Arismendy Nunez

Relation of the Ankle Brachial Index to Left Ventricular Ejection Fraction in Patients Without Coronary Artery Disease

Background: The low ankle brachial index (ABI) values are indicative of peripheral arterial disease, but have recently been found to be associated with reduced left ventricular ejection fraction (LVEF). This may relate to coexisting coronary artery disease (CAD). Aim: This study prospectively assessed a potential ABI–LVEF association in patients without CAD. Methods and Results: We studied 55 patients (age 57 ± 13 years, 49% male) with normal coronary arteries with LVEF determination. ABI, pulse wave velocity (PWV), and augmentation index (AI) were performed after coronary angiography. ABI correlated with LVEF (r = 0.40, p = 0.002), but not with PWV or AI. On linear regression analysis, ABI was independently associated with LVEF (B = 0.42, p = 0.004). The median LVEF was lower in subjects with low ABI values compared to those with normal ABI values (33 vs. 61%; p = 0.001). Conclusion: ABI may be influenced by LVEF independently of CAD, arterial stiffness or pressure wave reflection.

Assessment of arterial stiffness from pedal artery Korotkoff sound recordings: feasibility and potential utility

Brachial artery (BA) Korotkoff sound (KS) timing reflects arterial stiffness. We recorded pedal artery (PA) KS in 68 healthy subjects using an electronic stethoscope and electrocardiography. Intervals between QRS complex of the electrocardiogram and KS waveform peaks (termed the QKD interval) were measured for 60 seconds, averaged, and QKD velocity (v) calculated. Carotid-BA and carotid-PA pulse wave velocities (PWVs) were measured by applanation tonometry. Analyzable KS recordings were obtained from BA and PA in 100% and 92% subjects. PA QKDv decreased less than BA QKDv with progressive cuff inflation. At diastolic blood pressure + 20 mm Hg (maximal yield), BA QKDv was independently associated with weight and pulse pressure, whereas PA QKDv was related to weight and age. PA QKDv correlated with its corresponding PWV stronger than BA QKDv. In conclusion, PA KS is optimally recorded at diastolic blood pressure + 20 mm Hg; PA QKDv is correlated with age and better correlates with PWV than does BA QKDv. This technique may provide a simple arterial stiffness measure.