TY - JOUR
T1 - Hemodynamic patterns identified by impedance cardiography predict mortality in the general population
T2 - The PREVENCION study
AU - Medina-Lezama, Josefina
AU - Narvaez-Guerra, Offdan
AU - Herrera-Enriquez, Karela
AU - Morey-Vargas, Oscar L.
AU - Bolaños-Salazar, Juan Francisco
AU - Abugattas, Juan P.
AU - Zea-Diaz, Humberto
AU - Chirinos-Revilla, Jose L.
AU - Fernandez-Sivincha, Jenny G.
AU - Delgado-Lazo, Victor
AU - Chirinos, Diana A.
AU - Townsend, Raymond R.
AU - Chirinos, Julio A.
N1 - Funding Information:
Chirinos is supported by NIH grants R56HL-124073-01A1 and R01 HL 121510-01A1.
Funding Information:
Chirinos has received consulting honoraria from BMS, OPKO Healthcare, Fukuda Denshi, Microsoft, Merck, Ironwood Pharmaceuticals, Sanifit, and Vital Labs. He received research grants from National Institutes of Health, American College of Radiology Network, Fukuda-Denshi, Bristol-Myers Squibb, Microsoft, and CVRx Inc. and device loans from AtCor Medical. Chirinos is named as inventor in a University of Pennsylvania patent application for the use of inorganic nitrates/nitrites for the treatment of Heart Failure and Preserved Ejection Fraction. Other authors have no disclosures.
Publisher Copyright:
© 2018 The Authors.
PY - 2018/9/1
Y1 - 2018/9/1
N2 - Background-—Blood pressure is determined by the interactions between the heart and arterial properties, and subjects with identical blood pressure may have substantially different hemodynamic determinants. Whether arterial hemodynamic indices quantified by impedance cardiography (ICG), a simple operator-independent office procedure, independently predict all-cause mortality in adults from the general population, and specifically among those who do not meet criteria for American College of Cardiology/American Heart Association stage 2 hypertension, is currently unknown. Methods and Results-—We studied 1639 adults aged 18 to 80 years from the general population. We used ICG to measure hemodynamic parameters and metrics of cardiac function. We assessed the relationship between hemodynamic parameters measured at baseline and all-cause mortality over a mean follow-up of 10.9 years. Several ICG parameters predicted death. The strongest predictors were total arterial compliance index (standardized hazard ratio=0.38 95% confidence interval=0.31–0.46 P<0.0001) and indices of cardiac contractility: velocity index (standardized hazard ratio=0.45 95% confidence interval=0.37–0.55 P<0.0001) and acceleration index (standardized hazard ratio=0.44 95% confidence interval=0.35–0.55 P<0.0001). These remained independently predictive of death after adjustment for multiple confounders, as well as systolic and diastolic blood pressure. Among subjects without stage 2 hypertension (n=1563), indices of cardiac contractility were independently predictive of death and identified a subpopulation (25% of non-stage-2 hypertensives) that demonstrated a high 10-year mortality risk, equivalent to that of stage 2 hypertensives. Conclusions-—Hemodynamic patterns identified by ICG independently predict mortality in the general population. The predictive value of ICG applies even in the absence of American College of Cardiology/American Heart Association stage 2 hypertension and identifies higher-risk individuals who are in earlier stages of the hypertension continuum.
AB - Background-—Blood pressure is determined by the interactions between the heart and arterial properties, and subjects with identical blood pressure may have substantially different hemodynamic determinants. Whether arterial hemodynamic indices quantified by impedance cardiography (ICG), a simple operator-independent office procedure, independently predict all-cause mortality in adults from the general population, and specifically among those who do not meet criteria for American College of Cardiology/American Heart Association stage 2 hypertension, is currently unknown. Methods and Results-—We studied 1639 adults aged 18 to 80 years from the general population. We used ICG to measure hemodynamic parameters and metrics of cardiac function. We assessed the relationship between hemodynamic parameters measured at baseline and all-cause mortality over a mean follow-up of 10.9 years. Several ICG parameters predicted death. The strongest predictors were total arterial compliance index (standardized hazard ratio=0.38 95% confidence interval=0.31–0.46 P<0.0001) and indices of cardiac contractility: velocity index (standardized hazard ratio=0.45 95% confidence interval=0.37–0.55 P<0.0001) and acceleration index (standardized hazard ratio=0.44 95% confidence interval=0.35–0.55 P<0.0001). These remained independently predictive of death after adjustment for multiple confounders, as well as systolic and diastolic blood pressure. Among subjects without stage 2 hypertension (n=1563), indices of cardiac contractility were independently predictive of death and identified a subpopulation (25% of non-stage-2 hypertensives) that demonstrated a high 10-year mortality risk, equivalent to that of stage 2 hypertensives. Conclusions-—Hemodynamic patterns identified by ICG independently predict mortality in the general population. The predictive value of ICG applies even in the absence of American College of Cardiology/American Heart Association stage 2 hypertension and identifies higher-risk individuals who are in earlier stages of the hypertension continuum.
KW - Cardiac function
KW - Hemodynamics
KW - Impedance cardiography
KW - Population-based
KW - Systemic vascular resistance
KW - Total arterial compliance
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U2 - 10.1161/JAHA.118.009259
DO - 10.1161/JAHA.118.009259
M3 - Article
C2 - 30371205
AN - SCOPUS:85055612235
SN - 2047-9980
VL - 7
JO - Journal of the American Heart Association
JF - Journal of the American Heart Association
IS - 18
M1 - ee009259
ER -