HOME SUBSCRIPTIONS CURRENT ISSUE PAST ISSUES CARDIOSOURCE SEARCH HELP FEEDBACK		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Abstract Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Hayward, C. S. Articles by Collins, P. Search for Related Content PubMed PubMed Citation Articles by Hayward, C. S. Articles by Collins, P.

Assessment of endothelial function using peripheral waveform analysis

A clinical application

Christopher S. Hayward, MD^*,*, Mustafa Kraidly, MD, Carolyn M. Webb, PhD and Peter Collins, MD

^* St. Vincent’s Hospital, Sydney, Australia
National Heart and Lung Institute, Royal Brompton Hospital, London, United Kingdom

View larger version (15K): [in a new window]   Figure 1 An example of the effect of Salbutamol and glyceryl trinitrate (GTN) on the radial waveform in a single individual. It can be seen that the second systolic peak, obvious at baseline, is diminished by Salbutamol and almost completely abolished following GTN. The changes in the wave-shape are quantified using the augmentation index (AIx), calculated as the ratio of the pulse pressure at the second systolic peak to that at the first systolic peak. BP = blood pressure.

View larger version (42K): [in a new window]   Figure 2 (A, B) Salbutamol, given after saline, was associated with a significant decrease in augmentation index (AIx) compared to baseline (AIx; –11.8 ± 3.7%, p < 0.05). When given after N--nitro-monomethyl-L-arginine (L-NMMA) there was no significant change in AIx (–2.0 ± 3.1%). The GTN was associated with a similar significant decrease in AIx after saline (–35.1 ± 3.3%) and L-NMMA (–36.5 ± 3.3%), p < 0.001 by analysis of variance (ANOVA). (C, D) There was no significant effect of either Salbutamol alone or L-NMMA on mean blood pressure (BP). The GTN was associated with a slight decrease in BP in both cases. (E, F) Salbutamol was associated with a significant increase in heart rate, which was blocked after L-NMMA infusion, p < 0.05 by ANOVA.

View larger version (9K): [in a new window]   Figure 3 There was no relationship between the increase in heart rate (HR) seen after Salbutamol with the increase in augmentation index (AIx) seen in the same subjects (r = 0.11, p = 0.75).

View larger version (11K): [in a new window]   Figure 4 (Top) There was good agreement between the Salbutamol-induced responses on two separate visits (r = 0.80, p < 0.01). (Bottom) As shown by the Bland-Altman analysis, there was good reproducibility and no systematic error according to magnitude of Salbutamol-induced change in augmentation index (AIx).

View larger version (11K): [in a new window]   Figure 5 Comparison of Salbutamol and glyceryl trinitrate (GTN)-induced changes in augmentation index (AIx) in coronary artery disease patients (CAD) with control subjects. A significantly greater decrease occurred in AIx in control subjects compared to CAD patients following Salbutamol (–2.4 ± 1.9%; controls: –13.2 ± 2.3%, p < 0.002). This difference was not significant following GTN (–27.4 ± 4.2 vs. –38.9 ± 4.4%, p = 0.07).