Abstract 8395: Central Pressure Profiles as Predictors of Incident Cardiovascular Events and Heart Failure: The Multiethnic Study of Atherosclerosis

Abstract

Background: Experimental and physiologic data mechanistically implicate wave reflections in the pathogenesis of left ventricular failure and cardiovascular disease, but their association with these outcomes in the general population is unclear. Methods: Aortic pressure waveforms were derived from a generalized transfer function applied to the radial pressure waveforms recorded non-invasively at baseline from 5,958 participants in the Multi-Ethnic Study of Atherosclerosis. The central pressure waveform was separated into forward and reflected waves using a physiologic flow waveform. Reflection magnitude (RM=[reflected/forward wave amplitude]x100), augmentation index ([second/first systolic peak]x100) and pulse pressure amplification ([radial/aortic pulse pressure]x100) were assessed as predictors of cardiovascular events (CVE) and congestive heart failure (CHF). Results: During median 6.46 years of follow-up, aortic augmentation index and pulse pressure amplification did not independently predict CVE. After adjustment for established risk factors, RM was independently predictive of CVE (hazard ratio [HR] per 10%-increase=1.39; 95%CI=1.10-1.75; P=0.006) and strongly predictive of CHF (HR per 10%-increase=2.81; 95%CI=1.83-4.33; P<0.0001). RM was a stronger predictor of CHF risk than hypertension (HTN) and other established modifiable risk factors, judging by various measures of model performance and population-attributable risk. In fully adjusted models, compared to non-hypertensive subjects with low RM, the HR for hypertensive subjects with low RM, non-hypertensive subjects with high RM and hypertensive subjects with high RM were 1.82 (95%CI=0.85-3.86), 2.31 (95%CI=1.07-5.01) and 4.55 (95%CI=2.28-10.0), respectively (Figure). Conclusions: Arterial wave reflections represent an important novel modifiable risk factor for CHF in the general population and a potential therapeutic target for primary CHF prevention.