Effect of glyceryl trinitrate on peripheral arteries alters left ventricular hydraulic load in man

Yaginuma, Toshio; Avolio, Alberto; O’Rourke, Michael; Nichols, Wilmer W.; Morgan, John J. B.; Roy, Probal; Baron, D.; Branson, John; Feneley, Michael P.

doi:10.1093/cvr/20.2.153

Cited by 186 publications

(136 citation statements)

References 0 publications

Supporting

Mentioning

120

Contrasting

Unclassified

Order By: Relevance

“…Both effects would contribute to reducing the propagative properties of arterial wave velocities in the aorta. 37,38 In our model, the AoStiff index is a variable integrating two components: the local resistance of the aorta to the flow (that is, the turbulences and the mean shear stress) and the distensibility of the aortic wall, which could vary independently. With GTN administration, both components may counterbalance each other, leading to an apparently unchanged AoStiff.…”

Section: Discussionmentioning

confidence: 99%

Assessment of aortic stiffness by local and regional methods

et al. 2011

View full text Add to dashboard Cite

The stiffness of large arteries has an important role in cardiovascular hemodynamics. Aortic stiffness (AoStiff) can be assessed non-invasively with regional and local methods. In this paper, we compared these two techniques for evaluating AoStiff. Our subjects comprised of 118 consecutive patients (85 men, mean age: 49 ± 14 years). We evaluated regional AoStiff with carotid-femoral pulse wave velocity (PWV) measured with a tonometric technique and by bioelectrical impedance (BI) wave velocity (IWV). The local AoStiff was calculated from BI signals recorded at the chest. We used glyceryl trinitrate (GTN) to test the effect of peripheral vasodilatation on both methods in a subgroup of 52 patients (37 men, mean age: 52 ± 11 years). We found a significant correlation between IWV and PWV measurements (r¼0.88, Po0.0001) as well as between AoStiff and PWV measurements (r¼0.75, Po0.0001). GTN administration decreased mean arterial blood pressure by 4% (95% confidence interval: 2-8%, P¼0.002) without significant changes in AoStiff and regional IWV. Local AoStiff is correlated with regional measurements and is not influenced by changes in arterial pressure because of systemic peripheral vasodilatation.

show abstract

Section: Discussionmentioning

confidence: 99%

Assessment of aortic stiffness by local and regional methods

et al. 2011

View full text Add to dashboard Cite

show abstract

“…Vasoconstriction has little effect on wave reflection from the peripheral vascular bed, probably because wave reflection is already high under control circumstances as a result of high resting arteriolar tone, whereas vasodilation causes profound reduction in wave reflection. Effects of vasodilation on ascending aortic pressure wave contour have been studied by Takazawa, 22 Yaginuma et al, 25 and Fitchett et al 29 All have shown marked reduction in the amplitude of the late systolic pressure peak in the ascending aorta of human adults with nitroglycerin. Yaginuma et al 25 and Fitchett et al 29 have measured ascending aortic impedance as well and have confirmed that this change in pressure was attributable to reduction of wave reflection from peripheral sites.…”

Section: Effects Of Vasodilator Agents On Arterial Wave Reflection Anmentioning

confidence: 99%

“…Effects of vasodilation on ascending aortic pressure wave contour have been studied by Takazawa, 22 Yaginuma et al, 25 and Fitchett et al 29 All have shown marked reduction in the amplitude of the late systolic pressure peak in the ascending aorta of human adults with nitroglycerin. Yaginuma et al 25 and Fitchett et al 29 have measured ascending aortic impedance as well and have confirmed that this change in pressure was attributable to reduction of wave reflection from peripheral sites. This has recently been confirmed in dogs by Latson et al 30 Because the effect of nitroglycerin was seen without reduction in peripheral resistance, all investigators attributed this phenomenon to dilation of small conduit arteries.…”

Section: Effects Of Vasodilator Agents On Arterial Wave Reflection Anmentioning

confidence: 99%

Arterial dilation and reduced wave reflection. Benefit of dilevalol in hypertension.

et al. 1989

View full text Add to dashboard Cite

We compared dilevalol (an isomer of labetalol), 200-400 mg daily, against atenolol, 50-100 mg daily, in a double-blind, crossover, placebo-controlled trial with respect to effects on arterial distensibility (measured as pulse wave velocity [FVW]) and wave reflection (assessed from carotid pressure wave contour). Twelve patients of mean age 58 years (range 44-73 years) with essential hypertension (supine diastolic blood pressure 95-114 mm Hg) took active therapy for 12 weeks, separated by a 2-4-week placebo period. Carotid pressure waveforms were recorded noninvasively by applanation tonometry with a Millar micromanometer-tipped probe. PVW was measured between carotid and femoral arteries (aortic PWV), carotid and radial arteries (arm PVW), and femoral and pedal arteries (leg PWV). Early wave reflection was calculated from the ratio of the height of the peak of the carotid wave above its shoulder to the pulse pressure and was expressed as an augmentation index. Both drugs were equally effective in reducing brachial sphygmomanometric pressure and PWV in all three regions (active vs. placebo, p<0.001), but there was no significant difference between the two active therapies. However, the augmentation index (averaged during the treatment period) was significantly lower with dilevalol (19%) than with atenolol (28%, /;<0.01), corresponding to a greater decrease of 5-8 mm Hg in carotid systolic pressure compared with the brachial artery. Although both drugs were equally effective in reducing arterial distensibility, the vasodilating action of dilevalol gave added benefit in reducing wave reflection, presumably through its vasodilatory effect on peripheral conduit arteries. (Hypertension 1989;14:14-21)

show abstract

“…3,13 For example, nitroglycerin administration produces marked changes in the pressure pulse waveshape, which can be dissociated from a change in total peripheral resistance or the pulse transit time measured by aortic pulse wave velocity. 14,15 The effects are explained by changes in the mechanical properties of peripheral muscular arteries that result in improved impedance matching and attenuation of wave reflection in response to nitroglycerin. Direct ultrasonic techniques employed to assess local wall properties of peripheral muscular arteries indicate that arterial compliance (a property that depends on arterial geometry and intrinsic vessel wall properties) improves consistently, whereas distensibility (an intrinsic property of the arterial wall materials) does not necessarily change in response to nitroglycerin administration.…”

mentioning

confidence: 99%

Editorial Commentary

McVeigh¹

2003

Hypertension

View full text Add to dashboard Cite

R isk factors for cardiovascular disease mediate their effects by altering the structure, properties, and function of wall and endothelial components of arterial blood vessels. 1 The ability to detect and monitor change in the physical properties of arteries, representative of the cumulative and integrated influence of hemodynamic, metabolic, and inflammatory stimuli in impairing arterial wall integrity, holds potential to intervene at a preclinical stage to prevent or attenuate disease progression. The importance of assessing arterial wall integrity has been highlighted by recent studies demonstrating that a decrease in the pulsatile function of large arteries represents an independent predictor for future cardiovascular events. 2 Information about the interaction between the left ventricle and the physical properties of the arterial circulation can be derived by the descriptive and quantitative analysis of the arterial pressure pulse waveform. 3 Consistent characteristic changes in the pressure pulse waveshape have been described with aging and disease states predisposing to an increase in vascular events. One such age-related change involves a steepening of the pressure decay in diastole, largely determined by impaired buffering function of the proximal aorta. 3,4 Loss of the oscillatory waveform that distorts the proximal portion of diastole from a pure exponential represents a further early and consistent finding with aging and risk factors for cardiovascular disease including hypertension, smoking, and diabetes mellitus. [3][4][5][6][7] This feature arises from reflection of the incident pressure wave generated by the left ventricle from peripheral reflecting sites with a major contribution originating from impedance mismatches in small arteries and arterioles. The progressive appearance of the reflected wave in systole and eventual summation with the forward incident wave results in augmentation of the systolic blood pressure. Given the proximity of the central aorta to the major peripheral reflecting sites in the lower limbs, augmentation of the systolic blood pressure occurs in this vessel before changes are recorded in the upper limb vessels. Recently, techniques based on the determination of a pressure transfer function between the radial artery and the aorta have been employed to provide an estimate of central pressure wave reflection. 8 In this issue of Hypertension, Millasseau et al 9 report on the accuracy of employing a generalized transfer function to the radial artery pressure pulse waveform to provide an estimate of the aortic augmentation index. The accuracy of the approach was assessed against data derived directly from the carotid pressure pulse waveform or after application of a transfer function to the waveform. The authors confirm prior observations that indicate the use of a general transfer function can show a considerable amount of bias and variation that limits the utility of this approach in accurately predicting the central augmentation index. 10,11 Further support for this content...

show abstract

Effect of glyceryl trinitrate on peripheral arteries alters left ventricular hydraulic load in man

Cited by 186 publications

References 0 publications

Assessment of aortic stiffness by local and regional methods

Assessment of aortic stiffness by local and regional methods

Arterial dilation and reduced wave reflection. Benefit of dilevalol in hypertension.

Editorial Commentary

Contact Info

Product

Resources

About