Prognostic Value of Carotid and Radial Artery Reservoir‐Wave Parameters in End‐Stage Renal Disease

Abstract

Background Reservoir‐wave approach is an alternative model of arterial hemodynamics based on the assumption that measured arterial pressure is composed of volume‐related (reservoir pressure) and wave‐related components (excess pressure). However, the clinical utility of reservoir‐wave approach remains debatable. Methods and Results In a single‐center cohort of 260 dialysis patients, we examined whether carotid and radial reservoir‐wave parameters were associated with all‐cause and cardiovascular mortality. Central pulse pressure and augmentation index at 75 beats per minute were determined by radial arterial tonometry through generalized transfer function. Carotid and radial reservoir‐wave analysis were performed to determine reservoir pressure and excess pressure integral. After a median follow‐up of 32 months, 171 (66%) deaths and 88 (34%) cardiovascular deaths occurred. In Cox regression analysis, carotid excess pressure integral was associated with a hazard ratio of 1.33 (95% CI, 1.14–1.54; P<0.001 per 1 SD) for all‐cause and 1.45 (95% CI: 1.18–1.75; P<0.001 per 1 SD) for cardiovascular mortality. After adjustments for age, heart rate, sex, clinical characteristics and carotid‐femoral pulse wave velocity, carotid excess pressure integral was consistently associated with increased risk of all‐cause (hazard ratio per 1 SD, 1.30; 95% CI: 1.08–1.54; P=0.004) and cardiovascular mortality (hazard ratio per 1 SD, 1.31; 95% CI: 1.04–1.63; P=0.019). Conversely, there were no significant associations between radial reservoir‐wave parameters, central pulse pressure, augmentation index at 75 beats per minute, pressure forward, pressure backward and reflection magnitude, and all‐cause or cardiovascular mortality after adjustment for comorbidities. Conclusions These observations support the clinical value of reservoir‐wave approach parameters of large central elastic vessels in end‐stage renal disease.

Keywords

• aortic stiffness
• end‐stage renal disease
• excess pressure
• pulse wave analysis
• pulse wave velocity
• wave separation analysis