Departments of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.
Hypertension. 2010 Mar;55(3):799-805. doi: 10.1161/HYPERTENSIONAHA.109.139964. Epub 2010 Jan 11.
The value of increased arterial wave reflection, usually assessed by the transit time-dependent augmentation index and augmented pressure (Pa), in the prediction of cardiovascular events may have been underestimated. We investigated whether the transit time-independent measures of reflected wave magnitude predict cardiovascular outcomes independent of arterial stiffness indexed by carotid-femoral pulse wave velocity. A total of 1272 participants (47% women; mean age: 52+/-13 years; range: 30 to 79 years) from a community-based survey were studied. Carotid pressure waveforms derived by tonometry were decomposed into their forward wave amplitudes, backward wave amplitudes (Pb), and a reflection index (=[Pb/(forward wave amplitude+Pb)]), in addition to augmentation index, Pa, and reflected wave transit time. During a median follow-up of 15 years, 225 deaths occurred (17.6%), including 64 cardiovascular origins (5%). In univariate Cox proportional hazard regression analysis, pulse wave velocity, Pa, and Pb predicted all-cause and cardiovascular mortality in both men and women, whereas augmentation index, reflected wave transit time, and reflection index were predictive only in men. In multivariate analysis accounting for age, height, and heart rate, Pb predicted cardiovascular mortality in both men and women, whereas Pa was predictive only in men. Per 1-SD increment (6 mm Hg), Pb predicted 15-year cardiovascular mortality independent of brachial but not central pressure, pulse wave velocity, augmentation index, Pa, and conventional cardiovascular risk factors with hazard ratios of approximately 1.60 (all P<0.05). In conclusion, Pb, a transit time-independent measure of reflected wave magnitude, predicted long-term cardiovascular mortality in men and women independent of arterial stiffness.
动脉波反射增加的价值，通常通过 transit time-dependent 增强指数和增强压 (Pa) 来评估，其在心血管事件预测中的价值可能被低估了。我们研究了反射波幅度的 transit time-independent 测量是否可以独立于颈动脉-股动脉脉搏波速度指数化的动脉僵硬度来预测心血管结局。总共研究了来自社区调查的 1272 名参与者（47%为女性；平均年龄：52+/-13 岁；范围：30 至 79 岁）。通过张力测定法得出的颈动脉压力波形被分解为正向波幅度、反向波幅度 (Pb) 和反射指数 ([Pb/(正向波幅度+Pb)]), 此外还有增强指数、Pa 和反射波传输时间。在中位数为 15 年的随访期间，发生了 225 例死亡（17.6%），包括 64 例心血管源性（5%）。在单变量 Cox 比例风险回归分析中，脉搏波速度、Pa 和 Pb 预测了男性和女性的全因和心血管死亡率，而增强指数、反射波传输时间和反射指数仅在男性中具有预测性。在考虑年龄、身高和心率的多变量分析中，Pb 预测了男性和女性的心血管死亡率，而 Pa 仅在男性中具有预测性。每增加 1-SD（6mmHg），Pb 预测 15 年心血管死亡率独立于臂部但不独立于中心压、脉搏波速度、增强指数、Pa 和传统心血管危险因素，其危险比约为 1.60（所有 P<0.05）。总之，Pb 是反射波幅度的 transit time-independent 测量，独立于动脉僵硬度预测男性和女性的长期心血管死亡率。
