Department of Cardiovascular Medicine, Faculty of Life Sciences, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan.
Am J Hypertens. 2019 Jun 11;32(7):657-667. doi: 10.1093/ajh/hpz048.
Although pulse wave velocity (PWV) is recognized to be a risk predictor for various cardiovascular diseases, the association of brachial-ankle PWV (baPWV) with cardiovascular outcomes in heart failure (HF) with reduced ejection fraction (HFrEF) patients remains uncertain.
We measured ankle-brachial pressure index (ABI) and baPWV values at stable condition after optimal therapy for HF in 201 consecutive HFrEF patients admitted to Kumamoto University Hospital from 2007 to 2015 who were enrolled and followed until the occurrence of cardiovascular events. We defined peripheral artery disease (PAD) as ABI value ≤ 0.9.
Kaplan-Meier analysis revealed that HFrEF patients with peripheral artery disease PAD had a significant higher risk of total cardiovascular and HF-related events than those without PAD (P = 0.03 and P = 0.01, respectively). Next, we divided HFrEF patients without PAD into 3 groups according to baPWV values. In the Kaplan-Meier analysis, total cardiovascular and HF-related events in the highest baPWV group (1,800 cm/second ≤ baPWV) had a significantly higher frequency than those in the mid-level baPWV group (1,400 cm/second ≤ baPWV < 1,800 cm/second) (P = 0.007 and P = 0.004, respectively). The hazard ratio between HFrEF patients in the mid-level baPWV group and those with other baPWV groups was compared after adjustment for other cofounders. The probabilities of HF-related events were significantly higher in the lowest and highest baPWV group.
Identifying complications of PAD and measuring baPWV values in HFrEF patients were useful for predicting their prognosis.Trial Registration: UMIN000034358.
尽管脉搏波速度（PWV）已被认为是各种心血管疾病的风险预测指标，但肱踝 PWV（baPWV）与射血分数降低的心力衰竭（HFrEF）患者心血管结局的关系仍不确定。
我们在 2007 年至 2015 年期间，对连续 201 例因 HFrEF 入住熊本大学医院并接受最佳治疗后病情稳定的患者进行了踝臂血压指数（ABI）和 baPWV 值测量，这些患者被纳入并随访至心血管事件发生。我们将外周动脉疾病（PAD）定义为 ABI 值≤0.9。
Kaplan-Meier 分析显示，患有外周动脉疾病 PAD 的 HFrEF 患者发生总心血管和心力衰竭相关事件的风险明显高于无 PAD 的患者（P=0.03 和 P=0.01）。接下来，我们根据 baPWV 值将无 PAD 的 HFrEF 患者分为 3 组。在 Kaplan-Meier 分析中，baPWV 值最高组（1800cm/秒≤baPWV）的总心血管和心力衰竭相关事件的发生率明显高于中值 baPWV 组（1400cm/秒≤baPWV<1800cm/秒）（P=0.007 和 P=0.004）。在校正其他混杂因素后，比较了中值 baPWV 组与其他 baPWV 组之间的 HFrEF 患者的危险比。最低和最高 baPWV 组发生心力衰竭相关事件的概率明显更高。
识别 HFrEF 患者 PAD 的并发症并测量 baPWV 值有助于预测其预后。
UMIN000034358。
