Hemodynamic Gain Index Is Associated With Cardiovascular Mortality and Improves Risk Prediction: A PROSPECTIVE COHORT STUDY.
Journal
Journal of cardiopulmonary rehabilitation and prevention
ISSN: 1932-751X
Titre abrégé: J Cardiopulm Rehabil Prev
Pays: United States
ID NLM: 101291247
Informations de publication
Date de publication:
01 09 2023
01 09 2023
Historique:
medline:
25
8
2023
pubmed:
4
3
2023
entrez:
3
3
2023
Statut:
ppublish
Résumé
The hemodynamic gain index (HGI) and cardiorespiratory fitness (CRF) are parameters assessed during cardiopulmonary exercise testing (CPX). The association between the HGI and cardiovascular disease (CVD) mortality is uncertain. We evaluated the association between the HGI and CVD mortality risk using a prospective study. The HGI was calculated using heart rate (HR) and systolic blood pressure (SBP) measured in 1634 men aged 42-61 yr during CPX, using the formula: [(HR peak × SBP peak ) - (HR rest × SBP rest )]/(HR rest × SBP rest ). Cardiorespiratory fitness was directly measured using a respiratory gas exchange analyzer. During a median (IQR) follow-up of 28.7 (19.0, 31.4) yr, 439 CVD deaths occurred. The risk of CVD mortality decreased continuously with the increasing HGI ( P value for nonlinearity = .28). Each unit higher HGI (1.06 bpm/mm Hg) was associated with a decreased risk of CVD mortality (HR = 0.80: 95% CI, 0.71-0.89), which was attenuated after further adjustment for CRF (HR = 0.92: 95% CI, 0.81-1.04). Cardiorespiratory fitness was associated with CVD mortality and the association remained after adjustment for the HGI: (HR = 0.86: 95% CI, 0.80-0.92) per each unit (MET) higher CRF. Addition of the HGI to a CVD mortality risk prediction model improved risk discrimination (C-index change = 0.0285; P < .001) and reclassification (net reclassification improvement = 8.34%; P < .001). The corresponding values for CRF were a C-index change of 0.0413 ( P < .001) and a categorical net reclassification improvement of 14.74% ( P < .001). The higher HGI is inversely associated with CVD mortality in a graded fashion, but the association is partly dependent on CRF levels. The HGI improves the prediction and reclassification of the risk for CVD mortality.
Identifiants
pubmed: 36867712
doi: 10.1097/HCR.0000000000000777
pii: 01273116-990000000-00075
pmc: PMC10467812
doi:
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
368-376Informations de copyright
Copyright © 2023 The Authors. Published by Wolters Kluwer Health, Inc.
Déclaration de conflit d'intérêts
The authors declare no conflicts of interest.
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