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The importance of arterial stiffness
Dr. Tamás Hodosi MD medical director
www.arteriograph.co.uk
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Clinical manifestations of atherosclerosis

STROKE
CVD
CAD
PAD
In about 30 of CVD, the first clinical symptom
is unfortunately the last one(?)
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The genesis of atherosclerosis
SUNRISE
SUNSET
DECADES
AIX
PWV
STROKE, MI, PAD
ENDOTHEL DYSFUNCTION
VASCULAR DYSFUNCTION
HYPERTENSION
ART. SCLER.
REVERSIBLE
IRREVERSIBLE ? (CAMELOT, REVERSAL, ASTEROID)
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HYPERTENSION IS PRESENT IN LESS THAN 40 OF
PATIENTS SUSTAINING A HEART ATTACK, AND
HIGH CHOLESTEROL LEVELS ARE PRESENT IN LESS THAN
40 OF PATIENT SUSTAINING HEART ATTACK !
1998, John Hopkins Hospital (USA) White Papers,
Coronary Heart Disease
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Non-invasive methods detecting atherosclerosis

• Ankle/brachial index
• easy to measure - detects later stage (PAD)
• IMT (carotid arteries)
• expensive, difficult detects earlier stage
• Cardio-CT (calcium score and coronary arteries
  evaluation)
• expensive, difficult detects later stage
• MR
• expensive, difficult detects later stage
• Flow mediated vasodilatation (FMD)
• difficult, expensive detects early stage
• Arterial stiffness measurement with applanation
  tonometry
• moderate expensive, rather difficult, user
  dependent, detects early stage

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Methods and their Sensitivity for detecting CAD
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CV RISK STRATIFICATION (SCORE)
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The operation principle of oscillometric pressure
wave recording
SUPRASYSTOLIC (gtS35) PRESSURE IN THE CUFF
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THE PRINCIPLE OF OPERATION STOP FLOW CONDITION
P1
P2
P3
P2
?V1 ? ?P1
?V2 ? ?P2
P1
?V3? ?P3
P3
SUPRASYSTOLIC (S35 mmHg)
CUFF PRESSURE
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ARTERIOGRAPH MEASURED PARAMETERS DESCRIBING
ARTERIAL FUNCTION
AUGMENTATION INDEX (Aix)
WHICH REFLECTS TO THE TPR AND ENDOTHEL
FUNCTION AORTIC PULSE WAVE VELOCITY (PWVao)
WHICH REFLECTS TO THE
STIFFNESS OF THE AORTIC WALL SAI, DAI AND
DRA BY MEASURING THE SYSTOLIC AND DIASTOLIC AREA
INDEX AND DIASTOLIC REFLECTION AREA THE LEFT
CORONARY FILLING CONDITION CAN BE
ASSESSED SYSTOLIC/DIASTOLIC BP AND HR CENTRAL
(AORTIC) SBP

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INDICATIONS OF OSCILLOMETRIC ARTERIAL FUNCTION
MEASUREMENTS
SCREENING FOR EARLY ATHEROSCLEROSIS AMONG
ASYMPTOMATIC, APPARENTLY HEALTHY SUBJECTS (ONLY
ARTERIOGRAPH IS USEFUL FOR THIS PURPOSE) AND
ASSESSING THE EFFECT OF THE THERAPY ON VASCULAR
FUNCTION AMONG PATIENTS WHERE ATHEROSCLEROSIS HAS
BEEN ESTABLISHED (CAD, POST MI, STROKE, PAD) THE
METHOD CAN NOT BE USED FOR DETECTING LOCAL
STENOSIS IN A CERTAIN ARTERY !
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Horvath, I. et al. University of Pécs, Dept. of
Cardiology, Pécs, Hungary
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SIMULTANEOUS INTRAARTERIAL PRESSURE PULSE IN
THE BRACHIAL ARTERY
NON-INVASIVE OSCILLOMETRIC PULSE OF THE
BRACHIAL ARTERY, RECORDED BY ARTERIOGRAPH AT
DIASTOLIC CUFF PRESSURE
Horvath, I. et al. University of Pécs, Dept. of
Cardiology, Pécs, Hungary
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Wave reflection at low TPR in relation to the
central Aix
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Wave reflection at high TPR in relation to the
central Aix
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Aix can only be accurately calculated if late
systolic wave was recognized !
Normal Aix PWVao and SBPao
Augmentation index (Aix) (P2 P1 / PP) x 100
Low peripheral arterial resistance
P1 early systolic wave P2 late systolic
wave PP pulse pressure
P1
P2
PP
Ejection Duration
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Abnormal Aix PWVao and SBPao
Augmentation index (Aix) (P2 P1 / PP) x 100
P2
High peripheral arterial resistance
P1
PP
Ejection Duration
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PWVao MEASUREMENT
The time between the direct and reflected
pressure waves is equal with the transit time of
the direct wave to the reflection site
(bifurcation) and back.
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THRESHOLD VALUES OF AIX PWVao MEASURED WITH
ARTERIOGRAPH
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What to do if elevated stiffness parameters are
found?
Increased/abnormal Aix (during routine screening
without knowing anything about the subject)
Lipidprofile (LDL, HDL cholesterol,
trigliceride) fasting and postprandial
se-glucose, Hgb A1C routine liver
function tests, renal function tests,
24 collected urine
for microalbumin excretion and creatinine
clearance If BPgt140/90 mmHg - ABPM or
HBPM Lifestyle modification Increased/abnormal
PWVao The patient should be considered to be in
a high/very high CV risk! If SBPlt140 mmHg,
HRlt80/min carotid ultrasound for echogenic
plaque (gt1 mm, or IMT gt1,3 mm) If SBPgt140 mmHg,
HRgt80/min repeat Arteriograph measurement when
BPlt140 mmHg and HRlt80/min and if PWVao
increased/abnormal perform carotid ultrasound
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DRA is a new complex parameter
of describing left coronary perfusion
condition. The area of diastolic wave reflection
and the duration of diastole is
assessed.
AIx -38,2
DRA 50,7
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DRA is a new complex parameter
of describing left coronary perfusion
condition. The area of diastolic wave reflection
and the duration of diastole is
assessed.
Aix 29,1
DRA 11,8
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THANK YOU FOR YOUR ATTENTION !
Unimedic Ltd Distributor of  TensioClinic
Arteriograph Tel/Fax [phone]
6759 Mobile [phone] dr.tamas.hodosi
_at_unimedic.co.uk www.unimedic.co.uk Company
Registration Number 6435900 VAT Number 923 7885
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Dr. Tamás Hodosi MD medical director