Augmentation Pressure Research Articles

Total Diz Artroplastisinde Cerrahi Yara Kapatılması Öncesinde Kontrollü Arteriyel Hipertansiyon ile Yapılan Hemostazis Kanama Miktarını ve Transfüzyon İhtiyacını Etkiler mi?

Objective: We aimed to assess the efficacy of hemostasis while controlled augmentation of arterial blood pressure before surgical closure after total knee arthroplasty (TKA). 
 Materials and Methods: This retrospective cohort involved data collected from the medical files of 87 patients (62 women, 25 men) who underwent TKA using hypotensive epidural anesthesia (HEA). Patients were allocated into two groups. Group I (n=44) received HEA, while Group II (n=43) had controlled arterial hypertension before surgical closure. Perioperative hemoglobin and hematocrit levels, systolic and diastolic blood pressure, and the amount of erythrocyte suspension transfusion were compared between the two groups. 
 Results: The average age of our series was 66.41 ± 6.17 (range: 57-78) years. Notably, the amount of bleeding on postoperative 1st, 2nd, 4th, 12th, and 24th (p=0.031, 0.032, 0.001, 0.001, 0.001, respectively) hours was significantly less in Group II. There were no significant differences between the two groups for complications, operative duration, perioperative bleeding, duration of follow-up and hospitalisation, and compared descriptives. 
 Conclusion: Our data indicated that controlled elevation of mean arterial pressure before surgical closure might allow the achievement of meticulous hemostasis after TKA. Further prospective, randomised, controlled trials on more extensive series are warranted to verify our preliminary results.

Influence Of Absolute Force On Augmented Exercise Blood Pressure During Isometric Hand-gripping With Female Aging

Influence Of Absolute Force On Augmented Exercise Blood Pressure During Isometric Hand-gripping With Female Aging

Importance of Multimodal Spinal Cord Monitoring and Hemodynamic Augmentation during High Thoracic Ventral Dural Tear Repair Using the Posterior Approach

AbstractCerebrospinal fluid (CSF) leakage due to large ventral dural tears (VDT) often requires surgical intervention. Surgical closure of a high thoracic VDT is challenging and associated with high morbidity, especially if it is performed after multiple epidural blood patch (EBP)/fibrin glue injections. A 44-year-old woman was diagnosed with spontaneous intracranial hypotension due to VDT at T1-T2, causing CSF leakage. Multiple EBP and fibrin glue injections failed to treat her symptoms; hence, the patient underwent surgical closure using the posterior approach. The patient was anesthetized using standard anesthetic drugs and was maintained under total intravenous anesthesia to facilitate continuous motor-evoked potential (MEP) monitoring. The surgical course was complicated by bleeding, hypotension, and MEP loss. Continuous MEP monitoring, effective team communication, quick restoration of blood pressure(BP) and BP augmentation with fluid, blood, and vasopressor helped to restore the MEP back to baseline. Hence, the patient recovered without neurological morbidity. This case report highlights the importance of adequate vascular access, multimodal spinal cord monitoring, and BP augmentation during a high thoracic VDT repair.

Myocardial Work in Middle-Aged Adults with Overweight and Obesity: Associations with Sex and Central Arterial Stiffness.

We explored global myocardial work index (GWI), a novel measure of myocardial function that integrates left ventricular (LV) hemodynamic load, in relation to sex and increased body mass index (BMI). We used data from 467 individuals (61% women, average age 47 ± 9 years and BMI 31.2 kg/m2) without known cardiac disease. Central arterial function was analysed by applanation tonometry. GWI was calculated from global longitudinal strain (GLS) and post-echocardiography supine blood pressure (BP). Covariables of GWI were identified in linear regression analyses. Women had higher BMI, aortic augmentation pressure (12 ± 7 vs. 8 ± 6 mmHg), LV GLS (20.0 ± 2.8 vs. 18.8 ± 2.8%), and GWI (2126 ± 385 vs. 2047 ± 389 mmHg%) than men (all p < 0.05). In univariable analyses, higher GWI was associated with female sex, higher age, systolic BP, LV wall stress, LV ejection fraction, left atrial size, LV ejection time, and with lower waist circumference (all p < 0.05). In multivariable analysis, adjusting for these correlates, female sex remained independently associated with higher GWI (β = 0.13, p = 0.007). After additional adjustment for aortic augmentation pressure or central pulse pressure, this association became non-significant. In conclusion, the higher GWI in women compared to men was mainly explained by increased LV workload due to higher aortic augmentation pressure in women.

Norepinephrine corrected shock index as an innovative hemodynamic based prognosticator in critically ill patients

Background: Hemodynamic instability in critically ill patients can be assessed by various hemodynamic valid indicators. One of these approved hemodynamics’ prognosticator is the Shock Index (SI), which integrates both the heart rate and systolic blood pressure in one composite indicator. Arbitrarily, higher vasopressor rate indicates poorer prognostic. Whatever, Norepinephrine, the preferred vasopressor in most shock related scenarios, has a tendency to increase heart rate beside its vasoconstriction associated systolic blood pressure augmentation. Aim: In this study, we primarily aim to investigate the predictive power of a newer proposed composite hemodynamic prognosticator which integrates the average Norepinephrine infusion rates with the assessed patients’ Shock Indexes, and to explore its Sensitivity Indices regarding the critically ill patients’ major outcomes. Methods: This study trial was a non-funded, non-sponsored, observational study, which was conducted retrospectively on the Intensive Care Unit (ICU) at King Hussein Medical Center, Royal Medical Services, Amman, Jordan, over 60 months between Jan 2018 and Dec 2022. Exclusion criteria including but not excluded to, admission days less than 24 hours and missing data more than 80%. All eligible investigated critically ill patients were dichotomously divided into 2 comparative NE×SI products’ cohorts; lower product’s (NE×SI&lt;14.835 µg.bpm/min. mmHg) cohort (Cohort I) versus higher product’s (NE×SI≥14.835 µg.bpm/min. mmHg) cohort (Cohort II). A Chi Square test were conducted across these 2 dichotomized cohorts. The Binary Logistic Regression (BLgR) analysis was conducted for the tested patients’ prognosticator (NE×SI) against the probability of being allocated to the Non-Survivors State (The Positive State) rather than to the Survivors State (The Negative State). The Receiver Operating Characteristic (ROC) and Sensitivity Analysis were processed to explore the area under the ROC curves (AUROC±SEM), optimal cut-off points, and the other sensitivity indices. Results: Actually, 2528 and 3217 cases were processed as positive actual states (Positive OI, Non-Survivors) and as negative actual states (Negative OI, Survivors) respectively. The AUC±SEM for the NE×SI was significantly determined at 0.944±0.003 (95% CI; 0.938-0.949). The probability of the positive OI was 66.12% at the optimal operating cutoff point of 14.84 µg.bpm/min. mmHg. In this study, we constructed a BLgR model to prognosticate the admitted ICU patients’ mortality and was formulated as [e (-6.986+0.516× NE.SI) /1+ e (-6.986+0.516× NE.SI)]. Conclusion: Our results revealed that our proposed an innovative hemodynamic composited product had a reasonable constructed area under the curve with an interesting sensitivity index for prognosticating the admitted critically ill patients’ mortality rate.

Effect of tidal volume change on pressure-based prediction of fluid responsiveness in children.

It is known that pulse pressure variation and systolic pressure variation cannot predict fluid responsiveness in children. In adults, the ability of these dynamic parameters to predict fluid responsiveness is improved by increasing tidal volume. We planned to investigate whether pulse pressure variation or systolic pressure variation can predict fluid responsiveness in children when augmented by increasing tidal volume by conducting a prospective study. We enrolled children younger than 7 years who underwent cardiac surgery for atrial septal defect or ventricular septal defect. After sternum closure, pulse pressure variation and systolic pressure variation were continuously recorded while changing the tidal volume to 6, 10, and 14 mL/kg. Fluid loading was done with 10 mL/kg of crystalloids for 10 min, and stroke volume index was measured via transesophageal echocardiography. Children whose stroke volume index increased by more than 15% after the fluid loading were defined as responders to fluid therapy. We set primary outcome as the predictability of pulse pressure variation and systolic pressure variation for fluid responsiveness and measured the area under the curve of receiver operating characteristics curve. Twenty-six children were included, of which 15 were responders. At the tidal volume of 14 mL/kg, the area under the curves of receiver operating characteristics curves of pulse pressure variation and systolic pressure variation were 0.576 (p = .517) and 0.548 (p = .678), respectively. The differences in dynamic parameters between responders and nonresponders were not significant. Failure of pulse pressure variation or systolic pressure variation at augmented tidal volume in children may be due to difference in their arterial compliance from those of adults. Large compliance of thoracic wall may be another reason. Augmented pulse pressure variation or systolic pressure variation due to increased tidal volume cannot predict fluid responsiveness in children after simple cardiac surgery.

Investigation of the performance parameters for a PEMFC by thermodynamic analyses: Effects of operating temperature and pressure

In the present study, thermodynamic performance characteristics of the proton exchange membrane fuel cell (PEMFC) at ranging operating temperatures and pressures were examined through energy and exergy analyses. The energy and exergy figures of the reactants and products were taken into account by thermodynamic analysis. In addition, the significant parameters such as destroyed exergy, entropy generation, thermal efficiency, and exergy efficiency were calculated at the aforementioned conditions to give more knowledge regarding the PEMFC. In conclusion, the power density and exergy efficiency improved as the operating temperature of the FC boosted. When the current density was 1, the exergy efficiency increased by 13.17% as the operating temperature ascended from 303 K to 363 K. At all operating temperatures, the augmentation in current density caused irreversibility, so entropy generation ascended. Since the increase in operating temperature led to an increase in power density, amount of exergy that was destroyed declined. Augmentation of the working pressure at constant temperature did not remarkably enhance the exergy efficiency. In the case of a current density of 1, the exergy efficiency values at the operating pressures of 3 atm and 12 atm were found to be 54.42% and 53.79%, respectively.

Hemodynamic effects of a dielectric elastomer augmented aorta on aortic wave intensity: An in-vivo study

Dielectric elastomer actuator augmented aorta (DEA) represents a novel approach with high potential for assisting a failing heart. The soft tubular device replaces a section of the aorta and increases its diameter when activated. The hemodynamic interaction between the DEA and the left ventricle (LV) has not been investigated with wave intensity (WI) analysis before. The objective of this study is to investigate the hemodynamic effects of the DEA on the aortic WI pattern. WI was calculated from aortic pressure and flow measured in-vivo in the descending aorta of two pigs implanted with DEAs. The DEAs were tested for different actuation phase shifts (PS). The DEA generated two decompression waves (traveling upstream and downstream of the device) at activation followed by two compression waves at deactivation. Depending on the PS, the end-diastolic pressure (EDP) decreased by 7% (or increased by 5–6%). The average early diastolic pressure augmentation (Pdia¯) increased by 2% (or decreased by 2–3%). The hydraulic work (WH) measured in the aorta decreased by 2% (or increased by 5%). The DEA-generated waves interfered with the LV-generated waves, and the timing of the waves affected the hemodynamic effect of the device. For the best actuation timing the upstream decompression wave arrived just before aortic valve opening and the upstream compression wave arrived just before aortic valve closure leading to a decreased EDP, an increased Pdia¯ and a reduced.WH.

Effects of a Mitochondrial Targeted Ubiquinol (MitoQ) on Vascular Function and Exercise Capacity in Chronic Kidney Disease: A Randomized Controlled Pilot Study.

Mitochondrial derived oxidative stress is implicated in vascular and skeletal muscle abnormalities in chronic kidney disease (CKD). The purpose of this study was to investigate the effects of a mitochondrial targeted ubiquinol (MitoQ) on vascular function and exercise capacity in CKD. In this randomized controlled trial, 18 patients with CKD (Mean±SEM: Age, 62±3years; eGFR, 45±3ml/min/1.732) received 4 weeks of 20mg/day MitoQ (MTQ) or placebo (PLB). Outcomes assessed at baseline and follow up included macrovascular function measured by flow mediated dilation; microvascular function assessed by laser Doppler flowmetry combined with intradermal microdialysis; aortic hemodynamics assessed by oscillometery; and exercise capacity by cardiopulmonary exercise testing. Compared to PLB, MTQ improved flow mediated dilation (baseline vs follow up: MTQ, 2.4±0.3 vs. 4.0±0.9%; PLB, 4.2±1.0 vs. 2.5±1.0%; p=0.04). MTQ improved microvascular function (DCVC: MTQ, 4.50 ± 2.57 vs. PLB -2.22 ± 2.67%; p=0.053). Central aortic systolic and pulse pressures were unchanged, however, MTQ prevented increases in augmentation pressures that were observed in the PLB group (p=0.026). MTQ did not affect exercise capacity. This study demonstrates potential for a mitochondrial targeted ubiquinol to improve vascular function in CKD. The findings hold promise for future investigations of mitochondrial targeted therapies in CKD.

Oxidative Stress Response Kinetics after 60 Minutes at Different (1.4 ATA and 2.5 ATA) Hyperbaric Hyperoxia Exposures.

Hyperbaric oxygen therapy (HBOT) is a therapeutical approach based on exposure to pure oxygen in an augmented atmospheric pressure. Although it has been used for years, the exact kinetics of the reactive oxygen species (ROS) between different pressures of hyperbaric oxygen exposure are still not clearly evidenced. In this study, the metabolic responses of hyperbaric hyperoxia exposures for 1 h at 1.4 and 2.5 ATA were investigated. Fourteen healthy non-smoking subjects (2 females and 12 males, age: 37.3 ± 12.7 years old (mean ± SD), height: 176.3 ± 9.9 cm, and weight: 75.8 ± 17.7 kg) volunteered for this study. Blood samples were taken before and at 30 min, 2 h, 24 h, and 48 h after a 1 h hyperbaric hyperoxic exposure. The level of oxidation was evaluated by the rate of ROS production, nitric oxide metabolites (NOx), and the levels of isoprostane. Antioxidant reactions were assessed through measuring superoxide dismutase (SOD), catalase (CAT), cysteinylglycine, and glutathione (GSH). The inflammatory response was measured using interleukine-6, neopterin, and creatinine. A short (60 min) period of mild (1.4 ATA) and high (2.5 ATA) hyperbaric hyperoxia leads to a similar significant increase in the production of ROS and antioxidant reactions. Immunomodulation and inflammatory responses, on the contrary, respond proportionally to the hyperbaric oxygen dose. Further research is warranted on the dose and the inter-dose recovery time to optimize the potential therapeutic benefits of this promising intervention.

Study on adsorption-diffusion-seepage behavior of oxygen in coal gangue under the coupling of temperature and pressure

This research delves into the fundamental aspects of oxygen adsorption, diffusion, and seepage within gangue slits, aiming to avert the spontaneous combustion of coal gangue hills. Employing methodologies such as molecular dynamics (MD), Grand Canonical Monte Carlo simulations (GCMC), and the finite element simulation, the intricate behavior of O2 molecules within the coal gangue's slit structure is modeled under varying temperature and pressure conditions. The outcomes evince that augmented pressure facilitates oxygen adsorption while diminishing the diffusion coefficient. Conversely, elevated temperature curtails adsorption but augments the diffusion coefficient. At a pressure of 10 MPa, the system energy of oxygen-coal gangue undergoes the most substantial change (92.18 kcal/mol), and the energy peak exhibits the broadest displacement (0.7 kcal/mol), thus signifying the preeminence of pressure conditions in governing O2 adsorption and diffusion. At temperatures below 423.15 K, O2 molecules and coal gangue primarily undergo physical adsorption, with an amplified exposure of kaolinite (0 0–1) surfaces in coal gangue correlating to intensified adsorption. Within the pressure range of 0.2–10 MPa, the percolation process of oxygen in gangue slits unfolds across four discernible stages, with the structural characteristics of the slit channel, gas diffusion capacity, and oxygen consumption rate of coal gangue exerting a profound influence on the process. Based on these research findings, the reduction of pressure proves to be more efficacious in regulating the spontaneous combustion of coal gangue as compared to temperature control.

Arterial Stiffness in Overweight and Obesity: Association with Sex, Age, and Blood Pressure.

Obesity has been associated with increased arterial stiffness. Sex-differences in arterial stiffness in obesity have been less explored. To explore sex-differences in arterial stiffness by applanation tonometry in 323 women and 225 with overweight and obesity, free of cardiovascular disease. Covariables of arterial stiffness were identified in multivariable linear regression analyses in the total cohort and separately in women and men. In the total study cohort, women had higher augmentation pressure (AP) and augmentation index (AIx), and lower carotid-femoral pulse wave velocity (cf-PWV) than men, independent of confounders (all p < 0.001). In sex-specific analyses, higher AP was associated with higher age and 24-hours systolic blood pressure (BP), and with lower heart rate in women (all p < 0.001), and with higher age and BP in men (all p < 0.001). Similarly, higher AIx was associated with higher age and BP, and lower body mass index (BMI) and heart rate in women (all p < 0.05), and with higher age in men (all p < 0.001). Higher cf-PWV correlated with higher age and BP in women (all p < 0.005), and additionally with higher heart rate and non-smoking in men (all p < 0.05). When replacing BMI with waist-hip ratio, higher waist-hip ratio was associated with higher cf-PWV in men only (p < 0.05). Among subjects with overweight and obesity, AP and AIx were higher in women, and cf-PWV was higher in men. Age and 24-hours systolic BP were the main factors associated with arterial stiffness in both sexes, while measures of adiposity had little impact on arterial stiffness.

Comparison of effects of peripheral vasculature on tonometric radial pulse and cuff-based brachial pulse waveform as used in estimation of central aortic pressures.

Aortic pressure estimation requires reliable peripheral pulse waveform acquisition. The peripheral waveform can change with local vascular effects that can be independent of aortic pressure. This study quantifies the effects of peripheral vasculature changes on radial and brachial waveforms. In 20 subjects (37± 15 years, 7 female), brachial volumetric displacement (cuff-based) and radial tonometry waveforms were simultaneously measured whilst a cuff around the hand on the same arm was inflated to induce transmural pressures of -60, -30, -15, 0, 15 and 30 mmHg, altering local peripheral resistance and compliance by graded arterial wall unloading. Aortic blood pressure (BP), augmentation index (AIx) and ejection duration were calculated from the measurements using a generalized transfer function. The parameters under unloaded conditions were compared to baseline measurements. Brachial systolic and diastolic BP did not change throughout the experiment. Altering peripheral resistance and compliance did not significantly change calculated aortic BP values, although changes were nominally greater for radial (maximum +8±1 mmHg) compared to brachial (maximum +2±1 mmHg) waveforms. AIx at 0 mmHg transmural pressure (maximum arterial wall unloading) was higher when derived from radial waveforms (+24±3%, p<0.001) but not when derived from brachial waveforms. Localized changes in peripheral resistance and compliance affect tonometer acquired radial waveforms but not volumetric displacement acquired brachial pressure waveforms, as judged by computed central aortic augmentation pressure parameters. This suggests aortic pressure estimation from the brachial cuff waveform is less sensitive to peripheral vasculature disturbances that alter the peripheral arterial pulse morphology.

Mean arterial pressure (MAP) augmentation in traumatic spinal cord injuries: Early hyperperfusion treatment influences neurologic outcomes

Context: Hyperperfusion therapy, mean arterial blood pressure (MAP) > 85 mmHg, is a recommended treatment of blunt traumatic spinal cord injury (SCI). We hypothesized the first 24 h of MAP augmentation would be most influential on neurological outcomes. Design: This retrospective study from a level 1 urban trauma center dating 1/2017 to 12/2019 included all blunt traumatic spinal cord injured patients receiving hyperperfusion therapy. Patients were grouped as “No improvement” vs “Improvement” measured by change in American Spinal Injury Association (ASIA) score during their hospitalization. MAP values for the first 12, first 24 and last 72 h were compared between the two groups; P < 0.05 was significant. Results: After exclusions, 96 patients underwent hyperperfusion therapy for blunt traumatic SCI, 82 in the No Improvement and 14 in the Improvement group. Groups had similar treatment durations (95.6 and 96.7 h, P = 0.66) and ISS (20.5 and 23, P = 0.45). The area under the curve, calculation, to account for time less than goal and MAP difference from goal, in the No Improvement group was significantly higher (lower and more time below MAP goal) compared to the Improvement group for the first 12 h (40.3 v. 26.1 P = 0.03) with similar findings in the subsequent 12 h of treatment (13–24 h; 62.2 vs 43, P = 0.09). There was no difference between the groups in the subsequent 72 h (25–96 h; 156.4 vs 136.6, P = 0.57). Conclusions: Hyperperfusion to the spinal cord in the first 12 h correlated significantly with improved neurological outcome in SCI patients.

Impact of Dietary Nitrate on the Recovery of Therapy-related Vascular Health Impairments Following Standard Periodontal Aftercare Therapy: a Hypothesis-generating Subanalysis.

This follow-up study assessed the impact of a nitrate-rich diet on salivary nitrate/nitrite levels and the recovery of therapy-induced vascular impairments in a cohort of 39 periodontitis patients treated by standard subgingival mechanical plaque removal (PMPR). At baseline, saliva samples for nitrate/nitrite analysis were collected, and peripheral/central blood and augmentation pressure was documented using the Arteriograph® recording system. Immediately after, PMPR vascular parameters were reassessed. All study patients received a randomly allocated supply of a lettuce beverage to be consumed for 14 days, containing either a daily dosage of 200 mg nitrate (test group, n = 20) or being void of nitrate (placebo group, n = 19). At day 14, salivary and vascular parameters were reassessed. Initial salivary and vascular parameters did not differ significantly between the groups. PMPR impaired all vascular parameters in both groups with no differences between the groups. At day 14, salivary nitrate/nitrite levels of the test group were significantly elevated compared to baseline. All vascular parameters had significantly recovered from the impairment inflicted by PMPR. In the placebo group, by contrast, salivary parameters did not differ significantly from baseline, and the recovery of impaired vascular parameters was restricted to a significant improvement of diastolic blood pressure. Correlation analysis identified a significant inverse correlation between salivary nitrate/nitrite sum and central/peripheral blood pressure and augmentation pressure. In conclusion, the data of this subanalysis suggest that increasing salivary nitrate/nitrite levels by a diet rich in nitrate may improve recovery of therapy-induced vascular impairments after PMPR.

Association of time-restricted feeding, arterial age, and arterial stiffness in adults with metabolic syndrome.

Time-restricted feeding (TRF) is a kind of intermittent fasting defined as eating and drinking only during a certain number of hours in a day. It has been suggested that intermittent fasting may improve cardiovascular risk factors. This study evaluated the association of TRF and arterial stiffness, using pulse wave velocity (PWV), pulse wave analysis, and arterial age in metabolic syndrome participants. A cohort study was carried out among metabolic syndrome adults who were followed over the Ramadan fasting period (used as a model of TRF since food was only allowed for about 8 h/day). The subjects were divided into Ramadan fasting and Ramadan nonfasting groups. The aortic PWV and central aortic pressure waveform were measured. Central systolic pressure, central pulse pressure, and indices of arterial compliance, such as augmentation pressure and augmentation index (AIx), were determined from waveform analysis. Ninety-five adults (31.57% female, age: 45.46 ± 9.10 years) with metabolic syndrome (based on the International Diabetes Federation definition) participated in this study. Ramadan fasting and Ramadan nonfasting groups were including 80 and 15 individuals respectively. A significant reduction was seen in PWV (0.29 m/s), central systolic pressure (4.03 mmHg), central pulse pressure (2.43 mmHg), central augmentation pressure (1.88 mmHg), and central AIx (2.47) in the Ramadan fasting group (p = 0.014, p < 0.001, p = 0.001, p = 0.003, and p = 0.036 respectively). There were no significant changes in these indices among the Ramadan nonfasting group. This study suggested that TRF reduces arterial age and improves arterial stiffness among people with metabolic syndrome. This might be considered a beneficial nutrition strategy for extending healthspan (and perhaps longevity).

Nonlinear entropy stable Riemann solver with heuristic logarithmic pressure augmentation for supersonic and hypersonic flows

Nonlinear entropy stable Riemann solver with heuristic logarithmic pressure augmentation for supersonic and hypersonic flows

Correlation between pulse wave analysis parameters and left atrial strain and left ventricular myocardial work indices in patients with grade one hypertension

Abstract Funding Acknowledgements Type of funding sources: None. Introduction Central arterial blood pressure and wave reflection characteristics are independent predictors of cardiovascular morbidity and mortality. Pulse wave analysis (PWA) can non-invasively assess these central hemodynamic indices, by deriving central aortic waveform from brachial waveform, and allowing evaluation of central systolic pressure (CSP), Pulse Pressure (PP), augmentation pressure (AP) and augmentation index (AIx), defined as the ratio of AP to central pulse pressure (PP). These parameters are thought to relate to reflected pressure waves. Purpose To investigate whether central hemodynamic indices can impact on left atrial (LA) and left ventricular (LV) performance in patients with grade one hypertension. Materials and Methods 80 pts (male 39; mean age 41 ± 13 years) were prospectively enrolled, distinguishing between not-hypertensives(n=40; male 21; mean age 39 ± 10 years)and newly diagnosed grade one hypertensives(n=40; male 18; mean age 42 ± 11 years), not yet under treatment. All underwent PWA measurement through a standard brachial cuff for measuring CSP (mmHg), PP (mmHg), AP (mmHg), Aix (%) and augmentation index normalized to 75 bpm heart rate (AIx75%). At the same time a complete transthoracic echocardiogram was performed, and LA strain and LV myocardial work parameters were calculated. Results Hypertensives have higher LV mass index(73±16 vs 70±24;p = 0,4) but without any significant difference. On the other hand, hypertensives have significantly higher values of LA volume index (LAVi) (25±6 vs 19±7 ml/mq;p = 0,02). LV global longitudinal strain (GLS) values (−19,4±2 vs −20,3±1,7 %;p = 0,1) don't statistically differ between the two groups. Global work efficiency (GWE) is reduced in Hypertensives than in controls (94±2 vs 96±1,2 %;p = 0,003), while Global wasted work (GWW) is higher in Hypertensives than in controls (146±75 vs 85±27 mmHg%; p = 0,02). Higher values of LAVi are associated with higher values of CSP (r=0,4;p&amp;lt;0,0001), PP (r=0,3;p = 0,01), AP (r=0,4;p&amp;lt;0,0001); Aix (r=0,3;p&amp;lt;0,0001) and Aix75% (r=0,3;p = 0,01). LA reservoir inversely correlates to AP (r=-0,3;p = 0,01), Aix (r=-0,3;p = 0,01) and Aix75% (r=-0,3;p = 0,02). LV mass index directly correlates with PP (r=0,3;p = 0,01), Aix (r=0,3; p = 0,001), AIx75% (r=0,3; p = 0,01) and AP (r=0,4; p&amp;lt;0,0001). Central systolic pressure directly correlates with GLS (r=0,3; p = 0,001) and GWW (r=0,5;p&amp;lt;0,0001) and inversely correlates with GWE (r=-0,5;p&amp;lt;0,0001). Higher values of augmentation pressure are associated with lower values of GWE (r=-0,3;p = 0,01). Higher diastolic dysfunction degrees are associated with higher values of CSP (r=0,5;p&amp;lt;0,0001), PP (r=0,5; p&amp;lt;0,0001), AP (r=0,4;p = 0,0001); Aix (r=0,3; p = 0,002) and Aix75%(r=0,4; p&amp;lt;0,0001). Conclusions: Higher central pressure and reflected pressure waves can impact on LA and LV function leading to an early damage that can be correctly identified by an integrated approach between PWA and Advanced Echocardiography.

#6184 PULSE WAVE VELOCITY AND AMBULATORY BLOOD PRESSURE IN PATIENTS WITH RENAL HYPERFILTRATION

Abstract Background and Aims Recent studies have been implicated that abnormally increased glomerular filtration rate, defined as renal hyperfiltration, may be a risk factor for the development of renal damage and cardiovascular disease. Herein, we aimed to investigate the possible relationship between renal hyperfiltration(RHf) and pulse wave velocity, ambulatory blood pressure measurements and clinical parameters. Method All individuals included the study were between 18 and 65 years old. The eGFR (CKD-EPI) values of above 140 ml/min/1.73 m² were defined as RHf. Nineteen individuals in the renal hyperfiltration group and 20 in the control group were included. Blood and urine samples of the cases were examined. The individuals with diabetes, obesity, pregnancy, hypertension, cardiovascular disease, peripheral artery disease, cerebrovascular disease, chronic rheumatological disease, and thyroid dysfunction were excluded from the study. The parameters related arterial stiffness and ambulatory blood pressure measurements were obtained in all cases. The results were analyzed statistically. Results The two groups were similar in terms of gender, age, BMI and smoking. In RHf group, total cholesterol, 24-hour urine proteinuria and albuminuria, SBP, DBP, MAP and PP values ​​were found higher than control group. Interestingly, the differences of “night time” measurements of all these hemodynamic parameters were more pronounced in RHf group. The trend of “non-dipper” pattern was to be higher in the hyperfiltration group. In arterial stiffness parameters the augmentation pressure (AP), central systolic pressure (CSP), reflection magnitude (RM), central diastolic pressure (CBP), and pulse pressure amplification (PPA) were found significantly different. Pearson's corelation analysis revealed that AP, CSP, CBP was the positively; RM was negatively correlated with eGFR in hyperfiltration group (Table 1 and 2). Multivariate linear regression analysis revealed that AP, 24-hour proteinuria and mean arterial pressure were the independent parameters related to hyperfiltration. Logistic regression showed that only AP was an independent predictor of hyperfiltration (p = 0.001, OR = 0.84; 0.757-0.935, CI 95%). Conclusion We found that augmentation pressure is the most important independent parameter correlated with RHf among arterial stiffness measurements. The vascular risk may be increased in this population.

#4211 PULSE WAVE VELOCITY AND ERECTILE DYSFUNCTION IN PATIENTS WITH CHRONIC KIDNEY DISEASE

Abstract Background and Aims Erectile dysfunction is a frequent problem and adversely affects quality of life. In recent years, it has been shown to be an early indicator of cardiovascular disease and endothelial damage. For patients with chronic kidney disease, the incidence of cardiovascular events is increased, while erectile dysfunction is also more frequent. In this study we evaluated in patients with chronic kidney disease the incidence and the association of erectile dysfunction with pulse wave velocity (PWV) and reflection wave parameters. Method The incidence of erectile dysfunction was examined with the use of IIEF (5) Sexual Health Questionnaire in adult male patients aged less than 65 years with chronic kidney disease stage I-V or a history of kidney transplantation that were actively monitored or treated as outpatients. Peripheral blood pressure, central blood pressure, PWV and reflection wave parameters (augmentation pressure and augmentation index) were evaluated using the Mobil-o-graph device in office measurements. Results Overall, 69 men with a mean age of 46.5 ± 11.79 years were included in the study. Chronic kidney disease (CKD) classification according to baseline eGFR calculation was as follows: 12 patients with CKD-I, 27 with CKD-II, 12 with CKD-III, 6 with CKD-IV and 12 with CKD-V on maintenance hemodialysis. Erectile dysfunction of all degrees (mild to severe) was detected in 52% of patients. From the correlation of the various parameters assessed with the degree of erectile function, as calculated by the IIEF questionnaires, it was found that renal function as expressed by eGFR showed a positive correlation (r = 0.24, p = 0.047), while age and PWV showed a negative correlation (r = -0.384, p = 0.002 and r = -0.474, p&amp;lt;0.001 respectively). Moreover, pulse wave velocity was the only parameter which could predict erectile dysfunction (β = -0.995, 95% CI -0.465 to -10.074, p = 0.032). Conclusion The results of the study showed that worsening kidney function is associated with an increase in arterial stiffness and an increase in the incidence of erectile dysfunction. Moreover, erectile dysfunction was more common in patients with increased PWV.