CARDIOVASCULAR JOURNAL OF AFRICA • SAHS Biennial Congress 16-18 September 2022 31 AFRICA Submission ID: 1371 Introduction Although indexes of aortic stiffness increase the risk for coronary artery disease (CAD), the extent to which increases in proximal aortic stiffness enhance central arterial forward wave pressures beyond changes in peripheral pressures, is uncertain. We aimed to determine whether increases in proximal aortic stiffness, as indexed by aortic characteristic impedance (Zc) translate into an enhanced central arterial pressure for a given brachial BP. Methods From central pressure, aortic velocity and diameter measurements (outflow tract) and echocardiography, we determined Zc and arterial pressure wave morphology in 71 patients with angiographic proven CAD and with all other cardiac pathology excluded. We compared central arterial function in these patients with 230 age and sex-matched controls from a community study, and in patients with stroke and CLI (n=287) diagnosed in a hospital setting. Results With adjustments for confounders, including mean arterial pressure, and aortic root diameter, as compared to age- and sex-matched controls, both Zc and the pressures generated by the product of peak aortic flow (Q) and Zc (PQxZc) were markedly increased in patients with CAD (p<0.0001) and those with stroke or CLI (p<0.005). Moreover, as compared to patients with stroke and CLI, those with CAD also had marked increases in both Zc and PQxZc (p<0.0001). As a consequence, with adjustments for the same confounders, the pressures generated by forward wave pressures (Pf) were markedly increased in patients with CAD as compared to controls and to patients with alternative arterial diseases (p<0.0001). Importantly, after further adjustments for brachial PP or SBP, the higher Pf values in patients with CAD were retained (p<0.005 to <0.0001). In contrast, with adjustments for brachial SBP and confounders, central aortic PP did not differ between groups. Conclusion Independent of confounders and aortic root diameter, a marked increase in proximal aortic Zc occurs in patients with CAD as compared to both age and sex-matched controls and patients with arterial disease in alternative beds. This translates into a strikingly greater central arterial pulsatile load determined by forward travelling pressure waves, but not peak central PP than that predicted by brachial BP measurements. These data support a need for intense brachial BP lowering in CAD. Name: Presenting Author Information Article Category Abstract Title From the Cardiovascular Pathophysiology and Genomics Research Unit, Schools of Physiology,* Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa. nellyels14@gmail.com English Abstract Clinical Marked Increases in Proximal Aortic Characteristic Impedance and hence Forward Wave Pressures Beyond Brachial Blood Pressure in Patients with Angiographic Proven Coronary Artery Disease Author Affiliation: Email: Danelle Els Authors Name & Surname Title Expertise Affiliation Email Country Danelle Els Ms From the Cardiovascular Pathophysiology and Genomics Research Unit, Schools of Physiology,* Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa. nellyels14@gmail.com South Africa Ferande Peters Prof Cardiovascular Specialist From the Cardiovascular Pathophysiology and Genomics Research Unit, Schools of Physiology,* Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa. ferande.peters@gmail.com South Africa ORAL PRESENTATION
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