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Identification of Distinct Arterial Waveform Clusters and a Longitudinal Evaluation of Their Clinical Usefulness
John D Sluyter1, Alun D Hughes2,3, Carlos A Camargo4
1From the School of Population Health, University of Auckland, New Zealand (J.D.S., R.S.).
Insights
Clustering arterial blood pressure (BP) waveform parameters reveals distinct elements like BP pulsatility and wave reflection. These factors are meaningfully associated with cardiovascular events, offering new insights into risk prediction.
Area of Science:
- Cardiovascular Physiology
- Biomedical Engineering
- Epidemiology
Background:
- Arterial blood pressure (BP) waveform analysis offers detailed physiological insights.
- Summarizing complex waveform data into distinct elements can reveal cumulative associations with health outcomes.
- The ViDA (Vitamin D Assessment) trial provides a large population for investigating these associations.
Purpose of the Study:
- To investigate if clustering of arterial BP waveform parameters can summarize complex information into distinct, interpretable elements.
- To evaluate the predictors and associations of these distinct elements with cardiovascular events.
- To assess the prognostic significance of identified waveform parameter clusters.
Main Methods:
- Principal component analysis (PCA) was used to reduce 14 arterial waveform parameters into 3 uncorrelated factors.
- Factor analysis identified factors representing BP pulsatility, mean BP, and wave reflection.
- Associations with cardiovascular events were examined using survival analysis in 4253 adults over a median follow-up of 4.6 years.
Main Results:
- PCA explained 90% of the variability in arterial waveform parameters using 3 factors.
- Factor 3 (wave reflection) showed significant variations across antihypertensive drug classes, unlike brachial BP.
- Both Factor 1 (BP pulsatility) and Factor 3 (wave reflection) were positively associated with cardiovascular events.
- Factor 2 (mean BP) exhibited a J-shaped relationship with cardiovascular events.
Conclusions:
- BP pulsatility, mean BP, and wave reflection are distinct and prognostically meaningful aspects of arterial function.
- Clustering these parameters provides a method to summarize physiological variations and identify cumulative cardiovascular risk associations.
- These findings suggest a novel approach to cardiovascular risk assessment using detailed arterial waveform analysis.
Abstract:
Clustering of arterial blood pressure (BP) waveform parameters could summarize complex information into distinct elements, which could be used to investigate cumulative (nonredundant) associations. We investigated this hypothesis in a large, adult population-based study (ViDA trial [Vitamin D Assessment] trial). To interpret the clusters and evaluate their usefulness, we examined their predictors and associations with cardiovascular events. In 4253 adults (mean age 65 years; 55% male) without a prior cardiovascular event, suprasystolic oscillometry was performed, yielding aortic pressure waveforms and several hemodynamic parameters. Participants were followed up for 4.6 years (median), accruing 300 cardiovascular events. Principal component analysis reduced 14 arterial waveform parameters to 3 uncorrelated factors that together explained 90% of the variability of the original data. Factors 1, 2, and 3 appeared to represent BP pulsatility, mean BP, and wave reflection, respectively. Across 6 antihypertensive drug classes, there were no differences in brachial systolic (P=0.23) and diastolic (P=0.13) BP; but there were significant variations in factor 3 (P<0.0001), especially for β-blocker use. The first and third factors were positively associated with cardiovascular events (multivariable-adjusted standardized hazard ratio [95% CI]=1.33 [1.18-1.50] and 1.15 [1.02-1.30], respectively), whereas the second factor had a J-shaped relationship, with a nadir corresponding to a brachial diastolic BP of ≈75 mm Hg. In conclusion, BP pulsatility, mean BP, and wave reflection are prognostically meaningful, distinct aspects of arterial function that can be used to summarize physiological variations in multiple arterial waveform parameters and identify truly cumulative associations when used as cardiovascular risk outcomes.
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