Assessment of cardiovascular risk in type 2 diabetes patients by insight into radial pulse wave harmonic index

Abstract

Wang Lin provides an insightful explanation as to why the harmonic components of radial pulse waves may be an important set of signs to reveal the state of the ventricular-arterial system. 1 The important basis of the article comes from the "resonance theory" proposed by Wang et al through a series of elegant animal studies. 2,3 Here, we would like to provide further clinical references to point out the important correlation between the harmonic components of the radial pulse wave and the risk of future cardiovascular events.In 2017, we initiated an observational cohort study of RPWT2DM (IRB number: ISRCTN14306167) for cardiovascular risk assessment in patients with type 2 diabetes using radial pulse measurements. We found that the first harmonic amplitude (C1), the second harmonic phase (P2) and the variation coefficient of fourth harmonic amplitude (C4CV) of radial pulse wave are related to cardiovascular risk. The first cross-sectional survey showed that patients with more than 5% of ischaemic myocardium had higher C1 and C4CV than those without myocardial ischaemia. 4 In this cross-sectional study, we also found that patients with a left ventricular ejection fraction of less than 50% had higher C1, higher C4CV and lower P2 compared to patients with normal cardiac function. After a mean of 1.8 years of follow-up, we found a clearer association between these indicators and the risk of cardiovascular events. Cox proportional hazards model demonstrated that C1 is an independent predictor for major adverse cardiovascular events, 5 cardiovascular mortality 6 and microvascular events. 6 The results also demonstrate that C4CV is independently and positively correlated with macrovascular and microvascular events. 7 Macrovascular events combined the major adverse cardiovascular events, coronary artery disease and severe peripheral artery disease. Microvascular events combined the major adverse kidney events, macroalbuminuria, retinopathy and polyneuropathy. In addition, we demonstrate that lower quartile levels of P2 values can independently predict an increased risk of macrovascular and microvascular outcomes. 8 Based on the above studies, we determined three harmonic characteristics (C1 > 1.07, C4CV > 13% and P2 < 3.54) with high cardiovascular risk. In the RPWT2DM study, 556 (24%), 270 (12%) and 119 (5%) type 2 diabetic patients respectively, had 1, 2 and 3 cardiovascular risk-related harmonic characteristics as described above. One thousand three hundred and seventy-nine (59%) of those patients did not have any of the above harmonic characteristics. We performed a Cox proportional hazard model to determine the hazard ratios (HRs) between them. Compared with those without any high-risk harmonic pattern, patients with two of three high-risk harmonic characteristics had an approximately 80% increase in the incidence of microvascular events (HR, 1.76; 95% CI 1.44-2.16), and had more than doubled incidence of major adverse cardiovascular events (HR, 2.23; 95% CI 1.75-2.86) and macrovascular events (HR, 2.31; 95% CI 1.88...

A First Step towards a Comprehensive Approach to Harmonic Analysis of Synchronous Peripheral Volume Pulses: A Proof-of-Concept Study

“…In addition, we established a five-step HA computation formula for the peripheral volume pulse, described in Section 2.3.2. Hence, the current study obtained results for type 2 diabetes mellitus [14][15][16][17]. It has been reported that the fourth harmonic component of the radial pulse wave is important for the risk assessment of macrovascular and microvascular events in patients with type 2 diabetes [14], cardiovascular risk [15], and arterial blood pressure waveforms [16], with different radial pulse wave harmonic indices, silent coronary artery disease, and adverse cardiac events [17].…”

“…It has been reported that the fourth harmonic component of the radial pulse wave is important for the risk assessment of macrovascular and microvascular events in patients with type 2 diabetes [14], cardiovascular risk [15], and arterial blood pressure waveforms [16], with different radial pulse wave harmonic indices, silent coronary artery disease, and adverse cardiac events [17]. Therefore, our findings for synchronous peripheral volume pulses are consistent with the findings in [14][15][16][17], in which the radial pulse wave was adopted with different harmonic coefficients.…”

“…Professors Tsai et al indicated that the harmonic characteristics of the radial artery in the wrist at different positions and different parameters were not identical, and recommended that any measurement location in future studies on the HA of pressure pulse diagnosis needs a more finely adjusted analysis [10]. More importantly, there have been further studies about the HA of radial arterial waveform (e.g., a kind of peripheral pressure pulse) addressing hypertension [11] and monitoring applied to coronary artery disease [12], type 2 diabetes mellitus [13][14][15][16], and the preservation of health [17]. On the other hand, a noninvasive wearable MEMS pressure sensor array was proposed in [18] for monitoring the arterial pulse waveform and heart rate, and the detection of atrial fibrillation.…”