title: Incremental Prognostic Value of Brachial-Ankle Pulse Wave Velocity to Single-Photon Emission Computed Tomography in Patients with Suspected Coronary Artery Disease.
abstract: OBJECTIVE
  Arterial stiffness assessed by brachial-ankle pulse wave velocity (baPWV) is predictive of cardiovascular events. This study was designed to investigate whether baPWV has an additional prognostic value to single-photon emission computed tomography (SPECT) in patients with suspected coronary artery disease (CAD).
  
  
  METHODS
  A total of 350 subjects (age, 66.2 ± 10.5 years, 53.4% male) with suspected CAD undergoing myocardial SPECT and baPWV within 30 days were retrospectively analyzed. Cardiovascular events, including cardiovascular death, acute coronary syndrome and ischemic stroke, were assessed. Both fixed and reversible perfusion defects on SPECT were considered abnormal myocardial perfusion imaging (MPI) findings.
  
  
  RESULTS
  During the median follow-up period of 441 days (interquartile range 169-719 days), cardiovascular events occurred in 21 patients (6.0%). In multivariable Cox regression analysis, abnormal MPI [hazard ratio (HR), 2.67; 95% confidence interval (CI), 1.21-10.37; p=0.024] and high baPWV (≥ 1,790 cm/s) (HR, 2.03; 95% CI, 1.08-6.38; p=0.007) were independent predictors of clinical events even after adjusting for possible confounders. Also, high baPWV had an incremental prognostic value to traditional risk factors and abnormal MPI in predicting cardiovascular events (overall Chi-square, from 24.08 to 27.42; p ＜ 0.001). Kaplan-Meier survival curves stratified by baPWV and MPI proved significantly improved prediction of cardiovascular events (log-rank p=0.001).
  
  
  CONCLUSIONS
  baPWV has an incremental prognostic value to traditional risk factors and MPI. Therefore, baPWV can be used to identify subjects at higher risk of cardiovascular events in patients undergoing SPECT.
authors.affiliation: Division of Cardiology, Department of Internal Medicine, Boramae Medical Center, Seoul National University College of Medicine.
authors.forename: Hee-Sun
authors.initials: HS
authors.lastname: Lee
authors.forename: Hack-Lyoung
authors.initials: HL
authors.lastname: Kim
authors.forename: Hyeanji
authors.initials: H
authors.lastname: Kim
authors.forename: Doyeon
authors.initials: D
authors.lastname: Hwang
authors.forename: Hong-Mi
authors.initials: HM
authors.lastname: Choi
authors.forename: So-Won
authors.initials: SW
authors.lastname: Oh
authors.forename: Jae-Bin
authors.initials: JB
authors.lastname: Seo
authors.forename: Woo-Young
authors.initials: WY
authors.lastname: Chung
authors.forename: Sang-Hyun
authors.initials: SH
authors.lastname: Kim
authors.forename: Myung-A
authors.initials: MA
authors.lastname: Kim
authors.forename: Joo-Hee
authors.initials: JH
authors.lastname: Zo
mesh_terms: D000368:Aged; D055109:Ankle Brachial Index / Q000379:methods*; D003324:Coronary Artery Disease / Q000175:diagnosis* / Q000503:physiopathology; D003326:Coronary Circulation / Q000502:physiology*; D003331:Coronary Vessels / Q000000981:diagnostic imaging / Q000503:physiopathology*; D003937:Diagnosis, Differential; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D011237:Predictive Value of Tests; D011379:Prognosis; D063177:Pulse Wave Analysis / Q000379:methods*; D012039:Regional Blood Flow / Q000502:physiology*; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D015899:Tomography, Emission-Computed, Single-Photon / Q000379:methods*