Prediction of cardiovascular events and all-cause mortality with central haemodynamics: a systematic review and meta-analysis

Aims To calculate robust quantitative estimates on the predictive value of central pressures and derived central haemodynamic indices for cardiovascular (CV) outcomes and all-cause mortality by meta-analysis of longitudinal studies. Methods and results We meta-analysed 11 longitudinal studies that h...

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Bibliographic Details
Published in:European heart journal 2010-08, Vol.31 (15), p.1865-1871
Main Authors: Vlachopoulos, Charalambos, Aznaouridis, Konstantinos, O'Rourke, Michael F., Safar, Michel E., Baou, Katerina, Stefanadis, Christodoulos
Format: Article
Language:English
Subjects:
Aged
Arterial hypertension. Arterial hypotension
Arterial stiffness
Atherosclerosis (general aspects, experimental research)
Augmentation index
Biological and medical sciences
Blood and lymphatic vessels
Blood Pressure - physiology
Blood Pressure Determination
Brachial Artery - physiology
Cardiology. Vascular system
Cardiovascular Diseases - mortality
Cardiovascular Diseases - physiopathology
Cardiovascular risk
Cause of Death
Central pressure
Central Venous Pressure - physiology
Female
Hemodynamics - physiology
Humans
Hypertension
Longitudinal Studies
Male
Medical sciences
Meta-analysis
Middle Aged
Prediction
Predictive Value of Tests
Publication Bias
Risk Factors
Systole
Wave reflections
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Summary:Aims To calculate robust quantitative estimates on the predictive value of central pressures and derived central haemodynamic indices for cardiovascular (CV) outcomes and all-cause mortality by meta-analysis of longitudinal studies. Methods and results We meta-analysed 11 longitudinal studies that had employed measures of central haemodynamics and had followed 5648 subjects for a mean follow-up of 45 months. The age- and risk-factor-adjusted pooled relative risk (RR) of total CV events was 1.088 (95% CI 1.040–1.139) for a 10 mmHg increase of central systolic pressure, 1.137 (95% CI 1.063–1.215) for a 10 mmHg increase of central pulse pressure (PP), and 1.318 (95% CI 1.093–1.588) for a 10% absolute increase of central augmentation index (AIx). Furthermore, we found that a 10% increase of central AIx was associated with a RR of 1.384 (95% CI 1.192–1.606) for all-cause mortality. When compared with brachial PP, central PP was associated with marginally but not significantly higher RR of clinical events (P = 0.057). Conclusion Central haemodynamic indexes are independent predictors of future CV events and all-cause mortality. Augmentation index predicts clinical events independently of peripheral pressures, while central PP has a marginally but not significantly (P = 0.057) better predictive ability when compared with peripheral PP.
ISSN:0195-668X
1522-9645
DOI:10.1093/eurheartj/ehq024