Higher Baseline Pulse Wave Velocity Research Articles

PP.24.22] HIGHER PULSE WAVE VELOCITY IS ASSOCIATED WITH NON-RECOVERY OF LEFT VENTRICULAR SYSTOLIC FUNCTION IN PATIENTS AFTER MYOCARDIAL INFARCTION

Objective: Functional recovery or irreversible negative remodeling of injured myocardial segments has different prognostic implication in patients with myocardial infarction (MI) undergoing coronary percutaneous intervention (PCI). Increased pulse wave velocity (PWV),is one of the important risk factors of cardiovascular events in different clinical conditions. The aim of the study was to assess the relationship between PWV and changes of left ventricular (LV) systolic function in patients with acute MI. Design and method: In 112 patients with acute MI and PCI (68% male,age 61.1 ± 9.5 years (M ± SD),57.2% with ST-elevation MI (STEMI),smokers 35%,arterial hypertension 83%,diabetes 7%,blood pressure (BP) 128 ± 8/82 ± 87mmHg, LV ejection fraction (LVEF) 48.2 ± 4.6%). Arterial stiffness was assessed using applanation tonometry. Global longitudinal peak strain (GLPS) by speckle tracking echocardiography (STE) was calculated in a 16-segment LV model as the average segmental value on the basis of three apical imaging planes. Cardiac adverse remodeling was defined by ratio [follow up - initial LV end diastolic volume (LVEDV)] / initial LVEDV) more than 20%. Mann-Whitney and Spearman tests were considered significant if p < 0.05. Results: Baseline GLPS >20% was not detected in any patient. GLPS increased from 14.4 ± 2.4 to 17.4 ± 3.5% in 4 weeks (p < 0.05) and to 18.1 ± 2.7 in 6 months after PCI (p < 0.05). GLPS normalized (>20%) in 31 (28%) patients after 4 weeks and 6 months. After 6 months adverse cardiac remodeling was found in 81 (72%) patients (53% STEMI). Achieved GLPS differed significantly in patients with vs without adverse cardiac remodeling (16.7 ± 1.9 vs 21.4 ± 1.2%, p < 0.001). Mean carotid-femoral PWV decreased from 11.1 ± 2.1 to 8.7 ± 1.8 m/s,p < 0.05. Patients without vs with GLPS normalization in 6 months after PCI were older (62.5 ± 8.5 vs 60.6 ± 9.9 years, p < 0.05), more frequent male (71vs 66.2%, χ2 = 11.1;p < 0.05),smokers (36.2vs 31.2%, χ2 = 3.4;p < 0.04),STEMI (58.7vs 53%, χ2 = 7.7; p < 0.05),had higher systolic BP (134 ± 10vs 130 ± 6 mmHg, p < 0.03),baseline PWV (11.4 ± 1.9vs 10.4 ± 2.6 m/s, p < 0.03),lower baseline EF (47.6 ± 4.9 vs 49.6 ± 3.5%, p < 0.05). A significant correlation was found between decreased δspeckle tracking and higher PWV (r = −0.31,p < 0.05) and speckle tracking and LVEDV after 6 months (r = −0.75,p < 0.05). Conclusions: 65% of patients with MI treated with PCI failed to normalize GLPS after 6 months. Adverse cardiac remodeling was revealed in 72% of patients and they more often had non-recovery of left ventricular longitudinal function. Higher baseline PWV is associated with less effective recovery of LV function.

The Temporal Relationship between Arterial Stiffening and Blood Pressure Is Modified by Methotrexate Treatment in Patients with Rheumatoid Arthritis.

Background: The temporal relationship between arterial stiffness and blood pressure (BP) may vary depending on age and other clinical and demographic factors. Since both BP and arterial stiffness are also affected by inflammatory processes, we examined the temporal arterial stiffness-BP relationship in patients with rheumatoid arthritis (RA) treated with either methotrexate (MTX), an anti-rheumatic agent shown to reduce cardiovascular risk in meta-analyses, or other disease-modifying anti-rheumatic drugs (DMARDs).Methods: Measurements of clinic and 24-h peripheral and central systolic and diastolic BP (SBP and DBP), and pulse wave velocity (PWV) were assessed in RA patients on stable treatment with either MTX ± other DMARDs (MTX group, n = 41, age 61 ± 14 years, 73% females) or other DMARDs (non-MTX group, n = 18, age 65 ± 13 years, 89% females). Measurements were performed at baseline and after 8 months. The temporal relationships were examined using cross-lagged path analysis with models that included age, sex, body mass index, prednisolone, and folic acid use and 28-joint disease activity score.Results: There were significant differences in the temporal arterial stiffness-BP relationships between those in the MTX and DMARD groups. A higher PWV at baseline caused a significant increase in 6 out of 8 different measures of SBP at 8 months amongst those treated with DMARDs (standardized β, range = 0.54–0.66, p < 0.003 for each) and 3 out of 8 different measures of DBP (standardized β, range = 0.52–0.61, p < 0.003 for each) but was not associated with either SBP or DBP at 8 months amongst those treated with MTX. The difference in the effect of baseline PWV on 8-month BP between the 2 groups was also significant (p < 0.003) for 4 measures including clinic peripheral SBP (β = 7.0, 95% CI = 2.8–11.1 mmHg per 1 m/s higher baseline PWV; p < 0.001).Conclusions: Higher arterial stiffness preceded increases in BP in subjects with RA treated with DMARDs, but these effects did not occur amongst those treated with MTX. The different effects were seen mostly in measures of SBP but were also present in some measures of DBP. Our findings suggest MTX may confer a protective effect against stiffness mediated increases in BP in patients with RA.

Longitudinal Changes in LV Structure and Diastolic Function in Relation to Arterial Properties in General Population

ObjectivesWe assessed to what extent arterial properties measured at baseline and follow-up predict longitudinal alterations in echocardiographic indexes reflecting left ventricular (LV) structure and function. BackgroundSerial imaging studies are needed to clarify the relation of changes in LV structure and function to arterial stiffness. MethodsIn 607 participants (50.7% women; mean age 50.7 years), using echocardiography and Doppler imaging, we measured LV dimensions, transmitral blood flow, and mitral annular tissue velocities at baseline and after 4.7 years. Using applanation tonometry, we assessed central pulse pressure (cPP) and carotid-femoral pulse wave velocity (PWV) at baseline. We regressed longitudinal changes in LV indexes on the arterial stiffness parameters and reported standardized effect sizes as a fraction of SD of LV change. ResultsAfter full adjustment, longitudinal increase in LV septal (standardized effect size: +14.4%; p = 0.0018) and posterior wall (+12.6%; p = 0.0027) thickness was associated with higher baseline PWV, whereas LV internal diameter (-12.4%; p = 0.012) decreased during follow-up with PWV. Consequently, greater increase in relative wall thickness was associated with higher baseline PWV (+17.2%; p <0.0001). Participants with higher baseline PWV had a greater risk to develop or retain LV concentric remodeling during follow-up (odds ratio 1.35; p = 0.028). In addition, in women, baseline cPP predicted a greater increase in LV mass (+22.8%; p = 0.0009) and E/e′ ratio (+36.1%; p <0.0001). ConclusionsProgression to LV concentric remodeling pattern was associated with higher baseline PWV. In women, cPP predicted worsening of LV diastolic function. Our study highlights the importance of arterial properties as mediator of LV concentric remodeling in men and women, and diastolic dysfunction in women.

Twenty‐Five‐Year Alcohol Consumption Trajectories and Their Association With Arterial Aging: A Prospective Cohort Study

BackgroundEmerging evidence suggests that arterial stiffness, an important marker of cardiovascular health, is associated with alcohol consumption. However, the role of longer‐term consumption patterns in the progression of arterial stiffness over time remains unclear. A longitudinal cohort design was used to evaluate the association between alcohol consumption over 25 years and subsequent changes in arterial stiffness.Methods and ResultsData (N=3869; 73% male) were drawn from the Whitehall II cohort study of British civil servants, in which participants completed repeat pulse wave velocity assessments of arterial stiffness across a 4‐ to 5‐year interval. Repeated alcohol intake measurements were used to categorize participants into alcohol consumer types, accounting for longitudinal variability in consumption. Sex‐stratified linear mixed‐effects modeling was used to investigate whether drinker types differed in their relationship to pulse wave velocity and its progression over time. Males with consistent long‐term heavy intake >112 g of ethanol/week had significantly higher baseline pulse wave velocity (b=0.26 m/s; P=0.045) than those who drank consistently moderately (1–112 g of ethanol/week). Male former drinkers showed significantly greater increases in arterial stiffness longitudinally compared to consistently moderate drinkers (b=0.11 m/s; P=0.009). All associations were nonsignificant for females after adjustment for body mass index, heart rate, mean arterial pressure, diabetes mellitus, high‐density lipoprotein, and triglycerides.ConclusionsThis work demonstrates that consistently heavy alcohol consumption is associated with higher cardiovascular risk, especially among males, and also provides new insights into the potential impact of changes in drinking levels over time. It discusses the additional insights possible when capturing longitudinal consumption patterns in lieu of reliance on recent intake alone.Clinical Trial Registration URL: http://www.clinicaltrials.gov. Unique identifier: NCT02663791.

ПРЕДИКТОРЫ НЕБЛАГОПРИЯТНОГО РЕМОДЕЛИРОВАНИЯ ЛЕВОГО ЖЕЛУДОЧКА У ПАЦИЕНТОВ, ПЕРЕНЕСШИХ ИНФАРКТ МИОКАРДА

Functional recovery or irreversible negative remodeling of injured myocardial segments has different prognostic implication in patients with myocardial infarction (MI) undergoing coronary percutaneous intervention (PCI). Increased pulse wave velocity (PWV), a non-invasive index of arterial stiffness, is one of the important risk factors of cardiovascular events in different clinical conditions. The aim of the study was to assess the relationship between PWV and changes of left ventricular (LV) systolic function in patients with acute MI. Adverse cardiac remodeling was revealed in 72% of patients and they more often had non-recovery of left ventricular longitudinal function. Higher baseline PWV is associated with less effective recovery of LV function.

OP.4B.04] LONGITUDINAL CHANGES IN LEFT VENTRICULAR STRUCTURE AND DIASTOLIC FUNCTION IN RELATION TO ARTERIAL PROPERTIES IN A GENERAL POPULATION

Objective: Serial imaging studies are needed to clarify the relation of change in left ventricular (LV) structure and function with arterial stiffness. In this longitudinal population study, we assessed in continuous and categorical analyses to what extent arterial properties predict alterations in echocardiographic indexes reflecting LV structure and function. Design and method: In 607 participants (50.7% women; mean age, 50.7 years), using conventional echocardiography and tissue Doppler imaging, we measured LV dimensions, transmitral blood flow and mitral annular tissue Doppler velocities at baseline and after 4.7 years. Using applanation tonometry, we assessed augmentation pressure (AP), central pulse pressure (cPP) and carotid-femoral pulse wave velocity (PWV) at baseline. Standardized effect size was expressed as percent of changes in standard deviation (SD) of δ echocardiographic indexes associated with 1-SD increase in baseline arterial indexes. Results: The clinical correlates of δLV indexes included baseline LV index, age, sex, body mass index, mean blood pressure, pulse rate and changes over time in these co-variables. After full adjustment, longitudinal increase in LV septal (standardized effect size: +14.6%; P = 0.0017) and posterior wall (+13.3%; P = 0.0015) thickness was significantly associated with higher PWV at baseline, whereas LV internal diameter (−12.2%; P = 0.014) decreased with PWV. Consequently, a greater increase in relative wall thickness was associated with baseline PWV (+17.2%; P < 0.0001). We observed similar longitudinal increase in LV wall thickness in relation to higher baseline PWV in men and women. In adjusted logistic analysis, higher baseline PWV was associated with a 156% increase in the odds of developing LV concentric remodeling during follow-up as compared to participants who improved LV geometry (P = 0.0088). Furthermore, in women, a higher baseline cPP predicted a greater increase in LV mass (+18.1%, P = 0.018) and E/e’ ratio (+25.8%, P = 0.0064). Conclusions: The key finding of this study is that longitudinal increase in LV relative wall thickness was associated with higher baseline PWV, measure of arterial stiffness. Moreover, in women, a higher cPP predicted worsening of LV diastolic function. Our study demonstrated the importance of arterial properties as a mediator of LV concentric remodeling in men and women, and diastolic dysfunction in women.

A meta-analysis of randomized controlled trials assessing the impact of beta-blockers on arterial stiffness, peripheral blood pressure and heart rate

BackgroundThe recognition of beta-blockers as a preferred initial therapy for hypertension has been a hot topic of debate recently. This meta-analysis was aimed to assess the impact of different beta-blockers on arterial stiffness as indexed by pulse wave velocity (PWV), peripheral blood pressure (BP) and heart rate, relative to the placebo, angiotensin converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs). MethodsTwo authors independently searched articles, appraised eligibility and abstracted information, and the data were analyzed using STATA. ResultsTwenty-four articles involving 27 independent trials were eligible. Relative to the placebo, treatment with beta-blockers led to remarkable improvement in PWV (WMD, 95% CI, P: −1.115m/s, −1.561 to −0.669, <0.001), systolic BP (−12.355mmHg, −14.330 to −10.380, <0.001), diastolic BP (−8.619mmHg, −10.357 to −6.880, <0.001), mean BP (−9.683mmHg, −11.172 to −8.194, <0.001), pulse pressure (−4.448mmHg, −7.386 to −1.510, 0.003) and heart rate (−12.335, −22.739 to −1.932, 0.020). Beta-blockers were remarkably superior to ACEIs in DBP (−2.540mmHg, −4.463 to −0.617, 0.010) and heart rate (−9.859bpm, −11.752 to −7.969, <0.001). In contrast to ARBs, beta-blocker treatment increased systolic BP (2.042mmHg, 0.639 to 3.444, 0.004) but reduced heart rate (−8.814bpm, −9.756 to −7.873, <0.001) significantly. No publication bias was observed. ConclusionsBeta-blockers exerted more favorable impact than the placebo on arterial stiffness, peripheral BP and heart rate, but less favorable impact than ACEIs or ARBs on all, except heart rate, characters, especially in trials with longer duration of treatment and higher baseline PWV.

Impact of a cold wave on disease course, hemodynamics, carbohydrate metabolism, and blood rheological properties in cardiac patents

To study the impact of cold waves on disease course, hemodynamics, lipid and carbohydrate metabolisms, oxidative stress, and blood rheological properties in patients with cardiovascular diseases (CVD). 24 men and 36 women (their mean age was 62.9±9.7 years) were examined; coronary heart disease (CHD) and hypertension were present in 40 and 95% of the patients, respectively; selected therapy remained unchanged throughout the entire period. The investigators measured blood pressure and pulse wave velocity (PWV), carried out biochemical blood tests, estimated plasma oxidized low-density lipoproteins (oxLDL) and malondialdehyde (MDA) and erythrocyte superoxide dismutase (SOD) activity, calculated a MDA/SOD ratio, determined blood viscosity; as well as assessed quality of life using a visual analogue scale (VAS) and a specially developed questionnaire. Female sex, CHD, type 2 diabetes mellitus (DM-2) were independent predictors of cardiovascular events (CVEs) in the frost period. The persons who had experienced CVEs in frost had higher baseline PWV. CVEs, such as hypertensive crisis, emergency calls, cardiac arrhythmias, and the larger number of adverse reactions, were more commonly recorded in frost. There was an increase in blood glucose levels, a decrease in oxLDL, a rise in η2/η1, and a reduction in plasma viscosity during frost and elevated glycation end product levels at visit 2. Conclusion. The cold wave is associated with the larger number of CVEs in some patients with CVD during selected therapy. CHD, DM-2, female sex are independent predictors of CVE in patients with CVD during the winter period. In this period, there were increases in the levels of glucose, glycation end products, and erythrocyte aggregation, and a reduction in plasma viscosity.

Do subclinical vascular abnormalities precede impaired physical ability and ADL disability?

Cardiovascular disease is an important cause of disability in activities of daily living (ADL) through its effect on physical functioning. However, it is unclear whether subclinical vascular abnormalities and rate of change in subclinical vascular abnormalities is also associated with an impaired physical ability and with ADL disability. In a longitudinal study, 490 middle-aged and older persons were included. Physical ability was measured using the Short Physical Performance Battery and ADL disability using a questionnaire on self-reported basic and instrumental ADL. Subclinical vascular abnormalities were measured by pulse wave velocity (PWV) and carotid intima media thickness (CIMT, in men only). Longitudinal associations between baseline markers of subclinical vascular abnormalities, their rate of change, and change in physical ability or ADL disability were assessed using generalized estimation equation models. After adjustment for confounders, higher baseline PWV, change in PWV, baseline CIMT (in men) and change in CIMT (in men) were associated with a higher rate of change in physical ability (regression coefficients 0.035, 95% CI [0.018; 0.052]; 0.047, 95% CI [0.024; 0.069]; 0.214, 95% CI [0.070; 0.358] and 0.148, 95% CI [0.019; 0.277], respectively). No relations were found for change in ADL disability. In subjects with incident cardiovascular disease, higher change in PWV was associated with a higher rate of change in ADL disability (regression coefficient 0.054, 95% CI [0.001; 0.106]). The present study showed that subclinical vascular abnormalities and rate of change were associated with higher rate of change in physical ability. The association between (change in) subclinical vascular abnormalities and ADL disability tended to be stronger in persons with incident and prevalent cardiovascular disease. These data may suggest that ADL decline is more a direct effect of experienced clinically manifest vascular events rather than the effect of progression of subclinical vascular abnormalities.

Abstract 18130: Acute Changes of Glucose and Insulin Levels During Oral Glucose Tolerance Test are Related to Changes in Arterial Stiffness and Wave Reflection

Background: Hyperglycemia is linked with arterial stiffness, a factor with significant prognostic value. We investigated whether the acute changes of glucose and insulin levels during oral glucose tolerance test (OGTT) are related with acute changes in arterial stiffness. Methods: In 60 consecutive subjects without known diabetes a standard 75-gr oral glucose tolerance test (OGTT) was performed and glucose and insulin levels were measured at 0, 30, 60, 90 and 120min after glucose loading. At the same time intervals, we measured the carotid- femoral pulse wave velocity (PWVc) using the Complior and aortic PWV (PWVa) and augmentation index (AI) using an oscillometric method (Arteriograph,TensioMed). We categorized patients in those with normal (n=21) and those with abnormal OGTT. Results: During OGTT, we found that increasing glucose levels were related with increasing PWVc and PWVa (r=0.28, r=0.42, p&lt;0.01) and increasing insulin levels were related with decreasing AI (r=-0.27) in all patients. Patients with abnormal OGTT had higher baseline PWVc (10.4±2 vs. 9.1±1.8 m/sec), PWVa (9.4±1.9 vs. 6.9±1.8 m/sec), AI (24±9 vs. 17±11 %), insulin (14±6 vs. 11±4μU/ml) and glucose(114±26 vs. 93±7 mg/dl) and similar age sex and BMI than those with normal OGTT (p&lt;0.05).Compared to baseline, AI was reduced by 44% at 30 min and 17% at 60 min in patients with normal OGTT (p&lt;0.01) compared to 7.8% and 11 % in abnormal OGTT (p=0.7). In all patients, the % decrease in AI at 30 min was related with the corresponding %increase in insulin (r=-0.46, p&lt;0.05) but not with % change in glucose. The % increase in glucose levels at 60, 90 and 120 min during abnormal OGTT was related to the % increase in PWVa (r=0.46, r=0.34, r=0.55, p&lt;0.05), PWVc (r=0.40, r=0.32, r=0.33, p&lt;0.05) and AI (r=0.36, r=0.34, r=-0.35, p&lt;0.05). Conclusions. Patients with normal OGTT show an acute decrease in AI related with the increase in insulin level likely because of insulin stimulation of endothelial NO synthesis. During abnormal OGTT, this beneficial effect of insulin on AI is blunted likely because of insulin resistance and the acute changes in glucose levels are linked with an increase in arterial stiffness. Thus, insulin resistance determines the acute changes of arterial stiffness after postprandial hypeglycemia.

Ageing and cardiovascular responses to head-up tilt in healthy subjects

Objective Ageing is associated with increased postural blood pressure changes and attenuated cardiovascular reactivity. As the background of these changes remains uncertain, we examined arterial stiffness, cardiac function and vascular resistance in healthy subjects in supine position and during orthostatic challenge. Methods Haemodynamics of 179 normotensive subjects (109 female and 70 male, 21–59 years) were examined using continuous radial pulse wave analysis, whole-body impedance cardiography, and plethysmographic finger blood pressures. Results Both in supine position and during head-up tilt central and peripheral blood pressure and augmentation index (amplitude of the reflected pressure wave divided by pulse pressure) increased, and time of pulse wave reflection decreased with age. Supine pulse wave velocity progressively increased with age. There were only minor differences in supine and upright systemic vascular resistance, cardiac index, stroke index, and heart rate that were not systematically related to age. In regression analysis, the explanatory factors for a more pronounced decrease in central systolic blood pressure during the head-up tilt were in the age of 50–59 years, higher baseline pulse wave velocity and central systolic BP. None of the changes in other haemodynamic variables during tilt were related to age. Conclusion As no systematic age-related differences were observed in cardiac function or vascular resistance, these results support the view that progressive reduction of large arterial compliance contributes to the exaggerated age-related decrease in central systolic blood pressure in response to head-up tilt.

Pulse Pressure and Pulse Wave Velocity Are Related to Cognitive Decline in the Baltimore Longitudinal Study of Aging

Pulse pressure and pulse wave velocity, markers of arterial stiffness, have been associated with stroke, dementia, and lowered levels of cognitive function. Here we examine longitudinal relations of pulse pressure and pulse wave velocity to multiple domains of cognitive function among nondemented, stroke-free persons. Up to 1749 participants from the Baltimore Longitudinal Study of Aging completed tests of verbal and nonverbal memory, attention, perceptuo-motor speed, confrontation naming, executive functions, and cognitive screening measures, as well as concurrent sphygmomanometric assessment of blood pressure (for derivation of pulse pressure) on 1 to 8 occasions over 14 years. A subset of <or=582 participants also underwent a single baseline assessment of pulse wave velocity and cognitive assessment on 1 to 6 occasions over 11 years. Results of mixed-effects regression models revealed a prospective decline on tests of verbal learning, nonverbal memory, working memory, and a cognitive screening measure among those with increasing levels of pulse pressure (P<0.05). Persons with higher baseline pulse wave velocity also exhibited prospective decline on tests of verbal learning and delayed recall, nonverbal memory, and a cognitive screening measure (P<0.05). Markers of arterial stiffness are associated prospectively with cognitive decline before dementia. Aggressive treatment of risk factors associated with greater arterial stiffness may help preserve cognitive function with individuals' increasing age.