Hypertension Center and Cardiovascular Research Laboratory, 1st Department of Propaedeutic and Internal Medicine, Laiko Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece.
Hypertens Res. 2011 Jul;34(7):803-8. doi: 10.1038/hr.2011.33. Epub 2011 Apr 7.
Aortic stiffness (pulse wave velocity, PWV) and pressure wave reflections (augmentation index, AI) are two interrelated markers of mortality. Their potential synergistic effect on mortality has never been studied. We sought to investigate the association as well as the combined effect of PWV and AI on mortality in a cohort (PROTEGER Study) of very old (>70 years, mean age ( ± s.d.): 85.4 ± 7.4 years). Aortic PWV and pressure wave AI were assessed by pulse wave analysis; carotid structure and cardiac function were analyzed by ultrasound. The analysis was performed in 259 patients who had all the data available. Neither PWV nor AI was, in separate, predictors of mortality (log-rank test: P=0.278 and P=0.433, respectively, Kaplan-Meier analysis). No linear association was found between PWV and AI (P=0.278). To investigate the possible synergistic effect of PWV and AI on mortality, the population was analyzed according to the tertiles of PWV and AI. Subjects with combined high PWV (third tertile) and moderate-to-high AI (second and third tertiles) had lower survival compared with the rest of the population (Kaplan-Meier survival curve, log-rank test: P=0.030). Cox regression analysis showed that this effect was independent from age, gender, blood pressure, cardiac/carotid parameters and other confounders, except creatinine and insulin resistance. The present study provides further insight on the pathophysiological association between large artery stiffness and pressure wave reflections, suggesting that when both are elevated they may increase the mortality in the elderly.
主动脉僵硬（脉搏波速度，PWV）和压力波反射（增强指数，AI）是两个与死亡率相关的标志物。它们对死亡率的潜在协同作用从未被研究过。我们旨在调查脉搏波分析评估的 PWV 和 AI 与死亡率之间的相关性以及它们对死亡率的联合影响，该研究纳入了一个非常高龄（>70 岁，平均年龄（±标准差）：85.4±7.4 岁）的队列（PROTEGER 研究）。通过脉搏波分析评估主动脉 PWV 和压力波 AI；通过超声分析颈动脉结构和心脏功能。对 259 名有所有可用数据的患者进行了分析。在单独分析中，PWV 和 AI 都不是死亡率的预测因子（对数秩检验：P=0.278 和 P=0.433，分别为 Kaplan-Meier 分析）。PWV 和 AI 之间没有线性关联（P=0.278）。为了研究 PWV 和 AI 对死亡率的可能协同作用，根据 PWV 和 AI 的三分位数对人群进行了分析。与其余人群相比，PWV（第三三分位数）和中至高 AI（第二和第三三分位数）合并的患者的生存率较低（Kaplan-Meier 生存曲线，对数秩检验：P=0.030）。Cox 回归分析表明，这种效应独立于年龄、性别、血压、心脏/颈动脉参数和其他混杂因素，除了肌酐和胰岛素抵抗。本研究进一步深入了解了大动脉僵硬和压力波反射之间的病理生理关联，表明当两者都升高时，它们可能会增加老年人的死亡率。
