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      Association of premature ventricular complexes with central aortic pressure indices and pulse wave velocity

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          Abstract

          Although premature ventricular complex (PVC) occurs frequently, its predisposing factors have rarely been studied. We examined the connection between PVC and aortic stiffness.

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          Most cited references25

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          Arterial stiffness, systolic blood pressure, and logical treatment of arterial hypertension.

          Arterial stiffening is the principal cause of increasing systolic pressure with advancing years and in patients with arterial hypertension. It is associated with progressive arterial dilation and is due to degeneration of the arterial wall, probably as a consequence of repetitive cyclic stress; it increases systolic pressure directly by increasing amplitude of the pressure wave generated by a given flow impulse from the heart and indirectly by increasing wave velocity so that wave reflection from the periphery occurs earlier, augmenting pressure in late systole. The first mechanism affects pressure in both the central and peripheral arteries, the second predominantly in the central arteries. Change in brachial systolic pressure with age underestimates the rise in systolic pressure in the aorta and left ventricle. Arterial stiffness is reduced passively with reduction in arterial pressure. Drugs have little or no direct effect on arterial stiffness but can markedly reduce wave reflection. In patients with stiffened arteries, reduction in wave reflection decreases aortic systolic pressure augmentation. The decreased systolic pressure in central arteries brought about by this mechanism is not detected when systolic pressure is measured in a peripheral (brachial or radial) artery but can be inferred from change in contour of the pressure wave recorded in peripheral arteries.
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            A multivariate analysis of the risk of coronary heart disease in Framingham

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              Augmentation index as a measure of peripheral vascular disease state.

              Pulse pressure, especially in central arteries, is an independent predictor of adverse cardiovascular events in patients with increased elastic artery stiffness (or elastance). The central arterial pressure wave is composed of a forward traveling wave generated by left ventricular ejection and a later arriving reflected wave from the periphery. Increased stiffness of elastic arteries is the primary cause of increased pulse pressure in subjects with degeneration and hyperplasia of the arterial wall. As stiffness increases, transmission velocity of both forward and reflected waves increase, which causes the reflected wave to arrive earlier in the central aorta and augments pressure in late systole [ie, augmentation index = (augmented pressure/pulse pressure) increases]. These changes in wave reflection properties are associated with vascular disease and aging and cause an increase in left ventricular afterload, myocardial mass, and oxygen consumption. Vasoactive drugs have little direct effect on large elastic arteries but can markedly change wave reflection amplitude and augmentation index by altering stiffness of the muscular arteries and modifying transmission velocity of the reflected wave from the periphery to the heart. This change in amplitude and timing of the reflected wave causes a generalized change in central arterial systolic and pulse pressure that is not detected by cuff pressure measurements in the brachial artery.
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                Author and article information

                Journal
                American Heart Journal
                American Heart Journal
                Elsevier BV
                00028703
                March 2008
                March 2008
                : 155
                : 3
                : 500.e1-500.e6
                Article
                10.1016/j.ahj.2007.11.033
                18294486
                13d5764b-d888-40f9-b3bd-15649870dbff
                © 2008

                http://www.elsevier.com/tdm/userlicense/1.0/

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