Background:Arterial stiffness (AS) is a known predictor of cardiovascular (CV) disease. The measurement of pulse wave velocity (PWV) is considered to be a gold standard of AS assessment but the recommended threshold of 10 m/s1 may not take into account multiple factors influencing PWV. Use of the proposed individual reference values may help to identify patients with AS increase despite PWV level below this threshold2. The impact of AS on CV outcomes may be mediated by the reversal of the aortic-brachial stiffness (AS gradient)3. One small study in patients with type 2 diabetes has shown that the aortic-brachial stiffness mismatch (hereafter AS mismatch) was an earlier marker of AS than PWV elevation4. Patients with rheumatoid arthritis (RA) have high CV risk and may benefit from early detection of AS increase. Both approaches have not been studied in RA previouslyObjectives:To evaluate the incidence of PWV elevation above individual reference values and the frequency of AS mismatch in RAMethods:Study group included 85 patients (pts) with RA (females 77.6%, aged 59.7±14.3 years, HTN 65%, mean DAS-28(CRP) 3.7±1.1) and control group (40 pts matched by gender, age and risk factors). Parameters of AS were measured by applanation tonometry. Individual PWV reference values were assessed2. The AS gradient was calculated as carotid-femoral (cf)PWV/carotid-radial (cr)PWV ratio and its elevation ≥1 was considered as AS mismatch. р<0,05 was considered significantResults:In pts with RA with and without history of HTN mean cfPWV was 10.3±3.1 and 7.3±1.5 m/s, respectively, mean AS gradient – 1.4±0.4 and 1.1±0.1 (p<0.001 for trend); in controls – 9.6±1.9 and 6.7±1.4 m/s and 1.3±0.3 and 0.99±0.2, respectively (p<0.001 for trend). cfPWV elevation ≥10 m/s was observed in 34.1% pts with RA and 32.5% of controls: 6.7 and 6.3% of normotensives and 49.1 and 50% of hypertensives, respectively (p>0.05). cfPWV elevation above individual reference values was observed in 41.2% RA pts and 27.5% of controls (p=0.03): in 40% and 6.3% of normotensives (p=0.02) and 41.8% and 41.7% of hypertensives, respectively. After adjustment by age, gender and systolic BP cfPWV elevation above individual reference values in normotensive RA pts was independently associated with BMI (beta=0.39, р=0.02) and dyslipidemia (beta=0.48, р=0.01). The frequency of AS mismatch in RA was significantly higher compared to the controls in both normotensive and hypertensive subgroups: 76.7% vs 43.8% (p=0.03) and 94.5% vs 79.2% (p=0.04), respectively. The same trend was observed in a subgroup with normal cfPWV: AS mismatch was present in RA and controls in 82.1% vs 51.9% (p=0.004) in pts with PWV ≤ 10 m/s and in 82% and 51.7% (p=0.04), respectively in pts with PWV below individual reference values.Conclusion:Patients with RA are characterized by higher frequency of cfPWV elevation above individual reference values compared to controls irrespectively of history of HTN. This method may be more appropriate for AS evaluation than use of standard criteria in this population. AS mismatch in RA pts is highly prevalent and may be considered as an earlier marker of AS than cfPWV elevation. These findings may be used for early detection of vascular ageing in patients with RA.References:[1]Williams B, et al. 2018 ESC/ESH Guidelines for the management of arterial hypertension. J Hypertens 2018;36(10):1953-2041[2]Reference Values for Arterial Stiffness’ Collaboration. Determinants of pulse wave velocity in healthy people and in the presence of cardiovascular risk factors: ‘establishing normal and reference values’. Eur Heart J. 2010;31(19):2338-50[3]Yu S, et al. Central Versus Peripheral Artery Stiffening and Cardiovascular Risk. Arterioscler Thromb Vasc Biol. 2020;40(5):1028-1033[4]Troitskaya, E., et al. Aortic-brachial stiffness mismatch in patients with arterial hypertension and type 2 diabetes mellitus, J Hypertens 2018;36:e191Disclosure of Interests:None declared
Reference Values of Pulse Wave Velocity in Healthy People from an Urban and Rural Argentinean Population
