This study evaluated the use of newer noninvasive pulse wave indices to detect and assess the severity of coronary artery disease. 48 patients undergoing coronary angiography were evaluated. Three new indices from pulse wave analysis - noninvasive CAD severity index, viability velocity index, and pressure ischemia index - were found to excellently predict significant CAD and assess its severity. The study suggests these indices could help extend use of arterial property measurements to broader prevention of cardiovascular disease and guide more aggressive diagnosis and treatment strategies.

1. Use of Newer Noninvasive Pulse Wave Indices
to detect and asses severity of Coronary Artery
Disease.
Gopi Krishna Rayidi M.D¹,Maddury Jyotsna MD, DM¹, Prof. D. Seshagiri rao MD,DM,
Prof. O. Sai Satish MD, DM¹, Prof. Ramesh MD², Padmaja MD ².
¹ Department of Cardiology, ² Department of Clinical Pharmacology,
Nizam’s institute of medical sciences .hyderabad.

2. Pulse Wave Indices

3. MATERIALS AND METHODS
Inclusion criteria:
 51 patients who were undergoing coronary
angiogram either for the diagnosis or
exclusion of CAD.
Exclusion criteria:
 Patients with:
 PVD.
 Valvular heart disease.
 CHF.
 Quality index of pulse <80%.
 Arrhythmias were excluded from the study.

4. AtCor Medical Applanation Tonometer Software Version 8,
AtCor Medical, West Ryde, New South Wales, Australia

5. 3 PATIENTS WERE EXCLUDED
48 patients underwent coronary angiogram.
CAD scoring based on severity
Normal=0,
<50 Stenosis =1
 Insignificant CAD (50-70% Stenosis in
any CA except for LMCA < 50 )=2
Significant CAD (>70% Stenosis in any CA)
=3.

6. Total CAD severity score is calculated by the score
of each CA multiplied by no. of CA
involvement(Range 0-9).
Sub scoring in significant CAD:
70 to 80 = 3,
80 to 90 = 4,
> 90 =5,
Each lesion score is multiplied by no Cor.Artery
involved.
So, Sub scoring in significant CAD -(Range 3-15).

7. NEWER PULSE WAVE INDICES
 Pressure Ischemia Index (PII - the product AI x SBP/
SEVR)
 Viability Velocity Index (VVI = the product of SBP x
PWV/ SEVR)
 Non Invasive CAD Severity Index (NI CAD SI =
the product AI x SBP x PWV/ SEVR)
 Above indices Were used to detect CAD and severity
of CAD

8. Baseline characteristics
AGE 51.66±7.94
NO.OF PTS 48
M:F 29:19
DM 24
HTN 28
SMOKING 13
F/H OF CAD 14
PTS WITH NO RISK FACTORS 20
HR (MEAN±SD bpm ) 74±11.61
SBP (MEAN±SD mm Hg) 129.85±16.45
DBP (MEAN±SD mm Hg) 79.27±4.94
PP (MEAN±SD mm Hg) 50.37±14.28

9. RESULTS
Angiogram Score Pulse Wave Analysis
16 patients had CAD NON Significance
GROUP CAD (p≤0.05)
angiographic score of 0 GROUP
15 patients had S.V.D NI 12389.4 5538.59 p≤0.005
13 patients had D.V.D. CAD SI
04 patients had T.V.D. VV 153911.4 127258.4 p≤0.018
Index
19 pts had severity score
<5. PII 1526.1 748.29 p≤0.008
13pt had severity score>5

11. Discussion
 Central blood pressure and measures of arterial
stiffness have been demonstrated to be important
parameters in assessing CV risk.
 Central systolic pressure has been shown to be an
independent predictor of incident CVD , independent
of brachial systolic blood pressure.
 Previous studies used noninvasive parameters which
can detect the presence or absence of CAD , but not
the severity of CAD.

12.  Nurnberger et al,. found a strong positive correlation between
Aix,pwv, and the risk of developing CAD, as assessed by the
ESC Risk Score, in 144 asymptomatic patients without a
previous history of CAD or atherosclerotic disease .
 Thomas Weber et al,study showed noninvasively determined
manifestations of arterial stiffening and increased wave
reflections are strong, independent risk markers for premature
coronary artery disease on 465 pts, both of which were similar
to the present study.
1.J Hypertens. 2002;20: 2407–2414.
2.Circulation. 2004;109:184-189

13. Limitations
 our study is the confinement to symptomatic patients
referred for coronary angiography
 Our findings might not be applicable to the general
population.
 Reasonable therapeutic strategy based on information
obtained by PWA has to be tested in a randomized controlled
trial.

14.  Radial artery AT has a sound physiologic
basis and hence exciting potential in the arena
of clinical medicine.
 published treatment and outcome data for it
are less complete than for brachial blood
pressure.

15. Conclusions
 Three New indices of Noninvasive Pulse Wave
Analysis (NI CAD SI, VVI and PII) are excellent in
the prediction of significant CAD.
 NI CAD SI is better in predicting even severity
of C.A.D.
 Present study findings might extend the
recommendation for
 measuring arterial wall properties for the
preventive management of CVD to a
broader spectrum of the population.
 planning more aggressive diagnostic as
well as therapeutic stratergies.

16. Thank You