Prediction of cardiovascular events and all-cause mortality with central haemodynamics: A systematic review and meta-analysis

Abstract

Aims To calculate robust quantitative estimates on the predictive value of central pressures and derived central haemodynamic indices for cardiovascular (CV) outcomes and all-cause mortality by meta-analysis of longitudinal studies. Methods and resultsWe meta-analysed 11 longitudinal studies that had employed measures of central haemodynamics and had followed 5648 subjects for a mean follow-up of 45 months. The age-and risk-factor-adjusted pooled relative risk (RR) of total CV events was 1.088 (95 CI 1.040-1.139) for a 10 mmHg increase of central systolic pressure, 1.137 (95 CI 1.063-1.215) for a 10 mmHg increase of central pulse pressure (PP), and 1.318 (95 CI 1.093-1.588) for a 10 absolute increase of central augmentation index (AIx). Furthermore, we found that a 10 increase of central AIx was associated with a RR of 1.384 (95 CI 1.192-1.606) for all-cause mortality. When compared with brachial PP, central PP was associated with marginally but not significantly higher RR of clinical events (P = 0.057). Conclusion Central haemodynamic indexes are independent predictors of future CV events and all-cause mortality. Augmentation index predicts clinical events independently of peripheral pressures, while central PP has a marginally but not significantly (P = 0.057) better predictive ability when compared with peripheral PP. Published on behalf of the European Society of Cardiology. © 2010 The Author.