Publications in Scientific Journals:
T. Weber, S. Wassertheurer, B. Hametner, M. Rammer, E. Lassnig, B. Eber:
"Aortic stiffness, measured invasively, or estimated from radial waveforms, predicts severe cardiovascular events";
European Heart Journal,
impact of true aortic PWV, as determined invasively, is unknown.
Methods: We measured aortic PWV (aoPWV) during catheter pullback in 698 patients (301 women; mean age 62.7 years) with preserved systolic function undergoing coronary angiography. In addition, we developed a method to estimate aortic flow waveforms from radial pressure curves, using modified Windkessel models. From this, we derived haracteristic impedance and, in a regression model including age and blood pressure, estimated aortic PWV (est aoPWV). Primary endpoint of our longitudinal study was the combination of death, myocardial nfarction, and stroke.
Results: 73.4% of our patients had hypertension, 18.9% diabetes, and 40.4% had significant coronary artery disease. Mean aoPWV was 8.9 m/sec, mean est aoPWV was 8.8 m/sec (correlation coefficient 0.72, p<0.0001). After a mean follow up of 4.6 years, 83 patients reached the combined endpoint (44 patients died, 20 myocardial infarctions, 27 strokes). In univariate analysis, a 1 m/sec increase of invasively measured and estimated aoPWV was associated with a 20.2% (p<0.0001) and 36.2% (p<0.0001) increased risk of the combined endpoint, respectively. In multivariable analysis (Cox proportional hazards
models), after adjusting for risk factors, clinical covariates, blood pressure, diastolic function, and medications, both invasively measured and estimated aoPWV still were significant predictors of the combined endpoint. Based on ROC analysis, both the model including the measured and the model including the estimated PWV predicted the combined endpoint with the same accuracy (AUC was 0.767 for the model with the measured and 0.760 for the model with the estimated aoPWV, p=0.50 for comparison).
Conclusions: Aortic PWV, as measured invasively, is an independent predictor of severe cardiovascular events in elderly patients undergoing coronary angiography. The predictive value of estimated aoPWV seems to be similar.
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