Liao Kuo-Meng, Chang Chi-Wei, Wang Sheng-Hung, Chang Yi-Ting, Chen Ying-Chun, Wang Gin-Chung
Division of Endocrinology & Metabolism of Zhongxiao Branch of Taipei City Hospital, Taipei, Taiwan.
MiiAnn Medical Research Center, Taipei, Taiwan.
Physiol Rep. 2019 Oct;7(19):e14252. doi: 10.14814/phy2.14252.
This investigation explored the hypothesis that whether the coefficient of variation of the fourth harmonic amplitude of the radial pulse wave (C4CV) predicts the risk of macrovascular and microvascular events in patients with type 2 diabetes mellitus (T2DM). Radial pulse wave and brachial blood pressure were measured at baseline in 2324 patients with T2DM and C4CV was calculated using the Fourier series method. Macrovascular and microvascular events during follow-up were determined by medical records. We plotted the Kaplan-Meier curve and performed a Cox proportional hazard model and a log-rank test to estimate the effectiveness of C4CV as a risk predictor. We divided patients into quartile groups based on C4CV (<4.3%, 4.3% to 6.8%, 6.8% to 11.4%, and >11.4%). Compared with patients with C4CV < 4.3%, patients with C4CV> 11.4% had a double incidence of macrovascular events (hazard ratio, 2.13; 95% CI, 1.70-2.67) and microvascular events (hazard ratio, 2.08; 95% CI, 1.67-2.58), and the incidence of cardiovascular death was three times (hazard ratio, 3.03; 95% CI, 1.10-8.83). The Cox regression analysis demonstrated that the risk of both macrovascular and microvascular outcomes increases with the increase in quartile level of C4CV value (P < 0.0001). These associations remained after adjustment for age, gender, smoking, systolic blood pressure, diastolic blood pressure, dyslipidemia, diabetes duration, Hba1c, and cardiovascular disease (P < 0.0001). C4CV is a novel independent predictor of cardiovascular mortality, macrovascular events, and microvascular events in patients with T2DM.
桡动脉脉搏波四次谐波振幅变异系数（C4CV）是否可预测2型糖尿病（T2DM）患者发生大血管和微血管事件的风险。对2324例T2DM患者在基线时测量桡动脉脉搏波和肱动脉血压，并采用傅里叶级数法计算C4CV。随访期间的大血管和微血管事件通过医疗记录确定。我们绘制了Kaplan-Meier曲线，并进行了Cox比例风险模型和对数秩检验，以评估C4CV作为风险预测指标的有效性。我们根据C4CV（<4.3%、4.3%至6.8%、6.8%至11.4%和>11.4%）将患者分为四分位数组。与C4CV<4.3%的患者相比，C4CV>11.4%的患者发生大血管事件的发生率翻倍（风险比，2.13；95%置信区间，1.70 - 2.67），微血管事件发生率翻倍（风险比，2.08；95%置信区间，1.67 - 2.58），心血管死亡发生率为三倍（风险比，3.03；95%置信区间，1.10 - 8.83）。Cox回归分析表明，大血管和微血管结局的风险均随C4CV值四分位数水平的升高而增加（P<0.0001）。在对年龄、性别、吸烟、收缩压、舒张压、血脂异常、糖尿病病程、糖化血红蛋白和心血管疾病进行校正后，这些关联仍然存在（P<0.0001）。C4CV是T2DM患者心血管死亡率、大血管事件和微血管事件的新型独立预测指标。
