 6 (16.7%) patients with СС genotype of angiotensin II type 1 receptor gene. Daily blood pressure monitoring was carried out at the beginning of the study and after 38 months. Results and discussion. At the beginning of the study, based on the results of daily blood pressure monitoring, it was found that in the group as a whole, the levels of systolic blood pressure and diastolic blood pressure, the pressure load index – the diastolic blood pressure time index corresponded to the target values according to the median, but the pressure load indices for systolic blood pressure exceeded the normal range. Against the background of long-term antihypertensive therapy, a reliable decrease in systolic blood pressure levels was established for all time periods of the day, especially during the daytime. A significant decrease in the values of the pressure load indices was established – the time index of systolic blood pressure at daytime (delta -10.49%, which was -27.9%) and the area index of systolic blood pressure at daytime (delta -34.89 mm Hg x h, which was -32.0%) (p <0.05). When analyzing the effectiveness of long-term antihypertensive therapy depending on the A1166C polymorphism of the angiotensin II type 1 receptor gene, it was established that the highest percentage of achieving the target blood pressure level (66.7%) in combination with the normalization of the circadian blood pressure rhythm was determined in patients with the AA genotype of the AGTR1 gene. Among patients with AC genotype, 33.3% reached the target blood pressure levels, but it was not possible to achieve normalization of blood pressure variability and pathological patterns of the circadian rhythm of blood pressure persisted, which are signs of a prognostically unfavorable course of the disease. Among patients with CC genotype of the AGTR1 gene, against the background of long-term treatment, 33.3% achieved the target level of blood pressure, in general, the group normalized the degree of nocturnal decrease in blood pressure, but only a decrease in the levels of systolic blood pressure and diastolic blood pressure during the day in combination with increased values of pressure load indices was observed, which indicates insufficiently effective control of arterial hypertension. Conclusion. During the long-term observation of patients with hypertension and a history of myocardial infarction, an assessment of the effectiveness of antihypertensive therapy was carried out taking into account the A1166C polymorphism of the AGTR1 gene based on the results of daily blood pressure monitoring

Blood pressure, arterial waveform, and arterial stiffness during hemodialysis and their clinical implications in intradialytic hypotension.

This study included 152 hemodialysis patients (mean age, 69 years; 34.2% female) and investigated serial changes in blood pressure (BP) and arterial stiffness indices during hemodialysis using an oscillometric device, SphygmoCor XCEL, and examined whether assessment of the arterial waveform has clinical implications for the management of intradialytic hypotension (IDH). Measurement was performed every 30 min during hemodialysis, and the threshold defining IDH was systolic BP (SBP) decrease ≥40 mmHg or a requirement for antihypotensive medication in all patients and ≥ the 75th percentile of maximum SBP decrease during hemodialysis (≥34 mmHg) in the subgroup without antihypotensive medication (n = 98). In all patients, a 1-standard deviation (SD) increase in the baseline subendocardial viability ratio (SEVR), an index of myocardial perfusion, was an independent predictor of IDH (odds ratio [OR] 0.43, p < 0.001). In the subgroup analysis, a serial change in SBP and all arterial waveform indices, including the augmentation index, augmented pressure (AP), and SEVR, during hemodialysis were greater for IDH than for non-IDH patients (all p < 0.01 by 2-way repeated-measures ANOVA), with the exception of heart rate (p = 0.40) and diastolic pressure time index (p = 0.21). Diabetes (OR 4.08), a 1-SD increase in ultrafiltration rate (OR 2.07), fractional shortening (OR 0.45), baseline SEVR (OR 0.36) and the first 1-h percent change in AP (OR 0.52) were independent predictors of IDH (all p < 0.05). In conclusion, impaired myocardial perfusion and increased arterial stiffness, particularly poor arteriolar responsiveness to acute dialysis-related changes, are associated with IDH, and predialysis SEVR evaluation can complement screening for IDH.

Myocardial remodeling and fibroblast growth factor in patients with resistant hypertension

Aim. To study the prevalence and severity of left ventricular hypertrophy (LVH), its relationship with fibroblast growth factor (FGF23) in patients with resistant hypertension (RH) depending on the effectiveness of multiagent antihypertensive therapy.Material and methods. The study included 92 patients diagnosed with RH. All patients underwent 24-hour ambulatory blood pressure monitoring (ABPM), echocardiography, general laboratory tests, and the serum FGF23 level was determined.Results. According to ABPM results, patients were divided into following groups: 1st — controlled RH (n=44) and 2nd — uncontrolled (n=48) RH. The groups were comparable in sex, age, main clinical and anthropometric parameters. In group 2, the main parameters of ABPM were higher. There were no differences in general laboratory tests, In the group of uncontrolled RH, the level of FGF23 was higher — 11,7 [8,5; 15,4] pmol/ml vs 9,2 [7,1; 11,6] pmol/ml in the 1st group (p=0,0036). According to echocardiography, a comparable violation of left ventricular (LV) diastolic function, an increase in left atrial size, LV mass (LVM) and LVM index were found. In patients of the 2nd group, large values of interventricular septal thickness were revealed — 1,3 [1,2; 1,4] cm vs 1,2 [1,1; 1,3] cm in the 1st group (p=0, 0043) and relative LV wall thickness (LVWT) — 0,50 [0,48; 0,53] vs, 0,45 [0,43; 0,50] in the 1st group (p&lt;0,0001). In the 1st and 2nd groups, concentric LVH was more common (18 (41%) patients in the 1st and 26 (54,1%) in the 2nd (p=0,044) groups) than eccentric LVH (15 (34,1%) and 13 (27,1%) patients in the 1st and 2nd groups, respectively). Correlation analysis revealed a positive relationship between pulse pressure and HTN duration (r=48, p=0,02) and FGF23 level (r=0,62, p=0,004). The LVM index was positively associated with the diastolic pressure-time index (BP) (r=51, p=0,02). A positive correlation was found between relative LVWT and pulse pressure (r=0,64, p=0,02) and a negative relationship with the duration of regular antihypertensive therapy (r=47, p=0,04), A strong relationship was found between LVEF and FGF23 levels (r=0,75, p=0,005).Conclusion. For patients with uncontrolled resistant hypertension, an increase in pulse pressure and myocardial remodeling in the form of concentric hypertrophy are more characteristic. FGF23 is significantly higher in uncontrolled RH and is positively associated with pulse pressure and relative LVWT.

Abstract 10550: Higher Endocardial Viability Ratio is Associated With Improved Left Ventricular Function After Transcatheter Aortic Valve Replacement

Introduction: Both LV dysfunction and AS lead to an increase in LVEDP, a decrease in oxygen delivery to cardiac muscle, and ultimately a decrease in the EVR. Hypothesis: We hypothesized that patients with low EVR would have less significant recovery of LV function after TAVR. Methods: Patients with LVEF &lt;40% and severe AS undergoing TAVR at the University of Virginia (UVA) between 2012 and 2019 were retrospectively reviewed. EVR was calculated by dividing the diastolic pressure time index (DPTI) [(Diastolic blood pressure – LVEDP) x (60seconds/ heart rate – 0.2 seconds)] by the tension time index (TTI) [systolic pressure x 0.2 seconds] using catheter-derived hemodynamics prior to TAVR. LVEF and mAG values were obtained from TTE measurements done for procedural planning and at, or closest to, 1-year follow-up. The patients were divided into cohorts based on EVR above or below 0.7, a value indicative of subendocardial ischemia. Mean change in LVEF was evaluated between these two groups (Figure [1] and Table [1]) and multivariable regression was performed using pre-procedural LVEF, EVR, and change in mean aortic gradient as shown in Table [2]. Results: 128 patients that underwent TAVR had a LVEF &lt;40%. 85 patients (32.5% female) had complete invasive hemodynamic and echocardiographic data. The mean change in post-TAVR LVEF in the lower subgroup was &lt;5% with a standard deviation of 12.5. In patients with EVR &gt;0.7 there was improvement of LVEF of &gt;10% with a standard deviation of 10.8. Two-tailed t-testing was performed with a corresponding p-value of 0.0181. Multivariable regression on pre-procedural LVEF, pre-procedural EVR, and change in mean AG were all statistically significant. Conclusion: EVR &gt;0.7 is associated with greater improvement in LV function in advanced heart failure patients after TAVR.

Numerical Analysis on Effect of Coronary Supply-Demand Equilibrium on Varying Coronary Blockage and Stress Conditions.

In this paper, we present a computational fluid dynamic (CFD) analysis to capture the effect of physical stress and stenosis severity in coronary arteries leading to changes in coronary supply demand oxygen equilibrium. We propose a coupled Od-3d coronary vessel model to predict the variation in flow dynamics of coronary as well as arterial system, modeled using an in-silico model replicating cardiovascular hemodynamics. CFD simulation were solved using subject specific CT scan for coronary and arterial flow and pressure along with metrics related to arterial wall shear stress. Simulations were performed for three heart rates (75, 90 and 120 bpm) and four stenosis states representing different stages of Coronary artery disease (CAD) namely healthy, 50%, 75%, 90% blockage in left anterior descending artery (LAD). Myocardial oxygen supply demand equilibrium were calculated for each cases using hemodynamic surrogate markers naming Diastolic pressure time index for supply and Tension time index for demand. The proposed 0d-3d coupled hemodynamic model of the coronary vessel bed along with supply-demand equilibrium estimated for different stress level and stenosis severity may provide useful insights on the dynamics of CAD manifestation and predict vulnerable regions in coronary bed for early screening and interventions.

Resveratrol Reduces Arterial Stiffness and Improves Functional Capacity in Patients with COPD

IntroductionChronic Obstructive Pulmonary Disease (COPD) is the 3rd leading cause of death worldwide and is strongly associated with the development of cardiovascular disease (CVD). Large artery stiffening is recognized as a major CVD risk factor that contributes to diminished myocardial blood supply and reduced functional capacity, a marker of disease severity in COPD. Elevated oxidative stress plays a pivotal role in the etiology of both COPD and CVD. Apart from the body’s endogenous ability to counteract oxidative stress, the consumption of exogenous antioxidants also enhances the capacity to scavenge free radicals and reduce arterial stiffness. Whether or not antioxidants can reduce arterial stiffness and improve functional capacity in patients with COPD, however, has yet to be elucidated.PurposeThis study sought to test the hypothesis that oral resveratrol, a powerful antioxidant, will reduce arterial stiffness and improve functional capacity in patients with COPD.MethodsTen patients with COPD (GOLD Stage II‐IV) participated in this study and completed 6 weeks of oral resveratrol (500 mg/daily) or placebo (PLC) treatment. Arterial stiffness was evaluated via tonometry (SphygmoCor) before and after RES or PLC to assess augmentation index (AIx), AIx normalized to a heart rate of 75 beats per minute (AIx75), and diastolic pressure time index (DPTI). Functional capacity was measured via six‐minute walk test to evaluate distance walked.ResultsA single dose of RES significantly (p&lt;0.01) improved markers of arterial stiffness (AIx75: ∆RES=‐8±2% vs. ∆PLC=‐4±2%) while increasing myocardial perfusion (DPTI: ∆RES=158±79 mmHg vs. ∆PLC=‐23±18 mmHg p=0.04). No changes (p=0.171) in functional capacity were observed after a single dose of RES or PLC. However, six weeks of RES significantly (p=0.01) reduced AIx75 (∆RES=‐9±3% vs. ∆PLC=‐3±2%), while it improved myocardial perfusion (DPTI: ∆RES=166±85 mmHg vs. ∆PLC=‐36±18 mmHg; p=0.04) and distance walked (∆RES=25±13m vs. ∆PLC=‐2±4m; p=0.04).ConclusionFor the first time, we have identified that the antioxidant resveratrol reduces markers of arterial stiffness and improves myocardial perfusion in patients with COPD. In addition, six weeks of daily intake of this natural antioxidant also improved functional capacity in this population. Future studies are warranted to investigate the long terms effects of resveratrol in cardiovascular health in patients with COPD.

Abstract 11969: Endocardial Viability Ratio is Associated With Survival in Advanced Heart Failure Patients

Introduction: Myocardial oxygen supply is an important determinant of cardiac function. The Endocardial Viability Ratio (EVR), a measure of myocardial oxygen supply-demand balance, is calculated as a ratio of the diastolic pressure time index [(diastolic blood pressure - left ventricular end diastolic pressure) x (60 sec/heart rate - 0.2 sec)] and tension time index [systolic pressure x 0.2 sec]. We hypothesized that low EVR would be associated with adverse events in patients with heart failure (HF). Methods: EVR was calculated in the invasive arm of the ESCAPE trial in patients with available discharge blood pressure, pulmonary arterial wedge pressure, and heart rate as the ratio of the diastolic pressure time index (a measure of coronary blood supply) and tension time index (a measure of myocardial oxygen demand). Kaplan-Meier analysis and Cox proportional hazards regression was used to assess associations with EVR and a composite death endpoint including cardiac transplantation and left ventricular assist device implantation. Results: Among 143 patients (56.9 ± 13.3 years, 30.1% female), the median EVR was 1.168 (IQR 0.923-1.398). Survival during 180 days of follow-up was worse in patients with EVR below the median (p=0.0004) (Figure panel 1A). Among the 10 patients with EVR &lt; 0.7, considered to represent subendocardial ischemia, 50% reached this endpoint within 100 days (p=0.01 versus remaining patients) (Figure 1B). An increase of 0.1 in EVR was associated with an 18% relative risk reduction for this endpoint (HR 0.82, 95% CI 0.74-0.91, p=0.0002), while an increase of 0.5 in EVR was associated with a 62% relative risk reduction (HR 0.38, 95% CI 0.22-0.64, p=0.002). Conclusion: Decreased EVR, a marker of myocardial oxygen supply, is associated with adverse events in advanced HF patients. Further studies on the prognostic utility of EVR in HF are needed.

The Role of Aortic Stiffness Parameters in Evaluating Myocardial Ischemia.

BackgroundArterial stiffness is a process resulting in deterioration of hemodynamic function of the aorta, a decrease in its compliance and elasticity, caused by the proportional change of components of the extracellular matrix. Although many researches have been done to determine the etiologies of myocardial ischemia in the absence of obstructive coronary artery disease, none of them has investigated the relation between the parameters of aortic stiffness and the myocardial ischemia documented by the exercise stress test. The present cross-sectional study aimed to investigate the difference of aortic stiffness parameters between the groups separated by exercise stress test result as positive and negative ischemic findings in the absence of obstructive coronary artery disease.MethodsThe present study included 79 patients who were admitted to Istanbul Faculty of Medicine, Department of Cardiology with complaint of chest pain. Forty patients (21 women and 19 men) have ischemic findings on the exercise electrocardiography (ECG) test and 39 patients (20 women and 19 men) have normal exercise ECG results. The patients who have positive exercise ECG findings underwent coronary angiography and all the patients had non-obstructive coronary artery disease. Demographic features (age, sex and comorbidities) were statistically similar between the groups. Aortic stiffness measurements (pulse wave velocity, pulse pressure, aortic augmented pressure, augmentation index, systolic pressure-time index, diastolic pressure-time index and subendocardial viability ratio) were done with tonometric methods.ResultsThere was no significant difference between the two groups in terms of the aortic stiffness parameters. Systolic blood pressure (P = 0.33), diastolic blood pressure (P = 0.24), pulse pressure (P = 0.60), systolic pressure-time index (P = 0.10), diastolic pressure-time index (P = 0.91), subendocardial viability ratio (P = 0.19), aortic augmented pressure (P = 0.87), augmentation index (P = 0.58) and pulse wave velocity (P = 0.56) were detected between the two groups. Biochemical parameters were found similar between the two groups. Only low-density lipoprotein levels were slightly higher in patients with negative exercise stress test result (139 vs. 123 mg/dL, P = 0.02).ConclusionThere is no finding supporting that the aortic stiffness identifies the patients with non-obstructive coronary artery disease but with signs of myocardial ischemia and further investigation of other causes of myocardial ischemia is required.

Resistance Exercise on Pulse Wave Reflection and Arterial Stiffness Between Trained and Untrained Individuals

Pulse wave reflection [augmentation index (AIx), augmentation pressure (AP)], and arterial stiffness [pulse wave velocity (PWV)] are indicative of cardiovascular health. Acute resistance exercise (RE) alters pulse wave reflection, and arterial stiffness, but responses in resistance-trained individuals is unclear. PURPOSE: To examine the responses in pulse wave reflection and arterial stiffness after RE in resistance-trained (RT) versus untrained (UT) individuals. METHODS: Twenty-one (RT: n=14; UT: n=7) individuals volunteered. Pulse wave reflection and arterial stiffness were collected at rest, and 10min following a control, or RE consisting of 3 sets of 10 repetitions at 75% 1-repetition maximum (1RM) on the leg press, lat pulldown, leg extension, chest press and leg curl. A 2x2x2 ANOVA was used to examine group (RT, UT) differences across conditions (RE, control) and time (Rest, Recovery). RESULTS: The groups were similar (p>0.05) for age, height, and BMI, but not weight (p<0.05). The 1RMs for all exercises, except leg extension (p=0.26), were different between groups. At rest, the groups were statistically different for the tension-time index [TTI (RT: 1999±282ms; UT: 2192±209ms, p=0.04)], diastolic pressure-time index [DPTI (RT: 2817±316ms; UT: 3047±171ms, p=0.003)], and PWV (RT: 5.5±0.7m/s; UT: 6.3±0.4m/s, p=0.0001). There were significant time by condition interactions for aortic pulse pressure (Rest: 34±6mmHg; Recovery: 37±8mmHg, p=0.01), AP (Rest: 5±3mmHg; Recovery: 6±5mmHg, p=0.003), AIx normalized at 75bpm (Rest: 8.7±12.6%; Recovery: 16.4±6.0%, p=0.004), and TTI (Rest: 2084.6±273.4ms; Recovery: 2760.9±463.3ms, p=0.0001) such that they increased during recovery, compared to rest after RE, and the control. There were condition by time interactions for DPTI (Rest: 2889.6±297.0ms; Recovery: 2394.9±458.3ms, p=0.005) and subendocardial viability ratio SEVR (Rest: 138.4±19.3%; Recovery: 86.6±33.0%, p=0.006) such that they increased after acute resistance exercise, compared to rest and the control. There were no significant changes in arterial stiffness. CONCLUSION: These data suggest that resistance-trained individuals have reduced workload of the heart and lower arterial stiffness at rest, but are similar to untrained individuals after acute resistance exercise.

The Influence of Glycemic Control on Heart Rate Variability and Blood Pressure in Adult Patients with the Type 1 Diabetes

Abstract Background and aims: to identify heart rate variability (HRV) and blood pressure (BP) in patients with type 1 diabetes depending on the duration of disease and glycemic control. Materials and methods: 43 patients were examined. All patients were divided into 2 groups according to the level of НвА1с: group 1 (n=21) with НвА1с ≤ 7.5% and group 2 (n=22) with НвА1с &gt; of 7.5%. All patients underwent daily monitoring of electrocardiogram Holter and ambulatory BP monitoring within 24 hours in parallel with long term monitoring of blood glucose. Results: Hyppoglycemia is characterized by significant decrease root mean square difference between adjacent RR intervals (RMSSD) (r = −0.531; p = 0.003) and number of consecutive RR intervals, the difference between them is more than 50 ms expressed as a percentage of total number of RR-intervals (pNN50%) (r = the −0.503; p = 0.005) and increase of Low Frequency/High Frequency Ratio (LF/HF) (r = 0552; p = 0.002). Patients with hypoglycemia had significantly higher daily diastolic pressure area index (DPAI24) (p = 0.016), and daily diastolic pressure time index DPTI24 (p = 0.025). Conclusion: our findings demonstrate the need to reduce the frequency of hypoglycemia episodes in patients with T1DM.

CRT-700.35 Slope of Left Ventricular Filling as an Index of Valvular and Paravalvular Regurgitation in Native and Prosthetic Aortic Valves

Precise quantification of paravalvular aortic regurgitation (PAR) is challenging. Aortic regurgitation index (AR index) has been validated in transcatheter aortic valve replacement (TAVR) cohorts; however, accuracy is limited by heart rate dependency. Diastolic pressure time (DPT) index has been

Aortic Reservoir Function has a Strong Impact on the Cardiac Blood Supply-Workload Balance in Children.

It has been reported that more than half of the ejected blood from the left ventricle is stored in the aorta during systole and expelled during diastole. One important organ that receives blood flow mainly during diastole is the heart. It is also reported that the cardiac blood supply-workload balance in small children is disadvantageous to the heart. Therefore, we measured the aortic reservoir function and examined the relationship between the aortic reservoir function and the cardiac blood supply-workload balance. The percent diastolic runoff, which is the percentage of the diastolic blood flow of the total cardiac output, was measured as the index of the aortic reservoir function. The subendocardial viability ratio-the ratio of the diastolic pressure time index (the blood supply to the heart) to the tension time index (implying the myocardial oxygen demand)-was investigated as an index of the cardiac blood supply-workload balance in children. The percent diastolic runoff was 51.7 ± 4.5%, smaller than that in adult. It had a significant positive relationship to age (r2 = 0.32, p = 0.0052). The subendocardial viability ratio was 100.8 ± 19.6% and had a strong relationship to the percent diastolic runoff (r2 = 0.92, p < 0.0001). The percent diastolic runoff had a positive relationship with age during childhood. The value had a strong impact on the cardiac blood supply-workload balance.

Preserved Cardiac Blood Supply-Workload Balance in Pediatric Patients After Aortic Arch Repair.

One of the most important problems in patients with aortic coarctation after aortic arch repair is future cardiovascular disease. We have previously reported that the enhancement of aortic pressure wave reflection in patients could be one of the causes of future cardiovascular diseases, because it results in an increase of the left ventricular workload and is disadvantageous for coronary circulation. Seventeen patients who had undergone aortic arch repair without pressure gradient in their aortic arch were enrolled. An ascending aortic pressure waveform was recorded by a pressure-sensor-mounted catheter, and a subendocardial viability ratio, which measures cardiac blood supply-workload balance, was calculated. The values were compared with those in age-matched controls. The patients' mean age was 6.8±2.8years. The mean ascending aortic systolic pressure was higher (100.4±12.9 vs. 90.2±8.9mmHg, p=0.0011) and the pulse pressure was wider (38.1±7.1 vs. 32.5±5.4mmHg, p=0.0072) in patients than in control subjects. There was no difference in the mean subendocardial viability ratio (1.01±0.25 vs. 1.01±0.24, ns), while the mean tension time index (27.4±5.6 vs. 23.0±3.3, p=0.0001) and diastolic pressure time index (28.4±11.1 vs. 23.6±8.0, p=0.0082) were higher in patients than in controls. The cardiac blood supply-workload balance was preserved in patients after aortic arch repair, despite an increase in their cardiac workload.

Central diastolic pressure exponential decay constant and subendocardial flow supply.

Central diastolic pressure exponential decay constant and subendocardial flow supply.

Acute Hemodynamic Effects of Intra-aortic Balloon Counterpulsation Pumps in Advanced Heart Failure

BackgroundThe utility of intra-aortic balloon counterpulsation pumps (IABPs) in low cardiac output states is unknown and no studies have explored the impact of IABP therapy on ventricular workload in patients with advanced heart failure (HF). For these reasons, we explored the acute hemodynamic effects of IABP therapy in patients with advanced HF. MethodsWe prospectively studied 10 consecutive patients with stage D HF referred for IABP placement before left ventricular assist device (LVAD) surgery and compared with 5 control patients with preserved left ventricular (LV) ejection fraction (EF) who did not receive IABP therapy. Hemodynamics were recorded using LV conductance and pulmonary artery catheters. Cardiac index (CI)-responder and CI-nonresponder status was assigned a priori as being “equal to or above” or below the median of the IABP effect on CI, respectively, within 24 hours after IABP activation. ResultsCompared with controls, patients with advanced HF had lower LVEF, lower LV end-systolic pressure, lower LV stroke work, and higher LV end-diastolic pressures and volumes before IABP activation. IABP activation reduced LV stroke work primarily by reducing end-systolic pressure. IABP therapy increased CI by a median of 20% as well as increased diastolic pressure time index and the myocardial oxygen supply:demand ratio. Compared with CI-nonresponders, CI-responders had higher systemic vascular resistance, lower right heart filling pressures, and a trend toward lower left heart filling pressures with improved indices of right heart function. Compared with CI-nonresponders, the diastolic pressure time index was increased among CI-responders. ConclusionsIABP therapy may be effective at reducing LV stroke work, increasing CI, and favorably altering the myocardial oxygen supply:demand ratio in patients with advanced HF, especially among patients with low right heart filling pressures and high systemic vascular resistance.

Cardiovascular Response to Recreational Hockey in Middle-Aged Men

The present study examined the hemodynamic response to recreational pick-up hockey relative to maximal exercise testing in middle-aged men. A total of 23 men with a mean age of 53 ± 7years were studied. Graded exercise testing on a cycle ergometer determined maximal oxygen consumption, blood pressure (BP), and heart rate (HR). Ambulatory BP and Holter electrocardiographic monitoring was performed during one of their weekly hockey games (mean duration= 45 ± 7.2 minutes): for "On-Ice" responses (PLAY; data recorded while standing immediately after a shift; 8.0 ± 1.4 shifts per game) and during seated recovery (BENCH), 15minutes after the game. On-Ice HRs and BPs were significantly higher than values obtained during maximal cycle exercise, respectively (HR 174 ± 8.9 vs 163 ± 11.0 beats/min) (systolic blood pressure 202 ± 20 vs 173 ± 31mm Hg; p <0.05). Both systolic and diastolic blood pressures decreased significantly throughout the duration of the game, whereas HR increased from 139 ± 20 to 155 ± 16 beats/min during the game. The myocardial oxygen demand (myocardial time tension index) increased significantly during PLAY concurrent with a decrease in estimated myocardial oxygen supply (diastolic pressure time index), with the endocardial viability ratio during PLAY demonstrating a significant decrease during the third quarter of the game (1.25 ± 0.24) versus the first quarter (1.56 ± 0.30), which remained depressed 15minutes post-game (p <0.05). In conclusion, recreational pick-up hockey in middle-aged men is an extremely vigorous interval exercise with increasing relative intensity as the game progresses. Hockey elicits peak BPs and HRs that can exceed values observed during maximal exercise testing and is characterized by progressive increases in myocardial oxygen demand and lowered supply during PLAY and BENCH time. Given the progressive and high cardiovascular demands, caution is warranted when estimating the cardiovascular demands of hockey from clinical stress testing, particularly in those whom coronary reserve may be compromised.

Hemodynamic Assessment of AorticRegurgitation After TranscatheterAortic Valve Replacement: The Diastolic Pressure-Time Index.

Assessment of aortic regurgitation (AR) immediately after transcatheter aortic valve replacement (TAVR) is essential to guide further intervention in cases of relevant AR. It was the aim of this study to identify a simple and reproducible hemodynamic parameter for the assessment of AR. Relevant AR after TAVR is present in up to 21% of cases and might be associated with adverse long-term outcomes. Three hundred sixty-two consecutive patients who were treated with TAVR for symptomatic aortic valve stenosis were analyzed. AR was assessed by aortic root angiography according to the Sellers classification. For hemodynamic evaluation, the diastolic pressure-time (DPT) index was calculated after TAVR: the area between the aortic and left ventricular pressure-time curves was measured during diastole and divided by the duration of diastole to calculate the DPT index. The DPT index was finally adjusted for the respective systolic blood pressure: DPTindexadj=(DPT index/systolic blood pressure)×100. Patients with angiographically nonrelevant AR (grade<2) had higher DPT indexadj (30.7 ± 6.8) compared with those with relevant AR (grade≥2) (26.2 ± 5.8) (p< 0.05). Patients with DPT indexadj≤27.9 had significantly higher 1-year mortality risk in comparison with those with DPT indexadj >27.9: 41.4% versus 13.5% (hazard ratio: 3.8; 95% confidence interval: 2.4 to 5.9; p [log rank-test]< 0.001). In multivariate regression analysis, DPT indexadj≤27.9 was the strongest independent predictor of 1-year mortality (hazard ratio: 2.5; 95% confidence interval: 1.8 to 3.7; p< 0.001). DPT indexadj is a simple, investigator-independent parameter that should be considered to differentiatebetween relevant and nonrelevant AR after TAVR.

Albuminuria is Associated With Subendocardial Viability Ratio in Chronic Kidney Disease Patients

Background/Aims: Albuminuria is a well-established marker of subclinical organ damage. Pulse-wave analysis (PWA) employs the technique of applanation tonometry to obtain a peripheral pulse pressure waveform, from which central hemodynamic data are derived by application of the transfer function. Using PWA we can measure the subendocardial viability ratio (SEVR) and ejection duration (ED). SEVR or the Buckberg index is a non-invasive estimate of myocardial workload, oxygen supply and perfusion and a measure of the ability of the arterial system to meet the heart`s energy requirements. ED is the duration of ventricular ejection. The objective of this study was to evaluate the relationship between albuminuria and PWA parameters in chronic kidney disease (CKD) patients. Methods: We studied 86 CKD patients aged 59.8±13.5 years, 56 (65.1%) were male. PWA analysis and 24-hour ambulatory blood pressure (24hABP) monitoring were performed. The following parameters were calculated: (1) aortic augmentation index with and without correction for a heart rate of 75 (Aix and AIx@ HR75), (2) SEVR, calculated as the ratio of the diastolic pressure time index and the systolic pressure time index, (3) ED, (4) estimated central aortic systolic and diastolic pressure and (5) central aortic pulse pressure calculated as the difference between estimated aortic systolic and diastolic BP. Blood samples and urine albumin-to-creatinine ratio (UACR) were analyzed; UACR values were natural log transformed (lnUACR). Results: Using CKD-EPI creatinine-cystatin C formula the eGFR in patients was 7-130 ml/min/1.73m² (mean 32.6; SD±24.6). We found statistically significant correlation between lnUACR and cystatin C (r=0.308; P=0.004), eGFR (r=-0.219; P=0.04), hemoglobin (r=-0.255; P=0.02), phosphorus (r=0.222; P=0.04), iPTH (r=0.268; P=0.01), SEVR (r=-0.254; P=0.02) and ED (r=0.315; P=0.003). No statistically significant correlations between lnUACR and cardiac biomarkers TnI, NT-proBNP, central aortic BP and 24h ABP values were found. Using multiple regression analysis statistically significant association was found between SEVR as dependent variable and lnUACR (β=-0.223, P=0.039), sex (β=-0.216, P=0.035), and diabetes (β=0.332, P=0.001). Multiple regression analysis with ED as dependent variable has shown statistically significant association with lnUACR (β=0.242, P=0.031) and diabetes (β=-0.275, P=0.01). Patients were stratified into tertiles according to the lnUACR. Statistically significant differences in serum creatinine (P=0.001), cystatin C (P=0.012), hemoglobin (P=0.03), calcium (P=0.036), iPTH (P=0.008), SEVR (P=0.007) and ED (P=0.004) were found between tertiles. In post hoc analysis we found statistically significant differences between first and third tertile in SEVR (P=0.002; 95% CI:10.5-45) and in ED (P=0.001; 95% CI:-6.89-(-1.87)). Conclusions: Nondialysis CKD patients with higher levels of albuminuria have lower SEVR and higher ED and our results have shown the importance of central hemodynamic parameters like are SEVR and ED as a better or earlier noninvasive hemodynamic indexes in these patients.