Abstract 20316: Pulse Wave Velocity During Dobutamine Stress is an Independent Predictor of MACE in Asymptomatic High Risk Middle Aged and Elderly Men
Introduction: Resting measures of pulse wave velocity have been shown to forecast future major adverse cardiovascular events (MACE), but the utility of stress induced changes in PWV to forecast events is unknown.
Methods: A prospective cohort study was implemented in which 520 consecutive participants aged 55-85 years at high risk for MACE were recruited. A 1.5T MRI scanner was used to obtain PWV at baseline, low dose dobutamine (10 mcg/kg/min) and peak stress (dobutamine up to 40 mcg/kg/min and atropine up to 1.5mg administered to achieve 80% of the maximum predicted heart rate response for age). Aortic arch PWV was assessed using the velocity waveform transit time technique. Participants were followed-up at 3 month intervals by personnel who were blinded to the stress test results. Participants were stratified by gender and presence or absence of MACE. Two sample t-test was used for continuous variables while Chi-square test was used for categorical variables. Cox proportional hazards model was used to test the association between the risk of future MACE and individual characteristics.
Results: The participants averaged 69±0.3 years in age (Table 1) and were followed for 57.5±0.5 months with no loss to followup. There were 50 MACE (9 incident heart failure requiring admission for i.v. diuretics, 7 NSTEMI, 21 coronary revascularizations, 8 TIA/stroke and 5 sudden cardiac deaths). After accounting for age, hypertension, and diabetes; peak stress PWV, history of myocardial infarction (MI) and inducible left ventricular wall motion abnormalities indicative of ischemia forecasted future MACE. In survival analysis, a lower peak stress PWV was associated with longer event free survival in men (p = 0.0174) but not women (p = 0.32).
Conclusions: In asymptomatic middle aged and elderly men at high risk for MACE; peak stress PWV, inducible ischemia and history of MI were independently associated with MACE suggesting that PWV at peak stress is a novel independent predictor of MACE.
Author Disclosures: T. Vera: None. T.M. Morgan: None. J.H. Jordan: None. M.C. Whitlock: None. S. Vasu: None. C.A. Hamilton: None. D. Kitzman: None. W.C. Little: None. W.G. Hundley: None.
- © 2014 by American Heart Association, Inc.