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An outcome-driven threshold for pulse pressure amplification

2024; Springer Nature; Volume: 47; Issue: 9 Linguagem: Inglês

10.1038/s41440-024-01779-4

1348-4214

Qi‐Fang Huang, De‐Wei An, Lucas S. Aparicio, Yi‐Bang Cheng, Fang‐Fei Wei, Yu‐Ling Yu, Chang‐Sheng Sheng, Wen‐Yi Yang, Teemu Niiranen, José Boggia, Katarzyna Stolarz‐Skrzypek, Valérie Tikhonoff, Natasza Gilis‐Malinowska, Wiktoria Wojciechowska, Edoardo Casiglia, Krzysztof Narkiewicz, Jan Filipovský, Kalina Kawecka−Jaszcz, Tim S. Nawrot, Ji‐Guang Wang, Yan Li, Jan A. Staessen, Lucas S. Aparicio, Jessica Barochiner, Blerim Mujaj, Lutgarde Thijs, Jan A. Staessen, Fang‐Fei Wei, Wen‐Yi Yang, Zhen‐Yu Zhang, De‐Wei An, Yi‐Bang Cheng, Qian‐Hui Guo, Jianfeng Huang, Qi-Fang Huang, Yuan‐Yuan Kang, Yan Li, Changyuan Liu, Chang‐Sheng Sheng, Ji‐Guang Wang, Ying Wang, Dong‐Yan Zhang, Wei Zhang, Jan Filipovský, Jitka Seidlerová, Eeva P. Juhanoja, Antti Jula, Annika Lindroos, Teemu Niiranen, S. Sivén, Edoardo Casiglia, A. Pizziol, Valérie Tikhonoff, Babangida S. Chori, Benjamin Danladi, Augustine N. Odili, Henry Oshaju, W. Kucharska, Katarzyna Kunicka, Natasza Gilis‐Malinowska, Krzysztof Narkiewicz, Wojciech Sakiewicz, Ewa Świerblewska, Jianguo Lin, Katarzyna Stolarz‐Skrzypek, Catharina M. C. Mels, Ruan Kruger, Gontse Mokwatsi, Aletta E. Schutte, Gavin R. Norton, Angela J. Woodiwiss, Daniel Ackermann, Murielle Bochud, Georg Ehret, Ramón Álvarez-Vaz, Anna C. Rios, Florencia Carusso, Mariana Sottolano, José Boggia, Luciana Borgarello, Sebastián Robaina, Paula Moliterno, Óscar Noboa, Alicia Olascoaga, Alicia da Rosa, Nadia Krul, Matías Pécora,

Cardiac Imaging and Diagnostics

Abstract Pulse pressure amplification (PPA) is the brachial-to-aortic pulse pressure ratio and decreases with age and cardiovascular risk factors. This individual-participant meta-analysis of population studies aimed to define an outcome-driven threshold for PPA. Incidence rates and standardized multivariable-adjusted hazard ratios (HRs) of cardiovascular and coronary endpoints associated with PPA, as assessed by the SphygmoCor software, were evaluated in the International Database of Central Arterial Properties for Risk Stratification ( n = 5608). Model refinement was assessed by the integrated discrimination (IDI) and net reclassification (NRI) improvement. Age ranged from 30 to 96 years (median 53.6). Over 4.1 years (median), 255 and 109 participants experienced a cardiovascular or coronary endpoint. In a randomly defined discovery subset of 3945 individuals, the rounded risk-carrying PPA thresholds converged at 1.3. The HRs for cardiovascular and coronary endpoints contrasting PPA < 1.3 vs ≥1.3 were 1.54 (95% confidence interval [CI]: 1.00–2.36) and 2.45 (CI: 1.20–5.01), respectively. Models were well calibrated, findings were replicated in the remaining 1663 individuals analyzed as test dataset, and NRI was significant for both endpoints. The HRs associating cardiovascular and coronary endpoints per PPA threshold in individuals <60 vs ≥60 years were 3.86 vs 1.19 and 6.21 vs 1.77, respectively. The proportion of high-risk women (PPA < 1.3) was higher at younger age (<60 vs ≥60 years: 67.7% vs 61.5%; P < 0.001). In conclusion, over and beyond common risk factors, a brachial-to-central PP ratio of <1.3 is a forerunner of cardiovascular coronary complications and is an underestimated risk factor in women aged 30–60 years. Our study supports pulse wave analysis for risk stratification.