Risk assessment of macrovascular and microvascular events in patients with type 2 diabetes by analyzing the amplitude variation of the fourth harmonic component of radial pulse wave.

Kuo‐Meng Liao,Yi‐Ting Chang,Chi‐Wei Chang,Ying‐Chun Chen,Sheng‐Hung Wang,Gin‐Chung Wang

doi:10.14814/phy2.14252

Kuo‐Meng Liao, Yi‐Ting Chang + Show 4 more

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https://doi.org/10.14814/phy2.14252

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Abstract

This investigation explored the hypothesis that whether the coefficient of variation of the fourth harmonic amplitude of the radial pulse wave (C4CV) predicts the risk of macrovascular and microvascular events in patients with type 2 diabetes mellitus (T2DM). Radial pulse wave and brachial blood pressure were measured at baseline in 2324 patients with T2DM and C4CV was calculated using the Fourier series method. Macrovascular and microvascular events during follow‐up were determined by medical records. We plotted the Kaplan–Meier curve and performed a Cox proportional hazard model and a log‐rank test to estimate the effectiveness of C4CV as a risk predictor. We divided patients into quartile groups based on C4CV (<4.3%, 4.3% to 6.8%, 6.8% to 11.4%, and >11.4%). Compared with patients with C4CV < 4.3%, patients with C4CV> 11.4% had a double incidence of macrovascular events (hazard ratio, 2.13; 95% CI, 1.70–2.67) and microvascular events (hazard ratio, 2.08; 95% CI, 1.67–2.58), and the incidence of cardiovascular death was three times (hazard ratio, 3.03; 95% CI, 1.10–8.83). The Cox regression analysis demonstrated that the risk of both macrovascular and microvascular outcomes increases with the increase in quartile level of C4CV value (P < 0.0001). These associations remained after adjustment for age, gender, smoking, systolic blood pressure, diastolic blood pressure, dyslipidemia, diabetes duration, Hba1c, and cardiovascular disease (P < 0.0001). C4CV is a novel independent predictor of cardiovascular mortality, macrovascular events, and microvascular events in patients with T2DM.

Highlights

Harmonic analysis of arterial pressure pulse provides insightful hemodynamic information into the condition of the ventricular-arterial system through the resonance effects (Wang et al 1991; Wang and Wang 2018)
We divided patients into quartile groups based on C4CV levels at baseline and the remaining analysis is focused on the C4CV quartile (11.4%)
The Cox proportional hazard model further demonstrated that quartile level of C4CV independently predicted (HR, 1.26; 95% CI, 1.18–1.35 per quartile increase) the composite endpoint of microvascular events after adjusting for age, gender, smoking, systolic blood pressure, diastolic blood pressure, dyslipidemia, diabetes duration, estimated glomerular filtration rate (EGFR), Hba1c, and cardiovascular disease history

Summary

Introduction

Harmonic analysis of arterial pressure pulse provides insightful hemodynamic information into the condition of the ventricular-arterial system through the resonance effects (Wang et al 1991; Wang and Wang 2018). In a further clinical study, they found that coefficient of variation of the fourth harmonic amplitude of the radial pulse (C4CV) in cancer patients was significantly higher than healthy control group, and C4CV would be further elevated before the death of the cancer patients (Kuo et al 2004). We propose that C4CV may represent an integrated index of vascular structure and function in the arterial system, independent of other standard risk factors such as blood pressure, dyslipidemia, and glycated hemoglobin (Hba1c). To validate this hypothesis in this prospective cohort study, we sought to determine whether C4CV is an independent predictor of macrovascular and microvascular complications in patients with T2DM in the general clinical setting

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