Case studies

Subjects measured with Arteriograph

• The scope of the Arteriograph:1. Screening asymptomatic,

apparently healthy subjects• It makes possible to detect

atherosclerosis in an early phase

2. Evaluating the efficiency of applied therapy• Follow-up• Comparison

1. Screening asymptomatic, apparently healthy subjects

The data show low risk – the subject is presumed to be healthy, no intervention

is needed (according to guidelines) !!!

However, according to arterial stiffness evaluation with Arteriograph...

Elevated Aix = risk of endothel disfunction !!!

• Examination:– High cholesterol level (7,30 mmol/l)

was determined

• Conclusion:– By screening a low-risk, apparently

healthy subject with Arteriograph risk of endothel disfunction could be showed

– Therefore the screening of asymptomatic subject with Arteriograph is needed and important !!!

However according to arterial stiffness evaluation with Arteriograph...

Elevated PWV (>9,62) = high CV risk !!!

According to ESH / ESC guidelines intervention is needed !!!

Enalapril, Hydrochlorothiazide

Low CV risk, according to SCORE stratification, no intervention is needed

• Examination:– Carotid Ultrasound – positive

(plaque)

• Conclusion:– By screening an apparently healthy

subject with Arteriograph high CV risk could be showed

– Further examination (CUS) confirmed the necessity of treatment

2. Evaluating the efficiency

of applied therapy

Bisoprolol, Ramipril

Abnormal Aix, high central blood pressure

(Increased peripheral vasoconstriction!)

First example

Use a β-blocker, with vasodilation effect !!!

However…

Treated (β-blocker) hypertensive subject

Quinapril, Nebivolol, Atorvastatin, Acetylsalicylic Acid

First example

β-blocker with vasodilation effect

Normal Aix, normal central blood pressure !!!

The same subject with modified therapy

Bisoprolol, SimvastatinTreated (β-blocker) hypertensive subject

Abnormal Aix, high central blood pressure

(Increased peripheral vasoconstriction!)

What are we supposed to do???

Rethink the treatment!!! (Change therapy!)

Second example

Amlodipine, SimvastatinThe suggested new medicine is a CCB

Normal Aix, improved central systolic blood pressure !!!

Second example

• Conclusion:– When treating a hypertensive

subject, it is very important to lower - besides the peripheral BP - the central blood pressure as well !!!

– The Arteriograph gives important hemodynamical parameters by which the effect of an anti-hypertensive drug can be evaluated

Acetylsalicylic Acid, Clopidogrel, Ramipril

A study ???

Post-MI, post-PTCA subject

Which one is good prognosis:

• high Aix, or

• low Aix

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