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Should the augmentation index be normalized to heart rate?

Lee Stoner1, James Faulkner, Andrew Lowe

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Journal of Atherosclerosis and Thrombosis
|November 22, 2013
PubMed
Summary
This summary is machine-generated.

Pulse wave analysis (PWA) reveals arterial stiffness. Adjusting the augmentation index (AIx) for heart rate (HR) may be inappropriate; including HR as a predictor is recommended for better insights.

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Area of Science:

  • Cardiovascular Physiology
  • Biomedical Engineering
  • Clinical Diagnostics

Background:

  • Pulse wave analysis (PWA) is a key method for assessing systemic arterial stiffness.
  • The augmentation index (AIx) is a primary outcome of PWA, influenced by factors like mean arterial pressure (MAP), age, gender, and heart rate (HR).
  • Current practices often involve statistical adjustments for MAP and HR, with HR adjustments to 75 bpm being common.

Purpose of the Study:

  • To evaluate the physiological and statistical appropriateness of statistically adjusting AIx to a standard heart rate (HR).
  • To propose a more suitable method for accounting for HR in PWA studies.
  • To highlight the importance of considering HR as an independent predictor, especially in longitudinal studies.

Main Methods:

  • Review of existing literature on pulse wave analysis (PWA) and augmentation index (AIx) adjustments.
  • Discussion of the physiological interaction between heart rate (HR) and arterial stiffness.
  • Exploration of statistical assumptions underlying HR correction methods for AIx.

Main Results:

  • The common practice of statistically adjusting AIx to a fixed HR (e.g., 75 bpm) may be physiologically and statistically inappropriate.
  • There is evidence of a chronic physiological interaction between HR and arterial stiffness.
  • The assumption of a uniform relationship between AIx and HR across populations may not hold true.

Conclusions:

  • Statistically adjusting AIx to a standard HR is potentially flawed.
  • Including HR as an independent predictor or covariate in PWA is a more appropriate approach.
  • This alternative method is particularly valuable for longitudinal studies investigating changes in arterial stiffness over time.