Fractional Pulse Pressure Research Articles

Ascending aortic, but not brachial blood pressure-derived indices are related to coronary atherosclerosis

A recent study has demonstrated that pulse pressure (PP) measured in the ascending aorta is related to the extent of coronary artery disease in patients undergoing coronary angioplasty. However, no study so far has analyzed the relation between pulsatility of the ascending aorta and the extent of coronary artery disease in consecutive patients undergoing coronary angiography. Therefore, we investigated the relation between ascending aorta pulsatility and the extent of coronary atherosclerosis in unselected patients with angiographically confirmed coronary artery disease. The study group consisted of 423 consecutive patients (334 men and 89 women; mean age: 58.6±9.7 years) with angiographically confirmed coronary artery disease and ejection fraction ≤60% PP, fractional pulse pressure (the ratio of pulse pressure to mean pressure, FPP), and the ratio of pulse pressure to diastolic pressure (pulsatility index, PI) derived from intraaortic measurements differentiated patients with one-, two- and three-vessel coronary artery disease (PP, 63.0±16.0 versus 64.2±18.3 versus 71.8±19.1 mmHg ( P < 0.0001); FPP, 0.68±0.14 versus 0.69±0.15 versus 0.76±0.17 ( P < 0.0001); PI 0.89±0.25 versus 0.92±0.27 versus 1.04±0.32 ( P < 0.0001)). After multivariate stepwise adjustment, the odds ratio (OR) and confidence interval (CI) of having three-vessel disease was: PP per 10 mmHg OR 1.15 (95% CI 1.02–1.31); FPP per 0.1 OR 1.18 (95% CI 1.02–1.37); and PI per 0.1 OR 1.11 (95% CI 1.03–1.21). None of brachial blood pressure indices was independently related to the extent of coronary atherosclerosis. Conclusion: Pulse pressure, fractional pulse pressure, and pulsatility index of the ascending aorta are related to the risk of three-vessel disease in patients with coronary artery disease and preserved left ventricular function.

Ascending fractional pulse pressure closely relating to large artery function

It is not known whether ascending fractional pulse pressure (PPf) is related to large artery function. This study was to evaluate whether PPf is associated with large artery function by augmentation index. A total of 190 subjects were enrolled (age range: 50 to 78 years) who had normal contractions, no local asynergy, and no history of myocardial infarction. The ascending aortic pressure was measured using a fluid-filled system. To quantify the relative magnitude of the pulsatile to mean artery pressure, we normalised the pulse pressure to the mean pressure and referred to this value as PPf and the association between the PPf and the augmentation index was investigated. Augmentation index showed significant associations with PPf by univariate analysis (R = 0.690, P < 0.001). The associations between PPf and the factors influencing large artery function were examined by multivariate analysis, and PPf revealed significant associations with age, mean aortic pressure, heart rate and type 2 diabetes (R(2) = 0.477, P < 0.001). The results were that ascending aortic PPf is closely associated with large artery function detected by augmentation index.

Pulsatility of ascending aorta and restenosis after coronary angioplasty in patients >60 years of age with stable angina pectoris

A recent study has demonstrated that the pulsatility of the ascending aorta is a strong predictive factor for restenosis after coronary angioplasty. However, whether the pulsatility of the ascending aorta is still a significant predictor for restenosis in elderly patients with a stiffer aorta is unknown. We investigated the relation between arterial pulsatility in the ascending aorta and restenosis after coronary angioplasty in patients aged >60 years. Eighty-seven consecutive patients (80 men, aged 72.5 ± 5.1 years) with stable angina were included. Before angioplasty, the arterial systolic, diastolic, and mean pressure waveforms of the ascending aorta were measured. We used fractional pulse pressure (PPf, the ratio of pulse pressure to mean pressure) and pulsatility index (PI, the ratio of pulse pressure to diastolic pressure) to estimate the pulsatility of the ascending aorta. Angiographic restenosis occurred in 39 patients. Pulse pressure, PPf, and PI were significantly higher in patients with restenosis after coronary angioplasty (restenosis vs without restenosis: pulse pressure, 77.6 ± 12.2 vs 66.1 ± 15.4 mm Hg [p <0.001]; PPf, 0.80 ± 0.09 vs 0.69 ± 0.11 [p <0.001]; PI, 1.19 ± 0.20 vs 0.98 ± 0.21 [p <0.001]). After multivariate stepwise adjustment of risk factors of restenosis and using receiver-operating characteristic analysis, the odds ratio (OR) of restenosis was: pulse pressure >66 mm Hg, OR 5.88 (95% confidence interval [CI] 2.17 to 15.93); PPf >0.72, OR 13.71 (95% CI 4.81 to 39.05); PI >1.06, OR 13.56 (95% CI 4.67 to 39.38). Moreover, among patients aged >70 years (n = 60), the predictive values of PPf and PI were even higher than those in patients aged ≤70 years (n = 27). Thus, in elderly patients with stable angina, the pulsatility of the ascending aorta is a powerful predictor of restenosis after coronary angioplasty.

Pulsatility of ascending aortic blood pressure waveform is associated with an increased risk of coronary heart disease

Background: Although it was reported that pulse pressure of the peripheral artery could differentiate patients with coronary heart disease (CHD) from those without CHD, it is not known whether pulsatility of the ascending aortic pressure waveform differentiates patients with CHD from those without CHD. The purpose of this study was to evaluate whether the pulsatility of ascending aortic pressure is associated with an increased risk of CHD. Methods: For this study, we enrolled 293 subjects who had chest pain, normal contractions, no local asynergy, and no history of myocardial infarction. We measured the ascending aortic pressure using a fluid-filled system. To quantify the relative magnitude of the pulsatile to mean artery pressure, we normalized the pulse pressure to the mean pressure and referred to this value as the fractional pulse pressure (PPf). We investigated the association between the PPf and the risk of CHD. Results: The PPf of the ascending aorta was associated with an increased risk of CHD. The multiple-adjusted odds ratio of CHD was 2.93 (95% CI, 1.44 to 5.94) for the middle tertile of the PPf level and was 3.93 (95% CI, 1.74 to 8.85) for the highest tertile compared with the lowest tertile. Conclusion: Ascending aortic pulsatility is related to an increased risk of CHD.

The influence of fractional pulse pressure on the outcome of pulmonary thromboendarterectomy.

Although pulmonary thromboendarterectomy is an effective modality for the treatment of chronic thromboembolic pulmonary hypertension (CTEPH), the mortality in patients with severe haemodynamic disease is still high. Recently it was reported that fractional pulse pressure (pulmonary arterial pulse pressure/mean pulmonary arterial pressure) was higher in CTEPH than in primary pulmonary hypertension (PPH). It was hypothesized that fractional pulse pressure might be low in CTEPH with inaccessible distal thrombi and/or secondary pulmonary hypertensive change, resulting to the high operative mortality. To determine the influence of fractional pulse pressure to the outcome of surgery, 32 patients with CTEPH who had thromboendarterectomy between 1985 and 1998 were studied. Pulmonary haemodynamics and fractional pulse pressure were compared between survivors (n=26) and nonsurvivors (n=6) postoperatively. Those parameters in PPH (n=18) and large vessel pulmonary arteritis (n=6) were also analysed. Fractional pulse pressure in CTEPH (1.23+/-0.21) was significantly higher than in PPH (0.93+/-0.22; p=0.0017) and lower than in pulmonary arteritis (1.69+/-0.32; p=0.03). Fractional pulse pressure in survivors (1.26+/-0.21) was significantly higher than in nonsurvivors (1.06+/-0.16; p=0.03). Fractional pulse pressure is a significant predictor for mortality in patients with high pulmonary vascular resistance >1100 dynes.sec.cm(-5). To conclude fractional pulse pressure in addition to pulmonary vascular resistance might be useful in predicting for the outcome of surgery, especially in patients with severe haemodynamic impairment.

Effects of Nitric Oxide Inhalation After Pulmonary Thromboendarterectomy for Chronic Pulmonary Thromboembolism

To examine the hypothesis that nitric oxide (NO) inhalation improves hemodynamics and gas exchange in patients with chronic pulmonary thromboembolism after pulmonary thromboendarterectomy. Prospective crossover clinical study. : Surgical ICU in a national education and research hospital. : Seven patients (mean age +/- SD, 54 +/- 11 years) who underwent elective pulmonary thromboendarterectomy for chronic pulmonary thromboembolism. Patients breathed 20 parts per million of NO gas for 30 min at 12-h intervals until extubation of the trachea. Hemodynamics and arterial blood gas levels were analyzed before, during, and after NO inhalation. Waveform of pulmonary artery pressure (PAP) was evaluated using fractional pulse pressure (PPf): (systolic PAP - diastolic PAP)/mean PAP. After surgery, pulmonary vascular resistance decreased, PPf decreased, and cardiac index increased significantly. At the first trial, NO inhalation resulted in a slight improvement in arterial oxygen tension (from 173 +/- 33 to 196 +/- 44 mm Hg; p < 0.05), while hemodynamics did not change significantly. Twelve hours later, NO inhalation decreased pulmonary vascular resistance index (from 312 +/- 98 to 277 +/- 93 dyne.s. cm(-5)/m(2); p < 0.01), while the change in oxygenation was not significant. Immediately after pulmonary thromboendarterectomy for chronic pulmonary thromboembolism, NO inhalation improved oxygenation; at 12 h after surgery, NO inhalation resulted in decreased pulmonary vascular resistance, although both changes were small.

Pulsatility of Ascending Aortic Pressure Waveform Is a Powerful Predictor of Restenosis After Percutaneous Transluminal Coronary Angioplasty

Because ascending aortic pressure has a greater effect on coronary perfusion during diastole than systole, we hypothesized that a high coronary diastolic-to-systolic pressure ratio prevents coronary lesions from restenosing after percutaneous transluminal coronary angioplasty (PTCA) and that ascending aortic pulsatility relative to mean pressure is higher in patients with restenosis than in those without restenosis. The purpose of this study was to evaluate prospectively whether the morphology of the ascending aortic pressure wave can be used to predict restenosis after PTCA. We measured the coronary artery diameter and the aortic pressure before PTCA. To quantify the relative magnitude of the pulsatile-to-mean aortic pressure, we normalized the pulse pressure to mean pressure and referred to this value as the fractional pulse pressure (PPf). We prospectively investigated the effect of PPf in relation to subsequent risk of restenosis after PTCA in patients with coronary artery disease. PPf was a powerful predictor of restenosis. Crude cumulative incidence rates of restenosis were 17.6% for the lowest, 33.3% for the middle, and 77. 8% for the highest tertile of PPf levels. After adjustments for age, smoking habits, systolic blood pressure, type 2 diabetes, hypercholesterolemia, old myocardial infarction, vessel location, vessel size, and sex, the odds ratio of restenosis was 33.5 (95% confidence interval, 2.04 to 550.6) for the highest tertile of the PPf level compared with the lowest tertile level. Pulsatility of the ascending aortic pressure is a predictive factor for restenosis after PTCA.

Characteristics of Pulmonary Artery Pressure Waveform for Differential Diagnosis of Chronic Pulmonary Thromboembolism and Primary Pulmonary Hypertension

Objectives. The accurate diagnosis of chronic pulmonary thromboembolism (CPTE) is a prerequisite for life-saving surgical interventions. To help in the differential diagnosis of CPTE and primary pulmonary hypertension (PPH), we characterized the configuration of the pulmonary artery pressure waveform.Background. Because CPTE predominantly involves the proximal arteries, whereas PPH involves the peripheral arteries, we hypothesized that patients with CPTE would have stiff or high resistance proximal arteries, whereas those affected by PPH would have high resistance peripheral arteries. These differences in the primary lesions would make arterial pulsatility relative to mean pressure larger in CPTE than in PPH.Methods. In 34 patients with either CPTE (n = 22) or PPH (n = 12) whose pulmonary systolic pressure was ≥50 mm Hg, we measured pulmonary artery pressure using a fluid-filled system that included a balloon-tipped flow-directed catheter.Results. To quantify the magnitude of pulsatility relative to mean pressure, we normalized pulse pressure by mean pressure, hereinafter referred to as fractional pulse pressure(PPf). PPfwas markedly higher in CPTE than in PPH (mean [± SD] 1.41 ± 0.20 and 0.80 ± 0.18, respectively, p < 0.001) and was diagnostic in separating the two groups without overlap. Similarly, the coefficient of variation of pulmonary artery pressure also separated the two groups without overlap (0.45 ± 0.06 and 0.25 ± 0.06, respectively, p < 0.001). Fractional time to half the area under the pressure curve separated the two groups reasonably well (0.35 ± 0.02 and 0.43 ± 0.03, respectively, p < 0.001).Conclusions. The analysis of pulsatility of pulmonary artery pressure is useful in the differential diagnosis of CPTE and PPH.(J Am Coll Cardiol 1997;29:1311–6)

Effects of decreased aortic compliance on performance of the left ventricle.

Effects of decreased aortic compliance on performance of the left ventricle.