背景:波分离分析可以对主动脉脉搏波成分进行个性化评估。之前的研究主要集中在压力高度上,结果总体上是积极的,但结果有所不同。在本分析中,我们评估了前向和后向脉搏波压力(P for和 P ref)与预期心血管终点的关联,并对达到压力峰值的时间(T for和 T ref)进行了扩展分析。
方法:参与者纳入了 3 个 IDCARS(国际中央动脉特性风险分层数据库)队列(阿根廷、比利时和芬兰)年龄≥20 岁且具有有效脉搏波分析和随访数据的数据。使用 SphygmoCor 仪器进行主动脉脉搏波分析,并使用三角法进行脉搏波分离。主要终点包括心血管死亡率和非致命性心脑血管事件。使用多变量调整的 Cox 回归来计算风险比。
结果:总共分析了 2206 名参与者(平均年龄 57.0 岁;55.0% 为女性)。P for、P ref、T for和 T for /T ref的平均值±SD分别为 31.0±9.1 mm Hg、20.8±8.4 mm Hg、130.8±35.5 和 0.51±0.11。在中位随访 4.4 年中,146 名 (6.6%) 参与者经历了主要终点。P 、 T和T /T ref每增加 1 个 SD,与 27% (95% CI, 1.07–1.49)、25% (95% CI, 1.07–1.45) 和 32% (95% CI) 相关。CI,1.12–1.56) 风险分别较高。将 T for和 T for /T ref添加到现有风险模型改进了模型预测(ΔUno's C,0.020;P <0.01)。
结论:脉搏波中的信息可预测复合心血管终点,其中 T for /T ref显示出显着改善在风险预测方面。前向和后向压力峰值的时间比率可能有助于评估后负荷的增加并表明心血管风险的增加。
REFERENCES
1. Vos T, Lim SS, Abbafati C, Abbas KM, Abbasi M, Abbasifard M, Abbasi-Kangevari M, Abbastabar H, Abd-Allah F, Abdelalim A, et al. Global burden of 369 diseases and injuries in 204 countries and territories, 1990– 2019: a systematic analysis for the Global Burden of Disease Study 2019. Lancet. 2020;396:1204–1222. doi: 10.1016/S0140-6736(20)30925-9
2. Mitchell GF, Parise H, Benjamin EJ, Larson MG, Keyes MJ, Vita JA, Vasan RS, Levy D. Changes in arterial stiffness and wave reffection with advancing age in healthy men and women: the Framingham Heart Study. Hypertension. 2004;43:1239–1245. doi: 10.1161/01.HYP.0000128420.01881.aa
3. Franklin SS, Jacobs MJ, Wong ND, L’Italien GJ, Lapuerta P. Predominance of isolated systolic hypertension among middle-aged and elderly US hypertensives. Analysis based on National Health and Nutrition Examination Survey (NHANES) III. Hypertension. 2001;37:869–874. doi: 10.1161/01.hyp.37.3.869
4. Melgarejo JD, Thijs L, Wei DM, Bursztyn M, Yang WY, Li Y, Asayama K, Hansen TW, Kikuya M, Ohkubo T, et al. Relative and absolute risk to guide the management of pulse pressure, an age-related cardiovascular risk factor.Am J Hypertens. 2021;34:929–938. doi: 10.1093/ajh/hpab048
5. Chirinos JA, Segers P, Hughes T, Townsend R. Large-artery stiffness in health and disease. JACC State-of-the-Art Review. J Am Coll Cardiol. 2019;74:1237–1263. doi: 10.1016/j.jacc.2019.07.012 6. Chirinos JA, Rietzschel ER, De Buyzere ML, De Bacquer D, Gillebert TC, Gupta AK, Segers P; Asklepios Investigators. Arterial load and ventricular-arterial coupling. Physiologic relations with body size and effect of obesity. Hypertension. 2009;54:558–566. doi: 10.1161/HYPERTENSIONAHA.109.131870
7. Cauwenberghs N, Knez J, Boggia J, D’Hooge J, Yang WY, Wei FF, Thijs L, Staessen JA, Kuznetsova T. Doppler indexes of left ventricular systolic and diastolic function in relation to haemodynamic load components in a general population. J Hypertens. 2018;36:867–875. doi: 10.1097/HJH.0000000000001623
8. Chirinos JA, Kips JG, Jacobs DR Jr, Brumback L, Duprez DA, Kronmal R, Bluemke DA, Townsend RR, Vermeersch S, Segers P. Arterial wave reffections and incident cardiovascular events and heart failure: MESA (Multiethnic Study of Atherosclerosis). J Am Coll Cardiol. 2012;60:2170–2177. doi: 10.1016/j.jacc.2012.07.054
9. Cooper LL, Rong J, Benjamin EJ, Larson MG, Levy D, Vita JA, Hamburg NM, Vasan RS, Mitchell GF. Components of hemodynamic load and cardiovascular events. Circulation. 2015;131:354–61; discussion 361. doi: 10.1161/CIRCULATIONAHA.114.011357 10. Desbiens LC, Fortier C, Nadeau-Fredette AC, Madore F, Hametner B, Wassertheurer S, Agharazii M, Goupil R. Prediction of cardiovascular events by pulse waveform parameters: analysis of CARTaGENE. J Am Heart Assoc. 2022;11:e026603. doi: 10.1161/JAHA.122.026603
11. Van Bortel LM, Struijker-Boudier HA, Safar ME. Pulse pressure, arterial stiffness, and drug treatment of hypertension. Hypertension. 2001;38:914– 921. doi: 10.1161/hy1001.095773
12. Nichols WM, Denardo SJ, Wilkinson IB, McEniery CM, Cockcroft J, O’Rourke MF. Effects of arterial stiffness, pulse wave velocity, and wave reffections on the central aortic pressure waveform. J Clin Hypertens. 2008;10:295–303. doi: 10.1111/j.1751-7176.2008.04746.x
13. Wang KL, Cheng HM, Chuang SY, Li CH, Spurgeon HA, Ting CT, Najjar SS, Lakatta EG, Yin FCP, Chou P, et al. Wave reffection and arterial stiffness in the prediction of 15-year all-cause and cardiovascular mortalities. A community-based study. Hypertension. 2010;55:799–805. doi: 10.1161/HYPERTENSIONAHA.109.139964
14. Weber T, Wassertheurer S, Rammer M, Haiden A, Hametner B, Eber B. Wave reffection, assessed with a novel method for pulse wave separation, are associated with end-organ damage and clinical outcomes. Hypertension. 2012;60:534–541. doi: 10.1161/HYPERTENSIONAHA.112.194571
15. Tade G, Norton GR, Booysen HL, Sibiya MJ, Ballim I, Sareli P, Libhaber E, Majane OH, Woodiwiss AJ. Time to the peak of the aortic forward wave determines the impact of aortic backward wave and pulse pressure on left ventricular mass. J Hypertens. 2017;35:300–309. doi: 10.1097/HJH.0000000000001173
16. Tran AH, Kimball TR, Khoury PR, Dolan LM, Urbina EM. Obese and type 2 diabetic youth have increased forward and backward wave reffections. Arterioscler Thromb Vasc Biol. 2021;41:944–950. doi: 10.1161/ATVBAHA.120.315317
17. Steinberg RS, Udeshi E, Dickert N, Quyyumi A, Chirinos JA, Morris AA. Novel measures of arterial hemodynamics and wave reffections associated with clinical outcomes in patients with heart failure. J Am Heart Assoc. 2023;12:e027666. doi: 10.1161/JAHA.122.027666
18. Aparicio LS, Huang QF, Melgarejo JD, Wei DM, Thijs L, We FF, Gilis-Malinowska N, Sheng CS, Boggia J, Niiranen TJ, et al; International Database of Central Arterial Properties for Risk Stratiffcation (IDCARS) Investigators. The International Database of Central Arterial Properties for Risk Stratiffcation: research objectives and baseline characteristics of participants.Am J Hypertens. 2022;35:54–64. doi: 10.1093/ajh/hpab139
19. World Medical Association. World Medical Association Declaration of Helsinki. Ethical principles for medical research involving human subjects. JAMA. 2013;310:2191–2194. doi: 10.1001/jama.2013.281053
20. El Assaad MA, Topouchian JA, Asmar RG. Evaluation of two devices for selfmeasurement of blood pressure according to the international protocol: the Omron M5-I and the Omron 705IT. Blood Press Monit. 2003;8:127–133. doi: 10.1097/00126097-200306000-00006
21. Pauca AL, O’Rourke M, Kon ND. Prospective evaluation of a method for estimating ascending aortic pressure from the radial artery pressure waveform.Hypertension. 2001;38:932–937. doi: 10.1161/hy1001.096106
22. Westerhof BE, Guelen I, Westerhof N, Karemaker JM, Avolio A. Quantification of wave reflection in the human aorta from pressure Downloaded from http://ahajournals.org by on June 4, 2024ORRRRRRR ARRRRRRHypertension. 2024;81:1065–1075. DOI: 10.1161/HYPERTENSIONAHA.123.22036 May 2024 1075 Norton et al Risks Associated with Aortic Pulse Wave Componentsalone: a proof of principle. Hypertension. 2006;48:595–601. doi: 10.1161/01.HYP.0000238330.08894.17
23. Levey AS, Stevens LA, Schmid CH, Zhang YL, Castro AF III, Feldman HI, Kusek JW, Eggers P, Van Lente F, Greene T, et al; CKD-EPI (Chronic Kidney Disease Epidemiology Collaboration). A new equation to estimate glomerular ffltration rate. Ann Intern Med. 2009;150:604–612. doi: 10.7326/0003-4819-150-9-200905050-00006
24. World Health Organization. Global Status Report on Alcohol and Health 2018. World Health Organization; 2018.
25. Pencina MJ, D’Agostino RB Sr, D’Agostino RB Jr, Vasan RS. Evaluating the added predictive ability of a new marker: from area under the ROC curve to reclassiffcation and beyond. Stat Med. 2008;27:157–72; discussion 207. doi: 10.1002/sim.2929
26. Pencina MJ, D’Agostino RB Sr, Steyerberg EW. Extensions of net reclassiffcation improvement calculations to measure usefulness of new biomarkers. Stat Med. 2011;30:11–21. doi: 10.1002/sim.4085
27. Booysen HL, Woodiwiss AJ, Sibiya MJ, Hodson B, Raymond A, Libhaber E, Sareli P, Norton GR. Indexes of aortic pressure augmentation markedly underestimate the contribution of reffected waves toward variations in aortic pressure and left ventricular mass. Hypertension. 2015;65:540–546. doi: 10.1161/HYPERTENSIONAHA.114.04582
28. Bello H, Norton GR, Peterson VR, Mmopi KN, Mthembu N, Libhaber CD, Masiu M, Da Silva Fernandes D, Bamaiyi AJ, Peters F, et al. Hemodynamic determinants of age versus left ventricular diastolic function relations across the full adult age range. Hypertension. 2020;75:1574–1583. doi: 10.1161/HYPERTENSIONAHA.119.14622
29. Davies JE, Alastruey J, Francis DP, Hadjiloizou N, Whinnett ZI, Manisty CH, Aguado-Sierra J, Willson K, Foale RA, Malik IS, et al. Attenuation of wave reffection by wave entrapment creates a “horizon effect” in the human aorta. Hypertension. 2012;60:778–785. doi: 10.1161/HYPERTENSIONAHA.111.180604
30. Baksi AJ, Davies JE, Hadjiloizou N, Baruah R, Unsworth B, Foale RA, Korolkova O, Siggers JH, Francis DP, Mayet J, et al. Attenuation of reffected waves in man during retrograde propagation from femoral artery to proximal aorta. Int J Cardiol. 2016;202:441–445. doi: 10.1016/j.ijcard.2015.09.064
31. Liu YP, Richart T, Li Y, Zhan WW, Staessen JA. Is arterial stiffness related to body height? Hypertension. 2010;55:e24–e25. doi: 10.1161/HYPERTENSIONAHA.110.152553
32. Hofmann M, Bauer R, Handrock R, Weidinger G, Goedel-Meinen L. Prognostic value of the QRS duration in patients with heart failure: a subgroup analysis from 24 centers of Val-HeFT. J Card Fail. 2005;11:523–528. doi: 10.1016/j.cardfail.2005.03.008
33. Lund LH, Jurga J, Edner M, Benson L, Dahlström U, Linde C, Alehagen U. Prevalence, correlates, and prognostic signiffcance of QRS prolongation in heart failure with reduced and preserved ejection fraction. Eur Heart J. 2013;34:529–539. doi: 10.1093/eurheartj/ehs305
34. Weber T, Auer J, O’Rourke MF, Punzengruber C, Kvas E, Eber B. Prolonged mechanical systole and increased arterial wave reffections in diastolic dysfunction.Heart. 2006;92:1616–1622. doi: 10.1136/hrt.2005.084145
35. Tan I, Kiat H, Barin E, Butlin M, Avolio AP. Effects of pacing modality on noninvasive assessment of heart rate dependency of indices of large artery function. J Appl Physiol (1985). 2016;121:771–780. doi: 10.1152/japplphysiol.00445.2016
36. Upadhya B, Pajewski NM, Rocco MV, Hundley WG, Aurigemma G, Hamilton CA, Bates JT, He J, Chen J, Chonchol M, et al; SPRINT Research Group. Effect of intensive blood pressure control on aortic stiffness in the SPRINT-HEART. Hypertension. 2021;77:1571–1580. doi: 10.1161/HYPERTENSIONAHA.120.16676
37. Dudenbostel T, Glasser SP. Effects of antihypertensive drugs on arterial stiffness. Cardiol Rev. 2012;20:259–263. doi: 10.1097/CRD.0b013e31825d0a44
2024年学术会议
会议名称:2024中国高血压学术年会暨海峡两岸医药卫生交流协会高血压专业委员会学术年会暨国家心血管病中心高血压专病医联体学术年会
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会议时间:2024 年 7 月6 日
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