Radial Pulse Spectrum Analysis as Risk Markers to Improve the Risk Stratification of Silent Myocardial Ischemia in Type 2 Diabetic Patients

Abstract

Diabetic patients with silent myocardial ischemia (SMI) have elevated rates of morbidity and mortality and need intensive care and monitoring. An early predictor of SMI may lead to early diagnosis and medical treatment to prevent progression and adverse clinical events. Therefore, this paper was aimed to evaluate the radial pulse spectrum as risk markers to improve the risk stratification of SMI in type-2 diabetic patients; 195 diabetic patients at high-risk of SMI were enrolled. All patients underwent myocardial perfusion imaging and radial pressure wave measurement. The spectrum analysis of the radial pressure wave was calculated and transformed into Fourier series coefficients Cns and Pns. The risk of SMI (odds ratio: 4.46, 95%, C.I. 1.61–12.4, \documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{upgreek} \usepackage{mathrsfs} \setlength{\oddsidemargin}{-69pt} \begin{document} }{}$P<0.01$ \end{document}) was raised in diabetic patients classified high-risk group by C2. Multivariable regression analysis showed that C2 (\documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{upgreek} \usepackage{mathrsfs} \setlength{\oddsidemargin}{-69pt} \begin{document} }{}$P<0.05$ \end{document}) and ankle–brachial index [(ABI) \documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{upgreek} \usepackage{mathrsfs} \setlength{\oddsidemargin}{-69pt} \begin{document} }{}$P<0.05$ \end{document})] were related to SMI (\documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{upgreek} \usepackage{mathrsfs} \setlength{\oddsidemargin}{-69pt} \begin{document} }{}$R=0.46$ \end{document} and \documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{upgreek} \usepackage{mathrsfs} \setlength{\oddsidemargin}{-69pt} \begin{document} }{}$P<0.05$ \end{document}). The myocardial ischemic score (MIS), combining C2, C3, and P5, the albumin-to-creatinine ratio (ACR), and ABI, presented an excellent risk stratification performance in enrolled patients (odds ratio: 5.78, 95%, C.I. 2.29–14.6, \documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{upgreek} \usepackage{mathrsfs} \setlength{\oddsidemargin}{-69pt} \begin{document} }{}$P<0.01$ \end{document}). The area under receiver operating characteristic curves for C2, C3, P5, ABI, ACR, and MIS were 0.66, 0.60, 0.68, 0.51, 0.56, and 0.74, respectively, in identifying SMI. This paper demonstrated that C2 was independently associated with the extent of SMI in multivariable regression analysis. Odds ratio and chi-square tests reflected that C2 could b...

Risk assessment of macrovascular and microvascular events in patients with type 2 diabetes by analyzing the amplitude variation of the fourth harmonic component of radial pulse wave

“…Thus, we tried to use this technique and assess whether larger C4CV contributes to vascular risk in patients with type 2 diabetes (T2DM). Our cohort study on T2DM manifested that larger C4CV is associated with renal dysfunction (Liao et al 2018). Another study found that larger C4CV is associated with myocardial ischemia and a reduced left ventricular ejection fraction (<50%) (Liao et al 2018).…”

“…Our cohort study on T2DM manifested that larger C4CV is associated with renal dysfunction (Liao et al 2018). Another study found that larger C4CV is associated with myocardial ischemia and a reduced left ventricular ejection fraction (<50%) (Liao et al 2018). Recently, our preliminary study suggested that larger C4CV is independently associated with future major adverse cardiovascular events (MACE) in asymptomatic patients with T2DM (Liao et al 2019).…”

“…Our previous study found that traditional cardiovascular risk factors have limitations in identifying patients with T2DM who is at high risk of heart disease, especially in those without angina symptoms or history of cardiovascular disease. (Chen et al , ) Scognamiglio et al have also shown that myocardial perfusion defects and significant coronary stenosis in a great portion of asymptomatic patients with T2DM cannot be identified by traditional risk factors (Scognamiglio et al ). Those who fail to be identified early in cardiovascular disease will result in a poor prognosis and may face MACE or even cardiovascular death before appropriate medical intervention.…”

“…Harmonic analysis of arterial pressure pulse provides insightful hemodynamic information into the condition of the ventricular-arterial system through the resonance effects (Wang et al 1991;. Some researchers showed that changes in blood flow (Young et al 1989;1992;Chen et al 1993) and function (Liao et al 2018(Liao et al , 2018a of an organ could be revealed by changes in arterial pulse waveforms. Therefore, harmonic characteristics derived from arterial pulses can be used to monitor the progression of cardiovascular disease.…”

Did you know developing quantitative pulse diagnosis with realistic haemodynamic theory can pave a way for future personalized health care

“…The harmonic analysis of arterial pulses has been used by researchers to study the frequency characteristics of organs; to explore the meridian theory in traditional Chinese medicine; to find the effect of herbs, coffee, acupunctures, fasting and exercise . It has also been used to link the harmonic spectrum with some cardiovascular risk factors in clinical monitoring …”