Improved prediction of coronary disease in unselected patients: a ’real-world’ view of pulse wave analysis

Dipak Kotecha, Henry Krum, David Eccleston, Baki Billah, Marcus Flather

Research output: Contribution to journalMeeting AbstractOtherpeer-review

Abstract

Purpose: Conventional risk factors are poor at predicting coronary artery disease (CAD) in patients with symptoms or prior CAD. Pulse wave analysis (PWA) is a validated tool which derives central pressures from a radial artery waveform. However PWA has not been assessed in unselected populations and hence its true clinical application is unknown. Methods: Radial PWA was obtained prospectively in 289 patients undergoing elective coronary angiography, with no exclusion criteria aside from heart transplantation. Conventional risk markers (age, gender, family history of premature CAD, smoking, regular exercise, diabetes, body mass index, waist-hip ratio, pulse pressure, heart rate and left-ventricular function), cardiac symptoms and medications were included in logistic regression models in addition to PWA-derived central augmentation pressure (cAP), a marker of arterial stiffness. The highest quintile of cAP (≥24mmHg) and the presence of ≥50% stenosis of a coronary artery were assessed in cross-sectional analysis. Results: The odds ratio of significant CAD for high cAP was 3.50 (1.39-8.83; p<0.01; n=289) in multivariate analysis. This increased to 4.97 with the addition of cholesterol (1.35-18.27; p=0.016; n=170) suggesting independence from standard atherosclerotic variables. Odds ratios remained unchanged with the inclusion of renal function. Only age, male gender and chest pain independently predicted CAD from the conventional markers (see figure). There was also a linear increase in mean cAP according to disease severity (p for trend=0.01). Conclusion: PWA was an independent and superior predictor of CAD compared with traditional risk factors in this unselected population and is a promising technique for cardiovascular risk prediction. ClinicalTrials.gov NCT00403351
Original languageEnglish
Pages (from-to)708-708
Number of pages1
JournalEuropean Heart Journal
Volume29
Issue numbersuppl_1
DOIs
Publication statusPublished - 1 Sep 2008
EventCongress of the European-Society-of-Cardiology (ESC) 2008 - Munich, Germany
Duration: 30 Aug 20083 Sep 2008
Conference number: 30

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