Tavolinejad Hamed, Erten Ozgun, Maynard Hannah, Chirinos Julio A
Division of Cardiovascular Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA.
University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA.
JACC Adv. 2024 Jun 4;3(7):101019. doi: 10.1016/j.jacadv.2024.101019. eCollection 2024 Jul.
Arterial stiffness causes cardiovascular disease and target-organ damage. Carotid-femoral pulse wave velocity is regarded as a standard arterial stiffness metric. However, the prognostic value of cardio-ankle vascular index (CAVI), which is mathematically corrected for blood pressure, remains understudied.
The purpose of this study was to determine the association of CAVI with cardiovascular and kidney outcomes.
PubMed, Scopus, and Web of Science were searched until May 6, 2023, for longitudinal studies reporting the association of CAVI with mortality, cardiovascular events (CVEs) (including death, acute coronary syndromes, stroke, coronary revascularization, heart failure hospitalization), and kidney function decline (incidence/progression of chronic kidney disease, glomerular filtration rate decline). Random-effects meta-analysis was performed. Studies were assessed with the "Quality in Prognostic Studies" tool.
Systematic review identified 32 studies (105,845 participants; follow-up range: 12-148 months). Variable cutoffs were reported for CAVI. The risk of CVEs was higher for high vs normal CAVI (HR: 1.46 [95% CI: 1.22-1.75]; < 0.001; I = 41%), and per SD/unit CAVI increase (HR: 1.30 [95% CI: 1.20-1.41]; < 0.001; I = 0%). Among studies including participants without baseline cardiovascular disease (primary prevention), higher CAVI was associated with first-time CVEs (high vs normal: HR: 1.60 [95% CI: 1.15-2.21]; = 0.005; I = 65%; HR per SD/unit increase: 1.28 [95% CI: 1.12-1.47]; < 0.001; I = 18%). There was no association between CAVI and mortality (HR = 1.31 [0.92-1.87]; = 0.130; I = 53%). CAVI was associated with kidney function decline (high vs normal: HR = 1.30 [1.18-1.43]; < 0.001; I = 38%; HR per SD/unit increase: 1.12 [95% CI: 1.07-1.18]; < 0.001; I = 0%).
Higher CAVI is associated with incident CVEs, and this association is present in the primary prevention setting. Elevated CAVI is associated with kidney function decline.
动脉僵硬度会导致心血管疾病和靶器官损害。颈股脉搏波速度被视为动脉僵硬度的标准指标。然而，经血压数学校正的心脏-脚踝血管指数（CAVI）的预后价值仍未得到充分研究。
本研究旨在确定CAVI与心血管和肾脏结局之间的关联。
检索了PubMed、Scopus和Web of Science数据库，直至2023年5月6日，查找报告CAVI与死亡率、心血管事件（CVE）（包括死亡、急性冠脉综合征、中风、冠状动脉血运重建、心力衰竭住院）以及肾功能下降（慢性肾脏病的发病率/进展、肾小球滤过率下降）之间关联的纵向研究。进行随机效应荟萃分析。使用“预后研究质量”工具对研究进行评估。
系统评价纳入了32项研究（105845名参与者；随访时间范围：12 - 148个月）。报告的CAVI截断值各不相同。与正常CAVI相比，高CAVI者发生CVE的风险更高（HR：1.46 [95%CI：1.22 - 1.75]；P < 0.001；I² = 41%），且CAVI每增加1个标准差/单位（HR：1.30 [95%CI：1.20 - 1.41]；P < 0.001；I² = 0%）。在纳入无基线心血管疾病参与者（一级预防）的研究中，较高的CAVI与首次发生CVE相关（高CAVI与正常CAVI相比：HR：1.60 [95%CI：1.15 - 2.21]；P = 0.005；I² = 65%；每增加1个标准差/单位的HR：1.28 [95%CI：1.12 - 1.47]；P < 0.001；I² = 18%）。CAVI与死亡率之间无关联（HR = 1.31 [0.92 - 1.87]；P = 0.130；I² = 53%）。CAVI与肾功能下降相关（高CAVI与正常CAVI相比：HR = 1.30 [1.18 - 1.43]；P < 0.001；I² = 38%；每增加1个标准差/单位的HR：1.12 [95%CI：1.07 - 1.18]；P < 0.001；I² = 0%）。
较高的CAVI与新发CVE相关，且这种关联在一级预防环境中也存在。升高的CAVI与肾功能下降相关。
