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Norton GR, An DW, Aparicio LS, Yu YL, Wei FF, Niiranen TJ, Liu C, Stolarz-Skrzypek K, Wojciechowska W, Jula AM, Rajzer M, Martens DS, Verhamme P, Li Y, Kawecka-Jaszcz K, Nawrot TS, Staessen JA, Woodiwiss AJ. Mortality and Cardiovascular End Points In Relation to the Aortic Pulse Wave Components: An Individual-Participant Meta-Analysis. Hypertension 2024; 81:1065-1075. [PMID: 38390718 PMCID: PMC11025606 DOI: 10.1161/hypertensionaha.123.22036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Accepted: 02/11/2024] [Indexed: 02/24/2024]
Abstract
BACKGROUND 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 (Pfor and Pref) pulse waves with prospective cardiovascular end points, with extended analysis for time to pressure peak (Tfor and Tref). METHODS 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. RESULTS A total of 2206 participants (mean age, 57.0 years; 55.0% women) were analyzed. Mean±SDs for Pfor, Pref, Tfor, and Tfor/Tref 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 Pfor, Tfor, and Tfor/Tref 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 Tfor and Tfor/Tref to existing risk models improved model prediction (∆Uno's C, 0.020; P<0.01). CONCLUSIONS Pulse wave components were predictive of composite cardiovascular end points, with Tfor/Tref 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.
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Affiliation(s)
- Gavin R. Norton
- Cardiovascular Pathophysiology and Genomics Research Unit, School of Physiology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa (G.R.N., A.J.W.)
| | - De-Wei An
- Department 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, China (D.-W.A., Y.L.)
- Non-Profit Research Association Alliance for the Promotion of Preventive Medicine, Mechelen, Belgium (D.-W.A, Y.-L.Y., K.S.-S., J.A.S.)
- Research Unit Environment and Health, Department of Public Health and Primary Care (D.-W.A, Y.-L.Y., T.S.N.), University of Leuven, Belgium
| | - Lucas S. Aparicio
- Servicio de Clínica Médica, Sección Hipertensión Arterial, Hospital Italiano de Buenos Aires, Argentina (L.S.A.)
| | - Yu-Ling Yu
- Non-Profit Research Association Alliance for the Promotion of Preventive Medicine, Mechelen, Belgium (D.-W.A, Y.-L.Y., K.S.-S., J.A.S.)
- Research Unit Environment and Health, Department of Public Health and Primary Care (D.-W.A, Y.-L.Y., T.S.N.), University of Leuven, Belgium
| | - Fang-Fei Wei
- The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China (F.-F.W., C.L.)
| | - Teemu J. Niiranen
- Department of Chronic Disease Prevention, Finnish Institute for Health and Welfare, Turku, Finland (T.J.N., A.M.J.)
- Department of Medicine, Turku University Hospital and University of Turku, Finland (T.J.N., A.M.J.)
| | - Chen Liu
- The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China (F.-F.W., C.L.)
| | - Katarzyna Stolarz-Skrzypek
- Non-Profit Research Association Alliance for the Promotion of Preventive Medicine, Mechelen, Belgium (D.-W.A, Y.-L.Y., K.S.-S., J.A.S.)
- First Department of Cardiology, Interventional Electrocardiology and Hypertension, Jagiellonian University Medical College, Kraków, Poland (K.S.-S., W.W., K.K.-J., M.R.)
| | - Wiktoria Wojciechowska
- First Department of Cardiology, Interventional Electrocardiology and Hypertension, Jagiellonian University Medical College, Kraków, Poland (K.S.-S., W.W., K.K.-J., M.R.)
| | - Antti M. Jula
- Department of Chronic Disease Prevention, Finnish Institute for Health and Welfare, Turku, Finland (T.J.N., A.M.J.)
- Department of Medicine, Turku University Hospital and University of Turku, Finland (T.J.N., A.M.J.)
| | - Marek Rajzer
- First Department of Cardiology, Interventional Electrocardiology and Hypertension, Jagiellonian University Medical College, Kraków, Poland (K.S.-S., W.W., K.K.-J., M.R.)
| | - Dries S. Martens
- Center for Environmental Sciences, Hasselt University, Diepenbeek, Belgium (D.S.M., T.S.N)
| | - Peter Verhamme
- Center for Molecular and Vascular Biology, KU Leuven Department of Cardiovascular Sciences (P.V.), University of Leuven, Belgium
| | - Yan Li
- Department 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, China (D.-W.A., Y.L.)
| | - Kalina Kawecka-Jaszcz
- First Department of Cardiology, Interventional Electrocardiology and Hypertension, Jagiellonian University Medical College, Kraków, Poland (K.S.-S., W.W., K.K.-J., M.R.)
| | - Tim S. Nawrot
- Research Unit Environment and Health, Department of Public Health and Primary Care (D.-W.A, Y.-L.Y., T.S.N.), University of Leuven, Belgium
- Center for Environmental Sciences, Hasselt University, Diepenbeek, Belgium (D.S.M., T.S.N)
| | - Jan A. Staessen
- Non-Profit Research Association Alliance for the Promotion of Preventive Medicine, Mechelen, Belgium (D.-W.A, Y.-L.Y., K.S.-S., J.A.S.)
- Biomedical Science Group, Faculty of Medicine (J.A.S.), University of Leuven, Belgium
| | - Angela J. Woodiwiss
- Cardiovascular Pathophysiology and Genomics Research Unit, School of Physiology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa (G.R.N., A.J.W.)
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Claessens PJ, Peeters R, Claessens L, Claessens C, Claessens J, Claessens PM. Pulse wave analysis measurements: important, underestimated and undervalued parameters in cardiovascular health problems. Front Cardiovasc Med 2023; 10:1266258. [PMID: 38028442 PMCID: PMC10653328 DOI: 10.3389/fcvm.2023.1266258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Accepted: 09/25/2023] [Indexed: 12/01/2023] Open
Abstract
Background Central aortic stiffness is established as a reliable measure of cardiovascular disease. While pulse wave velocity (PWV) analysis measures arterial distensibility, risk profile of cardiovascular diseases can be expanded with following pulse wave analysis measurements: central aortic systolic blood pressure (CABPS), central aortic pulse pressure (CAPP), central aortic reflection magnitude (CARM), central aortic augmented pressure (CAAP) and central aortic augmentation index (CAAIx). The aim of this study is to evaluate the clinical usefulness and importance of pulse wave analysis measurements in specific cardiovascular conditions and diseases, both in term of diagnosis and therapeutic monitoring. Methods One thousand sixty-six subjects were included. According to age bracket, four cohorts were investigated-healthy subjects (NL), hypertensive patients (HP), ischemic heart disease (IHD) and valvular heart disease (VHD) patients. Arterial stiffness was analyzed through Sphygmocor XCEL Central Blood Pressure Measurement System and Sphygmocor XCEL PWV Measurement System. Furthermore we observed the pulse wave analysis measurements of 14 patients with diagnose of ADHD who were referred by a child psychiatrist, in order to investigate the initiation of methylphenidate treatment. Results Statistically significant differences were found between NL and HP cohorts, across almost all age brackets, regarding pulse wave analysis measurements. In the risk stratification of arterial stiffness hypertension and especially central aortic blood pressure systolic (CABPS) seems a determining factor. Pulse wave analysis measurements for IHD and VHD cohort comparisons with NL counterparts, revealed non- statistically significant variations. Elevated CAAP, CAAIx and CARM within the youngest age group (0-10 years) in attention-deficit-hyperactivity-disorder (ADHD) patients warrant attention. Conclusions Following such investigations, CABPS appears as a robust predominant factor in problems of arterial stiffness. Pulse wave analysis and PWV are important parameters in the evaluation and monitoring of arterial hypertension and cardiovascular diseases. There is a hypothesis that CAAP could be an important and even decisive parameter in the diagnosis of ADHD. Further investigation needed.
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Affiliation(s)
| | | | | | | | | | - Philip Maria Claessens
- Medical Center “Kloppend Hart Essen-Antwerpen- Schilde”, Antwerp, Belgium
- Department of Cardiology, AZ Monica Deurne, Antwerp, Belgium
- Department of Cardiology, AZ Voorkempen Malle, Antwerp, Belgium
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Chen JJ, Wu HT, Haryadi B. Reactive Hyperemia-Triggered Wrist Pulse Analysis for Early Monitoring of Young Men with High Atherosclerotic Risk. Diagnostics (Basel) 2021; 11:1918. [PMID: 34679616 PMCID: PMC8535088 DOI: 10.3390/diagnostics11101918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2021] [Revised: 10/12/2021] [Accepted: 10/15/2021] [Indexed: 11/30/2022] Open
Abstract
The high prevalence of cardiovascular disease in young adults has raised significant concern regarding the early identification of risk factors to allow for timely intervention. This study aimed to identify young males at risk of atherosclerosis using a noninvasive instrument and an initial application percussion entropy analysis of the wrist pressure pulse (WPP). In total, 49 young males aged 18 to 28, without any known history of vascular disease, were recruited. Blood samples were obtained whereby a TC/HDL cutoff value of 4 was used to divide the young men into low-risk (Group 1, TC/HDL < 4, N = 32) and high-risk (Group 2, TC/HDL ≥ 4, N = 17) groups regarding atherosclerosis. The reactive hyperemia-triggered WPPs were measured using a modified air-pressure-sensing system (MAPSS). The dilation index (DI) of the endothelial function and percussion entropy index (PEI) of the heart rate variability (HRV) assessments, calculated using pragmatic signal-processing techniques, were compared between the two groups. The nonparametric Mann-Whitney U test showed that the DI and PEI of the two groups showed statistical differences (both p < 0.05). Not only could the MAPSS assess endothelial function and HRV in young males, but the results also showed that waist circumference and PEI may serve as indicators for the early identification of young males at risk of atherosclerosis.
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Affiliation(s)
- Jian-Jung Chen
- Taichung Tzuchi Hospital, The Buddhist Tzuchi Medical Foundation, Taichung 42743, Taiwan
- School of Post-Baccalaureate Chinese Medicine, Tzu Chi University, Hualien 97002, Taiwan
| | - Hsien-Tsai Wu
- Department of Electrical Engineering, Dong Hwa University, No. 1, Sec. 2, Da Hsueh Rd., Hualien 97401, Taiwan; (H.-T.W.); (B.H.)
| | - Bagus Haryadi
- Department of Electrical Engineering, Dong Hwa University, No. 1, Sec. 2, Da Hsueh Rd., Hualien 97401, Taiwan; (H.-T.W.); (B.H.)
- Department of Physics, Universitas Ahmad Dahlan, Jendral A. Yani Street, Kragilan, Tamanan, Kec. Banguntapan, Bantul, Yogyakarta 55191, Indonesia
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