title: Arterial wave reflections and incident cardiovascular events and heart failure: MESA (Multiethnic Study of Atherosclerosis).
abstract: OBJECTIVE
  This study sought to assess the relationship between central pressure profiles and cardiovascular events (CVEs) in a large community-based sample.
  
  
  BACKGROUND
  Experimental and physiologic data mechanistically implicate wave reflections in the pathogenesis of left ventricular failure and cardiovascular disease, but their association with these outcomes in the general population is unclear.
  
  
  METHODS
  Aortic pressure waveforms were derived from a generalized transfer function applied to the radial pressure waveform recorded noninvasively from 5,960 participants in the Multiethnic Study of Atherosclerosis. The central pressure waveform was separated into forward and reflected waves using a physiologic flow waveform. Reflection magnitude (RM = [Reflected/Forward wave amplitude] × 100), augmentation index ([Second/First systolic peak] × 100) and pulse pressure amplification ([Radial/aortic pulse pressure] × 100) were assessed as predictors of CVEs and congestive heart failure (CHF) during a median follow-up of 7.61 years.
  
  
  RESULTS
  After adjustment for established risk factors, aortic AIx independently predicted hard CVEs (hazard ratio [HR] per 10% increase: 1.08; 95% confidence interval [CI]: 1.01 to 1.14; p = 0.016), whereas PPA independently predicted all CVEs (HR per 10% increase: 0.82; 95% CI: 0.70 to 0.96; p = 0.012). RM was independently predictive of all CVEs (HR per 10% increase: 1.34; 95% CI: 1.08 to 1.67; p = 0.009) and hard CVEs (HR per 10% increase: 1.46; 95% CI: 1.12 to 1.90; p = 0.006) and was strongly predictive of new-onset CHF (HR per 10% increase: 2.69; 95% CI: 1.79 to 4.04; p < 0.0001), comparing favorably to other risk factors for CHF as per various measures of model performance, reclassification, and discrimination. In a fully adjusted model, compared to nonhypertensive subjects with low RM, the HRs (95% CI) for hypertensive subjects with low RM, nonhypertensive subjects with high RM, and hypertensive subjects with high RM were 1.81 (0.85 to 3.86), 2.16 (1.07 to 5.01), and 3.98 (1.96 to 8.05), respectively.
  
  
  CONCLUSIONS
  Arterial wave reflections represent a novel strong risk factor for CHF in the general population.
authors.affiliation: Philadelphia VA Medical Center and University of Pennsylvania School of Medicine, Philadelphia, PA, USA. julio.chirinos@uphs.upenn.edu
authors.forename: Julio A
authors.initials: JA
authors.lastname: Chirinos
authors.forename: Jan G
authors.initials: JG
authors.lastname: Kips
authors.forename: David R
authors.initials: DR
authors.lastname: Jacobs
authors.forename: Lyndia
authors.initials: L
authors.lastname: Brumback
authors.forename: Daniel A
authors.initials: DA
authors.lastname: Duprez
authors.forename: Richard
authors.initials: R
authors.lastname: Kronmal
authors.forename: David A
authors.initials: DA
authors.lastname: Bluemke
authors.forename: Raymond R
authors.initials: RR
authors.lastname: Townsend
authors.forename: Sebastian
authors.initials: S
authors.lastname: Vermeersch
authors.forename: Patrick
authors.initials: P
authors.lastname: Segers
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001013:Aorta, Thoracic / Q000503:physiopathology*; D062186:Arterial Pressure / Q000502:physiology*; D050197:Atherosclerosis / Q000150:complications / Q000208:ethnology* / Q000503:physiopathology; D001783:Blood Flow Velocity; D001795:Blood Pressure Determination; D002318:Cardiovascular Diseases / Q000208:ethnology / Q000503:physiopathology; D004548:Elasticity; D005006:Ethnicity; D005500:Follow-Up Studies; D006333:Heart Failure / Q000208:ethnology* / Q000209:etiology / Q000503:physiopathology; D006801:Humans; D015994:Incidence; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D011795:Surveys and Questionnaires; D014481:United States / Q000453:epidemiology