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Arterial wave reflections and incident cardiovascular events and heart failure: MESA (Multiethnic Study of
Julio A Chirinos1, Jan G Kips, David R Jacobs
1Philadelphia VA Medical Center and University of Pennsylvania School of Medicine, Philadelphia, PA, USA. julio.chirinos@uphs.upenn.edu
Insights
Arterial wave reflections, measured by reflection magnitude, are a significant risk factor for cardiovascular events and heart failure in the general population. This finding highlights a novel predictor for cardiovascular disease risk assessment.
Area of Science:
- Cardiovascular Physiology
- Biomedical Engineering
- Epidemiology
Background:
- Physiologic data suggest arterial wave reflections contribute to cardiovascular disease.
- The association between wave reflections and cardiovascular events in the general population remains unclear.
Purpose of the Study:
- To assess the relationship between central pressure profiles and cardiovascular events (CVEs) in a large community-based sample.
- To investigate arterial wave reflections as a novel risk factor for congestive heart failure (CHF).
Main Methods:
- Aortic pressure waveforms were derived from radial pressure waveforms in 5,960 Multiethnic Study of Atherosclerosis participants.
- Central pressure waveforms were analyzed to separate forward and reflected waves.
- Reflection magnitude (RM), augmentation index (AIx), and pulse pressure amplification (PPA) were assessed as predictors of CVEs and CHF.
Main Results:
- Increased augmentation index (AIx) independently predicted hard CVEs.
- Pulse pressure amplification (PPA) independently predicted all CVEs.
- Reflection magnitude (RM) independently predicted all CVEs, hard CVEs, and was a strong predictor of new-onset CHF, outperforming other risk factors.
Conclusions:
- Arterial wave reflections, particularly RM, represent a novel and strong risk factor for CHF in the general population.
- These findings suggest that arterial wave reflections should be considered in cardiovascular risk assessment.
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] × 100), augmentation index ([Second/First systolic peak] × 100) and pulse pressure amplification ([Radial/aortic pulse pressure] × 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.
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