Relation Between Ascending Aortic Pressures and Outcomes in Patients With Angiographically Demonstrated Coronary Artery Disease

Chirinos, Julio A.; Zambrano, Juan P.; Chakko, Simon; Veerani, Anila; Schob, Alan; Pérez, Guido O.; Mendez, Armando J.

doi:10.1016/j.amjcard.2005.04.036

Cited by 63 publications

(45 citation statements)

References 17 publications

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“…Although the present study population was 3 times greater when compared with the single published study measuring central BP invasively and examining the relationship between central BP and cardiovascular risk, 21 it is still possible that the results may have differed if a larger group was analyzed. We did not assess the left ventricular stroke volume.…”

Section: Discussionmentioning

confidence: 76%

“…Our findings concur with the results of several small studies showing independent relationship between intra-aortic pulsatility and pulsatility index and the risk of restenosis in patients undergoing coronary angioplasty 3,4 as well as with the results of Chirinos et al who showed a correlation between central PP and cardiovascular risk in men with angiographically confirmed CAD. 21 Although these authors did not include the extent of the coronary atherosclerosis into the multivariable analysis 21 we did include it and therefore we were able to show that the relationship between central pulse pressure and cardiovascular risk is independent of the coronary atherosclerosis extent in subjects with CAD. Moreover, to our best knowledge, this is the first study to show that central pulsatility (a measure of relative changes of BP) is an independent predictor of event-free survival.…”

Section: Discussionmentioning

confidence: 92%

“…3,4,5,21 However, it would be far more convenient to measure central BP parameters noninvasively. Recently, greater attention has been given to pulse wave analysis which allows central BP assessment.…”

Section: Discussionmentioning

confidence: 99%

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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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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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Section: Discussionmentioning

confidence: 76%

Section: Discussionmentioning

confidence: 92%

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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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confidence: 99%

Quantification of Wave Reflection in the Human Aorta From Pressure Alone

Westerhof

Guelen²,

Westerhof³

et al. 2006

Hypertension

273

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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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“…Only 2 studies of limited size and duration have assessed the association between invasively measured aortic BP and cardiovascular risk yielding conflicting results. 10,11 Although patients with diabetes mellitus are at high risk of cardiovascular events, 12 no previous studies have Abstract-Aortic systolic blood pressure (BP) represents the hemodynamic cardiac and cerebral burden more directly than office systolic BP. Whether invasively measured aortic systolic BP confers additional prognostic value beyond office BP remains debated.…”

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confidence: 99%

Invasively Measured Aortic Systolic Blood Pressure and Office Systolic Blood Pressure in Cardiovascular Risk Assessment

et al. 2016

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768S troke and myocardial infarction (MI) remain common diseases with massive consequences for patients and healthcare systems.1,2 Improved risk stratification is crucial to optimize patient care and requires development of more sensitive tools to identify high-risk patients. Because blood pressure (BP) in the brachial artery differs from the BP in the aorta, to which the heart and brain are exposed, cardiovascular risk assessment based on aortic BP could potentially be superior to assessment based on office BP measured at the level of the brachial artery. 3 However, the prognostic value of aortic BP remains unresolved, as aortic BP estimated noninvasively has been found to predict cardiovascular events in some, [4][5][6][7] but not all, 8,9 studies. The gold-standard method for assessing aortic BP is by invasive measurements. Only 2 studies of limited size and duration have assessed the association between invasively measured aortic BP and cardiovascular risk yielding conflicting results. 10,11 Although patients with diabetes mellitus are at high risk of cardiovascular events, 12 no previous studies have Abstract-Aortic systolic blood pressure (BP) represents the hemodynamic cardiac and cerebral burden more directly than office systolic BP. Whether invasively measured aortic systolic BP confers additional prognostic value beyond office BP remains debated. In this study, office systolic BP and invasively measured aortic systolic BP were recorded in 21 908 patients (mean age: 63 years; 58% men; 14% with diabetes mellitus) with stable angina pectoris undergoing elective coronary angiography during January 2001 to December 2012. Multivariate Cox models were used to assess the association with incident myocardial infarction, stroke, and death. Discrimination and reclassification were assessed using Harrell's C and the Continuous Net Reclassification Index. Data were analyzed with and without stratification by diabetes mellitus status. During a median follow-up period of 3.7 years (range: 0. MethodsThis study was conducted using medical databases in Denmark. Denmark has free, universal tax-supported health care with unrestrained access to general practitioners and hospitals. Accurate linkage of all medical registries is possible through the unique central personal registry number. 13 In this study, patient data in The Western Denmark Heart Registry covering 3 million inhabitants 14 was linked to outcome data in The Danish National Registry of Patients 15 and The Danish Civil Registration System. 13The Western Denmark Heart Registry collects patient and procedure data from all cardiac intervention centers in Western Denmark.14 The registry was used to identify all elective CAG procedures performed between January 1, 2001, and December 31, 2012. For the present analysis, we considered patients without previous MI, stroke, heart failure, or valvular disease referred for CAG with suspicion of stable angina pectoris. The first CAG during the inclusion period was defined as the index CAG.Office BP and invasively measur...

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Relation Between Ascending Aortic Pressures and Outcomes in Patients With Angiographically Demonstrated Coronary Artery Disease

Cited by 63 publications

References 17 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

Invasively Measured Aortic Systolic Blood Pressure and Office Systolic Blood Pressure in Cardiovascular Risk Assessment

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