Oscillometric Pulse Wave Analysis Research Articles

Arterial stiffness is associated with prehypertension in both non-hypertensives and treated hypertensives–A matched case control study

BackgroundPrehypertension (PHT) is a cardiovascular health risk defined by blood pressure (BP). Arterial stiffness (AS) provides beyond brachial BP inference on vascular ageing and pulse wave analysis (PWA) can measure it non-invasively.We compared association between AS and PHT using age and gender matched case-controls. MethodsThis is a sub analysis of previous PWA studies of hypertensives and non-hypertensives. Using oscillometric PWA by Mobil-o-Graph (IEM, Stolberg, Germany), parameters of AS (augmentation pressure and index, reflection magnitude, aortic pulse wave velocity, pulse pressure amplification), brachial hemodynamics (BH), and central hemodynamics (CH; aortic BP, cardiac output related parameters, stroke work) were derived. Age and gender matched case controls were compared as: 1) Nonhypertensives with BP at prehypertensive level (PHT) versus normotensives (NT) (n = 217 each), 2) Under treatment hypertensives with BP at prehypertensive level (PHT-T) versus untreated, nonhypertensives with BP at prehypertensive level (PHT-UT) (n = 74 each). ResultsPHTs had higher AS, BH and CH than NTs, with statistical significance for all but few parameters. PHT-T had comparable BH but higher AS, CH than PHT-UT with significance for few parameters. ConclusionPulse wave analysis derived arterial stiffness is associated with prehypertension compared to normal, after age and gender matching. In hypertensives, arterial stiffness is significantly higher despite being treated to prehypertension level as compared to control. It hints arterial stiffness to be better parameter than brachial BP to study prehypertension.

Comparison of cardiac output estimates obtained from the Antares oscillometric pulse wave analysis algorithm and from Doppler transthoracic echocardiography.

In cardiology, cardiac output (CO) is an important parameter for assessing cardiac function. While invasive thermodilution procedures are the gold standard for CO assessment, transthoracic Doppler echocardiography (TTE) has become the established method for routine CO assessment in daily clinical practice. However, a demand persists for non-invasive approaches, including oscillometric pulse wave analysis (PWA), to enhance the accuracy of CO estimation, reduce complications associated with invasive procedures, and facilitate its application in non-intensive care settings. Here, we aimed to compare the TTE and oscillometric PWA algorithm Antares for a non-invasive estimation of CO. Non-invasive CO data obtained by two-dimensional TTE were compared with those from an oscillometric blood pressure device (custo med GmbH, Ottobrunn, Germany) using the integrated algorithm Antares (Redwave Medical GmbH, Jena, Germany). In total, 59 patients undergoing elective cardiac catheterization for clinical reasons (71±10 years old, 76% males) were included. Agreement between both CO measures were assessed by Bland-Altman analysis, Student's t-test, and Pearson correlations. The mean difference in CO was 0.04 ± 1.03 l/min (95% confidence interval for the mean difference: -0.23 to 0.30 l/min) for the overall group, with lower and upper limits of agreement at -1.98 and 2.05 l/min, respectively. There was no statistically significant difference in means between both CO measures (P = 0.785). Statistically significant correlations between TTE and Antares CO were observed in the entire cohort (r = 0.705, P<0.001) as well as in female (r = 0.802, P<0.001) and male patients (r = 0.669, P<0.001). The oscillometric PWA algorithm Antares and established TTE for a non-invasive estimation of CO are highly correlated in male and female patients, with no statistically significant difference between both approaches. Future validation studies of the Antares CO are necessary before a clinical application can be considered.

CARDIAC OUTPUT ESTIMATION: PULSE WAVE ANALYSIS (ANTARES) HIGHLY CORRELATES TO ECHOCARDIOGRAPHY ASSESSMENT

Objective: Evaluation of cardiac output (CO) is crucial for understanding cardiac function and diagnosis of heart failure. While invasive thermodilution procedures serve as the gold standard for CO assessment, routine clinical practice has widely adopted transthoracic Doppler echocardiography (TTE) as the established non-invasive method. Nevertheless, there is a persistent demand for alternative non-invasive approaches, aiming to improve the efficiency of CO estimation, mitigate complications associated with invasive methods, and extend its application to non-intensive care settings, all of which potentially can be offered by oscillometric pulse wave analysis (PWA). This study aims to compare the non-invasive estimation of CO using TTE and the oscillometric PWA algorithm Antares. Design and method: We compared non-invasive cardiac output data obtained through two-dimensional transthoracic echocardiography with data obtained from an oscillometric blood pressure device (custo med GmbH, Ottobrunn, Germany) utilizing the integrated Antares algorithm (Redwave Medical GmbH, Jena, Germany). A total of 59 patients, undergoing elective cardiac catheterization for clinical reasons, were included in the study (mean age 71±10 years, 24% females), but only echocardiography-data with CO were used for analysis. Agreement between the two CO measurement methods (TTE versus Antares) was evaluated through Bland-Altman analysis, Student's t-test, and Pearson correlations. Results: The mean difference in CO was 0.04 ± 1.03 l/min. No statistically significant difference in means was observed between the two CO measurement methods. Significant correlations between transthoracic echocardiography (TTE) and Antares CO were evident in the overall population (r=0.71), as well as in both, female (r=0.80) and male patients (r=0.67; all p&lt;0.001). Conclusions: The oscillometric PWA algorithm Antares and the established TTE exhibit strong correlations for non-invasive CO estimation in both male and female patients, with no statistically significant differences between the two approaches. This study opens the door to a valid and simple detection of heart failure that is seamlessly integrated into a quick and easy-to-perform upper arm blood pressure measurement.

Abstract 13220: Independent Effects of Baseline Pulse Wave Velocity versus Advancing Age on Changes in Arterial Stiffness Over Time

Introduction: While arterial stiffness (AS) is a known marker of vascular ageing that prognosticates cardiovascular disease (CVD), prospective analyses of AS evolution alongside chronological age are necessary to understand factors that drive progressive AS. Using pulse wave velocity (PWV) we investigated the impact of baseline factors in predicting PWV changes over a 5-year period. Hypothesis: We hypothesized that certain baseline factors in older Asian adults are predictive of PWV trajectories later in life independent of chronological age. Methods: Participants without CVD from a community-based cohort had their clinical risk factors collected prospectively, and PWV (m/s) measured using a cuff-based oscillometric pulse wave analysis machine at baseline and 5-year timepoint. Results: This analysis included 159 participants (41.5% women, mean age 67.7 ± 10.2 years). ΔPWV (2.19 ± 2.25), the 5-year change in PWV, was associated with baseline PWV (β = -0.687, p &lt; 0.001), age (β = 0.084, p &lt; 0.001), hypertension (β=0.763, p = 0.033), weight (β = -0.042, p = 0.018) and waist circumference (β = -0.045, p = 0.018). Gender, body mass index, dyslipidemia, diabetes mellitus and lifetime smoking status were not significantly associated with ΔPWV. ΔPWV was independently associated with baseline PWV (β = -1.17, 95% CI -1.65 - -0.70, p &lt; 0.001) and age (β = 0.144, 95% CI 0.09 - 0.20, p &lt; 0.001) adjusting for weight, waist circumference and hypertension, with insignificant interaction between baseline PWV and age (p = 0.431). Participants with increases in PWV after 5 years, compared to those without PWV increase, had lower PWV (8.52 ± 1.81 vs 11.10 ± 2.44) at baseline. Conclusions: Baseline PWV was associated with changes in AS over a 5-year period independent of age and clinical risk factors. The inverse relationship between baseline PWV and ΔPWV may suggest plateauing of PWV increases at higher baseline PWV levels. In addition, high baseline PWV may not predict worsening of AS later in life.

Abstract 13041: Effects of Parity on Arterial Stiffness Persists Into Old Age, Independent of Chronological Ageing

Introduction: Persistent effects of reproductive factors on vascular ageing, over chronological ageing, as examined through objective measurements of arterial stiffness, are rarely studied. Hypothesis: We hypothesized that the effects of parity and maternal age at first birth (AFB) on vascular ageing will persist over time independent of chronological ageing, in older Asian women. Methods: Among a community-based cohort of older Asian adults without cardiovascular disease, we prospectively studied demographics, parity, AFB, and cardiovascular risk factors, at baseline and 5-year examination timepoints. Arterial stiffness was measured through pulse wave velocity (PWV) using a cuff-based auscultatoric oscillometric pulse wave analysis machine. Results: 170 women (baseline mean age 60.76±13.75 years) were included. Parity ranged from 0 to 8 (mean parity 2±1.3). AFB ranged from 18 to 44 (mean age 28±4.4) years. By regression, univariate determinants of 5-year PWV were parity (β=0.491, p=&lt;.001), αFB (β=-0.107, p=.011), baseline age (β=3.884, p=&lt;.001), body mass index (βμΙ) (β=0.147, p=.006), waist circumference (β=0.076, p=&lt;.001), diabetes (β=1.681, p=&lt;.004), hypertension (β=2.383, p=&lt;.001), dyslipidemia (β=2.220, p=&lt;.001), 5-year age (β=3.886, p=&lt;.001),waist circumference (β=0.085, p=&lt;.001), diabetes (β=1.723, p=.001), hypertension (β=2.485, p=&lt;.001). Based on multivariate regression, parity (β=0.345, 95% CI 0.105, 0.586, p=.005), but not AFB, was independently associated with 5-year PWV, independent of age. Conclusions: Parity and AFB correlated with PWV, a marker of arterial stiffness, in old age in Asian women. Accounting for chronological ageing and clinical factors across 5 years, parity exerted a persistent independent effect on arterial stiffness in older women. Other biological factors surrounding parity in these women apart from traditional cardiovascular risk factors may explain these observations.

Comparison of Functional and Morphological Estimates of Vascular Age.

Vascular age (VA) is an emerging metric in preventive cardiovascular (CV) medicine. VA can be derived from morphological parameters such as carotid intima-media thickness (CIMT), or functional parameters such as pulse wave analysis (PWA), which celebrates its 100th birthday. This study aimed to investigate whether the results of both approaches are comparable. On the occasion of the double 100th anniversary of PWA and the Mannheim Clinic, 100 volunteers underwent a) bilateral CIMT assessment using high-resolution ultrasound and b) oscillometric PWA at the brachial forearm site. The respective VAs were calculated using previously published equations. Median age of the participants was 53.6 years (range=39.8-62.6 years), and 56% were female. Median CIMT was 632.5 μm (range=548.8-730.0 μm). Median PWA-derived VA was 55.3 years (36.5-70.5 years). Different values were obtained for CIMT-derived VA, depending on the reference cohort used as calculation basis, ranging from median 43.7 (26.2-59.5 years) to median 64.0 years (43.5-82.1 years). In 46% of the participants divergent VAs were found, that is, the calculated age was higher according to one method and lower according to the other. Correlation analysis revealed a strong dependence of VA (both PWA- and CIMT-derived) and chronological age, as well as an increase in CV risk factors and the detection of plaques with age. Different approaches for estimating VA are not comparable and often produce contradictory results. The current methods and their validity must be critically assessed if they are not standardized.

The Oscillometric Pulse Wave Analysis Is Useful in Evaluating the Arterial Stiffness of Obese Children with Relevant Cardiometabolic Risks.

Early detection of all complications of childhood obesity is imperative in order to minimize effects. Obesity causes vascular disruptions, including early increased arterial stiffness and high blood pressure. This study’s aim is to assess the reliability of pulse wave analysis (PWA) in obese children and how additional risk factors influence the evaluated parameters. We analyzed 55 children aged 6–18 years old by measuring their pulse wave velocity (PWV), augmentation index (AIx), peripheral blood pressure (SBP, DBP), heart rate, central blood pressure (cSBP, cDBP) and central pulse pressure (cPP). We used the oscillometric IEM Mobil-O-Graph and performed a single-point brachial measurement. The subjects were divided into two groups: obese (n = 30) and normal-weight (n = 25) and were clinically and anamnestically assessed. BMI and waist circumference are significantly correlated to higher values for PWV, SBP, DBP, cSBP, and cDBP. Weight significantly predicts PWV, SBP, DBP and cPP. The risk factors that significantly influence the PWA and BP values are: a cardiometabolically risky pregnancy (higher PWV, AIx, SBP), active and passive smoking (higher PWV, SBP, cSBP, cDBP), sleep deprivation (higher PWV, SBP, cSBP) and sedentariness (higher PWV, AIx, peripheral and central BP). We conclude that obese children with specific additional cardiometabolic risk factors present increased arterial stiffness and higher blood pressure values.

IMPACT OF ARTERIAL SITE AND PULSE WAVE ANALYSIS METHOD ON ARTERIAL FORM FACTOR AND MEAN ARTERIAL PRESSURE ESTIMATION

Objective: Mean arterial pressure (MAP) is often estimated from systolic (S) and diastolic (D) blood pressure (BP) using a constant “form factor’’ (FF), usually MAP = DBP + 0.33*pulse pressure (PP), yet accurate measurement requires pulse wave analysis (PWA) and waveform integration. MAP is constant across all conduit arteries but PP increases distally [peripheral (p)PP &gt; central ©PP]. Thus, cFF should be higher than pFF; results should also be similar between PWA methods. Design and method: We tested these principles in 2 cohorts using 2 transfer function-dependent PWA devices: SphygmoCor (SPG, radial tonometric PWA with integrated MAP) and Mobil-O-Graph (MOB, 24-hour ambulatory brachial oscillometric PWA with proprietary MAP). SPG data (signal-average of 10 PWA) were obtained after 5–10 minutes of rest and MOB values at 20-minute intervals. For direct MAP comparisons, 101 pairs from the SPG and MOB cohorts were matched precisely for pSBP and pDBP (130.9/78.7 mmHg for each, p&gt;.999). Results: For SPG, n = 376, [mean(SD)]: pBP 140(28)/80(15) and cBP 126(28)/81(15) mmHg, age 48(20) yr, BMI 28(6.6), 54% men, 20% black. SPG-cFF was higher than SPG-pFF [0.44(.049) vs 0.34(.056), p &lt; 0.000] and cFF and pFF were correlated (r2 = 0.23, p &lt; 0.000). On stepwise multiple regression, SPG-pFF was related to MAP &gt; gender &gt; age (multiple-r2 = 0.37, p &lt; 0.000; BMI and race were excluded). For MOB: n = 157, pBP 135(18)/81(12) and cBP 123(16)/83(12) mmHg, age 59(16) yr, BMI 30(6), 52% men, 24% black. MOB-pFF was almost invariate, lower than MOB-cFF [0.46(0.00098) vs 0.57(0.048), p &lt; 0.000], and not correlated with MOB-cFF or any other characteristic. MOB-cFF was higher than SPG-cFF (p &lt; 0.000) with similar variability. In the paired cohorts, mean FF’s were similar to the full cohorts but SPG-MAP was much lower than MOB-MAP [96.3 vs 102.6 mmHg (p &lt; 0.000)]. Conclusions: 1) FF varies within-subjects by arterial location, with cFF &gt; pFF; 2) SPG-pFF varies between-subjects and is affected by MAP, gender, and age; 3) proprietary MOB-pFF is invariate and higher than integrated SPG-pFF; and 4) MOB-MAP is 6% higher than SPG-MAP. These findings may impact studies requiring FF or MAP estimates, especially from proprietary oscillometric devices.

Arterial Stiffness and Left Ventricular Myocardial Function in Children with a Well-Functioning Bicuspid Aortic Valve.

ResumoFundamento:A rigidez arterial é um importante preditor de aortopatia e remodelamento miocárdico em pacientes com válvula aórtica bicúspide, podendo estar aumentada na infância.Objetivo:Avaliar a rigidez arterial e a função miocárdica do ventrículo esquerdo em crianças com válvula aórtica bicúspide funcional.Métodos:Quarenta e quatro crianças com válvula aórtica bicúspide e 41 pares saudáveis com válvula aórtica tricúspide foram incluídos neste estudo caso-controle. Foram obtidos os diâmetros e os escores-z relacionados da raiz aórtica e da aorta ascendente. Quanto à função miocárdica do ventrículo esquerdo, juntamente com as velocidades de fluxo mitral e parâmetros do Modo M, as velocidades miocárdicas e os intervalos de tempo foram avaliados com Doppler tecidual. A análise da onda de pulso foi realizada por aparelho oscilométrico (Mobil-o-Graph). Um valor de p<0,05 foi considerado significativo.Resultados:O índice da massa ventricular esquerda, a velocidade A do fluxo mitral, o diâmetro e o escore z da aorta ascendente e o índice de desempenho miocárdico estavam significativamente maiores nos pacientes (p = 0,04, p = 0,02, p = 0,04, p <0,001 e p <0,001 respectivamente). O índice de desempenho miocárdico correlacionou-se positivamente com o diâmetro da aorta ascendente e a velocidade A (r=0,272; p=0,01, r=356; p=0,001, respectivamente). A análise multivariada revelou que o índice de desempenho miocárdico estava relacionado ao diâmetro da aorta ascendente (p = 0,01). O índice de aumento e a velocidade da onda de pulso foram semelhantes entre os grupos (p> 0,05).Conclusão:De acordo com a análise da onda de pulso oscilométrico, as crianças com válvula aórtica bicúspide funcional apresentam rigidez arterial semelhante a seus pares saudáveis. O diâmetro da aorta ascendente foi estabelecido como preditor independente da função miocárdica do ventrículo esquerdo. A rigidez arterial pode não ser um fator de risco grave em pacientes pediátricos sem dilatação acentuada da aorta ascendente.

Central and peripheral arterial stiffness responses to uninterrupted prolonged sitting combined with a high-fat meal: a randomized controlled crossover trial

Independently, prolonged uninterrupted sitting and the consumption of a meal high in saturated fats acutely disrupt normal cardiovascular function. Currently, the acute effects of these behaviors performed in combination on arterial stiffness, a marker of cardiovascular health, are unknown. This study sought to determine the effect of consuming a high-fat meal (Δ = 51 g fat) in conjunction with prolonged uninterrupted sitting (180 min) on measures of central and peripheral arterial stiffness. Using a randomized crossover design, 13 young healthy males consumed a high-fat (61 g) or low-fat (10 g) meal before 180 min of uninterrupted sitting. Carotid-femoral (cf) and femoral-ankle (fa) pulse wave velocity (PWV), aortic-femoral stiffness gradient (af-SG), superficial femoral PWV beta (β), and oscillometric pulse wave analysis outcomes were assessed pre and post sitting. cfPWV increased significantly more following the high-fat (mean difference [MD] = 0.59 m·s−1) meal than following the low-fat (MD = 0.2 m·s−1) meal, with no change in faPWV in either condition. The af-SG significantly decreased (worsened) (ηp2 = 0.569) over time in the high- and low-fat conditions (ratio = 0.1 and 0.1, respectively). Superficial femoral PWVβ significantly increased over time in the high- and low-fat conditions (ηp2 = 0.321; 0.8 and 0.4 m·s−1, respectively). Triglycerides increased over time in the high-fat trial only (ηp2 = 0.761). There were no significant changes in blood pressure. Consuming a high-fat meal prior to 180 min of uninterrupted sitting augments markers of cardiovascular disease risk more than consuming a low-fat meal prior to sitting.

ASSOCIATION BETWEEN SHORT TERM BLOOD PRESSURE VARIABILITY AND ARTERIAL STIFFNESS IN SUSPECTED HYPERTENSIVES

Objective: To evaluate the association between arterial stiffness and short term blood pressure variability (BPV). Design and method: Four hundred fifty-five suspected hypertensive patients were referred to record a 24-hours ambulatory blood pressure monitoring (ABPM), and also were randomly enrolled from a population. They performed an oscillometric pulse wave analysis, using Mobil-O-Graph (I.E.M., Stolberg, Germany), following recommendations of Expert Consensus Document on the Measurement of Aortic Stiffness-2012. They also had a 24- hour of ABPM recorded. ABPM was made following protocols of European Guidelines. Short term BPV was evaluated by systolic or diastolic BP with: the standard deviation (SD) of 24 hs BP (24hBP-SD), Daytime BP-SD, Nighttime BP-SD, the 24 hs BP coefficient of variation (24hs CV), the weighted 24-h BP-SD and average real variability of 24-hour BP (ARV 24-h BP). Statistical Analysis: the Pearson correlation coefficient (r) was calculated by an univariate way comparing all systolic and diastolic BPV measures with brachial pulse wave analysis (bPWV). Partial correlation was adjusted to age and gender, and then for age, gender, 24 hs BP, and office BP do to avoid statistic influence of such confounders. Results: Data from 455 patients were analyzed. Clinical characteristics of the sample: age 48.8 ± 13.93 – women (41.9%), white people (69.5%), treated hypertensives (36%), diabetes (12.7%), statin use 22%, body mass index 28. 6 ± 5.8, smokers (8.6%), obese (36.3%). The findings are showed in table 1. All BPV variables had a significant correlation with bPWV. Daytime BP-SD and weighted 24-h BP-SD showed the best association. The worst results of the correlation were found, in systolic, in nighttime BP-SD, and in diastolic, in 24 hs CV. However, the comparison of diastolic 24hBP-SD and bPWV showed a negative correlation. Conclusions: Our data indicated an association between short blood pressure variability and oscillometric pulse wave velocity. A moderate correlation was demonstrated by systolic BPV and weak by diastolic. The best results of the association between the studied variables were shown in Daytime BP-SD and in weighted 24-h BP-SD.

Çocukluk Çağı Kanser Sağ Kalanlarında Antrasiklin İlişkili Arteriyel Sertliğin Değerlendirilmesi

Childhood cancer survivors have a significantly increased risk of cardiovascular morbidity and mortality. Improved screening methods are needed for early detection of cardiotoxicity. The aim of the study is to evaluate arterial stiffness as an indicator of vascular damage by oscillometric pulse wave analysis in childhood cancer survivors. A total of 38 patients and 25 age and gender matched healthy volunteers were included in this cross-sectional single centre study. All participants, underwent evaluation of arterial stiffness through non-invasive measurement of hemodynamic parameters such as pulse wave velocity (PWV) and central systolic blood pressure (c-SBP) with the Mobil-O-Graph® pulse wave analysis device. Left ventricular ejection fraction (LVEF) and left ventricular mass index (LVMI) were obtained by M-mode echocardiography. The median age of the childhood cancer survivors was 12.5 (4.25-18) and the median duration time after end of chemotherapy was 36 (12-116) months. Both groups were statistically similar in age, body mass index, LVEF and LVMI. Childhood cancer survivors had significantly lower peripheral systolic blood pressure compared to controls. Average c-SBP and PWV were similar between groups. Childhood cancer survivors > 15 years old also had similar PWV value with those < 15 years old. There were no signs of arterial stiffness in childhood cancer survivors late after chemotherapy according to the ambulatory oscillometric PWA. Longer follow-up duration may be required to determination of subclinical vascular damage 

Assessment of Arterial Stiffness, Brachial Haemodynamics, and Central Haemodynamics in Diabetic Hypertensives: A Pulse Wave Analysis-Based Case-Control Study from an Urban Area of West India

Introduction: Hypertension (HTN) and diabetes frequently coexist, imposing significant cardiovascular risk that is normally studied in terms of brachial blood pressure (bBP). Direct and superior parameters like central haemodynamics and arterial stiffness are studied scarcely. Pulse wave analysis (PWA) offers a non-invasive measurement of the same that we studied in diabetic hypertensives. Materials and Methods: We conducted a case-control study on 333 treated diabetic hypertensive cases and 333 euglycaemic normotensive controls. Oscillometric PWA was performed by Mobil-o-Graph (IEM, Aachen, Germany). Parameters were further analysed in relation to gender, physical activity, body mass index (BMI), glycaemic control, blood pressure control, and disease duration (cut-off 5 years). Multiple linear regressions were done to find significant associations. Results: Cases had significantly higher brachial haemodynamics (blood pressure, heart rate (HR), and rate pressure product); arterial stiffness measures (augmentation pressure, augmentation index, pulse wave velocity, total arterial stiffness, and pulse pressure amplification), and central haemodynamics (central blood pressure, cardiac output, stroke work) than controls. In the case group, female gender, BMI ≥23, and uncontrolled blood pressures were significant factors that affected the results while other factors such as glycaemic control, physical activity, and duration did not. HR was significantly associated with study parameters. Brachial pressures were not significantly associated with corresponding aortic pressures. Conclusion: Diabetic hypertensives had adverse profile of cardiovascular parameters beyond bBP, related to female gender, and HTN and its control, more than that of diabetes. This baseline work suggests further study on these potential parameters.

Effect of Menopause on Arterial Stiffness and Central Hemodynamics: A Pulse Wave Analysis-Based Cross-sectional Study from Gujarat, India.

Background:Menopause, a cardiovascular risk in mid-life women, is studied in terms of blood pressure mostly. Arterial stiffness (AS) and central hemodynamics (CH) are direct surrogates measured by pulse wave analysis (PWA) with no study from our region.Objective:We studied AS, CH in relation to menopause using PWA.Materials and Methods:A cross-sectional study was performed in 134 middle-aged females divided into groups with or without menopause. Oscillometric PWA done by Mobil-o-Graph (IEM, Germany) gave – AS like augmentation pressure, augmentation index at heart rate (HR) 75, aortic pulse wave velocity (aPWV), and total AS pulse pressure amplification; CH like aortic blood pressure, cardiac output and related parameters, peripheral resistance, stroke work, prevalent brachial/central hypertension, and raised central pulse pressure. They were further compared between groups, in relation to body mass index (BMI) and by multiple regressions with P < 0.05 as statistical significance.Results:Postmenopausal women were significantly elder, physically inactive with comparable BMI and showed higher AS (only aPWV was significantly different) and CH. BMI was unrelated to AS or CH in postmenopausal group. Age (except for aPWV), BMI, and HR (except for AIx@75) were insignificant predictors, while systolic blood pressure (SBP) in premenopausal and diastolic blood pressure (DBP) in postmenopausal group was major AS predictors. Age, HR, and BMI were insignificant predictors, while SBP more than DBP was significant predictors of CH.Conclusions:In obese, predominantly sedentary midlife Gujarati women, menopause negatively affects AS and hemodynamics, central more than peripheral. Menopause accelerates cardiovascular aging, independent of BMI, and age that calls for further studies.

Impact of diabetic retinopathy on pulse wave analysis-derived arterial stiffness and hemodynamic parameters: A cross-sectional study from Gujarat, India.

Purpose:Type 2 diabetes mellitus (T2DM) is known to produce diabetic retinopathy (DR). Pulse wave analysis (PWA) provides arterial stiffness (AS) and central hemodynamic (CH) parameters. We studied the effect of DR on AS and CH parameters in type 2 diabetics (T2D).Methods:We performed a cross-sectional study on 47 T2Ds attending a private ophthalmology clinic screened for DR by optical coherence tomography angiography and divided into NDR (non-DR), NPDR (non-proliferative DR), and PDR (proliferative DR). Mobil-o-graph (IEM, Germany) based oscillometric PWA yielded AS and CH parameters. They were further compared between groups stratified by DR with P value set at 0.05.Results:Participants had a mean age 62, mean diabetes duration 9 years, high mean BMI, and high prevalence of physical inactivity, hypertension, and poor diseases control. Significant differences were lacking in NPDR, NDR, and PDR in rate pressure product (mean 112.71 vs 116.06 vs 119.57), central pulse pressure (mean 46.50 vs 43.09 vs 42.72), stroke work (mean 153.36 vs 132.36 vs 146.08), augmentation index (mean 29.43 vs 33.14 vs 31.64), and aortic pulse wave velocity (mean 10.06 vs 9.08 vs 9.06). There was no clear pattern of distribution of most parameters among the three subgroups.Conclusion:We found a lack of association between DR and cardiovascular ageing studied by AS and hemodynamic parameters. It suggests a possible difference in risk factors for both of these aftermaths of T2DM and calls for further prospective studies with a large sample size.

0137 Self-Reported Sleep Quality is Associated with Central Hemodynamics in Healthy Individuals

Abstract Introduction Insufficient sleep is associated with arterial stiffness and elevated cardiovascular disease risk. Central hemodynamics are influenced by arterial stiffness, yet independently predict cardiovascular risk. Relationships between sleep characteristics and central hemodynamic parameters are largely unexplored. We aimed to characterize the relationship between self-reported sleep quality and central hemodynamics in healthy individuals. To explore the hypothesis that impairments in glucose metabolism, resulting from lack of sleep, may underlie relationships between sleep and central hemodynamic variables, we also examined associations between self-reported sleep quality and fasting blood glucose values. Methods Thirty-one healthy subjects (14 females /17 males; 20–69 years) that were free from metabolic or cardiovascular disease, and that did not take sleep medication were included in the study. Relationships between self-reported sleep quality, obtained using the Pittsburgh Sleep Quality Index (PSQI), with central hemodynamic profiles(systolic and diastolic blood pressures, pulse and augmentation pressures, augmentation index) estimated from oscillometric pulse wave analysis, and fasting blood glucose values were assessed. Results Central pulse pressure was significantly elevated (P&amp;lt;0.05) in poor (PSQIscore &amp;gt;5) compared to normal (PSQI score 0–5) self-reported sleepers. Linear regression models, adjusted for age, gender, and body mass index, demonstrated PSQI score to be an independent predictor (P&amp;lt;0.05) of both central pulse (β=0.469) and augmentation (β=0.364) pressures. Global PSQI scores were not related to fasting blood glucose values (r=0.045; P&amp;gt;0.05). Conclusion Significant relationships between central pulse and augmentationpressures and self-reported sleep quality highlight the importance of considering sleep when examining lifestyle contributors to central hemodynamics. Support No funding.

Self-reported sleep quality is associated with central hemodynamics in healthy individuals.

Insufficient sleep is associated with arterial stiffness and elevated cardiovascular disease risk. Central hemodynamics are influenced by arterial stiffness, yet independently predict cardiovascular risk. Relationships between sleep characteristics and central hemodynamic parameters are largely unexplored. We aimed to characterize the relationship between self-reported sleep quality and central hemodynamics in healthy individuals. To explore the secondary hypothesis that impairments in glucose metabolism may underlie relationships between sleep and central hemodynamic variables, we also explored associations between self-reported sleep quality and fasting blood glucose values. Thirty-one healthy study subjects (20 to 69 years, 17 men) were free from metabolic or cardiovascular disease and did not take sleep medication. Self-reported sleep quality was obtained using the Pittsburgh Sleep Quality Index (PSQI) with normal sleepers defined by PSQI scores 0-5 and poor sleepers by PSQI score > 5. Relationships were assessed between PSQI, central hemodynamic profiles (systolic and diastolic blood pressures, pulse and augmentation pressures, augmentation index) estimated from oscillometric pulse wave analysis, and blood glucose values. Central pulse pressure was significantly elevated in poor (PSQI score > 5) compared with that in normal (PSQI scores 0-5) sleepers (P < 0.05). Linear regression models, adjusted for age, gender, and body mass index, demonstrated PSQI score to be an independent predictor (P < 0.05) of both central pulse (β = 0.469) and augmentation (β = 0.364) pressures. Global PSQI scores were not related to fasting blood glucose values (r = 0.045; P > 0.05). Significant relationships between central pulse and augmentation pressures and self-reported sleep quality highlight the importance of considering sleep when examining lifestyle contributors to central hemodynamics.

WHITE COAT HYPERTENSION SHOWS EQUIVALENT ARTERIAL STIFFNESS AS SEEN IN SUSTAINED HYPERTENSION

Objective: To evaluate arterial stiffness using brachial pulse wave velocity (bPWV) values, among, four hypertension category: normotension (NT), hypertension (HT), white coat hypertension (WCH), and masked hypertension (MH). Design and method: 351 participants were recruited randomly from a population referred to record a 24-hour ambulatory blood pressure monitoring (ABPM). None was taking anti-hypertensive drugs. Using a Microlife - BP3AC1–1PC (Onbo Electronic Co, Shenzhen, China), a set of 3 sequential BP (OBPa) measurement was performed by a trained observer. Also, they performed an oscillometric pulse wave analysis, using Mobil-O-Graph (I.E.M., Stolberg, Germany). Following recommendations of Expert Consensus Document on the Measurement of Aortic Stiffness-2012. All of them made a 24-hour of ABPM. BP measurements and ABPM were made following protocols of European Guidelines. According to OBP and 24 hours BP average(24BPa) values, patients were sorted in four BP category: NT, MH, WCH and, HT. For comparison between PWV means in BP category, we applied statistics and analysis of variance with Tukey test) The differences in adjusted means of evaluated parameters between BP categories were assessed using an analysis of covariance. In all of the analyses, statistical significance was taken as a p-value of < 0.05. Results: Data from 351 patients were analyzed. Table 1 shows the characteristics of each subgroup. Also, it shows the cut-off values utilized to define each BP category. Analysis of variance (figure 1) demonstrated any significant difference of bPWV between NT (6.7 ± 0.12) and MH (6.6 ± 0.20), as well in WCH (7.6 ± 0.20) and HT (7.5 ± 0.12). while the bPWV was higher in WCH and HT than in NT and MH. Using analysis of covariance, these associations remained significant for bPWV even after adjustment for cardiovascular risk factors and 24 h systolic and diastolic BP. The bPWV was higher in WCH (7.3 ± 0.08) and HT (7.3 ± 0.04) than in NT (6.9 ± 0.04) and MH (6.9 ± 0.08).Conclusions: Data from the present study shows that white coat hypertension presents arterial stiffness equivalent to sustained hypertension, while masked hypertension demonstrated similar values of normotension.

Pulse Wave Velocities Derived From Cuff Ambulatory Pulse Wave Analysis.

Pulse wave velocity (PWV), a measure of arterial stiffness, is an independent risk factor for cardiovascular morbidity and mortality. We investigated the relationship of ambulatory brachial cuff-based oscillometric PWV (oPWV) to 2 known correlates: age and brachial systolic blood pressure (SBP). In 234 participants in the Masked Hypertension Study, we analyzed 7284 validated hourly ambulatory SBP and oPWV readings using the Mobil-O-Graph monitor, which uses a proprietary pulse wave analysis algorithm to determine oPWV. Carotid-femoral PWV (cfPWV) was also measured. Mixed linear models were developed to estimate oPWV from age and ambulatory SBP. Participants were 34% male, with mean (SD) age 52.8 (9.9) years, SBP 123.8 (18.4) mm Hg, and oPWV 7.6 (1.3) m/s and cfPWV of 7.7 (1.7) m/s. The relationship of oPWV to age and SBP is given below: [Formula: see text] Age uniquely accounted for an estimated 75% of the total variation of oPWV, whereas SBP uniquely accounted for 20%; these findings were confirmed in an external validation dataset. Together, age and SBP accounted for 99.1% of the total variance of oPWV but (only) 40.2% of the variance of cfPWV. The correlation between oPWV and cfPWV was 0.58 but was only 0.11 after controlling for age and SBP. We conclude that the Mobil-O-Graph's oPWV is nearly completely explained by age and SBP and its relationship to cfPWV is because of their shared associations with age and SBP. Other hemodynamic variables derived from oscillometric pulse wave analysis may be useful and deserve additional scrutiny.

Central hemodynamics and arterial stiffness in Gujarati diabetics not receiving any antihypertensive: A case-control study based on oscillometric pulse wave analysis.

Introduction:Diabetes is a modern epidemic imposing significant cardiovascular risk. Immediate and discrete parameters such as arterial stiffness and central hemodynamics are studied scarcely. Pulse wave analysis (PWA) offers noninvasive measurement of the same and we performed that in diabetics.Materials and Methods:We performed a case–control study on 148 treated diabetic not on antihypertensive and 148 nondiabetic normotensive controls. Oscillometric PWA was performed by Mobil-O-Graph (IEM). Parameters were further analyzed for effect of gender, physical activity, body mass index (BMI; cut-off 23), glycemic control, and disease duration (cut-off 4 years). Multiple linear regressions were used to find significant predictors. P <0.05 was taken as statistical significance.Results:Cases had significantly raised brachial hemodynamics (blood pressure, heart rate, rate pressure product), arterial stiffness (augmentation pressure, augmentation index, pulse wave velocity, total arterial stiffness, pulse pressure amplification), and central hemodynamics (central blood pressure, cardiac output, stroke work) than controls. In the case group, female gender, BMI ≥ 23, and physical inactivity were the significant factors affecting results (arterial stiffness more than central hemodynamics); glycemic control and duration were not. Heart rate was the major predictor of study parameters. Brachial pressure parameters were not significant predictors of corresponding central pressure parameters.Conclusion:Gujarati diabetics not using any antihypertensive had adverse profile of beyond brachial blood pressure discrete cardiovascular parameters, independent of duration and glycemic control, related to gender, BMI, and physical activity, indicating vascular progeria in the absence of hypertension. This baseline study suggests further work on these potential parameters.