title: Prognostic significance of mechanical biomarkers derived from pulse wave analysis for predicting long-term cardiovascular mortality in two population-based cohorts.
abstract: BACKGROUND
  Numerous mechanical biomarkers derived from pulse wave analysis (PWA) have been proposed to predict cardiovascular outcomes. However, whether these biomarkers carry independent prognostic value and clinical utility beyond traditional cardiovascular risk factors hasn't been systematically evaluated. We aimed to investigate the additive utility of PWA-derived biomarkers in two independent population-based cohorts.
  
  
  METHODS
  PWA on central arterial pressure waveforms obtained from subjects without a prior history of cardiovascular diseases of two studies was conducted based on the wave transmission and reservoir-wave theory: firstly in the Kinmen study (1272 individuals, a median follow-up of 19.8years); and then in the Cardiovascular Disease Risk Factors Two-Township Study (2221 individuals, median follow-up of 10years). The incremental value of the biomarkers was evaluated by net reclassification index (NRI).
  
  
  RESULTS
  In multivariate Cox analyses accounting for age, gender, body mass index, systolic blood pressure, fasting glucose, high-density- and low-density-lipoprotein cholesterol, and smoking, only systolic (SC) and diastolic rate constant (DC) of reservoir pressure could independently and consistently predict cardiovascular mortality in both cohorts and the combined cohort (SC: hazard ratio 1.18 [95% confidence interval 1.08-1.28, p<0.001; DC: 1.18 [1.09-1.28], p<0.001]. Risk prediction estimates in traditional risk prediction models were significantly more accurate when incorporating peak of reservoir pressure (NRI=0.049, p=0.0361), SC (NRI=0.043, p=0.0236) and DC (NRI=0.054, p=0.047).
  
  
  CONCLUSIONS
  Of all PWA-derived biomarkers, SC and DC were consistently identified as valuable parameters for incremental cardiovascular risk prediction in two large prospective cohorts.
authors.affiliation: Department of Medical Education, Taipei Veterans General Hospital, Taipei, Taiwan; Cardiovascular Research Center, National Yang-Ming University, Taipei, Taiwan; Faculty of Medicine, National Yang-Ming University, Taipei, Taiwan; Department of Public Health, National Yang-Ming University, Taipei, Taiwan.
authors.forename: Hao-Min
authors.initials: HM
authors.lastname: Cheng
authors.affiliation: Division of Preventive Medicine and Health Service, Research Institute of Population Health Sciences, National Health Research Institutes, Miaoli, Taiwan.
authors.forename: Shao-Yuan
authors.initials: SY
authors.lastname: Chuang
authors.affiliation: School of Medicine, Fu Jen Catholic University, Xinzhuang District, New Taipei City, Taiwan.
authors.forename: Jiun-Jr
authors.initials: JJ
authors.lastname: Wang
authors.affiliation: Molecular Imaging Center, National Taiwan University, Taipei, Taiwan.
authors.forename: Yuan-Ta
authors.initials: YT
authors.lastname: Shih
authors.affiliation: Faculty of Medicine, National Yang-Ming University, Taipei, Taiwan.
authors.forename: Hsin-Ning
authors.initials: HN
authors.lastname: Wang
authors.affiliation: Department of Medical Education, Taipei Veterans General Hospital, Taipei, Taiwan.
authors.forename: Chi-Jung
authors.initials: CJ
authors.lastname: Huang
authors.affiliation: Faculty of Medicine, National Yang-Ming University, Taipei, Taiwan.
authors.forename: Jui-Tzu
authors.initials: JT
authors.lastname: Huang
authors.affiliation: Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.
authors.forename: Shih-Hsien
authors.initials: SH
authors.lastname: Sung
authors.affiliation: The Laboratory of Cardiovascular Science in the National Institute on Aging Intramural Research Program in Baltimore, MD, USA.
authors.forename: Edward G
authors.initials: EG
authors.lastname: Lakatta
authors.affiliation: Department of Biomedical Engineering, Washington University, St Louis, MO, USA.
authors.forename: Frank C P
authors.initials: FC
authors.lastname: Yin
authors.affiliation: Department of Public Health, National Yang-Ming University, Taipei, Taiwan.
authors.forename: Pesus
authors.initials: P
authors.lastname: Chou
authors.affiliation: Department of Public Health, Chung-Shan Medical University, Taichung, Taiwan.
authors.forename: Chih-Jung
authors.initials: CJ
authors.lastname: Yeh
authors.affiliation: School of Public Health, Taipei medical university.
authors.forename: Chyi-Huey
authors.initials: CH
authors.lastname: Bai
authors.affiliation: Institute of Biomedical Sciences, Academia Sinica, Taipei, Taiwan.
authors.forename: Wen-Harn
authors.initials: WH
authors.lastname: Pan
authors.affiliation: Department of Medical Education, Taipei Veterans General Hospital, Taipei, Taiwan; Cardiovascular Research Center, National Yang-Ming University, Taipei, Taiwan; Faculty of Medicine, National Yang-Ming University, Taipei, Taiwan; Department of Public Health, National Yang-Ming University, Taipei, Taiwan. Electronic address: chench@vghtpe.gov.tw.
authors.forename: Chen-Huan
authors.initials: CH
authors.lastname: Chen
mesh_terms: D000328:Adult; D000368:Aged; D001794:Blood Pressure / Q000502:physiology*; D002318:Cardiovascular Diseases / Q000401:mortality* / Q000503:physiopathology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011379:Prognosis; D016016:Proportional Hazards Models; D011446:Prospective Studies; D063177:Pulse Wave Analysis / Q000379:methods*; D012307:Risk Factors
keywords: Epidemiology; Mortality; Pulse wave analysis; Reservoir pressure; Vascular aging; Wave reflection