SphygmoCor System Research Articles

High serum adipocyte fatty acid binding protein concentration linked with increased aortic arterial stiffness in patients with type 2 diabetes

BackgroundAdipocyte fatty acid binding protein (A-FABP) is a novel adipokine that contributes to the development of metabolic disorder, type 2 diabetes mellitus (T2DM) and atherosclerosis. We determined the correlation between serum A-FABP and aortic stiffness in T2DM patients. MethodsFasting blood samples were obtained from 156 patients with T2DM. Serum A-FABP concentration were determined using a commercial enzyme immunoassay. Carotid-femoral pulse wave velocity (cfPWV) was measured using SphygmoCor System, and cfPWV values of >10 m/s were defined as high aortic stiffness. ResultsSixty participants (38.4%) fell under the high aortic stiffness group. This group, compared to the control group, showed older age (P = .004), higher systolic blood pressure (P < .001), diastolic blood pressure (P = .027), urine albumin-to-creatinine ratio (P = .003), serum A-FABP (P < .001) and lower estimated glomerular filtration rate (P = .001). After adjusting for factors significantly associated with aortic stiffness using multivariable logistic regression analysis, serum A-FABP [OR = 1.029 (1.002–1.058), P = .039] was found to be an independent predictor of aortic stiffness in T2DM patients. ConclusionsSerum A-FABP is positively correlated with aortic arterial stiffness in patients with T2DM.

Comparison of Ambulatory, and Central Blood Pressure in Heart Transplant Recipients

Purpose The purpose of this study was to evaluate the relationship between ambulatory, and central blood pressure (BP) in heart transplant recipients. Methods We conducted a cross-sectional study in 97 adult heart transplant recipients. Twenty-four hour ambulatory BP was measured using a Takeda TM-2430 instrument (A&D Medical, Tokyo, Japan) with readings taken every 30 minutes. Central hemodynamics were evaluated in the sitting position after 10 min of rest using the SphygmoCor system (AtCor Medical, Sydney, Australia). We compared ambulatory BP measurements with central BP readings. Results The mean age of the studied subjects was 50 ± 15 years, and 68.0% of participants were male. Bland-Altman analysis showed a bias (mean of difference) of 17.4 ± 18.8 mmHg for 24-hour systolic BP, 17.9 ± 17.9 mmHg for daytime systolic BP, and 16.1 ± 21.7 mmHg for nighttime systolic BP compared with central systolic BP. The strongest correlation was observed between daytime systolic BP and central systolic BP (r=0.344, p Conclusion Daytime systolic BP was higher on average than central systolic BP, but the higher range of daytime systolic BP exhibited larger difference with central systolic BP. Long-term studies are needed to determine which of the central BP or ambulatory BP better predicts the prognosis of heart transplant recipients.

Aortic Pulsatility Propagates Intracranially and Correlates with Dilated Perivascular Spaces and Small Vessel Compliance

Introduction: To test the hypotheses that changes in the aortic pulse-wave produced by arterial stiffening are (1) propagated into cerebral small vessels, (2) associated with reduced compliance of small cerebral arterial vessels, and (3) associated with the presence of dilated perivascular spaces (PVS). Methods: Fifteen volunteers and 19 patients with late-onset depression (LOD) were prospectively recruited, of which 6 fulfilled the criteria for treatment-resistant depression (TRD). Aortic pulse-wave velocity (PWV) was determined using Carotid-Femoral Doppler. Pulse-wave analysis (PWA) was performed using a SphygmoCor system. White-matter lesion load and PVS were scored on established MRI scales. Cerebral arterial and aqueductal cerebrospinal fluid (CSF) flow patterns were studied using quantitative phase-contrast angiography. Results: Depressed patients had more PVS (P < .05) and prolongation of the width of the arterial systolic pulse-wave in the carotid arteries (P < .01). There was no significant group difference for any PWV or PWA measurement. TRD patients showed more PVS than other LOD patients (P < .05). The fractional width of the arterial systolic peak correlated significantly with augmentation index (AIx) and heart rate-corrected augmentation index (AIx75; R2 = 0.302, P < .01and R2 = 0.363, P < .01 respectively). Arterial–aqueductal delay showed a negative correlation with estimated aortic systolic pressure (PWVsys; R2 = 0.293; P < .01), AIx (R2 = −0.491; P < .01) and AIx75 (R2 = −0.310; P < .01). PVS scores correlated with AIx (R2 = 0.485; P < .01) and AIx75 (R2 = −0.292; P < .01). Conclusion: Our findings support the hypothesis that increased arterial pulsatility resulting from central arterial stiffness propagates directly into cerebral vessels and is associated with the development of microvascular angiopathy, characterized by dilated PVS and decreased compliance of small arterial vessels.

Comparison of the association of brachial arterial pressure and parameters of central aortic pressure with left ventricular hypertrophy in the general population of Novosibirsk

Aim.There is evidence that central aortic blood pressure (BP) is more associated with left ventricular myocardial hypertrophy than brachial BP. The purpose of this work is to compare the association of brachial and central aortic BP with electrocardiographic parameters of left ventricular hypertrophy in the general population of Novosibirsk.Material and methods. We examined 327 people: 155 men and 172 women aged 25-44 years from a representative sample from the general population of Novosibirsk. The study program included anthropometry, BP measurement, electrocardiography, biochemical blood analysis. Radial artery applanation tonometry and pulse wave analysis were performed using the SphygmoCor system. Left ventricular hypertrophy was determined by electrocardiographic parameters.Results.In the general population of Novosibirsk, central aortic BP is more associated with left ventricular myocardial hypertrophy than brachial BP. Central pulse pressure, in contrast to brachial BP, is significantly associated with the R+S index (p=0,0085), as well as RI (p=0,0038) and RaVL (p=0,0039) wave amplitude. Central systolic aortic BP, in contrast to brachial systolic BP, is significantly associated with RI (p=0,042) and RaVL (p=0,029) wave amplitudes. Amplification parameters of central aortic BP, regardless of brachial BP, are associated with indices of left ventricular hypertrophy. Pulse pressure amplification in groups with or without left ventricular hypertrophy, standardized for age, gender, height, waist circumference, heart rate, triglyceride levels, high density lipoprotein cholesterol, low density lipoprotein cholesterol, blood glucose, and brachial pulse pressure, was 13,3 mm Hg and 12,5 mm Hg, respectively (p=0,035).Conclusion.The results of this study substantiate the relevance of the practical use of central aortic BP parameters in addition to the office measurement of brachial BP.

A2328 The associations of target organ damage with morning hypertension by various definitions

Objectives: Morning Hypertension (MHT) can be defined based on ambulatory blood pressure (BP) monitoring (ABPM) or home BP monitoring (HBPM). In which definition MHT is more associated with cardiovascular outcome remains unknown. Methods: From 2010–2015, we consecutively recruited untreated outpatients from our Hypertension Clinic. MHT was an average BP≥135/85 mmHg in the morning defined either based on HBPM, or the diary (the first 2 h after awakening) or short-clock time interval (6–10 AM) on the day of ABPM, irrespective of the BP levels at other time windows. We assessed carotid-femoral pulse wave velocity (cfPWV) by SphygmoCor system, left ventricular mass index (LVMI) and carotid intima-media thickness (IMT) by ultrasonography, and urinary albumin/creatinine ratio (ACR) as measures of target organ damage. Results: In the 1085 untreated patients (age 51.2 years), the prevalence of MHT were 63.7%, 65.1% and 48.7% based on the ABPM diary, short-clock time interval and HBPM, respectively. After adjustment for age, sex, and other cardiovascular risk factors, patients with MHT compared to normotensives had significantly (P < 0.001) increased cfPWV, urinary ACR and carotid IMT, irrespective of the definitions. In multivariate-adjusted continuous analyses, target organ measures were all positively associated with morning systolic BP recorded by ABPM and HBPM (P < 0.002), except for that of LVMI with home BP. After further including the systolic BP at other time windows in the models, morning systolic BP during 6–10 AM remained significantly associated with cfPWV (β = 0.019, P < 0.001), and home morning systolic BP was associated with cfPWV (β = 0.024, P < 0.001) and urinary ACR (β = 0.012, P = 0.003). Conclusion: Irrespective of the definitions based on ABPM or HBPM, morning hypertension was associated with target organ measures.

Measurement of pulse wave velocity, augmentation index, and central pulse pressure in atrial fibrillation: a proof of concept study

Individualized weighing of the risk benefit of anticoagulation is recommended in patients with atrial fibrillation (AF) who have low established risk scores or, conversely, are at increased risk for bleeding. Parameters of arterial stiffness and wave reflection could improve risk stratification, but their use has not been evaluated in arrhythmia. We measured carotid-femoral pulse wave velocity (PWV), central augmentation index (AI), and central pulse pressure (CPP) using the SphygmoCor system in 34 patients (53 to 85 years; 25 males) with AF before and after elective electrical cardioversion. Agreement was assessed using the intraclass correlation coefficient (ICC) and the coefficient of variation, completed with Bland–Altman plots. After cardioversion, mean arterial blood pressure (MAP) and heart rate (HR) decreased significantly by 8 mmHg and 18 bpm, respectively. PWV decreased from 11.8 m/s to 10.7 m/s, AI increased from 24% to 29%, and CPP rose from 38 mmHg to 43 mmHg. The decrease in PWV was related to the decrease in MAP (beta = 0.57; R2 = 0.33; P < .001), whereas changes in AI and CPP were related to the decrease in HR (AI: beta = −0.59; R2 = 0.35; P < .001, CPP: beta = −0.55; R2 = 0.28; P = .001). After adjustment for changes in MAP and HR, reliability analysis showed an excellent agreement for PWV (ICC = 0.89; 95% confidence interval (CI): 0.79–0.95) but moderate agreement for AI (ICC = 0.59; 95% CI: 0.17–0.80). Excellent agreement was also found for CPP (ICC = 0.89; 95% CI: 0.72–0.95). Measurement of PWV and CPP is reliable in patients with AF, as they appear unaffected by the presence of arrhythmia.

Central Blood Pressure Parameters Correlate with Cardiac Structure and Function in Healthy Chinese Individuals without Cardiovascular Disease

Purpose: To explore the relationship between central blood pressure (BP) parameters and cardiac structure and function parameters in healthy individuals. Methods: Four hundred Chinese participants with no overt cardiovascular disease participated in this study. One hundred and seventy-one participants (42.8%) were male and the mean age was 60 years. Central BP was measured with the SphygmoCor system. Cardiac structure and function were assessed by echocardiography. Results: We showed a significant association of left atrial volume and left ventricular mass index (LVMI) with brachial and central systolic BP (SBP) and pulse pressure (PP; r = 0.189–0.0.39, p < 0.001). Left ventricular diastolic function and the E/A ratio were significantly associated with brachial and central BP (r = 0.228–0.469, p < 0.001). Multivariate regression analysis revealed that central SBP and PP were independently correlated with LVMI after normalization for age and other confounding variables (sex, body mass index, smoking, and alcohol intake, and the levels of triglycerides, high-density lipoprotein, low-density lipoprotein, creatinine, uric acid, fasting blood glucose, log C-reactive protein, and fibrinogen. However, only central SBP was found to be independently correlated with the E/A ratio. Conclusions: Cardiac structure and diastolic function were associated with brachial and central BP. However, after normalization, cardiac structure parameters were independently correlated with central SBP and PP. Diastolic function was the only cardiac function parameter that correlated with central SBP.

Non-invasive Estimation of the Intracranial Pressure Waveform from the Central Arterial Blood Pressure Waveform in Idiopathic Normal Pressure Hydrocephalus Patients

This study explored the hypothesis that the central aortic blood pressure (BP) waveform may be used for non-invasive estimation of the intracranial pressure (ICP) waveform. Simultaneous invasive ICP and radial artery BP waveforms were measured in 29 individuals with idiopathic normal pressure hydrocephalus (iNPH). The central aortic BP waveforms were estimated from the radial artery BP waveforms using the SphygmoCor system. For each individual, a transfer function estimate between the central aortic BP and the invasive ICP waveforms was found (Intra-patient approach). Thereafter, the transfer function estimate that gave the best fit was chosen and applied to the other individuals (Inter-patient approach). To validate the results, ICP waveform parameters were calculated for the estimates and the measured golden standard. For the Intra-patient approach, the mean absolute difference in invasive versus non-invasive mean ICP wave amplitude was 1.9 ± 1.0 mmHg among the 29 individuals. Correspondingly, the Inter-patient approach resulted in a mean absolute difference of 1.6 ± 1.0 mmHg for the 29 individuals. This method gave a fairly good estimate of the wave for about a third of the individuals, but the variability is quite large. This approach is therefore not a reliable method for use in clinical patient management.

High serum leptin levels are associated with central arterial stiffness in geriatric patients on hemodialysis.

Objective:Central arterial stiffness predicts cardiovascular (CV) mortality in hemodialysis (HD) patients. The aging process transforms lipid distribution and thus alters adipokine secretion. The harmful effects of leptin on CV events may change in the elderly. The purpose of this study was to investigate the relationship between leptin and central arterial stiffness markers through carotid–femoral pulse wave velocity (cfPWV) in geriatric HD patients.Materials and Methods:Patients over 65 years old on chronic HD were recruited. Blood samples were collected, and the cfPWV was measured with the SphygmoCor system. The patients with cfPWV values >10 m/s were defined as the high arterial stiffness group.Results:In total, 30 (51.7%) of the 58 geriatric patients on chronic HD in this study were in the high arterial stiffness group. The high arterial stiffness group had higher rates of diabetes mellitus (P = 0.019), hypertension (P = 0.019), and higher systolic blood pressure (P = 0.018), pulse pressure (P = 0.019), body mass index (P = 0.018), serum leptin levels (P = 0.008), and hemoglobin levels (P = 0.040) than those in the low arterial stiffness group. Multivariable forward stepwise linear regression analysis showed logarithmically transformed leptin (log-leptin, β =0.408, adjusted R2 change = 0.164; P = 0.001) and diabetes (β =0.312, adjusted R2 change = 0.085; P = 0.009) were associated with cfPWV values in geriatric HD patients. Moreover, an increased serum leptin level (odds ratio: 1.053; 95% confidence interval: 1.007–1.100; P = 0.023) was an independent factor for central arterial stiffness among geriatric HD patients after multivariate logistic regression analysis.Conclusion:In this study, a higher serum leptin level was correlated with central arterial stiffness in geriatric HD patients.

Growth Hormone, Insulin-Like Growth Factor-1, Insulin Resistance, and Leukocyte Telomere Length as Determinants of Arterial Aging in Subjects Free of Cardiovascular Diseases.

Background: Increased arterial stiffness (AS), intima-media thickness (IMT), and the presence of atherosclerotic plaques (PP) have been considered as important aspects of vascular aging. It is well documented that the cardiovascular system is an important target organ for growth hormone (GH) and insulin-like growth factor (IGF)-1 in humans, and GH /IGF-1 deficiency significantly increases the risk for cardiovascular diseases (CVD). The telomere length of peripheral blood leukocytes (LTL) is a biomarker of cellular senescence and that has been proposed as an independent predictor of (CVD). The aim of this study is to determine the role of GH/IGF-1, LTL and their interaction cardiovascular risk factors (CVRF) in the vascular aging.Methods: The study group included 303 ambulatory participants free of known CVD (104 males and 199 females) with a mean age of 51.8 ± 13.3 years. All subjects had one or more CVRF [age, smoking, arterial hypertension, obesity, dyslipidemia, fasting hyperglycemia, insulin resistance—HOMA (homeostatic model assessment) >2.5, or high glycated hemoglobin]. The study sample was divided into the two groups according to age as “younger” (m ≤ 45 years, f ≤ 55 years) and “older” (m > 45 years, f > 55 years). IMT and PP were determined by ultrasonography, AS was determined by measuring the carotid-femoral pulse wave velocity (c-f PWV) using the SphygmoCor system (AtCor Medical). LTL was determined by PCR. Serum IGF-1 and GH concentrations we measured by immunochemiluminescence analysis.Results: Multiple linear regression analysis with adjustment for CVRF indicated that HOMA, GH, IGF-1, and LTL had an independent relationship with all the arterial wall parameters investigated in the younger group. In the model with c-f PWV as a dependent variable, p < 0.001 for HOMA, p = 0.03 for GH, and p = 0.004 for LTL. In the model with IMT as a dependent variable, p = 0.0001 for HOMA, p = 0.044 for GH, and p = 0.004 for IGF-1. In the model with the number of plaques as a dependent variable, p = 0.0001 for HOMA, and p = 0.045 for IGF-1. In the older group, there were no independent significant associations between GH/IGF-1, LTL, HOMA, and arterial wall characteristics.Conclusions: GH/IGF-1, IR, HOMA, and LTL were the important parameters of arterial aging in younger healthy participants.

Aldosterone breakthrough does not alter central hemodynamics.

Introduction:Angiotensin-converting enzyme inhibitors and angiotensin receptor blockers are widely used in congestive heart failure and chronic kidney disease, but up to 40% of patients will experience aldosterone breakthrough, with aldosterone levels rising above pre-treatment levels after 6–12 months of renin-angiotensin-aldosterone system blockade. Aldosterone breakthrough has been associated with worsening congestive heart failure and chronic kidney disease, yet the pathophysiology remains unclear. Breakthrough has not been associated with elevated peripheral blood pressure, but no studies have assessed its effect on central blood pressure.Methods:Nineteen subjects with well-controlled peripheral blood pressure on stable doses of angiotensin-converting enzyme inhibitor/angiotensin receptor blocker had aldosterone levels checked and central blood pressure parameters measured using the SphygmoCor system. The central blood pressure parameters of subjects with or without breakthrough, defined as serum aldosterone >15 ng/dl, were compared.Results:Of the 19 subjects, six had breakthrough with a mean aldosterone level of 33.8 ng/dl, and 13 were without breakthrough with a mean level of 7.1 ng/dl. There was no significant difference between the two groups in any central blood pressure parameter.Conclusions:We found no correlation between aldosterone breakthrough and central blood pressure. The clinical impact of aldosterone breakthrough likely depends on its non-genomic, pro-fibrotic, pro-inflammatory effects rather than its regulation of extracellular volume.

Serum leptin is a predictor for central arterial stiffness in hypertensive patients.

Serum adipokines have a role in the development of arterial stiffness. We aimed to investigate the risk factors of developing arterial stiffness and the association of leptin and arterial stiffness in hypertensive (HTN) patients. There were 101 HTN patients enrolled. Fasting blood samples and baseline characteristics were obtained and carotid-femoral pulse wave velocity (cfPWV) was measured with the SphygmoCor system. A cfPWV > 10 m/s was defined as high arterial stiffness, and ≤ 10 m/s as low arterial stiffness. Forty-seven patients (46.5 %) had high arterial stiffness, and had a higher percentage of diabetes (P = 0.044), , older age (P < 0.001), higher pulse pressure (P = 0.049), and higher serum blood urea nitrogen (P = 0.029), creatinine (P = 0.027), intact parathyroid hormone (P = 0.004), serum leptin level (P = 0.002), C-reactive protein (P < 0.001), but lower estimated glomerular filtration rate (P = 0.006) compared to patients with low arterial stiffness. After adjusting for factors significantly associated with arterial stiffness by multivariate logistic regression analysis, it revealed that leptin (aOR = 1.037, 95% CI = 1.007-1.067, P = 0.014), having DM (aOR = 4.885, 95% CI = 1.590-15.006, P = 0.006), and elevated CRP (aOR = 1.503, 95% CI = 1.110-2.0371,P = 0.009) were significant independent predictors of arterial stiffness in HTN patients. Serum leptin level could be a predictor for arterial stiffness in HTN patients.

PP.19.04] CORONARY ARTERY PULSE WAVE VELOCITY

Objective: Albeit of utmost importance, especially with respect to plaque rupture, the biomechanical properties of coronary arteries are poorly assessable in routine practice. A classic method of assessment is to determine vascular compliance through pulse wave velocity (PWV). This has been done for aortic PWV, a strong predictor of coronary artery disease (CAD). To our knowledge, there is no way to assess coronary PWV (CoPWV) in routine practice. The first objective of this study was to describe a method of measuring coronary PWV (CoPWV) invasively, and to describe its determinants. The second objective was to assess both CoPWV and aortic PWV, in patients presenting with acute coronary syndromes (ACS) or with stable CAD. Design and method: In fifty-three patients, CoPWV was measured from the delay in pressure wave and distance travelled, as a pressure wire was withdrawn from the distal to the proximal coronary segment. Pressure and electrocardiographic signals were recorded at a high sampling frequency, and dedicated software was used to calculate CoPWV. Similarly, Aortic PWV was measured invasively when the wire was pulled across the ascending aorta; Carotid-femoral PWV was also measured non-invasively using the SphygmoCor system. Results: Mean CoPWV was 10.3 ± 6.1 m/s. Determinants of increased CoPWV were smoking, diastolic blood pressure, and previous stent implantation in the recorded artery. CoPWV was much lower in ACS versus stable CAD patients (7.6 ± 3 m/s vs. 11.5 ± 6.4 m/s; p = 0.02), and this persisted after adjustment for confounders. On the contrary, aortic stiffness, assessed by AoPWV and by Carotid-femoral PWV, did not significantly differ. Conclusions: CoPWV seems associated with acute coronary events more tightly than AoPWV. Low coronary compliance, whether per se or because it leads to a distal shift in compliance mismatch, may expose vulnerable plaques to high cyclic stretch. CoPWV is a new tool to assess local compliance at the coronary level; it paves the way for a new field of research.

PP.03.08] THE HAEMODYNAMIC MECHANISM OF THE AGE-RELATED INCREASE IN PULSE PRESSURE IN WOMEN

Objective: An age-related increase in pulse pressure is the major cause of morbidity and mortality in the ageing population and is more marked in women than in men. The haemodynamic determinants of increased pulse pressure remain incompletely understood. The aim of this study is was to examine the contribution of ventricular dynamics, large artery stiffness, and pressure wave reflection to central pulse pressure. Design and method: A total of 2162 women aged 18 to 91 years (mean ± SD, age 57 ± 13 years) from the Twins UK cohort were studied. Non-invasive aortic flow velocity and blood pressure were measured by Doppler sonography and carotid tonometry system respectively. Carotid-femoral PWV was measured using the SphygmoCor system. Reflection index (the ratio of the peak of the backward pressure wave over that of the forward pressure wave) was computed from the pressure and flow waves. Results: Central pulse pressure increased with age, from 29.5 ± 0.46 mmHg for those aged below 40 years to 52.6 ± 0.85 mmHg for those over 70 years (means ± SE, P < 0.001). PWV increased approximately 13.2% per decade. Maximum flow velocity tended to increase (from 1.11 ± 0.01 to 1.16 ± 0.01 m/s over the 5 decades, P < 0.01), and ejection volume at the time of peak pulse pressure increased from 63.3 ± 1.41 to 72.3 ± 1.92 ml (P < 0.001) but reflection index decreased from 0.28 ± 0.01 to 0.25 ± 0.01 (P < 0.001). Conclusions: These results suggest that the age-related increase in central pulse pressure is driven mainly by an increase in arterial stiffening and increased ventricular ejection.

PP.19.12] ASSOCIATION OF ISOLATED MORNING HYPERTENSION WITH ARTERIAL MEASURES IN UNTREATED CHINESE PATIENTS

Objective: Morning hypertension was suggested to be closely associated with target organ damage and cardiovascular events. However, the independent contribution of morning hypertension to cardiovascular damage remains controversial. The purpose of our study was to investigate the association of isolated morning hypertension with measures of arterial stiffness and microalbuminuria in an untreated outpatient cohort. Design and method: We recruited consecutive outpatients who was suspected of having hypertension but not taking antihypertensive drugs for at least 2 weeks and referred to our hypertension clinic from November 2010 to June 2015. Home BP was self-measured with the Omron 7051 monitors for 7 days. Hypertension was defined as a mean home BP of at least 135/85 mmHg either in the morning or in the evening. We assessed carotid-femoral pulse wave velocity (cfPWV) and central augmentation index (cAIx) with the SphygmoCor system as measures of arterial stiffness, and the morning urinary albumin/creatinine ratio (ACR) as measures of microalbuminuria. Results: In the 1537 untreated outpatients (mean age, 51.0 years; women, 51.9%), 200 (13.0%) had isolated morning hypertension. Patients with isolated morning hypertension compared to normotensive subjects had faster cfPWV (8.1 vs 7.5 cm/s, P < 0.001), increased urinary ACR (0.76 vs 0.65 mg/mmol, P = 0.049), but similar cAIx (26.7 vs 25.3%, P = 0.14). After adjustment for age, sex, body height and weight, heart rate, current smoking and alcohol intake, serum total cholesterol and fasting glucose, the between-group difference in cfPWV (8.0 vs 7.5 cm/s, P < 0.001), cAIx (25.8 vs 23.5%, P < 0.001) and ACR (0.72 vs 0.62, P = 0.037) were statistically significant. In continuous analysis, home morning systolic BP was significantly (P < 0.001) associated with cfPWV and ACR after adjustment with aforementioned variables and evening SBP. In addition, for cfPWV and ACR, morning systolic BP explains the greatest part of the variations in the model. Conclusions: The prevalence of isolated morning hypertension is 13% in our untreated Chinese outpatients. Isolated morning hypertension is associated with arterial stiffness and increased wave reflections in untreated Chinese patients. Home morning BP was independently associated with arterial damage.

High serum adipocyte fatty acid binding protein level as a potential biomarker of aortic arterial stiffness in hypertensive patients with metabolic syndrome

BackgroundThe adipocyte-fatty-acid-binding protein (A-FABP) has been implicated in arterial stiffness, metabolic syndrome (MetS), and cardiovascular disease. We aimed to determine the relationship among serum A-FABP concentration, cardiometabolic risk factors, and central arterial stiffness in a hypertensive population. MethodsFasting blood samples and baseline characteristics were obtained from 110 hypertensive patients. Serum A-FABP concentrations were determined by enzyme immunoassay kit. High arterial stiffness was defined as carotid-femoral pulse wave velocity values >10m/s via the SphygmoCor system. ResultsPatients with MetS and high arterial stiffness accounted for 67.3% and 42.7% of the study population, respectively. Serum A-FABP was positively associated with MetS and high arterial stiffness (P=0.006 and P<0.001, respectively). Multivariable stepwise linear regression analysis of the significant variables of arterial stiffness revealed that logarithmically transformed A-FABP (log-A-FABP, β=0.278, P=0.002) was positively correlated arterial stiffness in hypertensive patients. Subgroup analysis revealed that log-A-FABP (β=0.327, P=0.003), age (β=0229, P=0.032), and triglyceride (β=0.307, P=0.004) were significantly positively correlated with arterial stiffness in hypertensive patients with MetS. ConclusionsElevated A-FABP concentration could be a predictor for MetS and arterial stiffness in hypertensive patients.

Serum resistin as an independent marker of aortic stiffness in patients with coronary artery disease.

BackgroundSubjects with higher carotid–femoral pulse wave velocity (cfPWV) will be at an increased risk for cardiovascular (CV) events in future. Resistin is an inflammatory mediator and a biomarker of CV diseases. We evaluated the association between serum resistin and aortic stiffness in patients with coronary artery disease (CAD).MethodsA total of 104 patients with CAD were enrolled in this study. cfPWV was measured using the SphygmoCor system. Patients with cfPWV >10 m/s were defined as the high aortic stiffness group.ResultsThirty-seven patients (35.6%) had high aortic stiffness and higher percentages of diabetes (p = 0.001), were of older age (p = 0.001) and had higher waist circumference (p < 0.001), systolic blood pressure (p = 0.027), pulse pressure (p = 0.013), high-sensitivity C-reactive protein (p < 0.001) and resistin levels (p < 0.001) but lower estimated glomerular filtration rate (p = 0.009) compared to subjects with low aortic stiffness. After adjusting for factors significantly associated with aortic stiffness by multivariate logistic regression analysis, serum resistin (odds ratio = 1.275, 95% confidence interval: 1.065–1.527, p = 0.008) was also found to be an independent predictor of aortic stiffness in patients with CAD.ConclusionsSerum resistin level is a biomarker for aortic stiffness in patients with CAD.

Comparison of central and peripheral hemodynamics in association with left ventricular diastolic dysfunction in the community-based elderly Chinese

The aim of the study was to investigate the association of left ventricular diastolic dysfunction (LVDD) with central and peripheral hemodynamics. A total of 1599 community-based senior residents (aged ≥ 65 years) in northern Shanghai, China, were recruited as of August 2015. Echocardiography was performed for each participant using the MyLab30 Gold CV system. According to the recommendations from the American Society of Echocardiography, the ratio of E (peak early diastolic transmitral flow velocity) to E′ (early diastolic lateral mitral annulus velocity) was assessed for the evaluation of LVDD. Central blood pressure (BP) components were measured using the SphygmoCor system. In community older population (72.7 ± 6.01 years), brachial systolic BP (mm Hg) was higher than central systolic BP (141.9 ± 19.5 vs. 130.3 ± 20.1 mm Hg). A total of 214 subjects (13.4%) showed LVDD, and female showed higher prevalence of diastolic dysfunction than male (17.3% vs. 8.4%, P < .01). After adjustment for confounding variables, only central systolic BP, not brachial systolic BP, was significantly associated with E/E′ in the total population. Similar result was found in the subgroup analysis (participants without antihypertensive agents treatment, man, woman). Similar findings were obtained for the pulse pressure (PP) analysis. Within central hemodynamics, only central PP, but not central systolic BP or augmentation pressure, was significantly associated with E/E′ after adjustment. When LVDD was defined by E/E′ and other echocardiographic parameters, our findings remained unaltered in the multivariate logistic regression with similar adjustment in the total population and subgroup analysis. In the Chinese elderly cohort, central hemodynamics, especially central PP, is superior to other BP components in identifying LVDD (NCT02368938).

Abstract P310: Effect of Static Stretching Exercise on Aortic Pulse Wave Velocity

Introduction: Large-artery stiffness (i.e., aortic stiffness) is an independent predictor of hypertension which is a leading cause of excess cardiovascular morbidity and mortality. Carotid-femoral pulse wave velocity (cf-PWV) is considered the ‘gold-standard’ measure of arterial stiffness because it measures along the aorto-iliac pathway, which buffers blood pressure (BP) the most. While there is well-documented evidence on the health benefits of aerobic and resistance exercise, the information for the effect of stretching on aortic stiffness is limited. Previous studies have shown that arterial stiffness is associated with trunk flexibility. Stretching exercise targeted to improve flexibility may exert a beneficial effect on reducing aortic stiffness. Objectives: This study aimed to examine effects of a single bout of a structured static stretching exercise on aortic stiffness as well as trunk flexibility, blood pressure (BP), and heart rate (HR). Method: This study has a pretest-postest design without a control group. Thirty healthy women from the community were instructed to follow a video demonstration of a structured whole-body static stretching lasting 30 minutes. Each stretching was designed to improve range of motion and enhance flexibility in 10 body areas, and all stretching motions were performed in the sitting position. Aortic stiffness was measured by cf-PWV using the SphygmoCor system (AtCor medical, AU). Trunk Flexibility was measured by the sit and reach method. BP and HR were measured using the WelchAllyn Monitor (WelchAllyn, USA). Results: After stretching exercise, cf-PWV (m/s) was significantly reduced (M=6.93, SD=1.54 vs M=6.29, SD=1.17; t(29)=2.708, p =.011). In addition, HR (bpm) was significantly decreased (M=64.88, SD=6.29 vs M=61.77, SD=6.29; t(29) = 7.170, p=.000). A significant increase of lumbar flexibility (inches) was also detected (M=13.37, SD=4.3 vs M=16.45, SD=4.79; t(29) = 12.248, p=.000). Systolic BP and diastolic BP (mmHg) were decreased after stretching exercise from M=107.87 (SD 10.75) to M=106.82 (SD 12.48), from M=63.37 (SD 6.71) to M=61.88 (SD 6.47), respectively; however, the differences did not reach the statistical significance. Conclusions: Findings of the current study highlight the potential benefit of static stretching exercise on aortic stiffness independent of BP. The results also demonstrate that HR was significantly decreased after the stretching exercise. Given no sign of over-activity of sympathetic function, a structured static stretching exercise may be prescribed as an effective intervention to reduce aortic stiffness for the people with high risk of cardiac events. In addition, stretching motions that were conducted in the sitting position can be cautiously utilized as an effective intervention for stroke patients, post-surgery patients, and people who have unsteady walking.

Importance of arterial stiffness in predicting cardiovascular events.

Cardiovascular events represent an important cause of morbidity and mortality in the entire population. Arterial stiffness is currently considered one of the most important risk factors for the development of cardiovascular events. The gold-standard for evaluating arterial stiffness is pulse wave velocity (PWV). Recent studies have demonstrated that PWV is an independent risk factor regarding the development of cardiovascular events, especially in certain categories of patients. The development of cardiovascular events was assessed in 174 patients admitted in the Center of Internal Medicine, Fundeni Clinical Institute, between January 2011 - May 2012. Arterial stiffness was evaluated by measuring PWV using the Sphygmocor system (AtCor, Australia), which is based on the principle of applanation tonometry. The patients were monitored for the development of cardiovascular events (ischemic heart disease, heart failure, stroke, acute myocardial infarction) and for death of cardiovascular cause, over a median period of 51.5 months (43-60 months). Of the 174 patients, 81 (46.6%) were women and 93 (53.4%) were men. Mean age was 55.96 years. 93 of the 174 patients had chronic kidney failure in different stages (47.3% in stage V). Regarding PWV in the patient group, we obtained a mean score of 9.382. We observed a significant difference regarding the PWV level only for acute myocardial infarction and death between patients who developed these events and those who did not. Our study demonstrates that PWV increase can be positively associated with the occurrence of cardiovascular events, particularly in certain groups of patients.