Pulse Wave Velocity In Relation Research Articles

An Analysis of Burnout, Coping, and Pulse Wave Velocity in Relation to the Workplace of Healthcare Workers for the Sustainability of the Medical Career

The assessment of the health status of healthcare workers (HWs) is related to the growing interest in the sustainability of the medical profession. This study explores for the first time the level of burnout, coping strategies, and pulse wave velocity (PWV), the correlations between them, and possible connections with the workplace. It included 154 HWs, aged 25–64 years, 83.76% women, divided into five groups (oncology, cardiology, intensive care, occupational health, and residents). The Burnout Assessment Tool (BAT-23) questionnaire for the burnout level and the Carver Coping Orientation to Problems Experienced (COPE) questionnaire for the coping strategies were used. PWV was measured with a TensioMed arteriograph. Regarding BAT subscales, all studied groups are at burnout for exhaustion (E), prone to burnout for mental distancing (MD), emotional impairment (EI), and no burnout for cognitive impairment (CI). On the four subscales of the BAT, the MANOVA shows a medium-sized effect of the workplace on MD and on CI. All subjects use positive coping strategies. Problem-solving mechanisms are often used, followed by emotional support-based and social support-based coping. PWV correlates with age and BMI and has a small positive correlation with MD, CI, and EI. High burnout levels are related to the healthcare profession, not to the workplace. Our research shows the practical need to supervise the mental and physical health of HWs in order to preserve their health through medical and organizational methods.

Repeatability and reproducibility of pulse wave velocity in relation to hemodynamics and sodium excretion in stable patients with hypertension.

Pulse wave velocity (PWV) is a useful marker for determining subclinical vascular damage and patient risk stratification. Repeatability and reproducibility of PWV in relation to influencing factors have not yet been determined. This study examined the repeatability and reproducibility of PWV, and whether hemodynamics and sodium excretion impact on PWV in hypertensive patients remaining on stable medication. Office blood pressure (BP), heart rate (HR), carotid--femoral PWV and central BP (SphygmoCor device), impedance cardiography (HOTMAN device) and 24-h urinary sodium excretion (UNa) were measured at baseline and after 4 weeks in 74 hypertensive patients (age 56.8 ± 11.5 years, mean ± SD). Two PWV measurements were performed at each visit. Intraclass correlation coefficient (ICC) and 95% confidence interval (95% CI) between the two PWV measurements were 0.981 (0.970--0.988) at baseline, 0.975 (0.960--0.984) after 4 weeks and 0.851 (0.773--0.903) between both visits. There were no significant changes in BP, HR, thoracic fluid content, stroke volume and UNa between visits. Despite excellent ICC, reproducibility of PWV was related to BP (P < 0.001) and HR (P = 0.07) changes between visits. Nineteen out of 74 patients had a difference in PWV greater than ±1 m/s between both visits. In the medium-term observation, changes in BP and HR seem to affect PWV values. Our findings suggest that the assessment of PWV should be performed under stabilized BP and HR values, particularly in patients with newly diagnosed hypertension and/or low--moderate cardiovascular risk in whom the detection of asymptomatic hypertension-mediated organ damage impact on patient risk stratification.

Efficacy evaluation of renal denervation with a standard irrigated cardiac ablation catheter in a 44 years old male with refractory hypertension: a case report

Background: Central hemodynamics and arterial stiffness evaluations are important for cardiovascular risk. The behavior of central blood pressure (CBP), and pulse wave velocity (PWV) during 24 hours is not well known. Objective: To investigate CBP and PWV in relation to brachial BP in 24 hours, awake and sleep periods in normotensive and untreated hypertensive individuals from 18 to 50 years old. Methods: A total of 104 subjects (60 females (57.7%) and 44 males (42.3%)), 48 (46.2%) individuals between 18 and 35 years old and 56 (53.8%) individuals between 36 and 50 years old were included. Exclusion criteria were: use of antihypertensive drugs, body mass index 35 kg/m, eGFR <60 ml/min, diabetes and smoking. All were submitted to clinical and laboratory evaluation; office BP was measured using a oscillometric sphygmomanometer OMRON, model HEM-705CP, and 24h monitoring brachial BP, CBP, Augmentation Index (AIx) and PWV were obtained with the Mobil-O-Graph equipment (DINA MAP cardios ESI GmbH, Stolberg, Germany). Results: The study population showed a mean age of 36.99 8:53 years, BMI 25.80 3.82kg/m, and prevalence of hypertension 32.7%. Office BP means were: systolic BP (SBP) 130.45 17.28mmHg and diastolic BP (DBP) 80.11 10.39mmHg. Awake brachial was lower than office BP (p<0.001, difference between office SBP and awake SBP 1⁄4 11.17 14.21mmHg, and of office DBP and awake DBP 1⁄4 1.76 7.88mmHg). Systolic CBP was lower than brachial SBP in 24h, and awake and sleep periods (p<0.001, differences were 8.49 2.72mmHg, 9.35 3.42mmHg and 5.68 2.96mmHg between brachial SBP and systolic CBP in 24h, awake and sleep periods, respectively). Conversely, diastolic CBP was slightly higher than brachial DBP in 24h, awake and sleep periods (p<0.001, differences were 0.91 1.59mmHg, 1.55 1.78mmHg and 0.82 1.53mmHg between brachial SBP and diastolic CBP in 24h, awake and sleep periods, respectively). There were significant reductions between awake and sleep periods for systolic and diastolic CBP, for AIx and for PWV (p<0.001, differences were 5.62 7.13mmHg, 10.14 7.01mmHg, 3.85 9.07mmHg and 0.19 0.25mmHg for systolic CBP, diastolic CBP, AIx, and PWV, respectively). Conclusion: In normotensive and untreated hypertensive young adults, awake brachial BP was lower than office BP and systolic CBP means were lower than brachial BP, but diastolic CBP means were higher than brachial DBP. Reductions between awake and sleep periods were observed in the CBP, AIx and PWV means, similarly to what is observed with brachial BP, but with lower averages.

24 Hours central blood pressure and pulse wave velocity in normotensive and untreated hypertensive young adults

Background: Central hemodynamics and arterial stiffness evaluations are important for cardiovascular risk. The behavior of central blood pressure (CBP), and pulse wave velocity (PWV) during 24 hours is not well known. Objective: To investigate CBP and PWV in relation to brachial BP in 24 hours, awake and sleep periods in normotensive and untreated hypertensive individuals from 18 to 50 years old. Methods: A total of 104 subjects (60 females (57.7%) and 44 males (42.3%)), 48 (46.2%) individuals between 18 and 35 years old and 56 (53.8%) individuals between 36 and 50 years old were included. Exclusion criteria were: use of antihypertensive drugs, body mass index 35 kg/m, eGFR <60 ml/min, diabetes and smoking. All were submitted to clinical and laboratory evaluation; office BP was measured using a oscillometric sphygmomanometer OMRON, model HEM-705CP, and 24h monitoring brachial BP, CBP, Augmentation Index (AIx) and PWV were obtained with the Mobil-O-Graph equipment (DINA MAP cardios ESI GmbH, Stolberg, Germany). Results: The study population showed a mean age of 36.99 8:53 years, BMI 25.80 3.82kg/m, and prevalence of hypertension 32.7%. Office BP means were: systolic BP (SBP) 130.45 17.28mmHg and diastolic BP (DBP) 80.11 10.39mmHg. Awake brachial was lower than office BP (p<0.001, difference between office SBP and awake SBP 1⁄4 11.17 14.21mmHg, and of office DBP and awake DBP 1⁄4 1.76 7.88mmHg). Systolic CBP was lower than brachial SBP in 24h, and awake and sleep periods (p<0.001, differences were 8.49 2.72mmHg, 9.35 3.42mmHg and 5.68 2.96mmHg between brachial SBP and systolic CBP in 24h, awake and sleep periods, respectively). Conversely, diastolic CBP was slightly higher than brachial DBP in 24h, awake and sleep periods (p<0.001, differences were 0.91 1.59mmHg, 1.55 1.78mmHg and 0.82 1.53mmHg between brachial SBP and diastolic CBP in 24h, awake and sleep periods, respectively). There were significant reductions between awake and sleep periods for systolic and diastolic CBP, for AIx and for PWV (p<0.001, differences were 5.62 7.13mmHg, 10.14 7.01mmHg, 3.85 9.07mmHg and 0.19 0.25mmHg for systolic CBP, diastolic CBP, AIx, and PWV, respectively). Conclusion: In normotensive and untreated hypertensive young adults, awake brachial BP was lower than office BP and systolic CBP means were lower than brachial BP, but diastolic CBP means were higher than brachial DBP. Reductions between awake and sleep periods were observed in the CBP, AIx and PWV means, similarly to what is observed with brachial BP, but with lower averages.

Impact of Central Obesity on the Estimation of Carotid-Femoral Pulse Wave Velocity

Studies have found that central obesity is associated with higher carotid-femoral pulse wave velocity (PWV). However, traveled distance (TD) measured over the body surface can be substantially overestimated with wider waist circumference (WC). We sought to investigate whether central obesity biases the estimation of PWV and whether this bias explains the association between PWV and different measures of adiposity. Seven hundred eleven participants (49.5% men) from the Baltimore Longitudinal Study of Aging with PWV, anthropometrics, and quantification of different fat depots by computed tomography and dual x-ray absorptiometry were included. TD and relative PWV were estimated with a tape measure over the body surface or linear distances taken from radiological images, unaffected by obesity. A significant association was found between wider WC and a greater difference between the 2 TD measurements and their respective PWV in both sexes (r ≥ 0.34; P < 0.001). This overestimation bias appeared to be generally higher in women than men (0.27 m/sec for each unit increase in WC; P < 0.0001). When TD estimated over the body surface was used to calculate PWV, greater WC, total body fat, subcutaneous fat, and visceral fat were all associated with higher PWV (P < 0.05 for all). However, when PWV was calculated using TD estimated from radiological images or body height, only the association with visceral fat held significant. When TD is measured over the body surface, the role of obesity on PWV is substantially overestimated. After accounting for this bias, PWV was still independently associated with visceral fat but not with other measures of adiposity, confirming its contribution to arterial stiffening.

Destiffening effect of valsartan and atenolol

We investigated data in 373 patients from the EXPLOR trial to determine the influence of heart rate (HR) and blood pressure (BP) on aortic stiffness in response to beta-blockade or angiotensin 2 type 1 receptor antagonism, administered during 24 weeks. Carotid-femoral pulse wave velocity (PWV) was measured with aplanation tonometry (Sphygmocor ) after 8 (W8) and 24 weeks (W24) of treatment by the single-pill combination valsartan-amlodipine (80/5 mg, then 160/10 mg) or an atenolol-amlodipine combination (50/5 mg, then 100/10 mg) in a prospective, randomized, parallel-groups multicenter trial with PROBE design. Drugs were up-titrated at W8. We analyzed the changes in PWV in relation with the changes in BP and HR, and major covariates, using mixed models in each treatment arm. The unadjusted reductions in mean BP and PWV were not significantly different between groups. HR was significantly reduced in the atenolol group, but not in the valsartan group. After adjustment on BP and HR, PWV significantly decreased with valsartan [-0.37 m/s (-0.70 to -0.08) at W8 and -0.43 (-0.76 to -0.10) m/s at W24], whereas no significant change was observed after atenolol [-0.16 m/s (-0.49 to 0.17) at W8 and -0.05 (-0.35 to 0.44) m/s at W24]. These findings suggest that the reduction in PWV observed after atenolol could be explained by changes in BP and HR, whereas in patients treated by valsartan, about half of the decrease in aortic stiffness was BP-independent.

Assessment of Arterial Stiffness Index in Hypertensive Patients in Relation to Their Treatment Status Attending a Tertiary Care Center in South India

Objectives: To assess the arterial stiffness index (ASI) and pulse wave velocity (PWV) in patients with hypertension and to compare with age matched healthy controls; to assess and compare the ASI and PWV in relation to the treatment status. Methods: The study was observational-cross sectional. Group one included chronic hypertensive patients on regular treatment for more than 2 months; group two included newly diagnosed hypertensive patients and group three had age matched healthy controls with normal blood pressure. The hypertensives subjects with other comormid conditions such as renal disease, diabetes were excluded from the study. The study was approved by the Institute Ethics Committee. The subjects were interviewed and explained the purpose of the study. All subjects gave written informed consent. The noninvasive periscope device was used to measure PWV, ASI and pulse pressure. Results: PWV, ASI and pulse pressure were statistically higher in hypertensive patients when compared to controls. Further, carotid-femoral PWV was correlated with mean arterial pressure in hypertensive subjects and was found to be statistically significant. Conclusion: PWV, ASI and pulse pressure are significantly higher in chronic and newly diagnosed non-diabetic hypertensives as compared to controls irrespective of their treatment status.

Arterial pulse wave velocity in relation to carotid intima-media thickness, brachial flow-mediated dilation and carotid artery distensibility: The Cardiovascular Risk in Young Finns Study and the Health 2000 Survey

Objective Increased arterial pulse wave velocity (PWV) is a strong predictor of cardiovascular events and mortality. The data regarding the relationships between PWV and other indices of vascular damage is limited and partly controversial. We conducted the present study to examine PWV in relation to non-invasive measures of early atherosclerosis (brachial flow-mediated dilation [FMD], carotid intima-media thickness [IMT]) and local arterial stiffness (carotid artery distensibility [Cdist]). Methods The study population consisted of 1754 young adults (aged 30–45 years, 45.5% males) participating in the Cardiovascular Risk in Young Finns Study (YFS), and of 336 older adults (aged 46–76 years, 43.2% males) participating in the Health 2000 Survey. FMD was measured only in the YFS cohort. FMD, IMT and Cdist were assessed by ultrasound, and PWV was measured using the whole-body impedance cardiography device. Results In young adults, FMD and IMT were not associated with PWV independently of cardiovascular risk factors. Moreover, FMD status was not found to modulate the association between cardiovascular risk factors and PWV. In older adults, PWV and IMT were directly and independently associated ( β = 1.233, p = 0.019). In both cohorts, PWV was inversely related with Cdist, and this relation remained significant ( p < 0.04) in models adjusted for cardiovascular risk factors. Conclusions The current findings suggest that PWV reflects a different aspect of vascular damage than FMD or IMT in young adults, whereas in older adults the information provided by PWV and IMT may be, to some extent, similar as regards subclinical vascular damage. The present observations also suggest that PWV and Cdist represent, at least in part, a similar adverse vascular wall process.

Central blood pressure and pulse wave velocity: relationship to target organ damage and cardiovascular morbidity-mortality in diabetic patients or metabolic syndrome. An observational prospective study. LOD-DIABETES study protocol

BackgroundDiabetic patients show an increased prevalence of non-dipping arterial pressure pattern, target organ damage and elevated arterial stiffness. These alterations are associated with increased cardiovascular risk.The objectives of this study are the following: to evaluate the prognostic value of central arterial pressure and pulse wave velocity in relation to the incidence and outcome of target organ damage and the appearance of cardiovascular episodes (cardiovascular mortality, myocardial infarction, chest pain and stroke) in patients with type 2 diabetes mellitus or metabolic syndrome.Methods/DesignDesign: This is an observational prospective study with 5 years duration, of which the first year corresponds to patient inclusion and initial evaluation, and the remaining four years to follow-up.Setting: The study will be carried out in the urban primary care setting.Study population: Consecutive sampling will be used to include patients diagnosed with type 2 diabetes between 20-80 years of age. A total of 110 patients meeting all the inclusion criteria and none of the exclusion criteria will be included.Measurements: Patient age and sex, family and personal history of cardiovascular disease, and cardiovascular risk factors. Height, weight, heart rate and abdominal circumference. Laboratory tests: hemoglobin, lipid profile, creatinine, microalbuminuria, glomerular filtration rate, blood glucose, glycosylated hemoglobin, blood insulin, fibrinogen and high sensitivity C-reactive protein. Clinical and 24-hour ambulatory (home) blood pressure monitoring and self-measured blood pressure. Common carotid artery ultrasound for the determination of mean carotid intima-media thickness. Electrocardiogram for assessing left ventricular hypertrophy. Ankle-brachial index. Retinal vascular study based on funduscopy with non-mydriatic retinography and evaluation of pulse wave morphology and pulse wave velocity using the SphygmoCor system. The medication used for diabetes, arterial hypertension and hyperlipidemia will be registered, together with antiplatelet drugs.DiscussionThe results of this study will help to know and quantify the prognostic value of central arterial pressure and pulse wave velocity in relation to the evolution of the subclinical target organ damage markers and the possible incidence of cardiovascular events in patients with type 2 diabetes mellitus.Trial RegistrationClinicalTrials.gov Identifier: NCT01065155

Association of the Invasively Measured Aortic Stiffness and Coronary Artery Disease

Background and Objectives:Aortic stiffness is believed to be an important risk factor of coronary artery atherosclerosis (CAA), as it directly affects coronary perfusion. The following aspects of the invasively measured aortic pulse wave velocity (PWV) were assessed in relation to CAA: The effect of cardiovascular risk factors on PWV, the effect of PWV on the severity of CAA and on the development of the restenosis after drug-eluting stent (DES) implantation. Subjects and Methods:371 subjects who had undergone coronary angiography were enrolled, with all undergoing an invasive aortic PWV measurement also. 112 patients, who had undergone a DES implantation, were prospectively investigated for the effect of PWV in relation to the subsequent risk of major adverse cardiac events (MACE). Results:Among the conventional cardiovascular risk factors, an age >60 (10.79±4.92 vs. 8.35±4.02, p=0.0006), diabetes (10.97±4.66 vs. 9.26±4.70 m/sec, p=0.0118) and dyslipidemia (10.38±4.97 vs. 9.47±4.55m/sec, p=0.0421) were significantly associated with an increased PWV, but sex, smoking and hypertension were not associated with an increased PWV. The PWV was shown to be significantly associated with the severity of CAD. The odds ratio (OR) of 1m/sec increment in the PWV for an increased vessel score was 1.08 (95% confidence interval (CI): 1.03-1.13, p=0.0017). There were no differences in the incidence of MACE and the changes in the angiographic parameters between the high (>10 m/sec) and low PWV groups. Conclusion: The invasively measured aortic PWV was affected by age (>60), diabetes and dyslipidemia, and also showed a strong association with the severity of CAD. The aortic PWV was not a significant risk factor for restenosis following a DES implantation. (Korean Circulation J 2005;35:766-772)