Arterial Wave Reflections and Incident Cardiovascular Events and Heart Failure: MESA (Multiethnic Study of Atherosclerosis)

被引:340
作者
Chirinos, Julio A. [1 ,2 ]
Kips, Jan G. [3 ]
Jacobs, David R., Jr. [4 ,5 ]
Brumback, Lyndia [6 ]
Duprez, Daniel A. [7 ]
Kronmal, Richard [6 ]
Bluemke, David A. [8 ]
Townsend, Raymond R. [2 ]
Vermeersch, Sebastian [3 ]
Segers, Patrick [3 ]
机构
[1] Univ Penn, Sch Med, Dept Cardiol, Philadelphia, PA 19104 USA
[2] Philadelphia VA Med Ctr, Philadelphia, PA USA
[3] Univ Ghent, IBiTech, B-9000 Ghent, Belgium
[4] Univ Minnesota, Sch Publ Hlth, Div Epidemiol & Community Hlth, Minneapolis, MN USA
[5] Univ Oslo, Dept Nutr, Oslo, Norway
[6] Univ Washington, Sch Publ Hlth, Dept Biostat, Seattle, WA 98195 USA
[7] Univ Minnesota, Sch Med, Div Cardiol, Minneapolis, MN 55455 USA
[8] NIH, Ctr Clin, Bethesda, MD 20892 USA
关键词
arterial hemodynamics; cardiovascular risk; heart failure; left ventricular afterload; wave reflections; LEFT-VENTRICULAR MASS; INPUT IMPEDANCE; ALL-CAUSE; PRESSURE; PREDICTION; STIFFNESS; VELOCITY;
D O I
10.1016/j.jacc.2012.07.054
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Objectives This study sought to assess the relationship between central pressure profiles and cardiovascular events (CVEs) in a large community-based sample. Background Experimental and physiologic data mechanistically implicate wave reflections in the pathogenesis of left ventricular failure and cardiovascular disease, but their association with these outcomes in the general population is unclear. Methods Aortic pressure waveforms were derived from a generalized transfer function applied to the radial pressure waveform recorded noninvasively from 5,960 participants in the Multiethnic Study of Atherosclerosis. The central pressure waveform was separated into forward and reflected waves using a physiologic flow waveform. Reflection magnitude (RM = [Reflected/Forward wave amplitude] x 100), augmentation index ([Second/First systolic peak] x 100) and pulse pressure amplification ([Radial/aortic pulse pressure] x 100) were assessed as predictors of CVEs and congestive heart failure (CHF) during a median follow-up of 7.61 years. Results After adjustment for established risk factors, aortic AIx independently predicted hard CVEs (hazard ratio [HR] per 10% increase: 1.08; 95% confidence interval [CI]: 1.01 to 1.14; p = 0.016), whereas PPA independently predicted all CVEs (HR per 10% increase: 0.82; 95% CI: 0.70 to 0.96; p = 0.012). RM was independently predictive of all CVEs (HR per 10% increase: 1.34; 95% CI: 1.08 to 1.67; p = 0.009) and hard CVEs (HR per 10% increase: 1.46; 95% CI: 1.12 to 1.90; p = 0.006) and was strongly predictive of new-onset CHF (HR per 10% increase: 2.69; 95% CI: 1.79 to 4.04; p < 0.0001), comparing favorably to other risk factors for CHF as per various measures of model performance, reclassification, and discrimination. In a fully adjusted model, compared to nonhypertensive subjects with low RM, the HRs (95% CI) for hypertensive subjects with low RM, nonhypertensive subjects with high RM, and hypertensive subjects with high RM were 1.81 (0.85 to 3.86), 2.16 (1.07 to 5.01), and 3.98 (1.96 to 8.05), respectively. Conclusions Arterial wave reflections represent a novel strong risk factor for CHF in the general population. (J Am Coll Cardiol 2012;60:2170-7) (C) 2012 by the American College of Cardiology Foundation
引用
收藏
页码:2170 / 2177
页数:8
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