Mortality and Cardiovascular End Points In Relation to the Aortic Pulse Wave Components: An Individual-Participant...

Wave separation analysis enables individualized evaluation of the aortic pulse wave components. Previous studies focused on the pressure height with overall positive but differing results. In the present analysis, we assessed the associations of the pressure of forward and backward (P_for and P_ref) pulse waves with prospective cardiovascular end points, with extended analysis for time to pressure peak (T_for and T_ref).

Participants in 3 IDCARS (International Database of Central Arterial Properties for Risk Stratification) cohorts (Argentina, Belgium, and Finland) aged ≥20 years with valid pulse wave analysis and follow-up data were included. Pulse wave analysis was done using the SphygmoCor device, and pulse wave separation was done using the triangular method. The primary end points consisted of cardiovascular mortality and nonfatal cardiovascular and cerebrovascular events. Multivariable-adjusted Cox regression was used to calculate hazard ratios.

A total of 2206 participants (mean age, 57.0 years; 55.0% women) were analyzed. Mean±SDs for P_for, P_ref, T_for, and T_for/T_ref were 31.0±9.1 mm Hg, 20.8±8.4 mm Hg, 130.8±35.5, and 0.51±0.11, respectively. Over a median follow-up of 4.4 years, 146 (6.6%) participants experienced a primary end point. Every 1 SD increment in P_for, T_for, and T_for/T_ref was associated with 27% (95% CI, 1.07-1.49), 25% (95% CI, 1.07-1.45), and 32% (95% CI, 1.12-1.56) higher risk, respectively. Adding T_for and T_for/T_ref to existing risk models improved model prediction (∆Uno's C, 0.020; P<0.01).

Pulse wave components were predictive of composite cardiovascular end points, with T_for/T_ref showing significant improvement in risk prediction. Pending further confirmation, the ratio of time to forward and backward pressure peak may be useful to evaluate increased afterload and signify increased cardiovascular risk.