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Carotid-Femoral Pulse Transit Time Variability Predicted Mortality and Improved Risk Stratification in the Elderly

An, De-Wei ; Muhammad, Iram Faqir LU ; Li, Ming-Xuan ; Borné, Yan LU ; Sheng, Chang-Sheng ; Persson, Margaretha LU orcid ; Cai, Ren-Zhi ; Guo, Qian-Hui LU ; Wang, Ji-Guang and Engström, Gunnar LU , et al. (2021) In Hypertension 78(5). p.1287-1295
Abstract
The carotid-to-femoral pulse wave velocity, determined by pulse transit time (PTT) and distance, is a well-established measure of arterial stiffness and predicts adverse outcomes. However, its predictive value decreases with aging. To explore new risk indicator in the elderly, we investigated if the variation of carotid-to-femoral pulse wave velocity, registered as beat-to-beat variability of carotid-to-femoral PTT (cf-PTT), could predict outcome. Totally 3015 (median age, 72.4 years; 39.6% men) and 1181 (75.6 years; 42.2% men) subjects from communities of Malmö, Sweden, and Shanghai, China, were analyzed, respectively. Continuous pulse waves for 10 seconds were recorded sequentially at carotid and femoral arterial sites with applanation... (More)
The carotid-to-femoral pulse wave velocity, determined by pulse transit time (PTT) and distance, is a well-established measure of arterial stiffness and predicts adverse outcomes. However, its predictive value decreases with aging. To explore new risk indicator in the elderly, we investigated if the variation of carotid-to-femoral pulse wave velocity, registered as beat-to-beat variability of carotid-to-femoral PTT (cf-PTT), could predict outcome. Totally 3015 (median age, 72.4 years; 39.6% men) and 1181 (75.6 years; 42.2% men) subjects from communities of Malmö, Sweden, and Shanghai, China, were analyzed, respectively. Continuous pulse waves for 10 seconds were recorded sequentially at carotid and femoral arterial sites with applanation tonometry (SphygmoCor, Atcor, Australia). During a median of 6.6 and 10.2 years, 389 and 427 deaths occurred in the Malmö and Shanghai cohorts, respectively. Each one-SD increase in the log-transformed coefficient of variation of cf-PTT was associated with 24% (95% CI, 13%–37%) and 21% (10%–33%) increased risk for all-cause mortality in the Malmö and Shanghai subjects, and 60% (33%–91%) for cardiovascular mortality in the Malmö subjects. Adding the coefficient of variation of cf-PTT to the models including conventional risk factors and carotid-to-femoral pulse wave velocity significantly (P<0.05) improved prediction for all-cause mortality in both cohorts (integrated discrimination improvement, 0.005–0.008) and cardiovascular mortality in the Malmö cohort (net reclassification improvement, 0.206). In both cohorts, a coefficient of variation of cf-PTT <6% was not associated with increased mortality risk. In conclusion, the beat-to-beat variability of cf-PTT predicted mortality and improved risk stratification, which might be a novel risk indicator for elderly people. (Less)
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organization
publishing date
type
Contribution to journal
publication status
published
subject
in
Hypertension
volume
78
issue
5
pages
9 pages
publisher
Lippincott Williams & Wilkins
external identifiers
  • pmid:34565183
  • scopus:85117397781
ISSN
1524-4563
DOI
10.1161/HYPERTENSIONAHA.121.17891
language
English
LU publication?
yes
id
ee266cc3-7006-49d8-aca8-d3d60e74bacb
date added to LUP
2021-11-17 09:29:42
date last changed
2024-11-17 13:17:32
@article{ee266cc3-7006-49d8-aca8-d3d60e74bacb,
  abstract     = {{The carotid-to-femoral pulse wave velocity, determined by pulse transit time (PTT) and distance, is a well-established measure of arterial stiffness and predicts adverse outcomes. However, its predictive value decreases with aging. To explore new risk indicator in the elderly, we investigated if the variation of carotid-to-femoral pulse wave velocity, registered as beat-to-beat variability of carotid-to-femoral PTT (cf-PTT), could predict outcome. Totally 3015 (median age, 72.4 years; 39.6% men) and 1181 (75.6 years; 42.2% men) subjects from communities of Malmö, Sweden, and Shanghai, China, were analyzed, respectively. Continuous pulse waves for 10 seconds were recorded sequentially at carotid and femoral arterial sites with applanation tonometry (SphygmoCor, Atcor, Australia). During a median of 6.6 and 10.2 years, 389 and 427 deaths occurred in the Malmö and Shanghai cohorts, respectively. Each one-SD increase in the log-transformed coefficient of variation of cf-PTT was associated with 24% (95% CI, 13%–37%) and 21% (10%–33%) increased risk for all-cause mortality in the Malmö and Shanghai subjects, and 60% (33%–91%) for cardiovascular mortality in the Malmö subjects. Adding the coefficient of variation of cf-PTT to the models including conventional risk factors and carotid-to-femoral pulse wave velocity significantly (<i style="box-sizing: border-box; font-family: sans-serif; font-size: 16px; text-align: justify;">P</i>&lt;0.05) improved prediction for all-cause mortality in both cohorts (integrated discrimination improvement, 0.005–0.008) and cardiovascular mortality in the Malmö cohort (net reclassification improvement, 0.206). In both cohorts, a coefficient of variation of cf-PTT &lt;6% was not associated with increased mortality risk. In conclusion, the beat-to-beat variability of cf-PTT predicted mortality and improved risk stratification, which might be a novel risk indicator for elderly people.}},
  author       = {{An, De-Wei and Muhammad, Iram Faqir and Li, Ming-Xuan and Borné, Yan and Sheng, Chang-Sheng and Persson, Margaretha and Cai, Ren-Zhi and Guo, Qian-Hui and Wang, Ji-Guang and Engström, Gunnar and Li, Yan and Nilsson, Peter M}},
  issn         = {{1524-4563}},
  language     = {{eng}},
  number       = {{5}},
  pages        = {{1287--1295}},
  publisher    = {{Lippincott Williams & Wilkins}},
  series       = {{Hypertension}},
  title        = {{Carotid-Femoral Pulse Transit Time Variability Predicted Mortality and Improved Risk Stratification in the Elderly}},
  url          = {{http://dx.doi.org/10.1161/HYPERTENSIONAHA.121.17891}},
  doi          = {{10.1161/HYPERTENSIONAHA.121.17891}},
  volume       = {{78}},
  year         = {{2021}},
}