Pulse waveform characteristics predict cardiovascular events and mortality in patients undergoing coronary angiography

Weber, Thomas; O’Rourke, Michael; Laßnig, Elisabeth; Porodko, Michael; Ammer, Marcus; Rammer, M; Eber, Bernd

doi:10.1097/hjh.0b013e328336c8e9

Cited by 96 publications

(64 citation statements)

References 30 publications

(40 reference statements)

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“…[38][39][40] In this context, our findings are in accordance with the artery size hypothesis, according to which atherosclerosis is widespread throughout the arterial tree, but it is clinically manifest initially as ED because the same amount of atherosclerotic burden compromises flow first through the smaller lumen of the penile arteries. 7,41 However, it should be noted that arterial stiffness is also a predictor of acute coronary events, 38 which in their majority occur in the presence of nonobstructive atherosclerotic disease.…”

Section: Discussionsupporting

confidence: 89%

Prediction of Cardiovascular Events With Aortic Stiffness in Patients With Erectile Dysfunction

et al. 2014

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Abstract-Erectile dysfunction confers an independent risk for cardiovascular events and total mortality. Aortic pulse wave velocity (PWV) is an important predictor of cardiovascular events and all-cause mortality. We investigated whether PWV predicts major adverse cardiovascular events (MACEs) in patients with erectile dysfunction beyond traditional risk factors. Vlachopoulos et al Aortic Stiffness and Events in Erectile Dysfunction 673when indicated, to reveal occult CAD (58/436; 13.3% proved to have CAD). 6 Initially, 436 men were assessed for inclusion in the study. All patients with angiographically documented CAD at onset and 34 men who were lost to follow-up were excluded from the study. Finally, 344 men were analyzed (Figure 1).Hypertension, dyslipidemia, and diabetes mellitus were defined according to established diagnostic criteria or if the subject was taking any medication for these diseases. Patients with malignancy, overt endocrine disease, and use of steroid hormones were also excluded, because these conditions may have a significant influence on both plasma sex hormones and clinical outcome. Evaluation of EDED of vasculogenic origin was diagnosed according to (1) comprehensive medical and sexual history, (2) score of the 5-item form of the international index of erectile function, the sexual health inventory for men (≤21 indicates ED), (3) comprehensive medical examination (performed by cardiologists, urologists, psychotherapists, and allied health professionals), (4) hormonal testing (total testosterone and prolactin), and (5) dynamic penile Doppler ultrasound (with intracavernous injection of alprostadil). Through these evaluations, patients were excluded if their ED was secondary to hormonal, psychological, neurological, or anatomic abnormalities, pelvic surgery, or trauma. Vasculogenic ED is diagnosed when the peak systolic velocity is <35 cm/s and/or when the end-diastolic velocity is >5 cm/s.

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Section: Discussionsupporting

confidence: 89%

Prediction of Cardiovascular Events With Aortic Stiffness in Patients With Erectile Dysfunction

et al. 2014

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“…Aortic pressure augmentation due to wave reflection could cause myocardial ischemia by increasing the left ventricular wasted effort and ejection duration, even in the absence of overt coronary stenosis (Nichols et al 2013). As summarized in previous reviews (Vlachopoulos et al 2010;Hashimoto and Ito 2012), several prospective studies conducted on coronary artery disease patients have demonstrated that the central pulse pressure and augmentation index predict future cardiovascular events, and the predictive ability is superior to (or independent of) the brachial pressure (Chirinos et al 2005;Weber et al 2005Weber et al , 2010Jankowski et al 2008).…”

Section: Central Hemodynamics and Heartmentioning

confidence: 99%

Central Hemodynamics and Target Organ Damage in Hypertension

Hashimoto

2014

Tohoku J. Exp. Med.

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Recent advances in technology have enabled the noninvasive evaluation of pulsatile hemodynamics in the central aorta; namely, central pressure and flow measurements. The central blood pressure represents the true load imposed on the heart, kidney and brain, and the central blood flow influences the local flow into these vital organs. An elevation of the central blood pressure has a direct, adverse impact on the target organ and, thus, the cardiovascular prognosis in patients with hypertension. A decrease in the central blood flow can cause organ dysfunction and failure. The central pressure and flow dynamics were conventionally regarded as unidirectional from the heart to the periphery. However, current evidence suggests that it should be recognized as a bidirectional interplay between the central and peripheral arteries. Specifically, the pressure pulse wave is not only transmitted forward to the periphery but also reflected backward to the central aorta. The flow pulse wave is also composed of the forward and reverse components. Aortic stiffening and arteriolar remodeling due to hypertension not only augment the central pressure by increasing the wave reflection but also may alter the central bidirectional flow, inducing hemodynamic damage/dysfunction in susceptible organs. Therefore, central hemodynamic monitoring has the potential to provide a diagnostic and therapeutic basis for preventing systemic target organ damage and for offering personalized therapy suitable for the arterial properties in each patient with hypertension. This brief review will summarize hypothetical mechanisms for the association between the central hemodynamics and hypertensive organ damage in the heart, kidney and brain.

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“…Central hemodynamic properties may be monitored with accuracy [4] and precision [5] using pulse wave analysis (PWA). Typically, the pressure waveform is non-invasively monitored at a peripheral site, and using a generalized transfer function, a corresponding aortic arterial waveform can be generated [6,7].…”

Section: Introductionmentioning

confidence: 99%

Reliability of oscillometric central blood pressure responses to submaximal exercise

Lim

Faulkner²,

Lambrick³

et al. 2016

Journal of Hypertension

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Central blood pressure responses to exercise may provide clinicians with a superior diagnostic and prognostic tool. However, in order to be of value in a clinical setting these assessments must be simple to conduct and reliable. Objective: Using oscillometric pulse wave analysis (PWA), determine the upper limit for between-day reliability of central systolic blood pressure ( that, at least in a young health cohort, oscillometric PWA can be used to reliably assess central blood pressure measurements during exercise, up to a moderate intensity. While further work is required to validate these findings in clinical cohorts, these measurements may provide clinicians with a practical option for obtaining important hemodynamic information beyond that provided by resting peripheral blood pressure.

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Pulse waveform characteristics predict cardiovascular events and mortality in patients undergoing coronary angiography

Abstract: The study provides evidence that pulse waveform characteristics consistently and independently predict cardiovascular events in coronary patients.

Cited by 96 publications

References 30 publications

Prediction of Cardiovascular Events With Aortic Stiffness in Patients With Erectile Dysfunction

Prediction of Cardiovascular Events With Aortic Stiffness in Patients With Erectile Dysfunction

Central Hemodynamics and Target Organ Damage in Hypertension

Reliability of oscillometric central blood pressure responses to submaximal exercise

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