| Abstract: | Aims: The role of wave reflections in the pathogenesis of acute heart failure syndrome (AHFS) remains unclear. The present study investigated the long-term prognostic values of carotid augmentation index (cAI), carotid augmented pressure (cAP), amplitude of the reflected pressure wave from a decomposed carotid pressure wave (Pb), and carotid pulse pressure (PP) on admission in patients hospitalized due to AHFS.Methods and Results: A total of 120 patients (72?14 years, 83.3% men) hospitalized due to AHFS (55.8% with systolic heart failure) were enrolled. Measures of cAI, cAP, Pb, carotid PP, and carotid-femoral pulse wave velocity (cf-PWV) by tonometry and thoracic fluid content (TFC) by impedance cardiography were obtained within 24 hours of admission. N-terminal pro-brain natriuretic peptide (NT-proBNP) levels were determined before discharge. Patients were followed up for a median of 601 days, accruing 66 adverse events including re-hospitalization for heart failure, non-fatal myocardial infarction, non-fatal stroke, and death. In uni-variate Cox analysis, all measures significantly predicted post-discharge events (all P<0.05). In multi-variate analysis, cAP [hazard ratio per 1-s.d. and 95% confidence interval: 1.32 (1.051-1.67), P = 0.017], Pb [1.44 (1.13-1.84), P = 0.004] and carotid PP [1.35 (1.05-1.73), P = 0.019], but not cAI, TFC or cf-PWV, significantly independently predicted events with adjustments for age, estimated glomerular filtration rate, hemoglobin, and NT-proBNP.Conclusions: On-admission measures of wave reflection intensity, including cAP, Pb, and carotid PP, may be useful for predicting long-term outcomes in AHFS patients. The results support a major role of wave reflection in the pathogenesis of AHFS. |
