Beta-Blockade does not exert heart rate-independent effects on pulse wave reflection in men with high cardiovascular risk

Background: Endothelial function and arterial pulse wave reflections play a crucial role in the pathogenesis of atherosclerosis. While the endothelium-dependent reactive hyperemia index (RHI) of the digital arteries is considered as a marker of microvascular function, an increased augmentation index (AI) may indicate beginning macrovascular damage. In this study we assessed the interrelationships among these noninvasive measures of vascular function. Patients and methods: In 178 all-comer patients with documented cardiovascular risk factors (22 % female; 65 % coronary artery disease, CAD), we measured radial AI (rAI) by radial applanation tonometry and digital AI (dAI) as well as RHI by using fingertip peripheral arterial tonometry. A modified SMART risk score was calculated in all participants based on cardiovascular risk factors and preexisting vascular disease. Results: dAI and rAI demonstrated a significant and robust overall correlation (Pearson rank coefficient r = 0.63, p < 0.01), which was not affected by age, sex, diabetes mellitus and CAD. In contrast, both parameters demonstrated at most a weak correlation (dAI: r = 0.26, p < 0.01 and rAI: r = 0.12, p = 0.10) with microvascular function (RHI). While dAI and rAI were significantly correlated to female sex, age, low body height, low heart rate and the presence of CAD, RHI was associated with the presence of diabetes mellitus and nicotine use. Finally, only microvascular function was associated with the modified SMART risk score, but not augmentation indices. Conclusions: RHI and increased pulse wave reflection appear to represent two distinct vascular pathologies in patients with cardiovascular risk. In contrast, RHI might be useful to identify patients at highest cardiovascular risk once atherosclerotic disease has been diagnosed.

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Effects of aerobic, resistance and concurrent exercise on pulse wave reflection and autonomic modulation in men with elevated blood pressure

Scientific Reports ◽

10.1038/s41598-020-80800-5 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Paulo Farinatti ◽

Alex da Silva Itaborahy ◽

Tainah de Paula ◽

Walace David Monteiro ◽

Mário F. Neves

Keyword(s):

Blood Pressure ◽

Wave Reflection ◽

Pulse Wave ◽

Augmentation Index ◽

Aortic Pressure ◽

Elevated Blood Pressure ◽

Autonomic Modulation ◽

Elevated Blood ◽

Pulse Wave Reflection ◽

Concurrent Exercise

AbstractThe acute effects of exercise modes on pulse wave reflection (PWR) and their relationship with autonomic control remain undefined, particularly in individuals with elevated blood pressure (BP). We compared PWR and autonomic modulation after acute aerobic (AE), resistance (RE), and concurrent exercise (CE) in 15 men with stage-1 hypertension (mean ± SE: 34.7 ± 2.5 years, 28.4 ± 0.6 kg/m2, 133 ± 1/82 ± 2 mmHg). Participants underwent AE, RE, and CE on different days in counterbalanced order. Applanation tonometry and heart rate variability assessments were performed before and 30-min postexercise. Aortic pressure decreased after AE (− 2.4 ± 0.7 mmHg; P = 0.01), RE (− 2.2 ± 0.6 mmHg; P = 0.03), and CE (− 3.1 ± 0.5 mmHg; P = 0.003). Augmentation index remained stable after RE, but lowered after AE (− 5.1 ± 1.7%; P = 0.03) and CE (− 7.6 ± 2.4% P = 0.002). Systolic BP reduction occurred after CE (− 5.3 ± 1.9 mmHg). RR-intervals and parasympathetic modulation lowered after all conditions (~ 30–40%; P < 0.05), while the sympathovagal balance increased after RE (1.2 ± 0.3–1.3 ± 0.3 n.u., P < 0.05). Changes in PWR correlated inversely with sympathetic and directly with vagal modulation in CE. In conclusion, AE, RE, and CE lowered central aortic pressure, but only AE and CE reduced PWR. Overall, those reductions related to decreased parasympathetic and increased sympathetic outflows. Autonomic fluctuations seemed to represent more a consequence than a cause of reduced PWR.

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Peripheral artery disease impairs myocardial perfusion through increasing pulse wave reflection: the Northern Shanghai study

European Heart Journal ◽

10.1093/ehjci/ehaa946.2352 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

S Yu ◽

J Teliewubai ◽

X Fan ◽

C Chi ◽

H Ji ◽

...

Keyword(s):

Myocardial Perfusion ◽

Peripheral Artery Disease ◽

Wave Reflection ◽

Pulse Wave ◽

Ankle Brachial Index ◽

Community Dwelling ◽

Peripheral Artery ◽

Cardiac Damage ◽

Pulse Wave Reflection ◽

Artery Disease

Abstract Background Peripheral artery disease (PAD) is prevalent and substantially contributes to cardiovascular mortality particularly in the elderly, although the pathophysiological impact of PAD on heart itself still needs further investigation. In theory, PAD can increase pulse wave reflection which is an important determinant of subendocardial viability ratio (SEVR), a valuable estimate of myocardial perfusion as indicated by previous invasive studies. Thus, we hypothesize that PAD impairs myocardial perfusion through increasing pulse wave reflection. In this study, we aim to test this hypothesis in a large cohort from the Northern Shanghai Study. Methods A total of 2947 community-dwelling elderly Chinese (43.6% male, mean age: 71.3±5.9 years) were recruited. Ankle-brachial index were measured with the VP1000 device and used to diagnose PAD. Pulse wave reflection was estimated as aortic augmentation pressure (AP). Aortic BP, AP and SEVR were assessed by radial applanation tonometry. Multiple linear regression with SEVR and AP as dependent variable and PAD as independent variable, meanwhile adjusted for other covariates, were performed, respectively. Results 375 (12.7%) participants presented PAD. Compared to subjects without PAD, those with PAD showed significantly lower SEVR (126 vs. 132, P<0.001) but higher AP (19 vs. 17 mmHg, P<0.001). Multiple regression analysis revealed that both SEVR (regression coefficient [B] = −1.69, P=0.04, R2=0.61) and AP (B=1.19, P=0.04, R2=0.56) significantly associated with PAD, respectively. However, the association between SEVR and PAD was abolished when further adjusted for AP (B=−0.49, P=0.52). Similar results were obtained when inter-leg systolic BP difference was used to diagnose PAD. Conclusions PAD significantly and independently associates with myocardial perfusion; moreover, this association is mediated by increased pulse wave reflection. These findings provide a new dimension for understanding the pathophysiological mechanisms of cardiac damage of PAD. Funding Acknowledgement Type of funding source: None

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Free-Weight Resistance Exercise Versus Weight Machines on Pulse Wave Reflection

Medicine & Science in Sports & Exercise ◽

10.1249/01.mss.0000535699.32493.2b ◽

2018 ◽

Vol 50 (5S) ◽

pp. 186-187

Author(s):

Kathryn Geither ◽

Leslie Sensibello ◽

Jason C. Parks ◽

Erica M. Marshall ◽

Yu Lun Tai ◽

...

Keyword(s):

Resistance Exercise ◽

Wave Reflection ◽

Pulse Wave ◽

Pulse Wave Reflection ◽

Free Weight

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Effect of a mobile application and smart devices on heart rate variability in diabetic patients with high cardiovascular risk: A sub-study of the LIGHT randomized clinical trial

Kardiologia Polska ◽

10.33963/kp.a2021.0112 ◽

2021 ◽

Vol 79 (11) ◽

pp. 1239-1244

Author(s):

Mert İlker Hayıroğlu ◽

Göksel Çinier ◽

Gizem Yüksel ◽

Levent Pay ◽

Furkan Durak ◽

...

Keyword(s):

Clinical Trial ◽

Heart Rate ◽

Heart Rate Variability ◽

Cardiovascular Risk ◽

Randomized Clinical Trial ◽

Mobile Application ◽

Smart Devices ◽

Diabetic Patients ◽

High Cardiovascular Risk

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Effects of pacing modality on noninvasive assessment of heart rate dependency of indices of large artery function

Journal of Applied Physiology ◽

10.1152/japplphysiol.00445.2016 ◽

2016 ◽

Vol 121 (3) ◽

pp. 771-780 ◽

Cited By ~ 10

Author(s):

Isabella Tan ◽

Hosen Kiat ◽

Edward Barin ◽

Mark Butlin ◽

Alberto P. Avolio

Keyword(s):

Heart Rate ◽

Arterial Stiffness ◽

Pulse Pressure ◽

Wave Reflection ◽

Pulse Wave ◽

Augmentation Index ◽

Large Artery ◽

Rate Dependency ◽

Wave Reflections

Studies investigating the relationship between heart rate (HR) and arterial stiffness or wave reflections have commonly induced HR changes through in situ cardiac pacing. Although pacing produces consistent HR changes, hemodynamics can be different with different pacing modalities. Whether the differences affect the HR relationship with arterial stiffness or wave reflections is unknown. In the present study, 48 subjects [mean age, 78 ± 10 (SD), 9 women] with in situ cardiac pacemakers were paced at 60, 70, 80, 90, and 100 beats per min under atrial, atrioventricular, or ventricular pacing. At each paced HR, brachial cuff-based pulse wave analysis was used to determine central hemodynamic parameters, including ejection duration (ED) and augmentation index (AIx). Wave separation analysis was used to determine wave reflection magnitude (RM) and reflection index (RI). Arterial stiffness was assessed by carotid-femoral pulse wave velocity (cfPWV). Pacing modality was found to have significant effects on the HR relationship with ED ( P = 0.01), central aortic pulse pressure ( P = 0.01), augmentation pressure ( P < 0.0001), and magnitudes of both forward and reflected waves ( P = 0.05 and P = 0.003, respectively), but not cfPWV ( P = 0.57) or AIx ( P = 0.38). However, at a fixed HR, significant differences in pulse pressure amplification ( P < 0.001), AIx ( P < 0.0001), RM ( P = 0.03), and RI ( P = 0.03) were observed with different pacing modalities. These results demonstrate that although the HR relationships with arterial stiffness and systolic loading as measured by cfPWV and AIx were unaffected by pacing modality, it should still be taken into account for studies in which mixed pacing modalities are present, in particular, for wave reflection studies.

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Comparison of laboratory and ambulatory measures of central blood pressure and pulse wave reflection: hitting the target or missing the mark?

Journal of the American Society of Hypertension ◽

10.1016/j.jash.2018.01.014 ◽

2018 ◽

Vol 12 (4) ◽

pp. 275-284 ◽

Cited By ~ 2

Author(s):

Matthew J. Burns ◽

Jeremy D. Seed ◽

Anthony V. Incognito ◽

Connor J. Doherty ◽

Karambir Notay ◽

...

Keyword(s):

Blood Pressure ◽

Wave Reflection ◽

Pulse Wave ◽

Central Blood Pressure ◽

Pulse Wave Reflection

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Differential Associations for Salivary Sodium, Potassium, Calcium, and Phosphate Levels with Carotid Intima Media Thickness, Heart Rate, and Arterial Stiffness

Disease Markers ◽

10.1155/2018/3152146 ◽

2018 ◽

Vol 2018 ◽

pp. 1-12 ◽

Cited By ~ 3

Author(s):

Carlos Labat ◽

Silke Thul ◽

John Pirault ◽

Mohamed Temmar ◽

Simon N. Thornton ◽

...

Keyword(s):

Heart Rate ◽

Cardiovascular Risk ◽

Pulse Wave Velocity ◽

Wave Velocity ◽

Risk Evaluation ◽

Pulse Wave ◽

Intima Media Thickness ◽

Sodium Potassium ◽

Media Thickness ◽

Salivary Electrolytes

Salivary biomarkers may offer a noninvasive and easy sampling alternative in cardiovascular risk evaluation. The aim of the present study was to establish associations of salivary potassium, sodium, calcium, and phosphate levels with the cardiovascular phenotype determined by carotid ultrasound and carotid-femoral pulse wave velocity and to identify possible covariates for these associations. N=241 samples of nonstimulated whole buccal saliva were obtained from subjects with (n=143; 59%) or without (n=98; 41%) hypertension. The potassium concentrations were 10-fold higher in saliva compared with plasma, whereas sodium concentrations exhibited the reverse relation between saliva and blood. There were no significant correlations between the levels of sodium, potassium, or calcium in saliva and plasma. All salivary electrolytes, except sodium, were significantly associated with age. In age-adjusted analyses, salivary potassium was significantly associated with carotid artery intima media thickness (cIMT) and carotid-femoral pulse wave velocity, and these associations were at the limit of significance in multivariate analyses including prevalent cardiovascular disease and risk factors. Body mass index was a significant confounder for salivary potassium. Salivary phosphate was significantly associated with cIMT in the multivariate analysis. Salivary potassium, calcium, and phosphate levels were significantly associated with heart rate in the univariate age-adjusted as well as in two different multivariate models, whereas no significant associations between sodium and heart rate were observed. In conclusion, the differential association of salivary electrolytes with cardiovascular phenotypes indicates that these electrolytes should be further studied for their predictive value as noninvasive biomarkers for cardiovascular risk evaluation.

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