Division of Cardiology, Department of Internal Medicine, Kaohsiung Medical University Hospital.
Department of Internal Medicine, Kaohsiung Municipal Siaogang Hospital.
J Atheroscler Thromb. 2022 Mar 1;29(3):337-344. doi: 10.5551/jat.60806. Epub 2021 Feb 18.
Abnormal ankle-brachial index (ABI) is regarded as peripheral artery disease and can be used to predict cardiovascular (CV) outcomes. However, the usefulness of ABI for the prediction of CV outcome in patients with normal ABI is limited. Upstroke time per cardiac cycle (UTCC) is recently reported to be associated with mortality in patients with acute myocardial infarction and the elderly. Therefore, we aimed to evaluate UTCC, left ventricular ejection fraction (LVEF), brachial-ankle pulse wave velocity (baPWV), and ABI for the prediction of mortality in patients with normal ABI.
Patients arranged for echocardiographic examinations were enrolled, and 1076 patients with normal ABI were included. ABI, baPWV, and UTCC were measured by an ABI-form device.
The median follow-up to mortality was 95 months. There were 88 CV and 244 all-cause deaths. After multivariate analysis, UTCC was associated with increased CV and all-cause mortality (P ≤ 0.004). Age, diabetes, heart failure, left ventricular hypertrophy, baPWV, and LVEF were also independent predictors of CV and all-cause mortality, but ABI was not. Furthermore, UTCC had a better additive predictive value than ABI, baPWV, and LVEF for CV mortality ( P ≤ 0.012). It also had a better additive predictive value than ABI and LVEF for all-cause mortality (P ≤ 0.013).
UTCC is an independent predictor for CV and all-cause mortality in patients with normal ABI. It also has a better additive predictive value of CV and all-cause mortality than ABI and LVEF. Therefore, UTCC is a simple, novel, and useful parameter for identifying high-risk patients with normal ABI.
异常踝臂指数（ABI）被视为外周动脉疾病，可用于预测心血管（CV）结局。然而，ABI 对于预测正常 ABI 患者的 CV 结局的作用有限。最近有研究报道，心动周期上升时间（UTCC）与急性心肌梗死和老年人的死亡率相关。因此，我们旨在评估 UTCC、左心室射血分数（LVEF）、肱踝脉搏波速度（baPWV）和 ABI 对正常 ABI 患者死亡率的预测价值。
招募接受超声心动图检查的患者，共纳入 1076 例正常 ABI 的患者。ABI、baPWV 和 UTCC 通过 ABI 设备进行测量。
中位随访至死亡时间为 95 个月。有 88 例心血管死亡和 244 例全因死亡。多变量分析后，UTCC 与心血管和全因死亡率的增加相关（P ≤ 0.004）。年龄、糖尿病、心力衰竭、左心室肥厚、baPWV 和 LVEF 也是心血管和全因死亡率的独立预测因素，但 ABI 不是。此外，UTCC 对心血管死亡率的附加预测价值优于 ABI、baPWV 和 LVEF（P ≤ 0.012）。它对全因死亡率的附加预测价值也优于 ABI 和 LVEF（P ≤ 0.013）。
UTCC 是正常 ABI 患者心血管和全因死亡的独立预测因素。它对心血管和全因死亡率的附加预测价值也优于 ABI 和 LVEF。因此，UTCC 是一种简单、新颖、有用的参数，可用于识别正常 ABI 患者的高危人群。
