Cardiovascular endpoints in relation to the central arterial pressure-time indexes

Abstract

Multiple articles focused on the central arterial systolic (SPTI) and diastolic (DPTI) pressure-time indexes and the subendocardial viability ratio (SEVR). However,whether these indexes contribute to risk stratification in the general populationisunknown.SPTI,DPTIandSEVRwerenoninvasivelymeasuredbytheSphygmoCor technology. Incidence ratesandstandardized(per1-SDincrement)multivariable-adjustedhazardratios (HRs) for cardiovascular (primary) and cardiac endpoints and stroke were evaluated in the International Database of Central Arterial Properties for Risk Stratification (n=5099). Model refinement was assessed by the area under the curve (AUC) and the integrated discrimination(IDI)andnet reclassification(NRI) improvement.Over4years (median),215cardiovascular,133cardiac endpointsand79strokesoccurred.ForSPTI,fullyadjustedHRswere1.37(95%CI:1.18-1.59),1.35(1.11-1.64)and1.33 (1.05-1.69)forthecardiovascularandcardiacendpointsandstroke.ThecorrespondingHRsforDPTIwere1.49(1.31-1.69), 1.23 (1.02-1.48) and1.74 (1.46-2.07). ForSEVR, noneof theHRs reachedsignificance.Analyseswith these indexes categorizedbyquartileswereconfirmatory.Analysesstratifiedbyvariousriskfactorsdidnot revealsubgroupdifferences. For thecardiovascularendpoint,addingSPTIorDPTI tothebasemodel improvedtheAUC,whileaddingSPTIorDPTI combinedwithmeanarterialpressure,increasedIDIby~1.7%andNRIby~17%(P<0.001forall).Whereascardiovascular andcardiacendpointsandstrokewererelatedwiththenon-invasivelymeasuredSPTIandDPTI,SEVRwasnot.