Severity of Peripheral Arterial Disease is Associated With Aortic Pressure Augmentation and Subendocardial Viability Ratio

Mosimann, Kathrin; Jacomella, Vincenzo; Thalhammer, Christoph; Meier, Thomas; Kohler, Malcolm; Amann-Vesti, Beatrice; Husmann, Marc

doi:10.1111/j.1751-7176.2012.00702.x

Cited by 28 publications

(34 citation statements)

References 32 publications

(68 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Mosimann et al have shown that SEVR and aortic augmentation index are associated with ankle-brachial arterial pressure in a study of 65 patients with peripheral arterial disease [16]. Prince et al reported significantly lower SEVR in association with ankle-brachial arterial pressure index in 144 patients with type 1 diabetes [17].…”

Section: Discussionmentioning

confidence: 99%

Albuminuria is Associated With Subendocardial Viability Ratio in Chronic Kidney Disease Patients

Ekart¹,

Bevc

Hojs

et al. 2015

Kidney Blood Press Res

View full text Add to dashboard Cite

Background/Aims: Albuminuria is a well-established marker of subclinical organ damage. Pulse-wave analysis (PWA) employs the technique of applanation tonometry to obtain a peripheral pulse pressure waveform, from which central hemodynamic data are derived by application of the transfer function. Using PWA we can measure the subendocardial viability ratio (SEVR) and ejection duration (ED). SEVR or the Buckberg index is a non-invasive estimate of myocardial workload, oxygen supply and perfusion and a measure of the ability of the arterial system to meet the heart`s energy requirements. ED is the duration of ventricular ejection. The objective of this study was to evaluate the relationship between albuminuria and PWA parameters in chronic kidney disease (CKD) patients. Methods: We studied 86 CKD patients aged 59.8±13.5 years, 56 (65.1%) were male. PWA analysis and 24-hour ambulatory blood pressure (24hABP) monitoring were performed. The following parameters were calculated: (1) aortic augmentation index with and without correction for a heart rate of 75 (Aix and AIx@ HR75), (2) SEVR, calculated as the ratio of the diastolic pressure time index and the systolic pressure time index, (3) ED, (4) estimated central aortic systolic and diastolic pressure and (5) central aortic pulse pressure calculated as the difference between estimated aortic systolic and diastolic BP. Blood samples and urine albumin-to-creatinine ratio (UACR) were analyzed; UACR values were natural log transformed (lnUACR). Results: Using CKD-EPI creatinine-cystatin C formula the eGFR in patients was 7-130 ml/min/1.73m² (mean 32.6; SD±24.6). We found statistically significant correlation between lnUACR and cystatin C (r=0.308; P=0.004), eGFR (r=-0.219; P=0.04), hemoglobin (r=-0.255; P=0.02), phosphorus (r=0.222; P=0.04), iPTH (r=0.268; P=0.01), SEVR (r=-0.254; P=0.02) and ED (r=0.315; P=0.003). No statistically significant correlations between lnUACR and cardiac biomarkers TnI, NT-proBNP, central aortic BP and 24h ABP values were found. Using multiple regression analysis statistically significant association was found between SEVR as dependent variable and lnUACR (β=-0.223, P=0.039), sex (β=-0.216, P=0.035), and diabetes (β=0.332, P=0.001). Multiple regression analysis with ED as dependent variable has shown statistically significant association with lnUACR (β=0.242, P=0.031) and diabetes (β=-0.275, P=0.01). Patients were stratified into tertiles according to the lnUACR. Statistically significant differences in serum creatinine (P=0.001), cystatin C (P=0.012), hemoglobin (P=0.03), calcium (P=0.036), iPTH (P=0.008), SEVR (P=0.007) and ED (P=0.004) were found between tertiles. In post hoc analysis we found statistically significant differences between first and third tertile in SEVR (P=0.002; 95% CI:10.5-45) and in ED (P=0.001; 95% CI:-6.89-(-1.87)). Conclusions: Nondialysis CKD patients with higher levels of albuminuria have lower SEVR and higher ED and our results have shown the importance of central hemodynamic parameters like are SEVR and ...

show abstract

Section: Discussionmentioning

confidence: 99%

Albuminuria is Associated With Subendocardial Viability Ratio in Chronic Kidney Disease Patients

Ekart¹,

Bevc

Hojs

et al. 2015

Kidney Blood Press Res

View full text Add to dashboard Cite

show abstract

“…A low SEVR has been associated with albuminuria [8-10] and haemoglobin [11], as well as with markers of inflammation in patients with rheumatoid arthritis [12]. Hypertensive patients with reduced coronary flow reserve [13], extreme dippers [14], patients with rheumatoid arthritis [15] or peripheral artery disease [16], women with type 2 diabetes [17] and highly proteinuric CKD patients with an estimated glomerular filtration rate (eGFR) < 30 mL/min/1.73 m 2 [18] have also been associated with a lower SEVR. Recently, a reduced SEVR was shown to predict cardiovascular mortality in CKD patients [19] and combined endpoint all-cause mortality and end-stage renal disease in patients with type 1 diabetes [10].…”

Section: Introductionmentioning

confidence: 99%

Derived Subendocardial Viability Ratio and Cardiovascular Events in Patients with Chronic Kidney Disease

et al. 2018

View full text Add to dashboard Cite

Background: Chronic kidney disease (CKD) is a well-known mortality risk factor. The subendocardial viability ratio (SEVR) is one of the pulse wave analysis parameters that constitutes a non-invasive measure of coronary perfusion. We aimed to assess the prognostic value of the SEVR for cardiovascular outcome in non-dialysis CKD patients. Methods: A total of 98 CKD patients (mean age 60 years) were prospectively followed up from the date of the SEVR measurement until their death or the start of dialysis/transplantation, maximally up to 7.1 years (mean 5 years). According to the manufacturer’s instructions regarding normal SEVR values, the patients were divided into a low SEVR group (SEVR ≤130%, n = 26) and a normal SEVR group (SEVR > 130%, n = 72). Results: During the follow-up period, 13 patients (13.3%) suffered fatal and 23 patients (23.5%) suffered combined (non-fatal and fatal) cardiovascular events. In the patients who died of cardiovascular causes, the SEVR values were statistically significantly lower (130 vs. 154%; p = 0.017) than in those who survived. A Kaplan-Meier survival analysis showed that the cardiovascular survival rate in the low SEVR group of patients was statistically significantly lower (log-rank test: p < 0.001). Using an unadjusted Cox regression analysis, the patients in the low SEVR group had a 5.6-fold higher risk (95% CI: 1.8–17.3; p = 0.002) of fatal cardiovascular events and a 2.7-fold higher risk (95% CI: 1.1–6.3; p = 0.024) of combined fatal and non-fatal cardiovascular events. In the adjusted Cox regression model, the patients in the low SEVR group had a 16-fold higher risk (95% CI: 1.2–9.7; p = 0.004) of fatal cardiovascular events and a 7-fold higher risk (95% CI: 1–9.7; p = 0.009) of combined fatal and non-fatal cardiovascular events. Conclusions: An SEVR < 130% predicts fatal and non-fatal cardiovascular events in non-dialysis CKD patients.

show abstract

“…Several studies have demonstrated an elevation of the AI in subjects with PAD, in other words, an inverse correlation between the ABPI and the AI [8, 9]. A plausible explanation for this finding is that in the arterial tree, pressure wave reflection occurs at the site of increased arterial resistance, and arterial narrowing/severe stenosis is associated with a steep increase in arterial resistance.…”

Section: Discussionmentioning

confidence: 95%

“…Peripheral artery disease (PAD) is one of the manifestations of conditions associated with advanced atherosclerotic vascular damage, but some patients with PAD are asymptomatic. While some markers of vascular damage have been reported to be associated with PAD [8, 9], further study is needed to establish a tool to identify subjects with asymptomatic PAD.…”

Section: Introductionmentioning

confidence: 99%

Increase in the Arterial Velocity Pulse Index of Patients with Peripheral Artery Disease

Murata

Shiina

Yamashita

et al. 2017

Pulse

View full text Add to dashboard Cite

Background: Recently, a simple parameter calculated from the brachial pressure waveform recorded using an oscillometric device (arterial velocity pulse index [AVI]: ratio of the forward/reflected pressure wave amplitudes) has become available to assess the pathophysiological abnormalities associated with vascular damage. Peripheral artery disease (PAD) represents one of the disease entities associated with the advanced stages of atherosclerotic vascular damage. The present study was conducted to examine whether an increase in the AVI might be influenced by the presence of PAD. Methods and Results: The AVI was measured from oscillometric recordings of the brachial pressure waveform, and the ankle-brachial pressure index (ABPI) was determined by an oscillometric method. Study 1: In 341 consecutive patients admitted for the management of cardiovascular disease and/or cardiovascular risk factors, the ABPI and the AVI were measured simultaneously. An ABPI ≤0.90 was observed in 19 subjects, and logistic regression analysis revealed a significant association between AVI and ABPI ≤0.90 (odds ratio = 1.81; 95% confidence interval = 1.15–2.84; p = 0.01). Study 2: In another 19 patients with PAD, percutaneous transluminal angioplasty resulted in a decrease in the AVI from 31 ± 8 to 27 ± 8 (p < 0.01). Conclusion: Possible presence of PAD must be taken into account while applying the AVI for the assessment of vascular damage.

show abstract

Severity of Peripheral Arterial Disease is Associated With Aortic Pressure Augmentation and Subendocardial Viability Ratio

Cited by 28 publications

References 32 publications

Albuminuria is Associated With Subendocardial Viability Ratio in Chronic Kidney Disease Patients

Albuminuria is Associated With Subendocardial Viability Ratio in Chronic Kidney Disease Patients

Derived Subendocardial Viability Ratio and Cardiovascular Events in Patients with Chronic Kidney Disease

Increase in the Arterial Velocity Pulse Index of Patients with Peripheral Artery Disease

Contact Info

Product

Resources

About