title: Gender differences in the extent and timing of the reflected arterial waveform in the presence of coronary artery disease.
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).
  
  
  CONCLUSIONS
  The timing and extent of arterial wave reflections in the presence of CAD may differ in men and women.
authors: Institute of Applied Health Sciences, Aberdeen University Medical School, Aberdeen, Scotland. mike.crilly@abdn.ac.uk
authors: Michael A
authors: MA
authors: Crilly
authors: David J
authors: DJ
authors: Williams
authors: Hazel J
authors: HJ
authors: Clark
authors: Graham S
authors: GS
authors: Hillis
authors: Amanda J
authors: AJ
authors: Lee
mesh_terms: D000368:Aged; D055109:Ankle Brachial Index; D001158:Arteries / Q000000981:diagnostic imaging / Q000503:physiopathology*; D003324:Coronary Artery Disease / Q000150:complications*; D003430:Cross-Sectional Studies; D005260:Female; D054624:Health Status Disparities; D006801:Humans; D016014:Linear Models; D008297:Male; D008365:Manometry; D008875:Middle Aged; D058729:Peripheral Arterial Disease / Q000150:complications* / Q000175:diagnosis / Q000503:physiopathology; D011237:Predictive Value of Tests; D011673:Pulsatile Flow; D018570:Risk Assessment; D012307:Risk Factors; D012606:Scotland; D012737:Sex Factors; D013997:Time Factors; D018608:Ultrasonography, Doppler