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Published on: May 3, 2018
Cardiovascular endpoints in relation to the central arterial pressure-time indexes
Qi-Fang Huang1, De-Wei An1, Lucas S Aparicio2
1Department of Cardiovascular Medicine, Shanghai Key Laboratory of Hypertension, Shanghai Institute of Hypertension, State Key Laboratory of Medical Genomics, National Research Center for Translational Medicine, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China.
Insights
Central arterial pressure-time indexes, including systolic (SPTI) and diastolic (DPTI), aid in cardiovascular risk stratification. While SPTI and DPTI predict cardiovascular events and stroke, the subendocardial viability ratio (SEVR) does not.
Area of Science:
- Cardiovascular Physiology
- Biomedical Engineering
- Epidemiology
Background:
- Central arterial pressure-time indexes, such as systolic (SPTI) and diastolic (DPTI) pressure-time indexes, and the subendocardial viability ratio (SEVR) are established measures.
- Their utility in risk stratification within the general population remains largely uncharacterized.
Purpose of the Study:
- To investigate the predictive value of noninvasively measured SPTI, DPTI, and SEVR for cardiovascular outcomes and stroke in a general population.
- To assess the incremental predictive value of these indexes in cardiovascular risk stratification models.
Main Methods:
- Utilized data from the International Database of Central Arterial Properties for Risk Stratification (n=5099).
- Noninvasively measured SPTI, DPTI, and SEVR using SphygmoCor technology.
- Evaluated hazard ratios (HRs) for cardiovascular endpoints, cardiac endpoints, and stroke using multivariable-adjusted Cox proportional hazards models over a median follow-up of 4 years. Model refinement was assessed using AUC, IDI, and NRI.
Main Results:
- SPTI and DPTI were significantly associated with increased risk of cardiovascular endpoints, cardiac endpoints, and stroke (HRs ranging from 1.33 to 1.74).
- SEVR did not show a significant association with any of the evaluated endpoints.
- Adding SPTI or DPTI to risk models improved discrimination, with combined use with mean arterial pressure significantly increasing IDI (~1.7%) and NRI (~17%).
Conclusions:
- Noninvasively measured SPTI and DPTI are valuable independent predictors of cardiovascular events and stroke in the general population.
- SEVR does not appear to contribute to cardiovascular risk stratification in this population.
- These findings support the integration of SPTI and DPTI into cardiovascular risk assessment tools.
Abstract:
Multiple articles focused on the central arterial systolic (SPTI) and diastolic (DPTI) pressure-time indexes and the subendocardial viability ratio (SEVR). However, whether these indexes contribute to risk stratification in the general population is unknown. SPTI, DPTI and SEVR were noninvasively measured by the SphygmoCor technology. Incidence rates and standardized (per 1-SD increment) multivariable-adjusted hazard ratios (HRs) for cardiovascular (primary) and cardiac endpoints and stroke were evaluated in the International Database of Central Arterial Properties for Risk Stratification (n = 5099). Model refinement was assessed by the area under the curve (AUC) and the integrated discrimination (IDI) and net reclassification (NRI) improvement. Over 4 years (median), 215 cardiovascular, 133 cardiac endpoints and 79 strokes occurred. For SPTI, fully adjusted HRs were 1.37 (95% CI: 1.18-1.59), 1.35 (1.11-1.64) and 1.33 (1.05-1.69) for the cardiovascular and cardiac endpoints and stroke. The corresponding HRs for DPTI were 1.49 (1.31-1.69), 1.23 (1.02-1.48) and 1.74 (1.46-2.07). For SEVR, none of the HRs reached significance. Analyses with these indexes categorized by quartiles were confirmatory. Analyses stratified by various risk factors did not reveal subgroup differences. For the cardiovascular endpoint, adding SPTI or DPTI to the base model improved the AUC, while adding SPTI or DPTI combined with mean arterial pressure, increased IDI by ~1.7% and NRI by ~17% (P < 0.001 for all). Whereas cardiovascular and cardiac endpoints and stroke were related with the non-invasively measured SPTI and DPTI, SEVR was not.
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