Esben Laugesen1,2, Søren T Knudsen3, Klavs W Hansen4, Niklas B Rossen1, Lisette Okkels Jensen5, Michael S Hansen6, Lone K Andersen7, Kristian K Thomsen8, Hanne Søndergaard9, Morten Böttcher10, Bent Raungaard11, Kevin K W Olesen12, Michael Mæng12, Hans Erik Bøtker12, Per L Poulsen1,3. 1. Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Aarhus N. 2. Regional Hospital Horsens, Sundvej, Horsens. 3. Steno Diabetes Center Aarhus (SDCA), Aarhus University Hospital, Aarhus. 4. Diagnostic Center, Regional Hospital Silkeborg, Aarhus University Hospital, Falkevej 1-3, Silkeborg. 5. Department of Cardiology, Odense University Hospital, Odense. 6. Department of Cardiology, Hospital of Southern Jutland, Kresten Philipsensvej, Aabenraa. 7. Department of Cardiology, Vejle Hospital, Beriderbakken, Vejle. 8. Department of Cardiology, Hospital of South-Western Jutland, Finsensgade, Esbjerg. 9. Department of Cardiology, Viborg Regional Hospital, Heibergs Allé, Viborg. 10. Department of Cardiology, Gødstrup Hospital, Hospital Unit West, Gl. Landevej, Herning. 11. Department of Cardiology, Aalborg University Hospital, Hobrovej, Aalborg. 12. Department of Cardiology, Aarhus University Hospital Skejby, Palle Juul-Jensens Boulevard, Aarhus N, Denmark.
Abstract
OBJECTIVE: Aortic pulse pressure (PP) represents the hemodynamic cardiac and cerebral burden more directly than cuff PP. The objective of this study was to investigate whether invasively measured aortic PP confers additional prognostic value beyond cuff PP for cardiovascular events and death. With increasing age, cuff PP progressively underestimates aortic PP. Whether the prognostic association between cuff PP and outcomes is age-dependent remains to be elucidated. METHODS: Cuff PP and invasively measured aortic PP were recorded in 21 908 patients (mean age 63 years, 58% men, 14% with diabetes) with stable angina pectoris undergoing elective coronary angiography during January 2001--December 2012. Multivariate Cox models were used to assess the association with incident myocardial infarction, stroke, and death. Discrimination was assessed using Harrell's C-index. RESULTS: During a median follow-up period of 3.7 years (range 0.1-10.8 years), 422 strokes, 511 myocardial infarctions, and 1530 deaths occurred. Both cuff and aortic PP were associated with stroke, myocardial infarction, and death in crude analyses. However, only cuff PP remained associated with stroke (hazard ratio per 10 mmHg, 1.06 (95% confidence interval (CI) 1.01--1.12)] and myocardial infarction [hazard ratio per 10 mmHg 1.05 (95% CI 1.01--1.11)] in multivariate Cox models. Both cuff and aortic PP lost significance as predictors of death in multivariate models. Age did not modify the prognostic association between cuff PP and stroke, myocardial infarction, and death. CONCLUSION: Invasively measured aortic PP did not add prognostic information about cardiovascular outcomes and death beyond cuff PP in patients with stable angina pectoris.
OBJECTIVE: Aortic pulse pressure (PP) represents the hemodynamic cardiac and cerebral burden more directly than cuff PP. The objective of this study was to investigate whether invasively measured aortic PP confers additional prognostic value beyond cuff PP for cardiovascular events and death. With increasing age, cuff PP progressively underestimates aortic PP. Whether the prognostic association between cuff PP and outcomes is age-dependent remains to be elucidated. METHODS: Cuff PP and invasively measured aortic PP were recorded in 21 908 patients (mean age 63 years, 58% men, 14% with diabetes) with stable angina pectoris undergoing elective coronary angiography during January 2001--December 2012. Multivariate Cox models were used to assess the association with incident myocardial infarction, stroke, and death. Discrimination was assessed using Harrell's C-index. RESULTS: During a median follow-up period of 3.7 years (range 0.1-10.8 years), 422 strokes, 511 myocardial infarctions, and 1530 deaths occurred. Both cuff and aortic PP were associated with stroke, myocardial infarction, and death in crude analyses. However, only cuff PP remained associated with stroke (hazard ratio per 10 mmHg, 1.06 (95% confidence interval (CI) 1.01--1.12)] and myocardial infarction [hazard ratio per 10 mmHg 1.05 (95% CI 1.01--1.11)] in multivariate Cox models. Both cuff and aortic PP lost significance as predictors of death in multivariate models. Age did not modify the prognostic association between cuff PP and stroke, myocardial infarction, and death. CONCLUSION: Invasively measured aortic PP did not add prognostic information about cardiovascular outcomes and death beyond cuff PP in patients with stable angina pectoris.
Authors: Esben Laugesen; Kevin K W Olesen; Christian Daugaard Peters; Niels Henrik Buus; Michael Maeng; Hans Erik Botker; Per L Poulsen Journal: J Am Heart Assoc Date: 2022-05-10 Impact factor: 6.106