MD Conference Express AHA 2011 - (Page 26)

n S E L E C T E D U P D A T E S I N I M A G I N G Which Imaging Tools Are Best for CV Risk Assessment? Written by Anne Jacobson Risk stratification tools are critical for classifying cardiovascular (CV) risk and guiding therapy, particularly in asymptomatic patients. In this session, experts discussed new data that support the use of noninvasive imaging modalities as adjuncts to traditional risk factors in CV risk assessment. Pulse Wave Velocity The 2010 American Heart Association (AHA) guideline for the assessment of CV risk in asymptomatic adults recommends against the routine measurement of arterial stiffness outside of research settings. In particular, the AHA concluded that there is no benefit to measuring pulse pressure or aortic pulse wave velocity (PWV) in asymptomatic adults [Greenland P et al. Circulation 2010]. More recent findings, however, suggest an emerging role for assessing PWV in clinical practice. Gary F. Mitchell, MD, Cardiovascular Engineering, Inc., Norwood, Massachusetts, USA, described new insights into the value of PWV in CV risk assessment. In 2010, Mitchell and colleagues were the first to describe the prognostic stratification, discrimination, and risk reclassification that were achieved by adding PWV to standard risk factors in the community setting [Mitchell GF et al. Circulation 2010]. In the study, investigators evaluated PWV, wave reflection, and central pulse pressure in 2232 participants in the Framingham Heart Study. After a median follow-up of 7.8 years, 6.8% of patients experienced a first major CV event, such as myocardial infarction (MI), unstable angina, heart failure (HF), or stroke. In models that adjusted for standard risk factors, higher aortic PWV at baseline was associated with a 48% increase in the risk of a CV event (HR, 1.48 per SD; 95% CI, 1.16 to 1.91; p=0.002). Patients in the highest quartile of PWV had more than 3-fold the cumulative risk of major CV events compared with those in the lowest quartile of PWV (HR Q4 vs Q1, 3.4; 95% CI, 1.4 to 8.3; p=0.008; Figure 1). By comparison, baseline wave reflection, central pulse pressure, and pulse pressure amplification values did not correlate with CV disease outcomes. Adding PWV to components of the standard Framingham Risk Score improved the predictive value of this risk factor model (p<0.05). Figure 1. Carotid-Femoral PWV and CV Events in the Framingham Heart Study. Peer-Reviewed Highlights from the Cumulative Probablility of Major Cardiovascular Events 0.20 Aortic PWV (m/s) ≥11.8 7.8 - 9.2 9.3 - 11.7 ≤7.7 0.15 0.10 0.05 0 No. at Risk ≥11.8 9.3 - 11.7 7.8 - 9.2 ≤7.7 0 2 513 542 561 541 560 555 573 544 462 529 551 535 4 Years 6 424 502 537 531 8 161 246 278 275 scientificsessions.org my.americanheart.org Copyright © 2011 American Heart Association. All rights reserved. Which measure of PWV is preferred for widespread patient screening and risk assessment? The carotid-radial PWV captures muscular arterial PWV, while the carotid-femoral PWV provides a true assessment of aortic PWV. Carotid-femoral PWV clearly predicts CV outcomes and improves risk stratification beyond that provided by standard risk factor measures. Moreover, www.mdconferencexpress.com 26 January 2012  http://www.mdconferencexpress.com http://my.americanheart.org/professional/Sessions/ScientificSessions/Scientific-Sessions_UCM_316900_SubHomePage.jsp http://www.scientificsessions.org http://my.americanheart.org http://www.mdconferencexpress.com

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MD Conference Express AHA 2011

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