Augmentation index as an indicator of central arterial stiffness and indicators of carotid atherosclerosis by ultrasonography in relation to life stress

Objective.We evaluated the predictive value of these vascular biomarkers for cardiovascular disease (CVD) events in patients with rheumatoid arthritis (RA): aortic pulse wave velocity (aPWV), augmentation index (AIx), carotid intima-media thickness (cIMT), and carotid plaques (CP). They are often used as risk markers for CVD.Methods.In 2007, 138 patients with RA underwent clinical examination, laboratory tests, blood pressure testing, and vascular biomarker measurements. Occurrence of CVD events was recorded in 2013. Predictive values were assessed in Kaplan-Meier plots, log-rank, and crude and adjusted Cox proportional hazard (PH) regression analyses.Results.Baseline median age and disease duration was 59.0 years and 17.0 years, respectively, and 76.1% were women. CVD events occurred in 10 patients (7.2%) during a mean followup of 5.4 years. Compared with patients with low aPWV, AIx, cIMT, and without CP, patients with high aPWV (p < 0.001), high AIx (p = 0.04), high cIMT (p = 0.01), and CP (p < 0.005) at baseline experienced more CVD events. In crude Cox PH regression analyses, aPWV (p < 0.001), cIMT (p < 0.001), age (p = 0.01), statin (p = 0.01), and corticosteroid use (p = 0.01) were predictive of CVD events, while AIx was nonsignificant (p = 0.19). The Cox PH regression estimates for vascular biomarkers were not significantly altered when adjusting individually for demographic variables, traditional CVD risk factors, RA disease-related variables, or medication. All patients who developed CVD had CP at baseline.Conclusion.CP, aPWV, and cIMT were predictive of CVD events in this cohort of patients with RA. Future studies are warranted to examine the additive value of arterial stiffness and carotid atherosclerosis markers in CVD risk algorithms. Regional Ethical Committee approval numbers 2009/1582 and 2009/1583.

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Arterial stiffness is a potential mechanism and promising indicator of orthostatic hypotension in the general population

VASA ◽

10.1024/0301-1526/a000389 ◽

2014 ◽

Vol 43 (6) ◽

pp. 423-432 ◽

Cited By ~ 11

Author(s):

Qingtao Meng ◽

Si Wang ◽

Yong Wang ◽

Shixi Wan ◽

Kai Liu ◽

...

Keyword(s):

General Population ◽

Arterial Stiffness ◽

Orthostatic Hypotension ◽

Operating Characteristic ◽

Pulse Wave ◽

Augmentation Index ◽

Multiple Logistic Regression Analysis ◽

The Elderly ◽

Baroreceptor Sensitivity ◽

Roc Curve Analysis

Background: Orthostatic hypotension (OH) is a disease prevalent among middle-aged men and the elderly. The association between arterial stiffness and OH is unclear. This study evaluates whether arterial stiffness is correlated with OH and tests the usefulness of brachial-ankle pulse wave velocity (baPWV), an arterial stiffness marker, with regard to identifying OH. Patients and methods: A sample of 1,010 participants was recruited from the general population (64.8 ± 7.7 years; 426 men) who attended health check-ups. BaPWV and the radial augmentation index (rAI) were both assessed as the arterial stiffness markers, and OH was determined using blood pressure (BP) measured in the supine position, as well as 30 seconds and 2 minutes after standing. Results: The prevalence of OH in this population was 4.9 %. Compared with the non-OH group, both baPWV (20.5 ± 4.5 vs 17.3 ± 3.7, p < 0.001) and rAI (88.1 ± 10.8 vs 84.2 ± 10.7, p < 0.05) were significantly higher in the OH group. In the multiple logistic regression analysis, baPWV (OR, 1.3; 95 % CI, 1.106–1.528; p < 0.05) remained associated with OH. Moreover, the degree of orthostatic BP reduction was related to arterial stiffness. In addition, increases in arterial stiffness predicted decreases in the degree of heart rate (HR) elevation. Finally, a receiver operating characteristic (ROC) curve analysis showed that baPWV was useful in discriminating OH (AUC, 0.721; p < 0.001), with the cut-off value of 18.58 m/s (sensitivity, 0.714; specificity, 0.686). Conclusions: Arterial stiffness determined via baPWV, rather than rAI, was significantly correlated with the attenuation of the orthostatic hemodynamic response and the resultant OH. The impaired baroreceptor sensitivity might be the mechanism. In addition, baPWV appears to be a relatively sensitive and reliable indicator of OH in routine clinical practice.

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Markers of arterial stiffness in peripheral arterial disease

VASA ◽

10.1024/0301-1526/a000452 ◽

2015 ◽

Vol 44 (5) ◽

pp. 341-348 ◽

Cited By ~ 25

Author(s):

Marc Husmann ◽

Vincenzo Jacomella ◽

Christoph Thalhammer ◽

Beatrice R. Amann-Vesti

Keyword(s):

Arterial Stiffness ◽

Peripheral Arterial Disease ◽

Pulse Wave ◽

Augmentation Index ◽

Arterial Disease ◽

Care Physician ◽

Additional Information ◽

Non Invasive ◽

Assessment Techniques ◽

Peripheral Arterial

Abstract. Increased arterial stiffness results from reduced elasticity of the arterial wall and is an independent predictor for cardiovascular risk. The gold standard for assessment of arterial stiffness is the carotid-femoral pulse wave velocity. Other parameters such as central aortic pulse pressure and aortic augmentation index are indirect, surrogate markers of arterial stiffness, but provide additional information on the characteristics of wave reflection. Peripheral arterial disease (PAD) is characterised by its association with systolic hypertension, increased arterial stiffness, disturbed wave reflexion and prognosis depending on ankle-brachial pressure index. This review summarises the physiology of pulse wave propagation and reflection and its changes due to aging and atherosclerosis. We discuss different non-invasive assessment techniques and highlight the importance of the understanding of arterial pulse wave analysis for each vascular specialist and primary care physician alike in the context of PAD.

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Association of Carotid Atherosclerosis and Arterial Stiffness with Obesity

Soonchunhyang Medical Science ◽

10.15746/sms.11.020 ◽

2011 ◽

Vol 17 (2) ◽

pp. 95-99

Author(s):

Byung Kyu Ahn ◽

Sung Koo Kim ◽

Young Joo Kwon ◽

Min Su Hyon ◽

Duk Won Bang ◽

...

Keyword(s):

Arterial Stiffness ◽

Carotid Atherosclerosis

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Applanation Tonometry for Assessment of Left Ventricular Systolic Load

Journal of Biomedical and Clinical Research ◽

10.2478/jbcr-2019-0014 ◽

2019 ◽

Vol 12 (2) ◽

pp. 94-99

Author(s):

Rene D. Mileva-Popova ◽

Nina Y. Belova

Keyword(s):

Arterial Stiffness ◽

Augmentation Index ◽

Age Groups ◽

Systolic Pressure ◽

Left Ventricular ◽

Applanation Tonometry ◽

Non Invasive ◽

Pressure Area ◽

Older Subjects ◽

And Gender

Summary Vascular-ventricular coupling is a major determinant of left ventricular load. The aim of our study was to assess non- invasively left ventricular load and its dependency on central hemodynamics. Sixty-five healthy and gender-matched individuals were divided in two groups according to their age: 20y/o and 50y/o. Applanation tonometry was performed using the Sphygmocor device. Central pressures and pulse wave analysis indices were computed. Central systolic (120±3 vs. 98±2 mm Hg) and pulse pressures (43±3 vs. 29±1 mm Hg) as well as the augmentation index (AIx75) (23±3 vs. 6±2%) were significantly higher in the 50y/o group (p<0.01). These parameters are relevant markers of arterial stiffness and evidenced the development of central arterial morphological and functional alterations in the older subjects. The time-tension index (TTI) computed from the systolic pressure area was significantly higher in the 50y/o subjects as compared to the 20y/o group (2378±66 vs. 1954±73 mmHg×s, p<0.01). Moreover, we have shown the presence of significant correlation between TTI and AIx75 (p<0.01) in both age groups. This finding confirmed the contribution of arterial stiffness for the impaired vascular-ventricular coupling. In conclusion, applanation tonometry might be utilized for non-invasive evaluation of the left ventricular load, which is an important parameter of cardiovascular risk.

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Sex modulates the association of radial artery augmentation index with renal function decline in individuals without chronic kidney disease

International Urology and Nephrology ◽

10.1007/s11255-020-02776-5 ◽

2021 ◽

Author(s):

Qiao Qin ◽

Fangfang Fan ◽

Jia Jia ◽

Yan Zhang ◽

Bo Zheng

Keyword(s):

Chronic Kidney Disease ◽

Renal Function ◽

Kidney Disease ◽

Arterial Stiffness ◽

Confidence Interval ◽

Odds Ratio ◽

Adjusted Odds Ratio ◽

Augmentation Index ◽

Renal Function Decline

Abstract Purpose An increase in arterial stiffness is associated with rapid renal function decline (RFD) in patients with chronic kidney disease (CKD). The aim of this study was to investigate whether the radial augmentation index (rAI), a surrogate marker of arterial stiffness, affects RFD in individuals without CKD. Methods A total of 3165 Chinese participants from an atherosclerosis cohort with estimated glomerular filtration rates (eGFR) of ≥ 60 mL/min/1.73 m2 were included in this study. The baseline rAI normalized to a heart rate of 75 beats/min (rAIp75) was obtained using an arterial applanation tonometry probe. The eGFRs at both baseline and follow-up were calculated using the equation derived from the Chronic Kidney Disease Epidemiology Collaboration. The association of the rAIp75 with RFD (defined as a drop in the eGFR category accompanied by a ≥ 25% drop in eGFR from baseline or a sustained decline in eGFR of > 5 mL/min/1.73 m2/year) was evaluated using the multivariate regression model. Results During the 2.35-year follow-up, the incidence of RFD was 7.30%. The rAIp75 had no statistically independent association with RFD after adjustment for possible confounders (adjusted odds ratio = 1.12, 95% confidence interval: 0.99–1.27, p = 0.074). When stratified according to sex, the rAIp75 was significantly associated with RFD in women, but not in men (adjusted odds ratio and 95% confidence interval: 1.23[1.06–1.43], p = 0.007 for women, 0.94[0.76–1.16], p = 0.542 for men; p for interaction = 0.038). Conclusion The rAI might help screen for those at high risk of early rapid RFD in women without CKD.

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Association of changes of pulse wave velocity and augmentation index after isometric handgrip exercise with coronary lesion extent and revascularization

Clinical Hypertension ◽

10.1186/s40885-021-00163-5 ◽

2021 ◽

Vol 27 (1) ◽

Author(s):

Seong Taeg Kim ◽

Yeekyoung Ko ◽

Jong-Wook Beom ◽

Ki Yung Boo ◽

Jae-Geun Lee ◽

...

Keyword(s):

Arterial Stiffness ◽

Pulse Wave Velocity ◽

Iliac Artery ◽

Pulse Wave ◽

Augmentation Index ◽

Coronary Revascularization ◽

External Iliac Artery ◽

Handgrip Exercise ◽

Isometric Handgrip ◽

Isometric Handgrip Exercise

Abstract Background Arterial stiffness is associated with myocardial ischemia and incident coronary artery disease (CAD), and indexes of arterial stiffness are usually increased in patients with CAD. However, these indexes are often increased in elderly without CAD. Arterial stiffness in patients with CAD may become more evident after isometric handgrip exercise which increases systolic pressure and ventricular afterload. We investigated the association of the change of stiffness indexes after isometric handgrip exercise with the lesion extent of CAD and the necessity for coronary revascularization. Methods Patients who were scheduled a routine coronary angiography via a femoral artery were enrolled. Arterial waveforms were traced at aortic root and external iliac artery using coronary catheters at baseline and 3 min after handgrip exercise. Augmentation index (AIx) was measured on the recorded aortic pressure waveform, and pulse wave velocity (PWV) was calculated using the ECG-gated time difference of the upstroke of arterial waveforms and distance between aortic root and external iliac artery. Results Total 37 patients were evaluated. Both PWV and AIx increased after handgrip exercise. ΔPWV was significantly correlated with ΔAIx (r = 0.344, P = 0.037). Patients were divided into higher and lower ΔPWV or ΔAIx groups based on the median values of 0.4 m/sec and 3.3%, respectively. Patients with higher PWV had more 2- or 3-vessel CAD (69% vs. 27%, P = 0.034), and underwent percutaneous coronary intervention (PCI) more frequently (84% vs. 50%, P = 0.038), but higher ΔAIx was not associated with either the lesion extent or PCI. Area under curve (AUC) of ΔPWV in association with PCI by C-statistics was 0.70 (95% confidence interval [CI] 0.51–0.88; P = 0.056). In multiple logistic regression analysis, ΔPWV was significantly associated with PCI (odds ratio 7.78; 95% CI 1.26–48.02; P = 0.027). Conclusions Higher ΔPWV after isometric handgrip exercise was associated with the lesion extent of CAD and the necessity for coronary revascularization, but higher ΔAIx was not.

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Augmentation Index Is Inversely Associated with Skeletal Muscle Mass, Muscle Strength, and Anaerobic Power in Young Male Adults: A Preliminary Study

Applied Sciences ◽

10.3390/app11073146 ◽

2021 ◽

Vol 11 (7) ◽

pp. 3146

Author(s):

Dongmin Lee ◽

Kyengho Byun ◽

Moon-Hyon Hwang ◽

Sewon Lee

Keyword(s):

Skeletal Muscle ◽

Muscle Strength ◽

Arterial Stiffness ◽

Muscle Mass ◽

Muscular Strength ◽

Skeletal Muscle Mass ◽

Augmentation Index ◽

Anaerobic Power ◽

Negatively Associated ◽

Increased Risk

Arterial stiffness is associated with an increased risk of cardiovascular disease. Previous studies have shown that there is a negative correlation between arterial stiffness and variables such as skeletal muscle mass, muscular strength, and anaerobic power in older individuals. However, little research has been undertaken on relationships in healthy young adults. This study presents a preliminary research that investigates the association between arterial stiffness and muscular factors in healthy male college students. Twenty-three healthy young males (23.9 ± 0.5 years) participated in the study. The participants visited the laboratory, and variables including body composition, blood pressure, arterial stiffness, blood parameters, grip strength, and anaerobic power were measured. Measurements of augmentation index (AIx) and brachial-ankle pulse wave velocity (baPWV) were performed to determine arterial stiffness. There were significant positive correlations among skeletal muscle mass, muscle strength, and anaerobic power in healthy young adult males. AIx was negatively associated with a skeletal muscle mass (r = −0.785, p < 0.01), muscular strength (r = −0.500, p < 0.05), and anaerobic power (r = −0.469, p < 0.05), respectively. Likewise, AIx@75 corrected with a heart rate of 75 was negatively associated with skeletal muscle mass (r = −0.738, p < 0.01), muscular strength (r = −0.461, p < 0.05), and anaerobic power (r = −0.420, p < 0.05) respectively. However, the baPWV showed no correlation with all muscular factors. Our findings suggest that maintaining high levels of skeletal muscle mass, muscular strength, and anaerobic power from relatively young age may lower AIx.

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Arterial stiffness could reflect increased cardiac load and reduced pulmonary function in the general population

European Heart Journal ◽

10.1093/ehjci/ehaa946.2371 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

S Murai ◽

T Sugiura ◽

Y Dohi ◽

H Takase ◽

T Mizoguchi ◽

...

Keyword(s):

Regression Analysis ◽

General Population ◽

Arterial Stiffness ◽

Pulmonary Function ◽

Multivariate Regression ◽

Troponin I ◽

Augmentation Index ◽

Smoking Status ◽

Multivariate Regression Analysis ◽

The Other

Abstract Background Pulmonary function is known to decrease with age and reduced pulmonary function has been reported to be associated with all-cause mortality and cardiovascular death. The association between pulmonary impairment and atherosclerosis was reported previously but has not been investigated sufficiently in the general population. Purpose We hypothesized that arterial stiffness could reflect increase of cardiac load and reduced pulmonary function. The present study aimed to investigate whether increased cardiac load and reduced pulmonary function could affect arterial stiffness in the general population. Methods Subjects undergoing their health check-up were enrolled. Plasma B-type natriuretic peptide (BNP) levels and serum high-sensitivity cardiac troponin I (hs-cTnI) levels were measured to evaluate cardiac load and myocardial damage. Radial augmentation index (rAI) was measured to investigate arterial stiffness using HEM-9000AI device. Subjects with an ST-T segment abnormality on the electrocardiogram, renal insufficiency, cancer, active inflammatory disease, or a history of cardiovascular events and pulmonary disease were excluded. Pulmonary function was assessed using spirometry by calculating forced vital capacity (FVC) as a percentage of predicted value (FVC%-predicted), forced expiratory volume in 1 second (FEV1) as a percentage of predicted value (FEV1%-predicted), and the ratio of FEV1 to FVC (FEV1/FVC). Results A total of 1100 subjects aged 57 years were enrolled and their median values of BNP and hs-cTnI were 15.5 and 2.3 pg/ml. The levels of rAI were significantly associated with the levels of BNP after adjustment for possible confounders in multivariate regression analysis, but were not with the levels of hs-TnI. While the parameters of pulmonary function were inversely associated with the levels of rAI and hs-cTnI after adjustment for possible confounders in the multivariate regression analysis, but not with the levels of BNP. The other multivariate regression analyses where BNP, hs-cTnI, parameters of pulmonary function, and the other possible factors were simultaneously included as independent variables revealed that the BNP levels and the FVC%-predicted or FEV1%-predicted, besides age, gender, smoking status, body mass index, blood pressure, heart rate, creatinine, fasting plasma glucose, and triglyceride, were significantly associated with the levels of rAI. Conclusions The significant associations of rAI with BNP and pulmonary function were revealed in the general population. These findings support that arterial stiffness could reflect increased cardiac load and reduced pulmonary function, in apparently healthy individuals. Funding Acknowledgement Type of funding source: None

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OPTICAL SENSOR SYSTEM FOR THE NON-INVASIVE ASSESSMENT OF ARTERIAL STIFFNESS QUANTIFIED BY FOURTH DERIVATIVE OF PHOTOPLETHYSMOGRAM

Biomedical Engineering Applications Basis and Communications ◽

10.4015/s1016237215500210 ◽

2015 ◽

Vol 27 (03) ◽

pp. 1550021

Author(s):

S. Mohanalakshmi ◽

A. Sivasubramanian

Keyword(s):

Arterial Stiffness ◽

Elastic Properties ◽

Healthy Subjects ◽

Vascular System ◽

Augmentation Index ◽

Cardiac Risk ◽

Contour Analysis ◽

Non Invasive ◽

Asymmetrical Shape ◽

Fourth Derivative

Arterial stiffness, resulting in loss of the elastic properties of arteries walls, is an indicator of cardiovascular risk, though the presence of disease is not clinically evident. Augmentation index is an important biomarker of arterial stiffness by which the cardiac risk of the patient can be diagnosed. The current paper outlines the non-invasive assessment of arterial stiffness by analyzing the morphology or contour of PhotoPlethysmoGraph (PPG) signal. PPG pulse was optically acquired with the developed photometric measurement device and the desired features were extracted to determine PPG augmentation Index (PAI) through advanced signal processing implemented in MATLAB. PAI was quantified by the fourth derivative of the signal by enhancing the location of inflection point (augmentation point) after conditioning the signal by efficient pre-processing and filtering techniques. The results reveal that the statistical distribution of PAI for healthy subjects presents a very low value and a very tight distribution. On the contrary, patients have a higher value of PAI and a wide asymmetrical shape of distribution. This work also establishes the usefulness of PPG contour analysis in the investigation of changes in the elastic properties of the vascular system. In conclusion, PAI has revealed to be a non-invasive indicator for arterial stiffness assessments.

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