무증상 성인 남자에서 Aortic Augmentation Index와 Framingham Risk Score의 관계

이명진(Myoung Jin Lee),이상화(Sang Hwa Lee),이홍수(Hong Soo Lee),심경원(Kyung Won Shim),김수아(Sooa Kim),오영아(Young A Oh),우의정(Ui Jeong Woo) 대한임상노인의학회 2009 대한임상노인의학회지 Vol.10 No.4

연구배경: 동맥 경직도의 증가는 초기 혈관 손상과 이와 관련한 심혈관질환의 발생 및 사망의 독립적인 예측인자임이 밝혀지고 있다. 대동맥의 aortic augmentation index (AIx)는 대동맥 경직도 및 맥파 반사와 관련된 혈역학적인 지표로 맥압파형분석(pulse wave analysis; PWA)를 이용해 비침습적인 방법으로 구할 수 있다. 본 연구에서는 임상적인 심혈관 질환이 없는 성인 남자에서 대동맥의 AIx와 향후 10년간 심혈관계 질환이 발생할 위험도(Framingham Risk Score; FRS)와의 관계를 살펴보았다. 방법: 본 단면연구는 24∼74세의 임상적인 심혈관계 질환이 없는 성인 남자 103명을 대상으로 하였다. 대동맥 경직도 및 맥파 반사의 평가 지표로는 SphygmoCorⓇ를 이용하여 대동맥 AIx, HR 75 bpm을 기준으로 보정한 AIx (AIx@75), 말초에서 반사된 맥파의 귀환에 걸리는 시간(Tr)을 측정하였다. 향후 10년간 심혈관계 질환이 발생할 위험에 대한 평가는 FRS로 하였다. 결과: 단순 선형회귀분석에서 모든 대동맥 경직도 및 맥파 반사의 지표는 FRS와 유의한 상관관계를 보였다. 대상군을 FRS 기준에 따라 저위험군(FRS<10%), 중간 위험군(10%≤FRS≤20%), 고위험군(FRS>20%)으로 분류하였을 때 위험군간에 AIx의 유의한 차이가 있었다. 다중비교 결과 저위험군과 중간 위험군 및 저위험군과 고위험군 사이에 유의한 차이가 있었다. 중간이상 위험군을 판별해내는 진단기준으로서 AIx의 area under the curve (AUC)는 0.685±0.054 (P=0.003)이었고, 최적의 cut-off 수치는 AIx 12.5% (민감도 75.8%, 특이도 55.7%)였다. 결론: 이번 연구 결과는 AIx를 무증상 성인 남자에서 심혈관계 질환의 위험도를 층화하는데 있어서 유용한 지표로 사용할 수 있는 가능성을 제시한다. Background: Increased arterial stiffness has been shown to be an independent predictor of early vascular damage and related adverse cardiovascular outcome. The aortic augmentation index (AIx) is a parameter measured noninvasively by using applanation tonometry of radial artery with a validated transfer function to generate the corresponding ascending aortic pressure waveform and is used as a surrogate measure of arterial stiffness and wave reflection. The aim of this study was to assess the relationship between augmentation index and Framingham risk score in asymptomatic individuals. Methods: We performed a cross-sectional study on 103 Korean men aged 24 to 74 years, who were free from clinical cardiovascular disease. Noninvasive measures of large artery stiffness and wave reflection were aortic augmentation index (AIx), aortic augmentation index adjusted for heart rate (AIx@75) and reflection time (Tr). The Framingham risk score (FRS) was obtained. Results: In simple linear regression analysis, all indices (AIx, AIx@75 and Tr) were significantly correlated to the FRS (P<0.001). AIxs differed significantly according to the risk categories (<10%, 10∼20%, >20%) by the FRS. The receiver operating characteristic curve demonstrated that an AIx of 12.5% is useful for risk stratification. Conclusion: Our findings suggest that AIx may be a useful marker of cardiovascular risk in asymptomatic individuals.

대동맥 압력과 커프 오실로메트릭 신호 사이의 동적 시스템 모델링을 통한 대동맥 압력 파형 추정

홍준기,정재학,이보미,민창희,박용화 대한기계학회 2024 대한기계학회논문집A Vol.48 No.4

혈관 경직도는 심혈관 질환과 밀접한 관련이 있으며, 혈관 나이를 결정하는 주요 지표이다. 대동맥에서 측정한 혈압 파형의 맥파형 분석을 통해 증강 지수를 계산할 수 있으며 이는 인체 전반의 혈관 경직도를 나타내는 주요 인자로 알려져 있다. 비침습적으로 대동맥 압력 파형을 얻어내기 위해 이 연구에서는 커프 압력과 대동맥 압력 사이의 관계를 동적 시스템으로 모델링하였다. 심혈관계 시뮬레이터와 상완부 모사 팬텀을 활용하여 커프를 이용한 혈압 측정 과정을 재현하고, 대동맥 압력과 커프 압력을 동시에 측정하여 둘 사이의 전달함수를 계산하였다. 감압 중인 커프의 오실로메트릭 신호를 이용하여 구한 전달함수 값을 이용하여 대동맥 압력 파형을 추정 가능함을 확인하였다. Arterial stiffness is a crucial indicator in assessing cardiovascular health and determining vascular age. The augmentation index, which is obtained from aortic pressure wave analysis, is a reliable indicator of overall vascular stiffness. In this study, we use a dynamic system to model the relationship between cuff pressure and aortic pressure to obtain arterial pressure waveforms non-invasively. Using a cardiovascular simulator and upper-arm phantom, we recreate blood-pressure measurements using a cuff. Simultaneously measuring aortic and cuff pressures allows us to calculate their transfer function. By utilizing this transfer function from the cuff'’s oscillometric signal under pressure, we confirmed the feasibility of non-invasively estimating the aortic pressure waveform.

성인 남녀에서 혈장 호모시스테인 농도와 상완: 발목 동맥파속도의 연관성

윤경선,김상환,최희정 대한가정의학회 2009 Korean Journal of Family Medicine Vol.30 No.1

Background: Elevated plasma homocysteine appears to be causally related to atherosclerosis by inducing both endothelial dysfunction and vascular structure alteration. Brachial-ankle pulse wave velocity, a non-invasive means of measuring atherosclerosis, reflects arterial stiffness. In this study, we investigated the association between the plasma homocysteine level and arterial stiffness in Korean adults. Methods: The study group comprised of 405 subjects selected from examinees in the Health Promotion Center. Medical history, medication, and life style were recorded through a questionnaire and physical examination was performed on all subjects. We measured glucose tolerance index, lipid profile, inflammatory index, and plasma homocysteine level. We studied brachial-ankle pulse wave velocity (baPWV) as a measure of arterial stiffness. Results: A total of 379 subjects were examined on all components. The mean age in 172 males was 54.5 ± 8.7 years and in females was 57.2 ± 7.0 years. The baPWV was observed to be positively correlated with age, blood pressure, hs-CRP, and homocysteine in males. In contrast, males, age, BMI, waist circumference, blood pressure, glucose tolerance index, lipid profile except for HDL cholesterol, hs-CRP, and homocysteine were positively correlated with baPWV in females. The baPWV was increased according to the level of plasma homocysteine in males. After ontrolling or risk factors of cardiovascular diseases, homocysteine was associated with increased baPWV. Conclusion: The results indicate that elevated plasma homocysteine was associated with baPWV in middle-aged male after adjustment for the risk factors of cardiovascular diseases. 연구배경: 혈중 호모시스테인 농도의 증가는 혈관내피의 기능 뿐 아니라, 구조적 변화를 초래함으로써 동맥의 죽상경화증 발생에 기여한다. 상완-발목 동맥파속도는 비 침습적으로 동맥의 죽상경화 정도를 측정하는 방법으로, 동맥의 경직도를 반영한다. 이 연구는 중년의 성인남녀를 대상으로 혈중 호모시스테인 농도와 동맥의 경직도와의 연관성을 알아보고자 하였다. 방법: 건강증진센터에 방문한 성인 남녀 405명을 대상으로 하였다. 대상자들의 병력과 약물 복용력, 생활습관 등은 자가 기입 설문지와 의사의 면담을 통해 조사하였다. 기본적인 신체검사와 함께 검사실 검사로 당대사지표, 지질대사지표, 염증관련지표 및 혈중 호모시스테인 농도를 측정하였다. 동맥의 경직도를 측정하는 지표로 상완-발목 동맥파속도를 측정하였다. 결과: 모든 항목에 대한 조사가 이루어진 대상자는 379명이었다. 이중 남성이 121명(31.9%), 여성이 258명(68.1%)이었고, 이들의 평균연령은 각각 54.5±8.7세와 57.2±7.0세였다. 남성에서는 연령, 혈압, 심박동수, 혈액의 백혈구, 고감도 C-반응단백 농도, 혈중 호모시스테인 농도가, 여성에서는 연령, 체질량지수, 허리둘레, 혈압, 심박동수, 당대사지표, 고밀도지질단백을 제외한 지질지표, 고감도 C-반응단백 농도, 혈장 호모시스테인 농도가 상완-발목 동맥파속도와 유의한 양의 상관관계를 나타내었다. 남성에서는 혈중 호모시스테인 농도가 증가할수록 상완-발목 동맥파속도가 유의하게 증가하였으며, 심혈관계 질환 관련 위험인자를 통제하더라도 호모시스테인이 상완-발목 동맥파속도와 연관이 있는 것으로 나타났다(β=19.01, P=0.02). 결론: 중년남성에서 혈중 호모시스테인 농도는 심혈관계 질환 관련 위험인자를 통제하더라도 상완-발목 동맥파속도와 연관이 있었다.

운동형태가 노화에 따른 동맥경직도에 미치는 영향: 서술적 문헌고찰

박원일,이승희,조영현 한국체육대학교 체육과학연구소 2025 스포츠사이언스 Vol.43 No.1

노화가 진행됨에 따라 심혈관 질환의 발병 위험이 증가하며, 이를 예방하고 관리하기 위한 효과적인 전략으로 규칙적인 운동이 권장된다. 그러나 운동이 노화에 따른 동맥 경직도에 미치는 구체적인 영향에 대한 체계적인 검토는 상대적으로 부족한 실정이다. 본 연구는 운동이 노화에 따른 혈관 기능 변화와 운동의 동맥 경직도 개선 효과에 관한 선행 연구를 서술적 문헌 고찰을 통해 이를 종합적으로 분석하는 데 목적이 있다. 연구 결과, 노화로 인한 혈관의 구조적 및 기능적 이상의 부정적인 변화는 가중되고, 이를 개선하기 위한 규칙적인 운동은 중요한 역할을 하는 것으로 확인되었다. 특히 유산소 운동과 복합 운동은 동맥 경직도를 개선하는 데 효과적인 방법으로 확인된 반면, 저항 운동의 효과는 여전히 논쟁의 여지가 있다. 본 서술적 문헌 고찰은 노화로 인한 혈관 변화와 운동의 역할을 체계적으로 정리함으로써, 노화에 따른 심혈관 질환 예방을 위한 맞춤형 운동 프로그램 개발의 기초자료로 활용될 수 있을 것으로 기대된다. This study narratively and comprehensively analyzes previous research on the effects of exercise on vascular function changes associated with aging and its role in improving arterial stiffness. The findings suggest that the negative structural and functional vascular changes induced by aging are exacerbated over time, whereas regular exercise plays a pivotal role in mitigating arterial stiffness. Specifically, aerobic exercise and combined exercise have been identified as effective interventions for improving arterial stiffness, while the efficacy of resistance exercise remains a subject of debate. This descriptive literature review provides a systematic synthesis of the vascular changes linked to aging and the role of exercise, offering foundational evidence for developing tailored exercise programs aimed at preventing cardiovascular diseases associated with advancing age.

의학강좌 : 혈관기능검사

박정배 ( Jeong Bae Park ) 대한내과학회 2012 대한내과학회지 Vol.82 No.6

Division of Cardiology, Department of Internal Medicine, Cheil General Hospital, Kwandong University College of Medicine, Seoul, Korea

규칙적인 운동을 통한 심폐체력의 향상이 비만 청소년의 혈관기능에 미치는 영향

박수현 ( S. H Park ),윤은선 ( E. S Yoon ),제세영 ( S. Y Jae ) 한국운동생리학회 2012 운동과학 Vol.21 No.4

Vascular endothelial dysfunction and increased arterial stiffness are associated with early atherosclerosis in obese adolescents. High cardiorespiratory fitness (CRF) is associated with diminished cardiovascular risk factors and improved vascular endothelial function in children. The purpose of the study was to examine effects of the improvement of cardiorespiratory fitness by regular exercise training on vascular function in obese adolescents. Twenty one obese adolescents (Schoolboy, Mean age:13-14 yr) were randomly assigned to an exercise training (ET)(12 weeks, 40 minutes, 5 days/week) group (n=11) and a non exercise control (CON) group (n=10). Cardiorespiratory fitness was measured using maximal oxygen uptake with metabolic gas analysis and body composition was determined by bioelectrical impedance. We measured carotid-femoral pulse wave velocity and reactive hyperemia index as indices of vascular function. Waist girth was significantly decreased in ET group than in CON group (ET 94.41±6.17 to 92.62±6.13 vs. CON 92.62±7.80 to 94.27±9.23 ㎝, p <.05). Cardiorespiratory fitness was significantly increased in ET group than CON group(ET 32.35±6.49 to 39.24±6.63 vs. CON 34.59±5.47 to 38.36±6.54 ㎖/㎏/min, p <.05). Body mass index and selected CVD risk factors were not improved in ET group. Reactive hyperemia index was significantly increased in ET group (ET 1.60±0.45 to 1.87±0.58 vs. CON 1.73±0.39to 1.43±0.26%, p =<.05) but carotid-femoral pulse wave velocity did not significantly decrease in ET group (ET 5.77±5.40 to 5.40±0.53 vs. CON 5.12±0.53 to 5.05±0.54 m/s, NS). Change in cardiorespiratory fitness was associated with change in reactive hyperemia index after adjusted for changes in waist (r=.457, p <.037). These results show that regular exercise training improved endothelial function, and this was associated with improved cardiorespiratory fitness independent of changes in body weight in obese adolescents.

The Association between Resting Heart Rate and Arterial Stiffness in Men

두송희,최희정,박상봉,정동,심예나,오한진 대한임상건강증진학회 2019 Korean Journal of Health Promotion Vol.19 No.3

Background: Early detection of vascular change may improve prediction of subclinical stage of cardiovascular disease, allowing intervention to prevent overt vascular damage. High heart rate is known to increase cardiovascular morbidity and mortality rate in the general population and in individuals with cardiovascular disease. We aimed to investigate the association between resting heart rate (RHR) measured using electrocardiogram (ECG) and arterial stiffness measured using the cardio-ankle vascular index (CAVI) in men. Methods: Data were collected from 5,629 men aged between 20 and 78 years who visited a single-site health promotion center. RHR was measured in a supine posture after resting for 10 minutes using an ECG. Arterial stiffness was measured using the CAVI. The cutoff value for high CAVI was ≥9.0. Results: RHR was one of the major determinants of high CAVI after adjusting for age, waist circumference, mean arterial pressure, glycosylated hemoglobin level, triglyceride level, white blood cell count, and lifestyle factors. When RHR groups were defined according to the RHR quartiles, the odds ratio of group with RHR ≥70 bpm, for high CAVI was 3.62 (95% confidence interval [CI], 2.21-5.91) after adjusting for age and lifestyle factors. This association was not changed after adjusting for all other covariates (odds ratio, 2.39; 95% CI, 1.36-4.19). Conclusions: RHR measured using ECG is significantly associated with arterial stiffness in men not taking medications for hypertension, dyslipidemia, or diabetes. These findings suggest that RHR may be useful in assessing cardiovascular risk in men.

혈압측정 트렌드의 변화: 중심 동맥압과 대동맥 경직도, 맥파 분석

최철웅 ( Cheol Ung Choi ),박창규 ( Chang Gyu Park ) 대한내과학회 2009 대한내과학회지 Vol.76 No.4

The 2007 European Society of Hypertension/European Society of Cardiology guidelines acknowledged that the central (aortic) blood pressure (BP), which is the pressure exerted on the heart and brain, may differ from the pressure that is measured at the arm. They also recognized that central pressure may predict outcome in specific populations and is affected differently by antihypertensive drugs. These guidelines also regarded an increased carotid-femoral pulse wave velocity as subclinical organ damage and classified increased arterial stiffness into high/very-high risk. Clinical studies have indicated that the central BP and central hemodynamics (aortic stiffness, augmentation index) are important components in the determination of cardiovascular risk in some patients. More importantly, recent large-scale trials have shown that central hemodynamics may constitute a worthwhile treatment target. In addition, central hemodynamics can now be assessed reliably noninvasively with a number of devices. Accordingly, because arterial stiffness and central hemodynamics are markers and manifestations of organ damage, they independently predict future cardiovascular events. (Korean J Med 76:389-397, 2009)

활동적 비디오 게임을 활용한 신체활동이 고지방식이 후 혈관기능에 미치는 영향

윤은선,박수현,이용희,안의수,제세영 한국운동생리학회 2013 운동과학 Vol.22 No.1

A high fat meal transiently decreases vascular function, while acute aerobic exercise improves vascular function. Active video games are now highly popular and play a role in promoting physical activity. Although studies suggest that acute aerobic exercise attenuates high fat meal induced vascular dysfunction, but it is not clear whether an active video game could attenuate vascular dysfunction after a high fat meal. We tested the hypothesis that an active video game would partial l y prevent the unfavorable effect of vascular function by high fat meal in young adults. Using a randomized cross over design, sixteen healthy young subjects (male 9, female 7;age 24±4 yrs, BMI 22.4±2.1 ㎏/㎡) were assigned to both an active video game(AVG:50 minutes) and a seated rest(CON) after a high fat meal. Lipid profiles, blood pressure, and vascular function measured at baseline, 3 and 5 hours after a high fat meal. Vascular function was measured by endothelial function(brachial artery flow mediated dilation;FMD) and arterial stiffness(carotid-femoral pulse wave velocity;C-F PWV). Blood triglyceride levels were significantly increased in two treatment conditions after a high fat meal and did not significantly different between two groups(AVG:74.06±43.36, 160.63±106.20, 126.81±91.41 mg/dl;CON:70.06±38.67, 168.38±85.89, 128.75±87.26 mg/dl, p=0.878). FMD was decreased in the CON (9.32±2.86 to 8.13±3.56 %), but increased in the AVG (8.74±3.13 % to 9.21±3.40 %) at 3 hr after a high fat meal. However, there was no significantly different between two groups (p=0.189). C-F PWV was similarly decreased in two treatment conditions after a high fat meal and did not significantly different between two groups (AVG:6.39±1.12, 6.08±0.94, 6.38±1.07 m/s;CON:6.34±0.85, 6.19±0.89, 6.28±1.01 m/s, p=0.483). These findings show that a high fat meal caused a temporary decrease in endothelial function, but these decreases were not significantly attenuated in the group with active video game compare to the group with seated rest. Therefore, active video game may not have a cardioprotective effect in young healthy adults exposed to acute high fat meal.

투석 환자에서 혈관 석회화, 동맥 경직, 염증, 영양 상태와의 상관관계

신선영 ( Sun Young Shin ),한규현 ( Kyu Hyun Han ),정혜윤 ( Hye Yun Jeong ),추지민 ( Ji Min Chu ),김홍민 ( Hong Min Kim ),서성은 ( Seong Eun Suh ),현여경 ( Yu Kyung Hyun ),김형종 ( Hyung Jong Kim ) 대한내과학회 2014 대한내과학회지 Vol.87 No.1

Background/Aims: The vascular calcification (VC) score on a plain X-ray is associated with cardiovascular disease and mortality in hemodialysis (HD) patients. This study examined the correlations among the VC scores for the hands and pelvis X-rays, arterial stiffness, inflammation, and nutrition in HD patients. Methods: VC was evaluated using plain x-rays of the hands and pelvis. Patients were categorized into the VC (+) (VC score ≥ 3) or VC (-) (VC score < 3) groups. We measured the pulse wave velocity (PWV), ankle brachial index (ABI), and augmentation index (AI). Results: The mean age of the patients was 55.6 ± 13.2 years. The prevalence of diabetes mellitus (DM) was significantly higher in the VC (+) group than in the VC (-) group (87.5 vs. 34.2%, p < 0.05). The serum PTH (98.4 ± 141.9 vs. 183.6 ± 231.3 pg/mL, p < 0.05) and albumin (3.7 ± 0.5 vs. 3.9 ± 0.3 g/dL, p < 0.05) levels were significantly lower and PWV was significantly (p < 0.05) higher in the VC (+) group. In multiple linear regression analysis, only the presence of diabetes mellitus was significantly related to the VC score. Conclusions: The VC score was associated with the serum PTH and albumin, as well as with vascular stiffness. C-reactive protein did not show any significant association with the VC score. (Korean J Med 2014;87:42-52)