Central wave reflection is associated with peripheral arterial resistance in addition to arterial stiffness in subjects without antihypertensive medication

Abstract

Background: Augmentation index, a marker of central wave reflection, is influenced by age, sex, height, blood pressure, heart rate, and arterial stiffness. However, the detailed haemodynamic determinants of augmentation index, and their relations, remain uncertain. We examined the association of augmentation index with vascular resistance and other haemodynamic and non-haemodynamic factors.

Methods: Background information, laboratory values, and haemodynamics of 488 subjects (239 men, 249 women) without antihypertensive medication were obtained. Indices of central wave reflection, systemic vascular resistance, cardiac function, and pulse wave velocity were measured using continuous radial pulse wave analysis and whole-body impedance cardiography.

Results: In a regression model including only haemodynamic variables, augmentation index in males and female subjects, respectively, was associated with systemic vascular resistance (β = 0.425, β = 0.336), pulse wave velocity (β = 0.409, β = 0.400) (P < 0.001 for all), stroke volume (β = 0.256, β = 0.278) (P = 0.001 for both) and heart rate (β = -0.150, β = -0.156) (P = 0.049 and P = 0.036). When age, height, weight, smoking habits, and laboratory values were included in the regression model, the most significant explanatory variables for augmentation index in males and females, respectively, were age (β = 0.577, β = 0.557) and systemic vascular resistance (β = 0.437, β = 0.295) (P < 0.001 for all). In the final regression model, pulse wave velocity was not a significant explanatory variable for augmentation index, probably due to the high correlation of this variable with age (Spearman's correlation ≥0.617).

Conclusion: Augmentation index is strongly associated with systemic vascular resistance in addition to arterial stiffness.

Trial registration: ClinicalTrials.gov, NCT01742702 .

Keywords: Arterial stiffness; Augmentation index; Central wave reflection; Systemic vascular resistance.

Fig. 1

Associations between augmentation index and its known determinants. Scatter plots show associations between augmentation index and age (a, b), height (c, d), and heart rate (e, f) in male and female subjects, the lines depict mean and 95 % confidence intervals of mean

Fig. 2

Associations between augmentation index and haemodynamic variables, and association between pulse wave velocity and age. Scatter plots show associations between augmentation index and systemic vascular resistance index (a, b), the common logarithm of pulse wave velocity (c, d), and association between pulse wave velocity and age (e, f) in male and female subjects, the lines depict mean and 95 % confidence intervals of mean

Fig. 3

Associations between augmentation index and weight (a, b) and stroke volume index (c, d). Scatter plots in male and female subjects, the lines depict mean and 95 % confidence intervals of mean

Fig. 4

Comparison of two methods in the evaluation of large arterial stiffness. Correlation between pulse wave velocity measured using impedance cardiography and applanation tonometry, the lines depict mean and 95 % confidence intervals of mean (a); and differences between the two methods plotted against the average value of the methods with limits of agreement (±2SD) shown (b)