Abstract 2596: The Significance of a Reverse Pattern in Pulse Pressure Amplification in Predicting Coronary Artery Disease and Abnormal Left Ventricular Remodeling in Patients with Hypertension
Introduction: Under normal conditions, arterial pressure wave reflections affect the peak systolic pressure of the peripheral but not central waveform, leading to pulse pressure amplification (PPA) in the periphery. In conditions of vascular disease that lead to decreased compliance of the central arteries, it is possible for the reflected waves to affect the peak systolic pressure of the central waveform more so than in the periphery, thereby augmenting central aortic pulse pressure (PP) more than peripheral PP.
Hypothesis: We hypothesized, that in patients with hypertension, this reverse pattern in PPA may predict the presence of coronary artery disease as well as the presence of abnormal left ventricular (LV) remodeling.
Methods: We reviewed 370 consecutive patients with known hypertension, normal LV ejection fractions, no valvular disease who were sent for cardiac catheterization for the screening of coronary artery disease. Echocardiograms were reviewed for the presence of abnormal LV remodeling as defined by an increase in mass or relative wall thickness. The pattern of PPA, measured at time of catheterization, was quantified by the numerical difference of central PP minus peripheral PP; normal pattern a negative value, reverse pattern a positive value. The presence of significant coronary artery disease required at least 1 coronary artery stenosis >/= 70%.
Results: A reversal pattern of PPA had an increased odds ratio for CAD of 2.1 (95% CI 1.4 –3.8, p < 0.01). Adjusting for age, gender, systolic and diastolic pressures, the OR remained significant at 1.9 (1.3 - 3.8, p < 0.01). In contrast, there was no significant correlation with the presence of abnormal LV remodeling: Normal (n= 125) PPA = (+) 2.3; abnormal (n= 245) PPA = (+) 1.9 (p = 0.47).
Conclusion: A reversed pattern of PPA is predictive of CAD but not abnormal LV remodeling in patients with hypertension. While treatment of the overall absolute level of blood pressure is likely sufficient for the prevention of abnormal LV remodeling, a regimen that specifically improves central aortic compliance may also be necessary for the prevention of coronary artery disease. Newer technology that allows for the non-invasive measurement of central PP will make it easier to determine the pattern of PPA.