Arterial wave reflections and incident cardiovascular events and heart failure: MESA (Multiethnic Study of Atherosclerosis).
Arterial wave reflections and incident cardiovascular events and heart failure: MESA (Multiethnic Study of Atherosclerosis).
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DOI：
10.1016/j.jacc.2012.07.054
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发表时间：
2012-11-20
影响因子：
24
通讯作者：
Segers, Patrick
中科院分区：
文献类型：
--
作者：
Chirinos, Julio A.;Kips, Jan G.;Jacobs, David R., Jr.;Brumback, Lyndia;Duprez, Daniel A.;Kronmal, Richard;Bluemke, David A.;Townsend, Raymond R.;Vermeersch, Sebastian;Segers, Patrick
关键词：
实验和生理学数据从机制上认为波反射与左心衰和心血管疾病的发病机制有关，但在普通人群中，波反射与这些结果的相关性尚不清楚。评估中心压力分布与突发心血管事件之间的关系。在动脉粥样硬化多种族研究(MESA)中，从5960名参与者的无创性记录的径向压力波形中应用广义传递函数得出主动脉压力波形。使用生理流动波形将中心压力波形分离为前向波和反射波。在中位7.61年的随访中，反射幅度(Rm=[反射/前向波幅度]×100)、增强指数(AIX=[第二/第一收缩峰]×100)和脉压放大(PPA=[桡动脉/主动脉脉压]×100)被评估为心血管事件(CVE)和充血性心力衰竭(CHF)的预测因子。调整已建立的危险因素后，AIX独立预测硬性CVE(每10%增加HR=1.0 8；95%CI=1.0 1~1.14；P=0.016)，而PPA独立预测全部CVE(每10%增加HR=0.82；95%CI=0.7~0.96；P=0.012)。RM可独立预测所有慢性心力衰竭(每10%增加一次的危险比=1.34；95%CI=1.08-1.67；P=0.009)、硬性心动过速(每10%增加一次的危险比=1.46；95%CI=1.12-1.9；P=0.006)和对新发心力衰竭的强烈预测(每10%增加一次的危险比=1.69；95%CI=1.79-4.04；P<；0.0001)，与通过各种模型性能、重新分类和辨别力判断的其他心力衰竭的危险因素相比是有利的。在完全调整模型中，与非高血压低Rm组相比，高血压低Rm组、非高血压高Rm组和高血压高Rm组的HR分别为1.81(95%CI=0.85~3.86)、2.16(95%CI=1.07~5.01)和3.98(95%CI=1.96~8.05)。在普通人群中，动脉波反射是CHF的一个新的强烈危险因素。
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. To assess the relationship between central pressure profiles and incident cardiovascular events. 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. 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. Arterial wave reflections represent a novel strong risk factor for CHF in the general population.
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影响因子：
37.8
作者：
Mitchell GF;Hwang SJ;Vasan RS;Larson MG;Pencina MJ;Hamburg NM;Vita JA;Levy D;Benjamin EJ
通讯作者：
Benjamin EJ
影响因子：
24
作者：
Roman, Mary J.;Devereux, Richard B.;Kizer, Jorge R.;Okin, Peter M.;Lee, Elisa T.;Wang, Wenyu;Umans, Jason G.;Calhoun, Darren;Howard, Barbara V.
通讯作者：
Howard, Barbara V.
衡量心血管风险的个体预测因素的影响的进步：重新分类措施的作用。
影响因子：
39.2
作者：
Cook NR;Ridker PM
通讯作者：
Ridker PM
影响因子：
2
作者：
Pencina, Michael J.;D'Agostino, Ralph B., Sr.;Steyerberg, Ewout W.
通讯作者：
Steyerberg, Ewout W.
DOI：
10.1152/ajpheart.2000.279.2.h542
发表时间：
2000-08-01
影响因子：
4.8
作者：
Segers, P;Carlier, S;Verdonck, P
通讯作者：
Verdonck, P