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

• 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
• ISSN: 0195-668X; 1522-9645
• DOI: 10.1093/eurheartj/ehq024

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.