Upstroke Time Research Articles

P69 The Initial Upstroke Time is Most Strongly Associated with the Severity of as Among Brachial Pulse Wave Parameters

BackgroundAortic valve stenosis (AS) is the most common valve disease in an elderly population, therefore, simple screening examination for AS is needed. Although a prolonged carotid upstroke time (UT), and prolonged ejection time (ET) of a brachial pulse wave (BPW) have been observed in severe AS patients, it has been unclear which BPW parameters have a better correlation with the severity of AS. The aim of this study was to examine which BPW parameters are most relevant to the severity of AS.MethodsSixty-five Consecutive moderate and severe AS patients who were evaluated by trans-thoracic echocardiography were enrolled in this study. Control patients who were adjusted for age, gender, and blood pressure among outpatients were enrolled (N = 110). UT, ET, initial upstroke time (iUT), and half rise time of upstroke (1/2 hrUT) were evaluated correlations between mean pressure gradient (mPG) among AS patients.ResultsiUT and 1/2 hrUT have significant correlations with mPG among AS patients (iUT: R = 0.50, 95% CI = 0.29–0.67, p < 0.0001; 1/2 hrUT: R = 0.41, 95% CI = 0.19–0.60, p < 0.001), whereas UT and ET did not. Multivariate logistic regression analysis showed area under curve (AUC) of iUT and 1/2 hrUT were higher than UT and ET to predict mPG >40 mmHg (AUC: iUT vs 1/2 hrUT vs UT vs ET = 0.90 vs 0.89 vs 0.69 vs 0.77).ConclusionThe severity of AS appeared strongly in the first half of the BPW upstroke. iUT and 1/2 hrUT may be a simple and useful screening test to assess the severity of AS.

Association of Pulse Volume Recording at Ankle with Total and Cardiovascular Mortality in Hemodialysis Patients.

Pulse volume recording is an accurate modality for detecting arterial occlusion in the lower extremities. There are two indexes of pulse volume recording measured at ankle, percentage of mean arterial pressure (%MAP) and upstroke time (UT). The aim of the study was to examine the ability of %MAP and UT for the prediction of overall and cardiovascular mortality in hemodialysis (HD) patients. In 197 routine HD patients, ankle %MAP, ankle UT, and ankle–brachial index (ABI) were automatically measured by Colin VP-1000 instrument. Fourteen cardiovascular mortality and 29 overall mortalities were documented during 2.7 ± 0.6 years follow-up. In the univariate analysis, in addition to co-morbidities and traditional clinical parameters, increased total mortality was associated with decreased ABI, ABI < 0.9, increased %MAP and UT, %MAP > 50%, and UT > 169 ms (p ≤ 0.041) and increased cardiovascular mortality was associated with increased UT and %MAP > 50% (p ≤ 0.022). After multivariate analysis, increased %MAP and %MAP > 50% (p ≤ 0.047) were still the predictors of total mortality and %MAP > 50% (p = 0.024) was still the predictor of cardiovascular mortality. In HD patients, we found that ankle %MAP and %MAP > 50% could predict total mortality and ankle %MAP > 50% could predict cardiovascular mortality in the multivariate analysis. Hence, assessment of %MAP from pulse volume recording at ankle might be helpful in identifying the high-risk group for poor prognosis in HD patients.

Upstroke Time Per Cardiac Cycle is Associated with Cardiovascular Prognosis in Type 2 Diabetes

Objective: Upstroke time per cardiac cycle (UTCC) in the lower extremities has been found to be predictive of cardiovascular mortality in the general population. Therefore, the purpose of the study was to test the associations between increasing UTCC and outcomes in patients with type 2 diabetes. Methods: A total of 452 patients with type 2 diabetes (age, 67.5 ± 8.6 years; male, 54%) registered in a share-care program participated in the study at an outpatient clinic in Taipei Veterans General Hospital across a mean of 5.8 years. Primary outcomes were all-cause mortality hospitalization for coronary artery disease, stroke, revascularization, amputation, and diabetic foot syndrome. Secondary end-point outcome was all-cause mortality. Results: Increment of UTCC associations with primary and secondary outcomes were undertaken prior to baseline characteristic adjustments. A UTCC of 20.1% exhibited the greatest area under curve (AUC), sensitivity, and specificity balance to predict composite events in receiver operating curves (AUC, 0.63 [P = .001]; sensitivity, 67.7%; specificity, 54.9%). Sixty-four composite events and 17 deaths were identified from medical records. UTCC ≥20.1% was associated with the occurrence of composite events and an increased risk of mortality. For composite events, an adjusted hazard ratio (HR) of 2.45 and 95% confidence interval (CI) of 1.38 to 4.35 (P = .002) were calculated. For all-cause mortality, an adjusted HR of 1.91 and 95% CI of 0.33 to 10.99 (P = .467) were calculated. Conclusion: Increasing UTCC was associated with cardiovascular outcomes in patients with type 2 diabetes. Therefore, UTCC is advocated as a noninvasive screening tool for ambulatory patients with type 2 diabetes. Abbreviations: CAD = coronary artery disease; CI = confidence interval; eGFR = estimated glomerular filtration rate; HR = hazard ratio; PAD = peripheral artery disease; UTCC = upstroke time per cardiac cycle.

Retinal Arteriole Pulse Waveform Analysis Using a Fully-Automated Doppler Optical Coherence Tomography Flowmeter: a Pilot Study.

PurposeTo evaluate the repeatability and reproducibility of the measurement of retinal arteriole pulse waveforms using a novel fully-automated Doppler optical coherence tomography (DOCT) flowmeter in healthy subjects.MethodsTwenty eyes of 20 healthy subjects were included to test the intrasession repeatability of pulse waveform analysis. DOCT measurements were performed based on a newly developed instantaneous Doppler angle measurement method. Upstroke time (UT), which is the time from the minimum to the maximum retinal blood velocity, and the resistance index (RI) of the retinal arteriole pulse waveform were measured. Coefficients of variation (CVs) and intraclass correlation coefficients (ICCs) were calculated. Interdevice reproducibility between two instruments was assessed in five eyes of five subjects.ResultsThe mean UT was 130.3 ms (range, 110.1–152.1 ms), and the mean RI was 0.66 (range, 0.51–0.82). The respective ICCs of UT and the RI for the intrasession repeatability of assessment were 0.87 and 0.78. The respective CVs of UT and the RI were 6.6 ± 3.3% and 4.7 ± 2.1%. Regarding interdevice reproducibility, there were no significant differences between the measurements derived from the instruments (P > 0.05).ConclusionsPulse waveform measurement in retinal arterioles using a fully-automated DOCT flowmeter exhibited good repeatability and interdevice reproducibility.Translational RelevanceThe above-described improved DOCT flowmeter system provides reasonably repeatable measurements of retinal arteriole pulse waveforms, potentially facilitating systemic-circulation abnormality monitoring. The examination of the circulation with the novel device can be potentially useful for evaluating systemic circulation.

Image Analysis on Fingertip Video To Obtain PPG

Cardiovascular problems are evolving as the chief cause of death worldwide. Heart Rate, Blood Pressure, Respiratory Rate, Oxygen Saturation, Systolic Upstroke Time, Heart Beat duration, Diastolic time, RR intervalare some important physiological parameters that help to monitor our daily health condition. Those parameters are very useful to determine if a person is suffering from any cardiovascular problems or not based on daily data collection and monitoring over a certain period of time and in this context machine learning algorithms will be very helpful for developing a smart cardiovascular tele-monitoring &amp; recommendation system for better lifestyle. Irregularities in the heart signal can pop up a serious indication for upcoming cardiac problem. Here, we have concentrated on intensity variation based heart rate calculation process from PPG with major analysis on captured contact video. Here we have used normal handy smart phone camera which is available to everyone and able to capture fingertip videos of flowing blood in the vessels with visible light wavelength. In this paper, we have performed analysis on captured videos for accurate health parameter capturing and compared it with standard devices (FDA approved).

Association Between Prevalence of Peripheral Artery Disease and Radiation Exposure in the Atomic Bomb Survivors.

BackgroundPast reports suggested that total‐body irradiation at 0.5 to 1.0 Gy could be responsible for atherosclerosis. Peripheral artery disease (PAD) is a manifestation of systematic atherosclerosis. Whether the consequences of a low‐to‐moderate dose of radiation include increased risk of PAD remains to be determined. The purpose of this study was to examine the association between radiation exposure and prevalence of PAD among Japanese atomic bomb survivors.Methods and ResultsRadiation exposure from the atomic bombing was assessed in 3476 participants (41.1% men, mean age 74.8 years with SD 6.4 years) with a cross‐sectional survey in 2010 to 2014. Left‐ and right‐side ankle‐brachial indexes and upstroke time (UT) were obtained using oscillometric VP‐2000. PAD was defined as an ankle‐brachial index of 1.0 or less or a prior history related to revascularization. UT was considered a sensitive marker of early‐stage PAD. Association between radiation exposure and PAD or UT was assessed using multivariable regression analyses with adjustment for potential confounding factors. Of 3476 participants, 79 (2.3%) were identified as having prevalent PAD. Multivariate logistic regression analysis indicated that radiation dose was unrelated to PAD prevalence (odds ratio, 0.83; 95% confidence interval [0.57‐1.21]). UT appeared to increase with radiation dose, but the increase was not statistically significant (1.09 ms/Gy; 95% confidence interval [−0.17 to 2.36]).ConclusionsWe found no clear association of radiation dose with PAD, but it remains to be determined whether UT is associated with radiation dose.

A0520 Comparison of Ankle-Brachial Index and Upstroke Time per Cardiac Cycle in Association with Target Organ Damage in Elderly Chinese

Objectives: Recent studies indicated that upstroke time per cardiac cycle (UTCC) in lower extremities is equivalent to ankle-brachial index (ABI) in diagnosing peripheral arterial disease and in predicting cardiovascular mortality. In the present study, we aim to compare ABI and UTCC in terms of their association with target organ damage (TOD). Methods: 1841 elderly participants (mean age of 70 years) from the Northern Shanghai Study were included in the present study. ABI and UTCC were measured using VP-1000 device (Omron, Japan). TOD including left ventricular hypertrophy and diastolic dysfunction, carotid intima-media thickness and plaque, carotid-femoral pulse wave velocity (CF-PWV) and renal damage, were all evaluated. Results: ABI and UTCC both were significantly correlated with CF-PWV, carotid plaque and eGFR, but not with cardiac damage. Compared with ABI, UTCC showed stronger correlation with CF-PWV. When ABI and UTCC separately put into same multivariate full-mode logistic regression models, both ABI (Odds Ratio [OR]:2.273; 95% Confidence Interval [CI]:1.632–3.165) and UTCC (OR:1.627; 95%CI: 1.182–2.240) significantly associated with carotid plaque, but only UTCC significantly associated with increased CF-PWV (OR:1.664; 95%CI:1.147–2.416) and renal damage (OR:1.625; 95%CI:1.068–2.472). When ABI and UTCC both put into same multivariate stepwise logistic regression models, consistent results were observed. In ROC curve analysis, UTCC was better than ABI in discriminating increased CF-PWV (AUC:0.68 vs. 0.57; P < 0.001) and renal damage (AUC:0.67 vs. 0.60; P = 0.012). Conclusion: Compared with ABI, UTCC showed stronger association with vascular and renal damage in this elderly cohort. In combination with previous findings, UTCC may be a useful tool for diagnosing PAD and stratifying cardiovascular risk.

P4779Comparison of ankle-brachial index and upstroke time per cardiac cycle in association with target organ damage in elderly Chinese: the Northern Shanghai Study

P4779Comparison of ankle-brachial index and upstroke time per cardiac cycle in association with target organ damage in elderly Chinese: the Northern Shanghai Study

Comparison of ankle-brachial index and upstroke time in association with target organ damage: the Northern Shanghai Study

A recent study indicated that upstroke time per cardiac cycle (UTCC) in lower extremities is equivalent to ankle-brachial index (ABI) in diagnosing peripheral arterial disease and in predicting cardiovascular mortality. In this study, we aimed to compare ABI and UTCC in relation to target organ damage. A cohort of 1841 elderly participants from the Northern Shanghai Study was studied. ABI and UTCC were measured using VP-1000 device. Target organ damage including left ventricular hypertrophy and diastolic dysfunction, carotid intima-media thickness and plaque, carotid-femoral pulse wave velocity (CF-PWV), and renal damage, were evaluated by standardized methods. In correlation analysis, ABI and UTCC both significantly correlated with CF-PWV, carotid plaque, and estimated glomerular filtration rate, but not with cardiac damage. Compared with ABI, UTCC showed stronger correlation with CF-PWV. When ABI and UTCC separately put into fully adjusted multivariate logistic regression models, both ABI (OR: 2.27; 95% CI: 1.63–3.17) and UTCC (OR: 1.63; 95% CI: 1.18–2.24) significantly associated with carotid plaque, but only UTCC significantly associated with increased CF-PWV (OR: 1.66; 95% CI: 1.15–2.42) and renal damage (OR: 1.63; 95% CI: 1.07–2.47). When ABI and UTCC both put into multivariate stepwise logistic regression models together with covariates, consistent results were observed. In ROC curve analysis, after adjusted for cofounding factors, UTCC showed slightly greater area under curve than ABI in detecting increased CF-PWV (area under curve: 0.79 vs. 0.78; P = .008); however, no difference was observed between UTCC and ABI in discriminating renal damage and carotid plaque. In conclusion, compared with ABI, UTCC showed significantly stronger association with vascular and renal damage in this elderly Chinese cohort.

Comparison of yoga and walking-exercise on cardiac time intervals as a measure of cardiac function in elderly with increased pulse pressure

ObjectiveArterial aging along with increased blood pressure(BP) has become the major cardiovascular(CV) risk in elderly. The aim of the study was to compare the effects of yoga program and walking-exercise on cardiac function in elderly with increased pulse pressure (PP). MethodsAn open label, parallel-group randomized controlled study design was adopted. Elderly individuals aged ≥60 years with PP≥60mmHg were recruited for the study. Yoga (study) group (n=30) was assigned for yoga training and walking (exercise) group (n=30) for walking with loosening practices for one hour in the morning for 6days in a week for 3 months. The outcome measures were cardiac time intervals derived from pulse wave analysis and ECG: resting heart rate (RHR), diastolic time(DT), ventricular ejection time(LVET), upstroke time(UT), ejection duration index (ED%), pre-ejection period (PEP), rate pressure product (RPP) and percentage of mean arterial pressure (%MAP). ResultsThe mean within-yoga group change in RHR(bpm) was 4.41 (p=0.031), PD(ms): −50.29 (p=0.042), DT(ms): −49.04 (p=0.017), ED%: 2.107 (p=0.001), ES(mmHg/ms): 14.62 (p=0.118), ET(ms): −0.66 (p=0.903), UT(ms): −2.54 (p=0.676), PEP(ms): −1.25 (p=0.11) and %MAP: 2.08 (p=0.04). The mean within-control group change in HR (bpm) was 0.35 (p=0.887), PD (ms): 11.15(p=0.717), DT (ms): 11.3 (p=0.706), ED%: −0.101 (p=0.936), ES (mmHg/ms): 0.75 (p=0.926), ET(ms): 2.2 (p=0.721), UT(ms):4.7(p=455), PEP (ms): 2.1(p=0.11), %MAP: 0.65 (p=0.451). A significant difference between-group was found in RHR (p=0.036), PD (p=0.02), ED% (p=0.049), LVET (p=0.048), DT (p=0.02) and RPP (p=0.001). ConclusionsYoga practice for 3 months showed a significant improvement in diastolic function with a minimal change in systolic function. Yoga is more effective than walking in improving cardiac function in elderly with high PP.

PS 02-11 Upstroke Time Is an Independent Predictor for the Presence of Coronary Artery Disease in Patients with Chronic Kidney Disease

Objective: Pulse wave velocity is a marker for arterial stiffness, and indicative of increased cardiovascular morbidity and mortality in the general population. Upstroke time (UT) of arterial pulse, defined as time from the initial rise to the peak of the wave, is another parameter for arterial stiffness that is obtained during brachial-ankle pulse wave velocity (baPWV) measurement. Studies have shown significant association between baPWV and cardiovascular events or mortality in hemodialysis patients. However, there are few studies examining such relationship in non-hemodialysis chronic kidney disease (CKD) patients. Moreover, clinical utility of UT among these patients remains unknown. The present study aimed to examine the association between UT and the presence of coronary heart disease (CAD) in non-hemodialysis CKD patients. Design and Method: We enrolled 105 patients (35 non-hemodialytic CKD; 70 non-CKD) who measured baPWV and UT and underwent elective coronary angiography for suspected CAD. CKD was defined as estimated glomerular filtration rate below 60 ml/min/1.73m2. Significant coronary artery disease (sCAD) was defined as one or more stenosis over 50%. To examine the contribution of baPWV and UT for the presence of sCAD, multivariate logistic regression analysis with adjustment for potential confounders was performed in each patient group. Results: In non-hemodialysis CKD patients, UT but not baPWV was associated with sCAD (UT: Odds Ratio(OR) 1.62[95% Confidence Interval (95% CI) 1.05–2.50], p = 0.029; baPWV: OR 1.13[95% CI 0.90–1.42], p = 0.280) in univariate logistic regression analysis. In multivariate analysis, UT remained significant after adjusting traditional risk factors and other potential confounders (OR 12.4 [95% CI 1.02–151.3]; p = 0.036). In non-CKD patients, neither UT nor baPWV was associated with sCAD in both univariate and multivariate analysis. Conclusions: In non-hemodialysis CKD patients, UT serves as independent predictive risk for the presence of significant CAD.

OS 13-03 HIGH UPSTROKE TIME OF ARTERIAL PULSE WAVE IS AN INDEPENDENT PREDICTOR FOR THE PRESENCE OF CORONARY ARTERY DISEASE

Objective: Pulse wave velocity is a non-invasive method that is useful not only for estimating arterial stiffness but also screening cardiovascular events in the general population. Upstroke time (UT) and % mean artery pressure (% MAP) are novel, adjunctive indices for arterial stiffness that are derived from morphology analysis of the pulse wave during brachial-ankle pulse wave velocity (baPWV) measurement. Several studies have shown the association between UT and coronary artery calcification score as assessed by multi-detector computed tomography (MDCT). However, there are no studies examining relationship between these markers and CAD as assessed by coronary angiography (CAG), the current gold standard for the diagnosis of CAD. The aim of this study was to determine the association between the indices for arterial stiffness such as UT and % MAP, and the presence of CAD as assessed by CAG. Design and Method: We enrolled 98 patients who underwent both baPWV measurement and elective CAG for suspected CAD. Significant coronary artery disease(sCAD) was defined as having at least one stenotic lesion over 50%. Using univariate and multivariate logistic regression analysis, we evaluated the contribution of UT and % MAP for the presence of sCAD, and determined if they served as independent, incremental risks for sCAD. Results: In univariate logistic regression analysis, UT and % MAP were associated with sCAD (UT: Odds Ratio(OR) 1.23[95% Confidence Interval (95% CI) 1.00–1.50], p = 0.015; % MAP: OR 0.81[95% CI 0.68–0.96], p = 0.018), whereas baPWV was not (OR 1.03[95% CI 0.91–1.16], p = 0.587). In multivariate analysis, only UT remained significant after adjusting traditional risk factors and other potential confounders (OR 1.29 [95% CI 1.02–1.64]; p = 0.036). Conclusions: Among indices for arterial pulse waves, only UT serves as independent, incremental risk for the presence of significant CAD.

Hemodynamic Correlates of Blood Pressure in Older Adults: The Atherosclerosis Risk in Communities (ARIC) Study

The primary aim of the present study was to identify the hemodynamic correlates of both steady and pulsatile blood pressure (BP) in community-dwelling older adults. In 3762 adults aged 70 to 89 years, significant hemodynamic determinants of both brachial and carotid systolic BP included arterial stiffness as measured by aortic pulse wave velocity, stroke volume (via echocardiography), arterial wave reflection, left ventricular ejection time, and upstroke time. The strongest influence was exerted by arterial stiffness. The steady-state component of blood pressure, mean arterial pressure, was associated with both cardiac index and total peripheral resistance (TPR), but was more strongly associated with TPR. Results were similar when participants taking antihypertensive medications were excluded from analyses. The overall findings suggest that mean arterial pressure is associated strongly with TPR and that significant hemodynamic correlates of systolic BP included arterial stiffness, stroke volume, and arterial wave reflection.

Usefulness of peripheral arterial signs in the evaluation of aortic regurgitation

BackgroundEarly diagnosis and optimal timing of surgical repair for chronic aortic regurgitation (AR) are topics of interest, because left ventricular compensation delays the clinical signs of the early stages of left ventricular dysfunction. Various physical signs have been described as indicators of chronic AR, but AR screening can be difficult depending on the proficiency of primary care providers. The recent use of the cardio-ankle vascular index (CAVI) measurement to assess peripheral atherosclerosis may detect AR objectively and simply because its arterial pulse wave configuration is closely related to the physical signs of AR. MethodsCAVI measurements include pulse pressure (PP), the difference in blood pressures between upper and lower limbs (ABD), ankle-brachial index (ABI), ejection time (ET), and upstroke time (UT). We evaluated the differences in CAVI parameters between AR group and age-matched control group, the relationships between CAVI parameters and the echocardiographic semi-quantitative measurements of AR severity such as left ventricular dimensions (Dd, Ds) and vena contracta (VC), and between the changes in CAVI parameters before and after aortic valve replacement. ResultsABD, PP, ET, ankle systolic pressure and ABI in the AR group were significantly higher than that in the control group. Brachial diastolic pressure and CAVI in the AR group were significantly lower than that in the control group. UT was lower than that in the control group (p=0.05). PP did not correlate with the semi-quantitative AR severity, but ABD was correlated with Dd, Ds, and VC and was negatively correlated with UT. The exaggerated ABD, PP, ET, and ABI were moderated after surgery. ConclusionsCAVI parameters could be useful in the screening and serial follow-up of AR patients.

Pulse volume recordings to identify falsely elevated ankle brachial index.

Ankle brachial index can be falsely elevated in cases of medial arterial calcification, and its clinical use should be limited, especially in patients with diabetes. The aim of this study was to evaluate the potential role of pulse volume recording in detecting falsely elevated ankle brachial index. Two parameters of the pulse waveform were automatically calculated: upstroke time and percentage mean artery pressure. Pulse volume recordings were retrospectively evaluated in 171 consecutive patients (342 limbs); 73 (43%) had a diagnosis of diabetes. On multivariate analysis, diabetes (hazard ratio = 1.7), ankle brachial index ≤ 0.90 (hazard ratio = 4.4), upstroke time ≥ 180 ms (hazard ratio = 2.1), and percentage mean artery pressure ≥ 45% (hazard ratio = 2.8) were significantly related to toe brachial index < 0.60. Further analysis for falsely elevated ankle brachial index was performed in 196 limbs (146 patients) with ankle brachial index > 0.90. The difference between ankle brachial index and toe brachial index differentiated the limbs of diabetic patients, with percentage mean artery pressure ≥ 45%, from controls (0.45 ± 0.17 vs. 0.35 ± 0.16, p = 0.03); upstroke time was not found to be a discriminating factor. Although measurement of ankle brachial index remains the gold standard for diagnosing peripheral arterial disease, percentage mean artery pressure, automatically obtained in ankle brachial index measurement, may be useful to detect falsely elevated ankle brachial index, especially in patients with diabetes.

Abstract P161: Effect of Yoga Program on Cardiovascular Function in Elderly with Stage-I Hypertension

Introduction: Hypertension is a major cause of cardiovascular (CV) morbidity and mortality in elderly population. Hypertension along with aging leads to left ventricular hypertrophy, systolic and diastolic dysfunction and congestive heart failure. We aimed to determine the effect of yoga program on cardiovascular indices in elderly with stage-I hypertension. Hypothesis: We hypothesize that yoga lifestyle modality may induce significant beneficial changes in cardiovascular function in elderly individuals with hypertension. Yoga program may be more beneficial than walking for cardiovascular health in elderly. Methods: A parallel arm, open label, single blind, randomized controlled study was conducted on elderly people with stage-I hypertension aged above 60 years (n=44). Yoga group (n=24) was assigned for yoga practice (includes asanas, pranayama and meditation) and control group (n=20) for brisk-walk for one hour in the morning for 6 days in a week for three months. The outcome measures were cardiovascular indices derived from pulse wave analysis such as left ventricular ejection time (ET), diastolic time (DT) pulse duration (PD), percentage of mean arterial pressure (%MAP), upstroke time (UT), ejection slope (ES), ejection duration index (ED%), pre-ejection period (PEP), and heart rate. Results: The mean within-yoga group change in PD(ms) was -50.29 (CI=-98.5, -2.07; p=0.042), DT(ms): -49.04 (CI=-88.47, -9.61; p=0.017), ED%: 2.107 (CI=0.92, 3.28; p=0.001), HR(bpm): 4.41 (CI=0.43, 8.4; p=0.031), %MAP: 2.08 (CI=0.71, 3.44; p=0.04), ES (mmHg/ms): 14.62 (CI=-3.99, 33.24; p=0.118), ET (ms): -0.66 (CI=11.89, 10.55; p=0.903), UT(ms): -2.54 (CI=14.95, 9.87; p=0.676), PEP (ms): -1.25 (CI=-4.17, 1.67; p=0.11). The mean within-control group change in PD(ms) was 11.15 (CI=-52.26, 74.56; p=0.717), DT(ms): 11.3 (CI=-50.56, 73.16; p=0.706), ED%: -0.101 (CI=-2.7, 2.5; p=0.936), HR (bpm): 0.35 (CI=-4.71, 5.41; p=0.887), %MAP: 0.65 (CI=-1.11, 2.41; p=0.451), ES(mmHg/ms): 0.75 (CI=-15.8, 17.38; p=0.926), ET(ms): 2.2 (CI=-10.5, 14.9; p=0.721), UT(ms): 4.7 (CI=-8.19, 17.59; p=455), PEP (ms): 2.1 (CI=-0.52, 4.72; p=0.11). Analysis of Covariance showed a significant change between-groups in PD (p=0.021), DT (p=0.02), UT (p=0.048), ED% (p=0.049), HR (p=0.036) while no significant difference was observed in ES (p=0.248), ET (p=0.245), PEP (p=0.102) and %MAP (p=0.262). Conclusions: These findings indicate that the yoga practice can induce beneficial changes in cardiovascular function in elderly hypertensive subjects. Further, yoga may be better than walking in improving cardiac health in older individuals.

Relationship between percentage of mean arterial pressure at the ankle and mortality in participants with normal ankle-brachial index: an observational study

ObjectivesPeripheral arterial disease (PAD) is associated with all-cause mortality. Ankle-brachial index (ABI) is the most widely used tool for detecting PAD, but can yield false-negative results in patients with non-compressible...

Combination of pulse volume recording (PVR) parameters and ankle-brachial index (ABI) improves diagnostic accuracy for peripheral arterial disease compared with ABI alone.

The ankle-brachial index (ABI) measurement is widely used as a screening tool to detect peripheral arterial disease (PAD). With the advent of the oscillometric ABI device incorporating a system for the measurement of pulse volume recording (PVR), not only ABI but also other parameters, such as the percentage of mean arterial pressure (%MAP) and the upstroke time (UT), can be obtained automatically. The purpose of the present study was to compare the diagnostic accuracy for PAD with ABI alone with that of a combination of ABI, %MAP and UT. This study included 108 consecutive patients on whom 216 limb measurements were performed. The sensitivity, specificity and positive and negative predictive values of ABI, %MAP, UT and their combination were evaluated and compared with CT angiography that was used as a gold standard for the detection of PAD. The diagnostic accuracy as well as the optimal cutoff values of %MAP and UT were evaluated using receiver operating characteristic (ROC) curve analysis. The combination of ABI, %MAP and UT achieved higher sensitivity, negative predictive value and accuracy than ABI alone, particularly for mild stenosis. The areas under the ROC curve for the detection of 50% stenosis with UT and %MAP were 0.798 and 0.916, respectively. The optimal UT and %MAP values to detect ≧50% stenosis artery were 183 ms and 45%, respectively. The combination of ABI, %MAP and UT contributed to the improvement of the diagnostic accuracy for PAD. Consideration of the values of %MAP and UT in addition to ABI may have a significant impact on the detection of early PAD lesions.

Pulse Waves in the Lower Extremities as a Diagnostic Tool of Peripheral Arterial Disease and Predictor of Mortality in Elderly Chinese.

Patients with peripheral arterial disease may have elongated upstroke time in pulse waves in the lower extremities. We investigated upstroke time as a diagnostic tool of peripheral arterial disease and predictor of mortality in an elderly (≥60 years) Chinese population. We recorded pulse waves at the left and right ankles by pneumoplethysmography and calculated the percentage of upstroke time per cardiac cycle. Diagnostic accuracy was compared with the conventional ankle-brachial index method (n=4055) and computed tomographic angiography (34 lower extremities in 17 subjects). Upstroke time per cardiac cycle at baseline (mean±SD, 16.4%±3.1%) was significantly (P<0.0001) associated with ankle-brachial index in men (n=1803; r=-0.44) and women (n=2252; r=-0.32) and had an overall sensitivity and specificity of 86% and 80%, respectively, for the diagnosis of peripheral arterial disease (upstroke time per cardiac cycle, ≥21.7%) in comparison with computed tomographic angiography. During 5.9 years (median) of follow-up, all-cause and cardiovascular deaths occurred in 366 and 183 subjects, respectively. In adjusted Cox regression analyses, an upstroke time per cardiac cycle ≥21.7% (n=219; 5.4%) significantly (P<0.0001) predicted total and cardiovascular mortality. The corresponding hazard ratios were 1.98 (95% confidence interval, 1.48-2.65) and 2.29 (1.58-3.32), respectively, when compared with that of 2.10 (1.48-3.00) and 2.44 (1.57-3.79), respectively, associated with an ankle-brachial index of ≤0.90 (n=115; 2.8%). In conclusion, pulse waves in the lower extremities may behave as an accurate and ease of use diagnostic tool of peripheral arterial disease and predictor of mortality in the elderly.

Comparison of Diagnostic Accuracy between Pulse Volume Recording Parameters and Exercise-Ankle-Brachial Pressure Index in Patients with Ankle-Brachial Pressure Index above 0.9.

Objective: The objective of this study was to clarify whether or not pulse volume recoding (PVR) parameters have screening capability equivalent to ankle-brachial pressure index after walking (Ex-ABI) for patients with 0.91 or higher ABI. Patients and Methods: The subjects were 87 patients (147 limbs) with symptoms of lower extremities with 0.91 or higher ABI. In all patients, upstroke time (UT), percentage of mean artery pressure (%MAP) of PVR and Ex-ABI were measured, and computed tomographic angiography (CTA) was concomitantly performed. Results: Area under the curve (AUC) of receiver operating characteristics (ROC) curves of Ex-ABI, %MAP, and UT were 0.90, 0.70, and 0.81, respectively. A significant difference was noted in AUC between Ex-ABI and %MAP (p <0.001). When the cut-off values were set at %MAP ≥45% and UT ≥180 msec, the accuracies of %MAP and UT were markedly lower than that of Ex-ABI. When the cut-off values were corrected to the values determined from the ROC curves (%MAP ≥41, UT ≥164 msec), the diagnostic accuracy of UT increased markedly. Conclusion: In patients with 0.91 or higher ABI, screening capability of PVR parameters was markedly lower than that of Ex-ABI, but UT has screening capability close to that of Ex-ABI when the cut-off value is corrected downward.