Potential of new pulse wave velocity index for assessing dynamic arterial stiffness

Document Type

Conference Proceeding

Publication Date

5-1-2020

Publication Title

Anesthesia and Analgesi

Abstract

INTRODUCTION: Dynamic assessment of arterial stiffness is important because it would lead to better outcome with real-time hemodynamic management and risk stratification towards cardiovascular diseases. The aim of this study is to determine if pulse wave velocity index (PWVi), which we defined using patients' demographics and perioperative monitor information, is an index of dynamic arterial stiffness. METHODS: An investigator, who was blinded to patients' information, measured the interval between the peak of the EKG T wave and the dicrotic notch of the radial arterial blood pressure wave (Tpeak-notch: Figure) for 5 consecutive beats, and then averaged them. Measurement was done at hemodynamic stabilization, which was defined with ± 20% of baseline blood pressure and heart rate without medication support for at least 1 minute, and using a scale which came with printed screenshot. We defined corrected Tpeak-notch as Tpeak-notch/square root of EKG RR interval, just as we calculate corrected QT interval. We also estimated the arterial path length (from the heart to the point where the radial arterial catheter was placed) as reported previously: Arterial path length for males (meters) = 0.520 x height (meters) - 0.00038 x age (years old) - 0.244; arterial path length for females (meters) = 0.546 x height (meters) - 0.00038 x age (years old) - 0.287). We defined PWVi as arterial path length/ corrected Tpeak-notch. Prospective observational study at a single medical center. 117 patients with standard ASA monitors and radial arterial catheter were reviewed, and distribution of PWVi was compared between patients with and without peripheral vascular disease (PVD) (52 vs. 65), left ventricular hypertrophy (LVH) (41 vs. 24) and coronary artery disease (CAD) (38 vs.79) using a Wilcoxon rank-sum test. We also assessed the correlation of PWVi with severity of LVH, and with risk factors for atherosclerosis using a Kruskal-Wallis rank sum test. A receiver-operating curve analysis was performed to assess predictive power of PWVi for PVD. RESULTS: PWVi was significantly higher in PVD (4.42 [3.74 to 6.31] vs. 3.35 [2.81 to 4.27], p < 0.01), LVH (4.55 [3.67 to 6.14] vs. 3.56 [2.81 to 4.22], p < 0.01), and CAD (4.28 [3.66 to 5.76] vs. 3.52 [2.87 to 4.77] p < 0.01). PWVi was significantly correlated with severity of LVH (p<0.01), and the number of risk factors for atherosclerosis (p<0.01). Area under curve for PVD was 0.761 with sensitivity 0.769 and specificity 0.645. CONCLUSION: Our study showed that PWVi has good potential to assess patients' dynamic arterial stiffness, and would lead to more effective choice of hemodynamic medications and pre-emptive interventions in the perioperative settings. (Figure Presented).

Volume

130

Issue

5

First Page

117

Last Page

118

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