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


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).


CONCLUSIONS
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.
Vlachopoulos
Charalambos
C
1st Department of Cardiology, Peripheral Vessels Unit, Athens Medical School, Hippokration Hospital, Profiti Elia 24, Athens, Greece. cvlachop@otenet.gr
Aznaouridis
Konstantinos
K
O'Rourke
Michael F
MF
Safar
Michel E
ME
Baou
Katerina
K
Stefanadis
Christodoulos
C
D000368:Aged; D001794:Blood Pressure / Q000502:physiology; D001795:Blood Pressure Determination; D001916:Brachial Artery / Q000502:physiology; D002318:Cardiovascular Diseases / Q000401:mortality* / Q000503:physiopathology; D002423:Cause of Death; D002496:Central Venous Pressure / Q000502:physiology; D005260:Female; D006439:Hemodynamics / Q000502:physiology*; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D017594:Publication Bias; D012307:Risk Factors; D013599:Systole