Aortic pulse wave velocity is associated with the presence and quantity of coronary artery calcium: a community-based study

We investigated the relationship of aortic pulse wave velocity (aPWV), a measure of central arterial stiffness, with the presence and quantity of coronary artery calcium (CAC) in a community-based sample of adults without prior history of heart attack or stroke (n=401, mean age 59.8 years, 53% men). ECG-gated waveforms of the right carotid and right femoral artery were obtained by applanation tonometry, and aPWV was calculated using established methods. CAC was measured noninvasively by electron beam computed tomography, and CAC score was calculated. aPWV was significantly correlated with log(CAC +1; r=0.41; P<0.0001) and pulse pressure (r=0.47; P<0.0001). Multivariable logistic and linear regression models were used to identify independent predictors of the presence and quantity of CAC, respectively. In multivariable logistic regression analyses, aPWV was associated with the presence of CAC (P=0.011) after adjustment for age, male sex, total cholesterol, high-density lipoprotein cholesterol, diabetes, history of smoking, systolic blood pressure, body mass index, and use of hypertension and statin medications. In multivariable linear regression analyses, aPWV was significantly associated with log(CAC +1) after adjustment for the covariates enumerated above (P<0.0001). aPWV remained significantly associated with both the presence and quantity of CAC even after the additional adjustment for diastolic blood pressure. We conclude that aPWV is related to subclinical coronary atherosclerosis independent of conventional risk factors (including indices of blood pressure) and may be a biomarker of cardiovascular risk in asymptomatic individuals.     

Usefulness of brachial-ankle pulse wave velocity measurement: correlation with abdominal aortic calcification.

At present, brachial-ankle pulse wave velocity (baPWV) can be measured easily and noninvasively. We studied the correlation between aortic damage estimated by baPWV and that determined by measuring the length of abdominal aortic calcification (AAC) on X-ray films, which parameter has been significantly associated with cardiovascular morbidity and mortality. baPWV was measured using the form PWV/ankle brachial index (ABI) device in 97 patients free of end-stage renal failure or peripheral arterial disease. baPWV correlated significantly with age (r2=0.625, p<0.0001), was significantly higher in hypertensives than in normotensives (2,109+/-67 vs. 1,623+/-93 cm/s, p<0.0001), and correlated significantly with systolic blood pressure (r2=0.64, p<0.0001) and diastolic blood pressure (r2=0.397, p<0.0001). baPWV was significantly higher in diabetic patients than in nondiabetics (2,068+/-73 vs. 1,813+/-97 cm/s, p<0.05), but was similar in normolipidemic and hyperlipidemic patients. baPWV did not correlate with body mass index, fasting plasma glucose, total cholesterol, high density lipoprotein (HDL)-cholesterol, low density lipoprotein (LDL)-cholesterol or triglyceride levels, but correlated significantly with AAC length (r2=0.599, p<0.0001). Multiple regression analysis indicated that age, systolic blood pressure and AAC length were independent determinants of baPWV. Our results indicate that baPWV is useful for estimating aortic damage and could be a potentially useful predictor of vascular morbidity and mortality.     

Ethnic differences in aortic pulse wave velocity occur in the descending aorta and may be related to vitamin D

We studied aortic pulse wave velocity (aPWV), a predictor of cardiovascular events independent of blood pressure, in a multiethnic sample of British men, to investigate the roles for blood levels of vitamin D and aldosterone in total and regional aortic stiffness. Total aPWV was estimated noninvasively by the Arteriograph device (aPWV(AG)) in 198 men, with its length measure calibrated by magnetic resonance. PWVs over the aortic arch and descending aorta were measured by magnetic resonance in a subsample (n=47). Mean (SE) aPWV(AG) in South Asians (n=68; age 55±10 years), at known higher coronary disease risk than other groups, was 0.5 m/s (0.2 m/s) higher than in African Caribbeans (n=67; 55±10 years), at lowest coronary disease risk here, and Europeans (n=63; 57±8 years), adjusted for age, systolic blood pressure, and diabetes mellitus (P=0.01). By magnetic resonance, PWV over the descending aorta in South Asians was 0.7 m/s (0.3 m/s) and 0.8 m/s (0.3 m/s) higher than in African Caribbeans and Europeans, respectively; PWV over the aortic arch was not different. South Asians and African Caribbeans had 21 nmol/L (3 nmol/L) and 14 nmol/L (3 nmol/L) lower mean (SE) 25(OH)D than Europeans (P<0.001). Unlike aldosterone, 25(OH)D was negatively correlated with aPWV(AG) adjusted for age and systolic blood pressure, as well as weakened or removed ethnic differences in aPWV(AG) in regression models. These data suggest that aortic stiffness as aPWV parallels coronary disease risk in ethnic groups, descending aortic but not arch PWV has this feature, and serum 25(OH)D is an independent negative correlate of aPWV and may partly account for ethnicity-related differences in aPWV and coronary disease risk.     

糖尿病患者颈股脉搏波传导速度与冠状动脉病变关系研究

目的探讨糖尿病（DM）患者颈股脉搏波传导速度（cfPWV）与冠状动脉狭窄程度的相关性,研究cfPWV对糖尿病患者合并冠心病的预测价值。方法将我院2010年1月~2011年2月收治的疑诊冠心病（CHD）并行冠脉造影术患者依据有无CHD和DM分为4组（每组n=40）,无CHD且无DM为对照组,有CHD无DM（CHD组）和无CHD有DM（DM组）统称单病组,同时合并CHD和DM为合并组。应用脉搏波传导速度测定装置检测患者cfPWV,冠状动脉狭窄的严重程度根据美国心脏协会制定的Gensini评分系统评定,并与cfPWV进行相关性分析。结果合并组、单病组和对照组cfPWV呈下降趋势,且差异均有统计学意义（P〈0.05）;合并组、CHD组、DM组和对照组Gensini积分呈下降趋势,且合并组与其他三组和CHD组与其他三组之间均有统计学差异（P〈0.05）。相关性分析显示,合并组患者cfPWV与Gensini积分呈正相关（r=0.408,P〈0.01）。绘制糖尿病患者cfPWV预测冠心病的ROC曲线,其曲线下面积为0.873±0.034（95%可信区间：0.808～0.937）,阈值11.74m/s预测糖尿病患者合并冠心病的灵敏度为89.4%,特异度为86.9%。结论糖尿病合并冠心病组的cfPWV、Gensini积分明显增高,且cfPWV与Gensini积分呈正相关,cfPWV对糖尿病患者冠心病的发生具有预测价值。     

Validity, reproducibility, and clinical significance of noninvasive brachial-ankle pulse wave velocity measurement.

The present study was conducted to evaluate the validity and reproducibility of noninvasive brachial-ankle pulse wave velocity (baPWV) measurements and to examine the alteration of baPWV in patients with coronary artery disease (CAD). Simultaneous recordings of baPWV by a simple, noninvasive method and aortic pulse wave velosity (PWV) using a catheter tip with pressure manometer were performed in 41 patients with CAD, vasospastic angina, or cardiomyopathy. In 32 subjects (15 controls and 17 patients with CAD), baPWV was recorded independently by two observers in a random manner. In 55 subjects (14 controls and 41 patients with CAD), baPWV was recorded twice by a single observer on different days. baPWV were compared among 172 patients with CAD (aged 62 +/- 8 years); 655 age-matched patients without CAD but with hypertension, diabetes mellitus, or dyslipidemia; and 595 age-matched healthy subjects without these risk factors. baPWV correlated well with aortic PWV (r=0.87, p<0.01). Pearson's correlation coefficients of interobserver and intraobserver reproducibility were r=0.98 and r=0.87, respectively. The corresponding coefficients of variation were 8.4% and 10.0%. baPWV were significantly higher in CAD patients than in non-CAD patients with risk factors, for both genders (p<0.01). In addition, baPWV were higher in non-CAD patients with risk factors than in healthy subjects without risk factors. Thus, the validity and reproducibility of baPWV measurements are considerably high, and this method seems to be an acceptable marker reflecting vascular damages. baPWV measured by this simple, noninvasive method is suitable for screening vascular damages in a large population.     

Increase in aortic pulse wave velocity is associated with abnormal postprandial triglyceride response

BACKGROUND: Aortic pulse wave velocity (aPWV), an index of aortic distensibility, and postprandial hypertriglyceridemia are recognized as independent cardiovascular risk factors. HYPOTHESIS: The aim of this study was to evaluate the relationship between postprandial hypertriglyceridemia and changes in aPWV. METHODS: We prospectively studied 45 patients (mean age 48 [14] years, 28.9% men), who were submitted to a standardized fat meal (FM) test. According to their triglyceride (TG) levels 2, 4, 6, and 8 h after the FM, the patients were divided into two groups: Group 1 (31 patients) with postprandial TG levels < or = 219 mg/dl, and Group 2 (14 patients) with TG levels > 219 mg/dl at one of the aforementioned time intervals. Before and 6 h after the FM, aPWV was measured noninvasively. RESULTS: Baseline characteristics in the two groups were similar, except for higher TG, pulse pressure, waist-to-hip ratio, percentage of patients who smoked or had arterial hypertension, and lower high-density lipoprotein cholesterol levels in Group 2. Postprandially, aPWV was higher in Group 2 [11.2(2.7) vs. 9.1(2.1) m/s, p = 0.004]. Changes in aPWV correlated with TG changes from baseline to 6 h after FM (r = 0.539, p < 0.001) and with the areas under the TG curve (r = 0.617, p < 0.001). A postprandial TG increase of 100 mg/dl resulted in a 0.88 m/s rise of aPWV. CONCLUSION: An increase in aPWV 6 h after an FM test correlates positively with abnormal postprandial hypertriglyceridemia. These relationships, reported here for the first time, could be of practical use for better evaluation of patient prognosis.     

Elevated pulse wave velocity increases the odds of coronary calcification in overweight postmenopausal women

BACKGROUND: Aortic stiffness, assessed using carotid-femoral pulse wave velocity (cfPWV), predicts all-cause and cardiovascular mortality. Brachial-ankle pulse wave velocity index (baPVI) is a newer measure of arterial stiffness obtained using an automated system. Our aim is to evaluate the association between both these measures of arterial stiffness and coronary calcification (CAC), in overweight/obese postmenopausal women, without apparent cardiovascular disease. METHODS: The CAC was assessed using electron beam tomography in 504 postmenopausal women, aged 52 to 62 years (88.2% white) with mean body mass index (BMI) 30.8 kg/m(2). The CAC scores were analyzed as CAC >0 and CAC >100 versus CAC = 0, or as ln (CAC + 1). RESULTS: The cfPWV was available in 476 women (mean [SD]: 900 (255) cm/sec) and baPVI was available in 441 women (mean [SD]: 1434 (231) cm/sec. Any CAC (CAC >0) was present in approximately 51% of the cohort. Both high cfPWV (RR = 1.5, 1.6, and 1.7 for quartiles 2, 3, and 4 v 1) and baPVI (RR = 2.9, 3.7. and 4.0 for quartiles 2, 3, and 4 v 1) were associated with the presence of calcification (CAC >0). The association was attenuated but remained significant only for baPVI after adjusting for age, systolic blood pressure, average waist circumference, BMI, fasting glucose, insulin, lipids, hormone replacement therapy, and smoking status. High odds of severe calcification (CAC >100) was seen with the highest quartile of the cfPWV (RR = 5.3) and baPVI (RR = 7.8), and these associations remained significant in multivariable analysis. CONCLUSIONS: Both cfPWV and baPVI are associated with presence and severity of coronary calcification in overweight postmenopausal women.     

糖尿病患者颈股脉搏波传导速度与冠脉病变严重程度的关系

目的探讨糖尿病患者颈股脉搏波速度（cfPWV）与冠状动脉狭窄程度积分（Gensini）的相关性及特点,为临床进一步广泛应用提供依据。方法入选疑诊冠心病并行冠脉造影术患者160例,其中男性82例,女性78例,年龄40-78（55±10）岁,分为四组：A组（无糖尿病及冠心病,对照组）、B组（无糖尿病有冠心病）、C组（有糖尿病无冠心病）和D组（糖尿病合并冠心病）,每组各40例。检测患者cfPWV;冠脉病变严重程度根据美国心脏协会制定的Gensini评分系统对每支血管病变程度进行定量评定;cfPWV与年龄、血脂、血压、Gensini积分分别进行相关分析。结果四组患者间年龄、性别、吸烟率、BMI、HDL—C差异无统计学意义（P〉0．05）,脉压、TG、TC及LDL—C差异有统计学意义（P〈0．05）。四组患者间收缩压及舒张压差异有统计学意义（P〈0．01）。D组cfPWV最快,与其他三组相比差异有统计学意义（P〈O．05）;B组与C组cfPWV比较差异无统计学意义（P〉0．05）;B组与C组cfPWV均大于A组,差异有统计学意义（P〈0．05）。B组与C组Gensini积分比较差异有统计学意义（P〈0．05）;D组Gensini积分明显高于其他三组,差异有统计学意义（P〈0．05）;B组明显高于A组和c组（P〈0．05）,A组与C组差异无统计学意义（P〉0．05）。cfPWV与年龄、收缩压、舒张压、Gensini积分呈正相关（相关系数分别为0．231、0．229、0．281和0．348,P均〈0．05）。D组患者cfPWV与Gensini积分呈正相关（r=0．408,P〈0．叭）;D组Gensini积分明显高于B组,差异有统计学意义（P〈0．01）。结论糖尿病合并冠心病组的cfPWV和Gensini积分明显增高。cfPWV与Gensini积分呈正相关,cfPWV可作为一项预测冠状动脉病变严重程度的无创性检查指标。     

Maternal and neonatal influences on, and reproducibility of, neonatal aortic pulse wave velocity

Aortic pulse wave velocity (aPWV), a noninvasive measure of vascular stiffness, is an independent predictor of cardiovascular disease both before and in overt vascular disease. Its characteristics in early life and its relationship to maternal factors have hardly been studied. To test the hypothesis that infant aPWV was positively related to maternal anthropometry and blood pressure (BP) at 28 weeks gestation, after adjusting for neonatal anthropometry and BP, 148 babies born in Manchester were measured 1 to 3 days after birth. A high reproducibility of aPWV, assessed in 30 babies within 3 days of birth, was found with a mean difference between occasions of -0.04 m/s (95% CI: -0.08 to 0.16 m/s). Contrary to our hypothesis, a significant inverse relation was found between neonatal aPWV (mean: 4.6 m/s) and maternal systolic BP (mean: 108.9 mm Hg; r=-0.57; 95% CI: -0.67 to -0.45) but not maternal height nor weight. Neonatal aPWV was positively correlated with birth length, birth weight, and systolic BP. In multiple regression, neonatal aPWV remained significantly inversely associated with maternal systolic BP (adjusted beta coefficient: -0.032; 95% CI: -0.040 to -0.024; P<0.001), after adjustment for maternal age, birth weight, length, and neonatal BP (all independently and positively related to aPWV) and for gestational age, maternal weight, and height (unrelated). These results suggest that infant aPWV may be a useful index of infant vascular status, is less disturbing to measure than infant BP, and is sensitive to the gestational environment marked by maternal BP.     

原发性高血压患者血清脑钠肽水平与动脉脉搏波传导速度的关系

目的:探讨原发性高血压患者颈-股动脉脉搏波传导速度(cfPWV)与血浆脑钠肽(BNP)水平的关系。方法:95例符合入选标准的无左室肥厚的原发性高血压患者,用动脉硬化测定仪测量其cfPWV,并依据cfPWV值分成3组,采用荧光免疫法定量测定其血清BNP水平。结果:各组患者在年龄、TC、空腹血糖、LDL、HDL、血肌酐、血尿素氮等生化指标和体质指数等方面比较均差异无统计学意义(均P>0.05),血压之间差异有统计学意义(P<0.01)。3组患者血清BNP水平随cfPWV增加而增加(P<0.01),BNP水平与cfPWV呈正相关(r=0.694,P=0.026);二尖瓣舒张早期充盈速度与舒张晚期充盈速度比值(E/A)随cfPWV、BNP水平的增加而降低(P<0.01),E/A值与cfPWV呈负相关(r=-0.837,P=0.041)。结论:在尚未出现左室肥厚的原发性高血压患者中,BNP可作为患者动脉硬化水平的预测指标。     

Forty-eight-hour ambulatory blood pressure and carotid-femoral pulse wave velocity in hemodialysis patients

Carotid-femoral pulse wave velocity (cfPWV) is an important predictor of cardiovascular events in the general population and also in hemodialysis (HD) patients. In the general population, cfPWV is strongly associated with age and blood pressure (BP). The best timing and method of BP measurement in HD patients is uncertain. Ambulatory blood pressure measurements (ABPM) have been used to better define the relationship between BP, target organ damage, and outcomes in HD patients. The aim of this study was to determine the possible association between cfPWV, cardiovascular risk factors, single BP measurements, and 48-hour ABPM in chronic HD patients. Thirty-three HD patients (22 men, 11 women) were included. After the end of the mid-week HD session, BP was measured, arterial stiffness was estimated by cfPWV, and 48-hour ABPM was performed. The mean systolic and diastolic BP readings before cfPWV measurement were 136/79 mmn Hg, and the mean 48-hour systolic and diastolic BP readings were 131/76 mm Hg. The mean and range of the cfPWV measurements were 8.31 ± 2.35 m/s and 5.18-16.53 m/s, respectively. Using regression analysis, no association between cfPWV and BP before PWV measurements was found. A statistically significant correlation between cfPWV and 48-hour systolic and diastolic ABPM was found. Using multiple regression analysis (including age, sex, smoking, diabetes, body mass index, total cholesterol, low- and high-density lipoprotein cholesterol, triglycerides, C-reactive protein, albumin, phosphorus, calcium, and iPTH) 48-hour systolic (P < 0.001) and diastolic ABPM (P < 0.005) still remain significantly associated with cfPWV. Only 48-hour ABPM was associated with cfPWV in HD patients in our study. We found no relationship between cfPWV and other cardiovascular risk factors.     

Atherosclerosis progression affects the relationship between endothelial function and aortic stiffness

Aortic stiffening is the most important determinant of elevated systolic blood pressure which in turn is the main contributor to the burden of disease attributable to hypertension. Endothelial function may affect arterial stiffening as has been shown for carotid-aorto-femoral segments in healthy humans or subjects with cardiovascular risk factors. We investigated whether this association is present selectively for aorta and whether it extends to patients with advanced atherosclerosis. Direct measurements of aortic pulse wave velocity (aPWV) to assess aortic stiffness and brachial artery flow-mediated dilatation (bFMD) tests to assess endothelial function were performed in 111 consecutive patients suspected of coronary artery disease. Progression of atherosclerosis was determined on the basis of the presence or absence of significant coronary artery stenosis, CAS (>or=50%) in angiography. bFMD was lower (P<0.001) and aPWV was higher (P<0.001) in a group of 72 patients with advanced atherosclerosis when compared with a group of 39 patients without significant CAS. bFMD was inversely associated with aPWV but only in patients without advanced atherosclerosis (r=-0.37, P=0.02), even after adjustment of confounding factors in a multivariate analysis model (R(2)=0.37, P<0.001). We concluded that endothelial function may influence aortic stiffness which is limited however by the progression of atherosclerosis.     

Non-invasive measures of pulse wave velocity correlate with coronary arterial plaque load in humans

OBJECTIVE: Arterial stiffness is an emerging major risk factor for cardiovascular morbidity and mortality. The aim of the present study was to assess if coronary artery plaque load correlates with non-invasive measures of arterial stiffness. DESIGN: Prospective investigational study. SETTING: Tertiary university hospital centre. PATIENTS: Patients undergoing elective diagnostic coronary angiography. INTERVENTIONS AND MAIN OUTCOME MEASURES: Coronary artery plaque burden was assessed using a 30 MHz intravascular ultrasound catheter during an automated pullback. Proximal coronary artery plaque volume was determined using a validated edge-detection algorithm following three-dimensional computerized reconstruction. Central arterial stiffness was assessed in each patient using applanation tonometry to radial, carotid and femoral pulses, with derivation of aortic pressure augmentation and pulse wave velocity using pulse wave analysis. RESULTS: In 35 patients (61 +/- 2 years), proximal coronary arterial plaque volume was 5.9 +/- 0.6 mm3/mm of vessel. Plaque volume correlated positively with carotid-radial pulse wave velocity (r = 0.47, P = 0.008) and appeared to correlate with carotid-femoral pulse wave velocity (r = 0.34, P = 0.07). Aortic augmentation (r = 0.24, P = 0.16), augmentation index (r = 0.3, P = 0.08), and pulse pressure (r = 0.22, P = 0.2) did not correlate significantly with proximal coronary artery plaque volume. CONCLUSIONS: Non-invasive measures of carotid-radial pulse wave velocity correlate with the extent of coronary artery plaque volume and may be a useful non-invasive surrogate marker for the extent of coronary atherosclerosis. Our findings are consistent with the suggestion that central aortic stiffness may promote the development of coronary atherosclerosis and ischaemic heart disease.     

The relationship between pulse wave velocity and pulse pressure in Chinese patients with essential hypertension.

Aortic pulse wave velocity (PWV) is a significant and independent predictor of cardiovascular disease in hypertensive subjects and in patients with end-stage renal disease, but there have been few studies on PWV in Chinese patients with essential hypertension. In this cross-sectional study, we investigated 3,156 consecutive patients (mean age: 53.7 +/- 11.58 years) of the Hypertension Division of Ruijin Hospital in Shanghai. Together with sphygmomanometric blood pressure measurements, aortic PWV was measured using a validated automatic device. PWV in patients with pulse pressure (PP) > or = 60 mmHg was significantly greater than that in patients with PP < 60 mmHg (p < 0.01). PP and PWV were positively related to age (PP: r = 0.396, p = 0.001; PWV: r = 0.531, p = 0.001). After adjustment by age and heart rate, PWV was still closely related to PP (r = 0.249, p = 0.001). At any given systolic blood pressure (SBP), PWV significantly decreased with the increase of diastolic blood pressure (DBP), whereas at any given DBP there was a significant increase of PWV with the increase of SBP. In conclusion, PWV was the major determinant of PP, and was highest in Chinese patients with isolated systolic hypertension, followed by those with systolic and diastolic hypertension, isolated diastolic hypertension, and normal blood pressure.     

臂踝脉搏波传导速度对女性冠状动脉粥样硬化的预测价值

目的探讨女性臂踝脉搏波传导速度(baPWV)的变化及对冠状动脉粥样硬化(CAAS)的预测价值。方法收集行64层冠状动脉CT血管造影(CTA)检查的女性健康体检者144例。根据CTA结果分为冠状动脉正常组(正常组)109例,CAAS组35例,对2组生化指标及常见危险因素进行对比分析。比较baPWV正常及baPWV升高者CAAS检出率。结果与正常组比较,CAAS组年龄、收缩压、LDL-C、baPWV明显升高(P<0.05,P<0.01);baPWV升高者CAAS检出率明显高于baPWV正常者(37.3%vs 10.1%);多元回归分析显示,女性baPWV受年龄、收缩压、体重指数及空腹血糖影响;根据CTA结果绘制ROC曲线,baPWV对CAAS具有中等预测价值,其截断点为1540 cm/s,敏感性为78.0%,特异性为81.0%。结论女性baPWV受年龄、收缩压、体重指数及空腹血糖影响;baPWV对女性CAAS有中等预测价值。     

A comparison of SphygmoCor and Vicorder devices for measuring aortic pulse wave velocity in pregnancy

BackgroundAortic pulse wave velocity (aPWV) has been found to be increased in preeclampsia when compared to normal pregnancy. Preeclampsia is associated with increased risk of later cardiovascular disease and, as such, study of the aortic stiffness in pregnancy, and its hypertensive disorders, is important to the understanding the underlying vascular changes. We compared two different techniques to measure aPWV in the mid-trimester of pregnancy.Methods58 women were recruited from the obstetric ultrasound clinic, mean (±SD) age 33 (±6) years and gestation 27 (±1) weeks. Aortic PWV was measured using SphygmoCor and Vicorder devices.ResultsWe found that both devices provided similar aPWV values with no significant difference between devices: mean difference (±SD), 0.1 (±0.9)m/s, p = 0.4. We found good correlation between devices (r = 0.6, p < 0.001). Good intra-observer variability was observed for both SphygmoCor and Vicorder devices, coefficients of variation 5.69% and 2.67%, respectively.ConclusionsThe SphygmoCor and Vicorder devices produce similar readings for aPWV in the second trimester of pregnancy, with good intra-observer variability. Due to its simpler technique the Vicorder device may be more suited to the clinical setting, particularly in advanced pregnancy or obesity.     

Augmentation index, pulse pressure amplification and superoxide anion production in patients with coronary artery disease

BACKGROUND: Free oxygen radicals appear to be involved in several processes that contribute to atherogenesis and increased arterial stiffness. METHODS: The aim of our study was to evaluate arterial stiffness and the production of superoxide anions by activated polymorphonuclear neutrophils (PMN) obtained from patients with stable coronary artery disease (CAD). Thirty four consecutive patients were studied (21 men, 13 women, mean age 58 years) who underwent coronary angiography. Arterial stiffness was assessed by pulse wave analysis using a validated system (Sphygmocor Mx, AtCor Medical). Superoxide anion production by activated neutrophils was determined by a spectrophotometric method involving the measurement of cytochrome C reduction. The extent of coronary narrowing was estimated by calculation of the Gensini score. RESULTS: Superoxide anion production by stimulated PMN showed a significant positive correlation with the augmentation index (AIx) and a significant negative correlation with pulse pressure amplification (PPA), (r=0.4, p=0.02; r=-0.5 and p=0.0026 respectively). In multivariable analyses, after adjustment for age, gender and Gensini score, superoxide anions and BMI were significant predictors of AIx (R2=57.37%, p=0.001) and PPA (R2=49.04%, p=0.008). Superoxide anion production was significantly higher in the middle (52.0+/-5.8 nmol O2-/2.5x10(6) PMN/30 min) and upper teriles (62.7+/-5.6) of AIx in comparison with the first tertile 31.8+/-4.1 (p< or =0.05, p< or =0.001). Moreover, superoxide anion production in the highest tertile of PPA was significantly lower (35.6+/-4.3 nmol O2-/2.5x10(6) PMN/30 min) than that in the tertile (60.8+/-6.2, p< or =0.05). Neither the augmentation index nor pulse pressure amplification correlate with the severity of coronary atherosclerosis as indicated by the Gensini score. Conclusions: markers of arterial stiffness, AIx and pulse pressure amplification correlate with superoxide anion production but not with the severity of atherosclerosis in coronary arteries.     

脉搏波传导速度与心血管病及其危险因素的相关性分析

目的探讨老年人群脉搏波速度（PWV）与心血管病及危险因素的相关性。方法采用整群抽样方法纳入≥70岁人群1701例,进行问卷调查、体格检查和实验室检验,测量颈-股动脉脉搏波速度（cfPWV）,观察cfPWV与高血压及相关危险因素的关系。结果 cfPWV水平随血压水平升高而升高,在高血压、脑卒中、心肌梗死和糖尿病患者中cfPWV明显高于正常人群,差异有统计学意义。多元逐步回归分析显示在入选者和脑卒中、心肌梗死和糖尿病人群中,年龄、男性、平均动脉压、心率、胰岛素抵抗指数（Homa IR）与cfPWV呈正相关（P〈0.001）,体重指数与cfPWV负相关。结论在老年人群中,cfPWV与高血压及心血管病危险因素密切相关。     

高血压患者脉压、颈动脉内膜中层厚度和颈股动脉脉搏波传导速度的关系

目的探讨高血压患者脉压、颈动脉内膜中层厚度(CIMT)与颈股动脉脉搏波传导速度(cfPWV)的关系。方法选择2016年1月至2017年6月期间就诊于福建医科大学附属第一医院全科医学和老年科门诊、住院部的原发性高血压患者469例,正常血压者274人。按2×2设计方法,将所有对象分为高血压组及正常血压组,然后以cfPWV 10 m/s为切点值,分别各自分为cfPWV增高组(cfPWV≥10 m/s)和cfPWV正常组(cfPWV<10 m/s)。再次,以CIMT 1.0 mm为切点,分别各自分为CIMT正常组及CIMT增厚组。最后,以年龄65岁为切点,分别各自分为中青年组(<65岁)及老年组(≥65岁)进行分析。测量所有研究对象的血压并计算脉压。应用Pearson相关分析和多元线性回归分析cfPWV的影响因素。结果与正常血压组比较,高血压患者的cfPWV[(9.56±1.93)比(8.46±1.47)m/s]、脉压[(58.6±13.5)比(49.2±10.3)mm Hg]、CIMT[(0.93±0.18)比(0.82±0.17) mm]升高(均P<0.05)。在高血压人群中,cfPWV增高组的脉压[(66.8±14.1)比(54.1±10.7)mm Hg]、CIMT[(0.98±0.16)比(0.90±0.18)mm]高于cfPWV正常组(均P<0.05);老年组的cfPWV[(10.52±2.11)比(9.00±1.55)m/s]、脉压[(66.1±13.7)比(54.1±11.1)mm Hg]、CIMT[(1.02±0.15)比(0.88±0.17)mm]高于中青年组(均P<0.05)。多元线性回归逐步分析结果显示,脉压(β=0.346)、年龄(β=0.345)、心率(β=0.241)、性别(β=-0.142)、空腹血糖(β=0.096)是所有对象cfPWV的相关因素(均P<0.05);分层分析结果显示,无论哪个年龄段及性别,脉压均是cfPWV的相关因素;而CIMT只在中青年人群中是cfPWV的相关因素。结论脉压是高血压患者cfPWV的相关因素,CIMT只是青中年高血压患者cfPWV的相关因素。     

Brachial-ankle pulse wave velocity for the prediction of the presence and severity of coronary artery disease

The predictability of brachial-ankle pulse wave velocity (baPWV) for the presence and severity of coronary artery disease (CAD) was investigated by measuring baPWV in 501 subjects scheduled for coronary angiography. Severity of CAD was measured using modified Gensini stenosis score (GSS) and classified as a vessel disease score (VDS) of 0–3. The presence of CAD was defined as diameter stenosis?>?50%. Subjects were grouped in tertile by level of baPWV (<14, 14–17, >17?m/s). Subjects with CAD showed higher mean age, prevalence of men and diabetes, and systolic blood pressure. The prevalence of hypertension, use of antihypertensive medications and use of statin was not different. Subjects with CAD had higher baPWV than subjects without CAD (16.70?±?3.46 versus 15.21?±?3.19?m/s, p?p?=?0.0337). ANCOVA adjusted with age, gender, body mass index, presence of hypertension or diabetes, status of smoking, use of antihypertensive medications and risk of hypercholesterolemia showed a statistically significant association of baPWV with VDS (p?p??17?m/s may be a threshold value for the presence and severity of CAD.