ulse wave velocity (PWV), which reflects arterial stiffness, is a predictor of future cardiovascular events in a general population or patients with either hypertension, diabetes mellitus or end-stage renal diseases. [1][2][3][4] The carotid-femoral PWV measurement is known as a conventional method. 5,6 Recently, brachialankle PWV (baPWV) measurement, which is easier to perform than the use of other noninvasive automatic devices and uses pressure cuffs wrapped on the brachium and ankle, has become available in clinical settings. This method can be used to measure PWV in a large number of subjects. 7,8 baPWV correlates with intima-media thickness of the carotid artery, which is a marker of the severity of atherosclerosis, 9 and a close association between baPWV and aortic PWV has been also demonstrated. 7 However, baPWV measurements include not only the aortic component, but also the muscular arterial component. 7,10 Therefore, the usefulness of baPWV as a predictor of cardiovascular events has yet to be decisively established.PWV is a marker related to the severity of atherosclerosis and the increased arterial stiffness (especially aortic stiffness) causes the increased left ventricular afterload and Circulation Journal Vol.69, July 2005 the impaired coronary blood supply. 9,11 These pathophysiological abnormalities are thought to be involved in the underlying mechanism of influencing the prognosis. [1][2][3][4][5][6] Acute coronary syndrome (ACS) is a critical condition and predicting the prognosis of patients with ACS is crucial for their management. 12,13 Increased aortic stiffness, resulting in the above-mentioned disorders, may have an unfavorable influence on the prognosis of patients with ACS.The present study was conducted to evaluate the usefulness of this simple baPWV measurement as a marker of predicting the prognosis in a clinical setting. We also examined whether the baPWV measurements can be used to predict the prognosis of patients with ACS. Methods Study Population, Follow-up Protocol, Study Endpoints and Endpoint DefinitionsBetween January 2001 and December 2003, 223 consecutive patients with ACS started their follow-up care in the outpatient cardiology department of the Tokyo Medical University Hospital. All of the patients had been hospitalized for the treatment of ACS between January 2001 and December 2003 and had undergone a coronary angiography procedure to confirm the culprit lesion and an echocardioigraphy examination to assess their left ventricular function. During the patients' hospitalization for ACS, percutaneous coronary intervention was conducted, if applicable. The baPWV was measured using the oscillometric method within 5 days before their discharge from the hospital.

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While arterial stiffness is known to be related to atherosclerosis, the association between arterial stiffness and cardiac systolic and diastolic function in hypertension has not been fully evaluated. The present study was conducted to simultaneously evaluate the relationship of brachial-ankle pulse wave velocity (PWV) to parameters reflecting atherosclerosis and to those reflecting the risk of congestive heart failure in patients with hypertension. In 147 patients with hypertension, the left ventricular ejection fraction, the ratio of the peak velocity of early rapid filling and the peak velocity of atrial filling (E/A ratio), and left ventricular mass index were obtained from echocardiographs, the intima-media thickness of the common carotid artery was

Abstract-Arterial stiffness is recognized as a marker of arterial damage and an indicator of cardiovascular risk. This observational study was conducted to examine the synergistic effect of raised blood pressure (RBP; Ն130/85 mm Hg) and raised plasma glucose (RPG; Ն110 mg/dL) even at levels below those conventionally used to define hypertension and diabetes on the rate of increase of the pulse wave velocity (PWV) over a 3-year period in 2080 Japanese men (age 42Ϯ9 years). First, the subjects were classified into 4 groups based on the presence at the first examination of RBP, RPG, both abnormalities, or neither abnormality. The estimated annual rate of increase of the PWV was higher in subjects with both the abnormalities than in those with either abnormality alone or neither of the 2 abnormalities. Second, the subjects were also classified based on the evolutional status of these abnormalities during the study period; persistence of both of the abnormalities synergistically accelerated the rate of increase of the PWV (68. A rterial stiffness is recognized as a marker of arteriosclerotic arterial damage 1,2 and has been shown to be a predictor of future cardiovascular events. 3,4 Hypertension and diabetes mellitus are major atherogenic factors, they frequently coexist, and when they coexist, they additively increase the risk of life-threatening cardiovascular events. 5 Some cross-sectional studies have demonstrated an increase of arterial stiffness in subjects with either hypertension or glucose intolerance, 6,7 and increased arterial stiffness is associated with an increased risk of cardiovascular events, both in subjects with hypertension and in those with diabetes mellitus or glucose intolerance. 3,4 Recent studies have demonstrated that values even below those defining the presence of hypertension and diabetes mellitus [raised blood pressure (RBP): Ն130/85 mm Hg and raised plasma glucose (RPG): Ն110 mg/dL] are also predictors of future cardiovascular events. 8,9 However, no studies until now have evaluated the effects of RBP, RPG, and the coexistence of both disorders on the rate of progression of arterial stiffening.In this observational cohort study of Japanese men, we succeeded in recording the brachial-ankle pulse wave velocity (PWV) twice in 2 examinations conducted at an interval of 3 years. Then, we examined whether the presence of RBP alone, RPG alone, and the coexistence of both at the first examination in this study predicted an acceleration of the rate of increase of the brachial-ankle PWV and whether the persistence of either or both disorders during the study period additionally affected the rate of increase of the brachial-ankle PWV. Methods Design and SubjectsThis observational study was performed on the Japanese male employees of a single large construction company. The routine annual health checkup included evaluation of the atherosclerotic risk factors (body mass index [BMI], serum levels of triglycerides [TG], high-density lipoprotein cholesterol [HDL], total cholesterol [TC], fasting plasm...

The present study was conducted to make a nomogram of the relation of brachial-ankle pulse wave velocity (baPWV) with blood pressure. In 11,375 subjects (age range: 30 to 79 years) in whom we measured baPWV, multivariate linear regression analysis demonstrated that age, systolic blood pressure, and gender were significant determinants of baPWV. Of them, we selected 5,302 subjects (2,630 men and 2,672 women, age 46 11 years) with either normal blood pressure or with high blood pressure without other atherosclerotic risk factors. Using data from these subjects, we tried to make an age-derived nomogram and a systolic blood

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Abstract-We examined whether the presence of an increasing number of metabolic syndrome "disorders" was associated with an increasing pulse wave velocity, which is recognized as a marker of cardiovascular risk, and evaluated whether an elevated plasma C-reactive protein level augments this increasing pulse wave velocity. Using a cross-sectional study design, C-reactive protein, metabolic syndrome-related anthropometric parameters, and pulse wave velocity were measured in 5752 middle-aged Japanese men (44Ϯ10 years old). In linear regression analyses, all of the metabolic "disorders" and the logarithm of the C-reactive protein significantly correlated with pulse wave velocity. Multiple linear regression analysis demonstrated that triglycerides, HDL cholesterol, mean blood pressure, fasting glucose, and the logarithm of the C-reactive protein were significant independent positive predictors of pulse wave velocity (Rsquareϭ0.38). The presence of an increasing number of metabolic "disorders" in the subjects was associated with an increasing pulse wave velocity (no disorders 1228Ϯ139 cm/s Ն3 disorders 1437Ϯ250 cm/s; PϽ0.01). Among subjects with the metabolic syndrome, pulse wave velocity was higher in cases with (1508Ϯ278 cm/s) than in those without an elevated C-reactive protein (1427Ϯ243 cm/s; PϽ0.01). In conclusion, an increase in arterial stiffness may constitute a pathophysiological basis for the increased risk of cardiovascular disease in patients with the metabolic syndrome and that an elevated C-reactive protein level may aggravate this cardiovascular risk.

ulse wave velocity (PWV) is used in the management of atherosclerotic cardiovascular disease as a validated marker of disease severity and a predictor of future events. [1][2][3][4] Recently, the use of brachial -ankle PWV, which can be obtained by simply wrapping the 4 extremities with blood pressure cuffs, was validated 5-7 and the technique is quite simple it is thus useful for screening the general population; in addition, the ankle -brachial blood pressure index (ABI) can also be simultaneously obtained. [5][6][7] For accurate PWV measurement, a clear recording of the pulse waves is very important, but in cases of severe atherosclerosis, the stenosis of the arteries affects the recording and it is not sufficiently clear. 8,9 ABI is a simple marker of peripheral arterial stenosis 10-15 and can provide information about the prevalence of arterial stenosis in subjects who are undergoing a brachial -ankle PWV recording. However, the cut-off value for ABI at which the accuracy of brachial -ankle PWV measurements is diminished because of arterial stenosis has not been established. Therefore, we proposed and evaluated the following hypothesis. At the site of arterial stenosis, the serial changes in the waveform obscure the foot of the waveform and delay the calculated PWV. 9 The discrepancy in brachial -ankle PWV (abnormal difference) between the 2 sides of the Circulation Journal Vol.69, January 2005body reflects the lack of accuracy of the brachial -ankle PWV measurement on the delayed side because of arterial stenosis. Therefore, we examined the ABI on the side of the delayed brachial -ankle PWV as a marker of the lack of brachial -ankle PWV accuracy in patients with a discrepancy in their brachial -ankle PWV values (abnormal difference). Methods SubjectsOf the patients who visited the outpatient clinic of the Second Department of Internal Medicine of Tokyo Medical University Hospital or were admitted to the department for the diagnosis or treatment of cardiovascular disease between April 2001 and August 2003, patients who underwent a brachial -ankle PWV recording and gave their informed consent were enrolled in the study. Subjects with a plasma creatinine concentration of greater than 176.8 mol/L, with an aortic graft, and those with atrial fibrillation, were excluded. The total number of subjects was 1,361 (60±12 years old). Atherosclerotic cardiovascular diseases were classified according to the criteria of the International Classification of Diseases (10th version) for coronary heart disease, cerebrovascular disease, and peripheral arterial disease. Hypertension, dyslipidemia and diabetes mellitus were diagnosed according to the guidelines of the Japanese Society of Hypertension, 16 the Japan Atherosclerosis Society 17 and the Japan Diabetes Society. 18 The study's protocol was approved by the ethical committee of Tokyo Medical University. Background The present study was conducted to establish the cutoff value of the ankle -brachial pressure index (ABI) at which the accuracy of brachial -ankle pulse wave v...