Interrogation of the radial artery waveform can provide information on augmentation index

In women with PE, compared to normotensive controls, PWV and AIx were both increased in one study whereas in a further study, none of them was increased following adjustment for possible confounders. Kaihura et al reported that only PWV, but not AIx, was increased whereas the last three studies only assessed AIx and this was found to be elevated. In the current study, we have used Doppler examination of the uterine arteries in the second trimester of pregnancy in order to identify women at risk of PE. We sought to investigate whether altered maternal arterial stiffness at mid-pregnancy, as assessed by applanation tonometry, precedes the onset of PE. Peripheral blood pressure was Clofazimine measured in the right arm using an ambulatory blood pressure monitor, which has been validated for use in pregnancy. Systolic and diastolic BP were measured twice and averaged. Each heartbeat generates a pulse wave that travels away from the heart and is reflected back at the areas of high resistance. The reflected wave travels back towards the heart and meets the advancing wave, augmenting its height. Generally, the reflected wave reaches the aorta during diastole, enhancing the cardiac perfusion. When arterial stiffness in increased, the arterial pulse wave travels faster, so the reflected wave reaches advancing wave in the systole, resulting in significant augmentation of the systolic peak. This can be measured as increased augmentation index. Interrogation of the radial artery waveform can provide information on augmentation index and the central, aortic haemodynamics. Radial artery waveforms were obtained with a high-fidelity micromanometer from the wrist,Clinafloxacin and a corresponding central waveform was generated with a validated transfer function. Augmentation index, a composite measure of systemic arterial stiffness and wave- reflection amplitude, and central systolic, diastolic, pulse pressure were determined with the integrated software. Normality of the distribution of the data was examined with the Kolmogorov-Smirnov test. For those parameters that were not normally distributed logarithmic transformation was performed. Data were expressed as mean 6 standard deviation or as median and interquartile range for normally and non-normally distributed data, respectively. Comparisons between groups were performed using t-test, Mann-Whitney or chi-square for numerical and categorical data, respectively. The findings of this study demonstrate that in women destined to develop PE, during the second-trimester of pregnancy there is an increase in maternal arterial stiffness as assessed by PWV of the carotid-femoral and carotid-radial parts of the arterial tree. The magnitude of the PWV increase of about 17% is similar to that reported in women with established PE and although small, is likely to be clinically significant considering the fact that aortic PWV increases by only,6% per decade in healthy individuals. Overall, women with impaired placentation, as detected by Doppler examination of the uterine arteries, had increased arterial stiffness suggesting that women at risk of developing PE have a high resistance circulation affecting different vascular beds including the fetoplacental unit and the maternal conduit arteries. It is likely that other, multiple factors such as maternal genetic susceptibility will eventually determine which women will develop PE.