Gender differences in the extent and timing of the reflected arterial waveform in the presence of coronary artery disease

Michael A Crilly, David J Williams, Hazel J Clark, Graham S Hillis, Amanda J Lee

Research output: Contribution to journalArticle

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Abstract

Background: The non-invasive assessment of arterial dysfunction may improve cardiovascular (CV) risk assessment. We studied the relationship of the reflected wave transit time (RWT) and augmentation index (AIX), both derived from pulse wave analysis (PWA), in the presence/absence of coronary artery disease (CAD), and compared PWA with the ankle-brachial index (ABI). Methods: A trained research nurse measured PWA (radial applanation tonometry, SphygmoCor device) and ABI (hand-held Doppler) in a consecutive series of fasted patients resting supine prior to elective coronary angiography. Measurements were undertaken blind to other clinical information. Mean differences in RWT, AIX, and ABI in the presence of CAD were adjusted for age, height, mean BP, fasting cholesterol, ever smoked, and treated hypertension using multiple linear regression. Results: We recruited 125 patients (49 women) with a mean age of 65 years, total cholesterol 4.4 mmol/l, BP 136/78, current smokers 22%, and previous myocardial infraction 30%. A statistically significant interaction between sex and CAD was present for both RWT (p = 0.003) and AIX (p = 0.03). No interaction was demonstrated for ABI (p = 0.21). Mean differences for men and women in the presence/absence of CAD were: RWT -10.1 vs. +5.2 milliseconds; AIX +1.2 vs. -5.4; ABI -0.02 vs. -0.10. Male and female area under receiver operating characteristic curves for CAD detection differed for RWT (0.33 vs. 0.67) and AIX (0.62 vs. 0.36), but were similar for ABI (0.40 vs. 0.34). Conclusion: The timing and extent of arterial wave reflections in the presence of CAD may differ in men and women.
Original languageEnglish
Pages (from-to)358-365
Number of pages8
JournalEuropean Journal of Cardiovascular Prevention and Rehabilitation
Volume19
Issue number3
Early online date1 Apr 2011
DOIs
Publication statusPublished - Jun 2012

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Ankle Brachial Index
Coronary Artery Disease
Pulse Wave Analysis
Cholesterol
Manometry
Coronary Angiography
ROC Curve
Linear Models
Fasting
Hand
Nurses
Hypertension
Equipment and Supplies
Research

Keywords

  • coronary artery disease
  • pulse wave analysis
  • sex

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Gender differences in the extent and timing of the reflected arterial waveform in the presence of coronary artery disease. / Crilly, Michael A; Williams, David J; Clark, Hazel J; Hillis, Graham S; Lee, Amanda J.

In: European Journal of Cardiovascular Prevention and Rehabilitation, Vol. 19, No. 3, 06.2012, p. 358-365.

Research output: Contribution to journalArticle

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abstract = "Background: The non-invasive assessment of arterial dysfunction may improve cardiovascular (CV) risk assessment. We studied the relationship of the reflected wave transit time (RWT) and augmentation index (AIX), both derived from pulse wave analysis (PWA), in the presence/absence of coronary artery disease (CAD), and compared PWA with the ankle-brachial index (ABI). Methods: A trained research nurse measured PWA (radial applanation tonometry, SphygmoCor device) and ABI (hand-held Doppler) in a consecutive series of fasted patients resting supine prior to elective coronary angiography. Measurements were undertaken blind to other clinical information. Mean differences in RWT, AIX, and ABI in the presence of CAD were adjusted for age, height, mean BP, fasting cholesterol, ever smoked, and treated hypertension using multiple linear regression. Results: We recruited 125 patients (49 women) with a mean age of 65 years, total cholesterol 4.4 mmol/l, BP 136/78, current smokers 22{\%}, and previous myocardial infraction 30{\%}. A statistically significant interaction between sex and CAD was present for both RWT (p = 0.003) and AIX (p = 0.03). No interaction was demonstrated for ABI (p = 0.21). Mean differences for men and women in the presence/absence of CAD were: RWT -10.1 vs. +5.2 milliseconds; AIX +1.2 vs. -5.4; ABI -0.02 vs. -0.10. Male and female area under receiver operating characteristic curves for CAD detection differed for RWT (0.33 vs. 0.67) and AIX (0.62 vs. 0.36), but were similar for ABI (0.40 vs. 0.34). Conclusion: The timing and extent of arterial wave reflections in the presence of CAD may differ in men and women.",
keywords = "coronary artery disease, pulse wave analysis, sex",
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AU - Williams, David J

AU - Clark, Hazel J

AU - Hillis, Graham S

AU - Lee, Amanda J

PY - 2012/6

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N2 - Background: The non-invasive assessment of arterial dysfunction may improve cardiovascular (CV) risk assessment. We studied the relationship of the reflected wave transit time (RWT) and augmentation index (AIX), both derived from pulse wave analysis (PWA), in the presence/absence of coronary artery disease (CAD), and compared PWA with the ankle-brachial index (ABI). Methods: A trained research nurse measured PWA (radial applanation tonometry, SphygmoCor device) and ABI (hand-held Doppler) in a consecutive series of fasted patients resting supine prior to elective coronary angiography. Measurements were undertaken blind to other clinical information. Mean differences in RWT, AIX, and ABI in the presence of CAD were adjusted for age, height, mean BP, fasting cholesterol, ever smoked, and treated hypertension using multiple linear regression. Results: We recruited 125 patients (49 women) with a mean age of 65 years, total cholesterol 4.4 mmol/l, BP 136/78, current smokers 22%, and previous myocardial infraction 30%. A statistically significant interaction between sex and CAD was present for both RWT (p = 0.003) and AIX (p = 0.03). No interaction was demonstrated for ABI (p = 0.21). Mean differences for men and women in the presence/absence of CAD were: RWT -10.1 vs. +5.2 milliseconds; AIX +1.2 vs. -5.4; ABI -0.02 vs. -0.10. Male and female area under receiver operating characteristic curves for CAD detection differed for RWT (0.33 vs. 0.67) and AIX (0.62 vs. 0.36), but were similar for ABI (0.40 vs. 0.34). Conclusion: The timing and extent of arterial wave reflections in the presence of CAD may differ in men and women.

AB - Background: The non-invasive assessment of arterial dysfunction may improve cardiovascular (CV) risk assessment. We studied the relationship of the reflected wave transit time (RWT) and augmentation index (AIX), both derived from pulse wave analysis (PWA), in the presence/absence of coronary artery disease (CAD), and compared PWA with the ankle-brachial index (ABI). Methods: A trained research nurse measured PWA (radial applanation tonometry, SphygmoCor device) and ABI (hand-held Doppler) in a consecutive series of fasted patients resting supine prior to elective coronary angiography. Measurements were undertaken blind to other clinical information. Mean differences in RWT, AIX, and ABI in the presence of CAD were adjusted for age, height, mean BP, fasting cholesterol, ever smoked, and treated hypertension using multiple linear regression. Results: We recruited 125 patients (49 women) with a mean age of 65 years, total cholesterol 4.4 mmol/l, BP 136/78, current smokers 22%, and previous myocardial infraction 30%. A statistically significant interaction between sex and CAD was present for both RWT (p = 0.003) and AIX (p = 0.03). No interaction was demonstrated for ABI (p = 0.21). Mean differences for men and women in the presence/absence of CAD were: RWT -10.1 vs. +5.2 milliseconds; AIX +1.2 vs. -5.4; ABI -0.02 vs. -0.10. Male and female area under receiver operating characteristic curves for CAD detection differed for RWT (0.33 vs. 0.67) and AIX (0.62 vs. 0.36), but were similar for ABI (0.40 vs. 0.34). Conclusion: The timing and extent of arterial wave reflections in the presence of CAD may differ in men and women.

KW - coronary artery disease

KW - pulse wave analysis

KW - sex

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