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. 2015 Jan 27;131(4):354-61; discussion 361.
doi: 10.1161/CIRCULATIONAHA.114.011357. Epub 2014 Nov 21.

Components of hemodynamic load and cardiovascular events: the Framingham Heart Study

Leroy L Cooper  1 , Jian Rong  1 , Emelia J Benjamin  1 , Martin G Larson  1 , Daniel Levy  1 , Joseph A Vita  1 , Naomi M Hamburg  1 , Ramachandran S Vasan  1 , Gary F Mitchell  2
Affiliations

Components of hemodynamic load and cardiovascular events: the Framingham Heart Study

Leroy L Cooper et al. Circulation. .

Abstract

Background: Elevated blood pressure is the leading modifiable risk factor for cardiovascular disease (CVD) and premature death. The blood pressure waveform consists of discrete hemodynamic components, derived from measured central pressure and flow, which may contribute separately to risk for an adverse outcome. However, pressure-flow measures have not been studied in a large, community-based sample.

Methods and results: We used proportional hazards models to examine the association of incident CVD with forward pressure wave amplitude, mean arterial pressure, and global reflection coefficient derived from wave separation analysis and echocardiography in 2492 participants (mean age 66±9 years, 56% women) in the Framingham Heart Study. During follow-up (0.04-6.8 years), 149 participants (6%) had a CVD event. In multivariable models adjusting for age, sex, antihypertensive therapy, body mass index, heart rate, total and high-density lipoprotein cholesterol concentrations, smoking, and the presence of diabetes mellitus, forward pressure wave amplitude (hazard ratio, 1.40; 95% confidence interval, 1.16-1.67; P=0.0003) was associated with incident CVD, whereas mean arterial pressure (hazard ratio, 1.10; 95% confidence interval, 0.94-1.29; P=0.25) and global wave reflection (hazard ratio, 0.93; 95% confidence interval, 0.78-1.12; P=0.58) were not. After adding systolic blood pressure and carotid-femoral pulse wave velocity to the model, forward pressure wave amplitude persisted as a correlate of events (hazard ratio, 1.33; 95% confidence interval, 1.05-1.68; P=0.02).

Conclusions: Higher forward pressure wave amplitude (a measure of proximal aortic geometry and stiffness) was associated with increased risk for incident CVD, whereas mean arterial pressure and relative wave reflection (correlates of resistance vessel structure and function) were not associated with increased risk for incident CVD.

Keywords: cardiovascular diseases; hemodynamics; pulsatile flow.

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Conflict of interest statement

Disclosures: G.F.M. is owner of Cardiovascular Engineering, Inc., a company that designs and manufactures devices that measure vascular stiffness. The company uses these devices in clinical trials that evaluate the effects of diseases and interventions on vascular stiffness. The remaining authors report no conflicts.

Figures

Figure 1
Figure 1
Central aortic wave separation analysis. Diastolic blood pressure is subtracted from measured pressure (Pm), leaving only the pulsatile component. Flow (Qm) is rescaled by characteristic impedance, Zc, in order to transform units to equivalent mm Hg and the upstrokes of pressure and flow are aligned. After rescaling and alignment, the forward pressure wave (Pf) is the average of Qm and Pm and backward wave (Pb) is the difference between Pm and Pf.
Figure 2
Figure 2
Kaplan-Meier plot of the probability of remaining free of first major CVD event during follow-up by quartiles of forward pressure wave amplitude. Participants are grouped according to quartiles of forward pressure wave amplitude: Group I (<45.0 mm Hg), Group II (45.0 to <55.1 mm Hg), Group III (55.1 to <66.8 mm Hg), and Group IV (≥66.8 mm Hg). CVD events per person for quartile groups of FWA were as follows: first quartile group, 16/618 (2.4%); second quartile group, 23/628 (3.7%); third quartile group, 40/623 (6.4%); and fourth quartile group, 71/623 (11.4%).
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