Pulse Pressure Index Research Articles

Evaluation of human nonmercaptalbumin as a marker for oxidative stress and its association with various parameters in blood.

Oxidative status of albumin was not a useful biomarker for oxidative stress in practical use due to time-consuming measuring method. We evaluated oxidized, human nonmercaptalbumin measured more quickly than ever by a novel method using anion-exchange HPLC. In 60 subjects taking a general health examination, mean serum human nonmercaptalbumin level was 25.1 ± 3.0% with no gender difference but positive correlation with age. There were no links between human nonmercaptalbumin and C-reactive protein, γ-glutamyltransferase or iron, reportedly associated with oxidative stress. Human nonmercaptalbumin correlated with systolic blood pressure, pulse pressure and body mass index among physical findings. Positive correlations were observed between human nonmercaptalbumin and AST, LDH, BUN, or creatinine, suggesting that oxidative stress may link with liver injury and renal function. Human nonmercaptalbumin correlated with uric acid in female but not in male, suggesting that higher uric acid levels may be associated with increased oxidative stress only in female. As another gender difference, white blood cell counts correlated with human nonmercaptalbumin in female, while the parameters for red blood cells correlated with human nonmercaptalbumin in male. In conclusion, serum human nonmercaptalbumin level in healthy subjects was approximately 25% as previously reported. Oxidative stress may be closely associated with hypertension, obesity, liver injury, renal function, and anemia.

Arterial pulsatility under phasic left ventricular assist device support.

The aim of this study is to understand whether the phasic Continuous Flow Left Ventricular Assist Device (CF-LVAD) support would increase the arterial pulsatility. AMicromed DeBakey CF-LVAD was used to apply phasic support in an ex-vivo experimental platform. CF-LVAD was operated over a cardiac cycle by phase-shifting the pulsatile pump control with respect to the heart cycle, in 0.05s increments in each experiment. The pump flow rate was selected as the control variable and a reference model was used to operate the CF-LVAD at a pulsatile speed. Arterial pulse pressure was the highest (9mmHg) when the peak pump flow is applied at the peak systole under varying speed CF-LVAD support over a cardiac cycle while it was the lowest (2mmHg) when the peak pump flow was applied in the diastolic phase. The mean arterial pressure and mean CF-LVAD output were the same in each experiment while arterial pulse pressure and pulsatility index varied depending on the phase of reference pump flow rate signal. CF-LVAD speed should be synchronized considering the timing of peak systole over a cardiac cycle to increase the arterial pulsatility. Moreover, it is possible to decrease the arterial pulsatility under counter-pulsating CF-LVAD support.

Association between pulse pressure and body mass index in hypertensive and normotensive populations in the Korea National Health and Nutrition Examination Survey V, 2010-2012.

The authors conducted a national cross-sectional cohort study to evaluate the associations between pulse pressure (PP) and body mass index (BMI) and sex, according to blood pressure (BP) status. A total of 18812 patients without a history of antihypertensive medication and cardiovascular disease were selected. There was good concordance between PP and the selected cardiovascular risk factors. PP increased with high BMI among patients with normal BP, but decreased with high BMI among patients with hypertension (HTN). BMI (ß, -0.260; SE, 0.039 [P<.001]) and male sex (ß, -4.727; SE, 1.100 [P<.001]) were negatively correlated with PP in a multivariate model adjusted for several risk factors in patients with HTN. In conclusion, PP was negatively correlated with BMI in patients with HTN, which may explain the higher cardiovascular risk in lean persons and women with HTN.

Association of left atrial phasic volumes with systemic arterial stiffness and ankle-brachial index in hypertensive patients.

Left atrial (LA) phasic volumes consist of reservoir, conduit and booster pump volumes. Arterial stiffness is linked to lower systemic arterial compliance (SAC) contributing to cardiac afterload. Arterial stiffness may be a modulator of LA phasic volumes. Echocardiography was performed in 161 hypertensive patients and in 50 normotensive subjects in order to assess biplane LA volumes (maximum, before atrial contraction, minimum), early and late diastolic mitral annular velocity (e' and a'), and LV stroke volume. LA emptying volumes (total, passive, active) were calculated from these LA volumes. Blood pressures were measured using an automated oscillometric device simultaneously at the four limbs for evaluating pulse pressure (PP) and ankle-brachial index (ABI). SAC was estimated by the ratio of LV stroke volume indexed by body surface area (BSA) divided by PP. All three LA volumes, LA total volume and LA active emptying volume were greater in hypertensive patients than in normotensive subjects. A multiple linear regression analysis indicated that LA passive emptying volume (reservoir=early diastole)/BSA correlated positively with ABI after being adjusted for age, gender, BSA, LV mass, max LA volume, e' and SAC in hypertensive patients. LA active emptying volume (booster=late diastole)/BSA correlated positively with SAC after being adjusted for age, gender, BSA, LV mass, LA volume before atrial contraction, a' and ABI. LA reservoir volume was associated with ABI, and LA booster volume was related to systemic arterial stiffness in hypertensive patients, suggesting the LA-arterial coupling in this clinical setting.

OP.2B.06] RENAL RESISTIVE INDEX AND PULSE PRESSURE AT 3 MONTHS HAVE A DIFFERENT IMPACT ON LONG-TERM RISK OF DEATH AND GRAFT LOSS IN RENAL TRANSPLANTATION

Objective: Some studies suggest that pulse pressure (PP) and renal resistive index (RI) could be predictive of the risk of death; however, whether they also predict graft loss is debated. It was recently demonstrated that RI reflects large artery arterial stiffness as PP does but RI is also affected by alteration in renal microcirculation alteration. Finally, the respective predictive value of these 2 parameters considered together on graft loss and death is unknown. Design and method: Cohort study of consecutive patients who received a renal graft in Tours from 1985 to 2014 in whom PP and RI were measured at 3 months. The long-term risk of death and graft loss was assessed. Results: 1237 renal transplant recipients were included (age: 49.3 ± 14.5; 61.8% men). At 3 months, RI was 0.68 ± 0.08 (RI > 0.75: 17.2%; RI > 0.80: 5.8%). Arterial pressure was 138 ± 16/79 ± 11 (PP: 59.6 ± 14.5 mmHg; médiane: 60 mmHg); 55.4% were uncontrolled (i.e. PA> = 140/90 mmHg). During follow-up (meidan: 5.9 years; range: 0.4–27.5; 9772 patients-years), 130 patients died and 216 lost their graft. In univariate analysis, RI (as well as PP) was associated with the risk of death (RI > 0.80: HR = 2.50 [1.63–3.83]; RI > 75: HR = 3.19 [2.32–4.39], both: P < 0.0001) and graft loss (RI > 0.80: HR = 1.71 [1.16–2.52], P = 0.0068; RI > 75: HR = 1.53 [1.15–2.03], P = 0.0035). RI significantly predicted death (RI > 0.80: HR = 2.98 [2.10–4.23]; RI > 75: HR = 3.63 [2.32–5.69], both: P < 0.0001) but not PP > 60 mmHg after adjustment on RI > 0.80 (HR = 1.07 [0.75–1.52], P = 0.7088) or RI > 0.75 (HR = 1.04 [0.74–1.48], P = 0.8109) when RI and PP were simultaneously considered in multivariate analyses. Similar results were observed when RI and PP were expressed as continuous parameters, and after adjustment on recipient age. In contrast, only PP > 60 mmHg was associated with the risk of graft loss after adjustment on RI (HR for adj. on RI > 0.80: HR = 1.31 [1.01–1.71], P = 0.0457; HR for adj. on RI > 0.75: HR = 1.30 [1.00–1.70], P = 0.0516), and adjustment on RI and age (HR = 1.32 [1.01–1.73], P = 0.0406; HR = 1.32 [1.01–1.72], P = 0.0441 respectively); RI was not (RI > 80: HR = 1.17 [0.68–2.01], P = 0.5765; RI > 75: HR = 1.20 [0.85–1.69], P = 0.2933). Conclusions: Pulse pressure and renal resistive index at 3 months differently impact the long-term risk of death and graft loss.

Altered matrix metalloproteinase 9 and tissue inhibitor of metalloproteinases 1 levels in children with primary hypertension.

Matrix metalloproteinases (MMP) and tissue inhibitors of metalloproteinases (TIMP) are involved in cardiovascular remodeling in hypertension. Because metabolic abnormalities typical of metabolic syndrome is the dominant phenotype of primary hypertension in children, we hypothesized that MMP-9 and TIMP-1 plasma concentrations are altered in hypertensive children and correlate with metabolic abnormalities and target organ damage. A total of 109 children (15.6, 10-17 years) with untreated primary hypertension were included to the study. The control group consisted of 74 healthy, normotensive children. Plasma MMP-9, TIMP-1 concentrations, and MMP-9/TIMP-1 ratio were significantly elevated in hypertensive boys in comparison with normotensive boys (P = 0.0001, P = 0.04, and P = 0.001, respectively), whereas there were no differences between hypertensive and normotensive girls. The levels of MMP-9 and TIMP-1 as well as MMP-9/TIMP-1 ratio were not associated either with hypertension stage, left ventricular hypertrophy, or carotid intima-media thickness. However, in a subgroup of 30 hypertensive patients in whom arterial stiffness was measured, TIMP-1 concentrations correlated with aortic pulse pressure (P < 0.05; r = 0.367), augmentation pressure (P < 0.05; r = 0.428), and augmentation index (P < 0.05; r = 0.404).Only hypertensive boys presented negative correlations of both MMP-9 and TIMP-1 levels with high-density lipoprotein cholesterol (r = -0.254, P = 0.01 and r = -0.241, P = 0.02, respectively). Hypertensive boys but not girls had elevated MMP-9 and TIMP-1 plasma concentrations, which indicates sex-related role of MMP/TIMP system in pediatric hypertension. The correlation between serum TIMP-1 and markers of arterial stiffness indicates on the involvement of TIMPs in arterial remodeling.

Physical Activity Is Associated With Arterial Stiffness In Post-myocardial Infarction Patients With Elevated Blood Pressure

Taking into account the risk associated with an increased blood pressure and arterial stiffness, it seems to be of particular relevance to look for possible associations with physical activity. PURPOSE: To analyze whether regular physical activity and cardiorespiratory fitness were correlated with arterial stiffness in post-myocardial infarction patients presenting blood pressure above the normal range despite being on medication. METHODS: In this cross-sectional study, 44 consecutive patients (age, 61.2±9.4 yrs; BMI, 27.5±3.5 kg/m2, 8 females) with systolic blood pressure ≥130 mm Hg and/or diastolic blood pressure higher ≥85 mm Hg, despite receiving the recommended medication, were assessed 6 weeks after suffering an acute myocardial infarction, for clinical variables, anthropometrics, physical activity, cardiorespiratory fitness and arterial stiffness. Resting systolic and diastolic blood pressure and heart rate were measured using a digital automatic blood pressure monitor. Physical activity was objectively measured during 7 consecutive days using an accelerometer. Cardiorespiratory fitness was assessed with an ergospirometry device to measure the peak oxygen uptake (VO2peak) during a maximal or symptom-limited treadmill exercise test (modified Bruce protocol). Arterial stiffness was evaluated using measures of carotid-femoral pulse wave velocity (cf-PWV), and central and peripheral pulse pressure (PP) and augmentation index adjusted to heart rate at 75 bpm ([email protected]). RESULTS: Moderate to vigorous physical activity showed a positive association with VO2peak (r=0.548, p<0.001) and [email protected] (r=0.473, p=0.002), and a negative association with cf-PWV (r=-0.351, p=0.031). cf-PWV was positively associated with systolic blood pressure (r=.427, p=0.005) and inversely associated with VO2peak (r=-0.472, p=0.002). In addition, cf-PWV was significantly lower in the patients with lower blood pressure (systolic 130-130 mm Hg) compared with those who higher values (systolic ≥140 mm Hg) (8.7±2.1 m/s vs. 10.2±2.5 m/s, p<0.05). CONCLUSIONS: Our data show that moderate to vigorous physical activity and cardiorespiratory fitness is inversely associated with arterial stiffness in post-myocardial infarction patients with blood pressure above the normal range despite being on medication.

The Influence of Normal and Early Vascular Aging on Hemodynamic Characteristics in Cardio- and Cerebrovascular Systems.

Age-associated alterations in cardiovascular structure and function induce cardiovascular disease in elderly subjects. To investigate the effects of normal vascular aging (NVA) and early vascular aging (EVA) on hemodynamic characteristics in the circle of Willis (CoW), a closed-loop one-dimensional computational model was developed based on fluid mechanics in the vascular system. The numerical simulations revealed that higher central pulse pressure and augmentation index (AIx) appear in the EVA subjects due to early arrival of reflected waves, resulted in the increase of cardiac afterload compared with the NVA subjects. Moreover, the hemodynamic characteristics in the CoW show that the EVA subjects in an older age display a higher blood pressure than that of the NVA with a complete CoW. Herein, the increased blood pressure and flow rate coexist in the subjects with an incomplete CoW. In conclusion, the hemodynamic characteristics in the aortic tree and CoW related to aging appear to play an important role in causing cardiovascular and intravascular disease.

Aortic stiffness and change in glomerular filtration rate and albuminuria in older people.

Aortic stiffness increases with age and increases pulsatile stress in the microcirculation. Abnormalities in kidney microvascular structure and function may contribute to development or progression of chronic kidney disease in older people. We performed a longitudinal analysis of 629 community-dwelling elderly Icelandic adults from the Age, Gene/Environment Susceptibility-Reykjavik Study with two visits over a mean follow-up of 5.3 years. We evaluated the associations of carotid-femoral pulse wave velocity (CFPWV), carotid pulse pressure (CPP) and augmentation index (AI), with the change in estimated glomerular filtration rate (eGFR) and urine albumin-to-creatinine ratio (UACR) assessed as annual change and dichotomized as large changes. Models were adjusted for age, sex, height, heart rate, traditional cardiovascular disease risk factors and baseline kidney measures. When eGFR was analyzed as a continuous variable, higher baseline CFPWV and CPP, but not AI, were significantly associated with a larger annual decline in eGFR in models adjusted for age, sex, height, heart rate and baseline eGFR, but not after additional adjustment for the mean arterial pressure. When eGFR was analyzed as a categorical variable, higher CFPWV was significantly associated with a decrease in eGFR of ≥3 mL/min/1.73 m 2 /year [odds ratio (OR) 1.53, 95% confidence interval (CI) 1.11-2.13] and higher AI was associated with 30% eGFR decline during follow-up (OR 1.44 and 95% CI 1.03-2.00) in fully adjusted models. None of the tonometry measures was associated with change in UACR. Abnormalities in vascular health may play a role in large declines in eGFR beyond the traditional cardiovascular disease risks in this older Icelandic cohort.

Serum adiponectin is a negative predictor of central arterial stiffness in kidney transplant patients

Background The role of adiponectin in arterial stiffness and its relationship to cardiovascular disease is not fully demonstrated and needs further elaboration. In this study, the association between adiponectin level and arterial stiffness is studied among kidney transplant patients. Material and methods Anthropometric data and biochemical data including fasting glucose, lipid profile, renal function and serum adiponectin were determined in 55 kidney transplant patients. Central arterial stiffness was measured and presented by carotid-femoral pulse wave velocity. Results Univariate linear analysis showed that body weight, waist circumference, brachial pulse pressure and body mass index were correlated positively with carotid-femoral pulse wave velocity in this patient group. However, logarithmically transformed adiponectin level (log-adiponectin) correlated negatively with carotid-femoral pulse wave velocity. In multivariate regression analysis of factors significantly associated with carotid-femoral pulse wave velocity, it showed that both log-adiponectin (β = −0.427; R2 = 0.205, p = 0.001) and body weight (β = 0.327; R2 = 0.106, p = 0.007) were independently predictive of central arterial stiffness. Conclusion Our study suggests that fasting serum adiponectin is negatively associated with carotid-femoral pulse wave velocity, hence arterial stiffness, in kidney transplant patients.

Use of noninvasive procedures in the cardiovascular risk assessment of hypertensive and normotensive individuals

Arterial hypertension is associated with a high prevalence of vascular alterations. The use of noninvasive procedures to assess peripheral arterial diseases in the ranking of cardiovascular risks has been increasingly valued in clinical practice and should be adopted in nursing. To identify the cardiovascular risk of hypertensive and normotensive individuals through the use of different noninvasive procedures to assess the vascular function and integrity: ankle-brachial index, pulse pressure, and delta brachial-brachial and delta ankle-brachial indexes. Quantitative, descriptive, and cross-sectional study undertaken at a health service in a Brazilian city. The research variables were age, sex, blood pressure, abdominal circumference, body mass index, ankle-brachial index, pulse pressure, and delta brachial-brachial and delta ankle-brachial indexes. Fifty-four (43.1%) normotensive and 69 (56.9%) hypertensive individuals participated in the study. Alterations were identified in ankle-brachial index, corresponding to mild and moderate arterial obstruction, among hypertensive individuals only (7.2%), with higher pulse pressure indices (P < 0.0001). The assessment of the correlation between the ankle-brachial index and pulse pressure showed no correlation in the normotensive group and a statistically significant correlation among hypertensive patients (Pearson's coefficient = -0.45, P < 0.0001, r(2) = 0.21). A statistically significant difference (P < 0.05) was found in the analysis of the mean delta brachial-brachial (6.2 ± 0.71 mm Hg for normotensive and 10.16 ± 1.45 mm Hg for hypertensive individuals) and delta ankle-brachial index (0.06 ± 0.01 for normotensive and 0.11 ± 0.01 for hypertensive individuals). The use of the proposed cardiovascular risk predictors shows more frequent alterations among hypertensive than normotensive individuals.

Abdominal obesity and hypertension: a double burden to the heart.

Abdominal obesity (AO) is strongly associated with increased cardiovascular risk in hypertensives. Visceral adipose tissue has an important part in water retention, the sympathetic nervous system and renin-angiotensin-aldosterone system activation, which may influence central and systemic hemodynamics. The aim of this study was to estimate the relationship between AO and the hemodynamic profile of patients with arterial hypertension (AH). The clinical evaluation of 144 hypertensives included the following: (1) echocardiographic assessment of the left ventricular ejection fraction (LVEF), the global longitudinal systolic strain (GLSS) and diastolic function (E/A-phase ratio of mitral flow early (E) and late (A) and E/e'-ratio of early mitral flow and mitral septal annulus early diastolic velocity (e')); (2) the applanation tonometry including the central pulse pressure (CPP) and augmentation index (AI); and (3) the impedance cardiography, acceleration index (ACI), velocity index (VI), systemic vascular resistance index (SVRI) and total artery compliance (TAC). Obese hypertensives in comparison with non-obese ones were characterized with the following values: (1) lower echocardiographic (GLSS: -17.2±2.5% vs. -19.0±2.8%, P=0.0002) and impedance indices of left ventricular performance (VI: 44.8±12.4 vs. 51.6±14.2 × 1000*Ω* s(-1), P=0.006; ACI: 66.7±27.8 vs. 79.1±31.2 100*Ω* s(-)(2), P=0.003) and (2) worse diastolic function (e': 9.08±2.69 vs. 10.39±2.34 cm*s(-1), P=0.003; E/e': 7.54±1.81 vs. 6.74±1.40, P=0.007; E/A: 1.02±0.34 vs. 1.15±0.33, P=0.008). No relevant differences for gender, age, blood pressure, heart rate, LVEF, SVRI, TAC, CPP and AI were identified. AH and AO have overlapping effects on cardiovascular hemodynamics. At the early asymptomatic stage, this overlap is exhibited in the impaired cardiac function.

0242: Carotid intima-media thickness in the Algerian population: reference ranges and association with cardiovascular risk factors

Carotid intima-media thickness as measured with ultrasonography is an inexpensive and noninvasive predictor of cardiovascular events. The objectives of this study were to determine the population reference ranges of carotid intima-media thickness for individuals aged 35-84 years in Algerian cohort and to analyze the association of carotid intima-media thickness with cardiovascular risk factors (age, smoking, diabetes, pulse pressure, lipid profile, and body mass index). Population-based cross-sectional study conducted in military hospitals of Constantine and Algiers (Algeria). We described the mean and maximal values of carotid intima-media thickness of the carotid artery and of its 3 segments (common carotid, carotid bulb and internal carotid). We assessed cardiovascular risk factors and analyzed their association with carotid intima-media thickness using adjusted linear regression models. A total of 1547 individuals (54% women) were included, with mean age 58 years. Men showed significantly higher mean common carotid intima-media thickness than did women (0.71 vs 0.67mm). The strongest predictors of this measure were age (coefficients for 10-year increase: 0.65 and 0.58 for women and men, respectively), smoking in men (coefficient: 0.26), high-density lipoprotein cholesterol in women (coefficient for 10mg/dL, increase: – 0.08) and pulse pressure in both sexes (coefficients for 10mmHg increase: 0.08 and 0.23 for women and men, respectively). The results were similar for the mean carotid intima-media thickness of all the segments. This population-based study presents the reference ranges for carotid intima-media thickness in the Algerian population. The main determinants of carotid intima-media thickness were age and pulse pressure in both sexes.

Effect of Enhanced External Counter Pulsation Treatment on Aortic Blood Pressure, Arterial Stiffness and Ejection Fraction in Patients with Coronary Artery Disease.

Enhanced External Counter Pulsation (EECP) is a non-invasive treatment option for patients with Coronary Artery Disease (CAD). The treatment has shown to augment diastolic pressure and reduce Left Ventricular (LV) after-load by reducing systemic vascular resistance. The effect of EECP in standard brachial blood pressure and central haemodynamic parameters are not known. We hypothesized that EECP may have differential effect in CAD patients with low systolic blood pressure when compared to normal systolic pressure and the mechanism underlying this differential effect may be due to improvement in LV function. A total of 72 consecutive patients who underwent EECP treatment for symptomatic CAD with LV dysfunction were divided into two groups based on cut-off value of 100mmHg for systolic blood pressure. First group had patients with brachial systolic blood pressure of >100mmHg and second group had patients with brachial systolic blood pressure of ≤100mmHg. We measured central aortic systolic pressure, pulse pressure, augmentation index and augmentation pressure by SphygmoCor device and Ejection Fraction (EF) was measured by echo-cardiography. All these measurements were carried out prior to and after completion of 35 days of EECP sessions. Central systolic pressure, brachial systolic pressure, aortic pulse pressure, augmentation pressure and augmentation index significantly decreased in patients with normal brachial systolic pressure with baseline moderate LV dysfunction. Brachial systolic, aortic systolic and aortic pulse pressure significantly increased with no change in augmentation index and pressure is observed in patients with baseline severe LV dysfunction associated with low systolic pressure post EECP treatment. EECP treatment has haemodynamically favourable differential effect in normal and low brachial systolic pressure and this is mainly driven by improvement in LV function in patients with symptomatic CAD with LV dysfunction.

Ring-reinforced Sano right ventricular to pulmonary artery conduit at Norwood stage I.

Reinterventions for proximal conduit obstruction or on the pulmonary arteries are frequent after Sano-modified stage I Norwood palliation of hypoplastic left heart syndrome. We report our experience with a modified Sano stage I, in which the right ventricle-to-pulmonary artery (PA) conduit used is reinforced by external rings to avoid collapse, and the conduit is inserted into the right ventricle through a limited ventriculotomy and 'dunked' into the ventricular cavity. In our experience, this modification was associated with fewer reinterventions or complications with the proximal anastomosis (P = 0.046 and 0.004), improved PA pulse pressure (9.1 ± 4.1 vs 4.8 ± 3.8 mmHg in controls, P < 0.001) and Nakata index (213 ± 76 vs 134 ± 68 mm(2)/m(2) in controls, P < 0.0001), although overall survival to a median of 20 months was not significantly different from controls. Right ventricular function at stage II-bidirectional Glen was marginally better in patients with the modified Sano conduit, however not to a significant level. Further evaluation of late ventricular function is currently ongoing.

Is There an Increased Arterial Stiffness in Patients with Primary Sjögren's Syndrome?

Primary Sjögren's syndrome (pSS) is a common chronic autoimmune disease that primarily affects the salivary and lacrimal glands. Arterial stiffness is one of the earliest detectable manifestations of adverse structural and functional changes within the vessel wall. The aim of this study was to evaluate the relationship between arterial stiffness and pSS. In this study, 75 female patients with pSS who fulfilled the American European Consensus Criteria for Sjögren's syndrome, were included. A total of 68 age-, sex- and body mass index-matched subjects were recruited as the control population. Arterial stiffness was assessed by measurement of the carotid-femoral pulse wave velocity (PWV). The mean age of the patients was 54.0±9.3 years and the median duration of the disease was 10 years. Compared with the control subjects, patients with pSS had a higher mean PWV (8.2±1.5 m/s vs. 7.5±1.4 m/s; p=0.01). Correlation analysis showed that the PWV was positively correlated with age, body mass index, serum cholesterol, low-density lipoprotein (LDL) and C-reactive protein levels, blood pressure, mean arterial pressure (MAP), pulse pressure and left ventricular mass index. A multiple linear regression analysis revealed that arterial stiffness was associated with age, MAP and LDL levels in pSS patients. Although patients with pSS appear to have increased arterial stiffness, risk factors associated with arterial stiffness in these patients are similar to the general population. However, we cannot exclude the possibility that a higher PWV in pSS patients is caused, not by pSS itself, but by the use of steroids, hypertension and dyslipidemia.

CO-39: Pulse pressure and renal resistive index at 3 months following transplantation differentially affect long-term risk of death and graft loss

Objectifs Certaines etudes ont suggere que la pression pulsee (PP) et l'index de resistance intra-renale (IR) pouvaient etre predictifs du risque de deces, mais leur impact sur la survie du greffon est controverse. Il a ete montre que l'IR etait un reflet de la rigidite arterielle des gros vaisseaux comme la PP, mais aussi de l'etat de la microcirculation renale. Cependant, l'impact respectif de ces 2 parametres sur les risques de deces et de perte de greffon n'est pas connu, et a ete l'objet de cette etude. Methodes Cohorte de patients consecutifs greffes de 1985 a 2014 au CHU de Tours dont la PP et l'IR ont ete mesures au 3 eme mois post-greffe a ete etudiee. Le risque a long terme de deces et de perte de greffon a ete etudie. Resultats 1 237 patients ont ete inclus. Leur âge etait de 49.3 ± 14,5 ans (61.8 % d'hommes). Au 3 eme mois, leur pression arterielle (PA) etait : 138 ± 16/ 79 ± 11 ; PP : 59.6 ± 14.5 mmHg (mediane : 60 mmHg) ; PA > = 140/90 mmHg : 55.4 % ; l'IR etait de : 0.68 ± 0.08 (IR > 0.75 : 17.2 % ; IR > 0.80: 5.8 %). Au cours du suivi (mediane : 5,9 ans ; extremes : 0.4 a 27,5 ans, soit 9 772 patients-annees), 130 patients sont decedes et 216 sont retournes en dialyse (par rejet chronique usuellement). En analyse uni-variee, l'IR constituait un facteur de risque (FDR) de deces (IR > 0.80 : HR = 2.50 [1.63-3.83] ; IR > 75 : HR = 3.19 [2.32-4.39], tous 2 : P 0.80 : HR = 1.71 [1.16-2.52], P = 0.0068 ; IR > 75 : HR = 1.53 [1.15-2.03], P = 0.0035). En analyse multi-variee, l'IR restait un FDR de deces (IR > 0.80 : HR = 2.98 [2.10-4.23] ; IR > 75 : HR = 3.63 [2.32-5.69], tous 2 : P 60 mmHg) apres ajustement sur l'IR > 0.80 (HR = 1.07 [0.75-1.52], P = 0.7088) ou sur IR > 0.75 (HR = 1.04 [0.74-1.48], P = 0.8109. Les resultats etaient similaires lorsque les donnees etaient exprimees en valeur continue, et apres ajustement sur l'âge. En revanche, seule la PP > 60 mmHg etait un FDR de perte de greffon apres ajustement sur l'IR > 0.80 (HR = 1.31 [1.01-1.71], P = 0.0457 ou sur l'IR > 0.75 (HR = 1.30 [1.00-1.70], P = 0.0516), meme apres ajustement supplementaire sur l'âge (respectivement: HR = 1.32 [1.01-1.73], P = 0.0406 ; HR = 1.32 [1.01-1.72], P = 0.0441) mais pas l'IR (IR > 80 : HR = 1.17 [0.68-2.01], P = 0.5765 ; IR > 75 : HR = 1.20 [0.85-1.69], P = 0.2933). Conclusion La pression pulsee et de l'index de resistance intra-renale 3 mois apres la greffe ont un impact different sur le risque a long terme de deces et de perte de greffon chez le transplante renal.

The relationship between indices of parasympathetic nervous activity and cardiovascular health in men

Background: Cardiovascular disease is a primary cause of death worldwide. Low parasympathetic nervous activity (PNA) is associated with negative cardiovascular health (CVH) [1]. Central augmentation pressure (CAP), aortic pulse pressure (APP) and augmentation index (Alx) are all strong indicators of CVH. Heart rate variability (HRV) and recovery heart rate (RHR) are both indices of PNA but they do not correlate [2]. Since these indices do not correlation we hypothesized that there would be a difference in their relationship with CVH as determined by CAP, APP and Alx75. Aim: To determine if there is a difference in the relationships between HRV, RHR and CAP, APP and Alx inmen. Methods: Seventeen healthy college aged men were examined for HRV via power spectral density analysis. Recovery heart rate was examined at minute one (RHR1) and two (RHR 2)) following a VO2max test. Pulse wave analysis via applanation tonometry and a generalized transfer function was used to determine CAP, APP and Alx. Results: There was a significant correlation between HRV and CAP (r = 0.61, P = 0.01) and Alx (r = 0.51, P = 0.05). No correlation was observed between RHR 1, RHR 2 and CAP, Alx and APP. Central augmentation pressure was significantly correlated with APP (r = 0.67, P= 0.01) and Alx r = 0.64, P= 0.01). Conclusions: Findings suggest a difference in the relationship between HRV, RHR and CVH. Here HRV was positively correlated with indices of CVH, while RHR did not correlate with these indices. Indicating that HRV seem to be more indicative of CVH versus RHR.

A pilot study investigating the effect of parathyroidectomy on arterial stiffness and coronary artery calcification in patients with primary hyperparathyroidism

Arterial stiffness (AS) and coronary artery calcification (CAC) are predictors of cardiovascular risk and can be measured noninvasively. The aim of this study was to analyze the effects of parathyroidectomy on AS and CAC in patients with primary hyperparathyroidism (PHP). This prospective, institutional review board-approved study included 21 patients with PHP, who underwent parathyroidectomy. Before and 6 months after parathyroidectomy, AS was assessed by measuring central systolic pressure (CSP), central pulse pressure, augmentation pressure (AP), and augmentation index (AIx); the CAC score (Agatston) was calculated on noncontrast computed tomography. AS parameters were compared with unaffected controls from donor nephrectomy database. Preoperative CSP and AIx parameters in PHP patients were higher than those in donor nephrectomy patients (P = .004 and P = .039, respectively). Preoperative total CAC score was zero in 15 patients (65%) and ranged from the 72nd to the 99th percentile in 6 patients (26%). Although there were no changes in CAC or AS after parathyroidectomy on average, there was variability in individual patient responses on AS. This pilot study demonstrates that CAC is not altered in PHP patients at short-term follow-up after parathyroidectomy. The heterogeneous changes in AS after parathyroidectomy warrant further investigation in a larger study with longer follow-up.

GW26-e0676 The impact of different periods of dynamic pulse pressure index on the target organ damage in hypertensive patients

To explore the impact of different periods the dynamic pulse pressure index (PPI) on hypertensive target organ damage (TOD). 553 hypertensive patients were enrolled. 24-hour, day and night PPI were calculated based on 24-hour ambulatory blood pressure measurement results. Each period of PPI were