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Published on: September 27, 2024
Invasive aortic pulse pressure is not superior to cuff pulse pressure in cardiovascular risk prediction
Esben Laugesen1,2, Søren T Knudsen3, Klavs W Hansen4
1Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Aarhus N.
Insights
Invasive aortic pulse pressure (PP) does not provide additional prognostic value for cardiovascular events or death compared to standard cuff PP in patients with stable angina. Cuff PP alone predicts stroke and myocardial infarction risk.
Area of Science:
- Cardiology
- Vascular Medicine
- Clinical Hemodynamics
Background:
- Aortic pulse pressure (PP) reflects cardiac and cerebral burden better than cuff PP.
- Cuff PP may underestimate aortic PP with increasing age, potentially affecting outcome predictions.
- The age-dependency of cuff PP's prognostic association with cardiovascular outcomes requires investigation.
Purpose of the Study:
- To determine if invasively measured aortic PP offers additional prognostic value beyond cuff PP for cardiovascular events and death.
- To assess the prognostic impact of aortic PP versus cuff PP in patients with stable angina pectoris.
- To explore potential age-related differences in the prognostic association of cuff PP.
Main Methods:
- Invasive aortic PP and cuff PP were measured in 21,908 patients with stable angina undergoing coronary angiography.
- Multivariate Cox models analyzed associations with incident myocardial infarction, stroke, and death.
- Harrell's C-index was used to assess predictive discrimination.
Main Results:
- During follow-up, 422 strokes, 511 myocardial infarctions, and 1530 deaths occurred.
- Both cuff and aortic PP were initially associated with adverse outcomes.
- In multivariate models, only cuff PP remained a significant predictor for stroke and myocardial infarction; neither predicted death.
Conclusions:
- Invasive aortic PP did not provide additional prognostic information beyond cuff PP for cardiovascular outcomes or death in this patient cohort.
- Cuff PP is a significant independent predictor of stroke and myocardial infarction in patients with stable angina.
- Age did not modify the prognostic association between cuff PP and major adverse cardiovascular events or death.
Objective:
Aortic pulse pressure (PP) represents the hemodynamic cardiac and cerebral burden more directly than cuff PP. The objective of this study was to investigate whether invasively measured aortic PP confers additional prognostic value beyond cuff PP for cardiovascular events and death. With increasing age, cuff PP progressively underestimates aortic PP. Whether the prognostic association between cuff PP and outcomes is age-dependent remains to be elucidated.
Methods:
Cuff PP and invasively measured aortic PP were recorded in 21 908 patients (mean age 63 years, 58% men, 14% with diabetes) with stable angina pectoris undergoing elective coronary angiography during January 2001--December 2012. Multivariate Cox models were used to assess the association with incident myocardial infarction, stroke, and death. Discrimination was assessed using Harrell's C-index.
Results:
During a median follow-up period of 3.7 years (range 0.1-10.8 years), 422 strokes, 511 myocardial infarctions, and 1530 deaths occurred. Both cuff and aortic PP were associated with stroke, myocardial infarction, and death in crude analyses. However, only cuff PP remained associated with stroke (hazard ratio per 10 mmHg, 1.06 (95% confidence interval (CI) 1.01--1.12)] and myocardial infarction [hazard ratio per 10 mmHg 1.05 (95% CI 1.01--1.11)] in multivariate Cox models. Both cuff and aortic PP lost significance as predictors of death in multivariate models. Age did not modify the prognostic association between cuff PP and stroke, myocardial infarction, and death.
Conclusion:
Invasively measured aortic PP did not add prognostic information about cardiovascular outcomes and death beyond cuff PP in patients with stable angina pectoris.
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Monitoring BP in both arms during the initial assessment is advisable, as the systolic value may differ by five to ten mm Hg between arms. For subsequent BP assessments, use the arm with the higher reading.