
Late systolic central hypertension as a predictor of incident heart failure : the Multi-Ethnic Study of Atherosclerosis
- Author
- Julio Chirinos Medina (UGent) , Patrick Segers (UGent) , Daniel A Duprez, Lyndia Brumback, David A Bluemke, Payman Zamani, Richard Kronmal, Dhananjay Vaidya, Pamela Ouyang, Raymond R Townsend and David R Jacobs
- Organization
- Abstract
- Background: Experimental studies demonstrate that high aortic pressure in late systole relative to early systole causes greater myocardial remodeling and dysfunction, for any given absolute peak systolic pressure. Methods and Results: We tested the hypothesis that late systolic hypertension, defined as the ratio of late (last one third of systole) to early (first two thirds of systole) pressure-time integrals (PTI) of the aortic pressure waveform, independently predicts incident heart failure (HF) in the general population. Aortic pressure waveforms were derived from a generalized transfer function applied to the radial pressure waveform recorded noninvasively from 6124 adults. The late/early systolic PTI ratio (L/ESPTI) was assessed as a predictor of incident HF during median 8.5 years of follow-up. The L/ESPTI was predictive of incident HF (hazard ratio per 1% increase= 1.22; 95% CI= 1.15 to 1.29; P<0.0001) even after adjustment for established risk factors for HF (HR=1.23; 95% CI= 1.14 to 1.32: P<0.0001). In a multivariate model that included brachial systolic and diastolic blood pressure and other standard risk factors of HF, L/E-SPTI was the modifiable factor associated with the greatest improvements in model performance. A high L/E-SPTI (>58.38%) was more predictive of HF than the presence of hypertension. After adjustment for each other and various predictors of HF, the HR associated with hypertension was 1.39 (95% CI= 0.86 to 2.23; P=0.18), whereas the HR associated with a high L/E was 2.31 (95% CI=1.52 to 3.49; P<0.0001). Conclusions: Independently of the absolute level of peak pressure, late systolic hypertension is strongly associated with incident HF in the general population.
- Keywords
- heart failure, arterial hemodynamics, late systolic load, left ventricular afterload, LEFT-VENTRICULAR RELAXATION, VARYING MYOCARDIAL STRESS, WAVE REFLECTION MAGNITUDE, QUALITY-OF-LIFE, LOADING SEQUENCE, CARDIOVASCULAR EVENTS, ARTERIAL LOAD, PRESSURE FALL, WALL STRESS, RECLASSIFICATION
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Citation
Please use this url to cite or link to this publication: http://hdl.handle.net/1854/LU-7006710
- MLA
- Chirinos Medina, Julio, et al. “Late Systolic Central Hypertension as a Predictor of Incident Heart Failure : The Multi-Ethnic Study of Atherosclerosis.” JOURNAL OF THE AMERICAN HEART ASSOCIATION, vol. 4, no. 3, 2015, doi:10.1161/JAHA.114.001335.
- APA
- Chirinos Medina, J., Segers, P., Duprez, D. A., Brumback, L., Bluemke, D. A., Zamani, P., … Jacobs, D. R. (2015). Late systolic central hypertension as a predictor of incident heart failure : the Multi-Ethnic Study of Atherosclerosis. JOURNAL OF THE AMERICAN HEART ASSOCIATION, 4(3). https://doi.org/10.1161/JAHA.114.001335
- Chicago author-date
- Chirinos Medina, Julio, Patrick Segers, Daniel A Duprez, Lyndia Brumback, David A Bluemke, Payman Zamani, Richard Kronmal, et al. 2015. “Late Systolic Central Hypertension as a Predictor of Incident Heart Failure : The Multi-Ethnic Study of Atherosclerosis.” JOURNAL OF THE AMERICAN HEART ASSOCIATION 4 (3). https://doi.org/10.1161/JAHA.114.001335.
- Chicago author-date (all authors)
- Chirinos Medina, Julio, Patrick Segers, Daniel A Duprez, Lyndia Brumback, David A Bluemke, Payman Zamani, Richard Kronmal, Dhananjay Vaidya, Pamela Ouyang, Raymond R Townsend, and David R Jacobs. 2015. “Late Systolic Central Hypertension as a Predictor of Incident Heart Failure : The Multi-Ethnic Study of Atherosclerosis.” JOURNAL OF THE AMERICAN HEART ASSOCIATION 4 (3). doi:10.1161/JAHA.114.001335.
- Vancouver
- 1.Chirinos Medina J, Segers P, Duprez DA, Brumback L, Bluemke DA, Zamani P, et al. Late systolic central hypertension as a predictor of incident heart failure : the Multi-Ethnic Study of Atherosclerosis. JOURNAL OF THE AMERICAN HEART ASSOCIATION. 2015;4(3).
- IEEE
- [1]J. Chirinos Medina et al., “Late systolic central hypertension as a predictor of incident heart failure : the Multi-Ethnic Study of Atherosclerosis,” JOURNAL OF THE AMERICAN HEART ASSOCIATION, vol. 4, no. 3, 2015.
@article{7006710, abstract = {{Background: Experimental studies demonstrate that high aortic pressure in late systole relative to early systole causes greater myocardial remodeling and dysfunction, for any given absolute peak systolic pressure. Methods and Results: We tested the hypothesis that late systolic hypertension, defined as the ratio of late (last one third of systole) to early (first two thirds of systole) pressure-time integrals (PTI) of the aortic pressure waveform, independently predicts incident heart failure (HF) in the general population. Aortic pressure waveforms were derived from a generalized transfer function applied to the radial pressure waveform recorded noninvasively from 6124 adults. The late/early systolic PTI ratio (L/ESPTI) was assessed as a predictor of incident HF during median 8.5 years of follow-up. The L/ESPTI was predictive of incident HF (hazard ratio per 1% increase= 1.22; 95% CI= 1.15 to 1.29; P<0.0001) even after adjustment for established risk factors for HF (HR=1.23; 95% CI= 1.14 to 1.32: P<0.0001). In a multivariate model that included brachial systolic and diastolic blood pressure and other standard risk factors of HF, L/E-SPTI was the modifiable factor associated with the greatest improvements in model performance. A high L/E-SPTI (>58.38%) was more predictive of HF than the presence of hypertension. After adjustment for each other and various predictors of HF, the HR associated with hypertension was 1.39 (95% CI= 0.86 to 2.23; P=0.18), whereas the HR associated with a high L/E was 2.31 (95% CI=1.52 to 3.49; P<0.0001). Conclusions: Independently of the absolute level of peak pressure, late systolic hypertension is strongly associated with incident HF in the general population.}}, articleno = {{e001335}}, author = {{Chirinos Medina, Julio and Segers, Patrick and Duprez, Daniel A and Brumback, Lyndia and Bluemke, David A and Zamani, Payman and Kronmal, Richard and Vaidya, Dhananjay and Ouyang, Pamela and Townsend, Raymond R and Jacobs, David R}}, issn = {{2047-9980}}, journal = {{JOURNAL OF THE AMERICAN HEART ASSOCIATION}}, keywords = {{heart failure,arterial hemodynamics,late systolic load,left ventricular afterload,LEFT-VENTRICULAR RELAXATION,VARYING MYOCARDIAL STRESS,WAVE REFLECTION MAGNITUDE,QUALITY-OF-LIFE,LOADING SEQUENCE,CARDIOVASCULAR EVENTS,ARTERIAL LOAD,PRESSURE FALL,WALL STRESS,RECLASSIFICATION}}, language = {{eng}}, number = {{3}}, pages = {{8}}, title = {{Late systolic central hypertension as a predictor of incident heart failure : the Multi-Ethnic Study of Atherosclerosis}}, url = {{http://doi.org/10.1161/JAHA.114.001335}}, volume = {{4}}, year = {{2015}}, }
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