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Late systolic central hypertension as a predictor of incident heart failure: the Multi-ethnic Study of Atherosclerosis.

Abstract：

BACKGROUND:Experimental studies demonstrate that high aortic pressure in late systole relative to early systole causes greater myocardial remodeling and dysfunction, for any given absolute peak systolic pressure. METHODS AND RESULTS:We tested the hypothesis that late systolic hypertension, defined as the ratio of late (last one third of systole) to early (first two thirds of systole) pressure-time integrals (PTI) of the aortic pressure waveform, independently predicts incident heart failure (HF) in the general population. Aortic pressure waveforms were derived from a generalized transfer function applied to the radial pressure waveform recorded noninvasively from 6124 adults. The late/early systolic PTI ratio (L/E(SPTI)) was assessed as a predictor of incident HF during median 8.5 years of follow-up. The L/E(SPTI) was predictive of incident HF (hazard ratio per 1% increase=1.22; 95% CI=1.15 to 1.29; P<0.0001) even after adjustment for established risk factors for HF (HR=1.23; 95% CI=1.14 to 1.32: P<0.0001). In a multivariate model that included brachial systolic and diastolic blood pressure and other standard risk factors of HF, L/E(SPTI) was the modifiable factor associated with the greatest improvements in model performance. A high L/E(SPTI) (>58.38%) was more predictive of HF than the presence of hypertension. After adjustment for each other and various predictors of HF, the HR associated with hypertension was 1.39 (95% CI=0.86 to 2.23; P=0.18), whereas the HR associated with a high L/E was 2.31 (95% CI=1.52 to 3.49; P<0.0001). CONCLUSIONS:Independently of the absolute level of peak pressure, late systolic hypertension is strongly associated with incident HF in the general population.

journal_name

J Am Heart Assoc

journal_title

Journal of the American Heart Association

authors

Chirinos JA,Segers P,Duprez DA,Brumback L,Bluemke DA,Zamani P,Kronmal R,Vaidya D,Ouyang P,Townsend RR,Jacobs DR Jr

doi

10.1161/JAHA.114.001335

subject

Has Abstract

pub_date

2015-03-03 00:00:00

pages

e001335

issue

issn

2047-9980

pii

jah3847

journal_volume

pub_type

杂志文章,多中心研究

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Late systolic central hypertension as a predictor of incident heart failure: the Multi-ethnic Study of Atherosclerosis.