Pulse Pressure Index Research Articles

Examination of nonlinear associations between pulse pressure index and incident prediabetes susceptibility: a 5-year retrospective cohort investigation

Prediabetes and related complications constitute significant public health burdens globally. As an indicator closely associated with abnormal glucose metabolism and atherosclerosis, the utility of Pulse Pressure Index (PPI) as a prediabetes risk marker has not been explored. We performed a retrospective cohort analysis to investigate this putative association between PPI and prediabetes hazard. Our analysis encompassed 183,517 Chinese adults ≥ 20 years registered within the Rich Healthcare Group 2010–2016. PPI was defined as (systolic blood pressure − diastolic blood pressure)/systolic blood pressure. The relationship between PPI and prediabetes risk was assessed via Cox proportional hazards regression modeling. Non-linearity evaluations applied cubic spline fitting approaches alongside smooth curve analysis. Inflection points of PPI concerning prediabetes hazard were determined using two-piecewise Cox models. During a median follow-up of 3 years (2.17–3.96 years), new-onset prediabetes was documented in 20,607 patients (11.23%). Multivariate regression analysis showed that PPI was an independent risk factor for prediabetes, and the risk of prediabetes increased by 0.6% for every 1% increase in PPI (Hazard Ratio [HR]: 1.006, 95% Confidence Interval [CI] 1.004–1.008, P < 0.001). This association was non-significant for PPI ≤ 37.41% yet exhibited a sharp upsurge when PPI surpassed 37.41% (HR: 1.013, 95% CI 1.005–1.021, P = 0.0029). Our analysis unveils a positive, non-linear association between PPI and future prediabetes risk. Within defined PPI ranges, this relationship is negligible but dramatically elevates beyond identified thresholds.

The Impact of Sex and Arterial Stiffness Interactions on the Outcome after an Acute Ischemic Stroke: A Retrospective Cohort Study.

Background/Objectives: Arterial stiffness (AS) is an independent predictor of cardiovascular events and is associated with a poor prognosis. While AS may represent a novel therapeutic target, recent evidence shows that it is sexually dimorphic. The aim of this study was to evaluate relative sex differences in arterial stiffness and their possible impact on the outcome of acute ischemic stroke. Methods: We retrospectively evaluated a cohort of adult patients with the following inclusion criteria: acute ischemic stroke, which occurred within 24 h from the onset of symptoms, confirmed through neuroimaging examinations, additional evaluations including extracranial and transcranial arterial ultrasound examinations, transthoracic echocardiography, a 12-lead resting ECG, and continuous 24 h in-hospital blood pressure monitoring. Based on the 24 h blood pressure monitoring, the following parameters were evaluated: systolic blood pressure, diastolic blood pressure, mean blood pressure, pulse pressure, and arterial stiffness index (ASI). The modified Rankin scale (mRS) was assessed at 90 days to evaluate the 3-month clinical outcome, defining an unfavorable outcome as an mRS score ≥ 3. To assess the factors associated with unfavorable outcomes, a stepwise logistic regression model was performed on the total sample size, and the analyses were replicated after stratifying by sex. Results: A total of 334 patients (176 males, 158 females) were included in the analysis. There was a significant sex-dependent impact of ASI on the 90-day unfavorable Rankin score (mRS score ≥ 3) as only men had a reduced likelihood of favorable outcomes with increasing arterial stiffness (OR:1.54, 95% CI: 1.06-2.23; P-interaction = 0.023). Conclusions: The influence of ASI on the 3-month functional outcome after acute ischemic stroke is at least in part sex-related, suggesting that, in males, higher ASI values are associated with a worse outcome.

Assessing the relationship between lipoprotein(a) levels and blood pressure among hypertensive patients beyond conventional measures. An observational study

High lipoprotein(a) (Lp(a)) levels are associated with an increased risk of arterial hypertension (AHT) and atherosclerotic cardiovascular disease. However, little is known about the detailed profile of AHT based on Lp(a) levels. This observational study focused on elucidating the relationship between Lp(a) concentrations and specific indices obtained from 24-h ambulatory blood pressure (BP) monitoring in hypertensive patients over 18 years of age. We gathered and analyzed data on BP indices along with demographic, epidemiological, clinical, and laboratory variables from 227 hypertensive patients, median age 56 years, including 127 women (56%). After comparing hypertensive patients with Lp(a) levels above and below 125 nmol/L, we found that a 10 mmHg increase in nocturnal systolic BP and all pulse pressure indices (24-h, daytime, and night-time) was associated with an increased risk of high Lp(a) levels by more than 20% and 40%, respectively. Similarly, each 10% increase in the area under the function over time of nocturnal diastolic BP dipping was associated with more than a 30% decrease in the odds of belonging to the elevated Lp(a) levels category. Additionally, Lp(a) levels above 125 nmol/L were associated with higher 24-h, daytime, and night-time systolic BP and pulse pressure load. The relationship between Lp(a) and AHT appears to extend beyond conventional BP measurements, which may be relevant given the prognostic implications of nocturnal BP and pulse pressure indices.

Predictors of length of hospital stay and in-hospital adverse events in patients with acute decompensated heart failure: in-hospital 24-hour blood pressure monitoring data

ObjectiveNeurohumoral alterations in heart failure (HF) affect blood pressure variability (BPV) and vascular compliance, but little is known about this subject among patients admitted to the hospital with decompensated HF. This study sought to investigate in-hospital 24-h blood pressure monitoring (BPM)–derived BPV parameters and vascular compliance in patients with decompensated HF and explore the association of these parameters with hospitalization length and in-hospital adverse events. MethodsA 24-h BPM was applied during the first 6 h of admission to the hospital in patients with decompensated HF. Circadian patterns were determined by the study patients. Average real variability (ARV), pulse pressure index (PPI), pulse stiffening ratio (PSR), and ambulatory arterial stiffness index (AASI) values were calculated from in hospital 24-h BPM recordings. Admission and discharge N-terminal pro–B-type natriuretic peptide (NT-proBNP) levels, length of hospitalization, and in-hospital adverse events were recorded. ResultsA total of 167 patients with decompensated HF were included in the study. The dipper group exhibited a greater NT-proBNP decrease with the treatment than the non-dipper group and reverse dipper group. Hospitalization length was shorter in the dipper group than in the non-dipper and reverse dipper groups. Although ARV, AASI, and PSR were independently associated with the length of hospitalization, ARV, AASI, and PPI were independently associated with in-hospital adverse events. ConclusionThe post-admission in hospital 24-h BPM-derived parameters (dipper pattern, ARV, PPI, PSR, and AASI) of patients admitted to hospital with decompensated HF provide important prognostic information and predict the length of hospital stay.

#1853 Comparative analysis of atherosclerotic risk factors in dialysis patients

Abstract Background and Aims Prevailing studies indicate a correlation between elevated serum phosphate levels and an augmented incidence of cardiovascular events. In patients undergoing dialysis, hyperphosphatemia contributes to vascular and valvular calcifications. This study analyzes the interrelation of phosphate levels, inflammatory markers, and additional risk determinants in the development of carotid artery atherosclerosis in individuals receiving peritoneal dialysis (PD) versus hemodialysis (HD). Method A cohort of 39 PD and 53 HD patients were recruited, all undergoing stable renal replacement therapy (RRT) for three to thirty-six months. B-mode ultrasonography assessed the carotid artery intima-media thickness (CIMT) and detected plaque and calcification occurrences. Patients were specified as having atherosclerosis when CIMT was greater than 1 cm, and the presence of plaque was identified. Logistic regression analysis was employed to discern the connection between potential risk factors and the incidence of atherosclerosis. Results The study encompassed 92 participants, 61% undergoing HD and an average age of 53.4 years (standard deviation ± 14.5 years). The tubulo-interstitial disease was the predominant initial pathology, followed by chronic glomerulonephritis and nephroangiosclerosis. Diabetic nephropathy was identified as the etiology of end-stage renal disease (ESRD) in 23.1% of PD and 11.4% of HD subjects (p = 0.047). Notably, PD patients showed better residual renal function (RRF) (p &amp;lt; 0.001), urine volume over 24 hours (p &amp;lt; 0.001), and C-reactive protein (CRP) (p = 0.047), alongside diminished phosphate (p = 0.01), parathyroid hormone (PTH) (p &amp;lt; 0.05), alkaline phosphatase (p &amp;lt; 0.05), and albumin levels (p &amp;lt; 0.001) relative to their HD counterparts. Atherosclerosis prevalence was 66.3%, inclusive of the entire diabetic cohort. The incidence of atherosclerosis did not significantly diverge between PD and HD groups [56.4% vs 73.6% in HD, respectively]. Atherosclerotic patients were older (p &amp;lt; 0.001) and exhibited heightened phosphate levels (p = 0.012), pulse pressure (p = 0.01), and calcium index (Ci) (p = 0.034). Multiple regression analysis elucidated age, phosphate, RRF, PTH, pulse pressure, diabetes, and HD modality as autonomous factors linked to atherosclerosis. Conclusion Beyond conventional risk factors like age and diabetes, metabolic disorders arising from renal insufficiency were identified as contributing to atherosclerotic development. Multivariate analysis identified phosphate, RRF, and pulse pressure (PP) as independent atherosclerotic risk factors. The HD modality carried an elevated atherosclerotic risk compared to PD. It was thought that preserving RRF in PD patients would improve phosphate regulation and maybe even improve endothelial function, explaining the differences found.

Pulse Pressure Index as an Indicator of Risk for Cardiovascular Disease, Chronic Kidney Disease, and Diabetes Mellitus in Korean Adults with Hypertension: the 8th Korea National Health and Nutrition Examination Survey, 2019–2021

Pulse Pressure Index as an Indicator of Risk for Cardiovascular Disease, Chronic Kidney Disease, and Diabetes Mellitus in Korean Adults with Hypertension: the 8th Korea National Health and Nutrition Examination Survey, 2019–2021

Obesity-Related Hemodynamic Alterations in Patients with Cushing's Disease.

Background: Cushing's disease (CD) is associated with a specific form of metabolic syndrome that includes visceral obesity, which may affect cardiovascular hemodynamics by stimulating hypercortisolism-related metabolic activity. The purpose of this study was to evaluate the relationship between obesity and the hemodynamic profile of patients with CD. Methods: This prospective clinical study involved a hemodynamic status assessment of 54 patients newly diagnosed with CD with no significant comorbidities (mean age of 41 years). The assessments included impedance cardiography (ICG) to assess such parameters as stroke index (SI), cardiac index (CI), velocity index (VI), acceleration index (ACI), Heather index (HI), systemic vascular resistance index (SVRI), and total arterial compliance index (TACI) as well as applanation tonometry to assess such parameters as central pulse pressure (CPP) and augmentation index (AI). These assessments were complemented by echocardiography to assess cardiac structure and function. Results: Compared with CD patients without obesity, individuals with CD and obesity (defined as a body mass index ≥ 30 kg/m2) exhibited significantly lower values of ICG parameters characterizing the pumping function of the heart (VI: 37.0 ± 9.5 vs. 47.2 ± 14.3 × 1*1000-1*s-1, p = 0.006; ACI: 58.7 ± 23.5 vs. 76.0 ± 23.5 × 1/100/s2, p = 0.005; HI: 11.1 ± 3.5 vs. 14.6 ± 5.5 × Ohm/s2, p = 0.01), whereas echocardiography in obese patients showed larger heart chamber sizes and a higher left ventricular mass index. No significant intergroup differences in blood pressure, heart rate, LVEF, GLS, TACI, CPP, or AI were noted. Conclusions: Hemodynamic changes associated with obesity already occur at an early stage of CD and manifest via significantly lower values of the ICG parameters illustrating the heart's function as a pump, despite the normal function of the left ventricle in echocardiography.

The influence of carotid plaque on carotid artery stiffness indicators in hypertensive patients with and without accompanying type 2 diabetes

Aim. To compare the elastic properties of the common carotid arteries (CCA) in patients with stage II hypertension (HTN) depending on the presence of diabetes mellitus (DM) and atherosclerotic plaque (ASP) &lt;50 % of carotid arteries (CA). Materials and methods. The study included 80 patients with stage II HTN, 43 of them without type 2 DM, 37 with type 2 DM, average age – 57.7, 55.3 % men. Basic anthropometric data, laboratory indicators of lipid and carbohydrate metabolism, creatinine, data of daily blood pressure monitoring, echocardiography, intima-media thickness, local stiffness indicators: artery diameter, distensibility, the distensibility coefficient (DC), and compliance coefficient (CC), stiffness indices α, β, local pulse wave velocity (PWV), pressure and augmentation index (using radiofrequency-based technologies) were studied. Statistical analysis was performed; the probability of differences is at the level of p &lt; 0.05. Results. The prevalence of ASP in the carotid basin in the group of patients with HTN without DM was 51.1 %, with DM – 54.0 % (p = 0.79). While comparing the elastic properties of CCA of patients without ASP, no reliable similarities were found in the studied indicators. In patients with HTN, accompanying type 2 DM with ASP, the diameter of the CCA was significantly larger by 11.8 % (p = 0.03), and the CC was also higher by 23.6 % (p = 0.049) than in patients with HTN without DM. In patients with HTN with and without DM the limit levels for the intima-media thickness of the left CCA associated with the presence of atheroma were determined, however, the comparison of the areas under the ROC curves did not reveal a statistical difference in the cut-off values in the studied groups (р = 0.681). Conclusions. A feature of CCA remodeling in HTN patients with DM at the stage of ASP presence should be considered a more substantial increase in the diameter of the CCA with preservation of the distensibility of the plaque-free vascular wall. The addition of a second factor (DM) to one risk factor (HTN) is not accompanied by a further statistically significant increase in IMT as a mandatory prerequisite for the appearance of ASP.

Dependence of local carotid arterial stiffness on the presence of atherosclerotic plaque in the carotid basin in hypertensive patients

Aim. To evaluate the viscoelastic properties of the common carotid arteries (CCA) in patients with stage II hypertension (HTN) and to compare these indicators between groups with and without carotid artery (CA) stenosis &lt;50 %. Materials and methods. The study included 48 patients with stage II HTN, mean age – 55.9 years, 45.8 % men. Basic anthropometric data, laboratory parameters of lipid and carbohydrate metabolism, creatinine, quality intima-media thickness (QIMT), local stiffness indicators: artery diameter, distensibility, distensibility coefficient (DC), compliance coefficient (CC), stiffness indices α, β, local pulse wave velocity (PWV), pressure and augmentation index (using RF-QIMT, RF-QAS technologies) were studied. Statistical analysis was performed, p values of &lt; 0.05 were considered statistically significant. Results. CA atheromas with stenosis up to 50 % were found in 48 % of the examined, they were older with higher parameters of vessel diameter by 4.6 %, QIMT – by 12.5 %, α index – by 28.0 %, β index – by 27.7 %, and PWV – by 14.7 %. A medium-strength positive correlation has been revealed for age, QIMT, HDL, creatinine level and local stiffness parameters (distensibility, CC, PWV, indices α, β). The atherosclerotic plaque (ASP) presence in the CA was associated with the limit levels of the left CCA QIMT over 698 μm (sensitivity 65.2 %, specificity 86.6 %, p &lt; 0.01), of the right – over 598 μm (sensitivity 73.9 %, specificity 66.6 %, p &lt; 0.01). However, a greater dependence on age than on the presence of atheroma has been proven. At the same time, the odds ratio of the ASP presence was 2.99-fold higher (p = 0.0065) with an increase in the CCA diameter of more than 7.94 mm, and in the multivariate model incorporating age – 2.6-fold higher (p = 0.036), while age has not impacted significantly (p = 0.301) the prognosis. Conclusions. In individuals with stage II HTN, the presence of CA atherosclerosis with stenosis up to 50 % is associated with a significant increase in vessel diameter regardless of age. CCA intima media thickness depends more on the age of hypertensive patients.

Association between blood pressure and dementia in older adults: a cross-sectional study from China.

The association between blood pressure (BP) and dementia in older adults remains unclear, prompting this study to investigate the relationship between various BP indicators and dementia in this population. A cross-sectional survey was conducted in 2019, including 3,599 participants aged 65 years or older. The basic demographic characteristics of participants were collected. BP measurements and neuropsychological assessments were performed. From the systolic BP (SBP) and diastolic BP (DBP) values, mean arterial pressure (MAP), pulse pressure (PP) and blood pressure index (BPI) were calculated. Generalized additive models and logistic regression models were used to analyze the association between BP indicators and dementia. Generalized additive models identified a U-shaped relationship between DBP and dementia, which was more significant in males and people 70 years of age and older. The optimal DBP associated with the lowest dementia risk was 85 mmHg. Logistic regression models revealed that compared to the DBP subgroup (80-89 mmHg), participants in the DBP < 80 mmHg subgroup and the DBP ≥100 mmHg subgroup had OR for dementia of 1.611 (95% CI: 1. 252-2.073, P < 0.001) and 1.423 (95% CI: 0.999-2.028, p = 0.050), respectively. A significant association was observed between BPI and dementia (OR:1.746 95% CI: 1.142-2.668, p = 0.010). In older adults, we found a U-shaped relationship between DBP and dementia, and a linear relationship between BPI and dementia. These results underscore the importance of considering DBP and BPI in BP management strategies for older adults to potentially prevent or delay dementia onset.

Early Abnormal Vital Signs Predict Poor Outcomes in Normotensive Patients Following Penetrating Trauma

IntroductionBecause trauma patients in class II shock (blood loss of 15%-30% of total blood volume) arrive normotensive, this makes the identification of shock and subsequent prognostication of outcomes challenging. Our aim was to identify early predictive factors associated with worse outcomes in normotensive patients following penetrating trauma. We hypothesize that abnormalities in initial vital signs portend worse outcomes in normotensive patients following penetrating trauma. MethodsA retrospective review was performed from 2006 to 2021 using our trauma database and included trauma patients presenting with penetrating trauma with initial normotensive blood pressures (systolic blood pressure ≥90 mmHg). We compared those with a narrow pulse pressure (NPP ≤25% of systolic blood pressure), tachycardia (heart rate ≥100 beats per minute), and elevated shock index (SI ≥ 0.8) to those without. Outcomes included mortality, intensive care unit admission, and ventilator use. Chi-squared, Mann–Whitney tests, and regression analyses were performed as appropriate. ResultsWe identified 7618 patients with penetrating injuries and normotension on initial trauma bay assessment. On univariate analysis, NPP, tachycardia, and elevated SI were associated with increases in mortality compared to those without. On multivariable logistic regression, only NPP and tachycardia were independently associated with mortality. Tachycardia and an elevated SI were both independently associated with intensive care unit admission. Only an elevated SI had an independent association with ventilator requirements, while an NPP and tachycardia did not. ConclusionsImmediate trauma bay NPP and tachycardia are independently associated with mortality and adverse outcomes and may provide an opportunity for improved prognostication in normotensive patients following penetrating trauma.

Diagnostic and Predictive Value of Brachial–Ankle Pulse Wave Velocity and Pulse Pressure Index for Coronary Heart Disease in Elderly Patients With Hypertension

Abstract OBJECTIVE To explore the diagnostic and predictive value of pulse pressure index (PPI) and brachial–ankle pulse wave velocity (baPWV) for coronary heart disease (CHD) in elderly patients with hypertension. METHODS A total of 307 elderly patients who had chest pain or chest distress and coronary angiography were enrolled. According to the Gensini score, patients with CHD (n = 260) were divided into low-risk group (&amp;lt;20 points, n = 96), moderate-risk group (20–40 points, n = 80), and high-risk group (&amp;gt;40 points, n = 84). baPWV was measured using an ankle–brachial index and pulse wave measuring device. Multivariate logistic regression analysis was used to analyze the risk factors of CHD. Receiver operating characteristic (ROC) curve was used to evaluate the diagnostic value of baPWV and PPI for CHD. RESULTS PPI and baPWV of elderly hypertensive patients with CHD at low, moderate, and high risk were higher than those without CHD [PPI: 0.43 ± 0.04, 0.45 ± 0.04, 0.45 ± 0.05 vs. 0.41 ± 0.05, F = 31.768, P &amp;lt; 0.001; baWV: 1,671 (1,587–1,755), 1,717 (1,597–1,843), 1,780 (1,661–1,960) vs. 1,570 (1,477–1,699) cm/s, X2 = 60.918, P &amp;lt; 0.001]. With the increase in CHD severity, the PPI and baPWV were significantly increased (P &amp;lt; 0.05). Spearman/Pearson correlation analysis showed that the Gensini score was positively correlated with baPWV and PPI, respectively (both P &amp;lt; 0.001). Multivariate logistic regression analysis showed that baPWV, PPI, and systolic blood pressure were the influencing factors of CHD in hypertensive patients. The areas under the ROC curve (95% CI) of baPWV, PPI, and their combination for diagnosing CHD were 0.792 (0.723–0.861), 0.708 (0.625–0.792), and 0.837 (0.779–0.895), respectively, and was significantly different between baPWV or PPI alone and the combination of the 2 (Z = −2.178, P = 0.029; Z = −3.330, P = 0.001). CONCLUSIONS Elevations of baPWV and PPI are positively correlated with the severity of CHD. Both baPWV and PPI have a diagnostic and predictive value for CHD in elderly hypertensive patients, and the combination of baPWV and PPI is more accurate.

Abstract 15999: Proportional Pulse Pressure and Shock Index as Predictors of Cardiac Index in Patients With Intermediate-Risk Pulmonary Embolism

Background: Risk stratification in intermediate-risk pulmonary embolism (PE) plays an important role in appropriate selection of therapies, however this is often challenging given variable phenotype. Proportional pulse pressure (PPP) and shock index (SI) have demonstrated to accurately predict cardiac index (CI) in patients with cardiogenic shock. Nonetheless, their applicability to patients with acute PE remains uncertain. Our objective is to investigate whether PPP and SI correlate with invasive assessment of CI in intermediate-risk PE. Methods: We retrospectively analyzed patients included in the Pulmonary Embolism Response Team (PERT) registry at NYCH+H/Bellevue who underwent invasive hemodynamic assessment. PPP was calculated as systolic blood pressure - diastolic blood pressure/systolic blood pressure. SI was calculated as heart rate/systolic blood pressure. Linear regression and correlation coefficients were used to examine the relationship between PPP, SI and CI as well as other clinical variables. Results: A total of 45 intermediate-risk PE patients were included (mean age was 57 ± 13 years and 43% were female). The SI moderately correlated with the composite pulmonary embolism shock score (CPES) (r = 0.5, p=0.0002), sPESI (r = 0.37, p=0.007), cardiac index (-0.42, p=0.004) and poorly correlated with lactate levels (r=0.23, p=0.18). PPP correlated poorly with CPES (r = 0.01, p=0.96), sPESI (r = -0.04, p=0.73), CI (r = 0.1 p=0.51) and lactate (-0.18, p=0.2). There was poor correlation between SI and PPP (r = -0.17, p=0.23). For every 0.1 increase in the shock index, the cardiac index was lower by 0.17L/minute/m 2 (p=0.017). Conclusions: In patients with intermediate-risk PE, a higher SI was associated with a lower CI, while PPP was not associated with CI. SI may provide additional valuable information to risk-stratify patients with acute PE and can potentially assist clinicians in triaging monitoring level therapeutic decisions.

EXPLORING THE ROLE OF CENTRAL VENOUS OXYGEN SATURATION IN THE EVALUATION AND MANAGEMENT OF SEVERE HYPOXEMIA IN MECHANICALLY VENTILATED PATIENTS.

Background: Although central venous oxygen saturation (ScvO 2 ) has been used as an endpoint for the treatment of circulatory shock, its role in guiding the evaluation and treatment of patients with severe hypoxemia remains to be assessed. The aim of this study was to assess the incidence of low ScvO 2 in a cohort of hypoxemic patients and the association of this finding with differences in clinical management and patient outcomes. Methods: Retrospective review of data from adult intensive care unit patients with hypoxemia who required invasive mechanical ventilation for over 24 h and had at least one ScvO 2 measured within 6 h of a PaO 2 /FiO 2 ratio <200. Results: Of 442 mechanically ventilated patients with severe hypoxemia, 249 (56%) had an ScvO 2 <70%. When compared with patients with ScvO 2 ≥70%, those with low ScvO 2 had worse systemic oxygenation and hemodynamic parameters and were more likely to receive red blood cell transfusions (31.7% vs. 18.1%, P = 0.001), epinephrine (27.3% vs. 16.6%, P = 0.007), and inodilators. Outcomes such as median intensive care unit length of stay (7.5 vs. 8.3 days, P = 0.337) and hospital mortality (39.8% vs. 35.7%, P = 0.389) were not different between groups. When stratified by the central venous-to-arterial CO 2 difference (∆PCO 2 ), patients with a low ScvO 2 and normal ∆PCO 2 had lower median PaO 2 and hemoglobin levels and received more red blood cell transfusions, whereas those with an increased ∆PCO 2 had a lower pulse pressure and cardiac index and were more likely to receive epinephrine and milrinone. Conclusion: Low ScvO 2 is frequently observed in mechanically ventilated patients with severe hypoxemia, and these patients receive different interventions. Clinicians often use therapies targeting systemic oxygen delivery to correct low ScvO 2 . Prospective research is needed to identify patients with severe hypoxemia that might benefit from interventions targeting systemic oxygen delivery.

Risk factors for high CAD-RADS scoring in CAD patients revealed by machine learning methods: a retrospective study.

This study aimed to investigate a variety of machine learning (ML) methods to predict the association between cardiovascular risk factors and coronary artery disease-reporting and data system (CAD-RADS) scores. This is a retrospective cohort study. Demographical, cardiovascular risk factors and coronary CT angiography (CCTA) characteristics of the patients were obtained. Coronary artery disease (CAD) was evaluated using CAD-RADS score. The stenosis severity component of the CAD-RADS was stratified into two groups: CAD-RADS score 0-2 group and CAD-RADS score 3-5 group. CAD-RADS scores were predicted with random forest (RF), k-nearest neighbors (KNN), support vector machines (SVM), neural network (NN), decision tree classification (DTC) and linear discriminant analysis (LDA). Prediction sensitivity, specificity, accuracy and area under the curve (AUC) were calculated. Feature importance analysis was utilized to find the most important predictors. A total of 442 CAD patients with CCTA examinations were included in this study. 234 (52.9%) subjects were CAD-RADS score 0-2 group and 208 (47.1%) were CAD-RADS score 3-5 group. CAD-RADS score 3-5 group had a high prevalence of hypertension (66.8%), hyperlipidemia (50%) and diabetes mellitus (DM) (35.1%). Age, systolic blood pressure (SBP), mean arterial pressure, pulse pressure, pulse pressure index, plasma fibrinogen, uric acid and blood urea nitrogen were significantly higher (p<0.001), and high-density lipoprotein (HDL-C) lower (p<0.001) in CAD-RADS score 3-5 group compared to the CAD-RADS score 0-2 group. Nineteen features were chosen to train the models. RF (AUC = 0.832) and LDA (AUC = 0.81) outperformed SVM (AUC = 0.772), NN (AUC = 0.773), DTC (AUC = 0.682), KNN (AUC = 0.707). Feature importance analysis indicated that plasma fibrinogen, age and DM contributed most to CAD-RADS scores. ML algorithms are capable of predicting the correlation between cardiovascular risk factors and CAD-RADS scores with high accuracy.

Relationship between pulse pressure and body mass index in active-duty Royal Thai Army personnel in Thailand

BackgroundElevated pulse pressure (PP) is a robust independent predictor of cardiovascular diseases. The relationship between PP and body mass index (BMI) was presented in a few studies. However, the findings were inconsistent. Therefore, the aim of the present study is to identify the association between elevated PP and BMI using a large sample of active-duty Royal Thai Army (RTA) personnel.MethodsA cross-sectional study was conducted through the use of the dataset obtained from the annual health examination database of RTA personnel in Thailand in 2022. BMI 25.0–29.9 kg/m2 was classified as obesity I, whereas BMI ≥ 30.0 kg/m2 was classified as obesity II. Elevated PP was defined as PP ≥ 50 mmHg. Multivariable linear regression and log-binomial regression models were utilized for determining the association between elevated PP and BMI.ResultsA total of 62,113 active-duty RTA personnel were included in the study. The average BMI was 25.4 ± 3.8 kg/m2, while the average PP was 50.1 ± 11.2 mmHg. Compared to individuals with normal weight, the beta coefficients of PP and BMI were 1.38 (95% CI: 1.15–1.60) and 2.57 (95% CI: 2.25–2.88) in individuals with obesity I and obesity II, respectively. Effect modification by high blood pressure (BP) on the association between elevated PP and BMI was observed. Among participants with normal BP, in comparison with BMI of 18.5–22.9 kg/m2, the adjusted prevalence ratio (PR) for elevated PP was 1.23 (95% CI: 1.19–1.28) and 1.41 (95% CI: 1.35–1.48) in those with obesity I and obesity II, respectively. Meanwhile, among individuals with high BP, the adjusted PR for elevated PP was 1.05 (95% CI: 1.01–1.08) and 1.09 (95% CI: 1.06–1.13) in those with obesity I and obesity II, respectively.ConclusionPP was positively associated with BMI in active-duty RTA personnel. High BP was the modifier of the association between PP and BMI. A weaker association between elevated PP and BMI was observed among RTA personnel with high BP.

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.

IMPACT OF CELIPROLOL THERAPY ON BLOOD PRESSURE AND HEART RATE IN PATIENTS WITH VASCULAR EHLERS-DANLOS SYNDROME

Objective: Vascular Ehlers-Danlos syndrome (vEDS) is an inherited connective tissue disorder characterized by arterial fragility. Celiprolol is a beta1-adrenoceptor antagonist with partial beta2 agonist activity that has been shown to reduce rates of vascular events in this setting, though the underlying mechanisms are not yet fully understood. Aim of the present study was to assess the impact of Celiprolol on blood pressure (BP) and heart rate (HR) in patients with vEDS. Design and method: Patients with genetically confirmed disease referred to our Institution between 2011 and 2022 were divided into two groups according to whether or not they were on Celiprolol therapy. The former were included if on Celiprolol at the dose of 400 mg daily for at least 12 months. Each participant underwent office blood pressure (BP) measurement, 24-h ambulatory BP monitoring (ABPM), and pulse wave analysis (PWA) of the radial artery with calculation of central pulse pressure (PP) and augmentation index (AIx). Results: Overall, 18 patients (11 females) were included. Mean age was 36 years and mean body mass index (BMI) was 22.1 kg/m2. Eleven patients were on Celiprolol therapy. No significant differences were found between groups in terms of age, sex, BMI, and presence of hypertension (p&gt;0.05). Patients on Celiprolol therapy displayed higher values of systolic BP (SBP) (124 vs 113 mmHg; p = 0.128), diastolic BP (DBP) (76 vs 67 mmHg; p = 0.236), mean BP (92 vs 83 mmHg; p = 0.173), and HR at office BP measurement, as well as lower AIx (126 vs 140%; p = 0.176) at PWA, although the difference was not statistically significant. Similarly, no significant difference was found for all ABPM parameters (24-h, day-time, and night-time SBP, DBP, mean BP, and HR), as well as central SBP, central DBP, central mean BP, and PP at PWA between groups (p&gt;0.05). Conclusions: Our study suggests little impact of Celiprolol therapy on both BP and HR in patients with vEDS, which hints additional mechanisms behind its protective effect in this clinical setting. Further studies on larger cohorts are needed to clarify these aspects.

Disturbances of the ascending aorta biomechanics in moderate dilatation and aneurysm

Aim. To compare disturbances of the ascending aorta (AA) biomechanics in pa­­tients with moderate dilatation and aneurysm using segmental aortic strain ultrasound.Material and methods. Fifteen patients with moderate AA dilatation (40-49 mm), 17 patients with AA aneurysm (≥50 mm) and 11 healthy volunteers (AA&lt;40 mm) were examined using 2D multiplane transesophageal echocardiography (TEE). The entire thoracic aorta (TA) was assessed. Using 2D speckle-tracking TEE, global peak systolic circumferential strain (GCS, %), global peak systolic circumferential strain normalized to pulse pressure (GCS/PP) and aortic stiffness (β2) index at 4 TA levels (sinuses of Valsalva, sinotubular junction, mid-ascending aorta, descending aorta) were calculated.Results. In healthy volunteers with TA diameter of 26,6 mm (25,2; 28,4) unidi­rec­tional uniform GCS of 9,7% (8,4; 11,7), GCS/PP of 18,4 (14,9; 2,.6) and uniform aortic stiffness (β2) 5,9 (4,8; 6,7) in all TA segments were revealed. There was a pro­portionally significant decrease in deformation parameters up to negative values and an increase of the ascending aortic wall stiffness from the aortic annulus to the descending aorta with a maximum in the highest dilatation zone in patients with moderate dilatation and aneurysm. Moreover, in these patients aortic wall strain and stiffness did not differ in all TA segments (p&gt;0,05). The AA diameter in maximum dilatation zone in patients with aneurysm was significantly higher than in patients with moderate dilatation — 52 mm (51; 55) versus 47 mm (45; 48), p&lt;0,001, respectively. An inverse correlation between the AA diameter in maximum dilatation zone and aortic strain (GCS: r=-0,61; p&lt;0.001 and GCS/PP: r=-0,62; p&lt;0,001) and a direct correlation with the aortic stiffness (β2) index (r=0,56; p&lt;0,05) were revealed.Conclusion. Assessment of the aortic biomechanics along with the AA diameter has an independent diagnostic value when choosing an individual surgical strategy in patients with moderate dilatation and AA aneurysm.

Associations between trajectories of cardiovascular risk factor change and cognitive impairment in Chinese elderly: A nationwide cohort study.

This study aimed to investigate the relationship between long-term trajectories of changes in cardiovascular risk factors (CVRFs) and the risk of cognitive impairment among Chinese adults over 60 years old. Data were obtained from the Chinese Longitudinal Healthy Longevity Survey 2005-2018. Cognitive function was evaluated longitudinally through the Chinese version of the Mini-Mental State Examination (C-MMSE), and cognitive impairment (C-MMSE ≤23) was used as the main outcome variable. The cardiovascular risk factors, including systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP), pulse pressure (PP), and body mass index (BMI), were continuously measured in the follow-up duration. The patterns of trajectories of changes in CVRFs were derived from the latent growth mixture model (LGMM). The Cox regression model was used to evaluate the cognitive impairment hazard ratio (HR) across different CVRF trajectories. A total of 5,164 participants aged ≥60 years with normal cognitive function at baseline were included in the study. After a median follow-up of 8 years, 2,071 participants (40.1%) developed cognitive impairment (C-MMSE ≤ 23). The four-class trajectories of SBP and BMI were obtained by means of LGMM, and the trajectories of DBP, MAP, and PP were grouped into a three-class subgroup. In the final adjusted Cox model, the lowered SBP [adjusted HR (aHR): 1.59; 95% CI: 1.17-2.16], lowered PP (aHR: 2.64; 95% CI: 1.66-4.19), and progressively obese (aHR: 1.28; 95% CI: 1.02-1.62) and stable slim (aHR: 1.13; 95% CI: 1.02-1.25) were associated with the higher risk of cognitive impairment. Low stable DBP (aHR: 0.80; 95% CI: 0.66-0.96) and elevated PP (aHR: 0.76; 95% CI: 0.63-0.92) decreased the risk for cognitive impairment among participants. Lowered SBP, lowered PP, progressive obesity, and stable slim increased the risk for cognitive impairment in the Chinese elderly. Low stable DBP and elevated PP were protective against cognitive impairment, but more DBP lowering and ≥25 mmHg growth in PP contributed to a higher risk of cognitive impairment. The findings have important implications for preventing cognitive impairment in elder adults based on the long-term trajectories of changes in CVRFs.