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Exaggerated Differences in Pulse Wave Velocity Between Left and Right Sides Among Patients With Anxiety Disorders and Cardiovascular Disease

From the Department of Psychiatry and Behavioral Neurosciences (V.K.Y., M.T.), Wayne State University School of Medicine, Detroit, Michigan; Institute of Cardiology (V.K.Y., R.K.), M.S. Ramaiah Institute of Cardiology, Bangalore, India; Department of Psychiatry (V.K.Y., P.C.), University of Alberta (V.K.Y., P.C.), Edmonton, Alberta, Canada; and Department of Psychiatry (K.J.B.), Friedrich Schiller University, Jena, Germany.

Address correspondence and reprint requests to V. K. Yeragani, #411, 11135-83 Avenue, Edmonton, Alberta, Canada T6G 2C6. E-mail: Vikramyershr{at}yahoo.com

Objective: To compare the left-right differences in pulse wave velocity (PWV) measures in normal controls and patients with anxiety disorders and cardiac disease. Pulses from the right and left sides of normal subjects are highly correlated at each segmental level. However, some evidence suggests that the right hemisphere has a greater effect on parasympathetic activity, as there may be a right hemisphere disadvantage in patients with low cardiac vagal function. Decreased vagal function is associated with vascular dysfunction and hypertension.

Methods: We compared normal controls (n = 22), patients with anxiety (n = 26), and patients with cardiovascular disease (n = 72) using the Vascular Profiler (VP-1000), which enables the measurement of ankle and brachial blood pressure (BP) in both arms (brachial), both legs (ankle) and carotid artery, and lead I electrocardiogram and phonocardiogram. Using these signals, PWV, and arterial stiffness index % were calculated for the comparison of these measures on the right and left sides of the body.

Results: Patients with anxiety and cardiovascular disease had significantly higher left-right differences in heart-ankle pulse wave velocity, brachial-ankle pulse wave velocity, and arterial stiffness index percentage compared with that of normal controls. Our data also showed significant differences between left-right vascular indices in patients with anxiety and cardiovascular disease (p < .00001); there was no such significant difference in normal controls.

Conclusions: These results may implicate an exaggerated vagal withdrawal in the left extremities resulting in higher PWV in patients with anxiety and cardiovascular illness.

Key Words: pulse wave velocity • autonomic function • atherosclerosis • arterial stiffness index • cardiovascular mortality • anxiety

Abbreviations: HR = heart rate; BP = blood pressure; PWV = pulse wave velocity; HF = high frequency (0.15–0.5 Hz); PTT = pulse transit time; HA = heart-ankle; BA = brachial-ankle; ECG = electrocardiogram; PCG = phonocardiogram; VP = vascular profiler; BMDP = biomedical data package; ANOVA = analysis of variance; MAP = mean arterial pressure; PEP = pre-ejection period; GAD = generalized anxiety disorder.