Share This Article:

Cardiac index (CI) versus cardio ankle vascular index (CAVI) at different degrees of head-up tilt (HUT) in healthy subjects

Abstract Full-Text HTML XML Download Download as PDF (Size:1370KB) PP. 71-79
DOI: 10.4236/ojmip.2013.32011    3,555 Downloads   6,566 Views   Citations


The cardio-ankle vascular index (CAVI) is a new index of arterial stiffness that can be measured with a VaSera VS-1000 device. An association between certain arterial stiffness indices and cardiac function has been found but has not yet been validated. The aim of this study was to establish whether any significant relationship exists between cardiac index (CI) and CAVI. Twenty healthy male volunteers with a mean age of 30 ± 5 years and a mean BMI of 23.1 ± 1.1 kg/m2 participated in the study. CO was estimated using a Doppler technique, and CAVI was measured with a VaSeraVS-1000 device. A motorised tilting table was used to achieve head-up tilt (HUT) angles of 0°, 30°and 60°, to modify the peripheral sympathetic outflow. We found that there was a significant inverse correlation between CI and the degree of head-up tilt, ( for 0°and 30°; for 0° and 60°, p < 0.001 for both; for 30° and 60°, ). CAVI showed a significant positive correlation relative with the degree of HUT, ( for 0° and 30°; for 0° and 60°; for 30° and 60°, for all). A significant negative correlation was found between CI and CAVI r = - 0.47, p < 0.05. Additionally, a significant p < 0.001 increase in PVR values was observed for increasing HUT values. In conclusion: An inverse relationship between CI and CAVI was shown; a decrease in cardiac output is associated with an increase in CAVI values at different degrees of HUT. This association provides further insight into the postural link between cardiac output and arterial compliance.

Conflicts of Interest

The authors declare no conflicts of interest.

Cite this paper

Zwain, A. , Al Esawi, R. and Al-Dejeli, A. (2013) Cardiac index (CI) versus cardio ankle vascular index (CAVI) at different degrees of head-up tilt (HUT) in healthy subjects. Open Journal of Molecular and Integrative Physiology, 3, 71-79. doi: 10.4236/ojmip.2013.32011.


[1] Mosteller, R.D. (1987) Simplified calculation of body surface area. The New England Journal of Medicine, 317, 1098. doi:10.1056/NEJM198710223171717
[2] Ganong, W.F. (2003) Methods of measurement of cardiac output. Review of Medical Physiology, 29, 572-573.
[3] Feigenbaum, H., Armstrong, W.F. and Ryan, T. (2005) Feigenbaum’s echocardiography. 6th Edition, Hemodynemics, Quantification of Blood Flow, Lippincott Williams & Wilkins, Philadelphia, 2005, 216-221.
[4] Cardiac Catheterization (2009) Cardiovascular tests and procedures: Merck manual professional.
[5] Brandfonbrener, M., landowner, M. and Shock, N.W. (1955) Changes in cardiac output with age. Circulation, 12, 557-566. doi:10.1161/01.CIR.12.4.557
[6] Kuikka, J.T. and Lansimies, E. (1982) Effect of age on cardiac index, stroke index and left ventricular ejection fraction at rest and during exercise as studied by radiocardiography. Acta Physiologica Scandinavica, 114, 339-343. doi:10.1111/j.1748-1716.1982.tb06993.x
[7] Narahara, K.A. and Blettel, M.L. (1983) Effect of rate on left ventricular volumes and ejection fraction during chronic ventricular pacing. Circulation, 67, 323-329. doi:10.1161/01.CIR.67.2.323
[8] Szturz, P.S., Maca, J.M., Tichy, J.T., Sukenik, P.S., Chylek, V.C., Sklienka, P.S., Jahoda, J.J., and Kula, R.K. (2010) Maintenance of cardiac index within normal range is associated with mortality reduction in patients undergoing major urological surgery. Critical Care, 14, 123. doi:10.1186/cc8355
[9] Zuccala, G., Cattel, C., Manes-Gravina, E., Di Niro, M.G., Cocchi, A. and Bernabei, R. (1997) Left ventricular dysfunction: A clue to cognitive impairment in older patients with heart failure. Journal of Neurology, Neurosurgery & Psychiatry, 63, 509-512. doi:10.1136/jnnp.63.4.509
[10] Putzke, J.D., Williams, M.A., Rayburn, B.K., Kirklin, J.K. and Boll, T.J. (1998) The relationship between cardiac function and neuropsychological status among heart transplant candidates. Journal of Cardiac Failure, 4, 295-303. doi:10.1016/S1071-9164(98)90235-4
[11] Qiu, C., Winblad, B., Marengoni, A., Klarin, I., Fastbom, J. and Fratiglioni, L. (2006) Heart failure and risk of dementia and Alzheimer disease: A population-based cohort study. Archives of Internal Medicine, 166, 1003-1008. doi:10.1001/archinte.166.9.1003
[12] Jafferson, A.L., Himali, J.J., Beiser, A.S., Au, R., Massaro, J.M., Seshadri, S., Gona, P., Salton, C.J., DeCarli, C., O’Donnell, C.J., Benjamin, E.J., Wolf, P.A. and Manning J. (2010) Cardiac index is associated with brain aging: The Framingham heart study. Circulation Journal, 122, 690-697. doi:10.1161/CIRCULATIONAHA.109.905091
[13] Coffey, J.P. and Hill, J.C. (2005) Cardiac output and index in obese and non-obese patient using gated single photon emission tomography sestamibi perfusion imaging. The Journal of Hong Kong College of Radiologists, 8, 226-232.
[14] Rossi, R., Iaccarino, D., Nuzzo, A., Chiurlia, E., Bacco, L., Venturelli, A. and Modena, M.G. (2011) Influence of body mass index on extent of coronary atherosclerosis and cardiac events in a cohort of patients at risk of coronary artery disease. Nutrition, Metabolism & Cardiovascular Diseases, 21, 86-93. doi:10.1016/j.numecd.2009.09.001
[15] Romero-Corral, A., Montori, V.M., Somers, V.K., Korinek, J., Thomas, R.J., Allison, T.G., Mookadam, F. and Lopez-Jimenez, F. (2006) Association of bodyweight with total mortality and with cardiovascular events in coronary artery disease: A systematic review of cohort studies. Lancet, 368, 666-678. doi:10.1016/S0140-6736(06)69251-9
[16] Van Popele, N.M., Grobbee, D.E., Bots, M.L., Asmar, R., Topouchian, J., Reneman, R.S., Hoeks, A.P., van der Kuip, D.A., Hofman, A. and Witteman, J.C. (2001) Association between arterial stiffness and atherosclerosis. Stroke, 32, 454-460. doi:10.1161/01.STR.32.2.454
[17] Murray, C.J.L. and Lopez, A.D. (1997) Alternative projections of mortality and disability by cause 1990-2020: Global burden of disease study. Lancet, 349, 1498-1504. doi:10.1016/S0140-6736(96)07492-2
[18] Boutouyrie, P., Tropeano, A.I., Asmar, R., et al. (2002) Aortic-stiffness as an independent predictor of primary coronary events in hypertensive patients: A longitudinal study. Hypertension, 39, 10-15. doi:10.1161/hy0102.099031
[19] Satoh, N., Shimatsu, A., Kato, Y., Araki, R., Kayama, K. Tanabe, M., Ooishi, M., Kotani, K. and Ogawa, Y. (2008) Evaluation of the cardio ankle vascular index, anew indicator of arterial stiffness independent of blood pressure, in obesity metabolic syndrome. Hypertension Research, 31, 1921-1930. doi:10.1291/hypres.31.1921
[20] Grundy, S.M. (1999) Hypertriglyceridemia, insulin resistance, and the metabolic syndrome. American Journal of Cardiology, 83, 25F-29F. doi:10.1016/S0002-9149(99)00211-8
[21] Friedrich, M.J. (2002) Epidemic of obesity expands its spread to developing countries. Journal of the American Medical Association, 287, 1382-1386. doi:10.1001/jama.287.11.1382
[22] Togashi, K., Masuda, H., Rankuich, T., Taicka, S., Butchard, C. and Kamiya, H. (2002) A 12 year follows up study of treated obese children in Japan. International Journal of Obesity and Related Metabolic Disorders, 26, 770-777.
[23] Izzo, J.L. and Shykoff, B.E. (2001) Arterial stiffness clinical relevance, measurement, and Treatment. Reviews in Cardiovascular Medicine, 2, 29-40.
[24] Li, B.Y., Gao, H.Q., Li, X.L., Liu, Y.P. and Wang, M. (2006) Correlation between brachial-ankle pulse wave velocity and arterial compliance and cardiovascular risk factors in elderly patients with arteriosclerosis. Hypertension Research, 29, 309-314. doi:10.1291/hypres.29.309
[25] Ibata, J., Sasaki, H., Kakimoto, T., Matsuno, S., Nakatani, M., Kobayashi, M., Tatsumi, K., Nakano, Y., Wakasaki, H., Furuta, H., Nishi, M. and Nanjo, K. (2008) Cardioankle vascular index measures arterial wall stiffness independent of blood pressure. Diabetes Research and Clinical Practice, 80, 265-270. doi:10.1016/j.diabres.2007.12.016
[26] Okura, T., Watanab, S., Kurata, M., Manabe, S., Koresawa, M., Irita, J., Enomoto, D., Miyoshi, K., Fukuoka, T. and Higaki, J. (2007) Relationship between cardio-ankle vascular index (CAVI) and carotid atherosclerosis in patients with essential hypertension. Hypertension Research, 30, 335-340. doi:10.1291/hypres.30.335
[27] Hayashi, K., Sato, M., Niimi, H., Handa, H. and Moritake, K. (1975) [Analysis of the constitutive laws of the vascular wall by finite deformation theory]. Iyodenshi to Seitai Kogaku, 13, 293-298.
[28] Kawazaki, T., Takeuchi, K., Hasegawa, M., Yagi, S., Na-kayama, S. and Takayama, Y. (1982) Noninvasive measurement of common carotid artery effect with echo phase tracking system. Japanese College of Angiology, 22, 241-248.
[29] Shirai, K., Utino, J., Otsuka, K. and Takata, M. (2006) A novel blood pressure-independent arterial wall stiffness parameter; cardio ankle vascular index (CAVI). Journal of Atherosclerosis and Thrombosis, 13, 101-110. doi:10.5551/jat.13.101
[30] Huck, C.J., Bronas, U.G., Williamson, E.B., Christopher, C.D., Duprez, D.A. and Dengel, D.R. (2007) Noninvasive measurement of arterial stiffness: Repeatability and interrelationship with endothelial function and arterial morphology measures. Vascular Health and Risk Management, 3, 343-349.
[31] Hainsworth, R. and AL-Shamma, Y.M. (1988) Cardiovasculer responses to upright tilting in healthy subjects. Clinical Science (London), 75, 17-22.
[32] Hainsworth, R. and AL-Shamma, Y.M. (1988) Cardiovascular responses to stimulation of carotid baroreceptor in healthy subjects. Clinical Science (London), 75, 159-165.
[33] Agnin, P.A., Stewart, J.A., Myers, S., von Ramm, O. and Kisslo, J.A. (1981) Combined doppler and phased-array echocardiographic estimation of cardiac output. Circulation, 63, 388-392. doi:10.1161/01.CIR.63.2.388
[34] Toska, K. and Wollqe, L. (2002) Dynamic time course of hemodynamic responses after passive head up tilt and time back to supine position. Journal of Applied Physiology, 92, 1671-1676.
[35] Cooke, W.H., Hoag, J.B., Crossman, A.A., Kuusela, T.A., Tahvanainen, K.U. and Eckberg, D.L. (1999) Human responses to upright tilt: A window on central autonomic integration. The Journal of Physiology, 517, 617-628. doi:10.1111/j.1469-7793.1999.0617t.x
[36] Rankin, L.S., Moos, S. and Grossnian, W. (1975) Alterations in preload and ejection phase indices of left ventricular performance. Circulation, 51, 910-915. doi:10.1161/01.CIR.51.5.910
[37] Benzing III, G., Stockert, J., Nave, E. and Kaplan, S. (1974) Evaluation of left ventricular performance: Circumferential fiber shortening and tension. Circulation, 49, 925-932. doi:10.1161/01.CIR.49.5.925
[38] Slordahl, S.A. and Piene, H. (1991) Haemodynamic effects of arterial compliance, total peripheral resistance, and glyceryl trinitrate on regurgitant volume in aortic regurgitation. Cardiovascular Research, 25, 869-874. doi:10.1093/cvr/25.10.869
[39] Urschel, C.W., Covell, J.W., Sonnenblick, E.H., Ross, J. and Braunwald, E. (1968) Effect of decrease of aortic compliance on performance of the left ventricle. American Journal of Physiology, 214, 298-304.
[40] Koivistoinen, T., Koobi, T., Moilanen, L., Jula, A., Lehtimaki, T., Hyttinen, J. and Kahonen, M. (2011) Arterial tension time reflects subclinical atherosclerosis, arterial stiffness and stroke volume. Clinical Physiology and Functional Imaging, 31, 464-471. doi:10.1111/j.1475-097X.2011.01042.x
[41] Groothuis, J.T., Boot, C.R., Houtman, S., van Langen, H. and Hopman, M.T. (2005) Leg vascular resistance increases during head-up tilt in paraplegics. European Journal of Applied Physiology, 94, 408-414. doi:10.1007/s00421-005-1340-5
[42] Cooper, V.L. and Hainsworth, R. (2001) Carotid baroreceptor reflexes in humans during orthostatic stress. Experimental Physiology, 86, 677-681. doi:10.1113/eph8602213
[43] Petersen, M.E.V., Williams, T.R., Gordon, C., Chamberlain-Webber, R. and Sutton, R. (2000) The normal response to prolonged passive head up tilt testing. Heart, 84, 509-514. doi:10.1136/heart.84.5.509

comments powered by Disqus

Copyright © 2018 by authors and Scientific Research Publishing Inc.

Creative Commons License

This work and the related PDF file are licensed under a Creative Commons Attribution 4.0 International License.