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BACKGROUND: To make good use of the prognostic value of arterial stiffness, it is important to identify the population with the greatest benefit. In this study, we compared the prognostic value of brachial-ankle pulse wave velocity (baPWV) according to various clinical characteristics. METHODS: A total of 10,597 subjects who underwent baPWV measurement (mean age, 61.4 ± 9.5 years; female proportion, 42.5%) were retrospectively analyzed. Major adverse cardiovascular events (MACEs), defined as a composite of cardiac death, non-fatal myocardial infarction, coronary revascularization, and ischemic stroke were assessed during the clinical follow-up period. RESULTS: In the multivariate analysis, clinical variables with more than 4,000 subjects were selected as grouping variables, which were sex (men and women), age (≥ 65 and < 65 years), body mass index (BMI) (≥ 25 and < 25 kg/m²), hypertension (presence and absence), estimated glomerular filtration rate (≥ 90 and < 90 mL/min/1.73 m²), and statin use (user and non-user). During the median clinical follow-up duration of 3.58 years (interquartile range, 1.43-5.38 years), there were 422 MACEs (4.0%). In total study subjects, baseline higher baPWV was associated with increased risk of MACE occurrence (hazard ratio for baPWV ≥ 1,800 cm/s compared to baPWV < 1,400 cm/s, 4.04; 95% confidence interval, 2.62-6.21; P < 0.001). The prognostic value of baPWV was statistically significant regardless of sex, age, BMI, hypertension, renal function, and statin use. CONCLUSION: Our results suggest that baPWV is not only effective in specific clinical situations, but can be effectively applied to predict cardiovascular prognosis in various clinical situations.
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Inibidores de Hidroximetilglutaril-CoA Redutases , Hipertensão , Rigidez Vascular , Masculino , Humanos , Feminino , Pessoa de Meia-Idade , Idoso , Prognóstico , Índice Tornozelo-Braço , Estudos Retrospectivos , Fatores de Risco , Análise de Onda de Pulso , Hipertensão/diagnósticoRESUMO
PURPOSE: There has been limited evidence for the association between socioeconomic status (SES) and arterial stiffness. This study was performed to investigate the association between household income and brachial pulse pressure (PP) in the general Korean population. MATERIALS AND METHODS: This study was based on data acquired in the 2018 Korea National Health and Nutrition Examination Survey (2018 KNHANES). A total of 13004 subjects at the age of 20 years or older analysed. The information on monthly household income was obtained through the questionnaire, and was stratified into 5 groups for each quintile. Brachial blood pressure (BP) was measured 3 times, and the average of the second and third measured BPs were used. PP was calculated as the difference between systolic and diastolic BPs. RESULTS: A lower household income was associated with a higher prevalence of cardiovascular risk factors. As household income increased, PP decreased proportionally (p < .001). In multiple linear regression analysis, household income (per quintile) was independently associated with PP even after controlling for potential confounders (ß = -.125, p < .001). Multiple binary logistic regression analysis showed that the increased household income level was significantly associated lower probability having higher PP (≥ 43.5 mmHg) even after controlling for multiple covariates (the lowest vs. the highest household income; odds ratio, 0.48; 95% confidence interval, .41-.55; p < .001). CONCLUSION: Low household income was associated with higher PP. This provides additional evidence for the association between low SES and high arterial stiffness.
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Renda , Adulto , Pressão Sanguínea , Humanos , Modelos Logísticos , Inquéritos Nutricionais , República da Coreia/epidemiologia , Fatores de Risco , Adulto JovemRESUMO
Background: The impact of age on the association between central aortic hemodynamics and left ventricular (LV) remodeling has not been well elucidated. We compared the relationship between measurements of central blood pressure (CBP) and LV mass index (LVMI) according to their ages (<50 years versus ≥50 years). Methods: A total of 305 consecutive subjects (64.4 ± 10.9 years, 60.7% males) who underwent invasive coronary angiography (ICA) for the evaluation of coronary artery disease were prospectively enrolled. Just before ICA, CBP was measured at the aortic root using a pig-tail catheter, and CBP indices, including aortic systolic blood pressure (aSBP), aortic pulse pressure (aPP), aortic fractional pulse pressure (=aPP/mean aortic pressure), and aortic pulsatility index (=aPP/diastolic aortic pressure), were recorded. All subjects underwent transthoracic echocardiography, and LVMI was measured on the same day of ICA. Results: In simple linear correlation analyses, LVMI was associated with all CBP indices in subjects aged <50 years (n = 29) (P < .05 for each), but not in those aged ≥50 years (n = 276) (P > .05 for each). In the younger age group (≤50 years), multivariable analysis showed that aSBP (ß = 0.457, P= .021) and aPP (ß = 0.610, P= .006) had a significant association with LVMI after adjusting for possible confounding factors. The results remained consistent even when analyzed in a 1:1 propensity score-matched cohort. In conclusion, invasively measured aPP showed the closest association with LVMI in subjects aged <50 years, but not those aged ≥50 years. Conclusion: Aortic pulsatile hemodynamic status appears to have a greater effect on LV remodeling in younger people than in older people.
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Envelhecimento/patologia , Pressão Sanguínea/fisiologia , Ventrículos do Coração/patologia , Ventrículos do Coração/fisiopatologia , Adulto , Fatores Etários , Idoso , Pressão Arterial/fisiologia , Estudos de Coortes , Ecocardiografia , Feminino , Ventrículos do Coração/diagnóstico por imagem , Hemodinâmica/fisiologia , Humanos , Hipertensão/fisiopatologia , Hipertrofia Ventricular Esquerda/fisiopatologia , Masculino , Pessoa de Meia-Idade , Tamanho do Órgão , Pontuação de PropensãoRESUMO
BACKGROUND: There is little data as to whether osteoprotegerin (OPG) is associated with target organ damage (TOD), so we evaluated the association in patients at high risk of coronary artery disease (CAD).MethodsâandâResults:A total of 349 patients who underwent invasive coronary angiography (ICA) for suspected CAD were prospectively recruited. During the index admission, 6 TOD parameters were collected: extent of CAD, glomerular filtration rate (GFR), left ventricular mass index (LVMI), E/e', brachial-ankle pulse wave velocity (baPWV), and ankle-brachial index (ABI). Serum OPG levels were measured using enzyme-linked immunosorbent assay. The OPG level was significantly higher in patients with ≥1 TOD parameter than in those without (314±186 vs. 202±74 pg/mL, P<0.001). For each TOD parameter, the serum OPG level was significantly higher in patients with TOD than in those without (P<0.05 for each) except for ABI. In correlation analysis, OPG was significantly associated with GFR, LVMI, E/e', baPWV and ABI (P<0.05 for each). The OPG concentration increased proportionally with increasing TOD (P<0.001). Higher OPG concentrations (≥198 pg/mL) was significantly associated with the presence of TOD (odds ratio 3.22; 95% confidence interval 1.51-6.85; P=0.002) even after controlling for potential confounders. CONCLUSIONS: Serum OPG level was significantly associated with a variety of TOD in patients undergoing ICA. OPG may be a useful marker for TOD and in the risk stratification of patients at high risk of CAD.
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Índice Tornozelo-Braço , Doença da Artéria Coronariana , Osteoprotegerina/sangue , Angiografia Coronária , Taxa de Filtração Glomerular , Humanos , Análise de Onda de Pulso , Fatores de RiscoRESUMO
BACKGROUND: The association between dental health and coronary artery disease (CAD) remains a topic of debate. This study aimed to investigate the association between dental health and obstructive CAD using multiple dental indices. METHODS: Eighty-eight patients (mean age: 65 years, 86% male) were prospectively enrolled before undergoing coronary CT angiography (n = 52) or invasive coronary angiography (n = 36). Obstructive CAD was defined as luminal stenosis of ≥50% for the left main coronary artery or ≥ 70% for the other epicardial coronary arteries. All patients underwent thorough dental examinations to evaluate 7 dental health indices, including the sum of decayed and filled teeth, the ratio of no restoration, the community periodontal index of treatment needs, clinical attachment loss, the total dental index, the panoramic topography index, and number of lost teeth. RESULTS: Forty patients (45.4%) had obstructive CAD. Among the 7 dental health indices, only the number of lost teeth was significantly associated with obstructive CAD, with patients who had obstructive CAD having significantly more lost teeth than patients without obstructive CAD (13.08 ± 10.4 vs. 5.44 ± 5.74, p < 0.001). The number of lost teeth was correlated with the number of obstructed coronary arteries (p < 0.001). Multiple binary logistic regression analysis revealed that having ≥10 lost teeth was independently associated with the presence of obstructive CAD (odds ratio: 8.02, 95% confidence interval: 1.80-35.64; p = 0.006). CONCLUSIONS: Tooth loss was associated with the presence of obstructive CAD in patients undergoing coronary evaluation. Larger longitudinal studies are needed to determine whether there is a causal relationship between tooth loss and CAD.
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Estenose Coronária/complicações , Saúde Bucal , Perda de Dente/complicações , Idoso , Angiografia por Tomografia Computadorizada , Angiografia Coronária/métodos , Estenose Coronária/diagnóstico por imagem , Cárie Dentária/diagnóstico , Cárie Dentária/terapia , Restauração Dentária Permanente , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Tomografia Computadorizada Multidetectores , Índice Periodontal , Radiografia Panorâmica , Medição de Risco , Fatores de Risco , Seul , Índice de Gravidade de Doença , Perda de Dente/diagnóstico , Perda de Dente/terapiaRESUMO
BACKGROUND: Although coronary artery disease (CAD) is a major cause of out-of-hospital cardiac arrest (OHCA), there has been no convinced data on the necessity of routine invasive coronary angiography (ICA) in OHCA. We investigated clinical factors associated with obstructive CAD in OHCA. METHODS: Data from 516 OHCA patients (mean age 58 years, 83% men) who underwent ICA after resuscitation was obtained from a nation-wide OHCA registry. Obstructive CAD was defined as the lesions with diameter stenosis ≥ 50% on ICA. Independent clinical predictors for obstructive CAD were evaluated using multiple logistic regression analysis, and their prediction performance was compared using area under the receiver operating characteristic curve with 10,000 repeated random permutations. RESULTS: Among study patients, 254 (49%) had obstructive CAD. Those with obstructive CAD were older (61 vs. 55 years, P < 0.001) and had higher prevalence of hypertension (54% vs. 36%, P < 0.001), diabetes mellitus (29% vs. 21%, P = 0.032), positive cardiac enzyme (84% vs. 74%, P = 0.010) and initial shockable rhythm (70% vs. 61%, P = 0.033). In multiple logistic regression analysis, old age (≥ 60 years) (odds ratio [OR], 2.01; 95% confidence interval [CI], 1.36-3.00; P = 0.001), hypertension (OR, 1.74; 95% CI, 1.18-2.57; P = 0.005), positive cardiac enzyme (OR, 1.72; 95% CI, 1.09-2.70; P = 0.019), and initial shockable rhythm (OR, 1.71; 95% CI, 1.16-2.54; P = 0.007) were associated with obstructive CAD. Prediction ability for obstructive CAD increased proportionally when these 4 factors were sequentially combined (P < 0.001). CONCLUSION: In patients with OHCA, those with old age, hypertension, positive cardiac enzyme and initial shockable rhythm were associated with obstructive CAD. Early ICA should be considered in these patients.
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Doença da Artéria Coronariana/patologia , Parada Cardíaca Extra-Hospitalar/patologia , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Área Sob a Curva , Angiografia Coronária , Doença da Artéria Coronariana/etiologia , Feminino , Humanos , Hipertensão/complicações , Hipertensão/patologia , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Razão de Chances , Parada Cardíaca Extra-Hospitalar/complicações , Curva ROC , Sistema de Registros , República da Coreia , Fatores de RiscoRESUMO
BACKGROUND: This study was conducted to determine the association between aortic pulse pressure (APP) and left ventricular (LV) filling pressure in the elderly of both genders. METHODS: A total of 211 stable elderly subjects (age ≥65 years, mean age 72.1 ± 5.2 years, 53.6% women) who underwent invasive coronary angiography (ICA) for the evaluation of coronary artery disease (CAD) were prospectively investigated. APP was measured in the ascending aorta using a pigtail catheter immediately before ICA. E/e', reflecting LV filling pressure, was assessed by transthoracic echocardiography. RESULTS: There were positive linear correlations between APP and E/e' in both genders, but the correlation power was stronger in women than in men (r = 0.402, P <.001 vs r = 0.208, P = .040). The significance of this association between APP and E/e' remained after controlling for potential confounders in multiple linear regression analysis in women (ß = 0.359, P <.001), but not in men (r = 0.139, P = .108). CONCLUSIONS: Invasively measured APP is independently associated with E/e' in elderly women, but not in elderly men undergoing ICA. Aortic stiffness may be a potential mechanism for more prevalent LV diastolic dysfunction and heart failure with preserved ejection fraction in elderly women.
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Aorta Torácica/fisiopatologia , Pressão Arterial/fisiologia , Insuficiência Cardíaca/fisiopatologia , Ventrículos do Coração/fisiopatologia , Função Ventricular Esquerda/fisiologia , Pressão Ventricular/fisiologia , Idoso , Aorta Torácica/diagnóstico por imagem , Cateterismo Cardíaco , Ecocardiografia Doppler em Cores , Feminino , Seguimentos , Insuficiência Cardíaca/diagnóstico , Insuficiência Cardíaca/epidemiologia , Ventrículos do Coração/diagnóstico por imagem , Humanos , Masculino , Prevalência , Estudos Prospectivos , República da Coreia/epidemiologia , Fatores Sexuais , Volume Sistólico/fisiologiaRESUMO
AIM: Although the diastolic flow reversal of the descending aorta has been recognized in patients with aortic regurgitation, its generation without this condition is still unknown. This study was performed to investigate whether flow patterns of the descending thoracic aorta, as measured by echocardiography, can represent invasively measured aortic pulse pressure (APP). METHODS: A total of 100 patients (age, 62.3±11.0 years; men, 62.0%) undergoing invasive coronary angiography (ICA) was analyzed. APP was measured at ascending thoracic aorta using pigtail catheter before ICA. Flow in the descending thoracic aorta was assessed using pulse wave Doppler echocardiography, and R/F ratio was defined as reverse peak velocity (R)/forward peak velocity (F). RESULTS: Eighty patients (80.0%) had obstructive coronary artery disease (CAD) (≥50% stenosis of one or more epicardial coronary arteries) in ICA. APP and R/F ratio were significantly higher in patients with obstructive CAD than those without (P<.05 for each). Both R/F ratio (ß=0.379, P<.001) and APP (ß=0.255, P<.001) were positively correlated with age. In simple linear regression analysis, there was a significant positive correlation between R/F ratio and APP (ß=0.266, P<.001). This correlation remained significant even after controlling for potential confounders including age, gender, E/e', and left atrial volume index in multiple linear regression analysis (ß=0.193, P=.036). CONCLUSIONS: R/F ratio may be independently associated with APP in patients undergoing ICA.
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Aorta Torácica/diagnóstico por imagem , Aorta Torácica/fisiopatologia , Pressão Arterial , Estenose Coronária/diagnóstico , Estenose Coronária/fisiopatologia , Ecocardiografia Doppler , Idoso , Velocidade do Fluxo Sanguíneo , Circulação Coronária , Diástole , Feminino , Humanos , Aumento da Imagem , Interpretação de Imagem Assistida por Computador , Masculino , Pessoa de Meia-Idade , Reprodutibilidade dos Testes , Sensibilidade e EspecificidadeRESUMO
The study aim was to investigate the relationship between blood pressure (BP) profile of ambulatory BP monitoring (ABPM) and brachial-ankle pulse wave velocity (baPWV). A total of 196 untreated hypertensive subjects (103 women, age 54.7 ± 12.4 years) who underwent both baPWV measurement and ABPM were analyzed. Systolic dipping of < 10% was defined as a non-dipper. Eighty subjects (40.8%) were non-dippers. The baPWV values were similar between dippers and non-dippers (1609 ± 293 vs 1539 ± 240, p = 0.070). In multiple regression analyses, after controlling age, height and heart rate, daytime systolic BP (SBP) (ß = 0.346, p < 0.001) and night-time SBP (ß = 0.244, p = 0.006) had significant positive associations with baPWV in women but not in men. Diastolic BP and dipping status were not associated with baPWV in either gender. Univariate analysis after further stratification of women according to postmenopausal status showed significant correlations of daytime SBP (ß = 0.317, p = 0.007) and night-time SBP (ß = 0.339, p = 0.004) with baPWV in postmenopausal women but not in premenopausal women. These results suggest that age and gender effects should be considered in the interpretation of the association between BP and arterial stiffness.
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Índice Tornozelo-Braço , Monitorização Ambulatorial da Pressão Arterial , Pressão Sanguínea , Hipertensão/fisiopatologia , Análise de Onda de Pulso , Caracteres Sexuais , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos RetrospectivosRESUMO
This study was conducted to determine clinical parameters predicting future major adverse cardiovascular events (MACEs) in patients without significant stenosis on coronary computed tomographic angiography (CCTA). A total of 625 patients with suspected coronary artery disease (CAD) who underwent CCTA that revealed insignificant (< 50%) CAD was reviewed in three cardiac centers. The MACEs including cardiac death, non-fatal myocardial infarction (MI), unstable angina and late (> 90 days after CCTA) revascularization were assessed. During the mean follow-up period of 819 ± 529 days (median 837 days), there were 28 cases of MACEs (4.5%). In multivariable Cox regression analysis, independent predictors for MACEs were male sex (hazard ratio [HR], 2.40; 95% confidence interval [CI], 1.01-5.69; P = 0.046) and low estimated creatinine clearance (eCCr) (< 60 mL/min/1.73 m(2)) (HR, 3.07; 95% CI, 1.22-7.74; P = 0.017). Low eCCr was the only independent predictor for hard events including cardiac death and MI (HR, 17.6, 95% CI, 1.44-215.7; P = 0.025). In conclusion, renal function is an independent predictor for cardiovascular events among patients without significant CAD by CCTA. Careful monitoring and preventive strategy are warranted in patients with impaired renal function even without significant CAD.
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Doenças Cardiovasculares/mortalidade , Angiografia Coronária/estatística & dados numéricos , Nefropatias/diagnóstico , Nefropatias/mortalidade , Testes de Função Renal/estatística & dados numéricos , Tomografia Computadorizada por Raios X/estatística & dados numéricos , Adulto , Idoso , Idoso de 80 Anos ou mais , Doenças Cardiovasculares/diagnóstico , Comorbidade , Estenose Coronária/diagnóstico por imagem , Estenose Coronária/mortalidade , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Prognóstico , Reprodutibilidade dos Testes , República da Coreia/epidemiologia , Medição de Risco , Sensibilidade e Especificidade , Taxa de SobrevidaRESUMO
This retrospective study investigated the impact of socioeconomic status (SES) on patients at high risk of cardiovascular disease, focusing on obstructive coronary artery disease (CAD) presence and long-term cardiovascular outcomes in individuals undergoing invasive coronary angiography (ICA). Analyzing data from 9530 patients categorized by health insurance type (medical aid beneficiaries (MABs) as the low SES group; national health insurance beneficiaries (NHIBs) as the high SES group), this research explores the relationship between SES and outcomes. Despite a higher prevalence of cardiovascular risk factors, the MAB group exhibited similar rates of obstructive CAD compared to the NHIB group. However, over a median 3.5-year follow-up, the MAB group experienced a higher incidence of composite cardiovascular events, including cardiac death, acute myocardial infarction, coronary revascularization, and ischemic stroke, compared with the NHIB group (20.2% vs. 16.2%, p < 0.001). Multivariable Cox regression analysis, adjusting for potential confounders, revealed independently worse clinical outcomes for the MAB group (adjusted odds ratio 1.28; 95% confidence interval 1.07-1.54; p = 0.006). Despite comparable CAD rates, this study underscores the fact that individuals with low SES encounter an elevated risk of composite cardiovascular events, emphasizing the association between socioeconomic disadvantage and heightened susceptibility to cardiovascular disease, even among those already at high risk.
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INTRODUCTION AND OBJECTIVES: There are no clinical data on the efficacy of intravascular imaging-guided percutaneous coronary intervention (PCI) compared with angiography-guided PCI in patients with acute myocardial infarction (AMI) and cardiogenic shock. The current study sought to evaluate the impact of intravascular imaging-guided PCI in patients with AMI and cardiogenic shock. METHODS: Among a total of 28 732 patients from the nationwide pooled registry of KAMIR-NIH (November, 2011 to December, 2015) and KAMIR-V (January, 2016 to June, 2020), we selected a total of 1833 patients (6.4%) with AMI and cardiogenic shock who underwent PCI of the culprit vessel. The primary endpoint was major adverse cardiovascular events (MACE) at 1 year, a composite of cardiac death, myocardial infarction, repeat revascularization, and definite or probable stent thrombosis. RESULTS: Among the study population, 375 patients (20.5%) underwent intravascular imaging-guided PCI and 1458 patients (79.5%) underwent angiography-guided PCI. Intravascular imaging-guided PCI was associated with a significantly lower risk of 1-year MACE than angiography-guided PCI (19.5% vs 28.2%; HR, 0.59; 95%CI, 0.45-0.77; P<.001), mainly driven by a lower risk of cardiac death (13.7% vs 24.0%; adjusted HR, 0.53; 95%CI, 0.39-0.72; P<.001). These results were consistent in propensity score matching (HR, 0.68; 95%CI, 0.46-0.99), inverse probability weighting (HR, 0.61; 95%CI, 0.45-0.83), and Bayesian analysis (Odds ratio, 0.66, 95% credible interval, 0.49-0.88). CONCLUSIONS: In AMI patients with cardiogenic shock, intravascular imaging-guided PCI was associated with a lower risk of MACE at 1-year than angiography-guided PCI, mainly driven by the lower risk of cardiac death.
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BACKGROUND: There has been a lack of research on further stratification of subjects who have pseudonormal pattern of mitral inflow. The study aim was to clarify 2 different groups with different diastolic function grades among these subjects using lateral tissue Doppler imaging (TDI). METHODS: A total of 122 consecutive subjects showing pseudonormal pattern of mitral inflow (E/A ≥ 1 and septal e'/a' < 1) without structural abnormality were prospectively recruited. TDI measurements were performed from both septal and lateral mitral annuli. RESULTS: Study subjects were stratified according to lateral TDI pattern (e'/a' < 1 [n = 50] versus e'/a' ≥ 1 [n = 72]). Subjects with lateral e'/a' < 1 had higher values of left atrial volume index (LAVI) and E/e' compared to those for lateral e'/a' ≥ 1 (p < 0.001 for each). Among subjects with lateral e'/a' ≥ 1, only 9.3% of subjects had grade II diastolic dysfunction, whereas among subjects with lateral e'/a' < 1, majority of subjects (64.1%) had grade II diastolic dysfunction (p < 0.001). Multiple linear regression analysis showed that lateral e'/a' was independently associated with LAVI (ß = -0.484, p < 0.001), even after adjusting for potential confounders including age, sex, body mass index, hypertension and diabetes. CONCLUSIONS: In subjects without structural abnormality showing E/A ≥ 1 and septal e'/a' < 1, lateral TDI measurement is useful in the assessment of diastolic dysfunction. Lateral e'/a' ≥ 1 is a valuable indicator of early diastolic dysfunction but not of advanced diastolic dysfunction in this population.
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Ecocardiografia Doppler/estatística & dados numéricos , Técnicas de Imagem por Elasticidade/estatística & dados numéricos , Insuficiência da Valva Mitral/diagnóstico por imagem , Insuficiência da Valva Mitral/epidemiologia , Volume Sistólico , Disfunção Ventricular Esquerda/diagnóstico por imagem , Disfunção Ventricular Esquerda/epidemiologia , Comorbidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Prognóstico , Reprodutibilidade dos Testes , República da Coreia/epidemiologia , Medição de Risco , Sensibilidade e EspecificidadeRESUMO
BACKGROUND: The aim of this study is to investigate the association between arterial stiffness and left ventricular filling pressure in an apparently healthy Korean population. METHODS: A total of 115 healthy subjects without known cardiovascular risk factors or overt heart disease who underwent both transthoracic echocardiography and brachial-ankle pulse wave velocity (baPWV) measurement at the same day during their routine check-ups were analyzed. RESULTS: The mean age of study subjects was 52.8 ± 8.4 years, and 78 (67.8%) were men. The mean baPWV value was 1,325 ± 185 cm/s. Study subjects were divided into 3 groups according to E/E' value: subjects with E/E' < 8, 8-12.9 and E/E' ≥ 13. As E/E' increased, baPWV value increased gradually: baPWV in subjects with E/E' < 8, E/E' 8-12.9 and E/E' ≥ 13, were 1,261 ± 163, 1,345 ± 169, 1,569 ± 232 cm/s, respectively (p < 0.001). In multiple linear regression analyses, baPWV was significantly associated with E/E' (ß = 0.371, p < 0.001) after controlling confounders including age, sex and body mass index. In receiver-operating characteristic (ROC) curve analysis, the sensitivity and specificity for detection of E/E' ≥ 10 were 78.6% and 59.8%, respectively with mean baPWV of 1,282 cm/s as the cut off value. The discriminatory capacity for predicting E/E' ≥ 10 was improved from an area under the ROC curve of 0.646 with age alone to 0.734 when baPWV was added (p < 0.001). CONCLUSIONS: There is a significant association between baPWV and E/E' in an apparently healthy Korean population. BaPWV is useful as a simple and non-invasive method for early detection of increased LV filling pressure among these people.
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Artéria Braquial/fisiologia , Ecocardiografia/estatística & dados numéricos , Ventrículos do Coração/diagnóstico por imagem , Análise de Onda de Pulso/métodos , Rigidez Vascular/fisiologia , Função Ventricular Esquerda/fisiologia , Pressão Ventricular/fisiologia , Distribuição por Idade , Artéria Braquial/diagnóstico por imagem , Feminino , Humanos , Coreia (Geográfico)/epidemiologia , Masculino , Pessoa de Meia-Idade , Valores de Referência , Distribuição por SexoRESUMO
OBJECTIVE: The prognostic value of changes in arterial stiffness has not been well evaluated. This study was conducted to investigate whether the change in arterial stiffness one month after percutaneous coronary intervention (PCI) affects the long-term cardiovascular prognosis. METHODS: A total of 405 patients (mean age, 62.0â±â11.0âyears; female sex, 27.7%) who underwent PCI with drug-eluting stent (DES) implantation was prospectively enrolled. The measurement of brachial-ankle pulse wave velocity (baPWV) was taken in all the study patient at the time of admission for index PCI. Major adverse cardiovascular event (MACE), a composite of cardiac death, nonfatal myocardial infarction, coronary revascularization and ischemic stroke, was assessed during clinical follow-up after index PCI. RESULTS: During the median follow-up duration of 5.3âyears (interquartile range. 2.9-7.9âyears), there was 65 MACE (16.0%). There was no significant difference in clinical characteristics between patients with and without MACE except for higher prevalence of triple vessel disease in those with MACE. The baPWV value decreased at one month after index PCI (1560â±â305 to 1530â±â318âcm, P â<â0.001). In multivariable cox regression analysis, the change of baPWV at one month was not associated with MACE occurrence ( P â>â0.05). However, the change in systolic blood pressure (SBP)-adjusted baPWV (baPWV/SBP) at one month (increased vs . decreased) was significantly associated with MACE occurrence even after controlling for potential confounders (hazard ratio, 2.25; 95% confidence interval, 1.37-3.69; P â=â0.001). CONCLUSION: The baPWV/SBP change at one month was associated with long-term MACE in patients undergoing DES implantation. The results of this study suggest that baPWV/SBP changes at one month may be helpful in risk stratification of patients at a high coronary risk.
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Doença da Artéria Coronariana , Stents Farmacológicos , Intervenção Coronária Percutânea , Humanos , Feminino , Pessoa de Meia-Idade , Idoso , Intervenção Coronária Percutânea/efeitos adversos , Pressão Sanguínea , Índice Tornozelo-Braço , Stents Farmacológicos/efeitos adversos , Análise de Onda de Pulso , Fatores de Risco , Resultado do TratamentoRESUMO
Background The prognostic value of estimated pulse wave velocity (ePWV) has been infrequently explored in high-risk patient groups. Our study aimed to evaluate the prognostic significance of ePWV among patients undergoing a percutaneous coronary intervention (PCI) with a drug-eluting stent (DES). Methods A total of 4119 consecutive subjects who underwent a PCI with a DES (mean age, 67.1 ± 11.6 years and 33.1% were female) were retrospectively analyzed. ePWV was calculated based on the patient's age and mean blood pressure. Major adverse cardiovascular events (MACE), including cardiac death, non-fatal myocardial infarction, coronary revascularization, and ischemic stroke, were evaluated. Results During a median follow-up duration of 3.51 years (interquartile range, 1.35-6.37 years), there were 746 MACEs (18.1%). A multivariable analysis showed that a higher ePWV was associated with a higher MACE incidence (middle tertile vs. the lowest tertile: hazard ratio [HR], 2.49; 95% confidence interval [CI], 1.81-3.42; p < 0.001; the highest tertile vs. the lowest tertile: HR, 6.18; 95% CI, 4.33-8.80; p < 0.001) The inclusion of ePWV data significantly increased the global chi-square values when added to the clinical information (from 96 to 128; p < 0.001). Conclusion ePWV demonstrated a significant association with MACEs in patients who underwent DES implantation. Given its relative simplicity to calculate, ePWV could potentially serve as a valuable instrument for stratifying cardiovascular risks within this high-risk patient population.
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The correlation between body fat parameters and arterial stiffness is still under debate. This study aimed to examine the associations of body mass index (BMI) and waist circumference (WC) with estimated pulse wave velocity (ePWV). We utilized data from 14,228 subjects (mean age 53.4 ± 16.8 years; 56.9% were female) from the Korean National Health and Nutrition Examination Survey. The ePWV was calculated using a formula based on age and blood pressure. Simple linear correlation analyses revealed significant associations between both BMI and ePWV (r = 0.098; p < 0.001) and WC and ePWV (r = 0.291; p < 0.001), with a stronger correlation observed between WC and ePWV. Multiple linear regression analysis demonstrated that WC remained significantly associated with ePWV after adjusting for potential confounders (ß = 0.020; p = 0.001). However, a statistically significant association was not found between BMI and ePWV (ß = 0.011; p = 0.076). Multiple binary logistic regression analysis further indicated that both higher BMI and WC were independently associated with higher ePWV, but the association was more pronounced between WC and ePWV than between BMI and ePWV. These findings underscore a stronger correlation between visceral obesity (as indicated by WC) and arterial stiffness (as indicated by ePWV) compared to overall obesity (as indicated by BMI). This highlights the potential significance of abdominal obesity in assessing cardiovascular risk.
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BACKGROUND: Individuals of low socioeconomic status (SES) often exhibit increased cardiovascular risk factors and a worse prognosis. We conducted this study to ascertain whether brachial-ankle pulse wave velocity (baPWV), a straightforward and reliable measure of arterial stiffness, can hold prognostic value for people with low SES. METHODS: We retrospectively analyzed a total of 1266 subjects (mean age 64.6 ± 11.6 years; 47.2% female) without documented cardiovascular disease who had undergone baPWV measurement. The subjects included 633 National Health Insurance Beneficiaries (NHIB) and 633 Medical Aid Beneficiaries (MAB), matched for major clinical features through a 1:1 propensity score matching method. Major adverse cardiovascular events (MACE), such as death, non-fatal myocardial infarction, non-fatal ischemic stroke, coronary revascularization, and heart failure necessitating admission, were assessed during the clinical follow-up. RESULTS: During a median follow-up period of 4.2 years (interquartile range, 2.2-5.7 years), there were 77 MACE cases (6.1%). In multivariable Cox regression analyses, baPWV was identified as a significant predictor of MACE in both groups, regardless of the use of three different baPWV criteria (median value, Asian consensus recommendation, and cut-off value obtained by receiver operating characteristic [ROC] curve analysis). In both groups, the baPWV value obtained using ROC curve analysis emerged as the best predictor of MACE. This predictive value was stronger in the NHIB group (hazard ratio, 5.80; 95% confidence interval, 2.30-14.65; p < 0.001) than in the MAB group (hazard ratio, 3.30; 95% confidence interval, 1.57-6.92; p = 0.002). CONCLUSIONS: baPWV was associated with future MACE incidence in both NHIB and MAB groups. Since baPWV is simple and cost-effective to measure, it could be efficiently used as a risk stratification tool for individuals with low SES.
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Data on the relationship between arterial pulsatile hemodynamics and aortic root geometry, using invasive hemodynamic measurement, has been scarce. Thus, this study aimed to assess the relationship between invasively measured aortic pulse pressure (aPP) and the diameter of ascending aorta (AoD). We analyzed 665 subjects (64.3 ± 11.0 years; 34.6% female) who underwent elective invasive coronary angiography (ICA) for the evaluation of coronary artery disease. Transthoracic echocardiography was performed on the same day, and AoD was measured at the level of 1 cm above the sinotubular junction at the end-diastole. Body surface area (BSA)-adjusted AoD (AoD/BSA) was used for the analysis. A pig-tail catheter was used to measure aortic pressures at a level approximately 3 cm above the aortic valve just before ICA. aPP was calculated as the difference between systolic and diastolic pressures of the aorta. In multiple linear regression analyses, aPP (ß = 0.259; P < 0.001) was found to be significantly correlated with AoD/BSA even after controlling for potential confounders. This correlation power was stronger than aortic systolic pressure (ß = 0.189; P < 0.001) and brachial pulse pressure (ß = 0.091; P = 0.018) at the same multivariable analyses. In conclusion, our study demonstrated a significant association between invasively measured aPP and AoD/BSA, providing stronger evidence for the link between central aortic pulsatile hemodynamics and aortic root geometry.
Assuntos
Pressão Arterial , Doença da Artéria Coronariana , Humanos , Feminino , Masculino , Aorta Torácica , Aorta/diagnóstico por imagem , Pressão SanguíneaRESUMO
BACKGROUND: Although the current guideline recommends the use of high-intensity statin to reduce the low-density lipoprotein cholesterol (LDL-C) level by 50% in patients with baseline value of ≥ 190 mg/dL, direct application of this recommendation to Asian populations is still questionable. This study was performed to investigate the statin response of LDL-C in Korean patients with LDL-C ≥ 190 mg/dL. METHODS: A total of 1,075 Korean patients (age 60.7 ± 12.2 years, women 68%) with baseline LDL-C ≥ 190 mg/dL without cardiovascular disease was retrospectively reviewed. Lipid profiles at 6 months, side effects and clinical outcomes during the follow-up period after statin treatment were assessed according to statin intensity. RESULTS: Most of the patients (76.3%) were treated with moderate-intensity statins, 11.4% with high-intensity statins, and 12.3% with a statin + ezetimibe. The reductions in LDL-C percentage at 6 months were 48.0%, 56.0% and 53.3% in patients treated with moderate-intensity statins, high-intensity statins and statin + ezetimibe, respectively (P < 0.001). Side effects requiring dose reduction, medication switch or drug interruption were observed in 1.3%, 4.9% and 2.3% of patients treated with moderate-intensity statin, high-intensity statin and statin + ezetimibe, respectively (P = 0.024). During the median follow-duration of 815 days (interquartile range, 408-1,361 days), the incidences of cardiovascular events were not different among the 3 groups (log-rank P = 0.823). CONCLUSIONS: Compared to high-intensity statin, moderate-intensity statin was effective enough in reaching target goal of LDL-C without increase in cardiovascular risk and with fewer side effects in Korean patients with LDL-C ≥ 190 mg/dL.