bluuebunny/crossref_metadata_2025 huggingface dataset:
P50 The Administration of Losartan/Amlodipine in Fixed Combination Versus Losartan Improves the Hemodynamic and Arterial Stiffness Parameters in Patients with Systemic Hypertension Grade 1 and 2
Authors: Jimenez Mayra , Grover Fernando , Barocio Marycruz , Cardona Ernesto , Quezada Patricia , Trujillo Jhonatan , Cardona David , Ramos Carlos
Published: March 2020

Purpose/Background/Objectives

Hypertension (HAS) represents 9.4 million deaths from all the cases of cardiovascular disease worldwide [1]. The pulse wave velocity (PWV) and some hemodynamic parameters have been associated with this outcome [2,3]. Losartan, as well as amlodipine, have shown benefits on hemodynamic parameters [4,5] however, it is unknown if losartan/amlodipine combination is better than losartan as a monotherapy. We evaluated losartan/amlodipine effect in a fixed combination versus losartan on hemodynamic and arterial stiffness parameters in patients with systemic arterial hypertension.

Design and Methods

We conducted a randomized, double-blind study in 28 hypertensive patients according to AHA criteria 2017 [6]. 14 patients received losartan 100 mg per day and 14 losartan/amlodipine 100/5 mg per day, for 8 weeks. Hemodynamic parameters and arterial stiffness measurement were performed with a Mobil-O-Graph® [7].

Results

The combination of losartan/amlodipine improved hemodynamic and arterial stiffness parameters compared with losartan, reducing peripheral vascular resistance (RVP) (0.10 ± 0.08 vs 0.05 ± 0.08), PWV (0.52 ± 0.45 vs 0.33 ± 0.359), daytime PWV (7.24 ± 0.90 vs 7.61 ± 1.03), nocturnal PWV (6.86 ± 0.96 vs 7.27 ± 1.17) and diastolic blood pressure (DBP) (11.21 ± 6.15 vs 5.92 ± 7.65).d)

Conclusion

We did not find differences between single or combined medication in terms of BP reduction. However, arterial stiffness parameters were better in the combined therapy.
P52 The Long-term Effects of Transcatheter Aortic Valve Implantation on Aortic Stiffness
Authors: Gardikioti Vasiliki , Terentes-Printzios Dimitrios , Vlachopoulos Charalambos , Toutouzas Konstantinos , Christoforatou Evangelia , Xanthopoulou Maria , Benetos Georgios , Latsios Georgios , Siasos Gerasimos , Mpei Evangelia , Vavuranakis Manolis , Tousoulis Dimitrios
Published: March 2020

Purpose/Background/Objectives

Aortic stiffness and hemodynamics are independent predictors of adverse cardiovascular events. Transcatheter aortic valve implantation (TAVI) is growingly used in high surgical risk patients with aortic valve stenosis. We sought to investigate the effect of TAVI on aortic stiffness.

Methods

Fifty-five high-risk patients (mean age 79.5 ± 8.8 years, 46% males) with severe symptomatic aortic stenosis undergoing TAVI were included. Arterial stiffness was estimated through carotid-femoral pulse wave velocity (cfPWV). Measurements were conducted prior to the implantation, at discharge and 1 year post-TAVI.

Results

Prior to the implantation, cfPWV was 7.5 ± 1.4 m/s for the overall population. There was a statistically significant increase in measurements of aortic stiffness at discharge (7.5 ± 1.4 vs 8.3 ± 1.9 m/s for cfPWV with p = 0.043) without a statistically significant change in SBP (p = NS) (Figure 1). There was also a significant increase in cfPWV (8.7 ± 1.8 m/s) after 1 year compared to the pre-procedural assessment (p = 0.001). We also observed a non-significant increase in peripheral SBP at 1 year compared to SBP measurements at baseline and at discharge (153 ± 24 m/s vs 147 ± 21and 148 ± 22 m/s, respectively; p = 0.319) and these changes were independent of age and gender (Figure 1).

Conclusion

Our study shows that both shortly as well as in the long-term after TAVI subjects experience an increase in aortic stiffness that is independent of changes in SBP. These findings further elucidate the hemodynamic consequences and provide evidence of a possible long-standing repercussion of TAVI.
P54 Age-specific, Pressure-independent Acute Changes in Carotid-femoral Pulse Wave Velocity During Head-up Tilt
Authors: Pucci Giacomo , Avolio Alberto , Spronck Bart , Vaudo Gaetano , Anastasio Fabio , Van den Meiracker Anton H. A. H. , Mattace-Raso Francesco U. S.
Published: March 2020

Introduction

Acute, gravity-induced blood pressure (BP) changes during head-up tilt may generate concomitant variations in carotid-femoral pulse wave velocity (cf-PWV). We aimed to separate the pressure-dependent and -independent components of cf-PWV changes observed during head-up tilt.

Methods

30 healthy individuals (age 48 ± 18 years (mean ± SD), 38% males, BP 130/74 ± 12/8 mmHg) underwent head-up passive tilting at a = 0°, 30°, and 60°. BP was taken at the upper arm, constantly kept at heart level. Aortic BP was reconstructed from radial tonometry (SphygmoCor). Stiffness index b0 was estimated at 0°. 1 Assumptions: [1] from MRI2, the effective cf-PWV travel distance (ETD, 80% of straight carotid-to-femoral distance) begins at heart level; [2] the change in DBP along the aorta is predictable from the hydrostatic pressure gradient (0.73 mmHg/cm) 3; [3] cf-PWV and hydrostatic pressure relate linearly, hence predicted cf-PWV can be calculated as the average of aortic (PWVaorta, using b0 and aortic DBP) and femoral (PWVfem, using b0 and femoral DBP, corresponding to aortic DBP + (ETD × sin(a)*0.73)) PWVs.

Results

Both young (24–48 years) and old (48–82 years) individuals showed increasing trends for peripheral SBP, DBP, PP, and central DBP with tilting; central SBP remained unchanged. Heart rate (HR) and cf-PWV increased with body tilt in both groups (Figure, left). b0 linearly correlated with age (R = 0.70, p < 0.01). After adjustment for HR4, observed-vs-predicted cf-PWV exponentially increased as a function of age (R2 = 0.38, p < 0.01 for quadratic equation, p = 0.04, vs. linear; Figure, right).

Conclusion

With aging, the acute relationship between BP and cf-PWV becomes progressively nonlinear.
P56 Renal Endovascular Interventions in Szeged Nephrology-Hypertension Center Between 2007–2016
Authors: Légrády Péter , Nádasdi Bernadett , Letoha Annamária , Gyói Alexandra , Bajcsi Dóra , Constantinou Kypros , Fejes Imola , Nagy Endre , Szakál Tibor , Vörös Erika , Sonkodi Sándor , Ábrahám György
Published: March 2020

There is no consensus on the antihypertensive effect and on the ability to preserve kidney function of ballon dilatations and/or stent implantation these in renal artery stenosis. From 2007 to 2016 at the 1st Department of Medicine, Nephrology-Hypertension Center, University of Szeged, total of 80 patients were diagnosed with unilateral or bilateral renal artery stenosis (female n = 49; male n = 35) with angiography. 80 of the patients underwent intervention (balloon dilatation n = 13; stent implantation n = 67). Following the intervention blood pressure significantly decreased and during the follow-up (3 months after the procedure, n = 54 patients) the blood pressure remained below the initial level, while the number of antihypertensive drugs did not change significantly. The kidney function was also improved (3 months after the procedure, n = 54 patients), except for patients with bilateral renal artery stenosis. There was a positive correlation between the resting, the separated plasma renin activity and systolic blood pressure. On the contrary, we did not find correlation between the severity of the renal stenosis and the separated renin plasma activity, and between the degree of stenosis and the ultrasound resistance index. Nevertheless, the resistance index correlated with the separated plasma renin activity. According to our results the renin release may depend rather on the state of the intrarenal microvasculature, than the degree of stenosis. Furthermore, the reason why the more severe stenosis is associated with worse kidney function — regardless the state of the microvasculature — may be the reduced kidney blood circulation caused by the stenosis cannot ensure appropriate intraglomerular pressure.
P58 Structured Exercise Training is Associated with Better Post Occlusive Reactive Hyperaemia in Skeletal Muscle Measured using Near Infrared Spectroscopy (NIRS)
Authors: Rao Chirag , Jones Siana , Ezzi Khadija , Hughes Alun
Published: March 2020

Background

Participation in structured exercise training may improve microvascular function. Post occlusive reactive hyperaemia (PORH) is a measure of microvascular function in skeletal muscle and can be assessed using near-infrared spectroscopy (NIRS). We examined PORH following a short and a long arterial occlusion to test whether individuals who participate in more structured exercise have better PORH.

Methods

18 healthy volunteers (mean age = 23.1 (standard deviation (SD) = 4.9 y), male = 12) underwent 30 s and 5 minute arterial occlusions of the left lower leg using a cuff inflated to supra-systolic pressure. Change in oxygenated haemoglobin concentration (oxy-Hb) was measured from the gastrocnemius using NIRS (Artinis, Netherlands). PORH was measured as time to 50% (T50) of peak oxy-Hb following cuff release and a lower T50 indicates a better response. Exercise participation was categorised into high (n = 12) or low (n = 6) based on self-reported hours of structured exercise per week (high ≥4 hr per week). Results are given as median (IQR) and statistical comparison was by the Mann Whitney U-Test.

Results

High exercise participants had a greater PORH response than low exercise participants (T50: 8.0 (6.2, 9.5)s vs 12.5 (8.6, 27.2)s, p = 0.04; Figure 1a). The hyperaemic response to 30 s occlusion was also better in the high exercise group (T50: 2.4 (1.7, 6.6)s vs 4.3 (3.6, 4.9)s p = 0.17; Figure 1b), although this difference was not statistically significant.

Conclusion

Individuals who participate in more structured exercise have evidence of improved microvascular function in skeletal muscle.
P62 Estimation of Wave Intensity in Humans Using only Pressure Waveforms and Reservoir Analysis
Authors: Hughes Alun , Parker Kim , Chaturvedi Nish , Park Chloe
Published: March 2020

Background

Measurement of wave intensity (WI) requires simultaneous or quasi-simultaneous measurement of pressure and flow limiting its use. Previous work in dogs [1] and humans [2] has shown that the excess pressure waveforms calculated using reservoir analysis correspond closely with aortic flow waveforms. This offers a potential method to estimate WI using only pressure waveforms (pWI). We investigated the feasibility of this approach and agreement with established methods.

Methods

262 participants (68.3 (SD = 5.5); 74% male) without aortic stenosis or heart failure were recruited from a UK-based longitudinal study, Southall and Brent Revisited. Central pressure waveforms, aortic flow velocity and carotid WI were measured using tonometry (Sphygmocor, AtCor), echocardiography (iE33, Philips) and ultrasonography (SSD-5500, Aloka) respectively. Reservoir analysis was performed as previously described [2] and excess pressure waveforms were calibrated to flow velocity assuming a peak velocity of 1 m/s. Method agreement was assessed as mean difference (MD), limits of agreement (LOA) and concordance coefficient (CC).

Results

Analysis failed in 9 individuals; results for those with analysable data are shown in Table 1. Aortic pWI was higher than aortic WI but showed good concordance (logW1: MD(LOA) = −0.41(−0.73, −0.09) CC = 0.7; logW2: MD(LOA) = −0.41 (−0.73, −0.09); CC = 0.7). Agreement of pWI with carotid WI showed no bias and concordance was fair to poor (logW1: MD (LOA) = −0.16 (−1.30, 0.99) CC = 0.3; logW2: MD (LOA) = −0.02 (−1.23, 1.2); CC = 0.1).

Conclusion

Estimation of aortic WI from pressure waveforms using reservoir analysis is feasible.

Table1

Results

Variables
N
Median/(%)
p25
p75

Age, y
207
67.9
63.6
71.9

BMI, kg/m2
207
26.6
24.1
30.1

Systolic BP, mmHg
207
139
126
148

Diastolic BP, mmHg
207
76
70
82

Heart rate, bpm
207
66
59
74.5

Male sex, %
150
72.5

Ethnicity

European
88
(42.5%)

South Asian
75
(36.2%)

African Caribbean
44
(21.3%)

Current smoker
18
(8.8%)

Diabetes
65
(31.4%)

Hypertension
130
(62.8%)

Aorta

W1, mmHg.m.s−3
207
7103
5041
9910

W2, mmHg.m.s−3
207
1637
1147
2518

pW1, mmHg.m.s−3
207
10,526
7677
14,336

pW2, mmHg.m.s−3
207
2491
1779
3560

time W1 to W2, s
207
0.25
0.23
0.27

Peak velocity, m/s
207
1.34
1.2
1.46

Variables
N
Median/(%)
p25
p75

Carotid artery

W1, mmHg.m.s−3
207
8714
6550
12,883

W2, mmHg.m.s−3
207
2327
1471
3227

time W1 to W2, s
207
0.29
0.27
0.31

Peak velocity, m/s
207
1.10
0.92
1.30

BMI, body mass index; BP, blood pressure; p25, 25th centile; p75, 75th centile; pW1, peak intensity of initial forward compression wave (W1) estimated using pressure only; pW2, peak intensity of initial forward compression wave (W2) estimated using pressure only; W1, peak intensity of initial forward compression wave (W1) calculated using aortic velocity; W2, peak intensity of initial forward compression wave (W2) calculated using aortic velocity.
P63 Accuracy (Validation) of Central Blood Pressure Measurement Using the Sphygmocor Xcel-cuff Device
Authors: Schultz Martin , Picone Dean , Armstrong Matthew , Black Andrew , Dwyer Nathan , Roberts-Thomson Philip , Sharman James
Published: March 2020

Background

Numerous devices purport to measure central aortic BP as distinct from conventional brachial BP. This study aimed to determine the accuracy (validation) of the Sphygmocor Xcel-cuff device (AtCor Medical, Sydney, Australia) for measuring central BP.

Methods

330 patients (mean age 61.3 ± 10.6 years) undergoing coronary angiography had simultaneous measurement of invasive aortic BP and non-invasive cuff-derived central BP using the Xcel device (total n = 552 individual comparisons). Methods were undertaken according to Artery Society guidelines and several calibration techniques to derive central SBP were examined.

Results

Central SBP was significantly underestimated, and with wide variability, when using the default calibration of brachial cuff SBP/DBP (−7.7 ± 11.0 mmHg). Similar wide variability was observed using other calibration methods (cuff 33% form-factor MAP/DBP, −4.4 ± 11.5 mmHg; cuff 40% form-factor MAP/DBP, 4.7 ± 11.9 mmHg; cuff oscillometric MAP/DBP, −18.2 ± 12.1 mmHg). Only calibration with invasive aortic integrated MAP/DBP resulted in a mean difference ± SD (3.3 ± 7.5 mmHg) within the minimum tolerable error of ≤5 ± ≤8 mmHg. The difference between brachial cuff SBP and invasive aortic SBP was 3.3 ± 10.7 mmHg. A subsample (n = 151) analysis to determine the accuracy of central-to-brachial SBP amplification, showed this to be over-estimated by the Xcel device (4.3 ± 9.1 mmHg, p = 0.02).

Conclusion

Irrespective of calibration technique, the Sphygmocor Xcel-cuff device does not pass the Artery Society accuracy (validation) criteria for non-invasive measurement of central BP. Further accuracy refinements of this device are required.
P66 Mathematical Model of the Renal Microcirculation and Effects of Chronic Kidney Disease
Authors: Fountoulakis Nikolaos , Sanchez-Cazares Karla , Parker Kim , Karalliedde Janaka
Published: March 2020

Background

Diabetes is one of the leading causes of chronic kidney disease (CKD) worldwide. CKD is directly linked to increased morbidity and mortality. The role of vascular changes in diabetes and underlying mechanism of kidney disease is not well understood.

Methods

We present a mathematical model of the small arteries in the kidney incorporating anatomical and dynamic features. It consists of a symmetrical bifurcating treeself-similar in length, cross-sectional area and wave speed. Each generation is related to the previous one by the scaling factors e.g. ln + 1 = λln, this gives properties (e.g. surface area, resistance) for each generation by a priori knowledge of the renal artery. We assume the flow is one-dimensional and laminar. Vessel walls are treated as porousmedia to find the glomerulus transmural flux. Effects of compliance are introduced by a pressure-area relationship based on circumferential stress in thin vessel walls. The set of ordinary differential equations is solved numerically.

Results

The results are in accordance with physiological measurements and indicate that pressure in the vasculature is highly sensitive to changes in vessel geometry, which also affects the transmural flux in the glomerulus. Changes in the structure of the arterial wall (e.g. Young’s modulus) alter the dynamics of the flow with an increased effect in the micro-circulation.

Conclusion

This is a functional model describing the behaviour of the small vasculature in the kidney. The model is computationally inexpensive, can be used for analysis and tested with in vivo data in pathological conditions.
P67 Detecting Preload Reduction with Machine Learning on Arterial Waveform Parameters
Authors: van der Ster Björn , Wijnberge Marije , Huntelaar Marthe , de Haan Job , van der Sluijs Koen , Veelo Denise , Westerhof Berend
Published: March 2020

Background

Hemodynamic optimization of unstable patients by means of fluid resuscitation improves patient outcome, but choosing the correct amount of fluid can be difficult. Too little fluid may not ensure adequate perfusion whereas too much fluid is associated with increased mortality. Static parameters are not sufficiently sensitive to detect a reduction in preload, and dynamic parameters rely on changes induced by mechanical ventilation. We hypothesized that the arterial wave form contains parameters that can be used as model input to identify patients that benefit from fluid administration.

Methods

Radial artery waveform parameters were extracted in patients after they had undergone a coronary artery bypass graft surgery (n = 20, all male). Three classes were defined: unchanged preload, preload reduction induced by positive end-expiratory breath holds (PEEP), and preload increase following fluid administration. A leave-one-out multinomial logistic regression was performed to train and evaluate the model. Model performance is reported as accuracy, sensitivity and specificity.

Results

In univariate analysis, left ventricular ejection time, augmentation index, dPdtmax and stroke volume showed the largest variation between the classes and were selected as model inputs. Following leave-one-out cross-validation the final model detected decreased preload with an accuracy, sensitivity and specificity of 87.5%, 85% and 90% respectively. Fluid administration did not give enough stimulus for modelling.

Conclusion

Arterial waveform parameters adequately distinguish unchanged from artificially reduced preload; preload increase could not be reliably detected. Since PEEP influences arterial compliance, future studies need to evaluate this effect, and also the applicability of the model in other populations.
P68 Usefulness of an Optimal Cut-off in Central Augmentation Pressure for the Detection of Left Ventricular Hypertrophy in Men
Authors: Obayashi Masakazu , Kobayashi Shigeki , Yamamoto Hirotaka , Hamada Yoriomi , Nanno Takumi , Kohno Michihiro , Yano Masafumi
Published: March 2020

Background

Recently, we showed an age-related increase in augmentation pressure (AP) measured using Mobil-O-Graph (MOG) in normotensive Japanese individuals. However, AP might be a poor index of wave reflection due to the overlap between the forward wave and reflected wave.

Methods

We enrolled untreated hypertensive patients and patients currently on antihypertensive treatment. For 70 patients (median age, 70.5 years; 34 men), M-mode echocardiography was performed for determination of left ventricular hypertrophy (LVH), while hemodynamic measurements were taken using MOG. We investigated the influence of central hemodynamic parameters on LVH.

Results

Spearman correlation coefficients between various parameters [age, height, systolic blood pressure (SBP), mean BP, diastolic BP, central systolic BP (cSBP), and AP] were calculated for LV mass indexed to body surface area (LVMI; g/m2). In men, age (r = 0.600, p = 0.0002), height (r = −0.495, p = 0.003), SBP (r = 0.423, p = 0.013), cSBP (r = 0.454, p = 0.007), and AP (r = 0.661, p < 0.0001) were correlated to LVMI. In women, cSBP (r = 0.334, p = 0.044) and AP (r = 0.480, p = 0.003) were correlated to LVMI. In men, LVMI (R2 = 0.578, p = 0.0001) was significantly associated with AP (β = 1.32 ± 0.56, p = 0.027) in multivariate regression analysis. In women, no significant independent parameter for LVMI was observed. ROC curve analysis was performed to estimate the utility of AP for the detection of LVH (LVMI >115 g/m2) in men. Area under the ROC curve was 0.83 (95% CI: 0.68–0.99). The optimal cut-off point of 12.5 mmHg produced 79.0% sensitivity and 86.7% specificity.

Conclusion

Higher AP showing >12.5 mmHg calculated by MOG was a significant independent predictor of LVH in male hypertensive patients.
P72 Vascular Aging Prediction in High Cardiovascular Risk Cohort
Authors: Laucyte-Cibulskiene Agne , Ryliskyte Ligita , Kovaite Milda , Rimsevicius Laurynas , Balkeviciene Laura , Badariene Jolita , Laucevicius Aleksandras
Published: March 2020

Aim

To assess a time-dependent change of arterial stiffness gradient (PWVratio calculated by dividing carotid-femoral to carotid-radialPWV), a marker of vascular aging, in high cardiovascular risk cohort.

Methods

This cohort study (n = 689) was conducted during the period 2010–2019 at Vilnius University Hospital Santaros Klinikos. Participants were referred by the primary health care institutions according to Lithuanian High Cardiovascular Risk (LitHiR) primary prevention program which recruited men at the age of 40–55 years and women at the age of 50–65 years without overt cardiovascular disease; they underwent a detailed cardiovascular risk assessment and arterial stiffness evaluation and were repeatedly examined after the mean follow-up of 965.63 ± 511.98 days.

Results

The cohort was comprised of 40.2% male participants. Cardiovascular risk factors were distributed as follows: 19.5% subjects had diabetes mellitus, 52.69% left ventricular hypertrophy, 95.21% hypertension, 99.13% dyslipidemia. During the follow-up period 52.1% of patients presented PWV ratio increase. In spite of the difference in age between men and women, PWV ratio progression adjusted for follow-up time and age was more pronounced in males (OR 1.72, p = 0.032). In the subanalysis, we found that in men, as compared to women, there was a more pronounced decrease in carotid-radialPWV (p < 0.001). The carotid-femoralPWV increased both in men and in women. Glucose level, abdominal obesity, mean arterial blood pressure, menopause was related to the change of the PWV ratio.

Conclusion

In this high cardiovascular risk cohort, the change in arterial stiffness gradient is related to abdominal obesity, mean arterial blood pressure, and menopause.
P78 Endothelial Dysfunction and Arterial Stiffness During Type 2 Diabetes
Authors: Toure Maimouna , Hallab Magid , Thiam Souleymane , Mane Sheikh AB , Belem Farid , Samb Abdoulaye
Published: March 2020

Objective

We aimed to study Endothelial dysfunction and Arterial Stiffness in Diabetes mellitus.

Methods

29 women with type 2 diabetes and 8 non-diabetic controls were included. Vascular function was studied with pOpmetre® (Axelife SAS-France) to assess the foot to toe Pulse Wave Velocity; and EndoPAT2000® (ITAMAR-Israel) to measure endothelial vasodilatation dependent by measurement of reactive hyperhemic index (RHI).

Results

Diabetics were 56 ± 6 years vs 47 ± 9 years. Mean diabetes duration was 9.07 ± 6.15 years. RHI was normal in all controls (1.94 ± 0.68) and abnormal in 51.72% of diabetics (1.83 ± 0.12). An abnormal ftPWV was found in 38% of diabetic subjects (11.6 ± 7.7 m/s) vs 12% of controls (7.7 ± 2.3 m/s, normal <10 m/s). There was a positive correlation between ftPWV and age (r = 0.25; p = 0.001); ftPWV and duration of diabetes (r = 0.12; p = 0.03). At the same time we found a negative correlation between RHI and fasting blood glucose (r = −0.46; p = 0.01), HbA1c (r = −0.37; p = 0.04), triglycerides (r = −0.49; p = 0.03) and total cholesterol (r = −0.37; p = 0.04). In a rapid and non-invasive way, we found endothelial dysfunction in 51.72% of diabetics and arterial stiffness in 38% of them.

Conclusion

During diabetes, endothelial dysfunction and arterial stiffness are therefore dependent on the glycemic balance, the duration of diabetes and lipid parameters. However, these two parameters appear independently and differently associated with diabetic disease.
P80 Predictors of Middle Cerebral Artery Pulsatility Index in Chronic Obstructive Pulmonary Disease and Healthy Controls; Data from the ACRADE Study
Authors: Shezawi Mahfoudha Al , Munnery Maggie , Cockcroft John , Watkeys Laura , Stohr Eric , Gale Nichola , McDonnell Barry
Published: March 2020

Background

Chronic obstructive pulmonary disease (COPD) is characterised by airway limitation which is an independent predictor of increased cardiovascular (CV) risk and mortality [1]. COPD is associated with increased arterial stiffness [2] and increased incidence of all stroke subtypes [3]. However, the mechanism linking this association is not fully understood. The study aims to identify predictors of middle cerebral artery pulsatility (MCAPI) in COPD and controls.

Method

MCAPI was measured using transcranial Doppler ultrasound. Aortic pulse wave velocity (aPWV) and central pulse pressure (CPP) were measured using the SphygmoCor system. Forced expiratory volume in the first second/forced vital capacity (FEV1/FVC) was measured using spirometry. Use of CV acting medications were recorded.

Result

45 COPD patients and 50 healthy controls were included in the analyses. Age, gender, CPP and MCAPI were similar between groups, however the COPD patients showed higher aPWV, lower FEV1/FVC and were on more CV acting medication (all, p < 0.05). In COPD, MCAPI was significantly associated with CPP (r = 0.433, p = 0.003) and FEV1/FVC (r = 0.330, p = 0.027), but not aPWV. In controls, MCAPI was significantly associated with CPP (r = 0.601, p = 0.001) and aPWV (r = 0.452, p = 0.001). However, Stepwise Multiple Regression Analysis illustrated that only CPP remained an independent predictor of MCAPI (p = 0.003), in a model which included age, aPWV, FEV1/FVC and use of CV acting medications.

Conclusion

Within the COPD group, CPP was independently associated with MCAPI, even when accounting for use of CV acting medications. However, the interaction between CV acting medications and the relationship between aPWV and MCAPI remains unclear and needs further investigations.
P82 Impaired Skin Microvascular Function in Systemic Lupus Erythematosus
Authors: Koletsos Nikolaos , Gkaliagkousi Eugenia , Lazaridis Antonios , Anyfanti Panagiota , Triantafyllou Areti , Dipla Konstantina , Dolgyras Panagiotis , Galanopoulou Vasiliki , Aslanidis Spyros , Douma Stella
Published: March 2020

Objectives

Alterations in skin microcirculation have been associated with damage in various microvascular beds [1]. Endothelial dysfunction in microcirculation plays a central role in the pathophysiology of rheumatic diseases, contributing substantially to the increased cardiovascular risk of these patients. Laser speckle contrast analysis (LASCA) is a novel non-invasive technique that can be used to evaluate endothelial function of skin microcirculation [2]. Previous studies have shown impaired skin endothelial function in patients with systemic sclerosis. To our knowledge, no previous study has evaluated skin microcirculation in patients with SLE using LASCA [3,4].

Design and Methods

Fifty-two individuals (25 SLE patients and 27 matched controls) were studied. In all subjects, forearm skin blood flow was recorded under standardized conditions using a laser speckle contrast imager (PeriCam PSI NR System, Perimed). Post-occlusive reactive hyperemia (PORH) was assessed following a standardized protocol and data were analyzed with signal processing software (PIMSoft, Perimed). The amplitude of PORH responses was expressed as a percentage increase between peak and baseline perfusion (%).

Results

There were no differences among the two groups in age, sex, body mass index and hypertension status. Post occlusion reperfusion in SLE patients, was significantly lower as compared to non-SLE controls (155.5 ± 53.1 vs 194.5 ± 40.5% respectively, p = 0.004).

Conclusion

Patients with SLE demonstrate impaired skin microvascular endothelial function, providing a link that could explain the increased cardiovascular risk that these patients bear.
P84 Prediction of Cardiovascular Events and Mortality by Pulse Wave Velocity: a Comparison of Invasive Measurements and Noninvasive Estimation Methods
Authors: Hametner Bernhard , Wassertheurer Siegfried , Mayer Christopher Clemens , Danninger Kathrin , Binder Ronald , Weber Thomas
Published: March 2020

Introduction

Arterial properties are linked to the presence and severity of coronary artery disease (CAD). Coronary blood flow is strongly and inversely related to arterial stiffness. Thus, the aim of this prospective study was to evaluate the prognostic value of PWV in high-risk patients with suspected CAD and to compare three different methods for assessing PWV.

Methods

In 1040 patients, invasive PWV (iPWV) was measured during catheter pullback. Additionally, PWV was estimated with a model incorporating age and the central pulse waveform obtained from non-invasive measurements (ePWV). As a third method, PWV was calculated with a formula solely based on age and blood pressure (fPWV). Survival analysis was done for continuous PWV as well as using cut-off values.

Results

After a median follow up duration of 1565 days, 24% of the patients reached the combined endpoint (cardiovascular events and mortality). Cox proportional hazard ratios per m/s were 1.13 for iPWV, 1.17 for ePWV and 1.13 for fPWV (p < 0.0001 for all three methods). Significant differences between patient groups according to a cut-off value of 10 m/s were found as well for all three methods. However, multivariable Cox models revealed a different performance of the three methods, indicating weaknesses of fPWV to mimic iPWV.

Conclusion

All three methods for the determination of PWV predicted cardiovascular events and mortality in patients with suspected coronary artery disease. This indicates that iPWV as well as both non-invasive estimation methods are suitable for the assessment of arterial stiffness, bearing in mind their individual characteristics.
P89 Non-invasive Blood Pressure Measurement System Using Three-axis Tactile Force Sensor
Authors: Lee Hae-Young
Published: March 2020

Blood pressure is most important parameter reflecting hemodynamic factors, however it is continuously variable in 24 hours. Here, we made a non-invasive and continuous BP measurement device using a three-axis tactile force sensor. All the data was collected every 2 min for the short-term experiment, and every 10 min for the long-term experiment. In addition, the effects on the BP measurement of external physical factors such as the tension to the radial artery on applying the device and wrist circumference were evaluated. A high correlation between the measured BP with the proposed system and with the cuff-based non-invasive blood pressure, and reproducibility, were demonstrated. All data satisfied the Association for the Advancement of Medical Instrumentation criteria. The external physical factors did not affect the measurement results. In addition to previous research indicating the high reliability of the arterial pulse waveforms, the present results have demonstrated the reliability of numerical BP values, and this implies that the three-axis force sensor can be used as a patient monitoring device.
P96 Soluble Receptor for Advanced Glycation End-products Independently Influenced Individual Age-dependent Increase of Arterial Stiffness
Authors: Gelžinský Július
Published: March 2020

Background

Soluble receptors for advanced glycation end-products (sRAGEs) have been suggested to have a protective role neutralizing the advanced glycation end-products (AGEs) and their pathological effect on vessel walls. We aimed to investigate the association between circulating concentrations of sRAGEs and dynamic of arterial wall stiffening as a manifestation of vascular ageing in general population.

Methods

In a prospective cohort study, we longitudinally followed 530 general-population-based subjects (subsample of Czech post-Monica study). Aortic pulse wave velocity (PWV) was measured twice (at baseline and after ≈8 years of follow-up) using a Sphygmocor device (AtCor Medical Ltd.) and intra-individual change of PWV per year (∆PWV/year) was calculated. Concentrations of sRAGE were assessed at baseline by ELISA methods (R&D Systems).

Results

Average ∆PWV/year significantly increased across the sRAGE quintiles (p = 0.0008) and drop by one sRAGE quintile was associated with ≈21% increase in the relative risk of accelerated age-dependent stiffening (∆PWV/year ≥0.2 m/sec). In a categorized manner, subjects in the bottom quintile of sRAGE (<889.74 pg/mL) had fully adjusted odds ratio of accelerated stiffening 1.72 (95% CI: 1.06–2.79), p = 0.028, while those with high sRAGE concentrations (≥1695.2 pg/mL) showed opposite effect [with odds ratio 0.55 (95% CI: 0.33–0.90), p = 0.017].

Conclusion

Circulating status of sRAGE independently influenced individual progression of arterial stiffness overt time. This finding strongly supports hypothesis, that high sRAGE have protective role against vascular ageing.
P102 Large Artery Stiffness is Associated with Lower Brain pH and Memory Performance in Middle-aged and Older Adults
Authors: DuBose Lyndsey , Magnotta Vincent , Moser David , Mitchell Gary , Nuckols Virginia , Ward Ryan , Pierce Gary , Ponto Laura Boles
Published: March 2020

Background/Objectives

Large artery stiffening is a novel risk factor for cognitive impairment including Alzheimer’s disease. Loss of impedance mismatch between central and cerebral arteries promotes cerebrovascular dysfunction via chronic transmission of excessive pulsatile pressure and flow to the brain. Cerebrovascular dysfunction uncouples cerebral blood flow supply from metabolic demand, contributing to hypoperfusion and acidosis. Conversely, greater impedance mismatch may protect against cerebrovasculature dysfunction, brain acidosis and cognitive impairment. Values for brain T1rho, a novel pH-sensitive MRI biomarker, are higher (more acidic) in patients with cognitive impairment compared with healthy controls. However, relations of T1rho with 1) large artery stiffness and central pulsatile hemodynamics and 2) memory performance are unknown.

Methods/Results

Middle-aged/older adults (n = 31, 68 ± 2 years) underwent vascular, global T1rho MRI and memory testing. In a subset (n = 17), common carotid artery (CCA) intima-medial thickness (IMT) and pulsatile pressure/flow hemodynamics were measured (applanation tonometry, Doppler ultrasonography). In the entire cohort, higher T1rho was associated with greater aortic stiffness (cfPWV; r = 0.36, p = 0.054, covariate: MAP) and lower memory performance (r = −0.43, p = 0.03, education). In the subset, greater CCA IMT was correlated with higher cfPWV (r = 0.45, p = 0.08, MAP), suggesting that elevated aortic stiffness may promote concentric CCA remodeling. Higher CCA characteristic impedance was associated with lower T1rho (r = −0.57, p = 0.02) and higher memory performance (r = 0.46, p = 0.08). T1rho was not correlated with CCA reflection coefficient or pulsatile flow parameters (p > 0.05).

Conclusion

These preliminary data suggest that compensatory remodeling of the CCA artery associated with elevated aortic stiffness may be protective against alterations in brain pH and cognitive performance.
P104 White Coat Hypertension is Associated with Increased Small Vessel Disease in the Brain
Authors: Kirkham Fran , Drazich E. , Vundavalli A. , Rankin P. , Timeyin J. , Bunting E. , Ali K. , Rajkumar C.
Published: March 2020

Objective

Small vessel disease, measured by brain white matter hyperintensity (WMH), is associated with increased stroke risk and cognitive impairment. This study aimed to explore the relationship between WMH on computerised tomography (CT) and white coat hypertension (WCH) in patients with recent transient ischaemic attack (TIA) or lacunar stroke (LS).

Methods

Ninety-six patients recruited for the ASIST trial (Arterial Stiffness in Lacunar Stroke and TIA) underwent measurement of clinic blood pressure (BP) and ambulatory BP monitoring (APBM) within two weeks of TIA or LS. Patients were grouped by BP phenotypes. Twenty-three patients had normotension (clinic BP <140/90 mmHg and day-time ABPM <135/85 mmHg) and 25 patients had WCH (clinic BP >140/90 mmHg and day-time ABPM <135/85 mmHg). CT brain images were scored for WMH using the four-point Fazekas visual rating scale. Patients were grouped into no-mild WMH (scores 0–1) or moderate-severe (scores 2–3) groups. The relationship between BP and WMH was explored with chi-square and logistic regression accounting for known cardiovascular risk factors (age, gender, smoking, diabetes and hyperlipidaemia).

Results

44% of WCH patients had moderate-severe WMH compared to 17% of normotensives (p = 0.047). Logistical regression incorporating WCH as the independent factor and cardiovascular risk factors as independent variables showed WCH to be the only independent significant factor contributing to WMH (p = 0.024).

Conclusion

Patients with WCH were more likely to have moderate-severe WMH on CT brain than normotensives. WCH was associated with increased WMH, independent of other cardiovascular risk factors. This study suggests that WCH is associated with increased small vessel disease in the brain and may benefit from treatment.

Normotension (n = 23)
WCH (n = 25)
Statistical significance

Female n(%)
8 (35%)
7 (28%)
p = 0.613

Age (years)
69.7 ± 11.79
76.52 ± 8.69
p = 0.026

Ever Smoker n(%)
12 (52%)
18 (72%)
p = 0.156

Hyperlipidaemia n(%)
18 (78%)
15 (60%)
p = 0.458

Diabetes n(%)
4 (17%)
7 (28%)
p = 0.173

No-Mild WMH n(%)
19 (83%)
14 (66%)
p = 0.047

Moderate-Severe WMH n(%)
4 (17%)
11 (44%)
p = 0.047
P109 The Influence of Sex on Cuff Blood Pressure Accuracy
Authors: Stoneman Elif , Picone Dean , Schultz Martin , Armstrong Matthew , Bos Willem , Dwyer Nathan , Lacy Peter , Laugesen Esben , Omboni Stefano , Pucci Giacomo , Roberts-Thomson Philip , Stouffer George , Takazawa Kenji , Weber Thomas , Westerhof Berend , Sharman James
Published: March 2020

Background

Cuff blood pressure (BP) is intended to approximate central aortic BP and accuracy is paramount. Sex differences in BP physiology could influence the accuracy of cuff BP as an estimate of invasive aortic BP, but this has not been explored in-depth and was the aim of this study.

Methods

Cuff and invasive aortic BP were measured in 1701 subjects (31.9% female, aged 63 ± 12) during coronary angiography from the INvaSive blood PressurE ConsorTium (INSPECT) database. Cuff accuracy was defined as cuff–invasive BP. In a sub-sample (n = 376, 27% female, aged 63 ± 11), invasive brachial BP was recorded to assess systolic (SBP) amplification (invasive brachial–aortic SBP).

Results

Invasive aortic SBP was higher in females compared with males (mean [95% CI]: 141.8 mmHg [137.1, 146.3] versus 132.9 mmHg [129.4, 136.4], p < 0.001). Cuff SBP significantly underestimated invasive aortic SBP in females compared with males (−3.1 mmHg [−5.9, −0.2] versus 1.4 mmHg [−1.1, 4.0], p < 0.001 for difference). Sex differences remained after adjustment for age and height. In the sub-sample, aortic-to-brachial SBP-amplification was lower in females (7.1 mmHg [3.3, 10.8] versus 10.2 mmHg [5.1, 15.4], p = 0.0070). Sex, SBP-amplification, height and age were associated with cuff BP inaccuracy, but only SBP-amplification and age remained associated in multivariable analysis (p < 0.05).

Conclusion

Females have greater propensity towards cuff BP inaccuracy through underestimation of aortic SBP. Both age and the magnitude of aortic-to-brachial SBP-amplification are related to cuff BP inaccuracy, which provide greater understanding of sex differences in BP physiology and may help improve the accuracy of cuff BP methods.
P110 Impact of Cardiac Pre-load on Arterial Stiffness in Patient with Essential Hypertension
Authors: Faconti Luca , McNally Ryan , Farukh Bushra , Chowienczyk Phil
Published: March 2020

Background

Effects of afterload and blood pressure (BP) on pulse wave velocity (PWV) have been investigated using vasoactive drugs but effects of cardiac pre-load have not previously been studied.

Methods

Transient mechanical reduction of cardiac pre-load (lower limb venous occlusion, LVO) and expansion of cardiac pre-load (intravenous infusion of 2 litres of saline solution, SST) were performed in patients with hypertension. BP, carotid-femoral PWV (Sphygmocor, AtCor Medical, Asutralia), cardiac stroke volume (SV) and total peripheral resistance (TPR) derived by transthoracic echocardiography were recorded during LVO and SST. Peak flow velocity in superior vena cava (SVCx) was used to asses change in pre-load.

Results

35 subjects were studied. SVCx decreased during LVO (n = 20) by mean (95% confidence-intervals) 7.6 (2.8–11.6) cm/s and increased during SST (n = 15) by 7.1 (−0.3–14.6) cm/s. LVO produced a small but significant reduction in mean arterial BP (MAP) of 1.5 (0.0–3.1) mmHg and SV of 6.7 (2.2–11.3) mL; while TPR and PWV increased by 236.9 (51.7–422.1) dynes-sec/cm5 and 0.7 (0.3–1.1) m/s respectively. SST produced a decrease of MAP of 4.3 (0.4–8.0) mmHg while SV increased by 4.8 (0.7–9.1) mL. TPR and PWV were reduced by 255.7 (15.4–490.5) dynes-sec/cm5 and 0.7 (0.1–1.0) m/s, respectively. All p < 0.05.

Conclusion

Modulation of cardiac pre-load affect PWV beyond the effects on afterload and BP. The reciprocal changes of BP, PWV, SV and TPR could be explained by a role of the autonomic nervous system in the regulation of vascular tone in response to change of pre-load.
P111 Arterial Stiffness and Unattended and Attended BP Values
Authors: Paini Anna , Aggiusti Carlo , Bertacchini Fabio , Stassaldi Deborah , Capellini Sara , Rosei Enrico Agabiti , Muiesan Maria Lorenza , Salvetti Massimo
Published: March 2020

Measurement of “unattended” blood pressure (BP) may reduce or eliminate the “white coat effect”. Despite the possible advantages of this approach for BP measurement, only few studies analysed the relationship between unattended BP and cardiovascular events or with hypertension mediated organ damage (HMOD). The aim of our study was to evaluate the relationship between “attended” or “unattended” BP values and carotid-femoral pulse wave velocity (PWV) in 285 subjects undergoing a visit and assessment of arterial stiffness at an ESH Excellence Centre. Unattended BP (measured with the patient alone in the room, with an oscillometric device programmed to perform 3 BP measurements, at 1 minute intervals, after 5 minutes) and attended BP were measured with the same device, on the same day of the measurement of PWV, in random order.

Results

Mean age was 63 ± 13 years, mean BMI 26 ± 4, 47% were female, 76% had hypertension (55% treated). Systolic unattended BP was lower as compared to attended SBP (124.4 ± 14.3 vs 130.9 ± 16.1 mmHg). PWV was similarly correlated with attended and unattended SBP values (r = 0.428 and r = 0.404, p < 0.0001, respectively). No difference for the prediction of increased arterial stiffness was observed at receiver operator curves (ROC) analysis: attended SBP area under the curve (AUC) 0.665, 95% CI 0.607–0.720 vs unattended SBP: AUC 0.651, 95% CI 0.593–0.706, p for the comparison = ns).

Conclusion

Attended and unattended BP values are similarly correlated with PWV, the gold standard measure of arterial stiffness. These findings may provide further information on the clinical value of unattended BP.
P114 “Stifflammation” is an Essential Cause of Cardiovascular Hospitalizations in Hypertensives
Authors: Christopoulou Georgia , Vlachopoulos Charalambos , Korogiannis Lambros , Terentes-Printzios Dimitrios , Sigala Evangelia , Koutagiar Iosif , Gardikioti Vasiliki , Tousoulis Dimitrios
Published: March 2020

Purpose/Background/Objectives

Hypertension is associated with increased cardiovascular risk, inflammation and arterial stiffness. We sought to investigate the role of inflammation and arterial stiffness in the prognosis of cardiovascular hospitalization in hypertensives patients over an extensive follow-up.

Methods

One hundred and seventy-three patients (mean age 52.5 ± 13.2 years, 57% males) untreated hypertensives at baseline without cardiovascular disease, were included in the study. Arterial stiffness was assessed with carotid-femoral pulse wave velocity (PWV). High-sensitivity C-reactive protein (hsCRP) was measured in venous blood samples.

Results

During 13.6 ± 0.4 years of follow-up, forty-four patients (25.4%) patients were admitted in hospital due to cardiovascular causes. In multivariable logistic regression analysis, only higher hsCRP (Odds Ratio [OR] = 3.34, 95% Confidence intervals [CI]: 1.22–9.51, p = 0.020) and increased PWV (OR = 1.48, 95% Confidence intervals [CI]: 1.03–2.12, p = 0.036) were associated with higher risk of cardiovascular hospitalizations, which was independent of age, gender, systolic blood pressure, left ventricular mass index and presence of diabetes. In further analysis, receiver operating characteristic (ROC) curves were generated to evaluate the ability of hsCRP and PWV to discriminate subjects with cardiovascular hospitalization. The area under the curve (AUC) and 95% CIs of the ROC curves were AUC = 0.69 (95% CI: 0.59–0.78, p < 0.001) for hsCRP and AUC = 0.74 (95% CI: 0.65–0.83, p < 0.001) for PWV (Figure 1).

Conclusion

Our study shows the independent complimentary prognostic role of inflammation and arterial stiffness in the prognosis of hypertensives even in studies with extensive follow-up.