Summary:Background: Biomarkers of vascular diseases such as ankle-brachial index (ABI), peripheral pulse pressure (pPP), central pulse pressure (cPP), and pulse wave velocity (PWV) allow assessment of arterial organ damage (AOD). However, the utility of markers other than ABI in patients with peripheral arterial disease (PAD), which are also associated with a significant increase of cardiovascular events, remains unclear. Patients and methods: Asymptomatic (n = 21) and symptomatic patients (n = 46) with a positive sonography for PAD or history of lower limb revascularization were included. ABI, pPP, cPP, and PWV were assessed. PWV were performed using a brachial cuff-based method (aortic PWV (aPWV)) and oscillography (carotid-femoral pulse wave velocity (cfPWV)), respectively. The two methods for PWV were compared using Bland Altman analysis. Sensitivities of ABI, pPP, cPP, cfPWV, and aPWV for AOD were calculated. Results: Sixty-seven patients (35.8 % female, mean age 69, range 39-91 years) had a signifi cantly higher aPWV than cfPWV (median 10.5 m/s (IQR: 8.8-12.65 m/s) vs. median 9.0 m/s (IQR: 7.57-10.55 m/s), p = 0.0013). There was no correlation between cfPWV and age (r = 0.311, p = 0.116). Bland Altman analysis revealed a mean difference of -1.04 (-2SD; -6.38 to + 2SD; 4.31). The sensitivities for AOD were 68.7 % for ABI, 61.2 % for aPWV, 40.3 % for cfPWV, 31.3 % for peripheral PP, and 10.4 % for central aortic PP (p < 0.001). Conclusions: Brachial-derived aPWV differs from the gold standard assessment (cfPWV), which may be underestimated in PAD due to atherosclerotic obstructions along the aorto-iliac segment. The sensitivities of noninvasive in vivo markers of AOD vary widely and tend to underestimate the actual presence of AOD.
Background: Obesity blunts the association of cfPWV with BP, at least in youth. We assessed the impact of BMI in the relationship between carotid artery function (CAF) and central BP. Methods: Stiffness index (b), Elastic modulus (Ep), Arterial Compliance (AC) and local PWV (PWVb) were measured at the common carotid arteries by echo-tracking (Aloka prosound alpha 10), and central BP was assessed with the SphygmoCor device. Patients were classified into 3 groups according to BMI (<25 normal weight; !25-<30 overweight; !30 obesity). Linear regression models, Pearson's correlation coefficient and ANCOVA models (age, gender, heart rate and central PP as covariates) were performed. Results: 222 patients (mean age 42.8 AE 14.2 years; 93 (42%) women; mean BMI 26.6 AE 4.4; 139 (62.6%) hypertensives, 104 (74.8%) under treatment). BMI categories: 85 (38.3%) normal weight, 88 (39.6) overweight, 49 (22.1%) obesity. Age, HR ,central PP showed significant positive association with CAF parameters. BMI categories and gender were not significantly associated with CAF parameters, except for overweight with PWVb (p-value 0.02). There was no significant difference in b, Ep, AC and PWVb between BMI groups after adjusting by covariates. Pearson's correlation coefficient between central SBP and CAF parameters was significantly lower if BMI!25 (â: 0.46, 0.19, 0.13; Ep: 0.69, 0.43, 0.3; AC: -0.48, -0.37, -0.31; PWVâ: 0.66, 0.48, 0.36 for normal weight, overweight and obesity, respectively; p-value for overweight<0.001, p-value for obesity<0.05). Conclusions: BMI categories are not closely related to CAF. BMI might blunt the increment of CAF parameters with rising central BP.
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