Cardiol Res

Cardiology Research, ISSN 1923-2829 print, 1923-2837 online, Open Access

Article copyright, the authors; Journal compilation copyright, Cardiol Res and Elmer Press Inc

Journal website https://www.cardiologyres.org

Original Article

Volume 8, Number 2, April 2017, pages 36-43

Arterial Velocity Pulse Index as a Novel Marker of Atherosclerosis Using Pulse Wave Analysis on High Sensitivity Troponin T in Hypertensive Patients

Figure 1. The measurement theory of AVI. (a) indicates normal pattern pulse wave pattern, and (b) indicates abnormal pulse wave pattern by increase of arterial reflection wave. AVI is automatically calculated as 20 × (Vr /Vf), wherein Vf is the first peak of the differentiated waveform between pulse wave and time and Vr is the absolute value of the bottom of the valley of differentiated waveforms between pulse wave and time. The systolic latter waveform rapidly increases and decreases in response to the reflected wave. However, the initial waveform is not influenced by the reflected wave. Vf reflects the initial waveform, and Vr reflects the decreased waveform. Therefore, as waves reflections increase, AVI increases in parallel with the increase in Vr unlike the normal pulse wave pattern. hs-cTnT: high-sensitivity cardiac troponin T; BP: blood pressure; FBG: fasting blood glucose; IRI: immunoreactive insulin; HOMA-IR: homeostatic model assessment of insulin resistance; LDL: low-density lipoprotein; HDL: high-density lipoprotein; eGFR: estimated glomerular filtration rate; BNP: brain natriuretic peptide; hs-CRP: high-sensitivity C-reactive protein; d-ROMs: derivatives of reactive oxygen metabolites; AVI: arterial velocity pulse index; CCB: calcium channel blocker; RAS: renin-angiotensin system.

Figure 2. Histogram of AVI values. AVI ranged from 11 to 49, and the median value was 28. The distribution AVI was nearly normal. hs-cTnT: high-sensitivity cardiac troponin T; BP: blood pressure; FBG: fasting blood glucose; IRI: immunoreactive insulin; HOMA-IR: homeostatic model assessment of insulin resistance; LDL: low-density lipoprotein; HDL: high-density lipoprotein; eGFR: estimated glomerular filtration rate; BNP: brain natriuretic peptide; hs-CRP: high-sensitivity C-reactive protein; d-ROMs: derivatives of reactive oxygen metabolites; AVI: arterial velocity pulse index; CCB: calcium channel blocker; RAS: renin-angiotensin system.

**Table 1.** Patient Characteristics
	Overall	hs-cTnT non-detection	hs-cTnT detection	P value
Data are expressed as mean ± SD. hs-cTnT: high-sensitivity cardiac troponin T; BP: blood pressure; FBG: fasting blood glucose; IRI: immunoreactive insulin; HOMA-IR: homeostatic model assessment of insulin resistance; LDL: low-density lipoprotein; HDL: high-density lipoprotein; eGFR: estimated glomerular filtration rate; BNP: brain natriuretic peptide; hs-CRP: high-sensitivity C-reactive protein; d-ROMs: derivatives of reactive oxygen metabolites; AVI: arterial velocity pulse index; CCB: calcium channel blocker; RAS: renin-angiotensin system.
n (male/female)	455 (181/274)	50 (20/30)	405 (161/244)	0.973
Age (years)	65 ± 11	61 ± 11	66 ± 11	< 0.01
Height (m)	1.6 ± 0.1	1.6 ± 0.1	1.6 ± 0.1	0.873
Body weight (kg)	57 ± 10	54 ± 11	58 ± 11	< 0.05
Body mass index (kg/m²)	22 ± 4	21 ± 3	23 ± 4	< 0.05
Smoking, n (%)	109 (24)	13 (26)	96 (24)	0.720
Systolic BP (mm Hg)	157 ± 8	157 ± 10	157 ± 8	0.953
Diastolic BP (mm Hg)	91 ± 9	91 ± 9	91 ± 10	0.572
Pulse rate (mm Hg)	68 ± 11	70 ± 11	68 ± 10	0.129
Cornell voltage (mm)	15 ± 6	12 ± 7	15 ± 5	< 0.001
Diabetes mellitus (%)	189 (42)	20 (40)	169 (42)	0.816
FBG (mg/dL)	113 ± 24	112 ± 20	113 ± 24	0.819
IRI (μg/mL)	7.3 ± 4.4	7.5 ± 4.8	7.3 ± 4.4	0.626
HOMA-IR	2.1 ± 1.4	2.1 ± 1.3	2.1 ± 1.4	0.864
Dyslipidemia (%)	346 (76)	29 (54)	317 (64)	0.172
Total cholesterol (mg/dL)	221 ± 42	219 ± 42	221 ± 41	0.541
LDL cholesterol (mg/dL)	137 ± 37	136 ± 40	137 ± 38	0.658
Triglyceride (mg/dL)	177 ± 72	170 ± 83	179 ± 69	0.279
HDL cholesterol (mg/dL)	49 ± 16	49 ± 14	48 ± 16	0.62
eGFR (mL/min/1.73 m²)	64 ± 21	69 ± 21	63 ± 18	< 0.05
Log-urinary albumin (mg/gCr)	1.5 ± 0.5	1.3±0.5	1.6 ± 0.5	< 0.01
Log-BNP (pg/mL)	86 ± 67	57±55	89 ± 67	< 0.01
Log-hs-CRP (mg/L)	-1.2 ± 0.6	-1.2±0.6	-1.2 ± 0.6	0.331
d-ROMs test (U. Carr)	355 ± 93	330±97	359 ± 92	< 0.01
AVI	28 ± 7	24±8	28 ± 7	< 0.001
Log-hs-cTnT (ng/mL)	-1.9 ± 0.2	-	-1.9 ± 0.2	-
Medication
CCB, n (%)	332 (73)	36 (72)	296 (73)	0.652
RAS inhibitor, n (%)	223 (49)	25 (50)	198 (49)	0.753
Statin, n (%)	155 (34)	17 (34)	138 (34)	0.889

Table 1. Patient Characteristics

Overall

hs-cTnT non-detection

hs-cTnT detection

P value

Data are expressed as mean ± SD. hs-cTnT: high-sensitivity cardiac troponin T; BP: blood pressure; FBG: fasting blood glucose; IRI: immunoreactive insulin; HOMA-IR: homeostatic model assessment of insulin resistance; LDL: low-density lipoprotein; HDL: high-density lipoprotein; eGFR: estimated glomerular filtration rate; BNP: brain natriuretic peptide; hs-CRP: high-sensitivity C-reactive protein; d-ROMs: derivatives of reactive oxygen metabolites; AVI: arterial velocity pulse index; CCB: calcium channel blocker; RAS: renin-angiotensin system.

n (male/female)

455 (181/274)

50 (20/30)

405 (161/244)

0.973

Age (years)

65 ± 11

61 ± 11

66 ± 11

< 0.01

Height (m)

1.6 ± 0.1

0.873

Body weight (kg)

57 ± 10

54 ± 11

58 ± 11

< 0.05

Body mass index (kg/m²)

22 ± 4

21 ± 3

23 ± 4

< 0.05

Smoking, n (%)

109 (24)

13 (26)

96 (24)

0.720

Systolic BP (mm Hg)

157 ± 8

157 ± 10

157 ± 8

0.953

Diastolic BP (mm Hg)

91 ± 9

91 ± 10

0.572

Pulse rate (mm Hg)

68 ± 11

70 ± 11

68 ± 10

0.129

Cornell voltage (mm)

15 ± 6

12 ± 7

15 ± 5

< 0.001

Diabetes mellitus (%)

189 (42)

20 (40)

169 (42)

0.816

FBG (mg/dL)

113 ± 24

112 ± 20

113 ± 24

0.819

IRI (μg/mL)

7.3 ± 4.4

7.5 ± 4.8

7.3 ± 4.4

0.626

HOMA-IR

2.1 ± 1.4

2.1 ± 1.3

2.1 ± 1.4

0.864

Dyslipidemia (%)

346 (76)

29 (54)

317 (64)

0.172

Total cholesterol (mg/dL)

221 ± 42

219 ± 42

221 ± 41

0.541

LDL cholesterol (mg/dL)

137 ± 37

136 ± 40

137 ± 38

0.658

Triglyceride (mg/dL)

177 ± 72

170 ± 83

179 ± 69

0.279

HDL cholesterol (mg/dL)

49 ± 16

49 ± 14

48 ± 16

0.62

eGFR (mL/min/1.73 m²)

64 ± 21

69 ± 21

63 ± 18

< 0.05

Log-urinary albumin (mg/gCr)

1.5 ± 0.5

1.3±0.5

1.6 ± 0.5

< 0.01

Log-BNP (pg/mL)

86 ± 67

57±55

89 ± 67

< 0.01

Log-hs-CRP (mg/L)

-1.2 ± 0.6

-1.2±0.6

-1.2 ± 0.6

0.331

d-ROMs test (U. Carr)

355 ± 93

330±97

359 ± 92

< 0.01

AVI

28 ± 7

24±8

28 ± 7

< 0.001

Log-hs-cTnT (ng/mL)

-1.9 ± 0.2

Medication

CCB, n (%)

332 (73)

36 (72)

296 (73)

0.652

RAS inhibitor, n (%)

223 (49)

25 (50)

198 (49)

0.753

Statin, n (%)

155 (34)

17 (34)

138 (34)

0.889

**Table 2.** Correlation Between hs-cTnT, AVI and Clinical Parameters in hs-cTnT Detectable Patients
	r
r is correlation coefficient. P < 0.001, P < 0.01, **P < 0.05. hs-cTnT: high-sensitivity cardiac troponin T; BP: blood pressure; FBG: fasting blood glucose; IRI: immunoreactive insulin; HOMA-IR: homeostatic model assessment of insulin resistance; LDL: low-density lipoprotein; HDL: high-density lipoprotein; eGFR: estimated glomerular filtration rate; BNP: brain natriuretic peptide; hs-CRP: high-sensitivity C-reactive protein; d-ROMs: derivatives of reactive oxygen metabolites; AVI: arterial velocity pulse index; CCB: calcium channel blocker; RAS: renin-angiotensin system.
Sex (female = 0, male = 1)	-0.06	-0.13**
Age	0.40*	0.36*
Height	0.06	-0.32*
Body weight	0.09	-0.18*
Body mass index	0.10***	-0.08
Smoking (no = 0, yes = 1)	0.02	0.09
Systolic BP	0.08	0.12**
Diastolic BP	0.05	0.08
Pulse rate	0.04	0.26*
Cornell voltage	0.21*	0.35*
Diabetes mellitus (no = 0, yes = 1)	0.07	0.08
FBG	0.03	0.09
IRI	0.04	0.07
Log-HOMA-IR	0.06	0.06
Dyslipidemia (no = 0, yes = 1)	-0.03	-0.01
Total cholesterol	-0.06	0.05
LDL cholesterol	-0.05	0.04
Triglyceride	-0.03	0.06
HDL cholesterol	-0.06	-0.04
eGFR	-0.13**	-0.10***
Log-urinary albumin	0.20*	0.29*
Log-BNP	0.25*	0.35***
Log-hs-CRP	0.10***	0.11***
d-ROMs test	0.35*	0.37*
AVI	0.42*	-
Log-hs-cTnT	-	0.42*
CCB (no = 0, yes = 1)	-0.06	-0.05
RAS inhibitor (no = 0, yes = 1)	-0.06	-0.05
Statin (no = 0, yes = 1)	-0.03	-0.02

Table 2. Correlation Between hs-cTnT, AVI and Clinical Parameters in hs-cTnT Detectable Patients

Log-hs-cTnT

AVI

r is correlation coefficient. *P < 0.001, **P < 0.01, ***P < 0.05. hs-cTnT: high-sensitivity cardiac troponin T; BP: blood pressure; FBG: fasting blood glucose; IRI: immunoreactive insulin; HOMA-IR: homeostatic model assessment of insulin resistance; LDL: low-density lipoprotein; HDL: high-density lipoprotein; eGFR: estimated glomerular filtration rate; BNP: brain natriuretic peptide; hs-CRP: high-sensitivity C-reactive protein; d-ROMs: derivatives of reactive oxygen metabolites; AVI: arterial velocity pulse index; CCB: calcium channel blocker; RAS: renin-angiotensin system.

Sex (female = 0, male = 1)

-0.06

-0.13**

Age

0.40*

0.36*

Height

0.06

-0.32*

Body weight

0.09

-0.18*

Body mass index

0.10***

-0.08

Smoking (no = 0, yes = 1)

0.02

0.09

Systolic BP

0.08

0.12**

Diastolic BP

0.05

0.08

Pulse rate

0.04

0.26*

Cornell voltage

0.21*

0.35*

Diabetes mellitus (no = 0, yes = 1)

0.07

0.08

FBG

0.03

0.09

IRI

0.04

0.07

Log-HOMA-IR

0.06

Dyslipidemia (no = 0, yes = 1)

-0.03

-0.01

Total cholesterol

-0.06

0.05

LDL cholesterol

-0.05

0.04

Triglyceride

-0.03

0.06

HDL cholesterol

-0.06

-0.04

eGFR

-0.13**

-0.10***

Log-urinary albumin

0.20*

0.29*

Log-BNP

0.25*

0.35***

Log-hs-CRP

0.10***

0.11***

d-ROMs test

0.35*

0.37*

AVI

0.42*

Log-hs-cTnT

0.42*

CCB (no = 0, yes = 1)

-0.06

-0.05

RAS inhibitor (no = 0, yes = 1)

-0.06

-0.05

Statin (no = 0, yes = 1)

-0.03

-0.02

**Table 3.** Multiple Regression Analysis
Dependent variable	β	t value	P value
(A) Subordinate factor is log-hs-cTnT. R² = 0.23, F = 12.5, P < 0.001. (B) Subordinate factor is AVI. R² = 0.43, F = 22.7, P < 0.001. hs-cTnT: high-sensitivity cardiac troponin T; BP: blood pressure; FBG: fasting blood glucose; IRI: immunoreactive insulin; HOMA-IR: homeostatic model assessment of insulin resistance; LDL: low-density lipoprotein; HDL: high-density lipoprotein; eGFR: estimated glomerular filtration rate; BNP: brain natriuretic peptide; hs-CRP: high-sensitivity C-reactive protein; d-ROMs: derivatives of reactive oxygen metabolites; AVI: arterial velocity pulse index; CCB: calcium channel blocker; RAS: renin-angiotensin system.
(A) AVI	0.35	6.6	< 0.001
Age	0.33	6.0	< 0.001
BNP	0.14	3.0	< 0.01
Log-urinary albumin	0.12	2.5	< 0.01
d-ROMs test	0.11	2.3	< 0.01
Cornell voltage	0.10	2.1	< 0.05
eGFR	-0.07	-1.5	0.152
Log-hs-CRP	0.06	1.4	0.148
Body mass index	0.02	0.3	0.730
(B) Log-hs-cTnT	0.27	6.3	< 0.001
Age	0.25	6.0	< 0.001
Cornell voltage	0.23	5.6	< 0.001
Height	-0.22	-3.6	< 0.001
Log-urinary albumin	0.12	2.9	< 0.01
Pulse rate	-0.11	-2.8	< 0.01
d-ROMs test	0.11	2.7	< 0.01
BNP	0.09	1.9	0.063
Sex	0.09	1.8	0.132
Systolic BP	0.06	1.5	0.168
Log-hs-CRP	0.06	1.4	0.173
eGFR	-0.04	-1.2	0.289
Body weight	-0.09	-1.9	0.058

Table 3. Multiple Regression Analysis

Dependent variable

t value

P value

(A) Subordinate factor is log-hs-cTnT. R² = 0.23, F = 12.5, P < 0.001. (B) Subordinate factor is AVI. R² = 0.43, F = 22.7, P < 0.001. hs-cTnT: high-sensitivity cardiac troponin T; BP: blood pressure; FBG: fasting blood glucose; IRI: immunoreactive insulin; HOMA-IR: homeostatic model assessment of insulin resistance; LDL: low-density lipoprotein; HDL: high-density lipoprotein; eGFR: estimated glomerular filtration rate; BNP: brain natriuretic peptide; hs-CRP: high-sensitivity C-reactive protein; d-ROMs: derivatives of reactive oxygen metabolites; AVI: arterial velocity pulse index; CCB: calcium channel blocker; RAS: renin-angiotensin system.

(A) AVI

0.35

6.6

< 0.001

Age

0.33

6.0

< 0.001

BNP

0.14

3.0

< 0.01

Log-urinary albumin

0.12

2.5

< 0.01

d-ROMs test

0.11

2.3

< 0.01

Cornell voltage

0.10

2.1

< 0.05

eGFR

-0.07

-1.5

0.152

Log-hs-CRP

0.06

1.4

0.148

Body mass index

0.02

0.3

0.730

(B) Log-hs-cTnT

0.27

6.3

< 0.001

Age

0.25

6.0

< 0.001

Cornell voltage

0.23

5.6

< 0.001

Height

-0.22

-3.6

< 0.001

Log-urinary albumin

0.12

2.9

< 0.01

Pulse rate

-0.11

-2.8

< 0.01

d-ROMs test

0.11

2.7

< 0.01

BNP

0.09

1.9

0.063

Sex

0.09

1.8

0.132

Systolic BP

0.06

1.5

0.168

Log-hs-CRP

0.06

1.4

0.173

eGFR

-0.04

-1.2

0.289

Body weight

-0.09

-1.9

0.058