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Nonlinear association and threshold effect between preoperative estimated pulse wave velocity and postoperative
Yi Hu1, Jiazhen Mei1, Siji Chen1
1Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China.
Insights
Estimated pulse wave velocity (ePWV) predicts postoperative atrial fibrillation (POAF) after coronary artery bypass grafting (CABG). Higher ePWV indicates increased POAF risk, especially below a 11.4 m/s threshold.
Area of Science:
- Cardiology
- Vascular Medicine
- Medical Diagnostics
Background:
- Postoperative atrial fibrillation (POAF) is a frequent complication following coronary artery bypass grafting (CABG).
- Reliable preoperative risk stratification for POAF remains a clinical challenge.
- Estimated pulse wave velocity (ePWV), a noninvasive marker of arterial stiffness, has potential for risk assessment but requires further investigation regarding its association with POAF.
Purpose of the Study:
- To investigate the nonlinear association between preoperative estimated pulse wave velocity (ePWV) and the occurrence of postoperative atrial fibrillation (POAF) in patients undergoing CABG.
- To identify potential threshold effects of ePWV on POAF risk.
- To evaluate the utility of ePWV in preoperative risk stratification for POAF.
Main Methods:
- A single-center retrospective cohort study involving 8,570 patients undergoing CABG.
- Calculation of ePWV using patient age and mean blood pressure.
- Application of logistic regression, restricted cubic spline (RCS) modeling, and two-piecewise linear regression to analyze the ePWV-POAF relationship and threshold effect.
Main Results:
- The incidence of POAF was 7.9%.
- Higher ePWV was independently associated with an increased risk of POAF (adjusted OR: 1.15, P<0.001).
- A nonlinear association was identified, with a threshold effect at 11.4 m/s; risk increased significantly below this value, but not above it.
Conclusions:
- ePWV demonstrates an independent, nonlinear association with POAF after CABG, featuring identifiable thresholds.
- ePWV serves as a valuable, noninvasive tool for identifying patients at higher risk of POAF.
- Further validation in multicenter prospective studies is recommended to confirm the clinical utility of ePWV in POAF risk stratification.
Background:
Postoperative atrial fibrillation (POAF) is a common complication after coronary artery bypass grafting (CABG), yet reliable preoperative risk markers remain limited. Estimated pulse wave velocity (ePWV), a simple noninvasive indicator of arterial stiffness, may enhance risk stratification; however, its association with POAF has not been fully elucidated. This study aimed to investigate the nonlinear association and potential threshold effect between preoperative ePWV and POAF in patients undergoing CABG.
Methods:
This single-center retrospective cohort study included 8,570 patients who underwent CABG between 2021 and 2022 at Beijing Anzhen Hospital. ePWV was calculated using age and mean blood pressure. Logistic regression, restricted cubic spline (RCS) modeling, and two-piecewise linear regression were used to evaluate the association and potential threshold effect between ePWV and POAF. Predictive performance was evaluated using receiver operating characteristic (ROC) analysis.
Results:
POAF occurred in 7.9% of patients. Higher ePWV was independently associated with POAF [adjusted odds ratio (OR): 1.15, 95% confidence interval (CI): 1.09-1.21; P<0.001]. A significant nonlinear relationship was observed, with an inflection point at 11.4 m/s. Below this threshold, each 1 m/s increase in ePWV was associated with a 27% higher risk of POAF, whereas no significant association was observed at ePWV values ≥11.4 m/s. The area under the curve (AUC) for ePWV was 0.583, and the optimal cutoff of 9.62 meters per second yielded a negative predictive value of 94.6%.
Conclusions:
ePWV shows an independent and nonlinear association with POAF after CABG, with identifiable thresholds that may inform preoperative risk stratification. As a simple and noninvasive measure of arterial stiffness, ePWV may assist in identifying patients at elevated risk of POAF. Validation in multicenter prospective cohorts is warranted to establish its broader clinical utility.
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