J Rheum Dis.  2017 Aug;24(4):185-191. 10.4078/jrd.2017.24.4.185.

Augmentation Index in Connective Tissue Diseases

• Choi JH
• Kim J

• KMID: 2389059
• DOI: http://doi.org/10.4078/jrd.2017.24.4.185

Abstract

Atherosclerosis and its complications are often reported in patients with connective tissue diseases (CTDs) showing chronic inflammation. Traditional cardiovascular risk factors do not account for accelerated atherosclerosis in patients with CTDs. Inflammation, although non-traditional, is considered one of the risk factors for endothelial dysfunction, atrial stiffness, and atherosclerosis. Therefore, it is essential to evaluate other risk factors for cardiovascular disease (CVD) in patients with CTDs. The interest in pulse wave analysis (PWA) is growing because of its predictive value for CVD. The arterial pressure waveform is a composite of an incidental wave produced by a ventricular contraction and a reflected wave. The wave reflection can be quantified using the augmentation index (AIx); it is defined as the difference between the inflection and peak systolic pressure, and expressed as a percentage of the pulse pressure. The PWA is represented by AIx. Risk score systems, such as the Framingham scoring system, were correlated with AIx. Many studies have analyzed the ability of the AIx to predict the CAD severity in the general population. In patients with CTDs, the AIx was found to increase compared to a healthy control group. The AIx was related to the activity of CTDs. The treatment for inflammation appeared to improve the AIx in some CTDs. Although more studies will be needed to obtain conclusive evidence, AIx is expected to be a prognostic factor or a risk factor for CVD in patients with CTDs.

Keyword

Pulse wave analysis; Connective tissue diseases; Atherosclerosis

MeSH Terms

Arterial Pressure
Atherosclerosis
Blood Pressure
Cardiovascular Diseases
Connective Tissue Diseases*
Connective Tissue*
Humans
Inflammation
Pulse Wave Analysis
Risk Factors

Figure

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  Figure 1. Central aortic pressure using SphygmoCor (Atcor Medical, Sydney, Australia) by applanating the left radial artery was separated into early incident wave and late reflected wave through the formula by central aortic flow using a Vivid 7 system (GE Vingmed, Horten, Norway) with a 3.5 MHz transducer.

• 

  Figure 2. Augmentation index is defined as the ratio of augment pressure and pulse pressure and is usually expressed as a percentage. The inflection point indicates the beginning up-stroke of the reflected wave. The inflection point time is equal to the peak flow time.

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