Fractional Pulse Pressure Research Articles

Association between pulse pressure and new-onset diabetes in hypertensive patients

Objective: To determine the association between pulse pressure and the risk of new-onset diabetes in hypertensive patients. Methods: In this prospective cohort study, hypertensive patients from the Kailuan Study, who were diagnosed in 2006-2007 check-up, were screened for enrollment. Participants who finished the biennial follow-up until December 31, 2017 were finally included in this analysis. The primary outcome was incident diabetes development. The pulse pressure variables were divided into quartiles (Q1-Q4), and the Kaplan-Meier curve was used to examine and estimate the cumulative incidence of new-onset diabetes among quartiles. Cox proportional hazards regression model was performed to explore the association between pulse pressure and the risk of new-onset diabetes in hypertensive patients. Results: During an average follow-up of 8.17 years, 6 617 new-onset diabetes were identified out of the 32 917 hypertensive patients with no history or evidence of diabetes in 2006-2007 check-up. Participants were classified into quartiles according to pulse pressure levels as follows: Q1 group(<41 mmHg (1mmHg=0.133kPa))(n=7 995); Q2 group(41-<51 mmHg) (n=8 196); Q3 group (51-<61 mmHg) (n= 8 270); Q4 group (≥61 mmHg) (n=8 456). The cumulative incidences of new-onset diabetes across the quartiles were 16.94%, 19.61%, 21.07%, and 22.33%, respectively, with the incidence density was 20.27, 23.20, 24.92, and 26.10 per 1 000 person-years, respectively. The cumulative incidence of new-onset diabetes increased in proportion with increasing pulse pressure levels (P<0.01 by the Log-rank test). After multivariate adjustment, compared with the first quartile, the hazard ratios for new-onset diabetes in the third and fourth quartiles were 1.13 (95%CI 1.04-1.22, P<0.01) and 1.14 (95%CI 1.05-1.24, P<0.01), respectively. The risk of new-onset diabetes increased 5%(HR=1.05, 95%CI 1.02-1.08, P<0.01) with the fractional pulse pressure increased per 1 SD (0.13). Findings from the three sensitivity analyses were consistent with the main results in this cohort. Conclusions: Pulse pressure at baseline is positively associated with the incidence of new-onset diabetes among hypertensive individuals, and pulse pressure is an independent risk factor for the development of diabetes in hypertensive patients.

Age-specific association between invasively measured central blood pressure and left ventricular mass index

ABSTRACT Background: The impact of age on the association between central aortic hemodynamics and left ventricular (LV) remodeling has not been well elucidated. We compared the relationship between measurements of central blood pressure (CBP) and LV mass index (LVMI) according to their ages (<50 years versus ≥50 years). Methods: A total of 305 consecutive subjects (64.4 ± 10.9 years, 60.7% males) who underwent invasive coronary angiography (ICA) for the evaluation of coronary artery disease were prospectively enrolled. Just before ICA, CBP was measured at the aortic root using a pig-tail catheter, and CBP indices, including aortic systolic blood pressure (aSBP), aortic pulse pressure (aPP), aortic fractional pulse pressure (=aPP/mean aortic pressure), and aortic pulsatility index (=aPP/diastolic aortic pressure), were recorded. All subjects underwent transthoracic echocardiography, and LVMI was measured on the same day of ICA. Results: In simple linear correlation analyses, LVMI was associated with all CBP indices in subjects aged <50 years (n = 29) (P < .05 for each), but not in those aged ≥50 years (n = 276) (P > .05 for each). In the younger age group (≤50 years), multivariable analysis showed that aSBP (β = 0.457, P= .021) and aPP (β = 0.610, P= .006) had a significant association with LVMI after adjusting for possible confounding factors. The results remained consistent even when analyzed in a 1:1 propensity score-matched cohort. In conclusion, invasively measured aPP showed the closest association with LVMI in subjects aged <50 years, but not those aged ≥50 years. Conclusion: Aortic pulsatile hemodynamic status appears to have a greater effect on LV remodeling in younger people than in older people.

The Association of Fractional Pulse Pressure with Acute Kidney Injury in Patients Undergoing Coronary Intervention due to ST-Segment Elevated Myocardial Infarction

Objective: Acute kidney injury (AKI), which is prevalent in ST-segment elevated myocardial infarction (STEMI) patients who have undergone primary percutaneous coronary intervention (PCI), is associated with poor cardiovascular outcomes. As high pulse pressure (PP) is associated with adverse cardiovascular events, the present study’s aim was to evaluate the relationship between fractional PP (PPf) and AKI in patients with STEMI who underwent primary PCI. Subjects and Methods: All laboratory findings as well as echocardiographic and angiographic data of 1,170 consecutive STEMI patients were retrospectively screened. PPf was calculated from the pressures invasively measured after sheath insertion and before performing coronary angiography. Results: From 1,170 eligible STEMI patients (mean age 56 years, 18.2% female), AKI developed in 143 (12.2%) patients. The PPf and pulsatility index were significantly higher in patients with AKI than those without (0.53 ± 0.10 vs. 0.61 ± 0.10, p < 0.001, and 0.80 ± 0.03 vs. 0.82 ± 0.03, p < 0.001, respectively). PPf was also found to be associated with AKI in univariable (OR 2.183, 95% CI 1.823–2.614, p< 0.001) and multivariable (OR 1.874, 95% CI 1.513–2.322, p < 0.001) analysis. In-hospital mortality was higher in patients with AKI than those without. Conclusion: Invasively measured PPf, which can be easily measured and has no additional cost in STEMI patients undergoing coronary intervention, is an independent predictor of AKI. In addition, PPf is superior to other blood pressure values and derivatives in AKI prediction.

New insights to the potential mechanisms driving coronary flow reserve impairment in Cushing's syndrome: A pilot noninvasive study by transthoracic Doppler echocardiography

BackgroundThe contribution of functional and/or structural remodeling to reduced coronary flow velocity reserve (CFVR), reflecting impaired coronary microcirculation in Cushing's syndrome (CS), has not been clearly elucidated. We aimed to identify the potential mechanisms of coronary microvascular impairment in CS. MethodsWe studied 15 CS patients (11 female, age 50 ± 9 years) without clinical evidence of cardiovascular disease. Coronary flow velocity in the left anterior descending coronary artery was measured by transthoracic Doppler echocardiography, at rest, and during adenosine infusion. Average peak flow velocities, CFVR, and microvascular resistance in baseline (BMR) and hyperemic conditions (HMR) were assessed. CFVR ≤2.5 was considered a marker of microvascular disease (CMD). Diastolic function (E/e′), global longitudinal strain (GLS) and fractional pulse pressure (fPP), an index of arterial stiffness, were also assessed. ResultsCMD was present in 5 patients (33.3%). CMD was primarily driven by increased baseline peak flow velocity (29 ± 12 versus 19.6 ± 4.2 cm/s, p = .03) in the presence of decreased BMR (3.62 ± 0.6 versus 5.46 ± 1.4 mm Hg·s/cm, p = .03). Moreover, urinary cortisol and E/e′ were higher (p = .001 and p = .001, respectively) and GLS was lower (p = .009) in patients with CMD. fPP was higher in patients with CMD (p = .01). Urinary cortisol correlated to CFVR (p = .008), E/e′ (p < .0001) and GLS (p < .0001). fPP directly correlated to average peak flow velocities at rest (p = .01) and inversely to BMR (p = .03). ConclusionsFunctional microvascular regulatory impairment seems to be the potential mechanism of CMD in CS. CMD seems to be related to decreased myocardial contractility and diastolic dysfunction associated with cortisol excess.

Investigating the Association of Relative Central Blood Pressure Indices and Severity of Coronary Artery Disease

BackgroundCentral blood pressure is an important index in central hemodynamic stress andmaybe associated with an increased risk of cardiovascular diseases.ObjectivesThis study evaluated the central blood pressure indices in coronary artery disease (CAD) subjects and their association with the number of diseased vessels involved in CAD.MethodsA random sample of 300 Iranian subjects who underwent coronary angiography (mean age 58.08  10.62 years) was studied. Coronary lesionsweredefinedas luminal stenosis 50% andthenumberof diseased vesselsandthe central aortic pressure were taken. The probability of central blood pressure indices with the number of diseased vessels was also determined by using cutoff points, based on the sensitivity, specificity, positive predictive value, and negative predictive value.ResultsThe central blood pressure indices (fractional pulse pressure (FPP), systolic pressure (FSP), diastolic pressure (FDP) and FSP/FDP) were statistically significant in CAD patients with an increase in the number of diseased vessels (P < 0.001). There was a significant association between central blood pressure indices and CAD (P < 0.001) as well as with the increase in the number of diseased vessels (P < 0.001). Both odds ratio (11.84; 95% CI: 6.11 - 22.95; P < 0.001) and ROC analysis (AUC: 0.909; 95% CI: 0.870 - 0.939; P < 0.001) showed FSP as the strongest predictor of CAD. Furthermore, cut-off points of the FSP ( 1.373), FDP (0.811), FPP ( 0.559) and FSP/FDP ( 1.688) were determined for CAD for the first time based on 92% sensitivity, and 74% specificity.ConclusionsFDP, FSP, and FSP, in particular, could be the effective predictors of CAD in Iranian populations. Therefore, the quality of life may be improved by the management of central blood pressure and using CAD cut-off points.

Investigation of Elastic Properties of Aorta in Patients with Coronary Slow Flow

Objective: Coronary slow flow (CSF) phenomenon is characterized by delayed opacification of coronary vessels in a normal coronary angiogram. Although clinical and pathological features have been previously described, the underlying pathophysiology has not been fully understood yet. Aortic elastic properties have a predictive value in detecting early stages of atherosclerosis. In this study, we aimed to the evaluate the elastic properties of ascending aorta in patients with CSF. Materials and Methods: This single-center study enrolled 50 angiographically identified patients with CSF (23 female, mean age: 51.6 ± 9.7 years), along with 50 controls (19 female, mean age: 53.5 ± 8.7 years) with normal coronary flow. The quantitative measurement of coronary blood flow was performed using the thrombolysis in myocardial infarction frame count method. Aortic elastic parameters including aortic strain, aortic distensibility, aortic stiffness index and aortic compliance were calculated using M-mode echocardiography derived aortic diameters using accepted formulae. Results: There was no significant difference in terms of clinical, demographic, echocardiographic and laboratory parameters between the patients with CSF and the controls. The hemodynamic parameters including aortic pulse pressure, aortic mean pressure, aortic fractional pulse pressure and aortic pulsatility index were similar between patients with CSF and controls. Systolic and diastolic aortic diameters and pulsatile aortic diameter change were similar between the groups. There was also no significant difference in terms of aortic strain, aortic distensibility, aortic stiffness index and aortic compliance between the groups. Conclusion: The results demonstrated that there was no significant difference in terms of hemodynamic parameters and elastic properties of ascending aorta between CSF patients and control group with a similar risk profile and demographic characteristics. Further large scale studies are required to determine the relationship between CSF and elastic properties of aorta.

Comparison of aortic pressures and aortic elastic properties between patients with end-stage renal disease and healthy controls.

BackgroundCurrent evidence indicates that vascular calcification plays an essential role in the development of cardiovascular diseases in end-stage renal disease (ESRD) patients. Arterial stiffness is a marker of increased cardiovascular risk in various populations. The aim of this study is to evaluate the elastic properties of ascending aorta in patients with ESRD.MethodsThis single-center study enrolled 96 patients (45 females, age: 57.2 ± 12.8 years) with ESRD and 96 healthy controls (52 females, age: 55.3 ± 10.1 years). Aortic pressures and aortic elastic parameters including aortic strain, aortic distensibility, aortic stiffness index, and aortic compliance were calculated using accepted formulae.ResultsThe hemodynamic parameters including aortic pulse pressure, aortic mean pressure, aortic fractional pulse pressure, and aortic pulsatility index were significantly higher in patients with ESRD. Systolic and diastolic aortic diameters were similar between the groups. However, pulsatile aortic diameter change, aortic strain, aortic distensibility, and aortic compliance were significantly lower, whereas aortic stiffness index was significantly higher in ESRD group.ConclusionsThe results demonstrated that a significant difference was present in terms of aortic blood pressures between patients with ESRD and controls. In addition, the elastic properties of ascending aorta were decreased in patients with ESRD.

Crucial Effect of Calibration Methods on the Association Between Central Pulsatile Indices and Coronary Atherosclerosis.

Several studies have reported that central systolic blood pressure (SBP) estimation is affected by calibration methods. However, whether central pulsatile indices, namely pulse pressure (PP) and fractional PP (FPP) (defined as PP/mean arterial pressure (MAP)), also depend on calibration methods remains uninvestigated. This study assessed the accuracy and discriminatory ability of these indices for coronary atherosclerosis using 2 calibration methods. Post-hoc analysis of a previous cross-sectional study (n = 139) that investigated the association between central pulsatile indices and coronary atherosclerosis. A validated-oscillometric device provided PP and FPP at the brachial artery (bPP and bFPP) and central artery using 2 calibration methods: brachial SBP/diastolic BP (DBP) (cPPsd and cFPPsd) and MAP/DBP (cPPmd and cFPPmd). Accuracy was assessed against invasive measurements (cPPinv and cFPPinv). Multivariate logistic and linear regression analyses were performed to assess the association between pulsatile indices and the presence of coronary artery disease (CAD) and SYNTAX score, respectively. cPPmd and cFPPmd were closer to invasive values than cPPsd (cPPsd: 39.6±12.6; cPPmd: 60.2±20.1; cPPinv: 71.4±22.9). cFPP exhibited similar results (cFPPsd: 0.35±0.09; cFPPmd: 0.55±0.14; cFPPinv: 0.70±0.19). In patients ≥70 years, only cFPPmd was significantly associated with CAD risk (odds ratio: 1.66 (95% confidence interval: 1.05-2.64)). SYNTAX score was significantly correlated with cPPmd, cFPPmd, and bFPP (standardized β: cPPmd 0.39, cFPPmd 0.50, bFPP 0.42, all P < 0.01). No significant association was observed in patients aged <70 years. Central pulsatile indices calibrated with brachial MAP/DBP were more accurate and discriminatory for coronary atherosclerosis than SBP/DBP calibration.

Aortic pulsatility assessed by an oscillometric method is associated with coronary atherosclerosis in elderly people

The aim of this study was to investigate the association of aortic pulsatility assessed by a non-invasive brachial cuff-based method with coronary atherosclerosis. In total, 139 patients undergoing coronary angiography were included in this cross-sectional study. Aortic blood pressure (BP) indices were recorded invasively by a fluid-filled catheter and non-invasively by a brachial cuff-based oscillometric device. Fractional pulse pressure (FPP) was defined as pulse pressure (PP)/mean BP and pulsatility index (PI) as PP/diastolic BP. Aortic FPP and PI in coronary artery disease (CAD) patients were significantly higher than in non-CAD patients in both invasive and non-invasive methods. Multivariate logistic regression analysis demonstrated that non-invasively measured aortic FPP and PI were associated with CAD risk in patients aged ≥70 years [aortic FPP per 0.1 odds ratio (OR) = 1.66, 95% confidence interval (CI) 1.05–2.64; aortic PI per 0.1 OR =1.39, 95% CI 1.02–1.88; all p < 0.05], but were not associated with CAD risk in patients aged <70 years. In linear regression analysis, non-invasively measured aortic FPP and PI correlated with SYNTAX and Gensini scores only in patients aged ≥70 years. Aortic FPP and PI measured non-invasively by a brachial cuff-based oscillometric device were associated with coronary atherosclerosis in elderly patients.

Associations of fractional pulse pressure to aortic stiffness and their impact on diastolic function and coronary flow reserve in asymptomatic diabetic patients with normal coronary angiography

We aimed to assess the relation of fractional pulse pressure (PPf) to aortic stiffness index and their impact on coronary flow reserve (CFR) and left ventricular diastolic function in asymptomatic diabetic patients. One hundred and thirty five consecutive asymptomatic diabetic patients (aged 48.8 ± 7.84 years), were included. CFR was calculated noninvasively using transthoracic echo-Doppler assessment with hyperemia induced by infusion of dipyridamole at a rate of 0.56 mg/kg over 4 min. PPf was calculated as pulse pressure divided by mean arterial pressure (SBP - DBP/MAP), while diastolic function was evaluated by means of transmitral flow and tissue Doppler imaging. Aortic stiffness indices (ASI) were measured as previously described. Diabetic patients with low CFR (n = 52) compared with those with normal CFR (n = 83) exhibited significantly increased PPf (75.2 ± 11.4 vs. 64.5 ± 6.7, p < 0.001). PPf was significantly correlated with ASI (r = 0.520, p < 0.001), E/Em ratio (r = 0.425,p < 0.001) and left atrial volume index (r = 0.462, p < 0.001). CFR was negatively correlated with both PPf (r = -0.68, p < 0.0001). After applying multivariate linear regression analysis,after correction for cardiovascular risk factors, importantly, PPf and ASI remained significant predictors of CFR (p < 0.0001 and p < 0.001, respectively). PPf was significantly correlated to ASI in asymptomatic diabetic patients. Likewise, increased PPf was associated with impaired CFR and subclinical diastolic dysfunction in diabetic patients. PPf could be utilized as a simple non-invasive predictor of occult atherosclerosis and diastolic dysfunction in diabetic patients.

Relation of Coronary Flow Reserve and Diastolic Function to Fractional Pulse Pressure in Hypertensive Patients

Fractional pulse pressure (PPf), is thought to more directly reflect arterial stiffness than pulse pressure. Our aim was to evaluate the relationship between coronary flow reserve (CFR), left ventricular diastolic function (LVDf) and PPf in hypertensive patients with normal coronary arteries. Out of 109 hypertensive patients (aged 52.8 ± 9.4 years), with normal coronary angiography, CFR was calculated successfully in 106 patients. CFR was calculated using transthoracic echo Doppler assessment with hyperemia induced by infusion of dipyridamole at a rate of 0.56 mg/kg over 4 minutes, while diastolic function was evaluated by means of transmitral flow and tissue Doppler imaging. PPf was calculated as pulse pressure divided by mean arterial pressure [Systolic blood pressure - Diastolic blood pressure/Mean arterial pressure (SBP - DBP/MAP)], Hypertensive patients with low CFR (n = 54) compared with those with normal CFR (n = 52) exhibited significantly increased PPf (75.2 ± 11.4 vs. 61.5 ± 6.7 P < 0.001). Moreover, patients with higher PPf had significantly decreased transmitral E/A ratio (P < 0.01), as well as increased E/Em ratio (P < 0.01). In hypertensives with low CFR, PPf was negatively correlated with CFR (r = -0.815, P < 0.0001). After applying multivariate linear regression analysis, PPf turned out to be a powerful independent predictor of CFR. Receiver operating characteristic (ROC) analysis revealed that a PPf of ≥0.63 was the best cutoff value for prediction of CFR <2.0 and E/Em ≥ 8 (AUC = 0.916 and 0.929 respectively; P < 0.001). Increased PPf was associated with impaired CFR and diastolic dysfunction in hypertensive patients with normal coronary arteries. PPf could be used as a simple non-invasive index for assessment of coronary microcirculation in hypertensives with normal coronary arteries.

Fractional pulse pressure as a simple index of impaired coronary flow reserve in hypertensive patients

Fractional pulse pressure (PPf), is thought to be more directly reflect arterial stiffness than pulse pressure. Our aim was to evaluate the relationship between coronary flow reserve (CFR) and PPf in hypertensive patients with normal coronary arteries One-hundred and six consecutive hypertensive patients (aged 52.8 + 9.4 years), with indications of myocardial ischaemia with exercise electrocardiogram (EECG) and normal coronary arteries in coronary angiography. CFR was calculated noninvasively using transthoracic echo-Doppler assessment with hyperemia induced by infusion of dipyridamole at a rate of 0.56 mg/kg over 4 min. PPf was calculated as pulse pressure divided by mean arterial pressure (SBP-DBP/MAP), while diastolic function was evaluated by means of transmitral flow and tissue Doppler imaging. Hypertensive patients with low CFR ( n = 54) compared with those with normal CFR ( n = 52) exhibited significantly incresed PPf (75.2 ± 11.4 vs 64.5 ± 6.7 P < 0.001). In hypertensives with low CFR, CFR was negatively correlated with PPf ( r = −0.651, P < 0.0001). After applying multivariate linear regression analysis, age, left ventricular mass index, Em/Am, and PPf turned out to be independent predictors of CFR. Estimation of PPf by using simple sphygmomanometer blood pressure measurement is simple non-invasive index for assessment of coronary microcirculation in essential hypertensive patients with indications of myocardial ischaemia and normal coronary arteries.

Assessment of right ventricular afterload by pressure waveform analysis in acute pulmonary hypertension

To characterize hydraulic right ventricle (RV) afterload by pulmonary arterial pressure waveform analysis in an acute pulmonary hypertension (PH) model. Pulmonary artery (PA) flow and pressure were recorded in six anesthetized sheep. Acute isobaric PH was induced by phenylephrine (active) and PA mechanical constriction (passive). We estimated the amplitude of the forward and reflected pressure waves according to the inflection point. In most cases the inflection pressure was smooth, thus the inflection point was defined as the time at which the first derivative of pulmonary arterial pressure reached its first minimum. We calculated the input and characteristic (Z(C), time-domain Li method) impedances, the capacitance index (stroke volume/pulse pressure), the augmentation index (AI) (reflected pressure/pulse pressure), the fractional pulse pressure (pulse pressure/mean pressure) and the wasted energy generated by the RV due to wave reflection during ejection (E(W)). Pulse pressure, fractional pulse pressure, AI and Z(C) increased and capacitance index decreased during passive PH with respect to control (P < 0.05). In contrast, Z(C) and the capacitance index did not change and E(W) and the AI decreased during active PH. Pulse pressure correlated with E(W) and Z(C) and the AI was correlated with E(W) (r > 0.6, P < 0.05). PA pressure waveform analysis allows the quantification of the dynamic RV afterload. Prospective clinical studies will be necessary to validate this time-domain approach to evaluate the dynamic RV afterload in chronic PH.

Aortic Pressures, Stiffness and Left Ventricular Function in Coronary Slow Flow Phenomenon

Background: Coronary slow flow (CSF) phenomenon is characterized by delayed opacification of coronary vessels in a normal coronary angiogram. Although clinical and pathological features have been previously described, the underlying pathophysiology has not been fully elucidated. In this study, we aimed to evaluate central aortic pressure, aortic stiffness and left ventricular (LV) function in patients with coronary slow flow. Method and Results: The study population consisted of 154 patients who underwent coronary angiography because of typical and quasi-typical symptoms of angina. 81 patients with angiographically proven CSF and 73 cases with normal coronary flow pattern with similar risk profiles were enrolled in the study. Aortic pressures and indexes of elastic properties were evaluated using invasive methods. Aortic pulse pressure (mm Hg) and pulsality index of patients with CSF were found to be significantly higher than those of controls (60.8 ± 13.8 vs. 53.7 ± 14.5, p = 0.002; 0.84 ± 0.22 vs. 0.67 ± 0.18, p = 0.0001, respectively). LV Doppler parameters were deteriorated in patients with CSF. Aortic fractional pulse pressure and pulsality index were significantly correlated with the mean TIMI frame count and LV diastolic parameters in correlation analysis. Conclusion: The present findings allow us to conclude that impaired aortic elasticity in patients with CSF may also be responsible for the impaired LV diastolic parameters.

The severity of coronary artery disease evaluated by central systolic pressure and fractional diastolic pressure.

Background:Central pulse pressure, pulse pressure index and fractional pulse pressure have been confirmed to be associated with increased risk of cardiovascular disease, but if the severity of cardiovascular disease, specifically for the coronary artery disease, is evaluated by central systolic pressure and fractional diastolic pressure has been not well studied.Aims:This study was designed to examine if central systolic pressure and fractional diastolic pressure could act as a predicting factor for the severity of coronary artery disease.Patients and Methods:A total of 310 patients were included in this study. 154 patients were diagnosed with coronary artery disease, and 156 with non-coronary artery disease, which was confirmed with diagnostic coronary angiography. The average age and sex in the two groups were same.Results:Age, peripheral and central systolic blood pressure, fractional systolic pressure, and fractional diastolic pressure were significantly higher in the patients with coronary artery disease (P<0.05). The central fractional systolic pressure and fractional diastolic pressure were abnormal in the patients with coronary artery disease. Central fractional systolic pressure and fractional diastolic pressure presented a positive correlation between them and coronary Gensini Score (P<0.05), in the patients with coronary artery disease.Conclusions:The severity of coronary artery disease may be predicted by examination of central fractional systolic pressure and fractional diastolic pressure.

Ascending aortic pressure-derived indices are associated with the presence and severity of aortic stenosis

Background. Almost the same pathophysiological mechanism has been suggested for both atherosclerosis and calcific aortic stenosis (AS). In this study, we examined any association between ascending aortic pressure-derived indices and hemodynamic characteristics of calcific AS. Methods. A total of 90 patients were studied (26 males, 64 females; mean age: 64.4 ± 11.3 years). The study population consisted of two groups: AS and a control group. Both groups were well matched. Ascending aortic pressure-derived indices were obtained from all patients via catheterization. Results. Two groups were well matched according to demographic characteristics. Aortic pulse/FPPs (fractional pulse pressure = aortic pulse pressure/ aortic mean pressure), and PI (pulsatility index = aortic pulse pressure/aortic diastolic pressure) were significantly higher in patients with AS than in those without. Mean aortic mean gradient had significant positive correlation with aortic diastolic pressure, FPP and PI. The multiple-adjusted odds ratios of the risk of AS was 4.51 (95% CI 1.63–12.48) and 4.34 (95% CI 1.59–11.88) for the higher aortic FPP and PI levels compared with lower levels, respectively. Conclusion. Ascending aortic pressure-derived indices were significantly and independently associated with the presence and severity of calcific AS. This confirms the participation of blood pressure in the pathogenesis of AS.

Effect of aortic pulse and fractional pulse pressures on early patency of sapheneous vein grafts

Coronary artery bypass grafting has a mortality benefit compared to medical therapy in some patient groups, such as those with left main or left anterior descending coronary artery disease, and those with left ventricular dysfunction. Therefore, patency of grafts, especially sapheneous grafts, is an important issue. Aortic pulse and fractional pulse pressures are strong and independent indicators of the risk of atherosclerosis. We studied whether there was any negative effect of increased aortic pulse and fractional pulse pressures on saphenous vein graft (SVG) patency in the short term. We evaluated aortic pulse and fractional pulse pressures of patients with occluded and patent SVGs, and investigated the relation between the two groups. One hundred and twenty-six patients with occluded SVGs with a mean age of 65.9+/-8.9 years and 114 patients with patent SVGs with a mean age of 66.9+/-8.6 years were studied consecutively. Aortic systolic and diastolic pressures were measured, and mean, pulse, and fractional pulse pressures (aortic pulse pressure/mean pressure) were calculated. Aortic pulse and fractional pulse pressures were significantly higher in the occluded SVG group than in the patent SVG group (58+/-19 and 48+/-13 mmHg, P=0.001; 0.59+/-0.16 and 0.50+/-0.10, P<0.001, respectively). In addition, a cut-off value of 50 mmHg and 0.52 for aortic pulse and fractional pulse pressures were determined, respectively. Increased aortic pulse (>50 mmHg) and fractional pulse (>0.52) pressures were present in 54.0 and 58.7% of patients in group 1 and 28.1 and 33.3% of patients in group 2, respectively (P=0.004 and P=0.005, respectively). Having increased aortic pulse and fractional pulse pressures increased the risk of SVG occlusion by 3.00 and 2.85-folds, respectively. The multiple-adjusted odds ratio of the risk of SVG occlusion was 6.86 (95% confidence interval 2.14-21.96) and 4.76 (95% confidence interval 1.58-14.30) for the higher aortic pulse and fractional pulse pressure levels compared with lower levels, respectively. Increased ascending aorta pulse and fractional pulse pressures have a significant and independent negative effect on the fate of SVGs.

Noninvasively assessed pulsatility of ascending aortic pressure waveform is associated with the presence of coronary artery narrowing

Several hemodynamic indices, measured invasively in the ascending aorta during routine angiography, are related to the presence and severity of coronary atherosclerosis. Radial artery tonometry, when combined with a validated transfer function, offers the possibility of noninvasive assessment of central arterial pressure. We aim to evaluate the association between noninvasive indices of aortic or radial pressure waveforms and the presence of a significant coronary stenosis. Patients who underwent elective coronary angiography were studied (110 men, 91 women, mean age 53 +/- 0.9 years). Noninvasive measurement of their central hemodynamics was performed by analysis of the aortic pressure waveform derived from the radial artery. An increase in aortic fractional pulse pressure was associated with coronary artery narrowing or previous myocardial infarction. After multivariate adjustment, the odds ratio and confidence intervals (CI) of having a significant coronary aortic stenosis was 1.72 (95% CI, 1.1-2.7) and of previous myocardial infarction 1.6 (95% CI, 1.1-2.2). An increase in noninvasively assessed aortic fractional pulse pressure, but not of the peripheral index is significantly associated with the presence of coronary artery disease.

Increased aortic pulse and fractional pulse pressures in patients with cardiac syndrome X

Background. Angina with normal coronary arteries, cardiac syndrome X, is a diagnosis of exclusion. The exact mechanism of this clinical syndrome remains unclear. Although the prognosis is as good as equal to that of the normal population, symptoms related to the syndrome largely impair quality of life. Aortic pulse and fractional pulse pressures are strong and independent indicators of the risk of coronary heart disease. An increase in these hemodynamic parameters is significantly associated with the presence of coronary artery disease in men and women. Methods and results. We evaluated aortic pulse and fractional pulse pressures of patients with cardiac syndrome X and control subjects, and investigated the relation between the two groups. One hundred and twenty‐six patients with cardiac syndrome X with a mean age of 53.1±9.5 years and 76 patients without the syndrome with a mean age of 53.1±11.2 years were studied consecutively from May 2004 to May 2005. Aortic systolic, diastolic, mean and pulse pressures were measured and the fractional pulse pressure was calculated (aortic pulse pressure/mean pressure). Aortic pulse and fractional pulse pressures were significantly higher in the cardiac syndrome X group than in the control group (51±13 mmHg and 43±9 mmHg, p<0.001; 0.54±0.11 and 0.47±0.08, p<0.001, respectively). All patients were classified into tertiles of aortic pulse pressure level to evaluate whether aortic pulse pressure was associated with the presence of cardiac syndrome X in the study. The multiple‐adjusted odds ratio of the risk of cardiac syndrome X was 6.72 (95% CI 2.76–16.37) for tertile 2 and 29.94 (95% CI 5.59–160.44) for tertile 3 of aortic pulse pressure level compared with tertile 1. In addition, all patients were divided into two groups as lower and higher levels of aortic fractional pulse pressure. The multiple‐adjusted OR of the risk of cardiac syndrome X was 4.09 (95% CI 2.05–8.15) for the higher group compared with the lower group of aortic fractional pulse pressure level. Conclusion. Ascending aorta pulse and fractional pulse pressures are significantly associated with the presence of cardiac syndrome X and these associations are independent of age and other cardiovascular risk factors.

Fractional diastolic and systolic pressure in the ascending aorta are related to the extent of coronary artery disease

Background Ascending aortic fractional pulse pressure and fractional systolic pressure (FSP) were demonstrated to differentiate patients with and without coronary artery disease. However, no study so far has analyzed the relationship between FSP and fractional diastolic pressure (FDP) and the extent of coronary artery disease. Therefore, we investigated the relationship between ascending aortic FSP and FDP and the extent of coronary atherosclerosis in unselected patients with angiographically confirmed coronary artery disease. Methods The study group consisted of 445 patients (350 men and 95 women, mean age 58.5 ± 9.7 years) with angiographically confirmed coronary artery disease and ejection fraction >55%. Invasive ascending aortic blood pressure during catheterization and conventional sphygmomanometer measurements were taken. Results Pulse pressure (PP), FSP, and FDP derived from intraaortic measurements differentiated patients with one-, two-, and three-vessel coronary artery disease (PP, 62.8 ± 15.8 v 64.8 ± 17.9 v 71.7 ± 19.1 [ P < .0001]; FSP, 1.45 ± 0.09 v 1.46 ± 0.10 v 1.51 ± 0.12 [ P < .0001]; FDP 0.77 ± 0.05 v 0.77 ± 0.05 v 0.75 ±0.06 [ P < .0001]). After multivariate stepwise adjustment, the odds ratio (OR) and confidence interval (CI) of having three-vessel disease was as follows: PP per 10 mm Hg, OR = 1.15, 95% CI = 1.01 to 1.30; FSP per 0.1, OR = 1.28, 95% CI = 1.03 to 1.60; and FDP per 0.1, OR = 0.61, 95% CI = 0.39 to 0.95. None of the brachial pressure indices was independently related to the extent of coronary atherosclerosis. Conclusions Pulse pressure (PP), FSP, and FDP of the ascending aorta are related to the risk of three-vessel disease in patients with coronary artery disease and preserved left ventricular function.