title: Arterial stiffness, central blood pressures, and wave reflections in cardiomyopathy-implications for risk stratification.
abstract: BACKGROUND
  In general, pulse pressure (PP), augmentation index (AIx), and pulse wave velocity (PWV) are directly and positively associated with cardiovascular risk. However, in patients with systolic heart failure, the opposite (ie, an association between a lower PP and a worse outcome) has been reported as well.
  
  
  RESULTS
  We assessed central PP and AIx, using applanation tonometry (SphygmoCor, AtCor Medical) in 63 patients with cardiomyopathy (CMP) and 126 controls, matched for age, gender, and brachial blood pressure (BP). All patients underwent coronary angiography for suspected coronary artery disease. In a subgroup (21 patients, 42 controls), we additionally measured aortic PWV invasively during catheter pullback. Mean age was 63.9 versus 64.1 years and ejection fraction (EF) was 29.9 versus 72.2% in patients versus controls, respectively. Calculated aortic systolic BP as well as invasively measured systolic BP was lower in patients versus controls. Central (but not peripheral) PP (33.8 versus 37.8 mm Hg, P = .01) and AIx (17.5 versus 23.3, P = .002) were lower and ejection duration was shorter (265 versus 314 ms, P < .00001) in patients as compared with controls. When we subdivided the CMP patients with respect to AIx, those with values below and equal to the median (median AIx = 17) had more advanced systolic dysfunction. In multiple regression analysis, EF was an independent predictor of AIx. PVW did not differ between CMP patients and controls (8.6 versus 8.2 m/s in patients versus controls, P = .43). Within the group of CMP patients, however, we observed a strong, positive correlation (r = 0.62, P = .003) between PWV and EF.
  
  
  CONCLUSIONS
  Central PP, AIx, but also aortic PWV, key measures of arterial function, are susceptible to left ventricular performance.
authors.affiliation: Cardiology Department, Klinikum Kreuzschwestern Wels, Austria.
authors.forename: Thomas
authors.initials: T
authors.lastname: Weber
authors.forename: Johann
authors.initials: J
authors.lastname: Auer
authors.forename: Gudrun
authors.initials: G
authors.lastname: Lamm
authors.forename: Michael F
authors.initials: MF
authors.lastname: O'Rourke
authors.forename: Bernd
authors.initials: B
authors.lastname: Eber
mesh_terms: D000368:Aged; D001158:Arteries / Q000473:pathology; D001783:Blood Flow Velocity; D001794:Blood Pressure; D001916:Brachial Artery; D009202:Cardiomyopathies / Q000503:physiopathology*; D017023:Coronary Angiography; D003925:Diabetic Angiopathies / Q000503:physiopathology; D004548:Elasticity; D005260:Female; D006801:Humans; D008297:Male; D008365:Manometry; D008875:Middle Aged; D015999:Multivariate Analysis; D017202:Myocardial Ischemia / Q000503:physiopathology; D011673:Pulsatile Flow / Q000502:physiology; D018570:Risk Assessment; D014655:Vascular Resistance / Q000502:physiology; D016277:Ventricular Function, Left