Ascending aortic, but not brachial blood pressure-derived indices are related to coronary atherosclerosis

Jankowski, Piotr; Kawecka‐Jaszcz, Kalina; Czarnecka, Danuta; Brzozowska-Kiszka, Małgorzata; Styczkiewicz, Katarzyna; Styczkiewicz, Marek; Pośnik-Urbańska, Aneta; Bryniarski, Leszek; Dudek, Dariusz

doi:10.1016/j.atherosclerosis.2004.04.021

Cited by 54 publications

(51 citation statements)

References 20 publications

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“…3 Unlike SBP, DBP, and PP, this new parameter is not correlated with MBP, and thus it may be very useful in research on atherosclerosis pathogenesis and its complications development. 5,6 Pulsatility may be seen as indicator of the relative changes of blood pressure in opposition to pulse pressure which is an index of absolute blood pressure changes.Although the differences between central and peripheral BP values have been known for decades, the consequences of decision making based on peripheral rather than central BP have only recently been recognized. 6 -9 As central BP directly affects heart and coronary as well as carotid arteries and is directly related to the incidence of major cardiovascular complications, more and more attention is being given to the ascending aortic BP measurements.…”

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confidence: 99%

Pulsatile but Not Steady Component of Blood Pressure Predicts Cardiovascular Events in Coronary Patients

et al. 2008

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Abstract-Although the differences between central and peripheral blood pressure (BP) values have been known for decades, the consequences of decision making based on peripheral rather than central BP have only recently been recognized. There are only a few studies assessing the relationship between intraaortic BP and cardiovascular risk. In addition, the relationship between central BP and the risk of cardiovascular events in a large group of coronary patients has not yet been evaluated. Therefore, the aim of the study was to determine the prognostic significance of central BP-derived indices in patients undergoing coronary angiography. Invasive central BPs were taken at baseline, and study end points were ascertained during over a 4. Key Words: blood pressure Ⅲ central pulse pressure Ⅲ pulsatility Ⅲ cardiovascular risk Ⅲ atherosclerosis Ⅲ coronary artery disease D iastolic blood pressure (DBP) was previously believed to be the only meaningful predictor of cardiovascular events; however, systolic blood pressure (SBP) is now being considered an even more important cardiovascular risk factor. 1 Recently, the prospective and retrospective epidemiological studies have demonstrated that elevated pulse pressure (PP, the difference between systolic and diastolic pressure) is independently related to the risk of cardiovascular events, especially in the elderly. 1,2 Furthermore, new parameters (pulsatility and pulsatility index) of the pulsatile component of blood pressure (BP) have been developed. 3,4 Pulsatility is calculated as PP divided by mean blood pressure (MBP). 3 Unlike SBP, DBP, and PP, this new parameter is not correlated with MBP, and thus it may be very useful in research on atherosclerosis pathogenesis and its complications development. 5,6 Pulsatility may be seen as indicator of the relative changes of blood pressure in opposition to pulse pressure which is an index of absolute blood pressure changes.Although the differences between central and peripheral BP values have been known for decades, the consequences of decision making based on peripheral rather than central BP have only recently been recognized. 6 -9 As central BP directly affects heart and coronary as well as carotid arteries and is directly related to the incidence of major cardiovascular complications, more and more attention is being given to the ascending aortic BP measurements. 6,7 There are only a few studies assessing the relationship between central BP and cardiovascular risk. The relationship between pulsatility (as measured invasively in the ascending aorta) and the risk of cardiovascular events has not yet been evaluated. Therefore, the present study was designed for the assessment of the relationship between prognosis and the steady and pulsatile components of central BP. Methods Study PopulationConsecutive patients suspected of having coronary artery disease (CAD) who were undergoing nonemergency coronary angiography from

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Pulsatile but Not Steady Component of Blood Pressure Predicts Cardiovascular Events in Coronary Patients

et al. 2008

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“…Healthy subjects, including interventions such as exercise and Valsalva maneuvers, and patients with ischemic heart disease and failure were analyzed. RMs and RIs using F tIP and F t30 were compared with those using measured flow (F m Key Words: aorta Ⅲ blood flow Ⅲ blood flow velocity Ⅲ blood pressure Ⅲ pulse A ortic pressure, and especially pulse pressure (PP), is now recognized as an important indicator of cardiovascular risk [1][2][3][4] and can guide pharmaceutical treatment. 5,6 Wave reflections affect the pressure and flow wave in the proximal aorta, 7 and their contribution depends on their magnitude (determined by the periphery and the large arteries) and time of return (mainly determined by the large, conduit arteries).…”

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Quantification of Wave Reflection in the Human Aorta From Pressure Alone

Westerhof

Guelen²,

Westerhof³

et al. 2006

Hypertension

272

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Abstract-Wave reflections affect the proximal aortic pressure and flow waves and play a role in systolic hypertension. A measure of wave reflection, receiving much attention, is the augmentation index (AI), the ratio of the secondary rise in pressure and pulse pressure. AI can be limiting, because it depends not only on the magnitude of wave reflection but also on wave shapes and timing of incident and reflected waves. More accurate measures are obtainable after separation of pressure in its forward (P f ) and reflected (P b ) components. However, this calculation requires measurement of aortic flow. We explore the possibility of replacing the unknown flow by a triangular wave, with duration equal to ejection time, and peak flow at the inflection point of pressure (F tIP ) and, for a second analysis, at 30% of ejection time (F t30 ). Wave form analysis gave forward and backward pressure waves. Reflection magnitude (RM) and reflection index (RI) were defined as RMϭP b /P f and RIϭP b /(P f ϩP b ), respectively. Healthy subjects, including interventions such as exercise and Valsalva maneuvers, and patients with ischemic heart disease and failure were analyzed. RMs and RIs using F tIP and F t30 were compared with those using measured flow (F m Key Words: aorta Ⅲ blood flow Ⅲ blood flow velocity Ⅲ blood pressure Ⅲ pulse A ortic pressure, and especially pulse pressure (PP), is now recognized as an important indicator of cardiovascular risk 1-4 and can guide pharmaceutical treatment. 5,6 Wave reflections affect the pressure and flow wave in the proximal aorta, 7 and their contribution depends on their magnitude (determined by the periphery and the large arteries) and time of return (mainly determined by the large, conduit arteries). When the reflected wave arrives in systole, it augments pressure, leading to increased systolic and PP. This augmentation is greater when the heart is hypertrophied. 8 In heart failure, wave reflections affect the flow wave negatively, thereby reducing stroke volume and cardiac output. 8 -10 One way to estimate the amount of reflection is by waveform analysis in which aortic pressure is separated into its forward and backward components. 7,11,12 The ratio of the magnitudes of the backward (reflected) wave and the forward (incident) wave, the reflection magnitude (RM), allows for the estimation of the amount of reflection, but this waveform analysis requires measurement of both pressure and flow waves. A method that requires the measurement of pressure only is computation of the augmentation index (AI). 13,14 AI gives reproducible results 15,16 and is in use in clinical settings. [17][18][19][20] However, AI is determined by both the magnitude and timing of the reflected wave. This is evident from Figure 1A. In this figure, the original pressure wave is separated into its forward and backward components and then reassembled for different delays of the same backward wave. AI is clearly influenced by the time of return of the reflected wave. Figure 1B gives 2 examples in w...

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“…Left ventricular EF was measured on the 301 right anterior oblique projection, using the commercial software available at each of the participating centres. [10][11][12][13][14][15][16] All measurements were performed in the morning and at stable room temperature, after an overnight fast. Brachial BP measurements were performed by traditional mercury sphygmomanometer in the supine position after a 15 min rest in the laboratory, using the first and the fifth Korotkoff sounds for SBP and DBP, respectively.…”

Section: Methodsmentioning

confidence: 99%

“…[10][11][12][13] Several of them have shown a significant association between aortic PP (but not aortic SBP) or aortic stiffness with the presence and extent of atherosclerotic stenosis of the coronary arteries. 11,13,14 However such investigations were mainly documented in subjects with preserved cardiac function, as judged from ejection fractions (EFs).…”

Section: Introductionmentioning

confidence: 99%

Aortic pulse pressure and atherosclerotic structural alterations of coronary arteries

Mourad

Danchin²,

Rudnichi

et al. 2009

J Hum Hypertens

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Pulse pressure (PP) is an independent predictor of myocardial infarction, mainly above 50 years of age. In subjects with preserved ejection fraction (EF), aortic PP predicts the severity of coronary atherosclerosis. Comparable findings in subjects with reduced EF have not been evaluated. In 1337 subjects with severe coronary ischaemic disease, intra-aortic and brachial blood pressures were measured together with EF and coronary angiography to evaluate cardiac function, the presence of coronary stenosis and/or occlusions or calcifications. The presence (odds ratio±95% CI) of coronary calcification was marginally but not significantly associated (P ¼ 0.06) to increased aortic PP (1.32 (0.97-1.80)), whereas that of coronary occlusion was significantly associated (Po0.01) with decreased aortic PP (0.62 (0.42-0.91)), even after adjustment to EF and heart rate. Increased aortic PP did not correlate with stenosis number. No comparable predictive value was observed using intra-aortic or non-invasive brachial systolic blood pressure (SBP) or diastolic blood pressure (DBP). In high cardiovascular risk populations, even in the presence of reduced EF and high heart rate, intra-aortic PP, but not SBP or DBP, is a significant predictor of coronary occlusions and possibly calcifications, but not stenosis.

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Ascending aortic, but not brachial blood pressure-derived indices are related to coronary atherosclerosis

Cited by 54 publications

References 20 publications

Pulsatile but Not Steady Component of Blood Pressure Predicts Cardiovascular Events in Coronary Patients

Pulsatile but Not Steady Component of Blood Pressure Predicts Cardiovascular Events in Coronary Patients

Quantification of Wave Reflection in the Human Aorta From Pressure Alone

Aortic pulse pressure and atherosclerotic structural alterations of coronary arteries

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