Increased pulse wave velocity and augmentation index after isometric handgrip exercise in patients with coronary artery disease

다국어 초록 (Multilingual Abstract)

Background Arterial stiffness of patients with coronary artery disease (CAD), which is expected to be increased due to a generalized atherosclerotic process of human body, may be more evident after the acute increase of blood pressure (BP) or peripheral vascular resistance. Isometric handgrip exercise is a simple and easily applicable method to achieve this goal. We investigated the changes of hemodynamic parameters and arterial stiffness indexes after handgrip exercise in patients with CAD.
Methods Forty-two subjects, who underwent coronary angiography (CAG), were enrolled. After CAG, baseline arterial waveforms were traced at the aortic root and external iliac artery using right coronary catheters. Arterial waveforms were recorded at 1, 2, and 3 min in the aortic root and at 3 min in the external iliac artery after isometric handgrip exercise at 30% ~ 40% of the maximal handgrip power. Augmentation pressure (AP) and augmentation index (AIx) were measured at aortic pressure waveforms. Pulse wave velocity (PWV) was calculated using the ECG-gated time difference of the upstroke of arterial waveforms and the distance between the aortic root and the external iliac artery.
Results Thirty patients had CAD (CAD group), and others showed no significant coronary stenosis (non-CAD group). Baseline hemodynamic parameters including AIx and PWV were not different between both groups. After isometric handgrip exercise, central systolic blood pressure (BP), central diastolic BP, central pulse pressure, peripheral systolic BP, and peripheral pulse pressure were increased in all patients. AIx inclined significantly from 1 min after exercise only in patients with CAD (before 17.7% ± 9.7% vs. 3 min after exercise 22.3% ± 10.7%, p < 0.001). PWV also increased significantly after exercise only in patients with CAD (before 10.03 ± 1.99 m/s vs. 3 min after 11.09 ± 2.45 m/s, p < 0.001).
Conclusions Arterial stiffness indexes at rest were not different between patients with and without CAD.
After isometric handgrip exercise, increased arterial stiffness became evident only in patients with CAD.

참고문헌 (Reference)

1 채명준, "The Brachial Ankle Pulse Wave Velocity is Associated with the Presence of Significant Coronary Artery Disease but Not the Extent" 대한심장학회 43 (43): 239-245, 2013

2 Fischer-Rasokat U., "Radial augmentation index unmasks premature coronary artery disease in younger males" 14 : 59-67, 2009

3 Vlachopoulos C., "Prediction of cardiovascular events and all-cause mortality with arterial stiffness : a systematic review and meta-analysis" 55 : 1318-1327, 2010

4 Cho SW., "Non-invasively measured aortic wave reflection and pulse pressure amplification are related to the severity of coronary artery disease" 62 : 131-137, 2013

5 Kingwell BA., "Large artery stiffness predicts ischemic threshold in patients with coronary artery disease" 40 : 773-779, 2002

6 Bilinska M., "Influence of dynamic training on hemodynamic, neurohormonal responses to static exercise and on inflammatory markers in patients after coronary artery bypass grafting" 74 : 2598-2604, 2010

7 Bechlioulis A., "Increased aortic pulse wave velocity is associated with the presence of angiographic coronary artery disease in overweight and obese patients" 26 : 265-270, 2013

8 Kivowitz C., "Effects of isometric exercise on cardiac performance : the grip test" 44 : 994-1002, 1971

9 Helfant RH., "Effect of sustained isometric handgrip exercise on left ventricular performance" 44 : 982-993, 1971

10 Geleris P., "Effect of cold, isometric exercise, and combination of both on aortic pulse in healthy subjects" 93 : 265-267, 2004

11 김경민, "Do Different Arterial Stiffness Parameters Provide Similar Information in High-Risk Patients for Coronary Artery Disease?" 대한심장학회 43 (43): 819-824, 2013

12 Lydakis C., "Changes of central haemodynamic parameters during mental stress and acute bouts of static and dynamic exercise" 22 : 320-328, 2008

13 Hietanen E., "Cardiovascular responses to static exercise" 10 : 397-402, 1984

14 Hayashi S., "Augmentation index does not reflect risk of coronary artery disease in elderly patients" 78 : 1176-1182, 2014

15 Weber T., "Arterial stiffness, wave reflections, and the risk of coronary artery disease" 109 : 184-189, 2004

16 Mattace-Raso FU., "Arterial stiffness and risk of coronary heart disease and stroke : the Rotterdam Study" 113 : 657-663, 2006

17 Mitchell GF., "Arterial stiffness and cardiovascular events : the Framingham Heart Study" 121 : 505-511, 2010

18 Sakuragi S., "Arterial stiffness : methods of measurement, physiologic determinants and prediction of cardiovascular outcomes" 138 : 112-118, 2010

19 Hope SA., "Arterial pulse wave velocity but not augmentation index is associated with coronary artery disease extent and severity : implications for arterial transfer function applicability" 25 : 2105-2109, 2007

20 Kullo IJ., "Aortic pulse wave velocity is associated with the presence and quantity of coronary artery calcium : a community-based study" 47 : 174-179, 2006

21 Ben-Shlomo Y., "Aortic pulse wave velocity improves cardiovascular event prediction : an individual participant meta-analysis of prospective observational data from 17, 635 subjects" 63 : 636-646, 2014

22 Lim HE., "Aortic pulse wave velocity as an independent marker of coronary artery disease" 13 : 369-375, 2004

23 Covic A., "Aortic pulse wave velocity and arterial wave reflections predict the extent and severity of coronary artery disease in chronic kidney disease patients" 18 : 388-396, 2005

24 Mancia G., "2013ESH/ESC guidelines for the management of arterial hypertension : the Task Force for the Management of Arterial Hypertension of the European Society of Hypertension(ESH)and of the European Society of Cardiology(ESC)" 34 : 2159-2219, 2013