Relation between Oscillometric Measurement of Central Hemodynamics and Left Ventricular Hypertrophy in Hypertensive Patients

Abstract

<b><i>Introduction:</i></b> The augmentation index (AIx) or central systolic blood pressure (SBP), measured by radial applanation tonometry, has been reported to be independently associated with left ventricular hypertrophy (LVH) in Japanese hypertensive patients. Cuff-based oscillometric measurement of the AIx using Mobil-O-Graph® showed a low or moderate agreement with the AIx measurement with other devices. <b><i>Methods:</i></b> The AIx measured using the Mobil-O-Graph was validated against the tonometric measurements of the radial AIx measured using HEM-9000AI in 110 normotensive healthy individuals (age, 21–76 years; 50 men). We investigated the relationship between the central hemodynamics assessed using the Mobil-O-Graph and LVH in 100 hypertensive patients (age, 54–75 years; 48 men), presenting a wall thickness of ≥11 mm and ≥10 mm in men and women, respectively. <b><i>Results:</i></b> Although the Mobil-O-Graph-measured central AIx showed no negative values, it correlated moderately with the HEM-9000AI-measured radial AIx (<i>r</i> = 0.602, <i>p</i> < 0.001) in the normotensive individuals. The hypertensive patients did not show a significant difference in the central SBP between the sexes, but the central AIx was lower in men than in women. The independent determinants influencing left ventricle (LV) mass index (LVMI) (<i>R</i><sup>2</sup> = 0.362; adjusted <i>R</i><sup>2</sup> = 0.329, <i>p</i> < 0.001) were heart rate (β = −0.568 ± 0.149, <i>p</i> < 0.001), central SBP (β = 0.290 ± 0.100, <i>p</i> = 0.005), and aortic root diameter (β = 1.355 ± 0.344, <i>p</i> = 0.001). Age (β = −0.025 ± 0.124, <i>p</i> = 0.841) and the central AIx (β = 0.120 ± 0.131, <i>p</i> = 0.361) were not independently associated with the LVMI. The area under the receiver operator characteristic curve to evaluate the diagnostic performance of the central AIx for the presence of LVH (LVMI >118 g/m<sup>2</sup> in men or >108 g/m<sup>2</sup> in women) was statistically significant in men (0.875, <i>p</i> < 0.001) but not in women (0.622, <i>p</i> = 0.132). In men, a central AIx of 28.06% had a sensitivity of 83.3% and specificity of 80.0% for detecting LVH. <b><i>Conclusions:</i></b> AIx measurement in men provided useful prognostic information for the presence of LVH. Pulse-wave analysis assessed using the Mobil-O-Graph may be a valuable tool for detecting LVH in hypertensive patients.

Comparison of Risk of Target Organ Damage in Different Phenotypes of Arterial Stiffness and Central Aortic Blood Pressure

“…However, opinion on the influence of cAIx@HR75 on LVH varies. In Obayashia's study ( 33 ), central AIx was lower in men than in women with hypertension, but the central AIx was not independently associated with the LVMI. It has been shown that in patients with never-treated hypertension, female sex, and shorter height are the important risk factors of elevated radial AIx 75 ( 34 ).…”

“…However, multiple logistical regression with age stratified by 60 years showed that cAIx@HR75 was not significantly associated with LVH. Aix was associated with arterial stiffness; however, it has been shown that central SBP, but not the central AIx, was an independent determinant of LVH in hypertensive patients in general ( 33 ). Further research needs to be conducted to explore the varying relationship of cAIx@HR75 and LVH.…”

Association of Pressure Wave Reflections With Left Ventricular Mass: a Systematic Review and Meta-Analysis

“…The main descriptive characteristics of the studies that have been included in the meta-analysis are described in Tables 1 through 4 per PWRs biomarker AIx, AP, Pb, RI, respectively. Out of the 17 identified studies on AIx (Table 1), 13 studies [25][26][27][28][29][30][31][32][33][34][35][36][37] with overall 5799 participants assessed AIx at the level of central arteries (either the carotid artery or the aorta) and 4 studies [38][39][40][41] with overall 993 participants assessed AIx at the peripheral arteries (either the radial artery or the finger). Carotid AIx was more often assessed, overall, in 7 studies 26,[31][32][33][34][35][36] with overall 3331 participants using local carotid pulse wave recording with either applanation tonometry (k=6, n=3129, 4 different recording systems were identified) 26,[31][32][33][34][35] or ultrasonography (k=1, n=202).…”

“…Carotid AIx was more often assessed, overall, in 7 studies 26,[31][32][33][34][35][36] with overall 3331 participants using local carotid pulse wave recording with either applanation tonometry (k=6, n=3129, 4 different recording systems were identified) 26,[31][32][33][34][35] or ultrasonography (k=1, n=202). 36 Aortic AIx was assessed in 6 studies 25,[27][28][29][30]37 38,39,41 with overall 553 participants with the use of radial applanation tonometry and PWA using in all cases the HEM-9000/9010AI (Omron Healthcare Co. Ltd, Kyoto, Japan) device. Patients with paroxysmal atrial fibrillation were included as subgroup in 2 studies 28,39 ; all subjects were in sinus rhythm at the time the AIx was measured.…”

“…Further details including study design and population characteristics are presented in Table 1. All 4 identified studies on AP (Table 2) 29,30,33,42 with overall 2745 participants assessed AP at the level of central arteries (either the carotid artery or the aorta). Carotid AP was assessed in 1 study 33 with overall 1272 participants using local carotid pulse wave recording with applanation tonometry.…”