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Aortic stiffness and central wave reflections predict outcome in renal transplant recipients

(2011) HYPERTENSION. 58(5). p.833-838
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Abstract
Although renal transplantation improves survival, cardiovascular morbidity and mortality remain significantly elevated compared with nonrenal populations. The negative impact of traditional, uremia-related, and transplantation-related risk factors in this process remains, however, largely unexplored. Surrogate markers such as aortic stiffness and central wave reflections may lead to more accurate cardiovascular risk stratification, but outcome data in renal transplant recipients are scarce. We aimed to establish the prognostic significance of these markers for fatal and nonfatal cardiovascular events in renal transplant recipients. Carotid-femoral pulse wave velocity, central augmentation pressure, and central augmentation index were measured in a cohort of 512 renal transplant recipients using the SphygmoCor system. After a mean follow-up of 5 years, 20 fatal and 75 nonfatal cardiovascular events were recorded. Using receiver operating characteristic curves, the area under the curve for predicting cardiovascular events was 0.718 (95% CI 0.659-0.776) for pulse wave velocity, 0.670 (95% CI 0.604-0.736) for central augmentation pressure, and 0.595 (95% CI 0.529-0.660) for central augmentation index. When we accounted for age, gender, and C-reactive protein in Cox-regression analysis, pulse wave velocity (hazard ratio: 1.349 per 1 SD increase; 95% CI 1.104-1.649; P = 0.003) and central augmentation pressure (hazard ratio: 1.487 per 1 SD increase; 95% CI 1.219-1.814; P < 0.001) remained independent predictors of outcome. Aortic stiffness and increased wave reflections are independent predictors of cardiovascular events in renal transplant recipients. As single parameter of wave reflection, central augmentation pressure was better than central augmentation index. Combined measurement of pulse wave velocity and central augmentation pressure may contribute to an accurate cardiovascular risk estimation in this heterogeneous population.
Keywords
mortality, augmentation pressure, cardiovascular events, SURVIVAL, DIALYSIS, ALL-CAUSE, VELOCITY, CARDIOVASCULAR EVENTS, ARTERIAL STIFFNESS, transplantation, kidney, augmentation index, MORTALITY, PRESSURE, pulse wave velocity, DISEASE

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Citation

Please use this url to cite or link to this publication:

Chicago
Verbeke, Francis, Celine Marechal, STEVEN VAN LAECKE, Wim Van Biesen, Olivier Devuyst, Lucas Van Bortel, Michel Jadoul, and Raymond Vanholder. 2011. “Aortic Stiffness and Central Wave Reflections Predict Outcome in Renal Transplant Recipients.” Hypertension 58 (5): 833–838.
APA
Verbeke, Francis, Marechal, C., VAN LAECKE, S., Van Biesen, W., Devuyst, O., Van Bortel, L., Jadoul, M., et al. (2011). Aortic stiffness and central wave reflections predict outcome in renal transplant recipients. HYPERTENSION, 58(5), 833–838.
Vancouver
1.
Verbeke F, Marechal C, VAN LAECKE S, Van Biesen W, Devuyst O, Van Bortel L, et al. Aortic stiffness and central wave reflections predict outcome in renal transplant recipients. HYPERTENSION. 2011;58(5):833–8.
MLA
Verbeke, Francis, Celine Marechal, STEVEN VAN LAECKE, et al. “Aortic Stiffness and Central Wave Reflections Predict Outcome in Renal Transplant Recipients.” HYPERTENSION 58.5 (2011): 833–838. Print.
@article{1997503,
  abstract     = {Although renal transplantation improves survival, cardiovascular morbidity and mortality remain significantly elevated compared with nonrenal populations. The negative impact of traditional, uremia-related, and transplantation-related risk factors in this process remains, however, largely unexplored. Surrogate markers such as aortic stiffness and central wave reflections may lead to more accurate cardiovascular risk stratification, but outcome data in renal transplant recipients are scarce. We aimed to establish the prognostic significance of these markers for fatal and nonfatal cardiovascular events in renal transplant recipients. Carotid-femoral pulse wave velocity, central augmentation pressure, and central augmentation index were measured in a cohort of 512 renal transplant recipients using the SphygmoCor system. After a mean follow-up of 5 years, 20 fatal and 75 nonfatal cardiovascular events were recorded. Using receiver operating characteristic curves, the area under the curve for predicting cardiovascular events was 0.718 (95\% CI 0.659-0.776) for pulse wave velocity, 0.670 (95\% CI 0.604-0.736) for central augmentation pressure, and 0.595 (95\% CI 0.529-0.660) for central augmentation index. When we accounted for age, gender, and C-reactive protein in Cox-regression analysis, pulse wave velocity (hazard ratio: 1.349 per 1 SD increase; 95\% CI 1.104-1.649; P = 0.003) and central augmentation pressure (hazard ratio: 1.487 per 1 SD increase; 95\% CI 1.219-1.814; P {\textlangle} 0.001) remained independent predictors of outcome. Aortic stiffness and increased wave reflections are independent predictors of cardiovascular events in renal transplant recipients. As single parameter of wave reflection, central augmentation pressure was better than central augmentation index. Combined measurement of pulse wave velocity and central augmentation pressure may contribute to an accurate cardiovascular risk estimation in this heterogeneous population.},
  author       = {Verbeke, Francis and Marechal, Celine and VAN LAECKE, STEVEN and Van Biesen, Wim and Devuyst, Olivier and Van Bortel, Lucas and Jadoul, Michel and Vanholder, Raymond},
  issn         = {0194-911X},
  journal      = {HYPERTENSION},
  keyword      = {mortality,augmentation pressure,cardiovascular events,SURVIVAL,DIALYSIS,ALL-CAUSE,VELOCITY,CARDIOVASCULAR EVENTS,ARTERIAL STIFFNESS,transplantation,kidney,augmentation index,MORTALITY,PRESSURE,pulse wave velocity,DISEASE},
  language     = {eng},
  number       = {5},
  pages        = {833--838},
  title        = {Aortic stiffness and central wave reflections predict outcome in renal transplant recipients},
  url          = {http://dx.doi.org/10.1161/HYPERTENSIONAHA.111.176594},
  volume       = {58},
  year         = {2011},
}

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