Higher Augmentation Index Research Articles

Paradoxical high augmentation index in females with diabetes mellitus.

The relationship between diabetes mellitus (DM) and augmentation index (AIx) remains unclear. We conducted an observational cross‐sectional study. Subjects were patients who underwent coronary angiography. We examined the relationship between high AIx and several factors. The total number of diabetic patients was 144, and median AIx was 0.256. In diabetic patients, the significant relationship between female gender and high AIx (median cut‐off value, ≥0.256) was found by the multivariate logistic analysis (adjusted odds ratio = 2.888; 95% confidence interval: 1.032‐8.081). The significant relationship between female gender and high AIx was found in patients with DM.

Reflection Magnitude, a Measure of Arterial Stiffness, Predicts Incident Heart Failure in Men But Not Women: Multi-Ethnic Study of Atherosclerosis (MESA)

BackgroundArterial stiffness is a risk factor for heart failure (HF) and is higher in women. Our objective was to investigate sex differences between arterial stiffness and incident HF in the Multi-Ethnic Study of Atherosclerosis (MESA) population. Methods and ResultsApplanation tonometry from 5959 participants (52.8% women) was used to calculate augmentation index (AIx), pulse pressure amplification (PPA), and reflection magnitude (RM). Sex-specific risk of HF was assessed with the use of a competing-risk regression model. Women had higher AIx (P < .00001), higher RM (P = .023), and lower PPA (P < .00001) indicating greater arterial stiffness in women. However, increasing RM quartile independently predicted HF in men (adjusted hazard ratios and 95% confidence intervals: Q2: 2.05 [1.06–3.96; P = .033]; Q3: 2.49 [1.30–4.73; P = .006]; Q4: 3.26 [1.75–6.08; P = .0002]) but not in women (Q2: 1.04 [0.54–1.98; P = .91]; Q3: 1.30 [0.71–2.37; P = .4]; Q4: 0.79 [0.4–1.55; P = .49]). ConclusionWomen demonstrate greater arterial stiffness than men. Despite this, arterial stiffness, as measured by RM, predicts incident HF in men but not in women. RM represents a novel risk factor for HF in men but not in women. Further investigation of risk factors for HF in women is warranted. ConclusionArterial stiffness, measured by RM, predicts incident HF in men but not in women in this MESA cohort.

Increased augmentation index and central systolic arterial pressure are associated with lower school and motor performance in young adolescents.

ObjectiveIn adults, improper arterial function has been linked to cognitive impairment. The pulse wave velocity (PWV), augmentation index (AIx) and other vascular parameters are useful indicators of arterial health. In our study, we monitored arterial properties, body constitution, school success, and motor skills in young adolescents. We hypothesize that reduced cognitive and motor abilities have a vascular origin in children.MethodsWe analysed 81 healthy school children aged 11–16 years. Anthropometry central systolic arterial pressure, body mass index (BMI), standard deviation scores (SDS) BMI, general school performance grade, and eight motor tests were assessed. PWV, AIx, and central systolic arterial pressure (SBPao) were measured.ResultsAIx and SBPao correlated negatively with school performance grades. Extremely high AIx, PWV and SBPao values were observed in 5% of children and these children had average to low school performance. PWV correlated significantly with weight, height, and waist and hip circumference. AIx, PWV, school success, and BMI correlated strongly with certain motor functions.ConclusionsIncreased AIx and SBPao are associated with lower school and motor performance in children. PWV is influenced by the body’s constitution.

The correlation between pulse diagnosis and constitution identification in traditional Chinese medicine

ObjectivesOur study aimed to correlate pulse wave parameters such as augmentation index (AI) and heart rate variability with traditional Chinese medicine (TCM) constitution for evaluating health status. DesignOut of 177 subjects, 69 healthy subjects were enrolled in the present study, and others were excluded because of cardiovascular, liver, kidney, or other diseases. Each subject was invited to complete pulse wave examination and the Constitution in Chinese Medicine Questionnaire. Independent Student’s t-tests, Mann-Whitney tests, and binary logistic regression analysis were used to analyse the correlation between pulse wave parameters and TCM constitution. ResultsQi-deficient individuals had higher AI (p=0.006) and lower diastolic blood pressure (p=0.011); yang-deficient individuals had lower dP/dt max (p=0.030), systolic blood pressure (p=0.020), and pulse pressure (p=0.048); and damp-heat individuals had higher subendocardial viability index (SEVI) scores (p=0.011). We then categorized the phlegm dampness and yang-deficiency individuals into the cold group and those with damp-heat and yin-deficiency into the heat group. A comparison of the two constitution groups showed higher AI in the cold group (p=0.026). Binary logistic regression analysis demonstrated that only AI was a determinant, as evidenced by the finding that an increase of one unit in AI corresponded to an increase of 5% in the odds ratio for individuals to have a cold constitution (p=0.026). ConclusionsIndividuals with qi-deficient and cold constitutions had higher AI and lower SEVI, potentially reflecting an increase in arterial stiffness. This study can provide a basis for further investigation of the physiological indicators of TCM constitutions in modern medicine.

Relation of Erectile Dysfunction to Subclinical Myocardial Injury

The circulating concentration of cardiac troponin I (cTnI) is an index of subclinical myocardial injury in several patient populations and in the general population. Erectile dysfunction is associated with greater risk for cardiovascular events, but the association with subclinical myocardial injury is not known. We aimed to test the hypothesis that the presence and severity of erectile dysfunction is associated with greater concentrations of cTnI in the general population. The presence and severity of erectile dysfunction was assessed by administering the International Index of Erectile Function 5 (IIEF-5) questionnaire to 260 men aged 30 to 65years recruited from a population-based study. Concentrations of cTnI were determined by a high-sensitivity (hs) assay. Hs-cTnI levels were significantly higher in subjects with than in those without erectile dysfunction (median 2.9 vs 1.6ng/l; p <0.001). Men with erectile dysfunction (i.e., IIEF-5 sum score <22) were also significantly older; had a higher systolic blood pressure, lower estimated glomerular filtration rate, higher augmentation index and N-terminal pro-B-type natriuretic peptide; and had a higher prevalence of hypertension, diabetes mellitus, and previous coronary artery disease than subjects without erectile dysfunction. These covariates were adjusted for in a multivariate linear regression model, yet the IIEF-5 sum score remained significantly negatively associated with the hs-cTnI concentration (standardized β-0.206; p <0.001). In conclusion, the presence and severity of erectile dysfunction is associated with circulating concentrations of hs-cTnI, indicating subclinical myocardial injury independently of cardiovascular risk factors, endothelial dysfunction and heart failure biomarkers.

PP.06.06] CAN ARTERIAL WAVE AUGMENTATION IN YOUNG ADULTS EXPLAIN VARIABILITY OF CARDIOVASCULAR RISK IN ETHNIC MINORITIES?

Objective: Traditional cardiovascular (CV) risk factors do not fully explain ethnic differences in CV disease. We tested if pulse wave velocity (PWV) and Augmentation Index (AIx), both independent predictors of later adult mortality, and their determinants from childhood may underlie ethnic variability in CV risk as young adults in the ‘DASH’ longitudinal study. Design and method: Details of our DASH study's longitudinal design can be found at http://dash.sphsu.mrc.ac.uk/, DASH includes representative samples of 6 main UK ethnic groups, starting at school aged 11–13y, followed again at 14–16y, both with anthropometry, blood pressures (BP) and psychosocial measures. PWV and AIx were then recorded using the Arteriograph device at ages 21–23y in a random sub-sample (n = 666). For n = 334, physical activity (PA) was also measured over 5 days (ActivPal). Results: Unadjusted PWVs in Black Caribbean and White UK young men were similar (7.9 + 0.3 vs 7.6 + 0.4 m/s) and lower in other ethnic groups at similar systolic (s)BPs (120mmHg) and BMIs (24.6 kg/m2). In fully adjusted regression models, independent of BP effects, Black Caribbeans, Black African and Indian young women had lower PWV (by 0.5–0.8, 95%CI 0.1–1.1 m/s) than did White UK women (6.9 + 0.2m/sec). Conversely, AIx appeared to be higher in ethnic minority groups - Indian (15.1, 13.0–17.2,%), Bangladeshi/Pakistani (15.7, 13.7–17.7,%), Caribbean (14.9, 12.3–17.0,%) and West African (15.3, 12.9–17.7,%) compared with White UK (11.9, 10.2–13.6,%), In multivariate models, adjusted for gender, central systolic BP, height and heart rate, Indian and Bangladeshi/Pakistani young adults had higher AIx (β = 3.35 and 4.20, p < 0.01) than White UK; with a similar trend for West African and Caribbeans, but not statistically significant (p = 0.08). PA, psychosocial or deprivation measures were not associated with AIx, with borderline associations from brachial BP but no other childhood variables. Conclusions: At this age AIx rather than arterial stiffness may be a useful tool for testing components of excess CV risk in some ethnic minority groups.

Relations of Arterial Stiffness and Brachial Flow-Mediated Dilation With New-Onset Atrial Fibrillation: The Framingham Heart Study.

The relations of measures of arterial stiffness, pulsatile hemodynamic load, and endothelial dysfunction to atrial fibrillation (AF) remain poorly understood. To better understand the pathophysiology of AF, we examined associations between noninvasive measures of vascular function and new-onset AF. The study sample included participants aged ≥45 years from the Framingham Heart Study offspring and third-generation cohorts. Using Cox proportional hazards regression models, we examined relations between incident AF and tonometry measures of arterial stiffness (carotid-femoral pulse wave velocity), wave reflection (augmentation index), pressure pulsatility (central pulse pressure), endothelial function (flow-mediated dilation), resting brachial arterial diameter, and hyperemic flow. AF developed in 407/5797 participants in the tonometry sample and 270/3921 participants in the endothelial function sample during follow-up (median 7.1 years, maximum 10 years). Higher augmentation index (hazard ratio, 1.16; 95% confidence interval, 1.02-1.32; P=0.02), baseline brachial artery diameter (hazard ratio, 1.20; 95% confidence interval, 1.01-1.43; P=0.04), and lower flow-mediated dilation (hazard ratio, 0.79; 95% confidence interval, 0.63-0.99; P=0.04) were associated with increased risk of incident AF. Central pulse pressure, when adjusted for age, sex, and hypertension (hazard ratio, 1.14; 95% confidence interval, 1.02-1.28; P=0.02) was associated with incident AF. Higher pulsatile load assessed by central pulse pressure and greater apparent wave reflection measured by augmentation index were associated with increased risk of incident AF. Vascular endothelial dysfunction may precede development of AF. These measures may be additional risk factors or markers of subclinical cardiovascular disease associated with increased risk of incident AF.

Endothelial Function in Youth: A Biomarker Modulated by Adiposity-Related Insulin Resistance

To investigate the physical and metabolic determinants of endothelial dysfunction, an early marker of subclinical atherosclerosis, in normal weight and overweight adolescents with and without type 2 diabetes mellitus. A cross-sectional study of 81 adolescents: 21 normal weight, 25 overweight with normal glucose tolerance, 19 overweight with impaired glucose regulation, and 16 with type 2 diabetes mellitus underwent evaluation of reactive hyperemia index (RHI) and augmentation index (AIx) at heart rate 75 bpm by peripheral arterial tonometry; oral glucose tolerance test, lipid profile, and hyperinsulinemic-euglycemic clamp to measure insulin sensitivity; and dual energy X-ray absorptiometry scan and abdominal magnetic resonance imaging for percentage of body fat and abdominal fat partitioning. Participants across tertiles of RHI (1.2 ± 0.02, 1.5 ± 0.02, and 2.0 ± 0.05, P < .001) had similar age, sex, race, lipid profile, and blood pressure. Body mass index z-score, percentage body fat, abdominal fat, and hemoglobin A1c decreased, and insulin sensitivity increased from the first to third tertile. RHI was inversely related to percentage body fat (r = -0.29, P = .008), total (r = -0.37, P = .004), subcutaneous (r = -0.39, P = .003), and visceral (r = -0.26, P = .04) abdominal fat. AIx at heart rate 75 bpm was higher (worse) in the lower RHI tertiles (P = .04), was positively related to percentage body fat (r = 0.26, P = .021), and inversely related to age, insulin sensitivity, and inflammatory markers (tumor necrosis factor-α and plasminogen activator inhibition-1). Childhood obesity, particularly abdominal adiposity, is associated with endothelial dysfunction manifested by worse reactive hyperemia and higher AIx. Insulin resistance appears to mediate this relationship.

Predictive value of the augmentation index derived vascular age in patients with newly diagnosed atherosclerosis

Early detection of atherosclerosis, i.e., in occupational health screening programs could reduce the rate of cardiovascular events in the working population. Changes of the augmentation index (AIX) correlate with changes of the arterial stiffness induced by aging, atherosclerosis, or arterial hypertension and have a prognostic value for cardiovascular events. Their diagnostic yield should be increased by normalizing the AIX to age, in terms of a calculating the vascular age (VA). In this pilot study, 30 patients (mean age 65.3 ± 8.8 years, 21 male) with suspected coronary heart disease underwent a duplex ultrasound of the carotid arteries and a measurement of the ankle brachial index in addition to the coronary angiography. The AIX was recorded with a portable device (Vascular Explorer), and the VA was calculated. Atherosclerosis was found in 24 patients. They were older than the patients without atherosclerosis, but there was no age dependency found for the distribution pattern or severity of atherosclerosis. In patients with findings of atherosclerosis, the calculated VA was higher than the chronological age, and these differences were significant in patients below 65 years of age. Comparing patients in higher blood pressure classes with patients in lower classes, significantly higher AIX, VA, and differences to the chronological age were found. The VA, deduced from the noninvasively obtained AIX, is a promising candidate for screening programs for atherosclerosis, i.e., in occupational health screening programs.

14 Central blood pressures and arterial stiffness in hypertensive pregnancies

Introduction Cardiovascular disease has a stronger association with central BP than brachial (conventional) BP. Women with hypertensive disorders in pregnancy are at increased risk of cardiovascular disease later in life and may have a pre-existing phenotype of increased risk, un-masked by pregnancy. It is unclear whether central BP is altered in all hypertensive pregnancies or just pre-eclampsia. Objectives To examine central blood pressure and vascular stiffness in normal and hypertensive pregnancies. Methods Four groups of 3rd trimester women were studied: normotensive pregnancy (NP); gestational hypertension (GH); essential hypertension (EH), pre-eclampsia (PE) as well as non-pregnant controls (C). Each woman had central blood pressures and Augmentation index (as a measure of arterial stiffness) measured by using the Sphygmocor® applanation tonometer. Results A total of 128 women have been recruited in an ongoing study as follows; NP = 20, GH = 51, EH = 16, PE = 14 and C = 27. Neither mean brachial or central systolic and diastolic BPs differed between the non-pregnant and the normal pregnant cohort. Mean brachial BP 116 ± 11/74 ± 8 mmHg vs 119 ± 7/75 ± 8 mmHg and central 103 ± 11/75 ± 8 mmHg vs 105 ± 9/77 ± 8 mmHg. Normotensive pregnant women had significantly lower brachial and central blood pressures than any of the hypertensive pregnant women ( p Augmentation index (AI) was elevated in all pregnant women NP 14 ± 15, GH 20 ± 9, EH 19 ± 10, PE 18 ± 8, cf the control group 9 ± 13, with a trend towards being highest in women with GH and EH, however all remained below the upper limit of normal for that age group( Conclusions These data confirm that in pregnancy central blood pressure measurements are significantly lower than brachial measurements. Pregnant women appear to have a higher AI than non pregnant controls with a trend towards higher values suggestive of vascular stiffness in those women with GH and PE however they remained below the upper limit of normal for this small cohort

Serum levels of Mac-2 binding protein increase with cardiovascular risk and reflect silent atherosclerosis

Background and aimsMac-2 binding protein (M2BP) was reported to be a useful biomarker for liver fibrosis and malignant tumors. We hypothesized that expression of M2BP might also change in the process of atherosclerosis. MethodsThis study included subjects who visited our hospital for a physical checkup. ResultsThe M2BP levels in subjects with hypertension, dyslipidemia, or abnormal glucose metabolism were higher than those in subjects without such risk factors. Moreover, the M2BP levels were associated with severity of cardiovascular risk. Subdivision of M2BP levels into quartiles revealed that M2BP was significantly associated with reactive oxygen metabolites, central systolic blood pressure, and radial augmentation index (AI). Logistic regression analysis with the endpoint of high radial AI (above mean value) showed that high radial AI was independently associated with high M2BP. ConclusionsAlthough the spectrum was narrow as compared to that in cases of hepatic fibrosis, serum M2BP may reflect silent atherosclerosis in apparently healthy subjects.

Predictive Value of Arterial Stiffness and Subclinical Carotid Atherosclerosis for Cardiovascular Disease in Patients with Rheumatoid Arthritis

We evaluated the predictive value of these vascular biomarkers for cardiovascular disease (CVD) events in patients with rheumatoid arthritis (RA): aortic pulse wave velocity (aPWV), augmentation index (AIx), carotid intima-media thickness (cIMT), and carotid plaques (CP). They are often used as risk markers for CVD. In 2007, 138 patients with RA underwent clinical examination, laboratory tests, blood pressure testing, and vascular biomarker measurements. Occurrence of CVD events was recorded in 2013. Predictive values were assessed in Kaplan-Meier plots, log-rank, and crude and adjusted Cox proportional hazard (PH) regression analyses. Baseline median age and disease duration was 59.0 years and 17.0 years, respectively, and 76.1% were women. CVD events occurred in 10 patients (7.2%) during a mean followup of 5.4 years. Compared with patients with low aPWV, AIx, cIMT, and without CP, patients with high aPWV (p < 0.001), high AIx (p = 0.04), high cIMT (p = 0.01), and CP (p < 0.005) at baseline experienced more CVD events. In crude Cox PH regression analyses, aPWV (p < 0.001), cIMT (p < 0.001), age (p = 0.01), statin (p = 0.01), and corticosteroid use (p = 0.01) were predictive of CVD events, while AIx was nonsignificant (p = 0.19). The Cox PH regression estimates for vascular biomarkers were not significantly altered when adjusting individually for demographic variables, traditional CVD risk factors, RA disease-related variables, or medication. All patients who developed CVD had CP at baseline. CP, aPWV, and cIMT were predictive of CVD events in this cohort of patients with RA. Future studies are warranted to examine the additive value of arterial stiffness and carotid atherosclerosis markers in CVD risk algorithms. Regional Ethical Committee approval numbers 2009/1582 and 2009/1583.

Aortic stiffness and change in glomerular filtration rate and albuminuria in older people.

Aortic stiffness increases with age and increases pulsatile stress in the microcirculation. Abnormalities in kidney microvascular structure and function may contribute to development or progression of chronic kidney disease in older people. We performed a longitudinal analysis of 629 community-dwelling elderly Icelandic adults from the Age, Gene/Environment Susceptibility-Reykjavik Study with two visits over a mean follow-up of 5.3 years. We evaluated the associations of carotid-femoral pulse wave velocity (CFPWV), carotid pulse pressure (CPP) and augmentation index (AI), with the change in estimated glomerular filtration rate (eGFR) and urine albumin-to-creatinine ratio (UACR) assessed as annual change and dichotomized as large changes. Models were adjusted for age, sex, height, heart rate, traditional cardiovascular disease risk factors and baseline kidney measures. When eGFR was analyzed as a continuous variable, higher baseline CFPWV and CPP, but not AI, were significantly associated with a larger annual decline in eGFR in models adjusted for age, sex, height, heart rate and baseline eGFR, but not after additional adjustment for the mean arterial pressure. When eGFR was analyzed as a categorical variable, higher CFPWV was significantly associated with a decrease in eGFR of ≥3 mL/min/1.73 m 2 /year [odds ratio (OR) 1.53, 95% confidence interval (CI) 1.11-2.13] and higher AI was associated with 30% eGFR decline during follow-up (OR 1.44 and 95% CI 1.03-2.00) in fully adjusted models. None of the tonometry measures was associated with change in UACR. Abnormalities in vascular health may play a role in large declines in eGFR beyond the traditional cardiovascular disease risks in this older Icelandic cohort.

Higher augmentation index is associated with tension-type headache and migraine in middle-aged/older humans with obesity.

Obesity is a major risk factor for chronic daily headaches, including migraine and tension-type headache (TTH). Although migraine is associated with increased risk of cardiovascular diseases (CVD), a relation between TTH and CVD risk has not been established. It was hypothesized that higher carotid-femoral pulse wave velocity (CFPWV) and augmentation index (AI), measures of aortic stiffness and pressure wave reflection, respectively, and biomarkers of CVD risk, would be higher among adults with obesity and migraine or TTH compared with those with no headache. Adults with obesity (n = 93; body mass index ≥30 kg/m(2) ) who were between 40 and 75 years old with at least one additional CVD risk factor were enrolled. Subjects had CFPWV and AI assessed and a complete neurological exam for diagnosis of headache in the past 12 months. Adults with obesity and TTH (P = 0.018), but not migraine (P = 0.29), had significantly higher AI compared with those with no headache. When both CFPWV and AI were considered in a logistic regression model with migraine or TTH, only AI was associated with TTH (P = 0.008) and migraine (P = 0.032) but could not distinguish between the two headache phenotypes. Increased aortic AI but not stiffness is associated with TTH and migraine among middle-aged/older adults with obesity and high CVD risk.

Arterial stiffness and carotid arteries: correlation with daily blood pressure profile in essential hypertension

Objective. To study the relationship between arterial stiffness, augmentation index and the structure of the carotid arteries with daily blood pressure (BP) profile in patients with essential hypertension (HTN). Design and methods. Altogether 155 patients with HTN aged 30–70 years were examined. A physical examination, glucose, creatinin level and lipid profile (low- and high-density lipoproteins, and triglycerides) (biochemical analyzer Sinсhron SX‑4 DELTA, Beckman, USA), duplex scanning of carotid arteries (Sequoia‑512, Acuson, USA), and arterial stiffness assessment by pulse wave contour analysis (Angioscan‑01, Angioscan, Russia) were performed. Results . Augmentation index was associated with the nocturnal BP reduction in hypertensive males, but not females. In males, augmentation index was 6,8 ± 11,5 %, 12,7 ± 10,9 % and 14,5 ± 7,7 % for the dippers, nondippers and night-peakers, respectively (p 0,05). The lowest values of augmentation index (15,6 ± 14,8 % versus 21,6 ± 13,4 % for non-dippers, p < 0,02) were found in patients with normal circadian BP profile. In addition, more severe carotid atherosclerotic lesions were found in non-dippers (23,2 ± 18,8 %) compared to dippers (13,7 ± 14,5 %, p < 0,01). Conclusions . Patients with HTN and abnormal circadian BP profile show higher augmentation index and more severe atherosclerotic lesions in carotid arteries.

Immediate hemodynamic changes after revascularization of complete infrarenal aortic occlusion: A classic issue revisited

Chronic total occlusion of the infrarenal aorta (CTOA) is a rare disease, characterized by severe impairment of limb perfusion. It is advocated that revascularization may improve survival rates, presumably due to improved cardiovascular performance; however no experimental or clinical data exist to identify a clear causative correlation and provide a relevant pathophysiologic background. Therefore we conducted a pilot study based on pulse wave analysis to detect the hemodynamic changes immediately after revascularization, in a group of six consecutive patients with CTOA. All patients were subjected to non-invasive measurements 1day before surgery and at the end of the 1st postoperative month. Pulse wave analysis was performed noninvasively with a novel validated brachial cuff-based automatic oscillometric device. All patients had markedly preoperative high Augmentation Index (adjusted at heart rate 75beats/min, AI@75). The AI@75 decreased from 46±6.6 preoperatively to 24±5.7 (p 0.0002). Wave reflection magnitude decreased from 72.3±5.2% to 63±6.7% (p 0.02). Cardiax index increased from 2.8±1.2 to 3.4±1.2l/min×1/m2 (p 0.41). Pulse wave velocity remained practically unchanged post-interventionally. These findings show that central aorta hemodynamics can be improved immediately following revascularization procedures in patients with complete occlusion of the entire length of the infrarenal aorta and can constitute the background of improved postoperative life-expectancy.

Клинико-гемодинамические предикторы рецидивов фибрилляции предсердий у больных с артериальной гипертонией с различной скоростью пульсовой волны

The article presents own experience of treating patients with atrial fibrillation. Asymptomatic&#x0D; lesion of the target organ is detected in patients with arterial hypertension in the early stages of the disease before&#x0D; obvious clinical manifestations. The question of studying the mutual influence of arterial hypertension and atrial&#x0D; fibrillation is important, because this combination significantly increases the risk of cardiovascular events. The&#x0D; study included 55 patients with hypertension and recurrent atrial fibrillation by the prescription of an average of&#x0D; 11 months with an average frequency of 2 episodes a year. All were performed applanation tonometry,&#x0D; echocardiography and daily monitoring of blood pressure. The patients were allocated on the 3 groups. Groups&#x0D; differed significantly by age, the risk of thromboembolic complications on a scale CHA2-DS2-VASc score,&#x0D; creatinine level. Patients with increased arterial stiffness had the highest heart rate, a shorter return time of the&#x0D; pulse wave and a higher augmentation index at comparable values of peripheral and central systolic and diastolic&#x0D; blood pressure. Multivariate regression analysis found that independent predictors of recurrent relapses of atrial&#x0D; fibrillation in patients with arterial hypertension were age, higher the index on a scale CHA2-DS2-VASc score&#x0D; and the creatinine levels, the return of the reflected wave. In the group of patients with arterial hypertension and&#x0D; normal arterial stiffness the positive correlation of the recurrence of atrial fibrillation with age, scale CHA2-DS2-&#x0D; VASc score, creatinine level, and the maximum daily heart rate. It is necessary to highlight the role of the reflected wave in the modification of arterial stiffness in patients with arterial hypertension and the velocity of&#x0D; propagation of pulse wave ≥10 m/s, making rational control of heart rate in case reduced elastic properties of&#x0D; arteries.

O113. Measurements of arterial stiffness and uterine artery Doppler for the prediction of preeclampsia in women presenting with gestational hypertension

Objective While gestational hypertension (GH) and chronic hypertension are usually benign, pre-eclampsia (PE) is more commonly associated with adverse maternal and fetal outcomes. About 15–25% of women initially diagnosed with GH will develop PE, but only 10% of women who develop GH after 36 weeks of gestation will develop PE. Pulse wave velocity (PWV) and augmentation index (AIx) are markers of arterial stiffness and endothelial dysfunction, while uterine artery Doppler pulsatility index (UtA PI) reflects the resistance in the uteroplacental circulation. These parameters have been shown to be associated with the risk of PE. The main aim of this study was to investigate whether maternal cardiovascular changes can discriminate pregnancies which will subsequently develop PE among those presenting with GH. Methods This was a prospective cohort study in women with singleton pregnancies presenting with GH at St George’s Hospital (n = 112). Another group of uncomplicated singleton pregnancies were recruited as controls. PWV, AIx and aortic systolic blood pressure (SBPAo) were recorded using the Arteriograph® (TensionMed Ltd., Budapest, Hungary). The uterine artery Doppler was recorded on both sides and the mean PI was calculated. Mann-Whitney and Chi-Square tests were used to compare the groups, while regression analysis was used to identify and adjust for potential confounders. The predictive accuracy for the development of PE was assessed using the ROC curve analysis. Results The analysis included 105 pregnancies with GH and 356 controls. Compared to the group that remained as GH (n = 82), the group that developed PE (n = 23) had significantly higher AIx (25.9%, IQR 12.8–34.3 vs 15.8%, IQR 6.1–25.6; p = 0.019) and SBPAo (141 mmHg, IQR 130–158 vs 130 mmHg, IQR 123–142; p = 0.005) at the initial assessment. They also had significantly higher UtA mean PI at 20–24 weeks (1.10, IQR 0.78–1.47 vs 0.83, IQR 0.68–1.04; p = 0.008). AIx was significantly associated with the risk of development of PE (odds ratio 1.05; 95% CI 1.01–1.09, p = 0.016). For a cut-off of 31.18%, AIx had sensitivity of 41.2% (95% CI 18.4–67.1%) and specificity of 93.2% (95% CI 83.5–98.1%) and LR 6.07 (AUC 0.69; 95% CI 0.53–0.84, p = 0.019). Conclusion Arterial stiffness and SBPAo measured at the initial assessment of GH can potentially discriminate the pregnancies that will develop PE. Identification of women who will develop PE among those who initially present with PIH is likely to facilitate targeted antenatal surveillance and possibly intervention.

Coronary collateral development and arterial stiffness in patients with chronic coronary total occlusions

Objective. Coronary collateral circulation (CCC) mainly develops through arteriogenesis in response to shear forces. Increased arterial stiffness (AS) causes decreased coronary perfusion, which may reduce shear stress, arteriogenesis, and thus collateral formation. The aim of this study was to assess the relationship between CCC and AS in patients with chronic coronary total occlusion (CTO). Design. We prospectively enrolled 163 patients with CTO. Patients were divided into two groups according to their Rentrop scores: (a) poorly developed (PD) CCC group (Rentrop 0–1) and (b) well-developed (WD) CCC group (Rentrop 2–3). AS measurements were carried out using a Mobil-O-Graph arteriography system. Results. Fasting glucose, creatinine, uric acid, neutrophil count, and neutrophil-to-lymphocyte ratio were found to be higher in patients with PD-CCC. Moreover, patients with PD-CCC had significantly higher augmentation index (AIx) and pulse wave velocity (PWV) compared with WD-CCC group (27.3 ± 8.9 vs. 18.7 ± 7.4, p < 0.001 and 11.7 ± 2.6 vs. 8.5 ± 1.4, p < 0.001, respectively). In multivariate logistic regression analysis, PWV, AIx, and serum uric acid were found to be independently associated with the development of CCC. Conclusion. AS parameters, such as AIx and PWV, as well as serum uric acid are independently associated with the development of CCC in stable coronary artery disease with CTO.

Abstract 174: Relationship between Kawasaki Disease Related-Angiopathy and Pressure Wave Reflection in the Arterial System

Background: Recently we reported that the carotid arteries of Kawasaki disease (KD) appear to develop mild sclerotic changes shortly after onset using the speckle tracking echocardiography. However, it remains to be elucidated what factors hemodynamically may induce these sclerotic changes. Objectives: The aim of this study was to investigate the relationship between KD related-angiopathy and arterial pressure wave reflection using the two-dimensional speckle tracking echocardiography and radial augmentation index (AIx). Subjects &amp; Methods: We studied a cohort of children with history of KD. The subjects were 87 KD patients (age, 9.7±2.9 years) and 93 healthy controls (11.3±3.2 years). As for our methodology, the two regions of interest (ROI) for speckle tracking were manually positioned at near and far carotid arterial walls using a Philips iE33. Continuously, we examined the following strain values: (A) peak strain in expansion phase, (B) peak strain before aortic valve closure, and (C) strain value at aortic valve closure (Figure 1). Also, we examined two ratios, B/A and C/A, for emphasizing recoil function. Concurrently, the radial AIx were obtained. Results: KD patients had significantly the lower A values, the higher B/A, and the higher radial AIx, compared with controls. Furthermore, there was good correlation between B/A and radial AIx in KD. Conclusions: It is well known that a higher AIx results from earlier arrival of reflected pressure waves and an early return of reflected waves is closely correlated with peripheral stiffness. Therefore, these results indicate that peripheral angiopathy may induce sclerotic changes of carotid arteries in KD patients.