Measurement of pulse wave velocity, augmentation index, and central pulse pressure in atrial fibrillation: a proof of concept study

Rogier Caluwé; An S De Vriese; Bruno Van Vlem; Francis Verbeke

doi:10.1016/j.jash.2018.06.016

Measurement of pulse wave velocity, augmentation index, and central pulse pressure in atrial fibrillation: a proof of concept study

J Am Soc Hypertens. 2018 Aug;12(8):627-632. doi: 10.1016/j.jash.2018.06.016. Epub 2018 Jun 30.

Authors

Rogier Caluwé¹, An S De Vriese², Bruno Van Vlem³, Francis Verbeke⁴

Affiliations

¹ Division of Nephrology, Dialysis and Hypertension, OLV Hospital, Aalst, Belgium. Electronic address: rogier.caluwe@olvz-aalst.be.
² Division of Nephrology and Infectious Diseases, AZ Sint-Jan Brugge, Brugge, and Ghent University, Ghent, Belgium.
³ Division of Nephrology, Dialysis and Hypertension, OLV Hospital, Aalst, Belgium.
⁴ Division of Nephrology, Ghent University Hospital, Ghent, Belgium.

PMID: 30049625
DOI: 10.1016/j.jash.2018.06.016

Abstract

Individualized weighing of the risk benefit of anticoagulation is recommended in patients with atrial fibrillation (AF) who have low established risk scores or, conversely, are at increased risk for bleeding. Parameters of arterial stiffness and wave reflection could improve risk stratification, but their use has not been evaluated in arrhythmia. We measured carotid-femoral pulse wave velocity (PWV), central augmentation index (AI), and central pulse pressure (CPP) using the SphygmoCor system in 34 patients (53 to 85 years; 25 males) with AF before and after elective electrical cardioversion. Agreement was assessed using the intraclass correlation coefficient (ICC) and the coefficient of variation, completed with Bland-Altman plots. After cardioversion, mean arterial blood pressure (MAP) and heart rate (HR) decreased significantly by 8 mmHg and 18 bpm, respectively. PWV decreased from 11.8 m/s to 10.7 m/s, AI increased from 24% to 29%, and CPP rose from 38 mmHg to 43 mmHg. The decrease in PWV was related to the decrease in MAP (beta = 0.57; R² = 0.33; P < .001), whereas changes in AI and CPP were related to the decrease in HR (AI: beta = -0.59; R² = 0.35; P < .001, CPP: beta = -0.55; R² = 0.28; P = .001). After adjustment for changes in MAP and HR, reliability analysis showed an excellent agreement for PWV (ICC = 0.89; 95% confidence interval (CI): 0.79-0.95) but moderate agreement for AI (ICC = 0.59; 95% CI: 0.17-0.80). Excellent agreement was also found for CPP (ICC = 0.89; 95% CI: 0.72-0.95). Measurement of PWV and CPP is reliable in patients with AF, as they appear unaffected by the presence of arrhythmia.

Keywords: Arterial stiffness; atrial fibrillation; augmentation index; pulse wave velocity.