Boos Christopher J, Thiri-Toon Lin, Steadman Christopher D, Khambekar Sujata, Jordan Andrew, Carpenter John Paul
Department of Cardiology, Poole Hospital NHS Foundation Trust, Longfleet Rd., Poole, Dorset, BH15 2JB, UK.
Department of Postgraduate Medical Education, Bournemouth University, Bournemouth, BH1 3LT, UK.
Cardiol Res. 2021 Jun;12(3):161-168. doi: 10.14740/cr1189. Epub 2021 May 14.
The ambulatory arterial stiffness index (AASI) obtained during ambulatory blood pressure monitoring (ABPM) has been cited as an independent predictor of major adverse cardiovascular events (MACEs) including cardiovascular death, stroke and worsening chronic kidney disease (CKD) among mixed-sex adult populations. This study aimed to determine the relationship between AASI and MACE and its predictive precision in women.
This work follows the guidelines of the STROBE initiative for cohort studies. This was a retrospective single-center observational study of adult women (aged 18 - 75 years), who underwent 24-h ABPM for the diagnosis of hypertension or its control. The primary endpoint was a composite MACE of cardiovascular death, acute limb ischemia, stroke, acute coronary syndrome (ACS), or progression to stage V CKD.
A total of 219 women aged 57.4 ± 13.3 years were followed up for a median (interquartile range (IQR)) of 25.5 (18.3 - 31.3) months. Overall, 16 (7.3%) patients suffered one or more MACE events. AASI was significantly higher in patients with known coronary artery disease (CAD), diabetes mellitus, peripheral vascular disease (PVD), heart failure, previous stroke, or transient ischemic attack (TIA). AASI was a significant predictor of MACE (area under the curve: 0.78; P < 0.001) with an optimal cut-off of ≥ 0.56. On Kaplan-Meier analysis AASI ≥ 0.56 was significantly associated with MACE (log-rank test, P < 0.001). The only independent predictors of MACE on Cox proportional hazard analysis were diabetes mellitus, low high-density lipoprotein (HDL) levels, cumulative AASI values, or AASI ≥ 0.56.
An AASI of ≥ 0.56 is an independent predictor of MACE in women. A further validation study in a larger cohort of women is recommended.
动态血压监测（ABPM）期间获得的动态动脉僵硬度指数（AASI）被认为是包括心血管死亡、中风和慢性肾脏病（CKD）恶化在内的主要不良心血管事件（MACE）在成年混合性别群体中的独立预测指标。本研究旨在确定AASI与MACE之间的关系及其在女性中的预测精度。
本研究遵循队列研究的STROBE倡议指南。这是一项针对成年女性（年龄18 - 75岁）的回顾性单中心观察性研究，这些女性接受24小时ABPM以诊断高血压或控制血压。主要终点是心血管死亡、急性肢体缺血、中风、急性冠状动脉综合征（ACS）或进展至Ⅴ期CKD的复合MACE。
共纳入219名年龄为57.4±13.3岁的女性，中位（四分位间距（IQR））随访时间为25.5（18.3 - 31.3）个月。总体而言，16名（7.3%）患者发生了一次或多次MACE事件。已知患有冠状动脉疾病（CAD）、糖尿病、外周血管疾病（PVD）、心力衰竭、既往中风或短暂性脑缺血发作（TIA）的患者AASI显著更高。AASI是MACE的显著预测指标（曲线下面积：0.78；P<0.001），最佳截断值为≥0.56。根据Kaplan-Meier分析，AASI≥0.56与MACE显著相关（对数秩检验，P<0.001）。Cox比例风险分析中，MACE的唯一独立预测指标是糖尿病、低高密度脂蛋白（HDL）水平、累积AASI值或AASI≥0.56。
AASI≥0.56是女性MACE的独立预测指标。建议在更大规模的女性队列中进行进一步的验证研究。
