Higher PWV Research Articles

Abstract 17049: Specific Subspecies of High Density Lipoprotein are Associated With Arterial Stiffness in Youth With and Without Diabetes

Introduction: Early vascular aging (EVA), a risk factor for cardiovascular disease (CVD), is evident in youth with diabetes. The mechanisms responsible for EVA are not well understood. Causal relationship of HDL-C with CVD is doubtful, but HDL particle concentration (HDL-P) and HDL function (cholesterol efflux capacity, CEC) are associated with incident and prevalent CVD independent of HDL-C. We investigated whether these metrics associate with EVA in youth. Methods: We studied three cohorts of youth with T1D (n=173), T2D (n=214) and healthy controls (n=116). We quantified total HDL-P and 6 HDL subspecies by differential ion mobility, serum HDL CEC (total and ABCA1-specific), and investigated their association with arterial stiffness (tonometric carotid-femoral pulse wave velocity, PWV) with multivariate regression. Results: PWV was not associated with total HDL-P in any of the three groups, but was associated positively with concentration of extra-small (xsHDL, 7.6nm, r=0.22, P=0.004) in T1D, small (sHDL, 8.2nm) particles in T1D (r=0.31, P<0.0001) and T2D (r=0.17, P=0.02), and negatively with large HDL particles (lHDL, 11.5 nm) in T1D (r=-0.19, P=0.01). None of the HDL subspecies associated with PWV in healthy subjects. The association of sHDL with PVW remained significant after adjustment for age, sex, BMIz, mean arterial pressure (MAP), and diabetes status when analyzing T1D and controls or T2D and control subjects (Table 1). Both HDL-CEC metrics were significantly associated with higher PWV in T1D cohort but not T2D cohort, however, in multivariate models neither remained significant after adjusting the model for MAP (Table 1). Conclusions: A specific population of small HDL particles, but not HDL CEC, is associated with EVA, a predictor of CVD, independent of traditional risk factors and distending pressure (MAP). How the small HDL particles relate to EVA and whether they may be a novel target for intervention to prevent EVA in youth remains to be investigated.

ARTERIAL HYPERTENSION IN PREGNANCY - PULSE WAVE VELOCITY EVALUATION AS A PROGNOSTIC MARKER

Objective: In the general population, arterial stiffness is associated with a higher incidence of cardiovascular complications. Little is known whether this same trend is observed in pregnant women with hypertension. The authors presented in 2020, a series of 234 pregnant women complicated by arterial hypertension submitted to 24-hour ambulatory monitoring (ABPM). They concluded that the absence of nocturnal pressure drop, especially diastolic pressure, was associated with a worse maternal-fetal outcome. The aim of this work is to present preliminary results of PWV in pregnant women with hypertension, and its relationship with an aggravated maternal-fetal outcome, as well as its relationship with the findings previously obtained with ABPM. Design and method: Observational study of 22 pregnant women who underwent VOP (Complior Analyze) and ABPM (Spacelabs 90207), between July 2015 and July 2022. Event was defined by: maternal death, fetal or neonatal death, preeclampsia or eclampsia, gestational diabetes, prematurity, fetal growth retardation, or dystocia due to uncontrolled hypertension. Results: The mean age and BMI were 31.0 ± 6.0 years and 27.2 ± 4.3 kg/m2. PWV showed mean values of 6.2 ± 0.9 m/s, and ABPM values for the studied population, SBP 24h 117.8 ± 8.6mmHg; DBP 24h 73.3 ± 8.8 mmHg; daytime SBP 123.8 ± 8.5 mmHg; daytime DBP 78.4 ± 7.9 mmHg; nocturnal SBP 106.9 ± 9.7mmHg; Night DBP 63.4 ± 9.2 mmHg. Pearson's correlation coefficient was calculated to measure the linear correlation between the variables and a hypothesis test was performed to conclude on the hypothesis of correlation between the variables. Analysis with Pearson's correlation showed a negative correlation between PWV values and nocturnal DBP and SBP decreases in percentage, which infers that nocturnal decrease values decrease when PWV values increase. In the case of the correlation between PWV and nocturnal SBP decrease, the correlation coefficient was -0.495 (p = 0.016). In the case of the correlation between PWV and nocturnal fall in DBP, the correlation coefficient was -0.425 (p = 0.043). Conclusions: In line with what was previously demonstrated, the results suggest that a higher PWV, pathophysiological related to alterations in vessel elasticity, pro-inflammatory status

Abstract P392: Association Between Blood Pressure Variability and Subclinical Measures of Cardiovascular Disease in Desk Workers

Introduction: Previous research has demonstrated that variability in resting blood pressure (BP) across arms, measurements, or days may be associated with an increased risk for cardiovascular disease (CVD) and mortality. Yet, the extent to which BP variability increases cardiovascular risk and the mechanisms explaining this association are unclear. This study evaluated associations between BP variability with subclinical pathways of CVD development (arterial stiffness (pulse wave velocity [PWV]) and cardiac autonomic function (heart rate variability [HRV]) in desk workers. Hypothesis: Higher BP variability will be associated with higher PWV and lower (worse) HRV Methods: This secondary analysis of baseline data from the Effect of Reducing Sedentary on Blood Pressure randomized controlled trial included 265 sedentary and inactive desk workers (mean age 44.9±11.6 years; 82.0% white; 57.9% female) with elevated-to-stage 2 hypertension and who were not using antihypertensive medication. Sequential BP measurements determined the arm with the higher systolic BP by using an oscillometric device (Omron HEM-907XL). BP was then measured at least twice from the arm with the higher systolic BP at the first (visit-1) and second (visit-2) visits, occurring ≤30 days apart. Systolic BP variability metrics included inter-arm (first measurements between arms at visit-1), intra-arm (first two measurements on the arm with higher systolic BP at visit-1), and inter-visit (average BP from repeated measurements on the same arm across visits-1 and -2). Subclinical measures of CVD included resting carotid- femoral(cfPWV) and carotid-radial(crPWV) PWV (Complier Analyse) and the log transformed standard deviation of normal R-R intervals (SDNN) and the root mean square of the successive differences (RMSSD) HRV measures (Polar Electro). Adjusted linear regression estimated the associations between subclinical measures of CVD and BP variability metrics; Metrics were operationalized into three categories: differences of 0-5 mmHg, 6-10 mmHg, and 11 or more mmHg. Results: The prevalence of having 6 mmHg or more difference for the inter-arm, intra-arm, and inter-visit systolic BP was 43%, 38%, and 53%, respectively. PWV and HRV were not different across categories of inter-arm systolic BP variability or inter-visit systolic BP variability (all p>0.05). However, a same-day intra-arm difference in systolic BP of 6-10 mmHg within visit-1 was associated with higher cfPWV (β=0.42 m/s, (95% CI: 0.07, 0.77) as compared to those with an intra-arm difference of 0-5 mmHg. Conclusion: These data suggest that higher systolic BP variability in the same arm within visit, but not variability across arms or between visits, may be associated with higher aortic stiffness in desk workers with untreated elevated-to-stage 2 hypertension.

Association of ankle-brachial index with cognitive decline in patients with lacunar infarction.

Atherosclerosis is an important risk factor for cognitive decline. This study aimed to investigate the relationship of ankle-brachial pressure index (ABI) and brachial-ankle pulse wave velocity (baPWV) with cognitive function in patients with lacunar infarction. We included records of consecutive patients with their first-ever acute stroke and a diagnosis of lacunar infarction through magnetic resonance imaging (MRI) from July 1, 2011 to December 31, 2018. We excluded patients diagnosed with dementia, including strategic single-infarct dementia, before or after stroke onset. Moreover, we excluded patients with one or more microbleeds, severe white matter lesions, or severe medial temporal atrophy on MRI. For ABI, we used the lower ankle side and divided the results into ABI < 1.0 and ABI ≥ 1.0. For baPWV, we used the higher ankle side and divided the results into two groups based on the median value of the participants. We analyzed 176 patients with stroke (age 72.5 ± 11.4 years, 67 females). The median score on the Mini-Mental State Examination (MMSE) was 27. The number of patients with ABI < 1.0 was 19 (10.8%). Univariate analysis revealed that the MMSE score was associated with age, body mass index, education, chronic kidney disease, periventricular hyperintensity, and ABI < 1.0 (p < 0.10), but not baPWV. Multivariate analysis revealed that body mass index (p = 0.039) and ABI < 1.0 (p = 0.015) were independently associated with the MMSE score. For patients with lacunar infarction, a lower ABI, but not a higher PWV, was associated with cognitive decline.

Cardiovascular Burden Is High in Pediatric Lung Transplant Recipients.

Cardiovascular morbidity is common in adults after lung transplantation (LTx) but has not been described for pediatric LTx recipients. Early subclinical cardiovascular damage is reflected by increases in pulse wave velocity (PWV; indicating arteriosclerosis), intima-media thickness (IMT; indicating atherosclerosis), and left ventricular mass index (LVMI; indicating left ventricular hypertrophy). We annually assessed 47 pediatric LTx recipients in a prospective longitudinal study (144 observations, mean 3.1 visits/patient, range of 1-4 visits, mean follow-up 2.2 y). At inclusion, increased PWV and IMT were detected in 13% and 30%, respectively, and elevated LVMI was detected in 33%. Higher PWV was associated with male sex, longer time since LTx, higher diastolic blood pressure, and lower glomerular filtration rate. Male sex and lower hemoglobin levels were associated with higher IMT, and the presence of diabetes was associated with higher LVMI. Pediatric LTx recipients suffer from a high and sustained burden of subclinical cardiovascular damage. In light of improving long-term outcomes, cardiovascular morbidity needs to be addressed. Our analysis identified classical and nonclassical risk factors to be associated with the measures for cardiovascular damage, which could serve as targets for intervention.

Comparing the central arterial stiffness indices in the decompensated and compensated states of heart failure: a cohort study

Abstract Background Arterial stiffness is strongly linked to the pathogenesis of heart failure (HF), and development of acute decompensation of patients with stable chronic HF. Purpose To compare the arterial stiffness indices in patients with heart failure with reduced ejection fraction (HFrEF) during hospitalization with acute decompensated state, and then three months later after discharge during the compensated state. Methods One hundred patients with acute decompensated HFrEF (NYHA class III and IV) and left ventricular ejection fraction (LVEF) ≤35% were included in the study. Fifty-six patients (56%) had ischemic cardiomyopathy (ICM) and the rest had dilated cardiomyopathy (DCM). During the initial and follow up visits, all patients were subjected to full medical history taking, clinical examination, electrocardiography (ECG), transthoracic echocardiography (TTE), routine labs and non-invasive pulse wave analysis (PWA) by the Mobil-O-Graph 24h PWA device for measurement of arterial stiffness parameters. Results The mean age was 51.6±6.1 years and 80% were males. There was a significant reduction of the central arterial stiffness indices in patients with HFrEF during the compensated state as compared to their decompensated state values, table (1). During the decompensated state, patients with ICM showed a significantly higher PWV as compared to patients with DCM (9.2±1.1 vs 8.6±1.4 m/sec, P=0.042), patients presented with NYHA FC IV (n=64) showed higher AI (24.5±10.0 vs 16.8±8.6, p&amp;lt;0.001) and PWV (9.2±1.3 vs 8.5±1.2, p=0.021) than patients with NYHA FC III, and despite the relatively smaller number of females, they showed higher stiffness indices than males, table (2). Conclusion Central arterial stiffness indices derived from the non-invasive Mobil-O-Graph 24h PWA device in patients with HFrEF were significantly lower in the compensated state as compared to the decompensated state. Patients with ICM, NYHA FC IV and females showed higher stiffness indices in their decompensated state of heart failure. Funding Acknowledgement Type of funding sources: None.

Effects of hormone replacement therapy on endothelial function, arterial stiffness and myocardial deformation in women with Turner syndrome

Abstract Background/Introduction Turner syndrome (TS) is associated with increased cardiovascular risk. Purpose We investigated whether hormone replacement therapy (HRT) affects endothelial function, arterial stiffness and myocardial deformation in women with TS. Methods Twenty-five women with TS were studied in the estrogen phase of the HRT and two months after discontinuation of HRT. The following measurements were made: flow-mediated dilatation (FMD) of the brachial artery, pulse wave velocity (PWV-Complior) and central systolic blood pressure (cSBP), carotid intima-media thickness (cIMT), aortic (Ao) elastic indexes-namely Ao strain, distensibility, stiffness index and pressure strain modulus (Ep)-and left ventricular (LV) global longitudinal strain (GLS) using speckle tracking echocardiography. Ten healthy female of similar age and BMI served as control group. Results Compared to controls, women with TS on HRT had higher PWV (9.1±2.4 vs. 7.5±0.5m/s), cSBP (130±15 vs. 121±6mmHg), cIMT (0.66±0.06 vs. 0.55±0.05mm), aortic stiffness index, Ep and LA strain, and lower FMD (7.2±4 vs. 10.5±2.3%), Ao strain, Ao distensibility and GLS (−18.8±2.7 vs. −21.9±1.5%) (P&amp;lt;0.05 for all comparisons). Two months after discontinuation of HRT, all women increased FMD (11.7±6 vs. 7.2±4%) and reduced PWV (7.8±1.7 vs. 9.1±2.4m/s) and cSBP (123±14 vs. 130±15mmHg). There were no statistically significant changes in BMI, cIMT and GLS (P&amp;gt;0.05 for all comparisons). The percent decrease of cSBP was associated with the percent decrease of PWV (r=0.54) and reversely related with the percent increase of FMD (r=−0.57) (P&amp;lt;0.05 for all comparisons). Conclusion HRT in women with TS may deteriorate endothelial function contributing to increased arterial stiffness and central arterial blood pressure. Funding Acknowledgement Type of funding sources: None.

Firefighters On Medication Have Worse Health Profiles But Larger Improvements With Diet &amp; Exercise

Heart disease and sudden cardiac death account for an overwhelming number of on- and off-duty deaths in firefighters (FF). The alarm response, the FF lifestyle, and the heavy work of the job all add to the stress of firefighting. These inherent risks aggravate existing CVD, many FF are on medication regimen, yet it is unknown whether medication status affects vascular health in FF. Furthermore, using ambulatory BP (ABP) monitors to quantify the BP surge with alarm is a novel way to assess CVD risk in FF. PURPOSE: To compare changes in health after a 6-wk Mediterranean diet & circuit training program between medicated (MedFF) or non-medicated (NmFF) FF. METHODS: We included 40 FF who completed a 6-wk intervention. Pre- and post-testing included ABP monitoring, a fasted clinical appt, and fitness test. FF wore the ABP cuff for 12-hrs and were paged by emergency service dispatch or by a pager app (OnPage). When the pager sounded, they forced an ABP reading to measure BP surge. Fasted visit included BP, body fat, lipid panel, blood draw, and vascular health measures. VO2peak was measured on treadmill. Serum was isolated for ELISA analysis of superoxide dismutase (SOD) and C-reactive protein (CRP). RESULTS: MedFF were on medication for BP, cholesterol, and multiple other types. Nine of the FF reported multiple medications. MedFF (N = 19, 48.4 ± 2 yrs) had worse health and higher BP surges, but more improvements with diet+exercise compared to NmFF (N = 21, 31.7 ± 2 yrs), P < 0.05 with differences. MedFF had higher BP (130.2/81.3 vs 121.6/77.7 mmHg), higher average ABP (133.7/80.4 vs 123.7/75.2 mmHg), lower VO2peak (33.3 vs 37.1 ml/kg-min), lower FMD (8.5 vs 10.2 %), higher PWV (7.4 vs 5.7 m/s), and higher CRP (3.8 vs 3.1 mg/L) levels. MedFF also tend toward larger SBP and DBP surges with alarm (15.9 vs 13.9 mmHg SBP and 9.9 vs 8.1 mmHg DBP) and an improvement in surge after intervention (SBP surge 15.9 to 8.6 in MedFF vs 13.9 to 15.8 mmHg in NmFF; DBP surge 9.9 to 3.7 in MedFF vs 8.1 to 5.4 mmHg in NmFF). With intervention we found that BP lowered, body composition, vascular health, and VO2peak improved in MedFF. CONCLUSION: With this subset of data, we show that FF on medication have worse health profiles but may have larger improvements with exercise + diet. Data confirms the importance of wellness programs in the firehouse, in particular for FF already on medication.

Arterial stiffness and progression of cerebral white matter hyperintensities in patients with type 2 diabetes and matched controls: a 5-year cohort study

BackgroundStroke is a serious complication in patients with type 2 diabetes (T2DM). Arterial stiffness may improve stroke prediction. We investigated the association between carotid-femoral pulse wave velocity [PWV] and the progression of cerebral white matter hyperintensities (WMH), a marker of stroke risk, in patients with T2DM and controls.MethodsIn a 5-year cohort study, data from 45 patients and 59 non-diabetic controls were available for analysis. At baseline, participants had a mean (± SD) age of 59 ± 10 years and patients had a median (range) diabetes duration of 1.8 (0.8–3.2) years. PWV was obtained by tonometry and WMH volume by an automated segmentation algorithm based on cerebral T2-FLAIR and T1 MRI (corrected by intracranial volume, cWMH). High PWV was defined above 8.94 m/s (corresponding to the reference of high PWV above 10 m/s using the standardized path length method).ResultsPatients with T2DM had a higher PWV than controls (8.8 ± 2.2 vs. 7.9 ± 1.4 m/s, p < 0.01). WMH progression were similar in the two groups (p = 0.5). One m/s increase in baseline PWV was associated with a 16% [95% CI 1–32%], p < 0.05) increase in cWMH volume at 5 years follow-up after adjustment for age, sex, diabetes, pulse pressure and smoking. High PWV was associated with cWMH progression in the combined cohort (p < 0.05). We found no interaction between diabetes and PWV on cWMH progression.ConclusionsPWV is associated with cWMH progression in patients with type 2 diabetes and non-diabetic controls. Our results indicate that arterial stiffness may be involved early in the pathophysiology leading to cerebrovascular diseases.

Effects of hormone replacement therapy on endothelial function, arterial stiffness and myocardial deformation in women with Turner syndrome.

Turner syndrome (TS) is associated with increased cardiovascular risk. We investigated whether hormone replacement therapy (HRT) affects endothelial function, arterial stiffness and myocardial deformation in women with TS. Twenty-five women with TS were studied in the estrogen phase of the HRT and two months after discontinuation of HRT. The following measurements were made: flow-mediated dilation (FMD) of the brachial artery, pulse wave velocity (PWV-Complior) and central systolic blood pressure (cSBP), carotid intima-media thickness (cIMT), aortic (Ao) elastic indexes - namely Ao strain, distensibility, stiffness index and pressure strain modulus (Ep) - and left ventricular (LV) global longitudinal strain (GLS) using speckle-tracking echocardiography. Ten healthy female of similar age and BMI served as a control group. Compared to controls, women with TS on HRT had higher PWV (9.1 ± 2.4 vs. 7.5 ± 0.5 m/s), cSBP (130 ± 15 vs. 121 ± 6 mmHg), cIMT (0.66 ± 0.06 vs. 0.55 ± 0.05 mm), aortic stiffness index, Ep and LA strain, and lower FMD (7.2 ± 4 vs. 10.5 ± 2.3%), Ao strain, Ao distensibility and GLS (-18.8 ± 2.7 vs. -21.9 ± 1.5%) (P < 0.05 for all comparisons). Two months after discontinuation of HRT, all women increased FMD (11.7 ± 6 vs. 7.2 ± 4%) and reduced PWV (7.8 ± 1.7 vs. 9.1 ± 2.4 m/s) and cSBP (123 ± 14 vs. 130 ± 15 mmHg). There were no statistically significant changes in BMI, cIMT and GLS (P > 0.05 for all comparisons). The percentage decrease of cSBP was associated with the percentage decrease of PWV (r = 0.54) and reversely related with the percentage increase of FMD (r = -0.57; P < 0.05 for all comparisons). HRT in women with TS may deteriorate endothelial function contributing to increased arterial stiffness and central arterial blood pressure.

MO743FACTORS AFFECTING CEREBRAL OXYGENATION IN HEMODIALYSIS PATIENTS: ARTERIAL STIFFNESS, MENTAL ACTIVITIES, SMOKING

Abstract Background and Aims A significant deterioration of cognitive function in hemodialysis patients is observed in elderly and non-elderly patients. One of possible explantation is significant changes in the circulatory system caused by regular lower cerebral regional saturation of oxygen (rSO2) during dialysis. We aimed to identify the factors affecting the cerebral rSO2 in HD patients during session. Method 27 patients out of 80 hemodialysed in center patients were recruited for the study (exclusion criteria: significant vision defect, fistula in the dominant hand, previous stroke, other neurological diseases impaired cognitive functions). The mean age of the patients was 51 ±18 y, BMI 25.5±5, dialysis vintage was 2.3 y; 6 with DM and 22 with HT. During the study, each patient completed battery of cognitive function tests (MOCA, Beck's Scale) including computer based assessment validated for elderly (Cognifit), arterial stiffness surrogates (PWV, Aix75 using IEM Mobil-O-Graph) and the saturation (rSO2) of frontal lobes were measured (INVOS 5100c system). Patient regular passive or active (reading, crosswords solving, electronic games) behaviour during sessions was noticed. Results Factors showed correlations with rSO2 are displayed in table. Lack of correlations between rSO2 and HD vintage, diabetes or BMI was observed. Patients mentally active during dialysis showed significant (p&amp;lt;0.05) higher rSO2 (60 vs 53% left, 58 vs 49% right), Cognifit score (368 vs 233) and PWV (6,3 vs 9,3 m/s) when compared to passive patient behavior (sleeping, watching TV). Conclusion Significant differences in cerebral oxygenation in hemodialysis patients correlated with cognitive functions. In HD patients, cerebral rSO2 was affected by multiple factors, including non modifiable factors: arterial stiffness, age and modifiable factors – active mental activity during session and smoking. Furthermore, this is the first report describing lower levels of rSO2 in HD patients with significant central arterial stiffness (Figure).

AORTIC AND CAROTID STIFFNESS IN CHILDREN AND ADOLESCENTS: RELATIONSHIP AND DETERMINANTS

Abstract Objective: Arterial stiffness is an established surrogate measure of preclinical target-organ damage by elevated blood pressure (BP). This study assessed regional (aortic) and local (carotid) arterial stiffness measured by different noninvasive methods in children and adolescents and their relationship with BP levels. Design and method: Apparently healthy children and adolescents (age 6–18 years) referred for elevated BP were evaluated with: (i) office BP (OBP) measurement (3 visits, triplicate readings/visit), (ii) 24 h ambulatory BP (ABP) monitoring, (iii) home BP (HBP) monitoring during daytime and nighttime, (iv) M- and B-mode ultrasonography for the assessment of carotid distensibility coefficient (cCD) and carotid intima-media thickness (cIMT), (v) determination of carotid-femoral pulse wave velocity (cfPWV; Complior). Results: 93 subjects were analyzed (mean age 13.1 ± 2.9 years, 55 males, BMI 24.7 ± 5.2 kg/m2, 18 with 24 h ABP &gt; = 95th percentile). There was an inverse association between cfPWV and cCD (r = -0.42, p &lt; 0.01). Hypertensive subjects had higher PWV than normotensives (6.3 ± 1.0 vs. 5.3 ± 0.9 m/sec respectively, p &lt; 0.01 after adjustment for age and gender), but similar cCD (57.1 ± 47.6 vs. 57.8 ± 18.4 kPa-1/103, p = NS). cfPWV compared to cCD tended to be more strongly correlated with age (r = 0.65 vs. -0.28, p &lt; 0.01 for comparison), systolic OBP (0.60 vs. -0.31, p &lt; 0.01), systolic ABP (24 h/day/nighttime 0.60/0.57/0.49 vs. -0.39/-0.38/-0.31, p = 0.02/0.04/0.07), systolic HBP (day/nighttime 0.48/0.55 vs. -0.33/-0.26, p = 0.13/ &lt; 0.01), cIMT (0.24 vs. -0.08, p = NS), and similarly to BMI (0.28 vs. -0.26, p = NS for comparison). Conclusions: In young individuals aortic PWV as an index of regional stiffness appears to be more closely associated with age and BP levels than local carotid stiffness.

Arterial stiffness in acute COVID-19 and potential associations with clinical outcome.

BackgroundCoronavirus disease 2019 (COVID‐19) interferes with the vascular endothelium. It is not known whether COVID‐19 additionally affects arterial stiffness.MethodsThis case–control study compared brachial‐ankle pulse wave (baPWV) and carotid‐femoral pulse wave velocities (cfPWV) of acutely ill patients with and without COVID‐19.ResultsTwenty‐two COVID‐19 patients (50% females, 77 [67–84] years) were compared with 22 age‐ and sex‐matched controls. In COVID‐19 patients, baPWV (19.9 [18.4–21.0] vs. 16.0 [14.2–20.4], P = 0.02) and cfPWV (14.3 [13.4–16.0] vs. 11.0 [9.5–14.6], P = 0.01) were higher than in the controls. In multiple regression analysis, COVID‐19 was independently associated with higher cfPWV (β = 3.164, P = 0.004) and baPWV (β = 3.532, P = 0.003). PWV values were higher in nonsurvivors. In survivors, PWV correlated with length of hospital stay.ConclusionCOVID‐19 appears to be related to an enhanced PWV reflecting an increase in arterial stiffness. Higher PWV might be related to an increased length of hospital stay and mortality.

Effects of hormone replacement therapy on arterial stiffness, endothelial function and myocardial deformation in women with Turner syndrome

Abstract Funding Acknowledgements Type of funding sources: None. Background/Introduction: Turner syndrome (TS) is associated with congenital or acquired cardiovascular diseases. Purpose We investigated whether hormone replacement therapy (HRT) affects arterial elastic properties, endothelial function and myocardial deformation in women with TS. Methods In 25 women with TS (age: 29 ± 9years) we measured in the oestrogen phase of HRT cycle and 1 month after discontinuation of HRT: a)Pulse wave velocity (PWV-Complior), central systolic blood pressure (cSBP) and augmentation index (AI) of the aortic pulse wave, b)perfused boundary region (PBR) of the sublingual arterial microvessels, as a marker of endothelial glycocalyx thickness, c)carotid intima-media thickness (cIMT), d)flow-mediated dilatation (FMD) of the brachial artery and percentage difference of FMD (FMD%), and e)global LV longitudinal strain (GLS) and left atrium (LA) strain using speckle tracking echocardiography. Ten healthy subjects of similar sex, age and BMI served as control group. Results Compared to controls, women with TS under HRT had higher PWV (9.1 ± 2.4 vs. 7.5 ± 0.5m/s), AI (18 [7 to 27] vs. 5.8 [-10 to 19]%), cSBP (130 ± 15 vs. 121 ± 6mmHg), cIMT (0.66 ± 0.06 vs. 0.55 ± 0.05mm), FMD (7.2 ± 4 vs. 10 ± 2.3%) and lower LA volume index (14.3 ± 4 vs. 24 ± 13 mL/m²) and GLS (-18.8 ± 2.7 vs. -21.9 ± 1.5) (p &amp;lt; 0.05 for all comparisons). PBR was negatively related with FMD% (r=-0.58, p = 0.022) in women with TS under HRT. One month after discontinuation of HRT, all women reduced PWV, AI, cSBP and increased FMD. There were no statistically significant changes in BMI, PBR, cIMT, LA volume index, LA strain and LV GLS (p &amp;gt; 0.05 for all comparisons) (Table). The percent decrease of cSBP was associated with the percent decrease of PWV (r = 0.54) and inversely related with the percent increase of FMD (r=-0.57) (p &amp;lt; 0.05 for all comparisons). Conclusions Hormone replacement treatment in women with TS deteriorates arterial stiffness and endothelial function probably due to increased central arterial blood pressure. Women with Turner syndrome under HRT (n = 25) Women with Turner syndrome one month after discontinuation of HRT (n = 25) p-value PWV, m/s 9.1 ± 2.4 7.8 ± 1.7 0.028 Central SBP, mmHg 130 ± 15 123 ± 14 0.007 PBR, 5-25μm 2.11 ± 0.3 2.12 ± 0.2 0.983 cIMT, mm 0.66 ± 0.06 0.67 ± 0.06 0.947 FMD, % 7.2 ± 4 11.7 ± 6 0.042 LA strain, % 51 ± 12 54 ± 15 0.400 LV GLS, % -18.8 ± 2.7 -19.3 ± 2.3 0.594 Table

Impact of arterial stiffness on diastolic function and outcomes of heart failure in patients presenting with acute myocardial infarction

Abstract Background Relation of arterial stiffness and cardiovascular disease is well-known. However, there is no data on association between diastolic function and brachial-ankle pulse wave velocity (baPWV) and influence on heart failure outcomes in patients with acute myocardial infarction (AMI). Methods Among patients presenting with AMI, all subjects underwent baPWV and echocardiography were recruited. Diastolic function was categorized by 2016 guideline of ASE/EACVI left ventricular diastolic function. Heart failure outcomes were defined 1) hospitalization for heart failure, 2) cardiac death and 3) sudden cardiac arrest. Results Totally 1,016 subjects were enrolled (FU duration; 3.5±2.0 years, mean age 65±13, predominant male 71.3% and STEMI 40.8%) from 2012 to 2015 in the our University Hospital. Elderly, female, low BMI, higher PWV, HTN, DM and stroke were associated with higher baPWV. Increased arterial stiffness (defined as baPWV ≥1700) had higher prevalence of diastolic dysfunction compared with baPWV &amp;lt;1700 (98.3% vs 86.2%). HF outcomes of 69 events were identified (HF; n=48, cardiac death; n=16, sudden cardiac arrest; n=2, death d/t HF; n=3). In the multivariate analysis, baPWV ≥1700, HTN and low BMI (23 kg/m2) were independent predictors for HF outcomes after adjustment with age, LVEF, DM and stroke (Table 1). Furthermore, KM curve showed that increased arterial stiffness was associated with higher prevalence of diastolic dysfunction and poor outcomes of heart failure (Figure 1). Conclusions In patients with AMI, arterial stiffness was associated with higher prevalence of diastolic dysfunction an independent predictor for heart failure hospitalization and cardiac death. Figure 1. Diastolic dysfunction and HF in AMI Funding Acknowledgement Type of funding source: None

THU0126 COMBINATION OF NON-DIPPING PROFILE WITH ELEVATION OF NIGHTTIME SYSTOLIC BLOOD PRESSURE IN PATIENTS WITH RHEUMATOID ARTHRITIS IS ASSOCIATED WITH HIGHER ARTERIAL STIFFNESS AND CARDIOVASCULAR RISK

Background:Nocturnal hypertension (HTN) and non-dipping profile are important predictors of adverse cardiovascular (CV) outcomes. Their associations with subclinical vascular damage in rheumatoid arthritis (RA) are still a matter of investigation. It was shown that 10-year atherosclerotic CV disease risk (rASCVD) may be more accurate in CV risk prediction in RA than SCORE. Associations of impaired 24-h BP phenotypes with CV risk in RA are not well-studied yet.Objectives:To assess dipping patterns and nighttime systolic blood pressure (SBPn) and their associations with arterial stiffness and CV risk assessed by rASCVD in patients with RA.Methods:Study group included 90 patients with RA (females 78.7%, age 59.5±14.2 years, HTN 64%, median (med) HTN duration 6.4 years, RA duration – 7.2 years, seropositive RA 66%, mean DAS-28(CRP) 3.8±1.0) and control group (45 patients matched by gender, age and risk factors). All patients with HTN received antihypertensive therapy. Office BP was measured with a validated oscillometric device, 24-hour ABPM was performed with BPLab Vasotens, carotid-femoral PWV was assessed by applanation tonometry. 3 groups were formed after adjustment of dipping state by SBPn: dippers (G1), non-dippers with SBPn&lt;120 mmHg (G2), non-dippers with SBPn≥120 (G3). CV risk in RA group was calculated as 10-year rASCVD. Risk≥7.5% was considered as high. p&lt;0.05 was considered significant.Results:Median rASCVD was 6.3%. Rate of BP control was 60% in RA and 66% in the controls (p=0.5). Patients with RA vs controls had higher mean SBPn (124±16 vs 110±8 mmHg, p=0.003), lower diurnal index (DI) (med 3.8 vs 8.1%, p=0.02), higher rate of night HTN (49.6 vs 12.2% (p=0.0002). The RA and control groups didn`t differ by dipping patterns, although RA patients more often had non-dipping profile (DI &lt;10%): 83.9 vs 61.3%, (p=0.02). RA patients with SBPn ≥120 mmHg had higher age (63.7±12.5 vs 52.9±14.5 years), office SBP (143±17 vs 122±13 mmHg), HTN duration (med 5.4 vs 0.5 years), PWV (10.3±3.0 vs 7.9±2.5 m/s) and rASCVD (12 vs 3.4%), p&lt;0.001 for trend. Analysis in hypertensive RA group confirmed significant differences in PWV (11.3±3.1 vs 9.1±3.2 m/s, p=0.02) and rASCVD (med 13.5 vs 10.5%, p=0.045). Patients with DI&lt;10% had higher age (60.9±13.8 vs 54.3±11 years, p=0.04) and rASCVD (med 8.5 vs 3.1%, p=0.02). Patients with rASCVD ≥7.5% compared to &lt;7.5% had higher SBPn (133±11 vs 112±8 mmHg), lower median DI (0 vs 6%), more often had masked HTN (43 vs 16%) and night HTN (48 vs 16%), p&lt;0.01 for trend. SBPn significantly correlated with age (r=0.6), office SBP (r=0.5) and DBP (r=0.4), PWV (r=0.6), rASCVD (r=0.6); non-dipping pattern – with age (r=0.2), and rASCVD (r=0.3). After adjustment by SBPn, no differences were observed between G2 and G3. Patients in G3 vs G1 had higher PWV (10.4±3.1 vs 7.6±1.7 m/s, p=0.004), CRP (med 15.7 vs 7.8 mg/l, p=0.03), rASCVD (med 12.8 vs 3.1%) (p&lt;0.001); in G3 vs G2 – higher PWV (10.8±3.1 vs 8.2±2.3 m/s), rASCVD (med 12.8 vs 2.7%) and ESR (med 45 vs 21 mm/h, p&lt;0.01 for trend).Conclusion:Patients with RA had higher incidence of non-dipping pattern and SBPn elevation. Combination of high SBPn and non-dipping was associated with higher arterial stiffness and CV risk – this may be mediated by inflammation. Higher CV risk was associated with masked and night HTN. This may help in defining indications for ABPM in this population.

182-LB: Cardiovascular Response to Exercise in T2D

Type 2 diabetes (T2D) confers a greater likelihood of heart failure (HF) and hospitalization due to HF. Our group has reported sub-clinical cardiac dysfunction and aortic stiffness in youth and adults with uncomplicated T2D. As aortic stiffening is reported to precede HF and is common in people with uncomplicated T2D, we tested the hypothesis that aerobic exercise training will improve cardiac function and central arterial stiffness in people with T2D compared to participants of similar BMI without T2D. Sedentary adults with (n = 18, age 48±7, 45% female) and without (n = 20, age 45±7, 46% female) T2D, underwent MRI for cardiac function and aortic compliance (aortic relative area change [RAC] and pulse wave velocity [PWV]) before and after 15 weeks of aerobic exercise training. At baseline, both cohorts exhibit subclinical diastolic dysfunction, however, those with T2D had lower end-diastolic volume (EDVN,47.2±9.9 vs. 52.3±9.1 mL/m2) and end-systolic volume (ESVN,21.1±5.4 vs. 23.6±5.2 mL/m2), than controls. The T2D group had higher max thickness of the left ventricular (LV) septal wall (LVMTs, 10.5±1.8 vs. 9.3±1.6 mm) and LV lateral wall (LVMTl, 8.4±1.6 vs. 7.6±1.3 mm) than controls. Those with T2D also had lower RAC (12.7±1.6 vs. 20.2±1.6%) and higher PWV (7.4±1.3 vs. 3.9±0.6 m/s) than controls. Preliminary data in a subset post exercise intervention (n=7 with and n=8 without T2D), revealed increased EDVN(42.8±7.9 to 51.5±11.3 mL/m2) and ESVN(19.7±4.0 to 24.3±6.5 mL/m2) and decreased LVMTs(11.35±1.5 to 9.96±1.3 mm) and LVMTl(8.42±0.81 to 7.74±0.89 mm) in the T2D group, but cardiac endpoints were unchanged in controls. Post-intervention in both groups, ascending aorta RAC increased (control: 16.2±4 % to 18.5±1.7 and T2D: 10.6±1.7 % to 19.6±2.2 %) and PWV decreased (control: 6.3±2.0 to 3.4±0.3 and T2D: 8.0±1.4 to 2.9±0.7). Data from this study in progress suggest that adults with T2D have a greater degree of cardiac dysfunction and arterial stiffness than controls of similar BMI, which improve to a greater degree with exercise than in controls. Disclosure D. Enge: None. J.E. Reusch: None. J.G. Regensteiner: None. M. Schäfer: None. K.S. Hunter: None. A.J. Barker: None. K.J. Nadeau: None. R.L. Scalzo: None. I.E. Schauer: None. L. Abushamat: None. M.O. Whipple: None. D. Rafferty: None. Funding U.S. Department of Veterans Affairs (CX001532)

Higher Weekly Walking Volume Improves Cardiac Autonomic Profile and Arterial Stiffness Index in Hypertensive Elderly

BackgroundThe practice of daily aerobic exercise such as healthy walking could have an important effect on cardiovascular parameters. However, there is still little evidence of how much weekly walking volume is enough to influence cardiovascular autonomic modulation and arterial stiffness on hypertension.PurposeTo assess effects of weekly walking volume on cardiac autonomic function and arterial stiffness index in elderly hypertensive.MethodsSixty hypertensive elderly with 71.7 ± 3.4 years old were allocated in physically inactive (PI, n=30) and active (PA, n=30) groups. Hemodynamic parameters of heart rate (HR), peripheral blood pressure (SYS, DIA, MBP), cardiac autonomic modulation by the method of HR variability in both the time (root mean square of successive differences (RMSSD) and percentage of RR intervals differing by &lt;50ms (pNN50)) and frequency domains (low and high frequency (LF, HF), and LF/HF ratio), stiffness (augmentation index; AIX, pulse wave velocity; PWV) and total vascular conductance (TVC), and central blood pressure (cSYS, cDIA) were measured in baseline conditions.ResultsThe average of weekly walk in PA group was 312.4 ± 36.5 min. vs. 57.7 ± 47.9 min. in PI group (p &lt;0.001). Pronounced resting bradycardia was observed in PA group (62.1 ± 8.7 bpm) in comparison with PI group (75.7 ± 9.1; p=0.0). Brachial SYS (124.3 ± 7.6 mmHg) DIA (76.5 ± 7.4 mmHg) and MBP (92.4 ± 7.4 mmHg) were lowers in PA than PI group (133.6 ± 6.0 mmHg; p=0.003), (82.7 ± 7.6 mmHg; p=0.032) and (99.4 ± 7.0 mmHg; p&lt;0.05), respectively. The PA group showed higher cardiac parasympathetic modulation than PI group, evidenced by an increase in RMSSD (PI: 43.8 ± 23.9 vs. PA: 69.4 ± 29.4 ms; p=0.047), pNN50 (22.7 ± 3.9 vs. 40.7 ± 5.1 %; p=0.038) and in cardiac HF band (PI: 59.9 ± 5.8 vs. PA: 67.0 ± 3.7 nu; p=0.005). There were no differences in sympathetic modulation between PA and PI groups. The PI group had higher PWV (10.3 ± 1.2 m/s), AIX (36.4 ± 8.0 %) and TVC (1.4 ± 0.1 s*mmHg/ml) when compared to PA group (PWV = 9.1 ± 0.7 m/s; p = 0.005), (AIX = 23.5 ± 13.6 %; p = 0.003) and (TVC = 1.2 ± 0.1 s*mmHg/ml; p &lt;0.001). Additionally, the cSYS (119.5 ± 14.0 mmHg) and cDIA (76.2 ± 18.3 mmHg) were lower in PA than PI (135.8 ± 20.6 mmHg; p=0.045 and 91.8 ± 20.5 mmHg; p=0.034), respectively.ConclusionThese findings suggest that a higher weekly volume of walking improves baseline hemodynamic parameters and provides greater vagal modulation at rest, concomitant with attenuation of arterial stiffness evidencing that this type of intervention has important cardiovascular safety.Support or Funding InformationCAPES, CNPq, FAPEMIG, UFTM.

Abstract P347: Associations Between Carotid-femoral and Heart-femoral Pulse Wave Velocity in Older Adults: The Atherosclerosis Risk in Communities (ARIC) Study

Introduction: Carotid-femoral pulse wave velocity (cfPWV) is widely used in clinical and epidemiological studies to assess central arterial stiffness and predict cardiovascular outcomes. However, cfPWV assessments require applanation of the carotid artery, which may be challenging in some patients, and assessments may be confounded in the presence of carotid artery plaque. Further, since cfPWV is not consistent with the path of blood flow, the measure is adjusted according to an assumed timing of the pressure wave traveling in the opposite direction. Therefore, we hypothesize that heart-femoral PWV (hfPWV) could be a simpler measure of central arterial stiffness that is consistent with the path of blood flow. Objective: To estimate the strength of the association between hfPWV and cfPWV. Methods: We evaluated 4,476 older-aged (75.2 y [SD: 5.0]) adults in the community-based Atherosclerosis Risk in Communities (ARIC) Study. cfPWV and hfPWV were measured using an automated cardiovascular screening device (Omron VP-1000plus) equipped with an electrocardiogram, a phonocardiogram, and 2 applanation tonometry sensors attached to carotid and femoral arteries. Agreement between the two measurements was determined by calculating the intraclass correlation coefficient (ICC) and the standard error of estimate (SEE). We considered ICC value estimates of &lt;0.5, 0.5-0.75, 0.75-0.9, and &gt;0.9 as, respectively, poor, moderate, good, and excellent agreement. The SEE represents the average distance that the observed values fall from the regression line. Smaller values indicate that the observations are closer to the fitted line. The uniformity of error was assessed by visual analysis of regression plot. Results: There was ‘good’ agreement between hfPWV and cfPWV (ICC = 0.83, 95%CI: 0.82, 0.84). While the mean cfPWV (11.6 m/s [SD: 3.0]) and hfPWV (11.5 m/s [SD: 2.3]) were comparable, the SEE was 1.3 (95%CI: 1.27, 1.33) m/s. Inspection of the regression plot revealed bias, with higher PWV further away from the regression line. Conclusions: The current findings suggest good agreement between cfPWV and hfPWV, indicating that hfPWV may be a suitable alternative to cfPWV. Since hfPWV does not require applanation of the carotid artery, the measurement is easier to conduct and may be particularly suited for use in individuals for whom applanation of the carotid artery is challenging.

The association between resting-state functional magnetic resonance imaging and aortic pulse-wave velocity in healthy adults.

Resting‐state functional magnetic resonance imaging (rs‐fMRI) is frequently used to study brain function; but, it is unclear whether BOLD‐signal fluctuation amplitude and functional connectivity are associated with vascular factors, and how vascular‐health factors are reflected in rs‐fMRI metrics in the healthy population. As arterial stiffening is a known age‐related cardiovascular risk factor, we investigated the associations between aortic stiffening (as measured using pulse‐wave velocity [PWV]) and rs‐fMRI metrics. We used cardiac MRI to measure aortic PWV (an established indicator of whole‐body vascular stiffness), as well as dual‐echo pseudo‐continuous arterial‐spin labeling to measure BOLD and CBF dynamics simultaneously in a group of generally healthy adults. We found that: (1) higher aortic PWV is associated with lower variance in the resting‐state BOLD signal; (2) higher PWV is also associated with lower BOLD‐based resting‐state functional connectivity; (3) regions showing lower connectivity do not fully overlap with those showing lower BOLD variance with higher PWV; (4) CBF signal variance is a significant mediator of the above findings, only when averaged across regions‐of‐interest. Furthermore, we found no significant association between BOLD signal variance and systolic blood pressure, which is also a known predictor of vascular stiffness. Age‐related vascular stiffness, as measured by PWV, provides a unique scenario to demonstrate the extent of vascular bias in rs‐fMRI signal fluctuations and functional connectivity. These findings suggest that a substantial portion of age‐related rs‐fMRI differences may be driven by vascular effects rather than directly by brain function.