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NON-INVASIVE ASSESSMENT OF MYOCARDIAL PERFUSION IN ELDERLY MEN: THE IMPACT OF AORTIC STIFFNESS AND CENTRAL BLOOD PRESSURE
1878 JACC April 5, 2016 Volume 67, Issue 13
Prevention NON-INVASIVE ASSESSMENT OF MYOCARDIAL PERFUSION IN ELDERLY MEN: THE IMPACT OF AORTIC STIFFNESS AND CENTRAL BLOOD PRESSURE Poster Contributions Poster Area, South Hall A1 Saturday, April 02, 2016, 10:00 a.m.-10:45 a.m. Session Title: The Clinical Physiology of Systemic Hypertension Abstract Category: 34. Prevention: Hypertension Presentation Number: 1119-371 Authors: Elizabeth Ellins, Kirsten E. Smith, Lucy T. Lennon, Olia Papacosta, S. Goya Wannamethee, Peter H. Whincup, Julian P. Halcox, Swansea University, Swansea, United Kingdom, UCL, London, United Kingdom
Background: Increased arterial stiffness is a feature of both ageing and exposure to cardiovascular risk factors and predisposes patients to myocardial hypertrophy, ischemia and dysfunction. Subendocardial viability ratio (SEVR - an indicator of myocardial perfusion relative to cardiac work load, lower values ≈ lower perfusion) can be estimated non-invasively from the peripheral pulse waveform. We explored relationships between SEVR, aortic stiffness and peripheral and central hemodynamics in elderly men. Methods: 1720 men from the British Regional Heart study were studied. The Vicorder was used to assess carotid to femoral pulse wave velocity (PWV) and brachial waveforms from which central blood pressure was derived using a transfer function and SEVR calculated as diastolic pressure time integral / systolic pressure time integral).
Results: 1568 men aged 71 to 92 years had good quality SEVR and PWV measurements. Mean (SD) peripheral systolic blood pressure (pSBP) was 145±19 mmHg, diastolic BP (pDBP) 76±12 mmHg, and pulse pressure (pPP) 69±15 mmHg. Mean (SD) central SBP (cSBP) was 139±17 and central cPP 61±13. Mean SEVR was 161±30 % and PWV was 10.2±1.7 m/s. SEVR was negatively correlated with PWV (r=-0.26 p<0.001) and with all pBP and cBP variables. In regression analyses, PWV was associated with SEVR after adjustment for age, individual peripheral BP measures and heart rate (p <0.001). However, the association between PWV and SEVR was no longer significant if either cSBP or central cPP were included in the multivariate model. Multiple regression analysis showed that heart rate (β (SE), β =-1.72 (0.05) p=<0.001), and both cPP (β =-1.42 (0.08) p=<0.001) and cSBP (β =0.41 (0.06) p=<0.001) were independently associated with SEVR and age, while PWV and pSBP were not.
Conclusions: Although aortic stiffness is well known to have an important influence on central arterial hemodynamics, aortic PWV does not predict myocardial perfusion independently of central aortic systolic and pulse pressure, which were both independently associated with SEVR. The results suggest that the influence of aortic stiffening on myocardial perfusion can be accounted for by effects on central arterial hemodynamics.
Prevention NON-INVASIVE ASSESSMENT OF MYOCARDIAL PERFUSION IN ELDERLY MEN: THE IMPACT OF AORTIC STIFFNESS AND CENTRAL BLOOD PRESSURE Poster Contributions Poster Area, South Hall A1 Saturday, April 02, 2016, 10:00 a.m.-10:45 a.m. Session Title: The Clinical Physiology of Systemic Hypertension Abstract Category: 34. Prevention: Hypertension Presentation Number: 1119-371 Authors: Elizabeth Ellins, Kirsten E. Smith, Lucy T. Lennon, Olia Papacosta, S. Goya Wannamethee, Peter H. Whincup, Julian P. Halcox, Swansea University, Swansea, United Kingdom, UCL, London, United Kingdom
Background: Increased arterial stiffness is a feature of both ageing and exposure to cardiovascular risk factors and predisposes patients to myocardial hypertrophy, ischemia and dysfunction. Subendocardial viability ratio (SEVR - an indicator of myocardial perfusion relative to cardiac work load, lower values ≈ lower perfusion) can be estimated non-invasively from the peripheral pulse waveform. We explored relationships between SEVR, aortic stiffness and peripheral and central hemodynamics in elderly men. Methods: 1720 men from the British Regional Heart study were studied. The Vicorder was used to assess carotid to femoral pulse wave velocity (PWV) and brachial waveforms from which central blood pressure was derived using a transfer function and SEVR calculated as diastolic pressure time integral / systolic pressure time integral).
Results: 1568 men aged 71 to 92 years had good quality SEVR and PWV measurements. Mean (SD) peripheral systolic blood pressure (pSBP) was 145±19 mmHg, diastolic BP (pDBP) 76±12 mmHg, and pulse pressure (pPP) 69±15 mmHg. Mean (SD) central SBP (cSBP) was 139±17 and central cPP 61±13. Mean SEVR was 161±30 % and PWV was 10.2±1.7 m/s. SEVR was negatively correlated with PWV (r=-0.26 p<0.001) and with all pBP and cBP variables. In regression analyses, PWV was associated with SEVR after adjustment for age, individual peripheral BP measures and heart rate (p <0.001). However, the association between PWV and SEVR was no longer significant if either cSBP or central cPP were included in the multivariate model. Multiple regression analysis showed that heart rate (β (SE), β =-1.72 (0.05) p=<0.001), and both cPP (β =-1.42 (0.08) p=<0.001) and cSBP (β =0.41 (0.06) p=<0.001) were independently associated with SEVR and age, while PWV and pSBP were not.
Conclusions: Although aortic stiffness is well known to have an important influence on central arterial hemodynamics, aortic PWV does not predict myocardial perfusion independently of central aortic systolic and pulse pressure, which were both independently associated with SEVR. The results suggest that the influence of aortic stiffening on myocardial perfusion can be accounted for by effects on central arterial hemodynamics.