Estimated Pulse Wave Velocity Is Associated With All‐Cause Mortality During 8.5 Years Follow‐up in Patients Undergoing Elective Coronary Angiography

Abstract

Background Estimated pulse wave velocity (ePWV) calculated by equations using age and blood pressure has been suggested as a new marker of mortality and cardiovascular risk. However, the prognostic potential of ePWV during long‐term follow‐up in patients with symptoms of stable angina remains unknown. Methods and Results In this study, ePWV was calculated in 25 066 patients without diabetes, previous myocardial infarction (MI), stroke, heart failure, or valvular disease (mean age 63.7±10.5 years, 58% male) with stable angina pectoris undergoing elective coronary angiography during 2003 to 2016. Multivariable Cox models were used to assess the association with incident all‐cause mortality, MI, and stroke. Discrimination was assessed using Harrell´s C‐index. During a median follow‐up period of 8.5 years (interquartile range 5.5–11.3 years), 779 strokes, 1233 MIs, and 4112 deaths were recorded. ePWV was associated with all‐cause mortality (hazard ratio [HR] per 1 m/s, 1.13; 95% CI, 1.05–1.21) and MI (HR per 1 m/s 1.23, 95% CI, 1.09–1.39) after adjusting for age, systolic blood pressure, body mass index, smoking, estimated glomerular filtration rate, Charlson Comorbidity Index score, antihypertensive treatment, statins, aspirin, and number of diseased coronary arteries. Compared with traditional risk factors, the adjusted model with ePWV was associated with a minor but likely not clinically relevant increase in discrimination for mortality, 76.63% with ePWV versus 76.56% without ePWV, P <0.05. Conclusions In patients with stable angina pectoris, ePWV was associated with all‐cause mortality and MI beyond traditional risk factors. However, the added prediction of mortality was not improved to a clinically relevant extent.

Combined impact of elevated arterial stiffness and left ventricular filling pressure on outcomes after off-pump coronary artery bypass grafting

“…The two indicators are associated with each other in terms of diastolic dysfunction [ 8 ], and each of them has been reported to be associated with all-cause mortalities in various populations. In some large-scale cohort studies with follow-up periods longer than 8 years, PWV has been shown to be associated with all-cause mortality and MI in patients with stable angina, while also having been shown to be associated with cardiovascular mortalities in patients with type 2 diabetes [ 26 , 27 ]. Regarding the negative impact of E/e′, the increase in LV filling pressure, as assessed by E/e′, was associated with increasing death rate in a cohort of 577 patients undergoing CABG, aortic valve replacement (AVR), or CABG with AVR [ 6 ].…”

Expert Consensus on the Clinical Use of Pulse Wave Velocity in Asia

“…Despite these findings, whether ePWV Pulse 2022;10:1-18 DOI: 10.1159/000528208 can become a substitute for cfPWV as a marker of vascular aging remains to be determined. However, as ePWV reflects an interaction between age and MBP [61], this variable may not be viewed as synonymous with cfPWV [61] and may capture different risk information than cfPWV [56,61], thereby providing another important prognostic value to the prediction of CV health.…”

“…By contrast, an addition of ePWV to contemporary CVD risk scores does not improve discrimination of all-cause and CVD mortality risk [ 55 ]. Similarly, while ePWV is associated with all-cause mortality and MI, independent of traditional risk factors, discrimination is not improved to a clinically meaningful extent in patients with angina pectoris [ 56 ]. Given uncertainty related to the usefulness of ePWV, additional research examining the role of ePWV as a predictor of CVD outcomes is clearly warranted, especially in differing outcomes, populations, and racial/ethnic backgrounds.…”

“…Emerging evidence suggests that ePWV is associated with CVD outcomes and mortality, independent of traditional CVD risk factors in USA and European cohorts [ 52 , 53 , 55 , 56 , 57 , 58 , 59 ]. The role of ePWV as an independent predictor of CVD outcomes may also extend to Asian populations [ 54 , 60 ].…”

Estimating Is Not Measuring: The Lessons About Estimated Pulse Wave Velocity

“…In this issue of the Journal of the American Heart Association ( JAHA ), 8 Laugesen and colleagues measured the mortality rate in a large population of patients following coronary angiography. They demonstrated that the 8.5‐year mortality was predicted by estimated PWV, independently from major cardiovascular risk factors.…”