Peripheral Augmentation Index Research Articles

Central blood pressure and peripheral augmentation index following acute submaximal arm versus leg exercise.

Aerobic exercises like running and cycling may lower cardiovascular disease (CVD) risk through favorable effects on central blood pressure and vascular function. Arm ergometry is a popular exercise modality used in rehabilitation settings, but little is known regarding the central hemodynamic and vascular effects of this form of exercise. To compare the acute effects of leg versus arm exercise on central blood pressure and vascular function. Twenty-one participants (n = 11 female, Age 21 ± 3, BMI 24.5 ± 3.2kg/m2) completed two visits to the Human Performance Laboratory. Central systolic blood pressure (cSBP), central diastolic blood pressure (cDBP), and peripheral augmentation index (pAIx) were measured using a brachial oscillometric blood pressure cuff with measures being taken before and after 20min of acute moderate-intensity (submaximal) arm or leg cycling exercise. There was a condition-by-time interaction for pAIx (p = 0.011). pAIx slightly increased following arm exercise but significantly decreased following leg exercise. There was a condition-by-time interaction for cDBP (p = 0.011). cDBP significantly decreased following arm exercise but increased immediately following leg exercise. There was no condition-by-time interaction for cSBP (p = 0.721). There were similar acute increases in cSBP immediately post-exercise for both conditions. Arm exercise increased pAlx and decreased cDBP compared to leg exercise. As an increase in pAIx may increase left ventricular work and a reduction in cDBP may reduce coronary perfusion pressure, these findings suggest that a single bout of arm exercise may not have the same favorable acute effect on central hemodynamic load as a single bout of leg exercise.

Maternal vascular indices at 36 weeks’ gestation in the prediction of preeclampsia

Epidemiological studies have shown that women with preeclampsia (PE) are at increased long term cardiovascular risk. This risk might be associated with accelerated vascular ageing process but data on vascular abnormalities in women with PE are scarce. This study aimed to identify the most discriminatory maternal vascular index in the prediction of PE at 35 to 37 weeks' gestation and to examine the performance of screening for PE by combinations of maternal risk factors and biophysical and biochemical markers at 35 to 37 weeks' gestation. This was a prospective observational nonintervention study in women attending a routine hospital visit at 35 0/7 to 36 6/7 weeks' gestation. The visit included recording of maternal demographic characteristics and medical history, vascular indices, and hemodynamic parameters obtained by a noninvasive operator-independent device (pulse wave velocity, augmentation index, cardiac output, stroke volume, central systolic and diastolic blood pressures, total peripheral resistance, and fetal heart rate), mean arterial pressure, uterine artery pulsatility index, and serum concentration of placental growth factor and soluble fms-like tyrosine kinase-1. The performance of screening for delivery with PE at any time and at <3 weeks from assessment using a combination of maternal risk factors and various combinations of biomarkers was determined. The study population consisted of 6746 women with singleton pregnancies, including 176 women (2.6%) who subsequently developed PE. There were 3 main findings. First, in women who developed PE, compared with those who did not, there were higher central systolic and diastolic blood pressures, pulse wave velocity, peripheral vascular resistance, and augmentation index. Second, the most discriminatory indices were systolic and diastolic blood pressures and pulse wave velocity, with poor prediction from the other indices. However, the performance of screening by a combination of maternal risk factors plus mean arterial pressure was at least as high as that of a combination of maternal risk factors plus central systolic and diastolic blood pressures; consequently, in screening for PE, pulse wave velocity, mean arterial pressure, uterine artery pulsatility index, placental growth factor, and soluble fms-like tyrosine kinase-1 were used. Third, in screening for both PE within 3 weeks and PE at any time from assessment, the detection rate at a false-positive rate of 10% of a biophysical test consisting of maternal risk factors plus mean arterial pressure, uterine artery pulsatility index, and pulse wave velocity (PE within 3 weeks: 85.2%; 95% confidence interval, 75.6%-92.1%; PE at any time: 69.9%; 95% confidence interval, 62.5%-76.6%) was not significantly different from a biochemical test using the competing risks model to combine maternal risk factors with placental growth factor and soluble fms-like tyrosine kinase-1 (PE within 3 weeks: 80.2%; 95% confidence interval, 69.9%-88.3%; PE at any time: 64.2%; 95% confidence interval, 56.6%-71.3%), and they wereboth superior to screening by low placental growth factor concentration (PE within 3 weeks: 53.1%; 95% confidence interval, 41.7%-64.3%; PE at any time: 44.3; 95% confidence interval, 36.8%-52.0%) or high soluble fms-like tyrosine kinase-1-to-placental growth factor concentration ratio (PE within 3 weeks: 65.4%; 95% confidence interval, 54.0%-75.7%; PE at any time: 53.4%; 95% confidence interval, 45.8%-60.9%). First, increased maternal arterial stiffness preceded the clinical onset of PE. Second, maternal pulse wave velocity at 35 to 37 weeks' gestation in combination with mean arterial pressure and uterine artery pulsatility index provided effective prediction of subsequent development of preeclampsia.

Interpretable and accurate curve-fitting method for arterial pulse wave modeling and decomposition.

Arterial pulse waveforms contain a wealth of information about the cardiovascular system. There is a lack of physical meaning in the mathematical model of arterial pulse waves, while the physical model fails to offer individuality as too many assumptions are involved. In this article, we focus on promoting the interpretability of the arterial pulse mathematical model. The proposed method is based on newly developed 3-term fitting functions individualized by the physiological parameter assignment, which are the peak times of the reflected and dicrotic waves in a pulse. In this manner, the model allows decomposition of the pulse into sub-signals with clear physiological significance. With nearly 10,000 pulse fitting experiments, it is demonstrated that the proposed method outperforms the standard methods in fitting accuracy while providing parameters linked to hemodynamic characteristics and common clinical indices such as the peripheral augmentation index (pAI). The proposed method innovatively maintains the individuality and accuracy of mathematical models while improving the interpretability of their parameters. The applications of this newly developed method, which explicitly incorporates hemodynamic characteristics, are expected to be particularly valuable in future pulse wave decomposition studies.

Effect of Training on Vascular Function and Repair in Heart Failure With Preserved Ejection Fraction

BackgroundExercise training improves peak oxygen uptake (V.O2peak) in heart failure with preserved ejection fraction (HFpEF). Multiple adaptations have been addressed, but the role of circulating endothelium-repairing cells and vascular function have not been well defined. ObjectivesThe authors investigated effects of moderate-intensity continuous training (MICT) and high-intensity interval training (HIIT) on vascular function and repair in HFpEF. MethodsThis study is a subanalysis of the OptimEx-Clin (Optimizing Exercise Training in Prevention and Treatment of Diastolic Heart Failure) study randomizing patients with HFpEF (n = 180) to HIIT, MICT, or guideline control. At baseline, 3, and 12 months, the authors measured peripheral arterial tonometry (valid baseline measurement in n = 109), flow-mediated dilation (n = 59), augmentation index (n = 94), and flow cytometry (n = 136) for endothelial progenitor cells and angiogenic T cells. Abnormal values were defined as outside 90% of published sex-specific reference values. ResultsAt baseline, abnormal values (%) were observed for augmentation index in 66%, peripheral arterial tonometry in 17%, flow-mediated dilation in 25%, endothelial progenitor cells in 42%, and angiogenic T cells in 18%. These parameters did not change significantly after 3 or 12 months of HIIT or MICT. Results remained unchanged when confining analysis to patients with high adherence to training. ConclusionsIn patients with HFpEF, high augmentation index was common, but endothelial function and levels of endothelium-repairing cells were normal in most patients. Aerobic exercise training did not change vascular function or cellular endothelial repair. Improved vascular function did not significantly contribute to the V.O2peak improvement after different training intensities in HFpEF, contrary to previous studies in heart failure with reduced ejection fraction and coronary artery disease. (Optimizing Exercise Training in Prevention and Treatment of Diastolic Heart Failure [OptimEx-Clin]; NCT02078947)

PS-C17-1: PERIPHERAL MICROVASCULAR DYSFUNCTION IN SUBJECTS WITH TYPE2 DIABETES(T2DM) IN ACCORDANCE WITH ABSENCE OR PRESENCE OF CORONARY ARTERY DISEASE.

Background: Several studies demonstrated that endothelial function is impaired in patients with T2DM, but no study evaluated vascular parameters in patients with T2DM trough a combined analysis of macro and micro-endothelial function and arterial stiffness indexes. In addition, the difference in vascular parameters between T2DM patients with CAD and without CAD remains unknown. We assessed whether coronary artery disease is associated with impairment of peripheral endothelial function and arterial stiffness indexes in patients with T2DM. Methods: We measured vascular function in 219 T2DM subjects (age 68 ± 10 years), including 147 subjects with CAD (CAD group) and 72 subjects without CAD (control group). Flow mediated vasodilatation (FMD) indicating endothelial function in a conduit artery was measured by ultrasound using a semi-automatic device: UNEXEF18G (UNEX Co. Nagoya, Japan). Reactive hyperemia index (RHI) indicating peripheral endothelial function and Augmentation index (AI) indicating arterial stiffness were measured by peripheral arterial tonometry (EndoPAT 2000). Vascular function tests were measured on the same day. Results: RHI and AI was significantly impaired in CAD group (RHI: 2.0 ± 0.7 vs.1.7 ± 0.5 P = 0.012, AI: 30.2 ± 18.1 vs.22.1 ± 19.1 P = 0.043), however FMD had no deference in the two groups. Logistic regression analysis revealed that RHI (odds ratio: 0.44, 95% confidence interval: 0.21–0.94) was an independent predictor for CAD in subjects with T2DM. Conclusions: RHI, an acknowledged marker of microcirculatory endothelial function was a more sensitive method in evaluating the risk assessment of CAD in subjects with T2DM.

Estimation of Central Systolic Blood Pressure from Peripheral Pressure Waves using a Novel Second Systolic Pressure-Based Method in Normal and Heritable Hypercholesterolemic Rabbits.

Central systolic blood pressure (cSBP) was closely related to hypertension-related organ damage rather than peripheral systolic blood pressure (pSBP). We aimed to estimate cSBP from pSBP without generalized transfer function in normal and Kurosawa and Kusanagi-hypercholesterolemic (KHC) rabbits aged 12 months. Two catheter-tip transducers were advanced into the ascending aorta (AA) and distal end of the right brachial artery (Br) through the right common carotid and right radial arteries, respectively, under pentobarbital anesthesia. Pressure waves in response to the intravenous administration of angiotensin II and sodium nitroprusside were simultaneously recorded in AA and Br under regular cardiac pacing. The first (pSBP) and second peaks (pSBP2) of the brachial blood pressure and their average (pSBPm) were significantly correlated with cSBP, despite Murgo's wave pattern of central pressure waves in both rabbit groups. In Bland-Altman plot and its modification as a function of the peripheral augmentation index (pAI) analyses, the differences between pSBP and cSBP decreased, and those between pSBP2 and cSBP increased significantly in their average- or pAI-dependent manner, with undeniable mean biases in both rabbit groups. When the same analyses for SBPm were performed instead, the mean bias was around zero, with reduced variance in the two rabbit groups. The observed pressure or pAI-dependent systematic biases for pSBP and pSBP2 disappeared, representing the precise feature of pSBPm as a cSBP estimate. We conclude that pSBPm could be more precise than pSBP2 as a cSBP estimate, irrespective of blood pressure levels, pAI, or the presence of atherosclerosis.

Cardiorespiratory fitness but not physical activity are associated with pulse wave velocity and arterial stiffness in the general population

Abstract Funding Acknowledgements Type of funding sources: Public grant(s) – National budget only. Main funding source(s): BMBF Background Higher cardiorespiratory fitness (CRF) and physical activity (PA) are associated with lower cardiovascular morbidity and all-cause mortality. Pulse wave velocity (PWV) and augmentation index (AIx) are vascular parameters associated with aging and end-organ damage and provide reliable information about arterial stiffness. Therefore, PWV and AIx could represent attractive parameters for cardiovascular risk stratification. Purpose To improve our understanding of the relationship between CRF/PA and PWV and arterial stiffness, we associated CRF and PA with central and peripheral PWVs and AIx as outcomes using multivariable regression analysis using data from the population-based Study of Health in Pomerania (SHIP Trend 1). Methods CRF was assessed using cardiopulmonary exercise testing (CPET) on a bicycle ergometer. CRF was defined as peak oxygen uptake (VO2peak), VO2peak per kg fat free mass (VO2peak_ffm) and metabolic equivalent tasks (METs). PA was measured using the Baecke questionnaire. Aortic PWV (aoPWV), carotid-femoral PWV (cfPWV) and brachial-ankle PWV (baPWV) in m/s were determined non-invasively using the Vascular Explorer. Aortic AIx (aoAIx), aortic AIx at a heart rate of 75 bpm (aoAIx@75) and brachial-ankle AIx (brAIx) were measured using the same device. We used linear regression models adjusted for age, sex, smoking status, mean arterial pressure, antihypertensive medication, diabetic medication, HbA1c, fat mass, fat-free-mass and height. Fat-free mass was not included when VO2peak_ffm was the exposure. Fat-free mass and fat mass were not used in models with METs. Results We analysed data of 1,677 individuals which included 840 men (median age 56 years; inter-quartile range [IQR] 47 to 65) and 837 women (median age 54 years; IQR 46 to 65). A one l/min greater VO2peak was related to lower aoPWV (β - 0.22; 95% confidence interval (CI) -0.37 to -0.06, p &amp;lt; 0.01), cfPWV (β - 0.32; 95%CI -0.55 to -0.09; p &amp;lt; 0.01), baPWV (β -0.02; 95%CI -0.03 to 0.00, p &amp;lt; 0.05) and brAIx (β -3.49; 95%CI -6.95 to -0.03, p &amp;lt; 0.01). VO2peak was not related to aoAIx and aoAIx@75. VO2peak_ffm was associated with lower aoPWV (β -0.01; 95%CI -0.02 to -0.00, p &amp;lt; 0.05) and cfPWV (β -0.02; 95%CI -0.03 to -0.00, p &amp;lt; 0.05). VO2peak_ffm was not associated with baPWV, aoAIx, aoAIx@75 or brAIx. METs were positively associated with aoAIx@75 (β 0.30; 95%CI 0.02 to 0.59, p &amp;lt; 0.01). Sport and work related PA were not related to PWV or AIx. Sensitivity analysis with further adjustment for heart rate did not significantly change the results. Conclusions We found an association between CRF and central as well as peripheral PWV and AIx values in the adult general population. Interestingly, body composition had an impact on the relationship between CRF and peripheral but not central parameters. Further, PA was not related to these vascular markers which highlights the important difference between CRF and PA.

The Effect of Artificial Pulsatility on the Peripheral Vasculature in Patients With Continuous-Flow Ventricular Assist Devices

BackgroundImplantation of left-ventricular assist systems (LVASs) has become the standard of care for advanced heart failure (HF). The absence of pulsatility in previous devices contributes to vascular and endothelial dysfunction related to atherosclerotic or vascular complications. We hypothesized that the artificial pulsatility provided by the HeartMate 3 (HM3) (Abbott, Chicago, IL) LVAS would exert a favourable effect on the vasculature. MethodsIn 32 patients implanted with HM3 (5 female patients, mean age 55 ± 13.6 years), the reactive hyperemia index (RHI) and peripheral augmentation index (AI), markers of endothelial function and arterial stiffness, were measured with an EndoPAT2000 before and in the third and sixth month after implantation. RHI and AI data from 30 HeartMate II (HM II) (Abbott) recipients in the third and sixth month after implantation, from 15 patients with advanced HF without LVASs and from 13 healthy volunteers were also analyzed. ResultsIn HM3 recipients, the mean RHI significantly decreased at 3 and 6 months after implantation. The RHI was substantially lower at baseline than that of healthy or the HF reference group. Increasing AI values, indicating worsening arterial stiffness, were also observed. Similar trends were observed in HM II recipients between the third and sixth months but with higher absolute values of RHI and AI. ConclusionsWe detected impaired vascular function in HM3 patients and provided additional evidence on the negative effect of low pulsatility on vascular function after LVAS implantation. The results suggest that the artificial pulsatility of the HM3 does not avert the progression of endothelial dysfunction.

Multimodal Assessment of Vascular and Ventricular Function in Children and Adults With Bicuspid Aortic Valve Disease.

Background: Bicuspid aortic valve (BAV), the most common congenital cardiac anomaly, has been associated with an aortopathy, increased aortic stiffness and diastolic dysfunction. The involved mechanisms and impact of age remain unclear. It was the aim of this study to characterize arterial and cardiac function, their correlation, and the effect of age in children and adults with a history of BAV.Methods: Multimodal cardiovascular assessment included echocardiography, ascending aortic distensibility, common carotid intima media thickness [cIMT], parameters of wave reflection [central (cAIx75) and peripheral (pAIx75) augmentation index corrected to a heart rate of 75/min, aging index (AI)], carotid-femoral pulse wave velocity [cfPWV], and endothelial function (EndoPAT). Multivariable linear regression and correlation analyses were performed.Results: We included 47 BAV patients and 84 controls (age 8–65 years). Ascending aortic stiffness, pulse wave reflection (cAIx75, pAIx75, and AI) and central blood pressure were significantly increased in patients with BAV. However, PWV, cIMT, and endothelial function were not significantly different from controls. BAV patients had marginally reduced diastolic (E': β = −1.5, p < 0.001) but not systolic function compared to controls. Overall, all parameters of arterial stiffness had moderate-strong correlations with diastolic dysfunction and age. In the BAV group, ascending aortic distensibility had the strongest correlation with diastolic dysfunction.Conclusions: BAV is associated with increased proximal arterial stiffness and wave reflection. However, PWV and cIMT are not increased, and endothelial function is preserved. This suggests that the mechanism of arterial and cardiac stiffening is different from patients with acquired heart diseases.

CARDIORESPIRATORY FITNESS AND VASCULAR HEMODYNAMICS IN MIDDLE-AGED AND OLDER ADULTS

Clinical Exercise Physiology, Ball State University, Muncie, IN, USA Cardiovascular disease-related (CVD) mortality with older age is in part attributable to altered vascular hemodynamics including increased central and peripheral blood pressure (BP) and augmentation index (AIx). Cardiorespiratory fitness (CRF) is inversely associated with CVD mortality independent of traditional risk factors. It is unknown, however, if CRF is inversely related to vascular hemodynamics. PURPOSE: To investigate the relationship between CRF and vascular hemodynamics in an apparently healthy middle-aged and older adult population. METHODS: Apparently healthy males and females (N=101; 54 M, 47 F; Age: 63.5 ± 8.5) from the Ball State Adult Fitness Longitudinal Lifestyle Study (BALL ST) were studied. All participants underwent assessment of vascular hemodynamics, which included non-invasive central and peripheral BP, central and peripheral pulse pressure (systolic minus diastolic BP), AIx (%), AIx normalized to HR 75 (AIx% HR75) and directly-measured CRF (VO2max ; ml/kg/min). Age- and sex-adjusted CRF percentiles where calculated based on the Fitness Registry and Importance of Exercise National Database (FRIEND). Data were analyzed via Pearson correlations. RESULTS: CRF was inversely related with central systolic BP (cSBP, r = -0.330), central pulse pressure (cPP, r = -0.255), AIx %( r = -0.366), AIx% HR75 (r = -0.474), brachial systolic BP (bSBP, r = -0.227), and brachial pulse pressure (bPP, r = -0.172) (all, p<0.05). cSBP (r = -0.412), cPP (r = -0.249), AIx % (r = -0.202), AIx % HR75 (r = -0.292), and bSBP (r = -0.320) were correlated with FRIEND percentiles (all, p<0.05) whereas bPP (r = -0.131) was not (p> 0.05). CONCLUSION: Our findings demonstrate that more ideal measures of vascular hemodynamics are correlated with higher CRF in middle-age and older adults. These data support the notion that vascular hemodynamics may be a potential modulator in the inverse relationship between CRF and CVD in apparently healthy adults.

4392 Comparative Analysis of Vascular Hemodynamics in a Young Biracial Cohort

OBJECTIVES/GOALS: We investigated hemodynamic measures in young black and white adults below the age of 50 years to identify mechanisms that may predispose blacks to more CVE. METHODS/STUDY POPULATION: We recruited 276 young blacks and white adults in Jackson, MS (mean age: 33 ± 9 years; 70% women; 57% Black;). Participants had clinical and vascular tonometry parameters obtained. Vascular measures included carotid femoral pulse wave velocity, central and peripheral pulse pressure (CPP and PPP), characteristic impedance (Zc), augmentation index, and forward pressure wave. Race-specific characteristic means and proportions were tested using Student’s T- or Chi-square tests. After further sex stratification, significant variation in characteristics among sex within race were tested using nested ANOVA. RESULTS/ANTICIPATED RESULTS: Characteristics of the study group stratified by race were found to be similar. Vascular measures stratified by race revealed blacks to have significantly higher Zc (p = 0.03) and PPP (p = 0.03) than whites. DISCUSSION/SIGNIFICANCE OF IMPACT: In this study of vascular hemodynamics in young black and white participants we found differences in Zc and PPP. Findings suggest that differing relations between proximal aortic diameter and wall stiffness may contribute to the racial disparity in CVE in adults. This finding could offer an explanation to the beneficial effects of treatment modalities that target aortic stiffness in blacks.

Isometric handgrip training reduces blood pressure and wave reflections in East Asian, non-medicated, middle-aged and older adults: a randomized control trial.

The aim of this study was to investigate the effects of isometric handgrip (IHG) training on central and peripheral blood pressure (BP) and wave reflections in East Asian non-medicated middle-aged and older adults. Twenty-two men and women (mean age 65 ± 11years) who were not actively involved in regular resistance or endurance training were randomly assigned to a group that did IHG and a control (CON) group. The IHG training was comprised of four unilateral 2-min isometric contractions at 30% of maximal voluntary contraction using a programmed handgrip dynamometer with 1-min rest periods for 5days per week for 8weeks. Baseline central systolic BP (cSBP), brachial systolic BP (bSBP), brachial diastolic BP (bDBP), and the augmentation index (AIx) (via an automated applanation tonometric system) did not differ significantly between the groups. Compared to baseline, cSBP, bSBP, bDBP, and AIx decreased significantly after the 8-week study period in the IHG group (P < 0.05). No significant changes in central and peripheral BP and AIx were observed in the CON group. These results suggest that IHG training could reduce central and peripheral BP and wave reflections in East Asian non-medicated middle-aged and older adults.

Effect of golimumab on endothelial vasomotor function and arterial stiffness in ankylosing spondylitis

Objective: to evaluate the effect of golimumab (GLM) on endothelial vasomotor function and arterial stiffness in patients with ankylosing spondylitis (AS).Subjects and methods. A total of 42 patients with advanced-stage AS, who were older than 18 years and met the 1984 modified New York criteria with a disease duration of ≤5 years, were examined. The investigators visualized carotid arteries to determine local vascular wall stiffness, studied regional arterial stiffness to assess a pulse wave contour analysis, and a reactive hyperemia test before and after 104-week therapy.Results and discussion. RA patients without cardiovascular comorbidity were found to have signs of subclinical great artery involvement accompanied by endothelial vasoregulatory dysfunction in both the small resistance and large muscular arteries; by increases in common carotid artery (CCA) intima-media thickness (IMT) and stiffness index (SI); by rises in peripheral augmentation index (AIp), SI and reflection index (RI), the intensity of a change in which correlated with disease duration and activity assessed by ASDAS; as well as with the modified Schober test value, cervical rotation, and tragus-to-wall distance. In addition to a decrease in the Ankylosing Spondylitis Disease Activity Score (ASDAS), GML treatment in patients with AS caused a statistically significant increase in the amplitude occlusion index to the control values and a rise in the phase shift between the channels by an average of 2 times (p&lt;0.01) as compared to the baseline values; a decrease in CCA IMT by an average by 20% (p=0.01) and in the local stiffness of the (carotid) vascular bed by 31% (p=0.01). The pulse wave contour analysis after 104-week GLM therapy revealed that AIp, SI and RI decreased by an average of 5 (р&lt;0.001), 1.3 (р&lt;0.01), and 2 (p&lt;0.05) times, respectively, with the remaining statistically significant differences from the control values.Conclusion. In addition to the effectively reduced inflammatory activity, GLM therapy in patients with AS provides restoration of endothelial function in both the small resistance vessels (an increase in the amplitude occlusion index) and the large muscular arteries (a rise in the phase shift between the channels) and also has a vasoprotective effect on the wall of large elastic vessels (reductions in CCA IMT, SI, AIp, and SI) and small muscular arteries (a decrease in RI).

Noninvasive validation of central and peripheral augmentation index estimated by a novel wrist-worn tonometer.

The validation of new blood pressure devices with easier use and more rapid data collection may facilitate the incorporation of these measures into clinical practice. We analyze the reliability and validity of Pulse Wave Analysis as reported by a novel wrist-worn device, easy and quick to use, comparing central and peripheral augmentation index (AIx) with the same measures from the SphygmoCor. Additionally, we analyzed clinical relevance through the association of the Pulse Wave Analysis, as reported by a novel wrist-worn device, with other cardiovascular parameters. Cross-sectional study including 254 participants. Mean age was 51.9 ± 13.4 years and 53% were women. peripheral AIx (PAIx) and central AIx (CAIx) by the wrist-worn device and SphygmoCor (MM3); carotid-femoral (cf) pulse wave velocity (PWV) by SphygmoCor (MM3); cardioankle-vascular index (CAVI), ankle-brachial index (ABI) and brachial-ankle (ba) PWV by the Vasera device and carotid-intima media thickness (IMT) by ultrasonography. Intra-observer intra-class correlation coefficient (ICC) for PAIx was 0.886 (95% CI 0.803-0.934) and for CAIx 0.943 (95% CI 0.901-0.968) with Bland Altman limits of agreement -0.75 (-23.8 to 21.8) and 0.08 (-15.7 to 15.9), respectively. Inter-observer ICC for PAIx was 0.952 (95% CI 0.915-0.972) and CAIx 0.893 (95% CI 0.811-0.939) with limits of agreement -0.45 (-13.7 to 12.8) and 0.43 (-17.7 to 18.5), respectively. Comparing the wrist-worn device with SphygmoCor, the ICC was 0.849 (95% CI 0.798-0.887) for PAIx, and 0.783 (95% CI 0.711-0.838) for CAIx. In Bland-Altman, limits of agreement for PAIx 1.03 (-20.67 to 22.73), and for CAIx -2.14 (-24.79 to 20.50). PAIx and CAIx, from the wrist-worn device, correlated with age, CAVI, ABI, baPWV, cfPWV, IMT, glomerular filtration and cardiovascular risk. AIx measurements by wrist-worn device shows a good intra-observer and inter-observer reliability, inter-device noninvasive reliability and validity when compared with SphygmoCor, and clinical relevance by association with measures of vascular structure and function, end-organ damage and cardiovascular risk. Clinicaltrials.gov NCT02623894; https://clinicaltrials.gov/ct2/show/NCT02623894.

Pulse Wave Analysis of HbA1C Categorized Prediabetes, Type 2 Diabetes and Normo-Glycemic Populations

Arterial stiffness is a significant risk factor for cardiovascular events and early detection is key for intervention and monitoring. This pathophysiological process is accelerated in type 2 diabetes (T2D), yet the onset of this condition has a limited body of research. PURPOSE: To evaluate (1) arterial stiffness properties via pulse wave analysis (PWA) across a 4-group spectrum, and (2) determine whether waist-to-height-ratio (WHtR), waist circumference (WC) or body mass index (BMI) serves as the best predictor of early changes in PWA pathophysiology. METHODS: PWA was measured in 52 participants across four groups separated by HbA1c values: 13 normo-glycemic (N, 4.0-5.1), 14 high normal (HN, 5.2-5.6), 10 prediabetes (PD, 5.7-6.4) and 13 with T2D (T2D, ≥ 6.5). Brachial, central and peripheral pressures, central and peripheral augmentation index (AIx) data were collected via Sphygmocor using validated methods after overnight caffeine abstinence and a minimum 4-hr fast. Group differences were evaluated via MANCOVAs. HbA1C, WHtR, WC and BMI data were assessed through regression to determine the best predictor. RESULTS: Significant differences were found between N to T2D and HN to T2D for brachial systolic blood pressure (SBP) [F(3,46)=2.743, p<.05], brachial diastolic blood pressure (DBP) [F(3,46)=3.329, p<.028] and brachial mean pressures (MP) [F(3,46)=4.321, p<.009]. Central DBP and MP differed between N to T2D, and HN to PD and T2D groups [DBP:F(3,44)=3.874, p<.015; MP:F(3,44)=3.303, p<.029]. Central pulse pressure (PP) and CAIx showed no differences between groups. Peripheral pressures significantly differed between N and both PD and T2D; HN and both PD and T2D groups for peripheral SBP [F(3,44)=3.007, p<.040], peripheral DBP [F(3,44)=4.316, p<.009] and peripheral MP [F(3,44)=3.487, p<.023], but not PP or PAIx. WHtR and WC were identified as the best predictors of CAIx after adjusting for age and height [R2=.800, F(5,45)=16.023, p<.0005; adj. R2=.640], while PAIx had no significant predictor. CONCLUSIONS: PWA may be effective for identifying differences in multiple brachial, central and peripheral pressure measures across a novel, pre-defined HbA1C spectrum; however, more research needs to be executed to validate these findings. WHtR and WC, but not BMI, effectively predicts CAIx.

Foci of chronic infection and vascular rigidity in persons of military age

The role of focal infection as a possible risk factor for development of atherosclerotic cardiovascular diseases is discussed quite intensively now. Estimated some parameters of vascular stiffness in young men of military age with the features of their infectious-inflammatory medical history by the type of foci of chronic infection. It is established that in young men with foci of chronic infection such indicators of vascular stiffness, as peripheral augmentation index, augmentation index, normalized to heart rate, and augmentation index of the aorta were significantly higher than in their peers with a positive history. The differences in the first two indicators have reached a reliable level. It should be emphasized the presence of more low blood pressure in the presence of foci of chronic infection , which eliminates the distortion parameters of vascular status, influenced by the tensile effect from the blood pressure in the time of the study. The obtained data clearly indicate the higher rigidity of the walls of the aorta and large arteries in young men under the influence of their foci of chronic infection. Some tendency to development of left ventricular dysfunction in young people with presence of chronic tonsillitis and other infectious and inflammatory diseases was also revealed. This dysfunction is expressed in reducing the maximum rate of growth of blood pressure and increasing the period of expulsion of the left ventricle. The presented results confirm the concept of lifelong formation of «infectious-inflammatory load» in terms of increasing vascular rigidity and subclinical changes in the functioning of the myocardium at young age, subject to the presence of a focal chronic infection. These data allow us to regard foci of chronic infection as another risk factor of atherosclerosis, which in turn requires consideration when carrying out the relevant preventive measures among young population in the process of health checkups.

THE EFFECT OF GOLIMUMAB ON ARTERIAL STIFFNESS IN PATIENTS WITH RHEUMATOID ARTHRITIS

Objective: to evaluate the effect of golimumab (GLM) on arterial stiffness in patients with different clinical and immunological subtypes of rheumatoid arthritis (RA). Material and methods. Examinations were made in 48 patients with RA meeting the 1987 ACR/2010 EULAR classification criteria. The investigators visualized carotid arteries with determination of local vessel wall stiffness and studied regional arterial stiffness with assessment of contour pulse wave analysis before and 52 weeks after initiation of therapy. Results and discussion . Young and middle-aged RA patients without any concomitant cardiovascular diseases were found to have subclinical great artery involvement that was characterized by increases in intima-media thickness (IMT) and stiffness index β of the common carotid artery (CCA); by rises in peripheral augmentation index (AIp), stiffness index (SI), and reflection index (RI), the intensity of a change in which was associated with high DAS28 and seropositivity for rheumatoid factor (RF) and/or anti-cyclic citrullinated peptide (antiCCP) antibodies. GLM treatment in patients with RA was accompanied by a statistically significant decrease in DAS28 and a reduction in CCA IMT and local (carotid) stiffness of the vascular bed. More significant correction of the investigated parameters was achieved in patients with the seronegative subtype of the disease; in this group of patients, CCA IMT decreased by 29% by the end of observation (p=0.01), CCA SI β reduced by an average of 28.7% (p=0.0001). At 52 weeks after GLM therapy initiation, contour pulse wave analysis indicated that this subgroup of patients was observed to have decreases in AIp, SI, and RI to the control level; in RA seropositive for RF and/or anti-CCP, they reduced by an average of 1.8 (p=0.0001), 1.2 (p=0.005) and 1.6 (p=0.001) times, respectively. Conclusion. Along with high anti-inflammatory activity, GLM therapy in patients with RA has a vasoprotective effect on the walls of large elastic-type vessels (decreases in CCA IMT and SI β, AIp, and SI) and small muscular-type arteries (a reduction in RI).

Theobromine consumption does not improve fasting and postprandial vascular function in overweight and obese subjects

BackgoundTheobromine, a component of cocoa, may favorably affect conventional lipid-related cardiovascular risk markers, but effects on flow-mediated dilation (FMD) and other vascular function markers are not known.ObjectiveTo evaluate the effects of 4-week theobromine consumption (500 mg/day) on fasting and postprandial vascular function markers.DesignIn a randomized, double-blind crossover study, 44 apparently healthy overweight (N = 30) and obese (N = 14) men and women with low HDL-C concentrations, consumed daily 500 mg theobromine or placebo for 4 weeks. After 4 weeks, FMD, peripheral arterial tonometry (PAT), augmentation index (AIx), pulse wave velocity (PWV), blood pressure (BP) and retinal microvasculature measurements were performed. These measurements were carried out under fasting conditions and 2.5 h after a high-fat mixed meal challenge.Results4-week theobromine consumption did not change fasting vascular function markers, except for a decrease in central AIx (cAIx, − 1.7 pp, P = 0.037) and a trend towards smaller venular calibers (− 2 µm, P = 0.074). Consuming a high-fat mixed meal decreased FMD (0.89 pp, P = 0.002), reactive hyperemia index (RHI, − 0.30, P < 0.001), peripheral systolic BP (SBP, − 3 mmHg, P ≤ 0.001), peripheral diastolic BP (DBP, − 2 mmHg, P ≤ 0.001), central SBP (− 6 mmHg, P ≤ 0.001) and central DBP (− 2 mmHg, P ≤ 0.001), but increased heart rate (HR, 2 bpm, P < 0.001). Theobromine did not modify these postprandial effects, but increased postprandially the brachial artery diameter (0.03 cm, P = 0.015), and decreased the cAIx corrected for a HR of 75 (cAIx75, − 5.0 pp, P = 0.004) and peripheral AIx (pAIx, − 6.3 pp, P = 0.017).ConclusionTheobromine consumption did not improve fasting and postprandial endothelial function, but increased postprandial peripheral arterial diameters and decreased the AIx. These findings do not suggest that theobromine alone contributes to the proposed cardioprotective effects of cocoa.This trial was registered on clinicaltrials.gov under study number NCT02209025.

Characterizing the relationship between flow-mediated vasodilation and radial artery tonometry in peripheral artery disease

BackgroundArterial stiffness, measured by the augmentation index (AIX) from radial artery tonometry, and endothelial dysfunction, measured by brachial-artery flow-mediated vasodilation (FMD), have each been associated with increased risk of cardiovascular events. However, their interrelationship in peripheral artery disease (PAD) patients is poorly understood. Materials and methodsIn a cross-sectional analysis of 123 vascular surgery outpatients, the association between FMD and AIX was examined in controls with atherosclerotic risk factors (n = 32) and patients with PAD (n = 91). PAD was defined as claudication symptoms with an ankle-brachial index of <0.9 or a history of revascularization for symptomatic PAD. Controls had an ankle-brachial index ≥0.9 and no history of atherosclerotic vascular disease. ResultsCompared to controls, patients with PAD had lower FMD (6.3 ± 3.8 versus 8.4 ± 3.7, P = 0.008), while central AIX normalized to 75 beats per minute (25.5 ± 9.0 versus 19.3 ± 8.6, P = 0.001) and peripheral AIX (91.3 ± 14.5 versus 81.3 ± 11.4, P = 0.001) were higher. FMD was not significantly correlated with either central or peripheral AIX (central AIX: P = 0.58; peripheral AIX: P = 0.89) across the entire cohort, or in either the patients with PAD (central AIX: P = 0.48; peripheral AIX: P = 0.23) or controls (central AIX: P = 0.43; peripheral AIX: P = 0.92). In a multivariate model including FMD, higher AIX remained independently associated with PAD. ConclusionsIn an analysis of vascular surgery outpatients, no correlation between FMD and AIX was detected. Larger prospective studies are needed to determine whether the inclusion of both parameters improves predictive models for the early identification and potential risk stratification of PAD patients.

OP.7D.07] 24-HOUR CENTRAL BLOOD PRESSURE IS BETTER ASSOCIATED WITH TARGET ORGAN DAMAGE OF HYPERTENSION THAN BRACHIAL BLOOD PRESSURE

Objective: The VASOTENS international, multicenter, observational, non-randomized, prospective study aims at evaluating the impact of 24-hour pulse wave analysis of ambulatory blood pressure (BP) recordings on target organ damage and cardiovascular prognosis of hypertensive patients. In the present analysis of study baseline data we checked whether organ damage of hypertension i) is better associated with 24-hour central than peripheral BP and ii) is related to ambulatory arterial stiffness, estimated by pulse wave velocity (PWV) and augmentation index (AIx). Design and method: In 334 hypertensive patients (mean age 53+/−15, 52% males, 45% treated) we obtained 24-hour ABPMs, echocardiograms, carotid ultrasonograms and serum creatinine. Hypertensive organ damage was estimated by calculation of left ventricular mass index (LVMI, cardiac damage), intima-media thickness (IMT, vascular damage) and creatinine clearance (CC, renal damage). 24-hour hemodynamics and stiffness were estimated through the validated VASOTENS technology, based on transfer function analysis of brachial oscillograms. 24-hour brachial (bSBP) and aortic systolic BP (aSBP), standard deviation of bSBP, PWV and AIx were obtained. Relation of vascular indices with LVMI, IMT and CC was evaluated by bivariate and multivariate analysis (stepwise linear regression analysis). Results: In the bivariate analysis a statistically significant relation was found for age, bSBP and aSBP vs. LVMI and IMT (see table, correlation coefficients or r). IMT was also significantly related to SBP variability and arterial stiffness, whereas increasing age, SBP variability and AIx were significantly associated with a decline of renal function.In the multivariate analysis, including all variables entered in the bivariate model, adjusted by sex, statistically significant (p < 0.001) association was observed for aSBP and age with LVMI (standardized regression coefficient 0.25 and 0.18, respectively), and for age with IMT (0.56) and CC (−0.53). Conclusions: In hypertensive patients age appears to be the major determinant of organ damage, with central SBP, and marginally peripheral SBP, PWV and AIx, also playing a significant role. Our results suggest that estimation of 24-hour central hemodynamics and arterial stiffness in ambulatory conditions may help improve the individualized assessment of the BP-associated organ damage of hypertension