Online Supplement
Non-invasive methods to assess pulse wave velocity:
Comparison with the invasive gold-standard and relationship with organ damage
Thomas WEBER (a,b), Siegfried WASSERTHEURER (c), Bernhard HAMETNER (c), Stephanie PARRAGH (c), Bernd EBER (a)
a ... Cardiology Department, Klinikum Wels-Grieskirchen, Wels, Austria
b ... Paracelsus Medical University, Salzburg, Austria
c ... Austrian Institute of Technology, Vienna, Austria
Corresponding author:
Thomas Weber, MD, Associate Professor
Cardiology Department
Klinikum Wels-Grieskirchen
Grieskirchnerstrasse 42
4600 Wels
Austria
Email: [email protected]
Fax: 0043 7242 415 3992
1
All patients
Patients with direct
Patients with caliper
distance measurement
measurement
915
632
336
Patient number
61.0 (53.2-69.0)
60.0 (53.0-69.0)
63 (55-70)
Age years
752 (82.2%)
526 (83.2 %)
267 (79.5%)
Men
705 (77.0%)
491(77.7%)
265 (78.9%)
Hypertension
209 (22.8 %)
150 (23.7%)
96 (28.6%)
Diabetes mellitus
188 (20.5%)
122 (19.3%)
65 (19.3%)
Smoking
466 (50.9 %)
312 (49.4%)
186 (55.4%)
Coronary artery disease
0 (0-4)
0 (0-4)
0 (0-4)
AngioScore
727
(79.5%)
494
(78.2%)
259
(77.1%)
Normal systolic function
16 (12-20)
16 (12-20)
17 (12-21)
Left ventricular enddiastolic pressure mm Hg
28.3 (25.6-30.9)
28.4 (25.6-31.1)
28.4 (25.8-31.0)
Body Mass Index kg/m2
100 (94-107)
101 (94-108)
102 (95-109)
Waist circumference cm
200 (170-231)
201 (169-234)
195 (163-230)
Total cholesterol mg/dl
114 (89-144)
115 (88-148)
111 (84-142)
LDL-cholesterol mg/dl
5.7 (5.4-6.2)
5.7 (5.5-6.2)
5.7 (5.5-6.3)
HbA1c %
91 (71-114)
93 (72-116)
89 (69-115)
Creatinine clearence ml/min
2.1 (1.8-2.6)
2.1 (1.8-2.6)
2.1 (1.8-2.6)
Log nt-proBNP pg/ml
2.0 (1.8-2.2)
2.0 (1.8-2.2)
2.0 (1.8-2.2)
Left atrial diameter cm/m2
2
121 (100-149)
120 (99-148)
119 (99-140)
Left ventricular mass g/m
5.6 (4.5-7.0)
5.6 (4.5-7.0)
5.3 (4.1-6.5) *
E´cm/sec
10.6 (8.6-13.7)
10.6 (8.7-13.6)
11.3(9.5-14.1) *
E/E´
6.7 (5.7-7.7)
6.8 (1.6)
6.5 (5.6-7.4) *
S´cm/sec
Table S1: Baseline characteristics of the patients. Numbers are means (SD), medians (25.-75. Percentile), or absolute numbers (percentages).
* indicates a statistically significant difference between the three groups (Kruskal-Wallis test)
2
Age
groups
years
n
MBP
inv mm
Hg
MBP
noninv
mm Hg
TT
inv
msec
TT
noninv
msec
TD
inv
cm
TD
sub
cm
TD bh
cm
Height
cm
aoPWV
inv
m/sec
cfPWVsub
m/sec
aoPWVestim
m/sec
cfPWVbh
m/sec
< 41
30
90
(85-94)
94.5
(86-103)
6.7
(6.1-7.7)
6.2
(5.8-6.7)
7.1
(6.4-7.8)
282
98
(90-109)
100
(92-110)
7.6
(6.8-8.7)
7.7
(6.8-8.8)
7.4
(6.9-8.1)
7.8
(6.8-8.7)
61 to 70
289
99
(91-109)
101
(92-109)
9.1
(8.0-10.2)
8.9
(7.7-10.4)
9.2
(8.5-9.9)
8.8
(7.7-10.2)
71 to 80
166
97
(87-108)
98
(90-110)
10.1
(9.0-12.2)
9.5
(7.9-11.1)
10.5
(10.0-11.4)
9.4
(8.0-10.9)
80 +
18
101
(84-112)
96
(83-108)
180.0
(176.0185.0)
177.0
(171.0181.0)
174.0
(170.0179.0)
172.0
(167.0177.0)
169.0
(165.0173.0)
159.0
(154.0168.0)
6.4
(5.8-7.2)
51 to 60
52.3
(51.353.5)
51.5
(50.052.5)
50.8
(49.852.0)
50.3
(49.051.5)
49.5
(48.550.5)
47.0
(45.849.3)
7
(5.9-7.7)
97
(91-103)
49
(47.553.0)
50
(46.053.0)
50.5
(47.054.5)
50.5
(47.554.0)
49
(46.053.0)
45.7
(44.049.5)
5.3
(5.0-5.7)
93
(87-102)
49.5
(47.053.2)
50
(47.552.2)
51
(4953.5)
51
(48.554.0)
51
(48.554.2)
49.7
(47.554.0)
6.3
(5.6-7.1)
130
75.6
(68.284.9)
72.5
(65.580.8)
65.6
(57.774.1)
57.4
(49.464.5)
52.9
(46.362.4)
47.1
(38.849.9)
5.6
(4.9-6.2)
41 to 50
88.7
(81.797.5)
77.2
(69.286.7)
65.8
(58.775)
56.7
(49.263.1)
50
(41.756.7)
42.9
(35.850.0)
12.3
(10.314.0)
10.6
(9.2-11.4)
12.2
(11.8-13.0)
10.1
(9.6-12.2)
Table S2: Pulse wave velocities and their determinants in the entire study population (n=915), stratified across age groups. Numbers are medians
(25.-75. percentile). MBP ... mean blood pressure, TT ... transit time, TDinv ... invasive travel distance, TD subtr ... subtracted travel distance, TDbh ...
body height based travel distance, aoPWVinv ... invasive aortic pulse wave velocity, cfPWVsubtr ... subtracted distance-based carotid-femoral pulse
wave velocity; aoPWVestim ... estimated aortic pulse wave velocity, cfPWVbh, body-height based formula derived carotis-femoralis pulse wave
velocity
3
Age
groups
years
n
MBP
inv
mm
Hg
MBP
noninv
mm Hg
TT
inv
msec
TT
noninv
msec
TD
inv
cm
TD
sub
cm
TD
dirx0.8
cm
Height
cm
aoPWVinv
m/sec
cfPWVsub
m/sec
cfPWVdir0.8
m/sec
aoPWVest
m/sec
< 41 yrs
24
93.5
(85.5-101)
7.3
(6.7-8.4)
6.2
(5.9-6.7)
7.7
(6.7-8.9)
7.7
(6.8-8.6)
8.1
(7.5-9.3)
7.4
(7.0-8.1)
8.9
(8.1-10.2)
8.9
(7.8-10.5)
9.3
(8.5-11.1)
9.2
(8.5-9.9)
71 to 80
101
10.2
(9.0-12.0)
9.1
(8.1-11.1)
9.8
(8.6-11.3)
10.6
(10.1-11.4)
80 +
14
179.5
(176.0184.0)
177
(171180)
174
(170.5180)
172
(167177)
170
(165173)
160.5
(154170)
6.7
(6.2-7.6)
199
54.4
(52.858.0)
53.6
(51.256.8)
54.4
(51.656.8)
53.2
(51.256.0)
52.8
(49.656.0)
48.4
(45.652.8)
6.6
(5.8-7.3)
61 to 70
49.0
(47.254.0)
50
(46.052.5)
50.5
(48.054.7)
50
(46.554.0)
50
(47.053.3)
46.2
(44.550.0)
5.2
(4.9-5.7)
200
49.5
(47.253.2)
49.6
(47.552.0)
51
(49.054.0)
51
(48.554.0)
51
(49.054.2)
49.7
(47.556.0)
7.3
(6.7-7.9)
51 to 60
76.6
(67.484.6)
72.1
(65.080.0)
66.2
(58.574.8)
56.8
(48.962.5)
52.9
(46.562.4)
47.1
(36.449.9)
6.2
(5.7-7.1)
94
89.6
(81.397.5)
75.4
(67.585.0)
65.8
(58.375.0)
57.5
(49.263.1)
50
(43.356.3)
43.3
(39.250.0)
5.6
(4.9-6.2)
41 to 50
90.5
(85.095.5)
92
(87101)
98
(88.0108.0)
98
(92.0109.0)
96
(87.0108.0)
99.5
(84.0112.0)
11.7
(10.3-13.6)
10.8
(9.2-12.8)
11.2
(10.4-12.7)
12.2
(11.2-12.7)
97.5
(91-104)
100
(92.0109.5)
101
(92.0110.0)
97
(89.0113.0)
96
(83.0110.0)
Table S3: Pulse wave velocities and their determinants in the cohort with direct distance measurements (n=632), stratified across age groups.
Numbers are medians (25.-75. percentile). CfPWVdir0.8 ... direct distance x 0.8 based carotis-femoralis pulse wave velocity; other abbreviations see
Table S2
4
Age
groups
years
n
< 41
8
41 to
50
38
51 to
60
106
61 to
70
112
71 to
80
64
80 +
8
MBP
inv
mm
Hg
90
(88.092.5)
94.5
(89.0104.0)
97.0
(90.0105.0)
98.5
(90.0108.0)
94.5
(89.0108.0)
94.0
(84.0115.0)
MBP
noninv
mm Hg
TT
inv
msec
TT
noninv
msec
TD
inv
cm
TD
sub
cm
TD
caliper
cm
Height
cm
aoPWVinv
m/sec
cfPWVsub
m/sec
cfPWVcaliper
m/sec
aoPWVest
m/sec
100
(88.5108.8)
101.5
(95.0110.0)
103.0
(95.0111.0)
104.5
(96.0111.0)
99.0
(89.5112.5)
101.5
(89.0111.0)
86.2
(80.693.1)
74.5
(67.388.3)
67.1
(57.576.7)
57.6
(50.064.2)
50.4
(43.756.7)
42.9
(37.550.4)
71.2
(64.387.0)
72.5
(64.980.2)
65.1
(57.373.7)
55.8
(47.862.2)
52.0
(43.859.2)
40.1
(32.451.0)
49.2
(48.554.5)
50.5
(47.554.0)
51.2
(49.054.0)
51.0
(49.054.4)
50.5
(48.554.2)
49.7
(47.555.2)
50.7
(46.055.2)
49.0
(45.052.0)
50.0
(47.054.0)
48.7
(46.052.5)
49.0
(46.052.7)
46.2
(45.248.2)
46.2
(39.551.0)
46.0
(43.049.0)
46.0
(43.049.0)
45.0
(42.547.5)
44.5
(42.048.0)
43.7
(41.245.7)
181.5
(175.5185.0)
175
(168.0180.0)
175.0
(171.0180.0)
170
(166.0176.0)
169.5
(165.0173.0)
160.5
(154.5169.0)
5.8
(5.5-6.2)
6.4
(5.5-7.5)
5.6
(5.1-6.9)
5.5
(5.1-5.8)
6.6
(6.1-7.4)
6.6
(6.1-7.6)
6.2
(5.8-7.2)
6.5
(5.8-6.9)
7.7
(6.7-8.8)
7.6
(6.7-9.0)
7.0
(6.2-8.2)
7.6
(7.1-8.4)
9.0
(8.0-10.4)
8.8
(7.7-10.6)
8.0
(7.1-9.6)
9.3
(8.7-10.0)
10.2
(9.1-12.2)
9.8
(7.8-11.5)
8.8
(7.3-10.5)
10.7
(10.0-11.6)
12.3
(9.0-14.2)
11.9
(9.8-14.0)
10.6
(8.9-13.3)
12.7
(12.4-13.2)
Table S4: Pulse wave velocities and their determinantes in the cohort with caliper measurements of travel distance (n=336), stratified across age
groups. Numbers are medians (25.-75. percentile); cfPWVcalip ... caliper-based carotis-femoralis pulse wave velocity, other abbreviations see Table
S2 and S3
5
Age
Angioscore
LV EDP
CreaClearence
Ntpro-BNP
LVMass
LA diameter
E´med
E / E`med
S´med
aoPWVinv cfPWV sub cfPWVdir0.8 cfPWV bh aoPWVestim
0.68
0.48*§
0.46*§
0.47*§
0.91#
0.25
0.12*
0.11*
0.09*§
0.18
0.27
0.22
0.22
0.19*
0.23
-0.46
-0.28*§
-0.28*§
-0.34*§
-0.61#
0.27
0.27
0.27
0.28
0.33
0.21
0.21
0.19
0.15
0.16
0.29
0.23§
0.21*§
0.23§
0.37#
-0.46
-0.35*§
-0.34*§
-0.33*§
-0.51
0.31
0.29§
0.29§
0.27§
0.38#
-0.28
-0.19*§
-0.17*§
-0.19*§
-0.31
Table S5: Univariate correlations between PWVs and intermediate cardiovascular endpoints in 536 patients with preserved systolic function, in whom
direct distance measurements were available. * indicates a statistically significant different relationship with aoPWVinv, as compared to noninvasive
cfPWVs. # indicates a statistically significant different relationship with aoPWVest, as compared to aoPWVinv. § indicates a statistically significant
different relationship with aoPWVest, as compared to noninvasive cfPWVs.
LVEDP ... left ventriculat enddiastolic pressure, LVM ... left ventricular mass; BSA ... body surface area, LA ... left atrium, aoPWVinv ... invasive
aortic pulse wave velocity, cfPWVsubtr ... subtracted distance-based carotid-femoral pulse wave velocity; cfPWVdir0.8 ... direct distance x 0.8 based
carotis-femoralis pulse wave velocity; cfPWVbh, body-height based formula derived carotis-femoralis pulse wave velocity; aoPWVestim ... estimated
aortic pulse wave velocity
6
Figure S1: Bland-Altman plot comparing invasive aortic pulse wave velocity (aoPWVinv) and subtracted-distance based carotid-femoral pulse wave
velocity (cfPWVsub) in 915 patients. Mean difference was 0.1 m/sec, 1 standard deviation was 2m/sec.
7
Figure S2: Bland-Altman plot comparing invasive aortic pulse wave velocity (aoPWVinv) and body-height - distance based carotid-femoral pulse
wave velocity (cfPWVbh) in 915 patients. Mean difference was 0.1 m/sec, 1 standard deviation was 2 m/sec.
8
Figure S3: Bland-Altman plot comparing invasive aortic pulse wave velocity (aoPWVinv) and estimated aortic pulse wave velocity (aoPWVestim) in
915 patients. Mean difference was 0.2 m/sec, 1 standard deviation was 1.6 m/sec.
9
Figure S4: Bland-Altman plot comparing invasive aortic pulse wave velocity (aoPWVinv) and direct distance x 0.8 – based carotid-femoral pulse
wave velocity (cfPWVdir0.8) in 632 patients. Mean difference was 0.5 m/sec, 1 standard deviation was 1.9 m/sec.
10
Figure S5: Bland-Altman plot comparing invasive aortic pulse wave velocity (aoPWVinv) and caliper-based carotid-femoral pulse wave velocity
(cfPWVcalip) in 336 patients. Mean difference was 0.8 m/sec, 1 standard deviation was 2.1 m/sec.
11
Figure S6: Invasive aortic pulse wave velocity (aoPWVinv) in our study vs carotid-femoral pulse wvae velocity (cfPWV) from the ACCT trial (1).
12
References:
1.
McEniery CM, Yasmin, Hall IR, et al. Normal vascular aging: differential effects on wave reflection and aortic pulse wave velocity: the AngloCardiff Collaborative Trial (ACCT). Journal of the American College of Cardiology 2005;46:1753-60.
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