M. Illyes

Comparison of aortic and carotid arterial stiffness parameters in patients with verified coronary artery disease

Arterial stiffness parameters are commonly used to determine the development of atherosclerotic disease. The independent predictive value of aortic stiffness has been demonstrated for coronary events.

The prognostic value of arterial stiffness in systolic heart failure

BACKGROUND Increased arterial stiffness is an indicator of mortality. This study consists of an 18-month follow-up of the mortality in advanced heart failure patients with increased arterial stiffness. METHODS The study followed up 98 patients with a diagnosis of heart failure in NYHA class III and IV (76 males, 22 females and mean age of 60 ± 12 years) with a left ventricular ejection fraction ≤ 35% as determined by the Simpson method. Augmentation index (Aix) and pulse wave propagation velocity (PWV) parameters were used as indicators of arterial stiffness. Aix and PWV values were measured by arteriography. RESULTS 36 patients died. Both Aix and PWV were powerful determinants of mortality, independent of other prognostic variables (p = 0.013, OR: 0.805; p = 0.025, OR: 0.853). A cutoff value for Aix of -14.33 gave 91.2%, 80.3% sensitivity and specificity. A cutoff value for PWV of 11.06 gave 82.4%, 65.4% sensitivity and specificity mortality was predicted. Left ventricular ejection fraction (p = 0.008, OR: 0.859) and B-type natriuretic peptide (p = 0.01, OR: 0.833) was the other independent determinant of mortality. A significant difference was found in both Aix and PWV between the compensated measurements and decompensated heart failure measurements made in 70 patients (p = 0.035, p = 0.048). CONCLUSIONS Measurement of arterial stiffness is a convenient, inexpensive and reliable method for predicting mortality in patients with advanced heart failure.

Cystatin C is better than albuminuria as a predictor of pulse wave velocity in hypertensive patients

Abstract Introduction: Arterial stiffness is important in the evaluation of the cardiovascular risk in both general population and hypertensive patients. In this study, we aimed to investigate the associations of both serum cystatin C levels and albuminuria with arterial stiffness in healthy controls and hypertensive patients. Patients and methods: Seventy-six healthy controls (male/female = 44/32) and 76 hypertensive patients (male/female = 43/33) were enrolled. Arterial stiffness parameters such as augmentation index (AIx) and pulse wave velocity (PWV) were non-invasively measured with the Arteriograph (Tensiomed Ltd., Budapest, Hungary). Results: AIx (31.92 ± 14.31 vs. 27.95 ± 11.03, p = 0.03) and PWV (9.84 ± 1.62 vs. 8.87 ± 2.04, p < 0.001) were significantly higher in hypertensive patients compared to healthy controls. Patients with microalbuminuria had significantly higher AIx (43.47 ± 9.91 vs. 30.37 ± 14.13, p = 0.002) and higher serum cystatin C levels [0.76 (0.67–0.95) vs. 0.68 (0.62–0.78) mg/L, p = 0.03]. In the hypertensive group, AIx was significantly correlated with PWV (r = 0.519, p < 0.001), glomerular filtration rate (cystatin C) (r = –0.438, p = 0.003), mean arterial pressure (MAP) (r = 0.288, p = 0.015) and urinary albumin–creatinine ratio (ACR) (r = 0.386, p = 0.004). PWV was associated with serum cystatin C (r = 0.442, p = 0.003) and MAP (r = 0.377, p = 0.001). In the linear regression analysis (model r = 0.577, p = 0.006) for the prediction of PWV in hypertensive patients, MAP, urinary ACR, age and serum cystatin C levels were included as independent variables. Cystatin C was found to be the significant determinant of PWV in hypertensive patients. Conclusion: Multivariate analysis revealed that serum cystatin C but not albuminuria was significantly associated with PWV in hypertensive patients. Serum cystatin C may be better than albuminuria as a predictor of arterial stiffness in hypertensive patients.

P1-02: Aortic pulse wave velocity (PWVAO) but not augmentation index (AIX) is associated with asymptomatic carotid atherosclerosis (ACA)

BACKGROUND Association between ACA and aortic stiffness (PWVao) in healthy, normotensive population. METHODS 234 (51.0±11.1 years) normotensive subjects without cardiovascular disease or diabetes were studied. PWVao, Aix were measured with oscillometric, occlusive method (Arteriograph). ACA was defined as 1,0mm or larger echogen plaque and/or a focal increase of IMT 1,3mm or larger measured with ultrasound. Logistic regression analysis was used to define parameters related significantly and independently to ACA. RESULTS 60 patients (25.6%) had asymptomatic carotid atherosclerosis (ACA). Significant differences were found between patients with and without ACA in the stiffness parameters (PWVao 9.6±1,6m/s vs 8.2±v1.3, Aix 34.8±12.9 vs 25.7±14.5%), in age (58.9±8.7 vs 48.3±10.5 years) but no significant differences were seen in SBP (126.2±8.2 vs 124.1±9,2mmHg) and DBP (75.7±7.1 vs 75.2±7.6mmHg). Adding age, gender, smoking, BMI, SBP, HR, Aix and PWVao to the stepwise analysis PWVao was selected in the second step, and in the final model age, smoking and PWVao remained significant contributors to ACA. The optimal PWVao threshold for ACA proved to be 8.71m/s. The sensitivity of PWVao to reveal ACA turned to be 72%, the sensitivity 71%, the positive predictive value 45%, the negative predictive value 88%, the relative risk 3.77, the odds ratio 6.1. CONCLUSIONS In a middle age, apparently healthy, normotensive population PWVao measured with Arteriograph is independently related to ACA, while Aix did not, suggesting that PWVao is a more specific marker to macrovascular atherosclerosis. We hypothesize that Aix might be related to earlier stage of atherosclerosis that question has to be addressed for further studies.