Arterial Wave Reflections and Incident Cardiovascular Events and Heart Failure

Abstract

Background Experimental and physiologic data mechanistically implicate wave reflections in the pathogenesis of left ventricular failure and cardiovascular disease, but their association with these outcomes in the general population is unclear. Objectives To assess the relationship between central pressure profiles and incident cardiovascular events. Methods Aortic pressure waveforms were derived from a generalized transfer function applied to the radial pressure waveform recorded non-invasively from 5,960 participants in the Multiethnic Study of Atherosclerosis (MESA). The central pressure waveform was separated into forward and reflected waves using a physiologic flow waveform. Reflection magnitude (RM=[reflected/forward wave amplitude] ×100), augmentation index (AIx=[second/first systolic peak] ×100) and pulse pressure amplification (PPA=[radial/aortic pulse pressure] ×100) were assessed as predictors of cardiovascular events (CVE) and congestive heart failure (CHF) during median 7.61 years of follow-up. Results After adjustment for established risk factors, aortic AIx independently predicted hard CVE (HR per 10%-increase=1.08; 95%CI=1.01-1.14; P=0.016), whereas PPA independently predicted all CVE (HR per 10%-increase=0.82; 95%CI=0.70-0.96; P=0.012). RM was independently predictive of all CVE (hazard ratio [HR] per 10%-increase=1.34; 95%CI=1.08-1.67; P=0.009), hard CVE (HR per 10%-increase=1.46; 95%CI=1.12-1.90; P=0.006) and strongly predictive of new-onset CHF (HR per 10%-increase=2.69; 95%CI=1.79-4.04; P<0.0001), comparing favorably to other risk factors for CHF as judged by various measures of model performance, reclassification and discrimination. In a fully-adjusted model, compared to non-hypertensive subjects with low RM, the HR for hypertensive subjects with low RM, non-hypertensive subjects with high RM and hypertensive subjects with high RM were 1.81 (95%CI=0.85-3.86), 2.16 (95%CI=1.07-5.01) and 3.98 (95%CI=1.96-8.05), respectively. Conclusions Arterial wave reflections represent a novel strong risk factor for CHF in the general population.

Association of Systemic Arterial Properties With Right Ventricular Morphology: The Multi‐Ethnic Study of Atherosclerosis (MESA)‐Right Ventricle Study

“…Parameters of pulsatile load include TAC20, 21 and AI,22, 23 which encompass vascular elastance and the wave reflection physiology. The SVR quantifies the resistive load 24, 25.…”

Reliability of pulse waveform separation analysis

“…[2][3][4][5] The important parameters are central blood pressures and indices of arterial wave reflection, including augmentation index (AIx) and the promising wave separation analysis. However, to be of value in a clinical setting, an assessment tool must also be precise (reliable) when used during normal clinical operating conditions.…”

“…[6] Wave separation analysis is promising because it may provide a more accurate estimate of the effects of wave reflection on central blood pressure and centrally located organs than the more established AIx. [4,7] The AIx, which is calculated by dividing the central augmentation pressure by the corresponding pulse pressure, is affected by the reflected wave transit time. [8,9] Alternatively, by assuming a triangular or a physiologic flow waveform, [10] the aortic wave can be separated into its forward (Pf) component and timing-independent reflected component (Pb).…”

“…[8,9] Alternatively, by assuming a triangular or a physiologic flow waveform, [10] the aortic wave can be separated into its forward (Pf) component and timing-independent reflected component (Pb). Two large prospective studies [4,5] suggest that wave separation analysis may be superior to AIx as a subclinical marker of cardiovascular disease, one reporting that Pb better predicts 15-year cardiovascular mortality than AIx, [5] the other that reflection magnitude (RM, Pb/Pf) better predicts cardiovascular events than AIx. [4] Reliability of Waveform Separation Analysis 4…”

“…Two large prospective studies [4,5] suggest that wave separation analysis may be superior to AIx as a subclinical marker of cardiovascular disease, one reporting that Pb better predicts 15-year cardiovascular mortality than AIx, [5] the other that reflection magnitude (RM, Pb/Pf) better predicts cardiovascular events than AIx. [4] Reliability of Waveform Separation Analysis 4…”