Evaluation of the Cardio-Ankle Vascular Index, a New Indicator of Arterial Stiffness Independent of Blood Pressure, in Obesity and Metabolic Syndrome

Satoh, Noriko; Shimatsu, Akira; Kato, Yasuhisa; Araki, Rika; Kanemaru, Kazunori; Okajima, Taiichiro; Tanabe, Makito; Ooishi, Mariko; Kotani, Kazuhiko; Ogawa, Yoshihiro

doi:10.1291/hypres.31.1921

Cited by 149 publications

(191 citation statements)

References 30 publications

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“…However, there were no statistically significant correlations between CAVI, the visit-to-visit SBP variability parameters and the mean SBP. Previous reports 30,32 have established CAVI is not as influenced by blood pressure as brachial-ankle PWV is influenced. Therefore, brachial-ankle PWV might produce different results regarding correlations between arterial stiffness and visit-to-visit SBP variability and the mean SBP.…”

Section: Discussionmentioning

confidence: 75%

Visit-to-visit variability in blood pressure over a 1-year period is a marker of left ventricular diastolic dysfunction in treated hypertensive patients

et al. 2011

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Although visit-to-visit variability in systolic blood pressure (SBP) has recently been demonstrated to be a strong predictor of stroke, there are no data about relationships between SBP variability and cardiac damage in hypertensive patients. We compared relationships between visit-to-visit variability in SBP and left ventricular (LV) diastolic dysfunction with the relationships between the mean SBP value and cardiac parameters in treated patients. Forty treated hypertensive patients (69±9 years of age) had their blood pressure measured at outpatient clinics every 1 or 2 months over a 1-year period. The standard deviation (s.d.) of SBP and the difference between the maximum and minimum SBPs during this year were calculated to assess visit-to-visit variability. The mean SBP during the year was also calculated. LV diastolic function was assessed by the ratio (E/A) of early (E) and late (A) diastolic transmitral flows, early diastolic mitral annular velocity (e¢) and the ratio (E/e¢) of E to e¢ using Doppler echocardiography. E/A only correlated with the s.d. of SBP (r¼À0.327, P¼0.040), whereas e¢ correlated with s.d. of SBP (r¼À0.496, P¼0.001) and maximum-minimum SBP difference (r¼À0.490, P¼0.001). E/e¢ correlated with s.d. of SBP (r¼0.384, P¼0.014), maximum-minimum SBP difference (r¼0.410, P¼0.009), and the mean value of SBP (r¼0.349, P¼0.028). Multiple regression analysis demonstrated only the maximum-minimum SBP difference independently associated with E/e¢ (b¼0.410, P¼0.009). Thus, the visit-to-visit variability of SBP showed better correlation with LV diastolic dysfunction than mean values of SBP. High visit-to-visit variability of SBP was associated with LV diastolic dysfunction and may constitute a high risk for diastolic heart failure in hypertensive patients.

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Section: Discussionmentioning

confidence: 75%

Visit-to-visit variability in blood pressure over a 1-year period is a marker of left ventricular diastolic dysfunction in treated hypertensive patients

et al. 2011

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“…This may be a reason why CAVI did not correlate with CBP or the augmentation index (Table 2). This is reasonable because CAVI is thought to be less influenced by blood pressure 11,12 compared with other pulse wave-derived parameters. However, an earlier study 30 showed that the augmentation index reflected arterial stiffness and LV hypertrophy.…”

Section: Discussionmentioning

confidence: 81%

“…We hypothesize that CBP may reflect cardiac structure and function better than peripheral blood pressure and that it may show a better correlation with cardiac function compared with the cardio-ankle vascular index (CAVI), which has been an established marker of arterial stiffness from the aortic valve to the ankle. [10][11][12] In this study, we examined the associations between CBP and cardiac structure and function by comparing them with those of arterial stiffness assessed by CAVI in treated hypertensive patients.…”

Section: Introductionmentioning

confidence: 99%

Comparison of central blood pressure and cardio-ankle vascular index for association with cardiac function in treated hypertensive patients

et al. 2009

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Recent automated applanation tonometry can measure radial pulse wave-derived central blood pressure (CBP), which has shown a prognostic value independently of peripheral blood pressure. However, CBP's clinical significance has not been fully established. We examined the associations between CBP and cardiac structure and function by comparing them with those of arterial stiffness assessed by cardio-ankle vascular index (CAVI) in treated hypertensive patients. Enrolled in the study were 102 patients (71 ± 7 years) with treated hypertension. The transmitral early-to-atrial velocity ratio (E/A), peak systolic (S¢), early diastolic (E¢) mitral annular velocities and the Tei index were measured as indexes of cardiac function derived from conventional and tissue Doppler echocardiography. Left ventricular mass index (LVMI) was measured as an index of LV hypertrophy. CBP and CAVI were measured just after echocardiographic examination. CBP, but not CAVI, correlated with LVMI (r¼0.306, Po0.01). Although CBP correlated only with the Tei index (r¼0.201, Po0.05), CAVI correlated with E/A (r¼À0.387, Po0.001), S¢ (r¼À0.270, Po0.01), E¢ (r¼À0.362, Po0.01) and the Tei index (r¼0.339, Po0.01). Stepwise regression analysis revealed that neither CBP nor CAVI was independently associated with E/A, S¢ or E¢. However, CAVI, but not CBP, was independently associated with the Tei index (b coefficient¼0.311, Po0.001), reflecting both LV systolic and diastolic function. In conclusion, CBP may be suitable for detecting LV hypertrophy. In contrast, CAVI may be suitable for detecting LV dysfunction. This difference, suggesting the clinical value of each parameter, should be kept in mind when we use CBP and CAVI for assessing arteriosclerosis in treated hypertension.

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“…This new index is less influenced by the change in BP. 14,15 Importantly, CAVI has more significant correlations with left ventricular diastolic function, the number of stenotic coronary vessels and the severity of coronary atherosclerosis than with arterial intima-media thickness and plaque score. 16,17 There is evidence that oxidative modification of LDL (or oxidized LDL (oxLDL)) is relevant to atherosclerotic lesions, in which the LDL is easily taken up by damaged endothelial cells and macrophages, along with remnants and small, dense LDL.…”

Section: Introductionmentioning

confidence: 99%

“…To accurately evaluate the vascular dysfunction associated with metabolic syndrome, we used CAVI. 14,15 …”

Section: Introductionmentioning

confidence: 99%

Highly purified eicosapentaenoic acid reduces cardio-ankle vascular index in association with decreased serum amyloid A-LDL in metabolic syndrome

et al. 2009

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A recent clinical trial revealed that highly purified eicosapentaenoic acid (EPA), an n-3 polyunsaturated fatty acid, reduces the incidence of cardiovascular diseases. However, the detailed mechanism underlying the anti-atherogenic effect of EPA is still poorly understood. In this study, we examined the effect of EPA on cardio-ankle vascular index (CAVI), a new index of arterial stiffness that is less influenced by blood pressure (BP), as well as on serum amyloid A-low-density lipoprotein (SAA-LDL), an oxidized LDL (oxLDL), in the metabolic syndrome. Ninety-two obese Japanese subjects with metabolic syndromes were randomly divided into two groups (n¼46): the EPA-treated group (1.8 g administered daily for 3 months) and the control group. Measurements were taken to assess the changes in glucose-lipid metabolism, SAA-LDL, C-reactive protein (CRP), leptin, adiponectin and pulse wave velocity (PWV), and CAVI. EPA treatment significantly reduced the levels of immunoreactive insulin, triglycerides, SAA-LDL, CRP, PWV and CAVI and increased the levels of adiponectin relative to the control group for 3 months (Po0.05). Stepwise multivariate linear regression analysis revealed that the only significant determinant for a decrease in CAVI by EPA is a reduction in SAA-LDL (Po0.05). Moreover, the EPA-induced reduction of SAA-LDL was only significantly correlated with a decrease in total cholesterol and an increase in adiponectin (Po0.05). This study is the first demonstration that EPA improves arterial stiffness and is less influenced by BP, possibly through the suppression of SAA-LDL, thereby leading to a reduction in the frequency of cardiovascular disease development in metabolic syndrome.

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Evaluation of the Cardio-Ankle Vascular Index, a New Indicator of Arterial Stiffness Independent of Blood Pressure, in Obesity and Metabolic Syndrome

Cited by 149 publications

References 30 publications

Visit-to-visit variability in blood pressure over a 1-year period is a marker of left ventricular diastolic dysfunction in treated hypertensive patients

Visit-to-visit variability in blood pressure over a 1-year period is a marker of left ventricular diastolic dysfunction in treated hypertensive patients

Comparison of central blood pressure and cardio-ankle vascular index for association with cardiac function in treated hypertensive patients

Highly purified eicosapentaenoic acid reduces cardio-ankle vascular index in association with decreased serum amyloid A-LDL in metabolic syndrome

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