Seong Taeg Kim, Yeekyoung Ko, Jong-Wook Beom, Ki Yung Boo, Jae-Geun Lee, Joon-Hyouk Choi, Song-Yi Kim, Seung-Jae Joo
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Arterial waveforms were traced at aortic root and external iliac artery using coronary catheters at baseline and 3 min after handgrip exercise. Augmentation index (AIx) was measured on the recorded aortic pressure waveform, and pulse wave velocity (PWV) was calculated using the ECG-gated time difference of the upstroke of arterial waveforms and distance between aortic root and external iliac artery.</p><p><strong>Results: </strong>Total 37 patients were evaluated. Both PWV and AIx increased after handgrip exercise. ΔPWV was significantly correlated with ΔAIx (r = 0.344, P = 0.037). Patients were divided into higher and lower ΔPWV or ΔAIx groups based on the median values of 0.4 m/sec and 3.3%, respectively. Patients with higher PWV had more 2- or 3-vessel CAD (69% vs. 27%, P = 0.034), and underwent percutaneous coronary intervention (PCI) more frequently (84% vs. 50%, P = 0.038), but higher ΔAIx was not associated with either the lesion extent or PCI. Area under curve (AUC) of ΔPWV in association with PCI by C-statistics was 0.70 (95% confidence interval [CI] 0.51-0.88; P = 0.056). In multiple logistic regression analysis, ΔPWV was significantly associated with PCI (odds ratio 7.78; 95% CI 1.26-48.02; P = 0.027).</p><p><strong>Conclusions: </strong>Higher ΔPWV after isometric handgrip exercise was associated with the lesion extent of CAD and the necessity for coronary revascularization, but higher ΔAIx was not.</p>","PeriodicalId":10480,"journal":{"name":"Clinical Hypertension","volume":"27 1","pages":"5"},"PeriodicalIF":2.6000,"publicationDate":"2021-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1186/s40885-021-00163-5","citationCount":"0","resultStr":"{\"title\":\"Association of changes of pulse wave velocity and augmentation index after isometric handgrip exercise with coronary lesion extent and revascularization.\",\"authors\":\"Seong Taeg Kim, Yeekyoung Ko, Jong-Wook Beom, Ki Yung Boo, Jae-Geun Lee, Joon-Hyouk Choi, Song-Yi Kim, Seung-Jae Joo\",\"doi\":\"10.1186/s40885-021-00163-5\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>Arterial stiffness is associated with myocardial ischemia and incident coronary artery disease (CAD), and indexes of arterial stiffness are usually increased in patients with CAD. However, these indexes are often increased in elderly without CAD. Arterial stiffness in patients with CAD may become more evident after isometric handgrip exercise which increases systolic pressure and ventricular afterload. We investigated the association of the change of stiffness indexes after isometric handgrip exercise with the lesion extent of CAD and the necessity for coronary revascularization.</p><p><strong>Methods: </strong>Patients who were scheduled a routine coronary angiography via a femoral artery were enrolled. Arterial waveforms were traced at aortic root and external iliac artery using coronary catheters at baseline and 3 min after handgrip exercise. Augmentation index (AIx) was measured on the recorded aortic pressure waveform, and pulse wave velocity (PWV) was calculated using the ECG-gated time difference of the upstroke of arterial waveforms and distance between aortic root and external iliac artery.</p><p><strong>Results: </strong>Total 37 patients were evaluated. Both PWV and AIx increased after handgrip exercise. ΔPWV was significantly correlated with ΔAIx (r = 0.344, P = 0.037). Patients were divided into higher and lower ΔPWV or ΔAIx groups based on the median values of 0.4 m/sec and 3.3%, respectively. Patients with higher PWV had more 2- or 3-vessel CAD (69% vs. 27%, P = 0.034), and underwent percutaneous coronary intervention (PCI) more frequently (84% vs. 50%, P = 0.038), but higher ΔAIx was not associated with either the lesion extent or PCI. Area under curve (AUC) of ΔPWV in association with PCI by C-statistics was 0.70 (95% confidence interval [CI] 0.51-0.88; P = 0.056). 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引用次数: 0
摘要
背景:动脉僵硬度与心肌缺血和冠心病(CAD)的发生有关，冠心病患者动脉僵硬度指标通常升高。然而，这些指标在无CAD的老年人中往往增加。冠心病患者的动脉僵硬可能在等长握力运动后变得更加明显，这会增加收缩压和心室后负荷。我们探讨了等距握力运动后僵硬指标的变化与冠心病病变程度和冠脉重建术必要性的关系。方法:纳入经股动脉行常规冠状动脉造影的患者。在基线和握力运动后3分钟用冠状动脉导管追踪主动脉根部和髂外动脉的动脉波形。根据记录的主动脉压波形测量增强指数(AIx)，利用心电图门控的动脉波形上冲程时差和主动脉根部与髂外动脉的距离计算脉搏波速(PWV)。结果:共对37例患者进行评估。握力训练后PWV和AIx均增加。ΔPWV与ΔAIx显著相关(r = 0.344, P = 0.037)。以0.4 m/sec和3.3%的中位数为标准，将患者分为高、低ΔPWV或ΔAIx组。PWV较高的患者有更多的2支或3支血管CAD(69%对27%，P = 0.034)，并且更频繁地接受经皮冠状动脉介入治疗(PCI)(84%对50%，P = 0.038)，但较高的ΔAIx与病变程度和PCI无关。ΔPWV与PCI相关性曲线下面积(AUC) C-statistics为0.70(95%可信区间[CI] 0.51-0.88;p = 0.056)。多元logistic回归分析，ΔPWV与PCI显著相关(优势比7.78;95% ci 1.26-48.02;p = 0.027)。结论:握力运动后较高的ΔPWV与冠心病的病变程度和冠状动脉重建术的必要性有关，但较高的ΔAIx与冠心病的病变程度和冠状动脉重建术的必要性无关。
Association of changes of pulse wave velocity and augmentation index after isometric handgrip exercise with coronary lesion extent and revascularization.
Background: Arterial stiffness is associated with myocardial ischemia and incident coronary artery disease (CAD), and indexes of arterial stiffness are usually increased in patients with CAD. However, these indexes are often increased in elderly without CAD. Arterial stiffness in patients with CAD may become more evident after isometric handgrip exercise which increases systolic pressure and ventricular afterload. We investigated the association of the change of stiffness indexes after isometric handgrip exercise with the lesion extent of CAD and the necessity for coronary revascularization.
Methods: Patients who were scheduled a routine coronary angiography via a femoral artery were enrolled. Arterial waveforms were traced at aortic root and external iliac artery using coronary catheters at baseline and 3 min after handgrip exercise. Augmentation index (AIx) was measured on the recorded aortic pressure waveform, and pulse wave velocity (PWV) was calculated using the ECG-gated time difference of the upstroke of arterial waveforms and distance between aortic root and external iliac artery.
Results: Total 37 patients were evaluated. Both PWV and AIx increased after handgrip exercise. ΔPWV was significantly correlated with ΔAIx (r = 0.344, P = 0.037). Patients were divided into higher and lower ΔPWV or ΔAIx groups based on the median values of 0.4 m/sec and 3.3%, respectively. Patients with higher PWV had more 2- or 3-vessel CAD (69% vs. 27%, P = 0.034), and underwent percutaneous coronary intervention (PCI) more frequently (84% vs. 50%, P = 0.038), but higher ΔAIx was not associated with either the lesion extent or PCI. Area under curve (AUC) of ΔPWV in association with PCI by C-statistics was 0.70 (95% confidence interval [CI] 0.51-0.88; P = 0.056). In multiple logistic regression analysis, ΔPWV was significantly associated with PCI (odds ratio 7.78; 95% CI 1.26-48.02; P = 0.027).
Conclusions: Higher ΔPWV after isometric handgrip exercise was associated with the lesion extent of CAD and the necessity for coronary revascularization, but higher ΔAIx was not.
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