Abstract 507: Change in Pulse Wave Velocity and Short Term Development of Cardiovascular Events in the Hemodialysis Population

2016 ◽  
Vol 36 (suppl_1) ◽  
Author(s):  
Yazan Daaboul ◽  
Serge Korjian ◽  
Balsam El-Ghoul ◽  
Salam Samad ◽  
Pascale Salameh ◽  
...  
Keyword(s):  
Acute Coronary Syndrome ◽  
Pulse Wave Velocity ◽  
Wave Velocity ◽  
Pulse Wave ◽  
Cox Regression ◽  
Hemodialysis Patients ◽  
Short Term ◽  
Coronary Syndrome ◽  
Increased Risk

Objectives: It has previously been demonstrated that single elevated measurements of carotid-femoral pulse wave velocity (CFPWV) among end-stage renal disease (ESRD) patients are associated with an increased risk of cardiovascular (CV) events. However, the association between single measurements of CFPWV and CV events was mostly driven by the high incidence of late events beyond 12 months of follow-up. The present prospective study aims to compare single measurements of CFPWV vs. the 2-year change in CFPWV (delta CFPWV) and their association with short-term development of CV events through 12 months in hemodialysis patients. Methods: Patients on hemodialysis were enrolled for a first measurement of CFPWV (CFPWV t=0 ) followed by a second measurement (CFPWV t=1 ) 2 years ± 1 month later. Patients were then followed up for an additional 12 months for the development of CV events (CV death, acute coronary syndrome, acute ischemic peripheral event necessitating intervention, or stroke). Results: Both CFPWV t=0 and CFPWV t=1 were measured for a total of 66 hemodialysis patients. During the 12-month follow-up period, 13 patients developed a total of 15 events, almost half (7/15) of which were fatal, 4/15 attributed to acute coronary syndrome (ACS), and 4/15 attributed to acute ischemic peripheral artery disease (PAD) necessitating intervention. No stroke events were recorded over the 12-month follow-up duration. Delta CFPWV (CFPWV t=1 - CFPWV t=0 ) was significantly associated with the development of CV events through 12 months with and without adjustment for CV risk factors, including blood pressure parameters (unadjusted: HR=1.22; p=0.001 vs. adjusted: HR=1.14; p=0.002). When delta CFPWV was substituted for either CFPWV t=0 or CFPWV t=1 in both the unadjusted and adjusted Cox regression models, neither measurement was associated with the development of new CV events. Conclusions: The change in CFPWV, but not single measurements of CFPWV, was significantly associated with the short-term development of CV events through 12 months.

scholarly journals Reversed L-shaped Association Between Baseline Brachial-ankle Pulse Wave Velocity and Short-Term Risk of First Stroke in Patients With Hypertension: A Population-based Cohort Study

2020 ◽  
Author(s):  
Lihua Hu ◽  
Chonglei Bi ◽  
Lishun Liu ◽  
Yun Song ◽  
Yue Zhang ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Pulse Wave Velocity ◽  
Wave Velocity ◽  
Pulse Wave ◽  
Cox Proportional Hazards ◽  
Short Term ◽  
Cvd Risk ◽  
Value Analysis ◽  
Increased Risk

Abstract Background: Brachial–ankle pulse wave velocity (baPWV) is available as a noninvasive measure of arterial stiffness. However, little information is available on the association between baPWV and the short-term risk of stroke in patients with hypertension. Therefore, our current study aimed to assess the association between baseline baPWV and short-term risk of first stroke. We were particularly interested in identifying those individuals at high risk of developing stroke among patients with hypertension.Methods: From January 1, 2017, to December 31, 2017, a total of 9787 individuals without preexisting stroke from the China Hypertension Registry Study were included in this analysis. Follow-up continued until December 31, 2018. The primary outcome was first stroke. The crude and adjusted risks of first stroke were estimated by hazard ratios (HRs) and 95% CIs using Cox proportional hazards models, without or with adjusting for pertinent covariates, respectively.Results: During a median follow-up of 20.8 months, there were 138 total first strokes including 123 first ischemic strokes and 15 first hemorrhagic strokes. Smooth curve showed that the relationship between baPWV and risk of first stroke and first ischemic stroke was curvilinear and reversed L-shaped. High baPWV levels (≥ 21.31 m/s) was associated with increased risk of first stroke (HR = 1.52; 95% CI: 1.05-2.21) and first ischemic stroke (HR = 1.53; 95% CI: 1.03-2.26) compared to low baPWV levels (< 21.31 m/s). E-value analysis suggested robustness to unmeasured confounding. Our findings may propose the applicability of baPWV measurement for prediction of stroke development, especially in subjects with a low cardiovascular (CVD) risk.Conclusions: High baPWV levels (≥ 21.31 m/s) were associated with increased the short-term risk of first stroke among Chinese hypertensive adults, compared to low baPWV levels, supporting a reversed L-shaped association. Our findings warrant additional investigation.

Comparison of 24-hour and Office Pulse Wave Velocity for Prediction of Mortality in Hemodialysis Patients

2019 ◽  
Vol 49 (4) ◽  
pp. 317-327 ◽  
Author(s):  
Julia Matschkal ◽  
Christopher C. Mayer ◽  
Pantelis A. Sarafidis ◽  
Georg Lorenz ◽  
Matthias C. Braunisch ◽  
...  
Keyword(s):  
Regression Analysis ◽  
Pulse Wave Velocity ◽  
Wave Velocity ◽  
Cardiovascular Mortality ◽  
Pulse Wave ◽  
Cox Regression ◽  
Hemodialysis Patients ◽  
Cox Regression Analysis ◽  
Kaplan Meier ◽  
All Cause Mortality

Background: Mortality in hemodialysis patients still remains unacceptably high. Enhanced arterial stiffness is a known cardiovascular risk factor, and pulse wave velocity (PWV) has proven to be a valid parameter to quantify risk. Recent studies showed controversial results regarding the prognostic significance of PWV for mortality in hemodialysis patients, which may be due to methodological issues, such as assessment of PWV in the office setting (Office-PWV). Method: This study cohort contains patients from the “Risk stratification in end-stage renal disease – the ISAR study,” a multicenter prospective longitudinal observatory cohort study. We examined and compared the predictive value of ambulatory 24-hour PWV (24 h-PWV) and Office-PWV on mortality in a total of 344 hemodialysis patients. The endpoints of the study were all-cause and cardiovascular mortality. Survival analysis included Kaplan-Meier estimates and Cox regression analysis. Results: During a follow-up of 36 months, a total of 89 patients died, 35 patients due to cardiovascular cause. Kaplan-Meier estimates for tertiles of 24 h-PWV and Office-PWV were similarly associated with mortality. In univariate Cox regression analysis, 24 h-PWV and Office-PWV were equivalent predictors for all-cause and cardiovascular mortality. After adjustment for common risk factors, only 24 h-PWV remained solely predictive for all-cause mortality (hazard ratio 2.51 [95% CI 1.31–4.81]; p = 0.004). Conclusions: Comparing both measurements, 24 h-PWV is an independent predictor for all-cause-mortality in hemodialysis patients beyond Office-PWV.

P1539Aortic pulse wave velocity measured by an oscillometric device independently predicts all-cause mortality in a cohort of 4146 subjects

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
Z Lenkey ◽  
M Illyes ◽  
T Kahan ◽  
P Boutouyrie ◽  
S Laurent ◽  
...  
Keyword(s):  
Pulse Wave Velocity ◽  
Wave Velocity ◽  
Care Setting ◽  
Pulse Wave ◽  
Cox Regression ◽  
Aortic Pulse Wave Velocity ◽  
Oscillometric Device ◽  
All Cause Mortality ◽  
The Mean

Abstract Objectives Assessment of carotid-femoral pulse wave velocity by applanation tonometry independently predicts all-cause and cardiovascular mortality. However, there has been a need for a simpler, user-independent measurement with a validated device, that is applicable even in the primary care setting. Methods and subjects 4146 subjects (49% men) aged 35–75 years were measured in multiple centers in Hungary. Subjects visited the outpatient department of these centers on their own initiative. The measurement of aortic pulse wave velocity (PWVao) with Arteriograph was performed in addition to taking past medical history, physical examination and laboratory tests. The mean follow-up time of the study was 5.5 years. The number of events (all cause mortality) were provided by the Hungarian National Health Insurance Fund. Cox regression analyses were used to identify predictive factors for this endpoint. Results The mean age of the study population was 53 years, brachial systolic and diastolic blood pressure were 137±20 and 82±11 mmHg, and heart rate was 70±10 1/min. The mean value of SCORE was 3 in this large cohort. 410 subjects had a registered cerebro-or cardiovascular event before the measurement, the number of smokers was 656 (16%), 1974 subjects were treated with at least one anti-hypertensive drug (48%), while the number of subjects on lipid-lowering, antidiabetic or antiplatelet medication were 807 (19%), 352 (8%) and 398 (17%), respectively. There were 116 fatal events during a mean follow-up of 5.5 years. According to the Cox regression, PWVao is a significant and independent predictor of all cause-mortality and in univariate analysis, a 1.0 m/s increase in PWVao was associated with HR 1.7 [1.47–1.98; p<0.001], for this endpoint. Conclusion Aortic pulse wave velocity measured by an invasively validated, simple, oscillometric device predicted all-cause mortality in a large cohort of relatively young subjects of the general population that may improve risk stratification even in the everyday clinical practice or primary care setting.

scholarly journals Brachial - Ankle Pulse Wave Velocity is a Simple and Independent Predictor of Prognosis in Patients With Acute Coronary Syndrome

2005 ◽  
Vol 69 (7) ◽  
pp. 815-822 ◽  
Author(s):  
Hirofumi Tomiyama ◽  
Yutaka Koji ◽  
Minoru Yambe ◽  
Kazuki Shiina ◽  
Kohki Motobe ◽  
...  
Keyword(s):  
Acute Coronary Syndrome ◽  
Pulse Wave Velocity ◽  
Wave Velocity ◽  
Pulse Wave ◽  
Independent Predictor ◽  
Coronary Syndrome

scholarly journals Comparison of the Brachial-ankle Pulse Wave Velocity between Patients with Acute Coronary Syndrome and Effort Angina Pectoris

2018 ◽  
Vol 57 (10) ◽  
pp. 1371-1374
Author(s):  
Toshihiko Yamasa ◽  
Satoshi Ikeda ◽  
Seiji Koga ◽  
Hiroaki Kawano ◽  
Shuuhei Kaibara ◽  
...  
Keyword(s):  
Acute Coronary Syndrome ◽  
Angina Pectoris ◽  
Pulse Wave Velocity ◽  
Wave Velocity ◽  
Pulse Wave ◽  
Effort Angina ◽  
Coronary Syndrome

scholarly journals Association between estimated pulse wave velocity and the risk of stroke in middle-aged men

2020 ◽  
pp. 174749302096376
Author(s):  
Sae Young Jae ◽  
Kevin S Heffernan ◽  
Sudhir Kurl ◽  
Setor K Kunutsor ◽  
Jari A Laukkanen
Keyword(s):  
Pulse Wave Velocity ◽  
Wave Velocity ◽  
Hemorrhagic Stroke ◽  
Pulse Wave ◽  
Middle Aged ◽  
Cerebrovascular Events ◽  
Increased Risk ◽  
Hemorrhagic Events ◽  
Emerging Risk

Background Increased aortic stiffness, assessed as carotid-femoral pulse wave velocity (cfPWV), contributes to cerebrovascular damage and is predictive of cerebrovascular events. Aims and methods We sought to examine the association between estimated pulse wave velocity (ePWV), a proxy of carotid-femoral pulse wave velocity, and stroke and its subtypes (ischemic and hemorrhagic) in a prospective cohort of 2666 men (aged mean 53.1, range 42–61 years) enrolled in the Kuopio Ischemic Heart Disease cohort study. Results During a median 28-year follow-up, 471 incident stroke (397 ischemic and 94 hemorrhagic) events occurred. After adjusting for several established and emerging risk factors including age and pulse pressure, comparing the p versus bottom quartiles of ePWV, there was an increased risk of stroke (hazard ratio [HR] 2.37, 95% Confidence Interval [CI]: 1.57–3.58), ischemic stroke (HR 2.23, 95% CI, 1.42–3.50), and hemorrhagic stroke (HR 3.57, 95% CI, 1.45–8.76). Conclusion These findings demonstrate that ePWV is independently associated with the risk of stroke in middle-aged men.

scholarly journals Short-term and long-term prognostic value of circulating soluble suppression of tumorigenicity-2 concentration in acute coronary syndrome: a meta-analysis

2019 ◽  
Vol 39 (6) ◽  
Author(s):  
Linlin Gu ◽  
Jing Li
Keyword(s):  
Acute Coronary Syndrome ◽  
Prognostic Value ◽  
Meta Analysis ◽  
Continuous Variables ◽  
Short Term ◽  
Coronary Syndrome ◽  
Increased Risk ◽  
All Cause Mortality

Abstract Background: Higher circulating soluble suppression of tumorigenicity-2 (sST2) concentration is suggested as a marker of prognosis in many cardiovascular diseases. However, the short-term and long-term prognostic value of sST2 concentration in acute coronary syndrome (ACS) remains to be summarized. Methods: A meta-analysis of follow-up studies was performed. Studies were identified via systematic search of databases including PubMed, Cochrane’s Library, and Embase. A fixed- or random-effect model was applied according to the heterogeneity. We reported the prognostic value of sST2 concentration for all-cause mortality, heart failure (HF) events, and major adverse cardiovascular events (MACEs) within 1 month after hospitalization and during subsequent follow-up. Results: Twelve studies with 11690 ACS patients were included. Higher baseline sST2 concentration as continuous variables predicte the increased risk of all-cause mortality (risk ratio [RR]: 3.16, P=0.002), HF events (RR: 1.48, P<0.001), and MACEs (RR: 1.47, P<0.001) within 1 month after hospitalization, which is consistent with the results with sST2 concentration as categorized variables (RR = 2.14, 2.89, and 2.89 respectively, P all <0.001). Moreover, higher baseline sST2 concentration as continuous variables predict the increased risk of all-cause mortality (RR: 2.20, P<0.001), HF events (RR: 1.39, P<0.001), and MACEs (RR: 1.53, P=0.02) during subsequent follow-up. Meta-analysis with sST2 concentration as categorized variables retrieved similar results (RR = 2.65, 2.59, and 1.81 respectively, P all <0.001). Conclusions: Higher circulating sST2 concentration at baseline predicts poor clinical outcome in ACS patients.

Macrophage infiltrates in coronary plaque erosion portend a worse cardiovascular outcome in patients with acute coronary syndrome

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
R.A Montone ◽  
V Vetrugno ◽  
M Camilli ◽  
M Russo ◽  
M.G Del Buono ◽  
...  
Keyword(s):  
Acute Coronary Syndrome ◽  
Vulnerable Plaque ◽  
Cardiac Death ◽  
Cox Regression ◽  
Plaque Rupture ◽  
Culprit Lesion ◽  
Coronary Syndrome ◽  
Fibrous Cap ◽  
Plaque Erosion

Abstract Background Plaque erosion (PE) is responsible for at least one-third of acute coronary syndrome (ACS). Inflammatory activation is considered a key mechanism of plaque instability in patients with plaque rupture through the release of metalloproteinases and the inhibition of collagen synthesis that in turns lead to fibrous cap degradation. However, the clinical relevance of macrophage infiltration has never been investigated in patients with PE. Purpose In our study, we aimed at assessing the presence of optical coherence tomography (OCT)-defined macrophage infiltrates (MØI) at the culprit site in ACS patients with PE, evaluating their clinical and OCT correlates, along with their prognostic value. Methods ACS patients undergoing OCT imaging and presenting PE as culprit lesion were retrospectively selected. Presence of MØI at culprit site and in non-culprit segments along the culprit vessel was assessed. The incidence of major adverse cardiac events (MACEs), defined as the composite of cardiac death, recurrent myocardial infarction and target vessel revascularization (TVR), was assessed [follow-up median (interquartile range, IQR) time 2.5 (2.03–2.58) years]. Results We included 153 patients [median age (IQR) 64 (53–75) years, 99 (64.7%) males]. Fifty-one (33.3%) patients presented PE with MØI and 102 (66.7%) PE without MØI. Patients having PE with MØI compared with PE patients without MØI had more vulnerable plaque features both at culprit site and at non-culprit segments. In particular, culprit lesion analysis demonstrated that patients with PE with MØI had a significantly thinner fibrous cap [median (IQR) 100 (60–120) μm vs. 160 (95–190) μm, p&lt;0.001], higher prevalence of thrombus [41 (80.4%) vs. 64 (62.7%), p=0.028], lipid plaque [39 (76.5%) vs. 50 (49.0%), p&lt;0.001], TCFA [20 (39.2%) vs. 14 (13.7%), p=0.001], and a higher maximum lipid arc [median [IQR] 250.0° (177.5°-290.0°) vs. 190.0° (150.0°-260.0°), p=0.018) at the culprit lesion compared with PE without MØI. MACEs were significantly more frequent in PE with MØI patients compared with PE without MØI [11 (21.6%) vs. 6 (5.9%), p=0.008], mainly driven by a higher risk of cardiac death and TVR. At multivariable Cox regression model, PE with MØI [HR=2.95, 95% CI (1.09–8.02), p=0.034] was an independent predictor of MACEs. Conclusion Our study demonstrates that among ACS patients with PE the presence of MØI at culprit lesion is associated with a more aggressive phenotype of coronary atherosclerosis with more vulnerable plaque features, along with a worse prognosis at a long-term follow-up. These findings are of the utmost importance in the era of precision medicine because clearly show that macrophage infiltrates may identify patients with a higher cardiovascular risk requiring more aggressive secondary prevention therapies and a closer clinical follow-up. Prognosis Funding Acknowledgement Type of funding source: None

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