Abstract 168: Impact of Obesity and Atrial Fibrillation on Arterial Stiffness

Introduction Turbulent blood flow which occurs in atrial fibrillation patients due to an irregular heart rate may lead to vascular abnormalities and increased thrombotic risk. Obesity is an important emerging substrate for the development of atrial fibrillation. Obesity is also associated with endothelial dysfunction and increased arterial stiffness. We sought to determine the impact of obesity on arterial stiffness in patients with atrial fibrillation. Methods 34 patients with atrial fibrillation (age 59±12 years,) were evaluated in lean (n=21) and obese (n=13) subgroups, and compared to age-matched lean (n=15) and obese (n=14) control subjects. Arterial stiffness was assessed using radial applanation tonometry (SphygmoCor). Heart rate adjusted aortic augmentation index (AIx: a measure of arterial stiffness) was calculated from the corresponding waveforms utilizing validated transfer functions. Results Obese controls and obese atrial fibrillation patients had significantly higher AIx (arterial stiffness) than lean controls and lean atrial fibrillation patients (p=0.003 and p=0.03, respectively: Figure). There was no difference in AIx scores between obese atrial fibrillation patients and obese control subjects (p=0.3) and between lean atrial fibrillation and lean control subjects (p=0.8). Conclusion We conclude that obesity is associated with arterial stiffness and atrial fibrillation does not add additional burden. These results suggest the interaction between obesity and atrial fibrillation may contribute to the observed increase in thromboembolic risk, in part, through vascular abnormalities other than increased arterial stiffness.

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Left Atrial Function in Different Modes of Heart-Rate Lowering Therapy with Beta-Blockers in Patients with Recurrent Atrial Fibrillation and Hypertension

Rational Pharmacotherapy in Cardiology ◽

10.20996/1819-6446-2021-06-08 ◽

2021 ◽

Vol 17 (3) ◽

pp. 429-437

Author(s):

E. V. Kokhan ◽

G. K. Kiyakbaev ◽

E. M. Ozova ◽

V. A. Romanova ◽

Zh. D. Kobalava

Keyword(s):

Atrial Fibrillation ◽

Heart Rate ◽

Left Atrial ◽

Augmentation Index ◽

Beta Blockers ◽

Prospective Trial ◽

Applanation Tonometry ◽

Recurrent Atrial Fibrillation ◽

The Impact

Aim. To study the impact of heart rate (HR) reduction with beta-blockers (BB) on left atrial (LA) function in hypertensive patients with paroxysmal or persistent mild symptomatic atrial fibrillation.Material and methods. In this open prospective trial we randomly assigned patients with hypertension, sinus rhythm, elevated heart rate (≥70 bpm), and recurrent atrial fibrillation (EHRA 2A or less) to receive BB with a target HR of less or greater than 70 bpm for at least 4 months. All the patients underwent an echocardiogram [left atrial (LA) function was assessed as emptying fraction]and applanation tonometry at baseline and after 4 months. Primary endpoint was median LA emptying fraction (LAEF) measurement at the end of the study.Results. 47 patients were randomized to group with a target HR of ≤70 bpm and 44 patients to >70 bmp. Among them 44 and 41 patients completed the study. Median follow up was 4.4 months. At the end of the study (4.5 months) median HR was 62 [60; 67] bmp in ≤70 group and 73 [72; 76] bpm in >70 group. Both groups received similar antihypertensive therapy and there were no intergroup differences in systolic and diastolic blood pressure. At the end of the study, patients in ≤70 group had significantly lower LAEF compared with >70 group (37% vs 42%; p=0.01). E’avg was lower and augmentation index was higher in ≤70 group as compared to >70. In regression analysis, after E’avg and augmentation index were included in the model, the association between LAEF and randomization group lost its significance.Conclusion. Beta blockers treatment with strict HR reduction (≤70 bpm) significantly reduced LA function as compared to lenient target HR (>70 bpm).

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Abstract 12973: Atrial Fibrillation is Associated With Increased Central Blood Pressure and Arterial Stiffness

Circulation ◽

10.1161/circ.142.suppl_3.12973 ◽

2020 ◽

Vol 142 (Suppl_3) ◽

Author(s):

Priit Pauklin ◽

Jaan Eha ◽

Kaspar Tootsi ◽

Rein Kolk ◽

Rain Paju ◽

...

Keyword(s):

Atrial Fibrillation ◽

Blood Pressure ◽

Arterial Stiffness ◽

Pulse Pressure ◽

Augmentation Index ◽

Systolic Pressure ◽

Applanation Tonometry ◽

Central Blood Pressure ◽

Control Group ◽

Lack Of Information

Background: Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia in clinical practice, yet there is a lack of information about the hemodynamic profile and arterial stiffness of these patients. Purpose: The purpose of this study is to describe the differences in arterial stiffness and central blood pressures in patients with paroxysmal/persistent AF compared to a healthy control group. Methods: We included 76 patients with paroxysmal and persistent AF who underwent electrical cardioversion or pulmonary vein isolation (PVI) for AF. Carotid-femoral pulse wave velocity (cfPWV), augmentation index (AIx) and central blood pressure (cBP) were measured by applanation tonometry. All measurements were done in sinus rhythm (SR). We compared the results with 75 healthy age matched individuals. Results: Patients with a history of AF had higher cfPWV compared to the control group (8,0 m/s vs 7,2 m/s, p<0,001). AF patients also had higher central systolic blood pressure (cSBP) (118 mmHg vs 114 mmHg, p=0,03) and central pulse pressure (cPP) (39 mmHg vs 37 mmHg, p=0,03), without differences in peripheral systolic pressure (pSBP) (127 mmHg vs 123 mmHg, p=0,13), peripheral diastolic blood pressure (pDPB) (78 mmHg vs 76 mmHg, p=0,14) and peripheral pulse pressure (pPP) (48 mmHg vs 47 mmHg, p=0,37). There was no difference in heart rate (HR) (58 vs 61 bpm, p=0,08) (Table 1). In a multiple regression analysis (adjusted R 2 = 0,37) where cfPWV was set as the dependent variable and adjusting for age, sex, HR, weight, mean central arterial pressure (cMAP), estimated glomerular filtration rate (eGFR), the AF group remained to be an independent predictor for cfPWV (p=0,016). Conclusions: Patients with atrial fibrillation have a higher cSBP, cPP and cfPWV compared to healthy subjects without differences in peripheral blood pressure and HR. These findings support the hypothesis that arterial stiffness may play an important role in the development of atrial fibrillation.

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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 differences in associations between insulin resistance, heart rate variability, and arterial stiffness in healthy women and men: a physiology study

Canadian Journal of Physiology and Pharmacology ◽

10.1139/cjpp-2016-0122 ◽

2017 ◽

Vol 95 (4) ◽

pp. 349-355 ◽

Cited By ~ 6

Author(s):

Luke Anthony Rannelli ◽

Jennifer M. MacRae ◽

Michelle C. Mann ◽

Sharanya Ramesh ◽

Brenda R. Hemmelgarn ◽

...

Keyword(s):

Insulin Resistance ◽

Heart Rate ◽

Heart Rate Variability ◽

Sex Differences ◽

Arterial Stiffness ◽

Spectral Power ◽

Applanation Tonometry ◽

Healthy Population ◽

Model Assessment ◽

Healthy Women

Diabetes confers greater cardiovascular risk to women than to men. Whether insulin-resistance-mediated risk extends to the healthy population is unknown. Measures of insulin resistance (fasting insulin, homeostatic model assessment, hemoglobin A1c, quantitative insulin sensitivity check index, glucose) were determined in 48 (56% female) healthy subjects. Heart rate variability (HRV) was calculated by spectral power analysis and arterial stiffness was determined using noninvasive applanation tonometry. Both were measured at baseline and in response to angiotensin II infusion. In women, there was a non-statistically significant trend towards increasing insulin resistance being associated with an overall unfavourable HRV response and increased arterial stiffness to the stressor, while men demonstrated the opposite response. Significant differences in the associations between insulin resistance and cardiovascular physiological profile exist between healthy women and men. Further studies investigating the sex differences in the pathophysiology of insulin resistance in cardiovascular disease are warranted.

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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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Heart Rate Significantly Influences the Relationship between Atrial Fibrillation and Arterial Stiffness

International Journal of Medical Sciences ◽

10.7150/ijms.6619 ◽

2013 ◽

Vol 10 (10) ◽

pp. 1295-1300 ◽

Cited By ~ 4

Author(s):

Chun-Yuan Chu ◽

Tsung-Hsien Lin ◽

Po-Chao Hsu ◽

Wen-Hsien Lee ◽

Hung-Hao Lee ◽

...

Keyword(s):

Atrial Fibrillation ◽

Heart Rate ◽

Arterial Stiffness ◽

The Relationship

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Abstract TP216: Subtle Cardiovascular Measures in Young-onset Cryptogenic Ischemic Stroke: A Prospective Case-control Study

Stroke ◽

10.1161/str.48.suppl_1.tp216 ◽

2017 ◽

Vol 48 (suppl_1) ◽

Author(s):

Nicolas Martinez-Majander ◽

Daniel Gordin ◽

Jani Pirinen ◽

Juha Sinisalo ◽

Mika Lehto ◽

...

Keyword(s):

Heart Rate ◽

Case Control Study ◽

Augmentation Index ◽

Supply And Demand ◽

Case Control ◽

Applanation Tonometry ◽

Control Analysis ◽

Independent Association ◽

Case Control Analysis ◽

Control Study

Background: Worldwide, ≈1.3 million annual ischemic strokes (IS) occur in young adults (<50 years of age), of which up to 50% remain cryptogenic after a complete diagnostic work-up. In a pilot case-control study, we studied the value of arterial stiffness and related subendocardial viability in the search of underlying pathophysiology in these patients. Methods: We prospectively enrolled 51 patients aged 18-49 with recent imaging-positive cryptogenic IS and 51 age- and sex-matched stroke-free controls (NCT01934725). Measurements were done with an applanation tonometry (SphygmoCor). Augmentation Index (AIx) served as a measure of stiffness in small arteries. Aortic and brachial pulse wave velocities (aPWV; bPWV) reflected stiffness in large and intermediate-sized arteries, respectively. Subendocardial viability ratio (SEVR) was derived from radial artery waveform measures, reflecting myocardial oxygen supply and demand. Related-samples statistics were applied for univariate case-control analyses and linear regression to explore the relationship between parameters with significant association in case-control analysis. Results: AIx, aPWV, bPWV, heart rate, and systolic or diastolic blood pressures did not differ statistically between patients and controls. Mean SEVR was significantly lower in patients compared with controls (148±35 vs. 161±29, P=0.003). In patients, higher heart rate was inversely associated with SEVR (P<0.001). Age, sex, migraine with and without aura, smoking, and systolic and diastolic blood pressure showed no independent association with SEVR. Conclusions: To our knowledge, this is the first report to show an association between SEVR and stroke. Yet unrecognized subtle cardiovascular pathology may play a role in early-onset cryptogenic IS.

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Abstract 4688: The Impact of Marfan Syndrome on Arterial Stiffness and Endothelial Function: The Role of Matrix Metalloproteinases

Circulation ◽

10.1161/circ.118.suppl_18.s_930-c ◽

2008 ◽

Vol 118 (suppl_18) ◽

Author(s):

Stella Brilli ◽

Dimitris Tousoulis ◽

Charalambos Antoniades ◽

George Hatzis ◽

Nikos Ioakeimidis ◽

...

Keyword(s):

Matrix Metalloproteinases ◽

Arterial Stiffness ◽

Endothelial Function ◽

Marfan Syndrome ◽

Augmentation Index ◽

Flow Mediated Dilation ◽

Arterial Tree ◽

Augmentation Pressure ◽

The Impact

Background: Marfan syndrome is characterised by high risk of aortic dissections and increased cardiovascular risk. However, the impact of Marfan syndrome on endothelial function and arterial stiffness is unclear, while the role of matrix metalloproteinases is unknown. We examined the impact of Marfan syndrome on the elastic properties of the arterial tree, and vascular endothelial function, and we evaluated the potential role of matrix metalloproteinases in these effects. Methods: The study population consisted of 17 subjects with Marfan syndrome, aged 26.6±2.3 years old, with BMI 20.5±1.03Kg/m2 and 22 healthy individuals matched for gender, age (26.4±0.78 years old, p=NS) and BMI (22.4±0.86 Kg/m2). Arterial stiffness was evaluated by measuring carotid-femoral pulse wave velocity (PWV), while augmentation pressure and augmentation index (AIx) were also determined, as measures of arterial wave reflections. Endothelial function was evaluated by determining flow mediated dilation (FMD) in the brachial artery while matrix metalloproteinase 9 (MMP-9) levels were determined by ELISA. Results: Patients with Marfan syndrome had significantly lower pulse pressure in the radial artery (41.0±1.07mmHg) compared to controls (51.3±4.4mmHg). In addition, patients had higher AIx (17.6±2.4%) and augmentation pressure (5.44±0.65mmHg) compared to controls (7.72±3.43% and 2.41±1.14mmHg respectively, p<0.05 for both). However, the difference in PWV between patients and controls did not reach statistical significance (6.33±0.33 vs 5.96±0.23m/s respectively, p=NS). Patients with Marfan syndrome had lower FMD (2.05±1.13%) and higher plasma MMP-9 (827±70ng/ml) compared to controls (6.8±2.3% p<0.05 and 326±50ng/ml, p<0.01). Conclusions: Marfan syndrome is associated with increased MMP-9 levels, as well as with elevated augmentation index and augmentation pressure compared to healthy individuals, matched for age, gender and body mass index. Moreover, flow-mediated dilation is also impaired in these subjects. These findings suggest that Marfan syndrome directly affects the elastic properties and endothelial function of the arterial tree, with matrix metalloproteinases being important mediators in the pathophysiology of this syndrome.

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Increased augmentation index in patients with Ehlers-Danlos syndrome

BMC Cardiovascular Disorders ◽

10.1186/s12872-020-01684-x ◽

2020 ◽

Vol 20 (1) ◽

Author(s):

Maurice Roeder ◽

Sira Thiel ◽

Frederic Baumann ◽

Noriane A. Sievi ◽

Marianne Rohrbach ◽

...

Keyword(s):

Arterial Stiffness ◽

Augmentation Index ◽

Positive Association ◽

Joint Hypermobility ◽

Applanation Tonometry ◽

Classical Type ◽

Healthy Controls ◽

Ehlers Danlos Syndrome ◽

Vascular Type ◽

Danlos Syndrome

Abstract Background Ehlers-Danlos Syndrome (EDS) comprises a heterogeneous group of diseases characterized by joint hypermobility, connective tissue friability, and vascular fragility. Reliable prognostic factors predicting vascular disease progression (e.g. arterial aneurysms, dissections, and ruptures) in EDS patients are still missing. Recently, applanation tonometry derived augmentation index (AIx), an indirect marker of arterial stiffness, has shown to be positively associated with progression of aortic disease in Marfan syndrome. In this study, we assessed aortic AIx in patients with EDS and matched healthy controls. Methods We performed noninvasive applanation tonometry in 61 adults with EDS (43 women and 18 men aged 39.3 ± 14.6 years) and 61 age-, gender-, height-, and weight-matched healthy controls. Radial artery pulse waveforms were recorded and analyzed using the SphygmoCor System (AtCor Medical, Sydney, NSW, Australia). Calculated AIx was adjusted to a heart rate of 75/min. Groups were compared and association between AIx and EDS was determined by univariate and multivariate regression analysis. Results EDS patients were categorized in classical type EDS (34%), hypermobile type EDS (43%), vascular type EDS (5%), or remained unassignable (18%) due to overlapping features. EDS patients showed a significantly increased aortic AIx compared to healthy controls (22.8% ± 10.1 vs 14.8% ± 14.0, p < 0.001). EDS showed a positive association with AIx; independent of age, sex, height, blood pressure, medication, and pack years of smoking. Conclusions Patients with EDS showed elevated AIx, indicating increased arterial stiffness when compared to healthy controls. Further investigations are needed in order to assess the prognostic value of increased AIx for cardiovascular outcomes in patients with EDS.

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P3574Association of the plasma aldosterone, arterial stiffness and left atrium volume index in hypertensive patients

European Heart Journal ◽

10.1093/eurheartj/ehz745.0435 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

E Shavarova ◽

O A Kravtsova ◽

I A Chomova ◽

Z D Kobalava

Keyword(s):

Arterial Stiffness ◽

Multivariate Regression ◽

Augmentation Index ◽

Global Longitudinal Strain ◽

Left Ventricular ◽

Applanation Tonometry ◽

Plasma Aldosterone ◽

Volume Index ◽

Laboratory Evaluation ◽

Plasma Aldosterone Concentration

Abstract Relative aldosterone excess is related with arterial stiffness, endothelial dysfunction and profibrotic effects on the heart. We aimed to evaluate the association of plasma aldosterone and pulse wave velocity (PWV) with left ventricular (LV) diastolic function in patients with uncomplicated arterial hypertension (AH). Methods The study included 74 patients (41% male), mean age 62.0±8.2 years. Among these patients 22 (30%) had diabetes mellitus, 60 (81%) had dyslipidemia, 8 (11%) were smokers. All patients undergone clinical and laboratory evaluation, echocardiography and applanation tonometry. Plasma aldosterone concentration (PAC) was measured by using overnight fasting blood sampling between 7 am and 9 am. Results Mean PWV was 11.3±2.4 m/s, heart rate (H) was 72±10 bpm, aortic systolic BP was 160±21 mm Hg, aortic diastolic BP was 89±10 mm Hg, aortic pulse pressure was 60±19 mm Hg, augmentation index normalized for HR of 75 beats/min (AIx75) was 15±10%, LVMI was 124±33 g/m2, LAVI was 36±6 ml/m2, E/e' was 10.8±4.6. In simple analysis PAC significantly (p<0.05) correlated with brachial (r=0.29) and aortic diastolic BP (r=0.27), LAVI (r=0.32), E/e' (r=−0.41). After adjustment in multivariate regression model gender, waist circumference, creatinine, AIx, LV global longitudinal strain relationship between E/e' and PAC was lost. E/e' was significantly associated only with female gender (β=0.64, p=0.0008). Also multivariate regression analysis showed significant association of LAVI with brachial systolic BP (β=0.41, p<0.0001), PWV (β=0.94, p<0.0001), and PAC (β=0.75, p<0.0001). Conclusion Brachial systolic BP, PWV and PAC were independently associated with LAVI in patients with uncomplicated AH and herewith LAVI was more dominantly influenced by increased arterial stiffness and plasma aldosterone.

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