Increased arterial wave reflections predict severe cardiovascular events in patients undergoing percutaneous coronary interventions

Weber, Thomas; Auer, Johann; O’Rourke, Michael; Kvas, Erich; Laßnig, Elisabeth; Lamm, Gudrun; Stark, Nina; Rammer, M; Eber, Bernd

doi:10.1093/eurheartj/ehi504

Cited by 294 publications

(200 citation statements)

References 26 publications

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“…29,30 In our study, central AIx correlated with WLR. It is well known that age-related changes of central AIx are nonlinear, increasing more in younger (<50 years) individuals, suggesting that central AIx might be a more sensitive marker of arterial stiffening in the younger patients.…”

Section: Discussionsupporting

confidence: 54%

Central Pulse Pressure Is an Independent Determinant of Vascular Remodeling in the Retinal Circulation

et al. 2013

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A lthough the importance of hypertension as predictor of coronary heart disease and stroke has been known for a long time, the relative contribution of the individual components of peripheral blood pressure (BP) to the development of cardiovascular (CV) disease is still a matter of debate. [1][2][3][4][5] More striking nowadays, the importance of central hemodynamics is more and more acknowledged. Pathophysiologically, it seems consistent that the estimation of the central pressure in the aorta, which is actually the perfusion pressure to key organs, rather than the pressure in the arm, provides more relevant prognostic information. Indeed, it has been shown in a population-based study (the Strong Heart Study) 6 and in a hypertension trial (the Conduit Artery Function Evaluation [CAFÉ] study) 7 that the noninvasively measured central BP is superior to brachial BP in predicting CV outcomes. In a comprehensive review, Laurent et al 8 summarized the evidence that central pressure and pulse pressure (PP) are superior indicators of incident CV disease in a variety of prospective studies. Vascular remodeling, characterized by an increased mediato-lumen ratio (M/L) of small resistance and large arteries, has been identified as one of the early processes that occurs in response to increased BP and leads to hypertensive endorgan damage.9,10 The prognostic role of structural alterations of isolated subcutaneous small arteries and arterioles has been shown in arterial hypertension, with adverse prognosis in those patients with an increased M/L. 11,12 Moreover, in a former study it was shown that, although all known CV risk factors were considered, only PP and M/L were significantly associated with the occurrence of CV events. 11However, the evaluation of small artery and arteriolar structure of isolated subcutaneous small vessels requires an invasive procedure, namely the performance of a biopsy of subcutaneous tissue. Hence, this methodology is inadequate for routine patient management. In contrast, the analysis of the retinal vessels offers the opportunity to visualize the microvasculature of the body noninvasively, repeatedly, and safely in vivo. Hence, a new approach focuses on retinal arteriolar structural parameters by using scanning laser Doppler flowmetry (SLDF).Previously, both methodologies SLDF (in vivo) and myograph (in vitro) were assessed in patients with hypertension and normotensive controls. A close correlation was observed between M/L of subcutaneous small arteries and wall-to-lumen ratio (WLR) of retinal arteries, indicating that SLDF may provide similar information about microvascular morphology compared with an invasive, accurate, and prognostically Abstract-Pulse pressure has been recognized as a risk factor for stroke. Moreover, it was shown that central pulse pressure relates more strongly to vascular disease and outcome than (peripheral) brachial pulse pressure. Because vascular remodeling in the retinal circulation mirrors the 1 in the cerebral circulation and represents an easy, noninvasive possi...

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Section: Discussionsupporting

confidence: 54%

Central Pulse Pressure Is an Independent Determinant of Vascular Remodeling in the Retinal Circulation

et al. 2013

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“…Aortic pressure augmentation due to wave reflection could cause myocardial ischemia by increasing the left ventricular wasted effort and ejection duration, even in the absence of overt coronary stenosis (Nichols et al 2013). As summarized in previous reviews (Vlachopoulos et al 2010;Hashimoto and Ito 2012), several prospective studies conducted on coronary artery disease patients have demonstrated that the central pulse pressure and augmentation index predict future cardiovascular events, and the predictive ability is superior to (or independent of) the brachial pressure (Chirinos et al 2005;Weber et al 2005Weber et al , 2010Jankowski et al 2008).…”

Section: Central Hemodynamics and Heartmentioning

confidence: 99%

Central Hemodynamics and Target Organ Damage in Hypertension

Hashimoto

2014

Tohoku J. Exp. Med.

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Recent advances in technology have enabled the noninvasive evaluation of pulsatile hemodynamics in the central aorta; namely, central pressure and flow measurements. The central blood pressure represents the true load imposed on the heart, kidney and brain, and the central blood flow influences the local flow into these vital organs. An elevation of the central blood pressure has a direct, adverse impact on the target organ and, thus, the cardiovascular prognosis in patients with hypertension. A decrease in the central blood flow can cause organ dysfunction and failure. The central pressure and flow dynamics were conventionally regarded as unidirectional from the heart to the periphery. However, current evidence suggests that it should be recognized as a bidirectional interplay between the central and peripheral arteries. Specifically, the pressure pulse wave is not only transmitted forward to the periphery but also reflected backward to the central aorta. The flow pulse wave is also composed of the forward and reverse components. Aortic stiffening and arteriolar remodeling due to hypertension not only augment the central pressure by increasing the wave reflection but also may alter the central bidirectional flow, inducing hemodynamic damage/dysfunction in susceptible organs. Therefore, central hemodynamic monitoring has the potential to provide a diagnostic and therapeutic basis for preventing systemic target organ damage and for offering personalized therapy suitable for the arterial properties in each patient with hypertension. This brief review will summarize hypothetical mechanisms for the association between the central hemodynamics and hypertensive organ damage in the heart, kidney and brain.

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“…It is considered the 'gold standard' for the assessment of aortic stiffness, 25,26 and cfPWV and AIx have the greatest amount of evidence to support their predictive value for cardiovascular events in healthy and diseased populations. 26,[28][29][30]75,79,80 Therefore, other parameters of arterial stiffness, such as local distensibility or compliance, may not be as valuable to assess the vascular effects of OSA and are not as useful clinical parameters.…”

Section: Therapeutic and Clinical Implicationsmentioning

confidence: 99%

Increased arterial stiffness in obstructive sleep apnea: a systematic review

et al. 2010

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Obstructive sleep apnea is a prevalent disease that is associated with significant morbidity and mortality, particularly due to cardiovascular disease. An emerging cardiovascular risk factor, arterial stiffness, may also be involved in the cardiovascular complications of obstructive sleep apnea. The purpose of this review was to summarize the current literature regarding the effect of obstructive sleep apnea on arterial stiffness. We conducted a systematic literature review using PubMed, Embase and the Cochrane Library. We identified 24 studies that met search criteria investigating the effect of obstructive sleep apnea on arterial stiffness. Arterial stiffness was found to be increased in obstructive sleep apnea patients compared with controls or increased in severe compared with mild sleep apnea. In some studies, a positive correlation was identified between the degree of arterial stiffness and sleep apnea severity. In the two randomized, controlled trials and the two nonrandomized trials identified, treatment of obstructive sleep apnea with continuous positive airway pressure led to significant decreases in arterial stiffness. Obstructive sleep apnea appears to have an independent effect on arterial stiffness, which may be one of the mechanisms accounting for sleep apnea-associated cardiovascular risk.

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Increased arterial wave reflections predict severe cardiovascular events in patients undergoing percutaneous coronary interventions

Abstract: Increased arterial wave reflections are independently associated with an increased risk for severe short- and long-term cardiovascular events in patients undergoing PCI.

Cited by 294 publications

References 26 publications

Central Pulse Pressure Is an Independent Determinant of Vascular Remodeling in the Retinal Circulation

Central Pulse Pressure Is an Independent Determinant of Vascular Remodeling in the Retinal Circulation

Central Hemodynamics and Target Organ Damage in Hypertension

Increased arterial stiffness in obstructive sleep apnea: a systematic review

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