Prediction of cardiovascular events and all-cause mortality with central haemodynamics: a systematic review and...

Area of Science:

• Cardiovascular Medicine
• Hypertension Research
• Epidemiology

Background:

• Central haemodynamics, reflecting pressure dynamics within the aorta, are increasingly recognized for their clinical significance.
• Understanding the predictive value of central haemodynamic indices for cardiovascular (CV) outcomes and mortality is crucial for risk stratification.
• Previous studies suggest a role for central pressures, but robust quantitative estimates are needed.

Purpose of the Study:

• To quantitatively estimate the predictive value of central pressures and derived central haemodynamic indices for CV outcomes and all-cause mortality.
• To conduct a meta-analysis of longitudinal studies to provide robust estimates.
• To compare the predictive ability of central pulse pressure (PP) with brachial PP.

Main Methods:

• Meta-analysis of 11 longitudinal studies involving 5648 subjects with a mean follow-up of 45 months.
• Inclusion of studies measuring central haemodynamics.
• Age- and risk-factor-adjusted pooled relative risks (RR) were calculated for various central haemodynamic parameters.

Main Results:

• A 10 mmHg increase in central systolic pressure was associated with a RR of 1.088 for total CV events.
• A 10 mmHg increase in central pulse pressure (PP) showed a RR of 1.137 for total CV events.
• A 10% increase in central augmentation index (AIx) was linked to a RR of 1.318 for CV events and 1.384 for all-cause mortality.
• Central PP demonstrated marginally, but not significantly, better predictive ability than brachial PP (P = 0.057).

Conclusions:

• Central haemodynamic indices are independent predictors of future cardiovascular events and all-cause mortality.
• The augmentation index (AIx) predicts clinical events independently of peripheral pressures.
• Central PP offers a marginally, non-significantly, improved predictive capacity compared to peripheral PP.