Time to the peak of the aortic forward wave determines the impact of aortic backward wave and pulse pressure on left ventricular mass

Tade, Grace; Norton, Gavin R.; Booysen, Hendrik L.; Sibiya, Moekanyi J.; Ballim, Imraan; Sareli, Pinhas; Libhaber, Elena; Majane, Olebogeng H.I.; Woodiwiss, Angela J.

doi:10.1097/hjh.0000000000001173

Cited by 8 publications

(3 citation statements)

References 28 publications

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“…The use of the pressureblood flow ''triangulation method'' of aortic wave separation to derive aortic Pf and Pb has been largely employed and shown adequate reproducibility and clinical value. Tade et al showed similar relations between Pf or Pb and cardiovascular remodeling when Pb or Pf was derived from WSA employing pressure and blood flow measurements versus Pb or Pf derived from the triangular waveform approach to WSA [32]. Our work has the limitation of being a crosssectional design.…”

Section: Limitationsmentioning

confidence: 84%

Forward and Backward Aortic Components and Reflection Indexes in Children and Adolescents: Determinants and Role in High Pressure States

Zócalo

Castro

García-Espinosa

et al. 2018

CHYR

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There were systematic and proportional differences between the data obtained with SphygmoCor and Mobil-O-Graph devices. Heart rate (HR), peripheral pulse pressure, height and weight were the variables that isolated (simple associations) or combined (multiple associations), showed the major capability to explain interindividual differences in Pf, Pb, Pb/Pf and AIx. Arterial stiffness also showed explanatory capacity, being the carotid the artery with the major contribution. HBP associated higher Pf, Pb, AIx and lower Pb/Pf ratio. Those findings were observed together with higher weight, arterial stiffness and HR. After adjusting for anthropometric characteristics, HR, cardiac output and SVR, the HBP group showed greater Pf and Pb. Then, Pf and Pb characteristics associated with HBP would not be explained by anthropometric or hemodynamic factors. Evaluating wave components and reflection parameters could contribute to improve the comprehension and management of HBP states.

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Section: Limitationsmentioning

confidence: 84%

Forward and Backward Aortic Components and Reflection Indexes in Children and Adolescents: Determinants and Role in High Pressure States

Zócalo

Castro

García-Espinosa

et al. 2018

CHYR

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“…AIx offers some insight into global wave reflection magnitude in type A waveforms where there is a clear augmentation of pressure at the inflection point/ascending shoulder. However, as eloquently discussed by Mitchell 61, when AIx is > 0, augmented pressure from the pressure waveform alone represents just the "tip of the iceberg" because the majority of the reflected wave may be masked by the falling edge of the forward pressure wave (62,63). In children with Type C waveforms (negligible/no augmentation of pressure above the shoulder), AIx may not capture wave reflection magnitude because calculated values are negative (P 2 < P 1 ).…”

Section: Racial Differences In Central Hemodynamic Loadmentioning

confidence: 99%

Racial Differences in Left Ventricular Mass and Wave Reflection Intensity in Children

et al. 2020

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The burden of heart failure is disproportionately higher in African Americans, with a higher prevalence seen at an early age. Examination of racial differences in left ventricular mass (LVM) in childhood may offer insight into risk for cardiac target organ damage (cTOD) in adulthood. Central hemodynamic load, a harbinger of cTOD in adults, is higher in African Americans. The purpose of this study was to examine racial differences in central hemodynamic load and LVM in African American and non-Hispanic white (NHW) children. Two hundred sixty-nine children participated in this study (age, 10 ± 1 years; n = 149 female, n = 154 African American). Carotid pulse wave velocity (PWV), forward wave intensity (W1) and reflected wave intensity (negative area, NA) was assessed from simultaneously acquired distension and flow velocity waveforms using wave intensity analysis (WIA). Wave reflection magnitude was calculated as NA/W1. LVM was assessed using standard 2D echocardiography and indexed to height as LVM/[height (2.16) + 0.09]. A cutoff of 45 g/m (2.16) was used to define left ventricular hypertrophy (LVH). LVM was higher in African American vs. NHW children (39.2 ± 8.0 vs. 37.2 ± 6.7 g/m (2.16), adjusted for age, sex, carotid systolic pressure and socioeconomic status; p < 0.05). The proportion of LVH was higher in African American vs. NHW children (25 vs. 12 %, p < 0.05). African American and NHW children did not differ in carotid PWV (3.5 ± 4.9 vs. 3.3 ± 1.3 m/s; p > 0.05). NA/W1 was higher in African American vs. NHW children (8.5 ± 5.3 vs. 6.7 ± 2.9; p < 0.05). Adjusting for NA/W1 attenuated racial differences in LVM (38.8 ± 8.0 vs. 37.6 ± 7.0 g/m (2.16); p = 0.19). In conclusion, racial differences in central hemodynamic load and cTOD are present in childhood. African American children have greater wave intensity from reflected waves and higher LVMI compared to NHW children. WIA offers novel insight into early life origins of racial differences in central hemodynamic load and cTOD.

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“… 9 Moreover, the times to pressure peak of forward (T for ) and reflected (T ref ) waves were associated with higher risk groups in cross-sectional studies. 15 , 16 Although premature wave reflections were associated with outcomes in patients with heart failure with a reduced ejection fraction, 17 whether T for and T ref are predictive of cardiovascular end points in general populations is not known.…”

mentioning

confidence: 99%

Mortality and Cardiovascular End Points In Relation to the Aortic Pulse Wave Components: An Individual-Participant Meta-Analysis

Norton,

An,

Aparicio

et al. 2024

Hypertension

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BACKGROUND: Wave separation analysis enables individualized evaluation of the aortic pulse wave components. Previous studies focused on the pressure height with overall positive but differing results. In the present analysis, we assessed the associations of the pressure of forward and backward (P for and P ref ) pulse waves with prospective cardiovascular end points, with extended analysis for time to pressure peak (T for and T ref ). METHODS: Participants in 3 IDCARS (International Database of Central Arterial Properties for Risk Stratification) cohorts (Argentina, Belgium, and Finland) aged ≥20 years with valid pulse wave analysis and follow-up data were included. Pulse wave analysis was done using the SphygmoCor device, and pulse wave separation was done using the triangular method. The primary end points consisted of cardiovascular mortality and nonfatal cardiovascular and cerebrovascular events. Multivariable-adjusted Cox regression was used to calculate hazard ratios. RESULTS: A total of 2206 participants (mean age, 57.0 years; 55.0% women) were analyzed. Mean±SDs for P for , P ref , T for , and T for /T ref were 31.0±9.1 mm Hg, 20.8±8.4 mm Hg, 130.8±35.5 ms, and 0.51±0.11 ms, respectively. Over a median follow-up of 4.4 years, 146 (6.6%) participants experienced a primary end point. Every 1 SD increment in P for , T for , and T for /T ref was associated with 27% (95% CI, 1.07–1.49), 25% (95% CI, 1.07–1.45), and 32% (95% CI, 1.12–1.56) higher risk, respectively. Adding T for and T for /T ref to existing risk models improved model prediction (∆Uno’s C, 0.020; P <0.01). CONCLUSIONS: Pulse wave components were predictive of composite cardiovascular end points, with T for /T ref showing significant improvement in risk prediction. Pending further confirmation, the ratio of time to forward and backward pressure peak may be useful to evaluate increased afterload and signify increased cardiovascular risk.

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Time to the peak of the aortic forward wave determines the impact of aortic backward wave and pulse pressure on left ventricular mass

Abstract: Time to the peak of the aortic forward wave, but not early wave reflection markedly influences the impact of aortic backward wave pressure and hence aortic pulse pressure on LVMI and LVH in adults.

Cited by 8 publications

References 28 publications

Forward and Backward Aortic Components and Reflection Indexes in Children and Adolescents: Determinants and Role in High Pressure States

Forward and Backward Aortic Components and Reflection Indexes in Children and Adolescents: Determinants and Role in High Pressure States

Racial Differences in Left Ventricular Mass and Wave Reflection Intensity in Children

Mortality and Cardiovascular End Points In Relation to the Aortic Pulse Wave Components: An Individual-Participant Meta-Analysis

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