الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
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Abstract
Central pressure is more significantly related to CV events than brachial pressure. The CAP waveform is the sum of the pressure wave that is generated by the LV and the reflected waves from the peripheral circulation. When the large arteries are healthy and compliant, the reflected wave gets together with the incident wave during diastole, which maintains coronary blood flow, but when there is aortic stiffness, pulse wave velocity increases so that the reflected and incident waves get together in systole, thereby augmenting systolic rather than diastolic pressure which increases the left ventricular after load and reduces the diastolic coronary flow. Increased wave reflections accompanied by late systolic load while prolonging the process of relaxation, it increases the duration of LV ejection compromising diastole by shortening the time for complete relaxation.
The aim of the work is to assess the relation of aortic stiffness and central aortic blood pressure to left ventricular hypertrophy, function and extent of coronary artery disease.
Our study was carried on 25 patients with stable CAD presented to Alexandria Main University Hospital for coronary angiography and 10 healthy control subjects from September 2017 to December 2018.
All patients were subjected to detailed history taking and clinical evaluation. Noninvasive assessment of central aortic pressure and aortic stiffness by brachial cuff pulse volume plethysmography (ARCsolver) incorporated in Mobile-O-Graph PWA device (IEM GmbH) was done including AIx) and PWV. Using transthoracic echocardiography, we assessed LV thickness, diastolic and systolic dimensions and calculated LV mass. Left ventricular ejection fraction (LVEF) was measured by M-mode and by the biplane Simpson method. Mitral inflow was assessed using a pulsed-wave Doppler beam, the E- and A-wave peak velocities were measured and the E/A ratio calculated. Doppler tissue imaging of the mitral annulus was done using a sample volume placed in the septal and lateral mitral valve annulus and each of S , E’, A’ and were measured. E/E’ ratio was calculated . Coronary artery catheterization was done and the extent of CAD was calculated using the Gensini score.