Value of Excess Pressure Integral for Predicting 15‐Year All‐Cause and Cardiovascular Mortalities in End‐Stage Renal Disease Patients
BackgroundThe excess pressure integral (XSPI), derived from analysis of the arterial pressure curve, may be a significant predictor of cardiovascular events in high‐risk patients. We comprehensively investigated the prognostic value of XSPI for predicting long‐term mortality in end‐stage renal disea...
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| Format: | Article |
| Language: | English |
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Wiley
2017-12-01
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| Series: | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| Subjects: | |
| Online Access: | https://www.ahajournals.org/doi/10.1161/JAHA.117.006701 |
| _version_ | 1811332271469232128 |
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| author | Jui‐Tzu Huang Hao‐Min Cheng Wen‐Chung Yu Yao‐Ping Lin Shih‐Hsien Sung Jiun‐Jr Wang Chung‐Li Wu Chen‐Huan Chen |
| author_facet | Jui‐Tzu Huang Hao‐Min Cheng Wen‐Chung Yu Yao‐Ping Lin Shih‐Hsien Sung Jiun‐Jr Wang Chung‐Li Wu Chen‐Huan Chen |
| author_sort | Jui‐Tzu Huang |
| collection | DOAJ |
| description | BackgroundThe excess pressure integral (XSPI), derived from analysis of the arterial pressure curve, may be a significant predictor of cardiovascular events in high‐risk patients. We comprehensively investigated the prognostic value of XSPI for predicting long‐term mortality in end‐stage renal disease patients undergoing regular hemodialysis. Methods and ResultsA total of 267 uremic patients (50.2% female; mean age 54.2±14.9 years) receiving regular hemodialysis for more than 6 months were enrolled. Cardiovascular parameters were obtained by echocardiography and applanation tonometry. Calibrated carotid arterial pressure waveforms were analyzed according to the wave‐transmission and reservoir‐wave theories. Multivariable Cox proportional hazard models were constructed to account for age, sex, diabetes mellitus, albumin, body mass index, and hemodialysis treatment adequacy. Incremental utility of the parameters to risk stratification was assessed by net reclassification improvement. During a median follow‐up of 15.3 years, 124 deaths (46.4%) incurred. Baseline XSPI was significantly predictive of all‐cause (hazard ratio per 1 SD 1.4, 95% confidence interval 1.15‐1.70, P=0.0006) and cardiovascular mortalities (1.47, 1.18‐1.84, P=0.0006) after accounting for the covariates. The addition of XSPI to the base prognostic model significantly improved prediction of both all‐cause mortality (net reclassification improvement=0.1549, P=0.0012) and cardiovascular mortality (net reclassification improvement=0.1535, P=0.0033). XSPI was superior to carotid‐pulse wave velocity, forward and backward wave amplitudes, and left ventricular ejection fraction in consideration of overall independent and incremental prognostics values. ConclusionsIn end‐stage renal disease patients undergoing regular hemodialysis, XSPI was significantly predictive of long‐term mortality and demonstrated an incremental value to conventional prognostic factors. |
| first_indexed | 2024-04-13T16:34:09Z |
| format | Article |
| id | doaj.art-74fe491d44d34e28be69951a1196edac |
| institution | Directory Open Access Journal |
| issn | 2047-9980 |
| language | English |
| last_indexed | 2024-04-13T16:34:09Z |
| publishDate | 2017-12-01 |
| publisher | Wiley |
| record_format | Article |
| series | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| spelling | doaj.art-74fe491d44d34e28be69951a1196edac2022-12-22T02:39:29ZengWileyJournal of the American Heart Association: Cardiovascular and Cerebrovascular Disease2047-99802017-12-0161210.1161/JAHA.117.006701Value of Excess Pressure Integral for Predicting 15‐Year All‐Cause and Cardiovascular Mortalities in End‐Stage Renal Disease PatientsJui‐Tzu Huang0Hao‐Min Cheng1Wen‐Chung Yu2Yao‐Ping Lin3Shih‐Hsien Sung4Jiun‐Jr Wang5Chung‐Li Wu6Chen‐Huan Chen7Faculty of Medicine, National Yang‐Ming University, Taipei, TaiwanFaculty of Medicine, National Yang‐Ming University, Taipei, TaiwanFaculty of Medicine, National Yang‐Ming University, Taipei, TaiwanFaculty of Medicine, National Yang‐Ming University, Taipei, TaiwanFaculty of Medicine, National Yang‐Ming University, Taipei, TaiwanSchool of Medicine, Fu Jen Catholic University, New Taipei City, TaiwanDepartment of Medical Education, Center for Evidence‐Based Medicine, Taipei Veterans General Hospital, Taipei, TaiwanFaculty of Medicine, National Yang‐Ming University, Taipei, TaiwanBackgroundThe excess pressure integral (XSPI), derived from analysis of the arterial pressure curve, may be a significant predictor of cardiovascular events in high‐risk patients. We comprehensively investigated the prognostic value of XSPI for predicting long‐term mortality in end‐stage renal disease patients undergoing regular hemodialysis. Methods and ResultsA total of 267 uremic patients (50.2% female; mean age 54.2±14.9 years) receiving regular hemodialysis for more than 6 months were enrolled. Cardiovascular parameters were obtained by echocardiography and applanation tonometry. Calibrated carotid arterial pressure waveforms were analyzed according to the wave‐transmission and reservoir‐wave theories. Multivariable Cox proportional hazard models were constructed to account for age, sex, diabetes mellitus, albumin, body mass index, and hemodialysis treatment adequacy. Incremental utility of the parameters to risk stratification was assessed by net reclassification improvement. During a median follow‐up of 15.3 years, 124 deaths (46.4%) incurred. Baseline XSPI was significantly predictive of all‐cause (hazard ratio per 1 SD 1.4, 95% confidence interval 1.15‐1.70, P=0.0006) and cardiovascular mortalities (1.47, 1.18‐1.84, P=0.0006) after accounting for the covariates. The addition of XSPI to the base prognostic model significantly improved prediction of both all‐cause mortality (net reclassification improvement=0.1549, P=0.0012) and cardiovascular mortality (net reclassification improvement=0.1535, P=0.0033). XSPI was superior to carotid‐pulse wave velocity, forward and backward wave amplitudes, and left ventricular ejection fraction in consideration of overall independent and incremental prognostics values. ConclusionsIn end‐stage renal disease patients undergoing regular hemodialysis, XSPI was significantly predictive of long‐term mortality and demonstrated an incremental value to conventional prognostic factors.https://www.ahajournals.org/doi/10.1161/JAHA.117.006701cardiovascular mortalityhemodynamicsprognosisreservoir‐pressure analysisuremia |
| spellingShingle | Jui‐Tzu Huang Hao‐Min Cheng Wen‐Chung Yu Yao‐Ping Lin Shih‐Hsien Sung Jiun‐Jr Wang Chung‐Li Wu Chen‐Huan Chen Value of Excess Pressure Integral for Predicting 15‐Year All‐Cause and Cardiovascular Mortalities in End‐Stage Renal Disease Patients Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease cardiovascular mortality hemodynamics prognosis reservoir‐pressure analysis uremia |
| title | Value of Excess Pressure Integral for Predicting 15‐Year All‐Cause and Cardiovascular Mortalities in End‐Stage Renal Disease Patients |
| title_full | Value of Excess Pressure Integral for Predicting 15‐Year All‐Cause and Cardiovascular Mortalities in End‐Stage Renal Disease Patients |
| title_fullStr | Value of Excess Pressure Integral for Predicting 15‐Year All‐Cause and Cardiovascular Mortalities in End‐Stage Renal Disease Patients |
| title_full_unstemmed | Value of Excess Pressure Integral for Predicting 15‐Year All‐Cause and Cardiovascular Mortalities in End‐Stage Renal Disease Patients |
| title_short | Value of Excess Pressure Integral for Predicting 15‐Year All‐Cause and Cardiovascular Mortalities in End‐Stage Renal Disease Patients |
| title_sort | value of excess pressure integral for predicting 15 year all cause and cardiovascular mortalities in end stage renal disease patients |
| topic | cardiovascular mortality hemodynamics prognosis reservoir‐pressure analysis uremia |
| url | https://www.ahajournals.org/doi/10.1161/JAHA.117.006701 |
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