Arterial Stiffness

The Scientific World Journal
Volume 2013 (2013), Article ID 792693, 6 pages
http://dx.doi.org/10.1155/2013/792693

Clinical Study

Evaluation of Arterial Stiffness for Predicting Future Cardiovascular Events in Patients with ST Segment Elevation and Non-ST Segment Elevation Myocardial Infarction

Oguz Akkus,¹ Durmus Yildiray Sahin,² Abdi Bozkurt,³ Kamil Nas,⁴ Kazım Serhan Ozcan,¹ Miklós Illyés,⁵ Ferenc Molnár,⁶ Serafettin Demir,⁷ Mücahit Tüfenk,³ and Esmeray Acarturk³

¹Sanliurfa Siverek State Hospital, 63600 Sanliurfa, Turkey
²Department of Cardiology, Adana Numune Training and Research Hospital, Adana, Turkey
³Department of Cardiology, Faculty of Medicine, Cukurova University, Adana, Turkey
⁴Department of Radiology, Szent János Hospital, Budapest, Hungary
⁵Heart Institute, Faculty of Medicine, University of Pécs, Pécs, Hungary
⁶Department of Hydrodynamic Systems, Budapest University of Technology and Economics, Budapest, Hungary
⁷Department of Cardiology, Adana State Hospital, Adana, Turkey

Received 18 August 2013; Accepted 15 September 2013

Academic Editors: H. Kitabata and E. Skalidis

Copyright © 2013 Oguz Akkus et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Background. Arterial stiffness parameters in patients who experienced MACE after acute MI have not been studied sufficiently. We investigated arterial stiffness parameters in patients with ST segment elevation (STEMI) and non-ST segment elevation myocardial infarction (NSTEMI). Methods. Ninety-four patients with acute MI (45 STEMI and 49 NSTEMI) were included in the study. Arterial stiffness was assessed noninvasively by using TensioMed Arteriograph. Results. Arterial stiffness parameters were found to be higher in NSTEMI group but did not achieve statistical significance apart from pulse pressure . There was no significant difference at MACE rates between two groups. Pulse pressure and heart rate were also significantly higher in MACE observed group. Aortic pulse wave velocity (PWV), aortic augmentation index (AI), systolic area index (SAI), heart rate, and pulse pressure were higher; ejection fraction, the return time (RT), diastolic reflex area (DRA), and diastolic area index (DAI) were significantly lower in patients with major cardiovascular events. However, PWV, heart rate, and ejection fraction were independent indicators at development of MACE. Conclusions. Parameters of arterial stiffness and MACE rates were similar in patients with STEMI and NSTEMI in one year followup. The independent prognostic indicator aortic PWV may be an easy and reliable method for determining the risk of future events in patients hospitalized with acute MI.

1. Introduction

Acute myocardial infarction (AMI) continues a worldwide cause of mortality [1]. In-hospital and 6-month-mortality are approximately 5–7% versus 12-13%, respectively [2, 3]. Estimated risk of mortality for AMI is based on the clinical status of the patients [4]. Recent studies showed that conventional risk factors are inadequate for predicting cardiovascular (CV) mortality and morbidity. A novel risk factor called arterial stiffness, which is a defined reduction of the compliance of arterial wall, and relationship between coronary heart disease (CHD) have been demonstrated. Arterial stiffness results in faster reflection of the forward pulse wave from bifurcation points in peripheral vessels. As a result of new waveform, systolic blood pressure (SBP) increases, diastolic blood pressure (DBP) decreases, cardiac workload increases, and coronary perfusion falls down. It plays a major role in the determination of cardiovascular outcomes, and it is not inferior to the traditional risk factors to assess the future risk [5, 6]. Elevated arterial stiffness is associated with increased major adverse cardiovascular events (MACE) such as unstable angina, AMI, coronary revascularization, heart failure, stroke, and death [7]. Arterial stiffness parameters including mean arterial pressure (MAP), pulse pressure (PP), PWV (m/s), and augmentation index (AI) are directly proportional to the risk of MACE [8–10].

PWV is a susceptible diagnostic element, and it is also involved in risk stratification for subclinical organ damages [11]. Few studies regarding arterial stiffness demonstrated that PWV exhibits a close effect with coronary heart disease [5, 12, 13]. Whether arterial stiffness parameters are related to MACE after acute MI has not been studied sufficiently. The aim of our study was to compare arterial stiffness parameters in patients with ST segment elevation (STEMI) and non-ST segment elevation myocardial infarction (NSTEMI) and to validate its prognostic value.

2. Patients

Ninety-four patients with acute MI (72 men and 22 women, mean age 60,41 ± 11,17) were included in the study. There were 45 STEMI and 49 NSTEMI. Data of patients were analyzed within 24 hours after hospitalization. All patients received eligible treatment according to ESC guidelines. The choice of preparations was entrusted to the investigator. Hemodynamically compromised patients (Killip classifications II, III, and IV), patients with chronic atrial fibrillation and/or flutter, chronic renal failure, mild-severe valvular heart diseases and other chronic diseases were excluded. Our local ethics committee approved the study, and written informed consent was obtained from all participants. Patients were followed up for 12 months.

3. Diagnosis of Acute Myocardial Infarction

Diagnosis of AMI was based on symptoms, elevated cardiac markers, and electrocardiogram (ECG) changes. Patients with typical chest pain plus ECG changes indicative of an AMI (pathologic Q waves, at least 1 mm ST segment elevation in any 2 or more contiguous limb leads or new left bundle branch block, or new persistent ST segment and T wave changes diagnostic of a non-Q wave myocardial infarction) or a plasma level of cardiac troponin-T level above normal.

4. Laboratory Findings

Troponin T, creatine kinase-MB fraction (CK-MB), serum urea, creatinine, eGFR, and other hematological parameters were checked at the admission.

Risk factors, such as hypertension, hyperlipidemia, diabetes mellitus, cigarette smoking, and family history, were recorded. Hypertension was considered as SBP and DBP greater than 140 mmHg and 90 mmHg, respectively, using an antihypertensive medication. Diabetes mellitus, hyperlipidemia, and hypertriglyceridemia were defined as using antidiabetic drugs or fasting blood glucose over 126 mg/dL, as plasma low-density lipoprotein cholesterol (LDL-C) >130 mg/dL, using lipid-lowering drugs at the time of investigation, and as TG level >150 mg/dL, respectively, according to the Third Report of the National Cholesterol Education Program guidelines. First-degree relatives who are exposed to coronary artery disease (CAD) before the age for male is <55 and female <65 were considered as family history.

5. Pulse Waveform Analysis

Assessment of arterial stiffness was performed noninvasively with the commercially available TensioMed Arteriograph. We collected the oscillometric pulse waves from the patients. We measured the distance between the jugulum-symphysis (which is equal to the distance between the aortic root and the aortic bifurcation), and PWV was calculated. Pulse waves were recorded at suprasystolic pressure. The oscillation signs were identified from the cuff inflated at least >35 mmHg above the systolic blood pressure. In this state there was a complete brachial artery occlusion, and it functions as a membrane before the cuff. Pulse waves hit the membrane, and oscillometric waves were measured by the device and we could see the waveforms on the monitor. The AI was defined as the ratio of the difference between the second (P2 appearing because of the reflection of the first pulse wave) and first systolic peaks (P1 induced by the heart systole) to pulse pressure (PP), and it was expressed as a percentage of the ratio (AI = [P2 − P1]/PP × 100). SBP, DBP, PP, and heart rate and other hemodynamic parameters as return time (RT in sec.), diastolic reflection area (DRA), systolic area index (SAI %), and diastolic area index (DAI %) were measured noninvasively. DRA reflects the quality of the coronary arterial diastolic filling (SAI and DAI are the areas of systolic and diastolic portions under the pulse wave curve of a complete cardiac cycle, resp.). Hence, the bigger the DAI and DRA are, the better the coronary perfusion is. Furthermore, RT is the PWV time from the aortic root until the bifurcation and return, so this value is smaller as the aortic wall is stiffer.

 

Arterial Stiffness

Why you should buy an Arteriograph   Arteriograph- Comprehensive cardiovascular risk assessment in only 3 minutes! - A medical breakthrough in early diagnostics of atherosclerosis!  A big problem today is that many individuals with high risk of cardiovascular diseases otherwise have normal values; normal blood pressure, blood lipids and resting-EKG. The catastrophe strikes without any prior warning. The Arteriograph is an evidence based, fast, easy, noninvasive and user independent way of assessing cardiovascular risk. For the first time one have a good chance of finding high risk patient before it is too late. Screening of early atherosclerosis among ”healthy” individuals. Only the Arteriograph is useful for this. The Arteriograph gives an overall picture of the risk of assessing cardiovascular disease. Evaluating the effects of treatments (drugs, nutritional supplements and lifestyle changes etc) on the vascular functions among patients with established atherosclerosis (CAD, POST MI, STROKE, PAD) Is it not enough to check the blood lipids and blood pressure to prevent atherosclerosis and thereby strokes? No, 40-60% of patients with stroke or heart attacks do not have any know abnormal values such as high amount of blood lipids or high blood pressure (Johns Hopkins White Papers, Coronary Heart Disease - 1998, etc). They also have normal blood glucose values, resting-EKG, are non-smokers and have a healthy diet. Up until now it has been impossible to find there individuals. Todays metods of assessing cardiovascular risk (SCORE, Framingham) all have limits. They do not take into account important factors such as lack of physical activity, overweight, psychological factors or previous cardiovascular circumstances. (Simon, A. and Levenson, J.: May subclinical arterial disease helps to better detect and treat high-risk asymptomatic individuals? J Hypertension 2005, 23: 1939-1945) In most cases, lowering the blood pressure is not enough to avoid early death. Individuals who can lower both their arterial stiffness and blood pressure have a much greater chance of a longer life.Circulation 2001;103:987 The Arteriograph is mobile and easy to use. The screening is fast, comfortable, harmless and user independent. It takes only a few minutes and can be described as a computerized blood pressure measurement. Today´s other available methods are hard to use, expensive, and requires an adequate educated staff. In the future, the Arteriograph may replace the regular blood pressure measurement as it is just as easy but gives much more information.    The Arteriograph is intended for DAILY USE at your clinic to measure AIx, PWV and Central blood pressure etc.

 Arteriograph- Comprehensive cardiovascular risk assessment in only 3 minutes!

 

- A medical breakthrough in early diagnostics of atherosclerosis!

 

A big problem today is that many individuals with high risk of cardiovascular diseases otherwise have normal values; normal blood pressure, blood lipids and resting-EKG. The catastrophe strikes without any prior warning.

The Arteriograph is an evidence based, fast, easy, noninvasive and user independent way of assessing cardiovascular risk. For the first time one have a good chance of finding high risk patients before it is too late .The Arteriograph is also used to evaluate the effect of different medications.

 

Free demonstration of the Arteriograph on Wednesdays at 5-7 pm at Söderkliniken, Götgatan 82. Please call in advance to let us know that you will be there.

Arterial Stiffness

Smoking and Hypertension Associated With Greater Arterial Stiffness in People Aging With HIV

By Fred Furtado

From TheBodyPRO.com

November 8, 2013

Having HIV is not independently associated with arterial stiffness -- a trait linked to cardiovascular disease risk -- despite HIV-infected individuals having a modest, but clinically significant, increase in arterial stiffness when compared to their uninfected counterparts. Instead, factors such as smoking and hypertension may account for the increase, according to study results presented at EACS 2013 in Brussels, Belgium.

To provide some background, HIV infection has been associated with an increased risk of cardiovascular disease and one of the markers for this condition is arterial stiffness, which is measured by pulse wave velocity (PWV), or how fast blood moves through the circulatory system. With age, or other changes to the arterial wall, blood vessels become stiffer and blood moves faster through the system, giving the heart less time to rest. PWV is directly dependent on mean arterial pressure (MAP) and past research has shown that an increase of 1 m/s (meter per second) in PWV is associated with a 14% greater incidence in total cardiovascular events.

However, studies measuring PWV in HIV-infected patients have been small and their results inconsistent. So, researchers led by Katherine Kooij, M.D., compared PWV in a cohort of HIV-infected and HIV-uninfected people to determine if there is an independent association between HIV and PWV, as well as possible determinants of PWV.

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The study included 566 HIV-infected and 511 HIV-uninfected individuals, all 45 or older. Both groups had comparable median ages (52.8 versus 52), gender distribution (89.1% men versus 86% men) and proportion of men who have sex with men (76.4% versus 71.4%). However, the HIV-infected group included more current smokers (32.9% versus 24.8%) and users of antihypertensive drugs (31.3% versus 22.4%). The HIV-infected participants also displayed higher levels of inflammation and immune activation markers, such as hs-CRP and sCD163.

The researchers performed three measurements of PWV, as well as systolic and diastolic blood pressure, using an Arteriograph system, which registers oscillometric pressure waves in the aorta through an upper arm cuff. Additional information on potential determinants of arterial stiffness was collected with laboratory measurements and questionnaires. The data underwent a statistical analysis with multivariable linear regression models using PWV as a dependent variable, adjusted for MAP.

The analysis revealed a slightly higher, but significant unadjusted PWV in HIV-infected individuals than in HIV-uninfected individuals (7.9 m/s versus 7.7 m/s, P = .004). When these results were adjusted for MAP and gender, the difference between the two remained at 0.19 m/s (P = .04). If compared to a PWV increase due to age (+0.29 m/s per 5 years older, P < .001), having a positive HIV status would be the equivalent of being 3 to 3.5 years older.

However, when the PWV values were adjusted for other factors, such as smoking and use of antihypertensive drugs, HIV-infected status was no longer independently associated with arterial stiffness. In this setting, the difference between HIV-infected and HIV-uninfected PWV was only 0.022 m/s (P = .8). In contrast, every 5 pack-years (smoking 20 cigarettes a day per year, about 7,305 cigarettes) for current smokers accounted for a difference of 0.121 m/s (P < .001), while use of antihypertensive drugs represented an increase of 0.527 m/s (P < .001). The researchers also found that the inflammation marker hs-CRP and the monocyte activation marker sCD163 were associated with a higher PWV: 0.039 m/s (P = .001) and 0.056 m/s (P = .04), respectively. But sCD163 was only a significant determinant in men.

 

Arterial Stiffness

Assessment of arterial stiffness in hypertension: comparison of oscillometric (Arteriograph), piezoelectronic (Complior) and tonometric (SphygmoCor) techniques.

Abstract

BACKGROUND
Arterial stiffness, measured as aortic pulse wave velocity (PWV), and wave reflection, measured as augmentation index (AIx), are independent predictors for total and cardiovascular morbidity and mortality. The aim of this study was to compare a new device, based on oscillometric pressure curves (Arteriograph), which simultaneously measures PWV and AIx, with standard techniques for measuring PWV (Complior) and AIx (SphygmoCor) in untreated hypertensive patients.
METHODS
We compared PWV and AIx measured using the Arteriograph with corresponding Complior and SphygmoCor measurements in 254 untreated hypertensive patients, age 48 +/- 14 years (mean +/- SD, range 17-85 years).
RESULTS
Arteriograph PWV and AIx were closely related with Complior (r = 0.60, P < 0.001) and SphygmoCor (r = 0.89, P < 0.001), respectively. Using stepwise regression analysis, the independent determinants of Arteriograph PWV were age, mean arterial pressure, heart rate and sex (r(2) = 0.44, P < 0.0001) and for AIx were age, weight, mean arterial pressure, heart rate and sex (r(2) = 0.65, P < 0.0001). The bias between the different techniques was determined by age and sex for PWV and age, body weight, sex, heart rate and mean arterial pressure for AIx. Bland-Altman plots showed that although the techniques were closely related, the limits of agreement were wide.
CONCLUSION
Although Arteriograph values and the determinants of PWV and AIx are in close agreement with corresponding parameters obtained by Complior and SphygmoCor, respectively, the techniques are not interchangeable.

 

Arterial Stiffness

Hypertension Research (2011) 34, 202–208; doi:10.1038/hr.2010.196; published online 21 October 2010

Can arterial stiffness parameters be measured in the sitting position?

Jens Nürnberger¹, Rene Michalski², Tobias R Türk², Anabelle Opazo Saez¹, Oliver Witzke² and Andreas Kribben²

1. ¹Department of Nephrology and Dialysis, HELIOS Kliniken Schwerin, Wismarsche Straße, Schwerin, Germany
2. ²Department of Nephrology, University Hospital Essen, University Essen-Duisburg, Hufelandstraße, Essen, Germany

Correspondence: Dr J Nürnberger, Department of Nephrology, HELIOS Kliniken Schwerin, Wismarsche Straße 393-397, Schwerin 19049, Germany. E-mail: jens.nuernberger@uni-due.de

Received 2 May 2010; Revised 25 July 2010; Accepted 31 July 2010; Published online 21 October 2010.

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Abstract

Despite the introduction of arterial stiffness measurements in the European recommendation, pulse wave velocity (PWV) and augmentation index (AI) are still not used routinely in clinical practice. It would be of advantage if such measurements were done in the sitting position as is done for blood pressure. The aim of this study was to evaluate whether there is a difference in stiffness parameters in sitting vs. supine position. Arterial stiffness was measured in 24 healthy volunteers and 20 patients with cardiovascular disease using three different devices: SphygmoCor (Atcor Medical, Sydney, Australia), Arteriograph (TensioMed, Budapest, Hungary) and Vascular Explorer (Enverdis, Jena, Germany). Three measurements were performed in supine position followed by three measurements in sitting position. Methods were compared using correlation and Bland–Altman analysis. There was a significant correlation between PWV in supine and sitting position (Arteriograph: P<0.0001, r=0.93; Vascular Explorer; P<0.0001, r=0.87). There were significant correlations between AI sitting and AI supine using Arteriograph (P<0.0001, r=0.97), Vascular Explorer (P<0.0001, r=0.98) and SphygmoCor (P<0.0001, r=0.96). When analyzed by Bland–Altman, PWV and AI measurements in supine vs. sitting showed good agreement. There was no significant difference in PWV obtained with the three different devices (Arteriograph 7.5±1.6 m s⁻¹, Vascular Explorer 7.3±0.9 m s⁻¹, SphygmoCor 7.0±1.8 m s⁻¹). AI was significantly higher using the Arteriograph (17.6±15.0%) than Vascular Explorer and SphygmoCor (10.2±15.1% and 10.3±18.1%, respectively). The close agreement between sitting and supine measurements suggests that both PWV and AI can be reliably measured in the sitting position.

Keywords:

arterial stiffness; augmentation index; PWV; pluse wave velocity

 

Arterial Stiffness

Abstracts of the American Society of Hypertension, Inc.

28th Annual Scientific Meeting and Exposition, San Francisco, USA May 15-18, 2013

The Journal of Clinical Hypertension, 2013, Volume 15,
May 2013 Abstract Supplement

28th Annual Scientific Meeting and Exposition
San Francisco, USA May 15-18, 2013.

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Acute Coronary Syndrome Patients: How Stiff are their Arteries?

Deaconu   Alexandru Ioan ¹ , Tautu Oana Florentina ¹ , Fruntelata Ana Gabriela ² , Dorobantu Maria ¹

¹ Emergency Hospital of Bucharest, Bucharest, Romania;
² Monza Cardiovascular Center, Bucharest, Romania

Several non-invasive methods are currently used to assess vascular stiffness. Pulse wave velocity (PWV) and the augmentation index (AIx) are the two major non-invasive methods of assessing arterial stiffness. A large amount of evidence indicates that carotid-femoral PWV is an intermediate endpoint for cardiovascular (CV) events, either fatal or non-fatal. Central AIx and pulse pressure have shown an independent predictive value for CV events in hypertensives and patients with coronary disease. Studies of arterial stiffness in patients with cardiovascular emergencies and acute coronary syndromes, respectively, are missing.

We performed measurements of arterial stiffness parameters using the TensioMed Arteriograph in 34 patients admitted for acute coronary syndromes (ACS), 24 hours after admission. The study group included 28 males (82.4%) and mean age was 61.7 ± 14.07 years. Arterial stiffness parameters as aortic PWV, aortic AIx, central systolic blood pressure (aortic SBP), central pulse pressure (aortic PP) were analyzed in relation to clinical, historical and paraclinical parameters in order to describe particularities in this patient population. We compared the results with an age and sex adjusted population of 34 controls randomly selected from the most recent Romanian cross-populational statistical survey, SEPHAR II.

In our group, 45.7% of patients were hypertensive and 37.1% were diabetic. Most of the patients were on treatment with ACE inhibitors (91.4%) and beta-blockers (80%), while 71.1% were on intravenous or oral nitrates. Mean stiffness parameters in this group were: aortic AIx=28.51 + 10.81, with only 14.8% of patients showing normal values; aortic PWV = 9.71 ± 1.82 m/s; aortic SBP = 121.71 ± 21.07 mm Hg; aortic PP = 44.39 ± 13.74 mm Hg. No correlations were identified in this small group between arterial stiffness parameters and treatment, history of hypertension or diabetes, type of ACS and angiographic coronary anatomy. While aortic AIx was clearly abnormal, reflecting changes in endothelial function and waves’ reflection, the other parameters of arterial stiffness were not different from other patient populations.

Aortic AIx is abnormally increased in patients with acute coronary syndromes. Parameters of arterial stiffness in patients with ACS are not related to treatment, type of coronary disease or previous patient history.