Wave Reflection Predicts Cardiovascular Events in Hypertensive Individuals Independent of Blood Pressure and Other Cardiovascular Risk Factors An ASCOT (Anglo-Scandinavian Cardiac Outcome Trial) Substudy
Wave Reflection Predicts Cardiovascular Events in Hypertensive Individuals Independent of Blood Pressure and Other Cardiovascular Risk Factors An ASCOT (Anglo-Scandinavian Cardiac Outcome Trial) Substudy
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DOI：
10.1016/j.jacc.2010.03.030
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发表时间：
2010-06-29
影响因子：
24
通讯作者：
Hughes, Alun D.
中科院分区：
文献类型：
--
作者：
Manisty, Charlotte;Mayet, Jamil;Hughes, Alun D.
目的 本研究调查了通过波强度分析测量的波反射是否可以预测高血压患者未来的心血管事件，并试图确定这种关系是否独立于其他心血管危险因素，以及是否与左心室负荷增加的证据相关。 背景 波反射可能会对左心室施加额外的负荷，而在一些但并非所有研究中，据报道波反射的增强指数可以预测心血管事件。随机化后约 1 年，对 259 名 ASCOT（盎格鲁斯堪的纳维亚心脏结果试验）参与者进行了颈动脉超声、超声心动图和血液化学分析，并使用波强度分析来计算波反射指数 (WRI)、峰值前向压力与峰值后向压力的比率 (P-b/P-f) 和颈动脉增强指数 (cAI(x))。所有参与者均接受中位随访 5.9 年，发生 33 起心血管事件。结果 WRI、P-b/P-f 以及较小程度上的 cAI(x) 具有相关性。 WRI 在未经调整的模型中预测了心血管事件（风险比：2.10；95% 置信区间：1.10 至 3.99；p = 0.02）。多变量分析表明这种关联与血压无关。 P-b/P-f 和 cAI(x) 不能显着预测心血管事件。 WRI 还与左心室质量指数增加和 B 型利钠肽升高呈正相关（根据年龄和性别进行调整），并且这些关联与血压或其他心血管危险因素无关。结论 对于接受治疗的高血压患者，较高波反射可预测未来的心血管事件，与传统危险因素无关。 （J Am Coll Cardiol 2010；56：24-30）(C) 2010 年，美国心脏病学会基金会
Objectives This study investigated whether wave reflection measured by wave intensity analysis predicts future cardiovascular events in individuals with hypertension and sought to establish whether this relationship is independent of other cardiovascular risk factors and is associated with evidence of increased load on the left ventricle.Background Wave reflection may impose an additional load on the left ventricle, and augmentation index, a surrogate of wave reflection, has been reported to predict cardiovascular events in some, but not all studies.Methods Measurements of brachial and carotid blood pressure (BP) measurement, carotid ultrasound, echocardiography, and blood chemistry analyses were performed on 259 ASCOT (Anglo Scandinavian Cardiac Outcomes Trial) participants approximately 1 year after randomization, and wave intensity analysis was used to calculate wave reflection index (WRI), the ratio of peak forward to peak backward pressure (P-b/P-f), and carotid augmentation index (cAI(x)). All participants were followed up for a median period of 5.9 years, accruing 33 cardiovascular events.Results WRI, P-b/P-f, and to a lesser extent, cAI(x), were correlated. WRI predicted cardiovascular events (hazard ratio: 2.10; 95% confidence interval: 1.10 to 3.99; p = 0.02) in an unadjusted model. Multivariate analysis showed that this association was independent of BP. P-b/P-f and cAI(x) did not significantly predict cardiovascular events. WRI was also positively associated with increased left ventricular mass index and elevated B-type natriuretic peptide adjusted for age and sex, and these associations were independent of BP or other cardiovascular risk factors.Conclusions Higher wave reflection predicts future cardiovascular events independent of conventional risk factors in people with treated hypertension. (J Am Coll Cardiol 2010; 56: 24-30) (C) 2010 by the American College of Cardiology Foundation