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Hemodynamic Patterns Identified by Impedance Cardiography Predict Mortality in the General Population: The PREVENCION Study

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 oper...

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Autores principales: Medina‐Lezama, Josefina, Narvaez‐Guerra, Offdan, Herrera‐Enriquez, Karela, Morey‐Vargas, Oscar L., Bolaños‐Salazar, Juan Francisco, Abugattas, Juan P., Zea‐Diaz, Humberto, Chirinos‐Revilla, Jose L., Fernandez‐Sivincha, Jenny G., Delgado‐Lazo, Victor, Chirinos, Diana A., Townsend, Raymond R., Chirinos, Julio A.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: John Wiley and Sons Inc. 2018
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6222967/
https://www.ncbi.nlm.nih.gov/pubmed/30371205
http://dx.doi.org/10.1161/JAHA.118.009259
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author Medina‐Lezama, Josefina
Narvaez‐Guerra, Offdan
Herrera‐Enriquez, Karela
Morey‐Vargas, Oscar L.
Bolaños‐Salazar, Juan Francisco
Abugattas, Juan P.
Zea‐Diaz, Humberto
Chirinos‐Revilla, Jose L.
Fernandez‐Sivincha, Jenny G.
Delgado‐Lazo, Victor
Chirinos, Diana A.
Townsend, Raymond R.
Chirinos, Julio A.
author_facet Medina‐Lezama, Josefina
Narvaez‐Guerra, Offdan
Herrera‐Enriquez, Karela
Morey‐Vargas, Oscar L.
Bolaños‐Salazar, Juan Francisco
Abugattas, Juan P.
Zea‐Diaz, Humberto
Chirinos‐Revilla, Jose L.
Fernandez‐Sivincha, Jenny G.
Delgado‐Lazo, Victor
Chirinos, Diana A.
Townsend, Raymond R.
Chirinos, Julio A.
author_sort Medina‐Lezama, Josefina
collection PubMed
description 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.
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spelling pubmed-62229672018-11-19 Hemodynamic Patterns Identified by Impedance Cardiography Predict Mortality in the General Population: The PREVENCION Study Medina‐Lezama, Josefina Narvaez‐Guerra, Offdan Herrera‐Enriquez, Karela Morey‐Vargas, Oscar L. Bolaños‐Salazar, Juan Francisco Abugattas, Juan P. Zea‐Diaz, Humberto Chirinos‐Revilla, Jose L. Fernandez‐Sivincha, Jenny G. Delgado‐Lazo, Victor Chirinos, Diana A. Townsend, Raymond R. Chirinos, Julio A. J Am Heart Assoc Original Research 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. John Wiley and Sons Inc. 2018-09-17 /pmc/articles/PMC6222967/ /pubmed/30371205 http://dx.doi.org/10.1161/JAHA.118.009259 Text en © 2018 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley. This is an open access article under the terms of the http://creativecommons.org/licenses/by-nc/4.0/ License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes.
spellingShingle Original Research
Medina‐Lezama, Josefina
Narvaez‐Guerra, Offdan
Herrera‐Enriquez, Karela
Morey‐Vargas, Oscar L.
Bolaños‐Salazar, Juan Francisco
Abugattas, Juan P.
Zea‐Diaz, Humberto
Chirinos‐Revilla, Jose L.
Fernandez‐Sivincha, Jenny G.
Delgado‐Lazo, Victor
Chirinos, Diana A.
Townsend, Raymond R.
Chirinos, Julio A.
Hemodynamic Patterns Identified by Impedance Cardiography Predict Mortality in the General Population: The PREVENCION Study
title Hemodynamic Patterns Identified by Impedance Cardiography Predict Mortality in the General Population: The PREVENCION Study
title_full Hemodynamic Patterns Identified by Impedance Cardiography Predict Mortality in the General Population: The PREVENCION Study
title_fullStr Hemodynamic Patterns Identified by Impedance Cardiography Predict Mortality in the General Population: The PREVENCION Study
title_full_unstemmed Hemodynamic Patterns Identified by Impedance Cardiography Predict Mortality in the General Population: The PREVENCION Study
title_short Hemodynamic Patterns Identified by Impedance Cardiography Predict Mortality in the General Population: The PREVENCION Study
title_sort hemodynamic patterns identified by impedance cardiography predict mortality in the general population: the prevencion study
topic Original Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6222967/
https://www.ncbi.nlm.nih.gov/pubmed/30371205
http://dx.doi.org/10.1161/JAHA.118.009259
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