Cardiac Autonomic Response to Active Standing in Calcific Aortic Valve Stenosis.

Aortic stenosis is a progressive heart valve disorder characterized by calcification of the leaflets. Heart rate variability (HRV) analysis has been proposed for assessing the heart response to autonomic activity, which is documented to be altered in different cardiac diseases. The objective of the study was to evaluate changes of HRV in patients with aortic stenosis by an active standing challenge. Twenty-two volunteers without alterations in the aortic valve (NAV) and twenty-five patients diagnosed with moderate and severe calcific aortic valve stenosis (AVS) participated in this cross-sectional study. Ten minute electrocardiograms were performed in a supine position and in active standing positions afterwards, to obtain temporal, spectral, and scaling HRV indices: mean value of all NN intervals (meanNN), low-frequency (LF) and high-frequency (HF) bands spectral power, and the short-term scaling indices (α1 and αsign1). The AVS group showed higher values of LF, LF/HF and αsign1 compared with the NAV group at supine position. These patients also expressed smaller changes in meanNN, LF, HF, LF/HF, α1, and αsign1 between positions. In conclusion, we confirmed from short-term recordings that patients with moderate and severe calcific AVS have a decreased cardiac parasympathetic supine response and that the dynamic of heart rate fluctuations is modified compared to NAV subjects, but we also evidenced that they manifest reduced autonomic adjustments caused by the active standing challenge.

Central blood pressure and vascular stiffness in Mexican population / Presión central aórtica y rigidez vascular en mexicanos

Abstract Introduction: Central blood pressure (CBP) is considered a measure of prognostic value for cardiovascular risk. In turn, the aortic pulse wave velocity (PWVAo) and augmentation index (Aix) have been related to arterial stiffness and cardiovascular risk. Controversies exist regarding the reference values in different ethnic groups, ages, and anthropometrics. The objective of this study is to evaluate the CBP and arterial stiffness parameters in a Mexican population by age, gender, and anthropometry. Methods: Between 2015 and 2016, 1009 apparently healthy subjects were recruited in the Instituto Nacional de Cardiología Ignacio Chávez. Using the Arteriograph (TensioMed) equipment with an oscillometric technique, CBP, central pulse pressure (cPP), PWVAo, and Aix were acquired. All results were automatically obtained by computer software version 3.0.0.4. Results: Female sex was prevalent (72%), mean age was 47 ± 12 years; 26% had normal weight, 43% were overweight, and 30% had obesity. The reference values were higher than those reported in other populations. PWVAo and Aix were always found to be higher in females. A central-brachial pressure gradient was observed in < 40 years with lower CBP. Body mass index (BMI) presented a direct and positive correlation with CBP (p < 0.001); however, PWVAo and Aix were not modified. Conclusion: CBP, cPP, PWVAo, and Aix parameters should be considered based on age, gender, and BMI. In Mexican population, CBP and cPP values were higher compared with other previously reported values, especially in women, the elderly, and obese. PWVAo and Aix are higher in older women; however, they are not modified by BMI.

Resumen Introducción: La presión central aórtica (PCA) se considera una medida del valor pronóstico. A su vez, la velocidad de la onda del pulso aórtico (VOPA) y el índice de aumento (IA) se han relacionado con la rigidez arterial y riesgo cardiovascular. Existen controversias sobre los valores de referencia en diferentes grupos. El objetivo de este estudio es evaluar estos parámetros en una población mexicana por edad, género y antropometría. Métodos: Entre 2015 y 2016 se reclutaron 1,009 sujetos aparentemente sanos en el Instituto Nacional de Cardiología Ignacio Chávez. Usando el equipo de Arteriograph (TensioMed) con técnica oscilométrica, se adquirieron: PCA, presión de pulso central, VOPA e IA. Todos los resultados fueron obtenidos automáticamente. Resultados: El sexo femenino fue prevalente (72%), edad de 47 ± 12 años; 26% con peso normal, 43% con sobrepeso y 30% con obesidad. Todos los valores fueron superiores a los reportados en otras poblaciones. VOPA e IA siempre fueron más altos en mujeres. Se observó un gradiente de presión central-braquial en < 40 años, con menor PCA. El IMC presentó una correlación directa y positiva con la PCA (p < 0,001), sin embargo, VOPA e IA no se modificaron. Conclusión: Los parámetros de PCA, VOPA e IA deben considerarse en función de edad, género e IMC. En una población mexicana, los valores de PCA fueron más altos en comparación con informados previamente (Europa y Asia), especialmente en mujeres, ancianos y obesos. VOPA e IA son más altos en mujeres mayores; sin embargo, no son modificados por el IMC.

Central blood pressure and vascular stiffness in Mexican population.

Introduction: Central blood pressure (CBP) is considered a measure of prognostic value for cardiovascular risk. In turn, the aortic pulse wave velocity (PWVAo) and augmentation index (Aix) have been related to arterial stiffness and cardiovascular risk. Controversies exist regarding the reference values in different ethnic groups, ages, and anthropometrics. The objective of this study is to evaluate the CBP and arterial stiffness parameters in a Mexican population by age, gender, and anthropometry. Methods: Between 2015 and 2016, 1009 apparently healthy subjects were recruited in the Instituto Nacional de Cardiología Ignacio Chávez. Using the Arteriograph (TensioMed) equipment with an oscillometric technique, CBP, central pulse pressure (cPP), PWVAo, and Aix were acquired. All results were automatically obtained by computer software version 3.0.0.4. Results: Female sex was prevalent (72%), mean age was 47 ± 12 years; 26% had normal weight, 43% were overweight, and 30% had obesity. The reference values were higher than those reported in other populations. PWVAo and Aix were always found to be higher in females. A central-brachial pressure gradient was observed in < 40 years with lower CBP. Body mass index (BMI) presented a direct and positive correlation with CBP (p < 0.001); however, PWVAo and Aix were not modified. Conclusion: CBP, cPP, PWVAo, and Aix parameters should be considered based on age, gender, and BMI. In Mexican population, CBP and cPP values were higher compared with other previously reported values, especially in women, the elderly, and obese. PWVAo and Aix are higher in older women; however, they are not modified by BMI.

Introducción: La presión central aórtica (PCA) se considera una medida del valor pronóstico. A su vez, la velocidad de la onda del pulso aórtico (VOPA) y el índice de aumento (IA) se han relacionado con la rigidez arterial y riesgo cardiovascular. Existen controversias sobre los valores de referencia en diferentes grupos. El objetivo de este estudio es evaluar estos parámetros en una población mexicana por edad, género y antropometría. Métodos: Entre 2015 y 2016 se reclutaron 1,009 sujetos aparentemente sanos en el Instituto Nacional de Cardiología Ignacio Chávez. Usando el equipo de Arteriograph (TensioMed) con técnica oscilométrica, se adquirieron: PCA, presión de pulso central, VOPA e IA. Todos los resultados fueron obtenidos automáticamente. Resultados: El sexo femenino fue prevalente (72%), edad de 47 ± 12 años; 26% con peso normal, 43% con sobrepeso y 30% con obesidad. Todos los valores fueron superiores a los reportados en otras poblaciones. VOPA e IA siempre fueron más altos en mujeres. Se observó un gradiente de presión central-braquial en < 40 años, con menor PCA. El IMC presentó una correlación directa y positiva con la PCA (p < 0,001), sin embargo, VOPA e IA no se modificaron. Conclusión: Los parámetros de PCA, VOPA e IA deben considerarse en función de edad, género e IMC. En una población mexicana, los valores de PCA fueron más altos en comparación con informados previamente (Europa y Asia), especialmente en mujeres, ancianos y obesos. VOPA e IA son más altos en mujeres mayores; sin embargo, no son modificados por el IMC.